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Takeshima M, Yoshizawa K, Ogasawara M, Kudo M, Itoh Y, Ayabe N, Shibata N, Mishima K. Association between benzodiazepine anxiolytic polypharmacy and concomitant psychotropic medications in Japan: a retrospective cross-sectional study. Front Psychiatry 2024; 15:1405049. [PMID: 39026522 PMCID: PMC11254787 DOI: 10.3389/fpsyt.2024.1405049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Guidelines for various psychiatric disorders recommend short-term use of benzodiazepine anxiolytic monotherapy in few cases. Contrarily, benzodiazepine anxiolytic polypharmacy (BAP) is not recommended in any case. However, BAP is often used in real world. Therefore, this study aimed to determine the association between BAP and concomitant use of psychotropic medications. Method This retrospective cross-sectional study used claims data from the Japan Medical Data Center. Medical information of health insurance subscribers treated with benzodiazepine anxiolytics in June 2019 was extracted. Prescription of two or more benzodiazepine anxiolytics was defined as BAP. Binary logistic regression analysis was performed to investigate the factors associated with BAP, using age group, sex, type of subscriber, and number of concomitant hypnotics, antidepressants, and antipsychotics (none, one, and two or more) as covariates. Result The eligible participants were 104,796 adults who were prescribed benzodiazepine anxiolytics. Among them, 12.6% were prescribed two or more drugs. Logistic regression analysis revealed that BAP was significantly associated with those who received hypnotic monotherapy (adjusted odds ratio [aOR]: 1.04, 95% confidence interval [CI]: 1.001-1.09, p=0.04), antidepressant monotherapy and polypharmacy (aOR: 1.57, 95% CI: 1.51-1.63, p<0.001 and aOR: 1.98, 95% CI: 1.88-2.09, p<0.001, respectively), and antipsychotic monotherapy and polypharmacy (aOR: 1.12, 95% CI: 1.07-1.19, p<0.001 and aOR: 1.41, 95% CI: 1.30-1.54, p<0.001, respectively). Conversely, lower BAP was associated with those who received hypnotic polypharmacy (aOR: 0.86, 95% CI: 0.81-0.91, p<0.001). Discussion This study showed that the greater the number of concomitant antidepressants and antipsychotics, the greater the association with BAP. Since combination therapy with antidepressants or antipsychotics is generally not recommended, patients receiving combination therapy with these medications may be resistant to pharmacotherapy. Therefore, implementing the recommended non-pharmacological treatments may reduce BAP.
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Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhisa Yoshizawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mizuki Kudo
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yu Itoh
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoko Ayabe
- Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - Nana Shibata
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
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2
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Sartori SB, Keil TMV, Kummer KK, Murphy CP, Gunduz-Cinar O, Kress M, Ebner K, Holmes A, Singewald N. Fear extinction rescuing effects of dopamine and L-DOPA in the ventromedial prefrontal cortex. Transl Psychiatry 2024; 14:11. [PMID: 38191458 PMCID: PMC10774374 DOI: 10.1038/s41398-023-02708-8] [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: 04/12/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
The ventromedial prefrontal cortex (vmPFC; rodent infralimbic cortex (IL)), is posited to be an important locus of fear extinction-facilitating effects of the dopamine (DA) bio-precursor, L-DOPA, but this hypothesis remains to be formally tested. Here, in a model of impaired fear extinction (the 129S1/SvImJ inbred mouse strain; S1), we monitored extracellular DA dynamics via in vivo microdialysis in IL during fear extinction and following L-DOPA administration. Systemic L-DOPA caused sustained elevation of extracellular DA levels in IL and increased neuronal activation in a subpopulation of IL neurons. Systemic L-DOPA enabled extinction learning and promoted extinction retention at one but not ten days after training. Conversely, direct microinfusion of DA into IL produced long-term fear extinction (an effect that was insensitive to ɑ-/ß-adrenoreceptor antagonism). However, intra-IL delivery of a D1-like or D2 receptor agonist did not facilitate extinction. Using ex vivo multi-electrode array IL neuronal recordings, along with ex vivo quantification of immediate early genes and DA receptor signalling markers in mPFC, we found evidence of reduced DA-evoked mPFC network responses in S1 as compared with extinction-competent C57BL/6J mice that were partially driven by D1 receptor activation. Together, our data demonstrate that locally increasing DA in IL is sufficient to produce lasting rescue of impaired extinction. The finding that systemic L-DOPA increased IL DA levels, but had only transient effects on extinction, suggests L-DOPA failed to reach a threshold level of IL DA or produced opposing behavioural effects in other brain regions. Collectively, our findings provide further insight into the neural basis of the extinction-promoting effects of DA and L-DOPA in a clinically relevant animal model, with possible implications for therapeutically targeting the DA system in anxiety and trauma-related disorders.
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Affiliation(s)
- Simone B Sartori
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Thomas M V Keil
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Kai K Kummer
- Institute of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
| | - Conor P Murphy
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Ozge Gunduz-Cinar
- Laboratory of Behavioral and Genomic Neuroscience, NIH/NIAAA, Rockville, MD, USA
| | - Michaela Kress
- Institute of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
| | - Karl Ebner
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Andrew Holmes
- Laboratory of Behavioral and Genomic Neuroscience, NIH/NIAAA, Rockville, MD, USA
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria.
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Kurita K, Obata T, Sutoh C, Matsuzawa D, Yoshinaga N, Kershaw J, Chhatkuli RB, Ota J, Shimizu E, Hirano Y. Individual cognitive therapy reduces frontal-thalamic resting-state functional connectivity in social anxiety disorder. Front Psychiatry 2023; 14:1233564. [PMID: 38179253 PMCID: PMC10764569 DOI: 10.3389/fpsyt.2023.1233564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Previous neuroimaging studies in social anxiety disorders (SAD) have reported potential neural predictors of cognitive behavioral therapy (CBT)-related brain changes. However, several meta-analyses have demonstrated that cognitive therapy (CT) was superior to traditional exposure-based CBT for SAD. Objective To explore resting-state functional connectivity (rsFC) to evaluate the response to individual CT for SAD patients. Methods Twenty SAD patients who attended 16-week individual CT were scanned pre- and post-therapy along with twenty healthy controls (HCs). The severity of social anxiety was assessed with the Liebowitz Social Anxiety Scale (LSAS). Multi-voxel pattern analysis (MVPA) was performed on the pre-CT data to extract regions associated with a change in LSAS (∆LSAS). Group comparisons of the seed-based rsFC analysis were performed between the HCs and pre-CT patients and between the pre-and post-CT patients. Results MVPA-based regression analysis revealed that rsFC between the left thalamus and the frontal pole/inferior frontal gyrus was significantly correlated with ∆LSAS (adjusted R2 = 0.65; p = 0.00002). Compared with HCs, the pre-CT patients had higher rsFCs between the thalamus and temporal pole and between the thalamus and superior/middle temporal gyrus/planum temporale (p < 0.05). The rsFC between the thalamus and the frontal pole decreased post-CT (p < 0.05). Conclusion SAD patients had significant rsFC between the thalamus and temporal pole, superior/middle temporal gyrus, and planum temporale, which may be indicators of extreme anxiety in social situations. In addition, rsFC between the thalamus and the frontal pole may be a neuromarker for the effectiveness of individual CT.
