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Karim HT, Lee S, Gerlach A, Stinley M, Berta R, Mahbubani R, Tudorascu DL, Butters MA, Gross JJ, Andreescu C. Hippocampal subfield volume in older adults with and without mild cognitive impairment: Effects of worry and cognitive reappraisal. Neurobiol Aging 2024; 141:55-65. [PMID: 38823204 PMCID: PMC11246796 DOI: 10.1016/j.neurobiolaging.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 06/03/2024]
Abstract
Studies have confirmed that anxiety, especially worry and rumination, are associated with increased risk for cognitive decline, including Alzheimer's disease and related dementias (ADRD). Hippocampal atrophy is a hallmark of ADRD. We investigated the association between hippocampus and its subfield volumes and late-life global anxiety, worry, and rumination, and emotion regulation strategies. We recruited 110 participants with varying worry severity who underwent magnetic resonance imaging and clinical interviews. We conducted cross-sectional regression analysis between each subfield and anxiety, worry, rumination, reappraisal, and suppression while adjusting for age, sex, race, education, cumulative illness burden, stress, neuroticism, and intracranial volume. We imputed missing data and corrected for multiple comparisons across regions. Greater worry was associated with smaller subiculum volume, whereas greater use of reappraisal was associated with larger subiculum and CA1 volume. Greater worry may be detrimental to the hippocampus and to subfields involved in early ADRD pathology. Use of reappraisal appears protective of hippocampal structure. Worry and reappraisal may be modifiable targets for ADRD prevention.
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Affiliation(s)
- Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Soyoung Lee
- Department of Psychiatry, University of Maryland, Baltimore, MD, United States
| | - Andrew Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mark Stinley
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel Berta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca Mahbubani
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dana L Tudorascu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
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Gerlach AR, Karim HT, Lee S, Kolobaric A, Tudorascu DL, Butters MA, Andreescu C. White Noise-Is Anxiety in Late-Life Associated With White Matter Hyperintensity Burden? Am J Geriatr Psychiatry 2024; 32:83-97. [PMID: 37718134 PMCID: PMC10843002 DOI: 10.1016/j.jagp.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety phenotypes (global anxiety, worry, and rumination) and white matter hyperintensities (WMH), with special consideration for the roles of age and executive function (EF). Our hypotheses were 1) anxiety phenotypes would be associated with WMH and 2) EF would moderate this relationship. DESIGN Cross-sectional. SETTING Participants were recruited from the local community (Pittsburgh, PA). PARTICIPANTS We recruited 110 older adults (age ≥ 50) with varying worry severity and clinical comorbidity. INTERVENTIONS Not applicable. MEASUREMENTS Demographics (age, sex, race, education), clinical measures (cumulative illness burden, global anxiety, worry, and rumination), EF, and WMH quantified with magnetic resonance imaging. RESULTS Lower global anxiety and worry severity were significantly correlated with higher WMH volume, though the global anxiety relationship was not significant after controlling for age. Rumination as not associated with WMH burden. EF was not correlated with either global anxiety, worry, rumination, or WMH. However, in those with advanced age and/or greater WMH burden, there was an association between worry and EF as well as EF and WMH. CONCLUSION Longitudinal studies are needed in order to clarify the complex interactions between anxiety phenotypes, WMH, and EF.
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Affiliation(s)
- Andrew R Gerlach
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA
| | - Helmet T Karim
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering (HTK), University of Pittsburgh, Pittsburgh, PA
| | - Soyoung Lee
- Department of Psychiatry (SL), Brigham and Women's Hospital, Boston, MA; Department of Psychiatry (SL), Harvard Medical School, Boston, MA
| | | | - Dana L Tudorascu
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics (DLT), University of Pittsburgh, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA
| | - Carmen Andreescu
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA.
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Harandi AA, Kimia N, Medghalchi A, Sharifipour E, Pakdaman H, Siavoshi F, Barough SS, Esfandani A, Hosseini MH. Cerebral hemodynamic response to generalized anxiety disorder. Psychiatry Res Neuroimaging 2023; 333:111654. [PMID: 37229961 DOI: 10.1016/j.pscychresns.2023.111654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is the least studied among anxiety disorders. Therefore, we aimed to compare the cervical blood flow velocities using doppler ultrasonography in untreated chronic GAD patients and healthy individuals. MATERIAL AND METHODS In this study, thirty-eight GAD patients were enrolled. And thirty-eight healthy volunteers were recruited as control participants. The common carotid artery (CCA), internal carotid artery (ICA), and vertebral artery (VA) of both sides were explored. Also, we trained machine learning models based on cervical arteries characteristics to diagnose GAD patients. RESULTS Patients with chronic untreated GAD showed a significant increase in peak systolic velocity (PSV) bilaterally in the CCA and the ICA (P value < 0.05). In GAD patients, the end-diastolic velocity (EDV) of bilateral CCA, VA, and left ICA was significantly decreased. The Resistive Index (RI) showed a significant increase in all patients with GAD. Moreover, the Support Vector Machine (SVM) model showed the best accuracy in identifying anxiety disorder. CONCLUSION GAD is associated with hemodynamic alterations of extracranial cervical arteries. With a larger sample size and more generalized data, it is possible to make a robust machine learning-based model for GAD diagnosis.
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Affiliation(s)
- Ali Amini Harandi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Negin Kimia
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Medghalchi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Sharifipour
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Siavoshi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Akram Esfandani
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Effectiveness of ACT-based intervention in compliance with the model for sustainable mental health: A cluster randomized control trial in a group of older adults. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Rook L, Mazza MC, Lefter I, Brazier F. Toward Linguistic Recognition of Generalized Anxiety Disorder. Front Digit Health 2022; 4:779039. [PMID: 35493530 PMCID: PMC9051024 DOI: 10.3389/fdgth.2022.779039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Generalized anxiety disorder (GAD) refers to extreme, uncontrollable, and persistent worry and anxiety. The disorder is known to affect the social functioning and well-being of millions of people, but despite its prevalence and burden to society, it has proven difficult to identify unique behavioral markers. Interestingly, the worrying behavior observed in GAD is argued to stem from a verbal linguistic process. Therefore, the aim of the present study was to investigate if GAD can be predicted from the language people use to put their anxious worries into words. Given the importance of avoidance sensitivity (a higher likelihood to respond anxiously to novel or unexpected triggers) in GAD, this study also explored if prediction accuracy increases when individual differences in behavioral avoidance and approach sensitivity are taken into account. Method An expressive writing exercise was used to explore whether GAD can be predicted from linguistic characteristics of written narratives. Specifically, 144 undergraduate student participants were asked to recall an anxious experience during their university life, and describe this experience in written form. Clinically validated behavioral measures for GAD and self-reported sensitivity in behavioral avoidance/inhibition (BIS) and behavioral approach (BAS), were collected. A set of classification experiments was performed to evaluate GAD predictability based on linguistic features, BIS/BAS scores, and a concatenation of the two. Results The classification results show that GAD can, indeed, be successfully predicted from anxiety-focused written narratives. Prediction accuracy increased when differences in BIS and BAS were included, which suggests that, under those conditions, negatively valenced emotion words and words relating to social processes could be sufficient for recognition of GAD. Conclusions Undergraduate students with a high GAD score can be identified based on their written recollection of an anxious experience during university life. This insight is an important first step toward development of text-based digital health applications and technologies aimed at remote screening for GAD. Future work should investigate the extent to which these results uniquely apply to university campus populations or generalize to other demographics.