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Affiliation(s)
- Kohei Kurita
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Takayuki Obata
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Chihiro Sutoh
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Matsuzawa
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Naoki Yoshinaga
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Jeff Kershaw
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Ritu Bhusal Chhatkuli
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Junko Ota
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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4
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Sakurai H, Takeshima M, Inada K, Aoki Y, Ie K, Kise M, Yoshida E, Tsuboi T, Yamada H, Hori H, Inada Y, Shimizu E, Mishima K, Watanabe K, Takaesu Y. Clinical practice for unspecified anxiety disorder in primary care. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e118. [PMID: 38867823 PMCID: PMC11114420 DOI: 10.1002/pcn5.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/14/2024]
Abstract
Aim Clinicians face difficulties in making treatment decisions for unspecified anxiety disorder due to the absence of any treatment guidelines. The objective of this study was to investigate how familiar and how often primary care physicians use pharmacological and nonpharmacological approaches to manage the disorder. Methods A survey was conducted among 117 primary care physicians in Japan who were asked to assess the familiarity of using each treatment option for unspecified anxiety disorder on a binary response scale (0 = "unfamiliar," 1 = "familiar") and the frequency on a nine-point Likert scale (1 = "never used," 9 = "frequently used"). Results While several benzodiazepine anxiolytics were familiar to primary care physicians, the frequencies of prescribing them, including alprazolam (4.6 ± 2.6), ethyl loflazepate (3.6 ± 2.4), and clotiazepam (3.5 ± 2.3), were low. In contrast, certain nonpharmacological options, including lifestyle changes (5.4 ± 2.3), coping strategies (5.1 ± 2.7), and psychoeducation for anxiety (5.1 ± 2.7), were more commonly utilized, but to a modest extent. When a benzodiazepine anxiolytic drug failed to be effective, primary care physicians selected the following management strategies to a relatively high degree: differential diagnosis (6.4 ± 2.4), referral to a specialist hospital (5.9 ± 2.5), lifestyle changes (5.2 ± 2.5), and switching to selective serotonin reuptake inhibitor (5.1 ± 2.4). Conclusion Primary care physicians exercise caution when prescribing benzodiazepine anxiolytics for unspecified anxiety disorder. Nonpharmacological interventions and switching to SSRI are modestly employed as primary treatment options and alternatives to benzodiazepine anxiolytics. To ensure the safe and effective treatment of unspecified anxiety disorder in primary care, more information should be provided from field experts.
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Affiliation(s)
- Hitoshi Sakurai
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Masahiro Takeshima
- Department of NeuropsychiatryAkita University Graduate School of MedicineAkitaJapan
| | - Ken Inada
- Department of PsychiatrySchool of MedicineKanagawaJapan
| | - Yumi Aoki
- Department of Psychiatric and Mental Health NursingSt. Luke's International UniversityTokyoJapan
| | - Kenya Ie
- Department of Internal MedicineDivision of General Internal MedicineKanagawaJapan
- Department of Internal Medicine, Division of General Internal MedicineKawasaki Municipal Tama HospitalKanagawaJapan
| | - Morito Kise
- Centre for Family Medicine DevelopmentJapanese Health and Welfare Co‐Operative FederationTokyoJapan
| | - Eriko Yoshida
- Department of General Internal MedicineKawasaki Kyodo Hospital, Kawasaki Health Cooperative AssociationKanagawaJapan
| | - Takashi Tsuboi
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Hisashi Yamada
- Department of NeuropsychiatryHyogo Medicial UniversityHyogoJapan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of MedicineFukuoka UniversityFukuokaJapan
| | - Yasushi Inada
- Medical Corporation YUJIN‐KAI Inada ClinicOsakaJapan
| | - Eiji Shimizu
- Research Center for Child Mental DevelopmentChiba UniversityChibaJapan
- Department of Cognitive Behavioral PhysiologyGraduate School of MedicineChibaJapan
| | - Kazuo Mishima
- Department of NeuropsychiatryAkita University Graduate School of MedicineAkitaJapan
| | - Koichiro Watanabe
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
| | - Yoshikazu Takaesu
- Department of NeuropsychiatryKyorin University Faculty of MedicineTokyoJapan
- Department of NeuropsychiatryGraduate School of MedicineOkinawaJapan
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5
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Aoki Y, Takaesu Y, Inada K, Yamada H, Murao T, Kikuchi T, Takeshima M, Tani M, Mishima K, Otsubo T. Development and acceptability of a decision aid for anxiety disorder considering discontinuation of benzodiazepine anxiolytic. Front Psychiatry 2023; 14:1083568. [PMID: 37252154 PMCID: PMC10213963 DOI: 10.3389/fpsyt.2023.1083568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Aim We aimed to develop a decision aid (DA) for individuals with anxiety disorders who consider tapering benzodiazepine (BZD) anxiolytics, and if tapering, tapering BZD anxiolytics with or without cognitive behavioral therapy (CBT) for anxiety. We also assessed its acceptability among stakeholders. Methods First, we conducted a literature review regarding anxiety disorders to determine treatment options. We cited the results of the systematic review and meta-analysis, which we conducted previously, to describe the related outcomes of two options: tapering BZD anxiolytics with CBT and tapering BZD anxiolytics without CBT. Second, we developed a DA prototype in accordance with the International Patient Decision Aid Standards. We carried out a mixed methods survey to assess the acceptability among stakeholders including those with anxiety disorders and healthcare providers. Results Our DA provided information such as explanation of anxiety disorders, options of tapering or not tapering BZD anxiolytics (if tapering, the options of tapering BZD anxiolytics with or without CBT) for anxiety disorder, benefits and risks of each option, and a worksheet for value clarification. For patients (n = 21), the DA appeared to be acceptable language (86%), adequate information (81%), and well-balanced presentation (86%). The developed DA was also acceptable for healthcare providers (n = 10). Conclusion We successfully created a DA for individuals with anxiety disorders who consider tapering BZD anxiolytics, which was acceptable for both patients and healthcare providers. Our DA was designed to assist patients and healthcare providers to involve decision-making about whether to taper BZD anxiolytics or not.
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Affiliation(s)
- Yumi Aoki
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing, St. Luke’s International University, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hiroki Yamada
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | | | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masayuki Tani
- Department of Psychiatry, Oouchi Hospital, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Tempei Otsubo
- Department of Psychiatry, Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan
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Yoshinaga N, Thew GR, Hayashi Y, Matsuoka J, Tanoue H, Takanashi R, Araki M, Kanai Y, Smith A, Grant SHL, Clark DM. Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan. JMIR Form Res 2023; 7:e45136. [PMID: 37145850 DOI: 10.2196/45136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/15/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. OBJECTIVE This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. METHODS This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety-related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants' feedback about their experience with the iCT-SAD. RESULTS Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. CONCLUSIONS Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly.
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Affiliation(s)
- Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Graham R Thew
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Yuta Hayashi
- Department of Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Jun Matsuoka
- Higashi-Omiya Mental Health Clinic, Saitama, Japan
- Ogu Mental Health Clinic, Tokyo, Japan
| | - Hiroki Tanoue
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Rieko Takanashi
- Department of Psychology, Teikyo University, Tokyo, Japan
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | | | - Yoshihiro Kanai
- Department of Psychology and Behavioral Sciences, Faculty of Human Sciences, Tohoku Gakuin University, Sendai, Japan
| | - Alisha Smith
- School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Sophie H L Grant
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
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7
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Werner AM, Ernst M, Brähler E, Tibubos AN, Otten D, Reiner I, Wiltink J, Michal M, Schulz A, Wild PS, Münzel T, König J, Lackner KJ, Pfeiffer N, Beutel ME. The association of depressive symptoms and body weight change in midlife - Results from the Gutenberg Health Study in Germany. J Affect Disord 2023; 332:115-124. [PMID: 36977436 DOI: 10.1016/j.jad.2023.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The present study aimed to investigate how depressive symptoms affect bodyweight change (gain and loss), and how this association is intertwined with other psychosocial and biomedical factors in the adult general population. METHODS In a population-based, prospective, observational single-center cohort study in the Rhine-Main-Region, Germany (Gutenberg Health Study GHS) with N = 12,220 participants, we analyzed baseline and five year follow-up data with logistic regressions separately for bodyweight gain and loss (vs. stable bodyweight). RESULTS Overall, 19.8 % of participants gained bodyweight of at least 5 %. More female participants were affected than male participants (23.3 % vs. 16.6 %). Regarding weight loss, overall, 12.4 % lost >5 % of bodyweight; participants were more often female than male (13.0 % vs. 11.8 %). Depressive symptoms at baseline were associated with weight gain (OR = 1.03, 95 % CI = 1.02-1.05). In models controlling for psychosocial and biomedical factors, female gender, younger age, lower socioeconomic status and smoking cessation were associated with weight gain. In weight loss, there was no overall significant effect of depressive symptoms (OR = 1.01 [0.99; 1.03]). Weight loss was associated with female gender, diabetes, less physical activity, and higher BMI at baseline. Only in women, smoking and cancer were associated with weight loss. LIMITATIONS Depressive symptoms were assessed via self-report. Voluntary weight loss cannot be determined. CONCLUSIONS Significant weight change frequently occurs in middle to old adulthood resulting from a complex interplay of psychosocial and biomedical factors. Associations with age, gender, somatic illness and health behavior (e.g. smoking cessation) provide important information for the prevention of unfavorable weight change.
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Affiliation(s)
- Antonia M Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniëlle Otten
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine - Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine - Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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8
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Sakurai H, Inada K, Aoki Y, Takeshima M, Ie K, Kise M, Yoshida E, Tsuboi T, Yamada H, Hori H, Inada Y, Shimizu E, Mishima K, Watanabe K, Takaesu Y. Management of unspecified anxiety disorder: Expert consensus. Neuropsychopharmacol Rep 2023. [PMID: 36811273 DOI: 10.1002/npr2.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
AIMS Treatment guidelines with respect to unspecified anxiety disorder have not been published. The aim of this study was to develop a consensus among field experts on the management of unspecified anxiety disorder. METHODS Experts were asked to evaluate treatment choices based on eight clinical questions concerning unspecified anxiety disorder using a nine-point Likert scale (1 = "disagree" to 9 = "agree"). According to the responses from 119 experts, the choices were categorized into first-, second-, and third-line recommendations. RESULTS Benzodiazepine anxiolytic use was not categorized as a first-line recommendation for the primary treatment of unspecified anxiety disorder, whereas multiple nonpharmacological treatment strategies, including coping strategies (7.9 ± 1.4), psychoeducation for anxiety (7.9 ± 1.4), lifestyle changes (7.8 ± 1.5), and relaxation techniques (7.4 ± 1.8), were categorized as first-line recommendations. Various treatment strategies were categorized as first-line recommendations when a benzodiazepine anxiolytic drug did not improve anxiety symptoms, that is, differential diagnosis (8.2 ± 1.4), psychoeducation for anxiety (8.0 ± 1.5), coping strategies (7.8 ± 1.5), lifestyle changes (7.8 ± 1.5), relaxation techniques (7.2 ± 1.9), and switching to selective serotonin reuptake inhibitors (SSRIs) (7.0 ± 1.8). These strategies were also highly endorsed when tapering the dosage of or discontinuing benzodiazepine anxiolytic drugs. There was no first-line recommendation regarding excusable reasons for continuing benzodiazepine anxiolytics. CONCLUSIONS The field experts recommend that benzodiazepine anxiolytics should not be used as a first-line option for patients with unspecified anxiety disorder. Instead, several nonpharmacological interventions and switching to SSRIs were endorsed for the primary treatment of unspecified anxiety disorder and as alternatives to benzodiazepine anxiolytics.