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Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312786. [PMID: 34886512 PMCID: PMC8657712 DOI: 10.3390/ijerph182312786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged 81 to 97 years. Anxiety symptoms were identified using the short form of the Geriatric Anxiety Inventory (GAI-SF). Associations of potential risk factors with anxiety incidence were analyzed using Cox proportional hazard models. Out of the N = 702 older adults, N = 77 individuals developed anxiety symptoms during the follow-up period. The incidence rate was 51.3 (95% CI: 41.2-64.1) per 1000 person-years in the overall sample, compared to 58.5 (95% CI: 43.2-72.4) in women and 37.3 (95% CI: 23.6-58.3) in men. Multivariable analysis showed an association of subjective memory complaints (HR: 2.03, 95% CI: 1.16-3.57) and depressive symptoms (HR: 3.20, 95% CI: 1.46-7.01) with incident anxiety in the follow-up. Incident anxiety is highly common in late life. Depressive symptoms and subjective memory complaints are major risk factors of new episodes. Incident anxiety appears to be a response to subjective memory complaints independent of depressive symptoms.
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Spalding DM, MacAngus K, Moen MK, Nicholls LAB. Adult Aging Moderates the Relationship Between Trait Cognitive Anxiety and Subjective Everyday Cognitive Difficulties. Front Psychol 2021; 12:747839. [PMID: 34777140 PMCID: PMC8581743 DOI: 10.3389/fpsyg.2021.747839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
The present aim was to determine, across the adult lifespan, the extent to which different dimensions of trait anxiety might affect subjective cognitive difficulties in everyday life. Following Attentional Control Theory (ACT; Eysenck et al., 2007), we predicted that trait anxiety would have a greater effect on attention and verbal abilities than on visual abilities. We also expected trait cognitive anxiety to exhibit more robust relationships with cognition than trait somatic anxiety. Importantly, we predicted that effects of anxiety would be greater in older adults, in line with the Strength and Vulnerability Integration model (SAVI; Charles, 2010). The sample comprised 286 United Kingdom-based adults aged 18–93 years. Participants completed self-report measures of trait cognitive and somatic anxiety (the State-Trait Inventory for Cognitive and Somatic Anxiety; STICSA, Ree et al., 2008) and everyday cognitive difficulties (the Multiple Abilities Self-Report Questionnaire; MASQ, Seidenberg et al., 1994). Moderated regression models were constructed, including trait cognitive or somatic anxiety as a predictor of cognitive difficulties, and age as the moderator variable. Covariates included depression, stress (the Depression Anxiety Stress Scales—short form; DASS-21, Lovibond and Lovibond, 1995), gender, current mental health treatment status, and physical health status. When cognitive anxiety was the predictor variable, somatic anxiety was also included as a covariate, and vice-versa. Trait cognitive anxiety and age interacted to predict all MASQ subscales other than visual-perceptual ability. Difficulties with attention, verbal memory, and language abilities were significantly greater at higher levels of anxiety for all age groups, with the effect greatest in older adults. Difficulties with visual-spatial memory were significantly greater at higher levels of anxiety in middle-aged and older adults only. Higher trait somatic anxiety predicted difficulties with verbal memory and language ability independently of age, and interacted with age to predict language difficulties. Interestingly, age also significantly predicted less subjective difficulty with attention, independently of anxiety level. The results show that trait cognitive and somatic anxiety are both related to subjective, everyday cognitive difficulties. However, effects of trait cognitive anxiety are more robust across cognitive domains and tend to increase, or first appear, over the course of the adult lifespan.
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Affiliation(s)
- David M Spalding
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Kerry MacAngus
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Martine K Moen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Louise A Brown Nicholls
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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Transtornos de Ansiedade em Idosos. PAJAR - PAN AMERICAN JOURNAL OF AGING RESEARCH 2021. [DOI: 10.15448/2357-9641.2021.1.40528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivos: descrever a prevalência de transtornos de ansiedade e avaliar o perfil e os fatores associados em uma amostra de idosos atendidos no ambulatório de psiquiatria geriátrica de um hospital de Porto Alegre, Brasil.Métodos: trata-se de um estudo transversal que avaliou 69 idosos com diagnóstico de transtornos de ansiedade, atendidos no ambulatório de psiquiatria geriátrica, no período de 2014 a 2019.Resultados: a prevalência de transtornos de ansiedade foi de 21,9% e a média de idade 73,4±8,7 anos. Houve predomínio de indivíduos do sexo feminino (81,2%), com 5 a 8 anos de estudo (33,8%), casados (47,7%) e residentes de Porto Alegre (65,2%). Em relação a variáveis clínicas, a maior frequência dos idosos não apresentaram histórico familiar de doença ou de internação psiquiátrica. Do total, 92,6% relataram ter alguma comorbidade clínica, sendo a mais frequente as doenças cardiovasculares (69,8%). Os principais psicofármacos utilizados foram os antidepressivos (66,7%) e os benzodiazepínicos (44,9%).Conclusões: os transtornos de ansiedade são frequentes entre os idosos. Dessa forma, são necessários mais estudos na população geriátrica e padronizações das ferramentas de avaliação.
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Sabatini S, Woods RT, Ukoumunne OC, Ballard C, Collins R, Clare L. Associations of subjective cognitive and memory decline with depression, anxiety, and two-year change in objectively-assessed global cognition and memory. AGING NEUROPSYCHOLOGY AND COGNITION 2021; 29:840-866. [PMID: 33971790 DOI: 10.1080/13825585.2021.1923634] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research studies exploring the association of cognitive complaints with objectively assessed cognitive decline report inconsistent results. However, many of these have methodological limitations. We investigated whether 1) more severe subjective cognitive decline (SCD) and subjective memory decline (SMD) predict change in objectively assessed global cognition, remote memory, recent memory, learning; 2) the predictive value of more severe SMD over change in objectively assessed remote memory, recent memory, and learning is stronger for individuals that report an SMD that started within the past five years than for those that report an SMD that started five or more years previously and/or stronger for those that experienced SMD within the past two years than for those who had not; and 3) greater depression and anxiety are associated with more severe SCD and SMD. We used two-year longitudinal data from the CFAS-Wales study (N = 1,531; mean (SD) age = 73.0 (6.0) years). We fitted linear regression models. More severe SCD and SMD did not predict change in objectively assessed global cognition, remote memory, and recent memory but predicted lower scores in learning. The prediction of SMD over change in learning was not stronger when individuals reported an SMD that started within the past five years compared to when they reported an SMD that started five or more years previously nor when individuals reported an SMD that started within the past two years than those who did not. Greater depression and anxiety were associated with more severe SCD and SMD. More severe SMD may be useful for predicting lower learning ability and for identifying individuals experiencing depression and anxiety.
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Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Robert T Woods
- Dementia Services Development Centre, School of Health Sciences, Bangor University, Bangor, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, UK
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Witlox M, Garnefski N, Kraaij V, de Waal MWM, Smit F, Bohlmeijer E, Spinhoven P. Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial. J Med Internet Res 2021; 23:e24366. [PMID: 33769293 PMCID: PMC8088844 DOI: 10.2196/24366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023] Open
Abstract
Background Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated. Objective This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=−.63, P=.26; T1-T3: B=−.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ21=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes. Conclusions The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life. Trial Registration Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131
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Affiliation(s)
- Maartje Witlox
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Nadia Garnefski
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Margot W M de Waal
- Department Public Health & Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Filip Smit
- Department of Mental Health & Prevention, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Philip Spinhoven
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
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Curran E, Rosato M, Ferry F, Leavey G. Prevalence and factors associated with anxiety and depression in older adults: Gender differences in psychosocial indicators. J Affect Disord 2020; 267:114-122. [PMID: 32063562 DOI: 10.1016/j.jad.2020.02.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND With increasing numbers of people living into old age, health functioning and good quality of life are central to public health policy in aging. However, quality of life for many elders is undermined by anxiety and depression. Understanding gender differences in the determinants of anxiety and depression symptoms is crucial to policy and practice. OBJECTIVE To examine gender-specific symptom subtypes of later-life anxiety and depression, in relation to their socio-demographic, social and health context. METHOD Cross-sectional study using data from The Irish Longitudinal Study on Ageing (TILDA, 2009-2011). Latent class analysis defined gender-specific symptom profiles for anxiety and depression. Correlates of latent classes were analysed using logistic regression, assessing associations between socio-demographic factors; social indicators and health indicators. RESULTS Four classes of self-reported anxiety and depression were derived: 'low', 'comorbidity', 'anxiety and subthreshold depression' and 'anxiety' only. With males 8% were comorbid, 26% subthreshold and 26% with anxiety only. With female 12% were comorbid, 27% subthreshold and 29% with anxiety only. While symptom expression may relate to stress from common ageing, our findings show clear gradations of symptoms associated with a range of social and health indicators. CONCLUSION Our findings support the actuality of comorbid depression and anxiety with further evidence for anxiety and subthreshold depression. A sizeable subgroup confirms that many older people experience anxiety only. Our study indicates the need for a more sensitive recognition of needs and a more nuanced policy agenda for older people towards improving the quality of their social life.
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Affiliation(s)
- Emma Curran
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK.
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
| | - Finola Ferry
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
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Saade YM, Nicol G, Lenze EJ, Miller JP, Yingling M, Wetherell JL, Reynolds CF, Mulsant BH. Comorbid anxiety in late-life depression: Relationship with remission and suicidal ideation on venlafaxine treatment. Depress Anxiety 2019; 36:1125-1134. [PMID: 31682328 PMCID: PMC6891146 DOI: 10.1002/da.22964] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/14/2019] [Accepted: 09/13/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the influence of comorbid anxiety symptoms on antidepressant treatment remission in older adults with major depressive disorder (MDD). METHOD In this multisite clinical trial, 468 older adults aged 60 years or older with MDD received open-label protocolized treatment with venlafaxine extended release (ER) titrated to a maximum of 300 mg daily. At baseline, anxiety was assessed with the Anxiety Sensitivity Index, the Brief Symptom Inventory (BSI) anxiety subscale, and the Penn State Worry Questionnaire. To measure treatment response, depressive symptoms and suicidality were assessed every 1-2 weeks with the Montgomery-Asberg Depression Rating Scale and the 19-item Scale for Suicide Ideation; anxiety was assessed with the BSI. Logistic regression and survival analysis were used to evaluate whether anxiety symptoms predicted depression remission. We also examined the relationships between anxiety scores and suicidality at baseline. RESULTS Baseline anxiety symptoms did not predict remission or time to remission of depressive symptoms. Depressive, worry, and panic symptoms decreased in parallel in patients with high anxiety. Anxiety symptoms were associated with the severity of depression and with suicidality. CONCLUSION In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission.
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Affiliation(s)
- Yasmina M Saade
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Ginger Nicol
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Eric J Lenze
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - J Philip Miller
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Michael Yingling
- Washington University, St Louis, Missouri (Department of Psychiatry, 660 S. Euclid Box 8134, St Louis, MO 63110
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Villagrasa B, Olaya B, Lopez-Anton R, de la Cámara C, Lobo A, Santabárbara J. Prevalence of anxiety disorder among older adults in Spain: A meta-analysis. J Affect Disord 2019; 246:408-417. [PMID: 30597303 DOI: 10.1016/j.jad.2018.12.087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/15/2018] [Accepted: 12/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anxiety disorders are recognized as one of the most prevalent mental disorders in late-life. However, the prevalence of anxiety disorders in older Spanish people has not yet been determined. The aim was to review epidemiological studies systematically to calculate the overall prevalence of anxiety in Spanish older adults by using meta-analytic techniques. METHODS We searched relevant published studies in electronic databases up to January 2018 providing data on the prevalence of anxiety among people aged 65+ years in Spain. Overall anxiety prevalence estimates were calculated using random-effects models. Sources of heterogeneity were explored by means of univariate meta-regressions. RESULTS A total of 9 studies were included in the meta-analysis (N = 12,577). Pooled overall prevalence of anxiety was 11% (95% confidence interval (CI): 6%-18%) representing 1958,471 people aged 65+ (95%CI: 1068,257-3204,771). Point, 12-month and lifetime prevalence of anxiety disorders were 12%, 6% and 19%, respectively. LIMITATIONS We detected a small publication bias effect for life-time prevalence of anxiety. The use of different diagnostic methods across the studies would have required separate analyzes. CONCLUSION Some heterogeneity was found across studies, probably due to different methodological issues. Overall, the pooled prevalence of anxiety disorders in Spanish older adults was lower than that observed in other countries. Due to the negative consequences of anxiety disorders in older adults, detection and treatment should be a priority in this population.
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Affiliation(s)
- B Villagrasa
- Psychiatry Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - B Olaya
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.
| | - R Lopez-Anton
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria, IIS-Aragón, Zaragoza, Spain
| | - C de la Cámara
- Psychiatry Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Instituto de Investigación Sanitaria, IIS-Aragón, Zaragoza, Spain; Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - A Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - J Santabárbara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain; Instituto de Investigación Sanitaria, IIS-Aragón, Zaragoza, Spain; Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
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Witlox M, Kraaij V, Garnefski N, de Waal MWM, Smit F, Hoencamp E, Gussekloo J, Bohlmeijer ET, Spinhoven P. An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. Trials 2018; 19:502. [PMID: 30223873 PMCID: PMC6142346 DOI: 10.1186/s13063-018-2731-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/08/2018] [Indexed: 12/02/2022] Open
Abstract
Background Anxiety is among the most prevalent and disabling mental health problems in older adults. Few older adults with mild to moderately severe anxiety symptoms receive adequate interventions, putting them at risk for developing anxiety disorders, depression, and various somatic problems. Effective, low-threshold interventions should be developed. Blended care, in which a web-based intervention is combined with a limited amount of face-to-face contacts with a mental healthcare counselor at the general practice, is a promising option. The online self-help intervention “Living to the Full”—an Acceptance and Commitment Therapy (ACT) intervention—has been proven to reduce depression and anxiety in several patient groups, but has not yet been investigated in older adults. The aim of this study is to evaluate the (cost-)effectiveness of a blended form of “Living to the Full” in reducing anxiety symptoms in adults aged 55 to 75 years. Furthermore, moderators and mediators of the treatment effect are investigated. Methods/design The (cost-)effectiveness of the ACT intervention will be investigated in a cluster single-blind randomized controlled trial (RCT). The blended intervention will be compared to treatment-as-usual. Thirty-six mental health counselors working at general practices in the Netherlands will be randomized to deliver blended care or treatment as usual. A total of 240 participants (aged 55–75 years) with mild to moderately severe anxiety complaints (defined as a total score of 5–15 on the GAD-7) will be recruited. There are four measurements consisting of online questionnaires (primary outcome: GAD-7) and a telephone interview: before the start of the intervention; directly following the intervention (14 weeks after baseline); and six and twelve months after baseline. Possible mediator variables will be assessed multiple times basis during the intervention. Discussion This RCT will evaluate the effectiveness of a blended ACT intervention for older adults with anxiety symptoms. If the intervention is shown to be effective, it will be implemented, thereby improving the accessibility and quality of preventive interventions for older adults with anxiety problems. Trial registration Netherlands Trial Register, NTR6270. Registered on 21 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2731-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maartje Witlox
- Institute of Psychology, Leiden University, Leiden, The Netherlands.