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Affiliation(s)
- Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Yumi Aoki
- Psychiatric and Mental Health Nursing, St. Luke's International University, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Morito Kise
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Eriko Yoshida
- Department of General Internal Medicine, Kawasaki Kyodo Hospital, Kawasaki Health Cooperative Association, Kanagawa, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo Medicial University, Hyogo, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasushi Inada
- Medical corporation YUJIN-KAI Inada Clinic, Osaka, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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9
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Bandelow B, Wedekind D. Internet psychotherapeutic interventions for anxiety disorders - a critical evaluation. BMC Psychiatry 2022; 22:441. [PMID: 35768807 PMCID: PMC9241282 DOI: 10.1186/s12888-022-04002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, internet-delivered psychotherapeutic interventions (IPI) move increasingly into the focus of attention. METHOD We reviewed 39 randomized controlled studies of IPIs with 97 study arms (n = 4122 patients) for anxiety disorders (panic disorder/agoraphobia, generalized anxiety disorder, and social anxiety disorder) and performed a meta-analysis. Most studies were conducted with cognitive behavioural approaches (iCBT). Results were compared with a previous meta-analysis examining medications and face-to-face (F2F) psychotherapy. RESULTS In direct comparisons, IPIs were as effective as F2F-CBT and superior to waitlist controls. Programs with more intensive therapist contact yielded higher effect sizes (ES). We compared the obtained ES with a previous comprehensive meta-analysis of 234 studies. In this comparison, iCBT was less effective than individual F2F-CBT and medications, not different from pill placebos, and more effective than psychological placebo and waitlist (p > .0001 for all comparisons). ES of IPIs may be overestimated. Treatments were only compared to waitlist, which is not a sufficient control condition. 97% of the studies were not blinded with regard to the main outcome measure. 32% of the participants received antianxiety drugs during the trials. In 89%, participants were recruited by advertisements rather than from clinical settings, and 63% of the participants had an academic background (students or university employees) which might affect the generalizability of the findings. Remote diagnoses were often made by students without completed training in psychotherapy. In only 15% of the studies, diagnoses were made in personal contact with a psychiatrist or psychologist. In 44% of the studies, the 'therapists' maintaining remote contact with the participants were mostly students without completed psychotherapy education. CONCLUSIONS IPIs may be a useful tool when face-to-face psychotherapy is not easily available, or as an add-on to standard psychotherapeutic or psychopharmacological treatments but should perhaps not be used as monotherapy. We have suggested standards for future research and the practical use of IPIs.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Centre, Göttingen (UMG), D-37075, Göttingen, Germany.
| | - Dirk Wedekind
- grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, University Medical Centre, Göttingen (UMG), D-37075 Göttingen, Germany
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10
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Efficacy of Acupuncture for Parkinson's Disease Anxiety: Two-Stage Protocol for a Randomized Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5180193. [PMID: 35186098 PMCID: PMC8849893 DOI: 10.1155/2022/5180193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/25/2021] [Accepted: 01/21/2022] [Indexed: 01/01/2023]
Abstract
Parkinson's disease anxiety (PDA) is a nonmotor symptom of Parkinson's disease (PD) that is often neglected. PDA poses a far-reaching challenge to the treatment of PD. Acupuncture could be successful in the treatment of PDA. However, the evidence for this is still limited. We propose a two-stage clinical trial. In stage 1, a total of 70 volunteers with PDA will be randomly assigned to either acupuncture (manual acupuncture) or control group (sham acupuncture) in a 1 : 1 ratio. Treatments will be performed for four weeks. The change in the Hamilton Rating Scale for Anxiety (HAMA) score from baseline to week 4 and week 12 will be the primary outcome. The levels of adrenocorticotropic hormone (ACTH), cortisol (CORT), serotonin (5-HT), and corticotropin-releasing factor (CRH) in the patients' serum and the scores on the Hoehn–Yahr Rating Scale and the Unified Parkinson's Disease Rating Scale (UPDRS) will all be considered among the secondary outcomes. Participants will be followed up until week 12. In stage 2, a total of 82 volunteers with PDA will be randomly assigned to either an acupuncture (manual acupuncture) or a control group (anti-Parkinson drugs only) in a 1 : 1 ratio. HAMA score will be the primary outcome. Universality, feasibility and cost effectiveness, Hoehn–Yahr Rating Scale, UPDRS, and serological indicators will be secondary outcomes. Participants will be followed up until week 4. The statistical analysis will include all the allocated individuals. The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine's Research Ethical Committee authorized this procedure, and the trial is registered with ChiCTR2100047253.
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11
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Brunner LM, Maurer F, Weber K, Weigl J, Milenkovic VM, Rupprecht R, Nothdurfter C, Mühlberger A. Differential effects of the translocator protein 18 kDa (TSPO) ligand etifoxine and the benzodiazepine alprazolam on startle response to predictable threat in a NPU-threat task after acute and short-term treatment. Psychopharmacology (Berl) 2022; 239:2233-2244. [PMID: 35278124 PMCID: PMC9205810 DOI: 10.1007/s00213-022-06111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
RATIONALE Benzodiazepines have been extensively investigated in experimental settings especially after single administration, which mostly revealed effects on unpredictable threat (U-threat) rather than predictable threat (P-threat). Given the need for pharmacological alternatives with a preferable side-effect profile and to better represent clinical conditions, research should cover also other anxiolytics and longer application times. OBJECTIVES The present study compared the acute and short-term effects of the translocator protein 18 kDa (TSPO) ligand etifoxine and the benzodiazepine alprazolam on P-threat and U-threat while controlling for sedation. METHODS Sixty healthy male volunteers, aged between 18 and 55 years, were randomly assigned to receive a daily dose of either 150 mg etifoxine, 1.5 mg alprazolam, or placebo for 5 days. On days 1 and 5 of intake, they performed a NPU-threat task including neutral (N), predictable (P), and unpredictable (U) conditions, while startle responsivity and self-reports were studied. Sedative effects were assessed using a continuous performance test. RESULTS Neither alprazolam nor etifoxine affected startle responsivity to U-threat on any of the testing days. While etifoxine reduced the startle response to P-threat on day 1 of treatment for transformed data, a contrary effect of alprazolam was found for raw values. No effects on self-reports and no evidence of sedation could be observed for either drug. CONCLUSIONS None of the anxiolytic substances had an impact on startle potentiation to U-threat even after several days of intake. The effects of the anxiolytics on startle responsivity to P-threat as well as implications for future studies are discussed.
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Affiliation(s)
- Lisa-Marie Brunner
- Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053, Regensburg, Germany. .,Department of Psychology, Clinical Psychology and Psychotherapy, University Regensburg, Regensburg, Germany.
| | - Franziska Maurer
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Kevin Weber
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Johannes Weigl
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Vladimir M. Milenkovic
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Rainer Rupprecht
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Caroline Nothdurfter
- grid.7727.50000 0001 2190 5763Department of Medicine, Psychiatry and Psychotherapy, University Regensburg, 93053 Regensburg, Germany
| | - Andreas Mühlberger
- grid.7727.50000 0001 2190 5763Department of Psychology, Clinical Psychology and Psychotherapy, University Regensburg, Regensburg, Germany
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12
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Bandelow B, Werner AM, Kopp I, Rudolf S, Wiltink J, Beutel ME. The German Guidelines for the treatment of anxiety disorders: first revision. Eur Arch Psychiatry Clin Neurosci 2022; 272:571-582. [PMID: 34609587 PMCID: PMC8490968 DOI: 10.1007/s00406-021-01324-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/27/2021] [Indexed: 12/28/2022]
Abstract
Starting in 2019, the 2014 German Guidelines for Anxiety Disorders (Bandelow et al. Eur Arch Psychiatry Clin Neurosci 265:363-373, 2015) have been revised by a consensus group consisting of 35 experts representing the 29 leading German specialist societies and patient self-help organizations. While the first version of the guideline was based on 403 randomized controlled studies (RCTs), 92 additional RCTs have been included in this revision. According to the consensus committee, anxiety disorders should be treated with psychotherapy, pharmacological drugs, or their combination. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended when CBT was not effective or unavailable or when PDT was preferred by the patient informed about more effective alternatives. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are recommended as first-line drugs for anxiety disorders. Medications should be continued for 6-12 months after remission. When either medications or psychotherapy were not effective, treatment should be switched to the other approach or to their combination. For patients non-responsive to standard treatments, a number of alternative strategies have been suggested. An individual treatment plan should consider efficacy, side effects, costs and the preference of the patient. Changes in the revision include recommendations regarding virtual reality exposure therapy, Internet interventions and systemic therapy. The recommendations are not only applicable for Germany but may also be helpful for developing treatment plans in all other countries.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany.