| | - Vivivan Kraaij
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Nadia Garnefski
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Filip Smit
- Netherlands Institute of Mental Health and Addiction, Trimbos, Utrecht, The Netherlands
| | - Erik Hoencamp
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology Health and Technology, University of Twente, Twente, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands
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15
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Brenes GA, Divers J, Miller ME, Danhauer SC. A randomized preference trial of cognitive-behavioral therapy and yoga for the treatment of worry in anxious older adults. Contemp Clin Trials Commun 2018; 10:169-176. [PMID: 30009275 PMCID: PMC6042466 DOI: 10.1016/j.conctc.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 05/02/2018] [Indexed: 01/17/2023] Open
Abstract
Background Worry is a common problem among older adults. Cognitive-behavioral therapy is the most studied nonpharmacological intervention and it has demonstrated efficacy in reducing late-life worry and anxiety. Although the evidence-base is smaller, yoga has been shown to reduce anxiety and stress. However, little is known about the relative effectiveness of these two nonpharmacological interventions. Further, the impact of patient preference on outcomes is unknown. Purpose: The purpose to this study is to compare the effectiveness of cognitive-behavioral therapy (CBT) with yoga for improving late-life worry, anxiety, and sleep. We will also examine the effects of preference and selection on outcomes, adherence, and attrition. Methods We are conducting a two-stage randomized preference trial comparing CBT and yoga for the reduction of worry in a sample of anxious older adults. Five hundred participants will be randomized to either the preference trial (participants choose the intervention; N = 250) or to the randomized trial (participants are randomized to one of the two interventions; N = 250) with equal probability. CBT consists of 10 telephone-based sessions with an accompanying workbook. Yoga consists of 10 weeks of group yoga classes (twice a week) that is modified for use with older adults. Conclusions The study design is based on feedback from anxious older adults who wanted more nonpharmacological options for intervention as well as more input into the intervention they receive. It is the first head-to-head comparison of CBT and yoga for reducing late-life worry and anxiety. It will also provide information about how intervention preference affects outcomes. Trial registration ClinicalTrials.gov NCT02968238.
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Affiliation(s)
- Gretchen A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC, 27157, USA.,Department of Social Sciences and Health Policy, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC, 27157, USA
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16
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Yates JA, Clare L, Woods RT. What is the Relationship between Health, Mood, and Mild Cognitive Impairment? J Alzheimers Dis 2018; 55:1183-1193. [PMID: 27792011 PMCID: PMC5147483 DOI: 10.3233/jad-160611] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mild cognitive impairment (MCI) often co-exists with mood problems, and both cognitive functioning and mood are known to be linked with health. This study aims to investigate how health, mood, and cognitive impairment interact. Health is often assessed using a single proxy measure, but the use of a range of measures can provide a more informative picture and allows for combination into a comprehensive measure of health. We report an analysis of data from the Cognitive Function and Ageing Study Wales (CFAS Wales, N = 3,173), in which structured interviews with older people captured measures of cognition, mood, and health. Each measure of health was assessed independently in relation to cognition and mood, and then all measures were combined to form a latent health variable and tested using structural equation modeling (SEM). SEM confirmed the association between health and cognition, with depression acting as a mediator. All measures of health were individually associated with levels of anxiety and depression. Participants reporting mood problems were less likely to engage in physical activity and more likely to report poor or fair health, have more comorbid health conditions, use more services, and experience difficulties with instrumental activities of daily living. Perceived health was associated with cognitive status; participants with MCI were more likely to report fair or poor health than participants who were cognitively unimpaired. Careful intervention and encouragement to maintain healthy lifestyles as people age could help to reduce the risk of both mood problems and cognitive decline.
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Affiliation(s)
- Jennifer A Yates
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health, School of Psychology, and PenCLAHRC, University of Exeter Medical School, Exeter, UK
| | - Robert T Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
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17
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Karim HT, Tudorascu DL, Butters MA, Walker S, Aizenstein HJ, Andreescu C. In the grip of worry: cerebral blood flow changes during worry induction and reappraisal in late-life generalized anxiety disorder. Transl Psychiatry 2017; 7:e1204. [PMID: 28809854 PMCID: PMC5611745 DOI: 10.1038/tp.2017.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/16/2017] [Accepted: 06/07/2017] [Indexed: 12/29/2022] Open
Abstract
Severe worry includes a complex blend of maladaptive affective and cognitive processes. Contrary to other forms of anxiety, there is no consensus in the field regarding the neural basis of worry. To date, no study has looked at neural patterns associated specifically with in-scanner induction and reappraisal of worry. In this study, we attempt to describe distinct components of the 'neural phenomenology' of worry: induction, maintenance, severity and reappraisal, by using a personalized, in-scanner worry script. Twenty older, non-anxious participants and twenty late-life generalized anxiety disorder (GAD) participants were included. Whole-brain axial pseudo-continuous arterial spin-labeling scans were collected. We used a voxel-wise two-way ANOVA to test the group-by-block interaction. Worry induction was associated with greater cerebral blood flow (CBF) in the visual cortex, thalamus, caudate and medial frontal cortex compared with the rest. Reappraisal was associated with greater CBF in similar regions, whereas the orbital frontal gyrus showed lower CBF relative to rest. Relative to non-anxious participants, GAD had greater CBF in multiple regions during worry induction (visual and parietal cortex, middle and superior frontal) and lower CBF during reappraisal in the supplemental motor area, middle cingulate gyrus, insula and putamen. Except for the thalamus, there was no change in CBF throughout the five blocks of worry induction and reappraisal. Severe worry is distinctly associated with increased CBF in several neocortical regulatory regions. We present new data supporting the view of worry as a complex process, engaging multiple regions in the initiation, maintenance and reappraisal of worry.
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Affiliation(s)
- H T Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - D L Tudorascu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA, USA
| | - M A Butters
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - S Walker
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - H J Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - C Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA. E-mail:
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18
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Green JS, Magee JC, Steiner ARW, Teachman BA. When the "Golden Years" Turn Blue: Using the Healthy Aging Literature to Elucidate Anxious and Depressive Disorders in Older Adulthood. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2017; 41:295-307. [PMID: 28503011 PMCID: PMC5425168 DOI: 10.1177/0165025415613855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current treatments for disorders of emotion, like pathological anxiety, are often less effective in older adults than in younger adults and have poorly understood mechanisms, pointing to the need for psychopathology models that better account for age-related changes in normative emotional functioning and the expression of disordered emotion. This article describes ways in which the healthy aging and emotion literature can enhance understanding and treatment of symptoms of anxiety and depression in later life. We offer recommendations for how to integrate the healthy aging literatures' theories and findings with psychopathology research and clinical practice, and highlight opportunities for future research.