| | - Antonia M. Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ina Kopp
- AWMF Institute for Medical Science Management, Mainz, Germany
| | - Sebastian Rudolf
- Helios Clinic for Psychiatry and Psychosomatic Medicine, Schleswig, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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13
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Jonkers R, Wijnen BF, van Dijk MK, Oosterbaan DB, Verbraak MJ, van Balkom AJ, Lokkerbol J. The cost-effectiveness of the Dutch clinical practice guidelines for anxiety disorders. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Niu M, Gao Y, Yang M, Zhang Y, Geng J, Song Z, Chen Y, Li Y, Li J, Tian J. The quality and clinical applicability of recommendations in anxiety disorders guidelines: A systematic review of seventeen guidelines from seven countries. J Affect Disord 2021; 295:1301-1309. [PMID: 34706444 DOI: 10.1016/j.jad.2021.08.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/31/2021] [Accepted: 08/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anxiety disorders are the most common mental disorders, for which some countries and organizations have developed guidelines. It is necessary to understand the quality of these guidelines. METHODS The relevant guidelines were searched systematically by five reviewers using Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE Recommendation Excellence (AGREE-REX) instruments. The scores in each domain were descriptively analyzed, and guidelines from different countries were compared. RESULTS Seventeen guidelines were included. The scores in the domains "rigor of development" and "applicability" were the lowest and ranged from 16% to 77% and 25% to 71%, respectively. The scores in the domains "implementability" and "values and preferences" were similar and ranged from 30% to 67% and 25% to 77%. In terms of the comparison among countries, the Canadian guidelines achieved the highest scores in many domains but only scored 43% in the domain of "values and preferences". The Indian guidelines scored less than 50% in many domains but achieved a high score of 83% in the domain "scope and purpose". LIMITATIONS Language restrictions may cause selection bias. Besides, insufficient reports may lead to deviation of assessment results. CONCLUSIONS There was no obvious advantage in guidelines from different countries. There was still a lot of room for improvement in some domains, especially "applicability", "implementability", "rigor of development" and "values and preferences".
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Affiliation(s)
- Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Min Yang
- Comprehensive Department of Medical Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yonggang Zhang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Geng
- Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Ziwei Song
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yanchen Li
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jinhui Tian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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15
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Vergallito A, Gallucci A, Pisoni A, Punzi M, Caselli G, Ruggiero GM, Sassaroli S, Romero Lauro LJ. Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies. J Psychiatry Neurosci 2021; 46:E592-E614. [PMID: 34753789 PMCID: PMC8580831 DOI: 10.1503/jpn.210050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/23/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The possibility of using noninvasive brain stimulation to treat mental disorders has received considerable attention recently. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are considered to be effective treatments for depressive symptoms. However, no treatment recommendation is currently available for anxiety disorders, suggesting that evidence is still limited. We conducted a systematic review of the literature and a quantitative analysis of the effectiveness of rTMS and tDCS in the treatment of anxiety disorders. METHODS Following PRISMA guidelines, we screened 3 electronic databases up to the end of February 2020 for English-language, peer-reviewed articles that included the following: a clinical sample of patients with an anxiety disorder, the use of a noninvasive brain stimulation technique, the inclusion of a control condition, and pre/post scores on a validated questionnaire that measured symptoms of anxiety. RESULTS Eleven papers met the inclusion criteria, comprising 154 participants assigned to a stimulation condition and 164 to a sham or control group. We calculated Hedge's g for scores on disorder-specific and general anxiety questionnaires before and after treatment to determine effect size, and we conducted 2 independent random-effects meta-analyses. Considering the well-known comorbidity between anxiety and depression, we ran a third meta-analysis analyzing outcomes for depression scores. Results showed a significant effect of noninvasive brain stimulation in reducing scores on disorder-specific and general anxiety questionnaires, as well as depressive symptoms, in the real stimulation compared to the control condition. LIMITATIONS Few studies met the inclusion criteria; more evidence is needed to strengthen conclusions about the effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders. CONCLUSION Our findings showed that noninvasive brain stimulation reduced anxiety and depression scores compared to control conditions, suggesting that it can alleviate clinical symptoms in patients with anxiety disorders.
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Affiliation(s)
| | | | - Alberto Pisoni
- From the Department of Psychology, University of Milano Bicocca, Milan, Italy (Vergallito, Pisoni, Punzi, Romero Lauro); the Neuromi, Milan, Italy (Vergallito, Gallucci, Pisoni, Romero Lauro); the Department of Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (Gallucci); the Studi Cognitivi, Milan, Italy (Caselli, Ruggiero, Sassaroli); and the Faculty of Psychology, Sigmund Freud University, Milan, Italy (Caseli, Ruggiero, Sassaroli)
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16
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Lu G, Jia R, Liang D, Yu J, Wu Z, Chen C. Effects of music therapy on anxiety: A meta-analysis of randomized controlled trials. Psychiatry Res 2021; 304:114137. [PMID: 34365216 DOI: 10.1016/j.psychres.2021.114137] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
This study aims to evaluate the efficacy of music therapy on anxiety from randomized controlled trials (RCTs). The following electronic databases were utilized for selecting eligible studies that were published from inception to March 2021: PubMed, Cochrane Library, PsycINFO, Medline, Web of Science, and Embase. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the efficacy of music therapy on anxiety. Thirty-two studies with 1,924 participants were included in the meta-analysis. Music therapy lasted an average of 7.5 sessions (range, 1-24 sessions), while the average follow-up duration was 7.75 weeks (range, 1-16 weeks). Music therapy significantly reduced anxiety compared to the control group at post-intervention (SMD = -0.36, 95% CI: -0.54 to -0.17, p < 0.05), but not at follow-up (SMD = -0.23, 95% CI: -0.53 to 0.08, p >0.05). Subgroup analysis found a significantly positive effect of music therapy on anxiety in < 60 and ≥ 60 age-group (SMD = -0.31, 95% CI: -0.52 to -0.09, p < 0.05; SMD = -0.45, 95% CI: -0.85 to -0. 05, p < 0.05), developed and developing country group (SMD = -0.28, 95% CI: -0.51 to -0.06, p < 0.05; SMD = -0.49, 95% CI: -0.80 to -0.17, p < 0.05), < 12 and ≥ 12 sessions group (SMD = -0.24, 95% CI: = -0.44 to -0.03, p < 0.05; SMD = -0.59, 95% CI: -0.95 to -0.22, p < 0.05), respectively. Our study indicated that music therapy can significantly improve anxiety during treatment. But given that only eight RCTs reported the effects of music therapy at follow-up and the duration of follow-up was inconsistent, further researches are needed on the lasting effects after the intervention is discontinued.
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Affiliation(s)
- Guangli Lu
- Institute of Business, School of Business, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Ruiying Jia
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Dandan Liang
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Jingfen Yu
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Zhen Wu
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Chaoran Chen
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China.
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17
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The myth that psychotherapy is more effective than pharmacotherapy in anxiety disorders. Eur Neuropsychopharmacol 2021; 49:116-118. [PMID: 33989836 DOI: 10.1016/j.euroneuro.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 01/16/2023]
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18
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Richter J, Pané-Farré CA, Gerlach AL, Gloster AT, Wittchen HU, Lang T, Alpers GW, Helbig-Lang S, Deckert J, Fydrich T, Fehm L, Ströhle A, Kircher T, Arolt V, Hamm AO. Transfer of exposure therapy effects to a threat context not considered during treatment in patients with panic disorder and agoraphobia: Implications for potential mechanisms of change. Behav Res Ther 2021; 142:103886. [PMID: 34023593 DOI: 10.1016/j.brat.2021.103886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 01/07/2023]
Abstract
Further developments of exposure-based therapy (EBT) require more knowledge about transfer of treatment to non-trained everyday contexts. However, little is known about transfer effects of EBT. Using a standardized EBT protocol in 275 patients with panic disorder and agoraphobia we investigated the transfer of EBT to a highly standardized context during a Behavioral Avoidance Test (BAT; being entrapped in a small and dark test chamber) and not part of the exposure sessions. Patients of a treatment group underwent the BATs before treatment (t1), after a preparatory treatment phase (t2), and after an agoraphobic exposure phase (t3) and were compared with wait-list control patients, who repeated BAT assessments across the same time period. We found stronger reductions in avoidance behavior, reported fear, and autonomic arousal during the BAT from t1 to t3 in the treatment group patients who were anxious during t1 relative to the anxious but untreated patients. Fear reduction was related to treatment outcome indicating the contribution of transfer effects to successful EBT. Interestingly, reduction varied for different fear response systems suggesting different processes to may be involved in transfer effects. Importantly, final BAT assessment still evoked residual fear in the treatment group as compared to BAT non-anxious control patients, suggesting limited transfer effects - one possible reason for the return of symptoms in new situations.
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Affiliation(s)
- Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | - Christiane A Pané-Farré
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany; Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Alexander L Gerlach
- Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andrew T Gloster
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Thomas Lang
- Christoph-Dornier-Foundation for Clinical Psychology, Institute for Clinical Psychology Bremen, Bremen, Germany; Department for Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Sylvia Helbig-Lang
- Department of Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
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Takeshima M, Otsubo T, Funada D, Murakami M, Usami T, Maeda Y, Yamamoto T, Matsumoto T, Shimane T, Aoki Y, Otowa T, Tani M, Yamanaka G, Sakai Y, Murao T, Inada K, Yamada H, Kikuchi T, Sasaki T, Watanabe N, Mishima K, Takaesu Y. Does cognitive behavioral therapy for anxiety disorders assist the discontinuation of benzodiazepines among patients with anxiety disorders? A systematic review and meta-analysis. Psychiatry Clin Neurosci 2021; 75:119-127. [PMID: 33448517 PMCID: PMC8048602 DOI: 10.1111/pcn.13195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
Long-term use of benzodiazepines (BZD) is not recommended for the treatment of anxiety disorders. Cognitive behavioral therapy (CBT) is an effective treatment option for discontinuation of BZD in patients with anxiety disorders. This systematic review and meta-analysis sought to clarify whether CBT is effective for discontinuing BZD anxiolytics in patients with anxiety disorders. This study was preregistered with PROSPERO (registration number: CRD42019125263). A literature search of major electronic databases was conducted in December 2018. Three randomized controlled trials were included in this review, and meta-analyses were performed. The proportion of discontinuing BZD anxiolytics was significantly higher in the CBT plus gradual tapering group than in the gradual tapering alone group, both in the short term (3 months after allocation; number needed to treat: 3.2, 95% confidence interval [CI]: 2.1 to 7.1; risk ratio: 1.96, 95%CI: 1.29 to 2.98, P = 0.002, three studies) and long term (6 to 12 months after allocation; number needed to treat: 2.8, 95%CI: 1.9 to 5.3; risk ratio: 2.16, 95%CI: 1.41 to 3.32, P = 0.0004, three studies). CBT may be effective for discontinuing BZD anxiolytics, both in the short term and in the long term after the allocation. Further studies with larger sample sizes are necessary to draw definitive conclusions regarding the efficacy and safety of CBT for discontinuing BZD anxiolytics in patients with anxiety disorders.
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Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Tempei Otsubo
- Department of Psychiatry, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Daisuke Funada
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Maki Murakami
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Usami
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshihiro Maeda
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taisuke Yamamoto
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takuya Shimane
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yumi Aoki
- Psychiatric & Mental Health Nursing, Graduate School of Nursing, St. Luke's International University, Tokyo, Japan
| | - Takeshi Otowa
- Department of Psychiatry, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masayuki Tani
- Department of Psychiatry, Oouchi Hospital, Tokyo, Japan
| | - Gaku Yamanaka
- Department of Psychiatry, Yokohama Clinic, Yokohama, Japan
| | - Yojiro Sakai
- Department of Psychiatry, Akasaka Clinic, Tokyo, Japan
| | - Tomohiko Murao
- Department of Psychiatry, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Yamada
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Tsukasa Sasaki
- Laboratory of Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Pittig A, Hoyer J, Noack R. Smart-Glass Guided Exposure for Anxiety Disorders: A Proof-of-Concept Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Ernstmann N, Heuser C, Halbach S, Wegener I, Rambau S, Forstner AJ, Schumacher J, Mücke M, Geiser F, Conrad R. Interaktive Gesundheitskompetenz, soziodemografische Faktoren und der Zeitraum bis zur Inanspruchnahme psychotherapeutischer oder medikamentöser Behandlung – gibt es Hinweise auf soziale Ungleichheiten in der Therapie der Sozialen Angststörung? PSYCHIATRISCHE PRAXIS 2020; 48:201-207. [DOI: 10.1055/a-1294-0950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Zusammenfassung
Ziel Ziel ist die Untersuchung des Zusammenhangs zwischen soziodemografischen Merkmalen sowie der interaktiven Gesundheitskompetenz und dem Zeitraum zwischen der Behandlungsentscheidung und der Inanspruchnahme einer Therapie der Sozialen Angststörung.