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19
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Karim H, Tudorascu DL, Aizenstein H, Walker S, Good R, Andreescu C. Emotion Reactivity and Cerebrovascular Burden in Late-Life GAD: A Neuroimaging Study. Am J Geriatr Psychiatry 2016; 24:1040-1050. [PMID: 27633897 PMCID: PMC5914171 DOI: 10.1016/j.jagp.2016.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) in older adults is associated with persistent deficits in emotion reactivity (ER) and regulation, yet the neural basis of these deficits has not been explored. This study focuses on the neural basis of ER deficits in late-life GAD and the association with cerebrovascular burden. METHODS Twenty elderly nonanxious participants and 17 late-life GAD participants were included. The faces-shapes functional magnetic resonance imaging task was used to assess ER; the Hamilton Anxiety Rating Scale and the Penn State Worry Questionnaire to measure global anxiety and worry, respectively; linear regression models to examine the association between ER and global anxiety severity and between ER and worry severity; and mediation analysis to explore the effect of ER on the relationship between global anxiety/worry severity and cerebrovascular burden. RESULTS A positive association was found between ER and global anxiety in the left parahippocampus, left and right precuneus, and right superior occipital gyrus. A negative association was found between ER and worry severity in the left and right precuneus. The association between cerebrovascular burden and anxiety/worry severity was indirectly mediated by increased ER in limbic and paralimbic areas and by decreased ER in prefrontal regulatory regions. CONCLUSION These results indicate that ER is associated with different neural activation patterns for worry and global anxiety and that ER-related functional connectivity indirectly mediates the relationship between cerebrovascular burden and late-life GAD. This latter result supports a yet-unexplored cerebrovascular pathway involved in the pathophysiology of late-life anxiety.
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Affiliation(s)
- Helmet Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Dana Larisa Tudorascu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Biostatistics Department, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Howard Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rachel Good
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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20
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Lenze EJ, Butters MA. Consequences of Anxiety in Aging and Cognitive Decline. Am J Geriatr Psychiatry 2016; 24:843-5. [PMID: 27591156 DOI: 10.1016/j.jagp.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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21
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Moore RC, Depp CA, Wetherell JL, Lenze EJ. Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults. J Psychiatr Res 2016; 75:116-23. [PMID: 26851494 PMCID: PMC4769895 DOI: 10.1016/j.jpsychires.2016.01.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/09/2015] [Accepted: 01/15/2016] [Indexed: 12/19/2022]
Abstract
As mobile data capture tools for patient-reported outcomes proliferate in clinical research, a key dimension of measure performance is sensitivity to change. This study compared performance of patient-reported measures of mindfulness, depression, and anxiety symptoms using traditional paper-and-pencil forms versus real-time, ambulatory measurement of symptoms via ecological momentary assessment (EMA). Sixty-seven emotionally distressed older adults completed paper-and-pencil measures of mindfulness, depression, and anxiety along with two weeks of identical items reported during ambulatory monitoring via EMA before and after participation in a randomized trial of Mindfulness-Based Stress Reduction (MBSR) or a health education intervention. We calculated effect sizes for these measures across both measurement approaches and estimated the Number-Needed-to-Treat (NNT) in both measurement conditions. Study outcomes greatly differed depending on which measurement method was used. When EMA was used to measure clinical symptoms, older adults who participated in the MBSR intervention had significantly higher mindfulness and significantly lower depression and anxiety than participants in the health education intervention at post-treatment. However, these significant changes in symptoms were not found when outcomes were measured with paper-and-pencil measures. The NNT for mindfulness and depression measures administered through EMA were approximately 25-50% lower than NNTs derived from paper-and-pencil administration. Sensitivity to change in anxiety was similar across administration modes. In conclusion, EMA measures of depression and mindfulness substantially outperformed paper-and-pencil measures with the same items. The additional resources associated with EMA in clinical trials would seem to be offset by its greater sensitivity to detect change in key outcome variables.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0993, La Jolla, CA 92093-0993, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive 0664, La Jolla, CA 92093-0664, USA; VA San Diego Healthcare System, 3550 La Jolla Village Drive, San Diego, CA 92161, USA.
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0993, La Jolla, CA 92093-0993, USA; The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive 0664, La Jolla, CA 92093-0664, USA; VA San Diego Healthcare System, 3550 La Jolla Village Drive, San Diego, CA 92161, USA.
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, 3550 La Jolla Village Drive, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive 0993, La Jolla, CA 92093-0993, USA.
| | - Eric J Lenze
- Washington University School of Medicine, Department of Psychiatry, 660 So. Euclid Ave, Campus Box 8134, St. Louis, MO 63110, USA.
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Miloyan B, Pachana NA, Suddendorf T. Future-Oriented Thought Patterns Associated With Anxiety and Depression in Later Life: The Intriguing Prospects of Prospection. THE GERONTOLOGIST 2016; 57:619-625. [PMID: 26874188 DOI: 10.1093/geront/gnv695] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Anxiety and mood disorders in later life are the focus of an increasing amount of intervention research, however basic mechanisms and paradigms explaining etiology and maintenance warrant further exploration. Research on future-oriented thought patterns associated with anxiety and depression in this age group may prove useful, as these disorders are both characterized by a tendency to generate and fixate on threat-related future scenarios that may or may not materialize. Additionally, depression is associated with a reduced expectancy of positive future events. In this paper, we review the literature relevant to future thinking in anxiety and depression in older adults. We focus on the mental construction and anticipation of negative future events, and their underlying neurocognitive mechanisms. We then consider clinical and research implications of anxious and depressive future-oriented thought patterns for older adults. We believe that more research investigating future-oriented thought patterns associated with emotional disorders in later life could improve conceptualization, measurement, and perhaps potential treatments for late-life anxiety and depression.
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Affiliation(s)
- Beyon Miloyan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Thomas Suddendorf
- School of Psychology, The University of Queensland, Brisbane, Australia
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23
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Miloyan B, Pachana NA. Clinical significance of worry and physical symptoms in late-life generalized anxiety disorder. Int J Geriatr Psychiatry 2015; 30:1186-94. [PMID: 25703435 DOI: 10.1002/gps.4273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Worry is a hallmark feature of generalized anxiety disorder (GAD). However, age-related changes in symptom presentation raise questions about the clinical significance of these symptom clusters in later life. The aim of this study was to explore the relative contribution of worry and physical symptom frequency to clinical significance associated with late-life GAD. METHODS A sample of 637 self-reported worriers (aged 65 years and older) was extracted from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. RESULTS Consistent with previous findings, we observed reductions in worry frequency and increases in physical symptom frequency with increasing age of participants. Physical symptoms, but not worry symptoms, distinguished older adults with clinical and sub-threshold GAD. Whereas physical symptom count was associated with distress, occupational, and functional disability, worry count was only associated with distress. CONCLUSIONS Among self-reported worriers, worry frequency provides limited clinical utility over and above physical symptom frequency. These findings suggest that physical symptom frequency may become an increasingly important feature of GAD in later life.
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Affiliation(s)
- Beyon Miloyan
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Australia
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24
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Abstract
Anxiety disorders are frequently encountered in the elderly, but they are largely undetected and untreated. Epidemiological studies indicate a prevalence ranging from 1.2 to 15 %. With the exception of generalized anxiety disorder and agoraphobia, which can often start in late life, most anxiety disorders in older patients are chronic and have their onset earlier in life. Anxiety disorders are an often unrecognized cause of distress, disability, and mortality risk in older adults, and they have been associated with cardiovascular disease, stroke, and cognitive decline. The mechanisms of anxiety in older adults differ from that in younger adults due to age-related neuropathology, as well as the loss and isolation so prominent in late life. Our review intends to provide a comprehensive summary of the most recent research done in the field of anxiety disorders in the elderly. Recent findings in clinical research, neuroimaging, neuroendocrinology, and neuropsychology are covered. An update on treatment options is discussed, including pharmacological and non-pharmacological alternatives.
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25
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Shrestha S, Stanley MA, Wilson NL, Cully JA, Kunik ME, Novy DM, Rhoades HM, Amspoker AB. Predictors of change in quality of life in older adults with generalized anxiety disorder. Int Psychogeriatr 2015; 27:1207-15. [PMID: 25497362 PMCID: PMC4502441 DOI: 10.1017/s1041610214002567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quality of life (QOL) is lower in older adults with generalized anxiety disorder (GAD). QOL generally improves following cognitive-behavioral treatment for GAD. Little is known, however, about additional variables predicting changes in QOL in older adults with GAD. This study examined predictors of change in QOL among older participants in a randomized clinical trial of cognitive behavioral therapy (CBT) for GAD, relative to enhanced usual care (EUC). METHODS Hierarchical multilevel mixed-model analyses were used to examine inter-individual and intra-individual factors that predicted QOL over time. Predictors were categorized into treatment, personal and clinical characteristics. RESULTS QOL improved over time, and there was significant variability between participants in change in QOL. Controlling for treatment condition, baseline general self-efficacy, baseline social support, within-person variation in worry and depression and average levels of depression across different time points predicted changes in QOL. CONCLUSIONS QOL has increasingly been used as an outcome measure in treatment outcome studies to focus on overall improvement in functioning. Attention to improvement in symptoms of depression and worry, along with psychosocial variables, such as social support and self-efficacy, may help improve QOL in older adults with GAD. This study was a secondary study of data from a randomized clinical trial (NCT00308724) registered with clinical.trials.gov.
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Affiliation(s)
- Srijana Shrestha
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
- University of St. Thomas, Houston, TX
- VA South Central Mental Illness Research, Education and Clinical
| | - Melinda A. Stanley
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
- VA South Central Mental Illness Research, Education and Clinical
| | - Nancy L. Wilson
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Jeffrey A. Cully
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
- VA South Central Mental Illness Research, Education and Clinical
| | - Mark E. Kunik
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
- VA South Central Mental Illness Research, Education and Clinical
| | - Diane M Novy
- The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | - Amber B. Amspoker
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Andreescu C, Sheu LK, Tudorascu D, Gross JJ, Walker S, Banihashemi L, Aizenstein H. Emotion reactivity and regulation in late-life generalized anxiety disorder: functional connectivity at baseline and post-treatment. Am J Geriatr Psychiatry 2015; 23:200-14. [PMID: 24996397 PMCID: PMC4234701 DOI: 10.1016/j.jagp.2014.05.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Generalized anxiety disorder (GAD) is one of the most prevalent mental disorders in the elderly, but its functional neuroanatomy is not well understood. Given the role of emotion dysregulation in GAD, we sought to describe the neural bases of emotion regulation in late-life GAD by analyzing the functional connectivity (FC) in the Salience Network and the Executive Control Network during worry induction and worry reappraisal. METHODS The study included 28 elderly GAD and 31 non-anxious comparison participants. Twelve elderly GAD completed a 12-week pharmacotherapy trial. We used an in-scanner worry script that alternates blocks of worry induction and reappraisal. We assessed network FC, using the following seeds: anterior insula (AI), dorsolateral prefrontal cortex (dlPFC), the bed nucleus of stria terminalis (BNST), and the paraventricular nucleus (PVN). RESULTS GAD participants exhibited greater FC during worry induction between the left AI and the right orbitofrontal cortex, and between the BNST and the subgenual cingulate. During worry reappraisal, the non-anxious participants had greater FC between the left dlPFC and the medial PFC, as well as between the left AI and the medial PFC, and elderly GAD patients had greater FC between the PVN and the amygdala. Following 12 weeks of pharmacotherapy, GAD participants had greater connectivity between the dlPFC and several prefrontal regions during worry reappraisal. CONCLUSION FC during worry induction and reappraisal points toward abnormalities in both worry generation and worry reappraisal. Following successful pharmacologic treatment, we observed greater connectivity in the prefrontal nodes of the Executive Control Network during reappraisal of worry.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Lei K Sheu
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Dana Tudorascu
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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Letamendi AM, Ayers CR, Ruberg JL, Singley DB, Wilson J, Chavira D, Palinkas L, Wetherell JL. Illness conceptualizations among older rural Mexican-Americans with anxiety and depression. J Cross Cult Gerontol 2014; 28:421-33. [PMID: 24077906 DOI: 10.1007/s10823-013-9211-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research on barriers and utilization of mental health services in older ethnic minorities has been productive. However, little is known about the characterization and beliefs about anxiety and depression symptoms among older Mexican-Americans. Exploration of these conceptualizations will lead to better detection and provision of care to this large, yet underserved group. The present study used a mixed methods approach to explore conceptualizations of anxiety and depression in a group of rural older Mexican-Americans. Twenty-five Spanish-speaking participants (mean age 71.2) responded to flyers that solicited individuals who felt “tense or depressed.” Participants completed a structured diagnostic interview as well as self-report questionnaires about medical health, anxiety and depressive symptoms, and cognitive functioning. Qualitative interviews included questions about how participants describe, conceptualize, and cope with anxiety and depression symptoms. Sixty-eight percent of the sample met criteria for at least one anxiety or mood disorder with high comorbidity rates. Self-reported symptoms of depression, anxiety, and somatization were below clinical ranges for all participants. Medical illness, cognitive impairment, age, education, and acculturation were not associated with distress. Qualitative analyses revealed that nearly half of the terms used by the sample to describe distress phenomena deviated from Western labels traditionally used to indicate anxious and depressive symptomatology. Multiple methods of symptom endorsement demonstrated that older Mexican-Americans may report distress differently than detected by traditional self-report measures or common Western terminology. Understanding these additional illness conceptualizations may have implications for improving the detection of mental illness and increasing service use among this growing population.