Methodik Hierzu wurde eine Online-Befragung von N = 311 Personen mit Sozialer Angststörung durchgeführt (Responserate 54,1 %). Neben deskriptiven statistischen Verfahren wurde eine logistische Regressionsanalyse durchgeführt.
Ergebnisse Die Befragten sind durchschnittlich 46 Jahre alt (20–81), 59 % sind Frauen. Höheres Alter (OR 2,579), nicht in Partnerschaft lebend (OR 1,963), Angst vor persönlichen Kontakten (OR 5,716) und geringe (OR 3,585) bzw. mäßige (OR 3,144) interaktive Gesundheitskompetenz sind signifikant mit der Wartezeit auf eine Behandlung assoziiert.
Schlussfolgerung Die Ergebnisse können als Hinweise auf soziale Ungleichheiten in Bezug auf die Inanspruchnahme einer Therapie bei Personen mit sozialer Angststörung gedeutet werden.
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Affiliation(s)
- Nicole Ernstmann
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn
| | - Christian Heuser
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn
| | - Sarah Halbach
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn
- Bundeszentrale für gesundheitliche Aufklärung (BzgA), Köln
| | - Ingo Wegener
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn
| | - Stefanie Rambau
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn
| | - Andreas J. Forstner
- Zentrum für Humangenetik, Universität Marburg
- Institut für Humangenetik, Universitätsklinikum Bonn
| | - Johannes Schumacher
- Zentrum für Humangenetik, Universität Marburg
- Institut für Humangenetik, Universitätsklinikum Bonn
| | - Martin Mücke
- Zentrum für Seltene Erkrankungen Bonn (ZSEB), Universitätsklinikum Bonn
| | - Franziska Geiser
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn
| | - Rupert Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn
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Taipale H, Särkilä H, Tanskanen A, Kurko T, Taiminen T, Tiihonen J, Sund R, Tuulio-Henriksson A, Saastamoinen L, Hietala J. Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland. JAMA Netw Open 2020; 3:e2019029. [PMID: 33119104 PMCID: PMC7596584 DOI: 10.1001/jamanetworkopen.2020.19029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The proportion of patients who develop long-term benzodiazepine use remains controversial, as do the length of time before long-term use develops and the factors associated with long-term use. OBJECTIVE To investigate the incidence of long-term benzodiazepine and related drug (BZDR) use and factors associated with the development of long-term use implementing a follow-up design with new BZDR users. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used a nationwide cohort of 129 732 new BZDR users in Finland. New users of BZDRs aged 18 years or older were identified from the prescription register maintained by the Social Insurance Institution of Finland as individuals who initiated BZDR use during 2006 and had not used BZDRs from 2004 to 2005. The follow-up continued until death, long-term hospitalization, a gap of 2 years in BZDR use, or December 31, 2015. The population was analyzed according to age at treatment initiation, categorized into younger (<65 years) and older (≥65 years) subcohorts. Analyses were conducted from May 2019 to February 2020. EXPOSURES Use of BZDRs, modeled from register-based data using the PRE2DUP (from prescriptions to drug use periods) method. MAIN OUTCOMES AND MEASURES Long-term BZDR use, defined as continuous use of 180 days or longer, and factors associated with long-term vs short-term use, compared using Cox proportional hazards models. RESULTS Among the 129 732 incident BZDR users, the mean (SD) age was 52.6 (17.7) years, and 78 017 (60.1%) individuals were women. During the follow-up period, 51 099 BZDR users (39.4%) became long-term users. Long-term treatment was more common in the older subcohort (19 103 individuals [54.5%]) than the younger subcohort (31 996 individuals [33.8%]). At 6 months, 28 586 individuals (22.0%) had become long-term users: 11 805 (33.7%) in the older subcohort and 16 781 (17.7%) in the younger subcohort. The largest proportions of initiators who became long-term users were those persons who initiated treatment with nitrazepam (76.4%; 95% CI, 73.6%-79.1%), temazepam (63.9%; 95% CI, 62.9%-65.0%), lorazepam (62.4%; 95% CI, 59.7%-65.1%), or clonazepam (57.5%; 95% CI, 55.9%-59.2%). Factors associated with the development of long-term use included male sex, older age, receipt of social benefits, psychiatric comorbidities, and substance abuse. CONCLUSIONS AND RELEVANCE The findings of this population-based cohort study conducted in Finland suggest that the incidence of subsequent long-term BZDR use in individuals who initiate use of BZDRs is high, especially among older persons, and that the specific BZDR used initially is associated with the development of long-term BZDR use and should be carefully considered when prescribing BZDRs. The observed factors that appear to be associated with development of long-term BZDR use also should be considered in clinical decision-making when starting and monitoring BZDR treatment.
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Affiliation(s)
- Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- University of Eastern Finland School of Pharmacy, Kuopio
| | - Hanna Särkilä
- Turku University Hospital, Department of Psychiatry, University of Turku, Turku, Finland
- City of Turku Welfare Division, Turku City Hospital, Turku, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Terhi Kurko
- Research Unit, The Social Insurance Institution, Helsinki, Finland
| | - Tero Taiminen
- Turku University Hospital, Department of Psychiatry, University of Turku, Turku, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Reijo Sund
- University of Eastern Finland School of Medicine, Kuopio
| | | | | | - Jarmo Hietala
- Turku University Hospital, Department of Psychiatry, University of Turku, Turku, Finland
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24
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Psychische Erkrankungen bei Leistungssportlern. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Hurtado MM, Villena A, Vega A, Amor G, Gómez C, Morales-Asencio JM. 'I have anxiety, but I have values and preferences' Experiences of users with generalized anxiety disorder: A qualitative study. Int J Ment Health Nurs 2020; 29:521-530. [PMID: 31908140 DOI: 10.1111/inm.12690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 12/12/2022]
Abstract
To understand the experience and perceptions of people diagnosed with generalized anxiety disorder, along the whole process and their role through the decision-making process for their treatment. A qualitative study through focus groups composed of people diagnosed with generalized anxiety disorder was carried out. Content analysis was carried out to explore the most representative issues. Five thematic categories were identified: onset of the disorder, symptoms and course; daily life with the disorder; coping with the disorder; demand of healthcare for anxiety, and treatment options and decision-making. Most of the patients reported physical symptoms of anxiety. The majority of participants perceived little social support from their environment and occupational interferences. Coping seems to differ among participant that have recovered or not recovered. The involvement of users with generalized anxiety disorder was scarce, and pharmacological treatment was always the first option offered. There is scarce orientation to elicit preferences and values of patients across the process of care for people with generalized anxiety disorder. The consequence is a biased predisposition of the healthcare system to provide pharmacological treatment as the first option and ignore the perspective of patients on how to cope with their illness.