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Andreescu C, Sheu LK, Tudorascu D, Walker S, Aizenstein H. The ages of anxiety--differences across the lifespan in the default mode network functional connectivity in generalized anxiety disorder. Int J Geriatr Psychiatry 2014; 29:704-12. [PMID: 24254806 PMCID: PMC4028428 DOI: 10.1002/gps.4051] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/24/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders, but its neural basis is relatively understudied. This study aims to characterize the functional connectivity in the default mode network (DMN) in GAD across the lifespan. DESIGN AND SETTINGS Functional and structural magnetic resonance imaging data were collected with subjects at rest. We analyzed the resting state functional connectivity patterns in the DMN for 27 GAD participants and 39 non-anxious comparison participants. Using a two-way analysis of variance, we explored the interaction between age and GAD status on functional connectivity. In GAD participants, we analyzed the correlation of functional connectivity indices with the duration of illness and worry severity. RESULTS The age-by-anxiety interaction showed a greater anxiety effect on the functional connectivity between the posterior cingulate seed and the medial prefrontal cortex for the older group relative to the younger participants. Longer duration of illness was positively correlated with greater functional connectivity between the posterior cingulate cortex and the insula. Worry severity was inversely correlated with the functional connectivity between the posterior cingulate cortex seed and the medial prefrontal cortex. CONCLUSION The presence of GAD, longer duration of illness, and more severe worry exacerbate the effects of age on the functional connectivity in the DMN. These results support the need for tailored research and interventions in late-life anxiety.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Lei K. Sheu
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Dana Tudorascu
- Department of Medicine, University of Pittsburgh School of Medicine,Department of Biostatistics, Graduate School of Public Health
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine,Bioengineering Department, University of Pittsburgh
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Naarding P, Beekman ATF. Vascular depression: where do we go from here? Expert Rev Neurother 2014; 11:77-83. [DOI: 10.1586/ern.10.92] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Biological mechanisms of age-related disease and geriatric clinical research: a commentary from the NIMH. Am J Geriatr Psychiatry 2013; 21:415-7. [PMID: 23570885 DOI: 10.1016/j.jagp.2012.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/26/2012] [Indexed: 11/21/2022]
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Jameson JP, Shrestha S, Escamilla M, Clark S, Wilson N, Kunik M, Zeno D, Harris TB, Peters A, Varner IL, Scantlebury C, Scott-Gurnell K, Stanley M. Establishing community partnerships to support late-life anxiety research: lessons learned from the Calmer Life project. Aging Ment Health 2012; 16:874-83. [PMID: 22416908 DOI: 10.1080/13607863.2012.660621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This article outlines the development of the Calmer Life project, a partnership established between researchers and faith-based and social service organizations to examine the effectiveness of cognitive behavioral therapy (CBT) incorporating religious/spiritual components for older African Americans in low-income communities. METHOD The program was designed to bypass several barriers to delivery of CBT within the specified community; it allows multimodal delivery (in person or by telephone) that occurs outside traditional mental health settings through faith-based organizations and neighborhood community centers. It includes religion/spirituality as an element, dependent upon the preference of the participant, and is modular, so that people can select the skills they wish to learn. Established relationships within the community were built upon, and initial meetings were held in community settings, allowing feedback from community organizations. RESULTS This ongoing program is functioning successfully and has strengthened relationships with community partners and facilitated increased availability of education and services in the community. The lessons learned in establishing these partnerships are outlined. CONCLUSIONS The growth of effectiveness research for late-life anxiety treatments in underserved minority populations requires development of functional partnerships between academic institutions and community stakeholders, along with treatment modifications to effectively address barriers faced by these consumers. The Calmer Life project may serve as a model.
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Affiliation(s)
- John Paul Jameson
- Department of Psychology, Appalachian State University, Boone, NC, USA.
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Lenze EJ, Dixon D, Mantella RC, Dore PM, Andreescu C, Reynolds CF, Newcomer JW, Butters MA. Treatment-related alteration of cortisol predicts change in neuropsychological function during acute treatment of late-life anxiety disorder. Int J Geriatr Psychiatry 2012; 27:454-62. [PMID: 21681817 PMCID: PMC4601802 DOI: 10.1002/gps.2732] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/14/2011] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Older adults with anxiety disorders are burdened by impairment in neurocognition, which may be mediated by elevated circulating cortisol levels. In a randomized controlled trial of acute serotonin-reuptake inhibitor treatment for late-life anxiety disorder, we examined whether change in salivary cortisol concentrations during treatment predicted improvements in measures of memory and executive function. METHODS We examined 60 adults aged 60 years and older, who took part in a 12-week trial of escitalopram versus placebo for generalized anxiety disorder. All subjects had pre-treatment and post-treatment assessments that included monitoring of peak and total daily cortisol and a comprehensive neuropsychological evaluation. RESULTS Salivary cortisol changes during treatment showed significant associations with changes in immediate and delayed memory but no association with executive tasks (measures of working memory and set shifting). Analyses suggested that a decrease in cortisol due to serotonin-reuptake inhibitor treatment was responsible for the memory changes: memory improvement was seen with cortisol reduction among patients receiving escitalopram but not among patients receiving placebo. CONCLUSION Serotonin-reuptake inhibitor-induced alteration in circulating cortisol during treatment of generalized anxiety disorder predicted changes in immediate and delayed memory. This finding suggests a novel treatment strategy in late-life anxiety disorders: targeting hypothalamic-pituitary- adrenal axis dysfunction to improve memory.
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Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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Abstract
Neurodevelopmental changes over the lifespan, from childhood through adulthood into old age, have important implications for the onset, presentation, course, and treatment of anxiety disorders. This article presents data on anxiety disorders as they appear in older adults, as compared with earlier in life. In this article, we focus on aging-related changes in the epidemiology, presentation, and treatment of anxiety disorders. Also, this article describes some of the gaps and limitations in our understanding and suggests research directions that may elucidate the mechanisms of anxiety disorder development later in life. Finally we describe optimal management of anxiety disorders across the lifespan, in "eight simple steps" for practitioners.
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Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA.
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Butters MA, Bhalla RK, Andreescu C, Wetherell JL, Mantella R, Begley AE, Lenze EJ. Changes in neuropsychological functioning following treatment for late-life generalised anxiety disorder. Br J Psychiatry 2011; 199:211-8. [PMID: 21727232 PMCID: PMC3633554 DOI: 10.1192/bjp.bp.110.090217] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Generalised anxiety disorder (GAD) in older adults is associated with neuropsychological impairment. Aims We examined neuropsychological functioning in older adults with GAD in comparison with psychiatrically healthy older adults at baseline, and we examined changes following a 12-week placebo-controlled trial of escitalopram. METHOD A total of 160 participants without dementia aged ≥60 with current GAD and 37 individuals in a comparison group without psychiatric history underwent neuropsychological assessment. Of these, 129 participants with GAD were reassessed post-treatment (trial registration: NCT00105586). RESULTS The participants with GAD performed worse than the comparison group in information processing speed, working memory, inhibition, problem-solving (including concept formation and mental flexibility) and immediate and delayed memory. Neuropsychological functioning was correlated with everyday functioning. After treatment, those with low cognitive scores experienced working memory, delayed memory and visuospatial ability improvement and those who reported clinical improvement in anxiety exhibited improvement in the ability to engage inhibition and episodic recall. These improvements were modest and of similar magnitude in both treatment conditions. CONCLUSIONS Generalised anxiety disorder in older adults is associated with neuropsychological impairments, which are associated with functional impairment. Those with GAD who either have a low cognitive performance or report clinical improvement in anxiety post-treatment, show improvement in multiple cognitive domains. These findings underscore the importance of treatments that aid cognition as well as anxiety symptoms.
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Affiliation(s)
- Meryl A Butters
- Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213, USA.
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Abstract
OBJECTIVES While psychosocial interventions for late-life anxiety show positive outcomes, treatment effects are not as robust as in younger adults. To date, the reach of research has been limited to academic and primary care settings, with homogeneous samples. This review examines recently funded and ongoing late-life anxiety research that uses innovative approaches to reach unique patient populations and tailor treatment content and delivery options to meet the unique needs of older adults. METHOD A systematic search was conducted using electronic databases of funded clinical trials to identify ongoing psychosocial intervention studies targeting older adults with anxiety. The principal investigators (PIs) of the studies were contacted for study details and preliminary data, if available. In some cases, the PIs of identified studies acted as referral sources in identifying additional studies. RESULTS Eleven studies met inclusion criteria and represented three areas of innovation: new patient groups, novel treatment procedures, and new treatment-delivery options. Studies and their associated theoretical bases are discussed, along with preliminary results reported in published papers or conference presentations. CONCLUSION Psychosocial intervention trials currently in progress represent promising new strategies to facilitate engagement and improve outcomes among unique subsets of older adults with anxiety. Continued investigation of evidence-based treatments for geriatric anxiety will allow greater understanding of how best to tailor the interventions to fit the needs of older adults.
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Affiliation(s)
- Srijana Shrestha
- VA HSR&D Center of Excellence, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, T, USA
| | - Suzanne Robertson
- VA HSR&D Center of Excellence, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Melinda A. Stanley
- VA HSR&D Center of Excellence, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, T, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
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Wetherell JL, Stoddard JA, White KS, Kornblith S, Nguyen H, Andreescu C, Zisook S, Lenze EJ. Augmenting antidepressant medication with modular CBT for geriatric generalized anxiety disorder: a pilot study. Int J Geriatr Psychiatry 2011; 26:869-75. [PMID: 20872925 PMCID: PMC4070295 DOI: 10.1002/gps.2619] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/19/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) is a prevalent psychiatric condition in older adults with deleterious effects on health and cognition. Although selective serotonin reuptake inhibitor (SSRI) medications have some efficacy as acute treatments for geriatric GAD, incomplete response is the most common outcome of monotherapy. We therefore developed a novel sequential treatment strategy, using personalized, modular cognitive-behavioral therapy (mCBT) to augment SSRI medication. METHOD In an open label pilot study (N = 10), subjects received a sequenced trial of 12 weeks of escitalopram followed by 16 weeks of escitalopram augmented with mCBT. We also examined the maintenance effects of mCBT over a 28-week follow-up period following drug discontinuation and termination of psychotherapy. RESULTS Results suggest that (1) adding mCBT to escitalopram significantly reduced anxiety symptoms and pathological worry, resulting in full remission for most patients and (2) some patients maintained response after all treatments were withdrawn. CONCLUSION Findings suggest that mCBT may be an effective augmentation strategy when added to SSRI medication and provide limited support for the long-term benefit of mCBT after discontinuation of pharmacotherapy.
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Affiliation(s)
- Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, California, USA; Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.
| | - Jill A. Stoddard
- Department of Psychology, Alliant International University, San Diego, California, USA
| | - Kamila S. White
- Department of Psychology, University of Missouri, St. Louis, Missouri, USA
| | - Sander Kornblith
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hoang Nguyen
- VA San Diego Healthcare System, San Diego, California, USA,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sidney Zisook
- VA San Diego Healthcare System, San Diego, California, USA,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Andreescu C, Gross JJ, Lenze E, Edelman KD, Snyder S, Tanase C, Aizenstein H. Altered cerebral blood flow patterns associated with pathologic worry in the elderly. Depress Anxiety 2011; 28:202-9. [PMID: 21394853 PMCID: PMC3225118 DOI: 10.1002/da.20799] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder among the elderly and has high functional and cognitive morbidity. However, late-life GAD is relatively understudied and its functional neuroanatomy is uncharted. Several imaging studies have suggested abnormalities in the cognitive control systems of emotion regulation in anxiety disorders in young adults. The aim of this study was to examine the neural correlates of emotion regulation in late-life GAD. METHOD We compared 7 elderly GAD subjects and 10 elderly nonanxious comparison subjects using functional MRI. Regional cerebral blood flow (rCBF) was measured using pulsed arterial spin labeling perfusion MRI at rest and during an emotion regulation paradigm. RESULTS Relative to the rest condition, elderly nonanxious comparison subjects had increased rCBF during worry induction (WI) in the right insula, bilateral amygdala, and associative temporooccipital areas. Elderly GAD subjects had increased rCBF during WI in the associative temporooccipital areas, but not in the insula or the amygdala. During worry suppression (WS), elderly nonanxious comparison subjects had increased rCBF in the prefrontal cortex (PFC) and dorsal ACC. Elderly GAD subjects had no changes in rCBF during WS in the PFC. CONCLUSIONS When attempting to regulate their emotional responses, elderly anxious subjects failed to activate prefrontal regions involved in the downregulation of negative emotions. These results, showing that elderly anxious subjects are not effectively engaging the PFC in suppressing worry, may be clinically relevant for developing personalized therapeutic strategies for the treatment of late-life GAD.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic,3811 O’Hara Street, Pittsburgh, PA, USA.
| | - James J. Gross
- Department of Psychology, Stanford University, Saint Louis
| | - Eric Lenze
- Department of Psychiatry, Washington University School of Medicine, Saint Louis
| | | | - Sara Snyder
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
| | - Costin Tanase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Imaging Research Center, University of California Davis
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Bioengineering Department, University of Pittsburgh
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Petkus AJ, Gum AM, Small B, Malcarne VL, Stein MB, Wetherell JL. Evaluation of the factor structure and psychometric properties of the Brief Symptom Inventory-18 with homebound older adults. Int J Geriatr Psychiatry 2010; 25:578-87. [PMID: 20013879 PMCID: PMC4070299 DOI: 10.1002/gps.2377] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Homebound older adults are at high risk for depression and anxiety. Systematic screening may increase identification of these difficulties and facilitate service usage. The purpose of this study was to investigate the factor structure, internal consistency, and concurrent validity of the Brief Symptom Inventory-18 (BSI-18) for use as a screening instrument for depression and anxiety with homebound older adults and to examine if the BSI-18 could be shortened further and exhibit comparable psychometric properties. METHODS A sample of 142 older adults receiving in-home aging services completed interviews that included the BSI-18 and the depression and anxiety modules of the structured clinical interview for DSM-IV. RESULTS Confirmatory factor analysis showed that the theorized three-factor, second-order model of the BSI-18 fit the data well (S-B X(2) = 136.17; p = 0.36). The depression and anxiety subscales exhibited high internal consistency (alpha > 0.81), whereas the somatic subscale exhibited lower internal consistency (alpha = 0.69). Receiver operator curve (ROC) analyses suggest that the BSI-18 depression and anxiety subscales were able to predict those with DSM-IV diagnoses (Depression AUC = 0.89 p < 0.001; Anxiety AUC = 0.80, p < 0.001). The ROC results suggested adapting a cut score of T = 50 to achieve optimal sensitivity and specificity. The short three-item depression scale exhibited comparable psychometric properties to the full scale, while the three-item somatic and anxiety scales exhibited lower internal consistency and sensitivity. CONCLUSIONS These findings provide initial evidence that the BSI-18 is valid for use with homebound older adults.
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Affiliation(s)
- Andrew J. Petkus
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Amber M. Gum
- Department of Aging and Mental Health Disparities, Louis de la Parte Florida Mental Health Institute, University of South Florida, USA
| | - Brent Small
- School of Aging Studies, University of South Florida, USA
| | | | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, USA,Department of Family and Preventative Medicine, University of California, San Diego, USA
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Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety 2010; 27:190-211. [PMID: 20099273 DOI: 10.1002/da.20653] [Citation(s) in RCA: 354] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults.
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Abstract
Stress is a risk factor for depressive and anxiety disorders. Changes in lifestyle patterns that are associated with increased stress therefore place a greater burden on mental health. Stress challenges the organism's homeostatic mechanisms, triggering a cascade of events that should, normally, maintain or allow a return to equilibrium. Stressful events are perceived by sensory systems in the brain, facilitating evaluation and comparison of the existing and previous stimuli as well as the activation of hormones responsible for energy mobilization. The limbic system coordinates the release of corticosteroids, the primary stress hormones, by modulating activation of the hypothalamic paraventricular nucleus (PVN). The amygdala, a limbic structure related to emotional behavior, has a putative role in the evaluation of emotional events and formation of fearful memories; it is also a target of the neurochemical and hormonal mediators of stress. Clinical and experimental data have correlated changes in the structure/function of the amygdala with emotional disorders such as anxiety. In this chapter we review the neuroendocrinology of the stress response, focusing on the role of the limbic system in its establishment and supplementing that information with new experimental data that demonstrates the relationship between stress and anxiety disorders; we also discuss the structural changes that occur in the amygdala after stress.
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