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Affiliation(s)
- María M Hurtado
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Amelia Villena
- Mental Health Unit, Valle de los Pedroches Hospital, Pozoblanco, Spain
| | - Amanda Vega
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Gisela Amor
- Mental Health Unit, Regional University Hospital, Málaga, Spain
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Abstract
OBJECTIVE Anxiety disorders are among the most frequent mental disorders and are associated with a range of short- and long-term impairments and disabilities. Relatively little is known about anxiety disorders in patients with somatic diseases, and the present literature review highlights the current research in this field, data about prevalences of anxiety disorders in patients with somatic diseases, and the effectiveness of interventions. This article also introduces a comprehensive model of inpatient treatment and summarizes the evidence pertinent to this approach. METHODS A narrative review is presented with regard to prevalence and treatment of anxiety disorders in patients with somatic diseases. The effects of inpatient treatment are illustrated based on a case report. RESULTS This review indicates that anxiety disorders are more common in patients with somatic diseases, with prevalence estimates ranging from 2.5% to 55%, than in the general population. Several outpatient treatment options exist, with substantial support for the effectiveness of cognitive behavioral therapy, psychodynamic therapy, and pharmacotherapy. We also provide evidence in support of psychosomatic inpatient treatment for patients with anxiety disorders that are comorbid with somatic diseases. CONCLUSIONS Anxiety disorders are common in patients with somatic diseases, and several effective treatment options exist, including cognitive behavioral therapy and pharmacological interventions. We also provide support for the effectiveness of inpatient treatment with unique opportunities for multidisciplinary psychosomatic treatment of anxiety disorders with comorbid somatic diseases.
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Affiliation(s)
- Michaela Henning
- From the Department of Psychosomatic Medicine and Psychotherapy (Henning, Subic-Wrana, Wiltink, Beutel), University Medical Center, Mainz; and Department of Psychosomatics and Psychotherapy (Henning), University Hospital Cologne, University of Cologne, Cologne, Germany
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Kim SY, Oh KS, Shin DW, Lim WJ, Jeon SW, Kim EJ, Cho SJ, Shin YC. The association of physical activity and sleep duration with incident anxiety symptoms: A cohort study of 134,957 Korean adults. J Affect Disord 2020; 265:305-313. [PMID: 32090754 DOI: 10.1016/j.jad.2020.01.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Maintaining adequate levels of sleep and physical activity (PA) as self-help for the prevention of new-onset anxiety symptoms is becoming more important. METHODS A cohort study was performed with 134,957 adults, free of anxiety symptoms at baseline who underwent at least two comprehensive health screening examinations between 2012 and 2017. At baseline, the amount of PA was measured using the International Physical Activity Questionnaire-Short Form and sleep duration per day was assessed using a self-report questionnaire. The study's end point was new-onset anxiety symptoms, defined as a Beck Anxiety Inventory score of ≥19. RESULTS During 361,969 person-years of follow-up, 5086 participants developed case-level anxiety. Compared with a reference (0-600 METs-min/wk), a U-shaped relationship was observed between PA and case-level anxiety. The most beneficial levels of PA for reducing incident anxiety symptoms were higher in men than women (men: 1800-3000 METs-min/wk HR, 0.88 [95% CI, 0.78-0.81], 3000-6000 METs-min/wk HR, 0.81 [95% CI, 0.70-0.93]; women: 600-1,200 METs-min/wk HR, 0.86 [95% CI, 0.76-0.98]). In comparison with a reference (<6 h), the relationship between sleep duration and case-level anxiety also had a U-shaped pattern. The optimal sleep duration for decreasing the onset of case-level anxiety was 7-8 h, regardless of sex (men: HR, 0.75 [95% CI, 0.63-0.90]; women; HR, 0.61 [95% CI, 0.54-0.70]). LIMITATIONS PA, sleep duration, and anxiety symptoms were measured using self-report questionnaires. CONCLUSIONS The results of this study revealed the appropriate levels of PA and total sleep time for reducing incident anxiety symptoms.
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Affiliation(s)
- Sun-Young Kim
- Department of Psychiatry, Ewha Woman's University Seoul Hospital, Ewha Woman's University College of Medicine, 29 Saemunan-ro, Seoul, Republic of Korea
| | - Kang-Seob Oh
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Won Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Weon-Jeong Lim
- Department of Psychiatry, Ewha Woman's University Seoul Hospital, Ewha Woman's University College of Medicine, 29 Saemunan-ro, Seoul, Republic of Korea
| | - Sang-Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Eun-Jin Kim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Young-Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
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Brunoni AR, Santos IS, Passos IC, Goulart AC, Koyanagi A, Carvalho AF, Barreto SM, Viana MC, Lotufo PA, Benseñor IM. Socio-demographic and psychiatric risk factors in incident and persistent depression: An analysis in the occupational cohort of ELSA-Brasil. J Affect Disord 2020; 263:252-257. [PMID: 31818786 DOI: 10.1016/j.jad.2019.11.155] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/28/2019] [Accepted: 11/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is a main source of disability worldwide. Identifying risk factors associated with incident and persistent episodes could inform clinical practice and hence mitigate their burden. However, previous research has focused on populations from developed countries. Thus, we evaluated sociodemographic risk factors and psychiatric comorbidities associated with incident and persistent depression in a large Brazilian occupational cohort. METHODS We examined baseline (2008-2010, n = 15,105) and follow-up (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Based on the presence of depression diagnosis at two timepoints, we diagnosed persistent and incident depression. Simple and multiple logistic regression analyses were employed to explore risk factors associated with incident and persistent depression. As gender is associated with the exposure and outcome variables, analyses stratified by gender were also conducted. RESULTS Presence of any anxiety disorder, obsessive-compulsive disorder, and female gender were significant (p < 0.001) risk factors for depression incidence (odds ratios of 2.59, 3.6, and 1.82, respectively) and persistence (odds ratios of 6.94, 14.37, and 2.85, respectively) in multiple models, whereas having university degree decreased the odds of depression incidence (0.74) and persistence (0.45). In stratified analyses, the effects of low education were only evident in women. LIMITATIONS Brief depressive episodes could not be measured by our assessments. CONCLUSION In this occupational cohort, female gender, low education and psychiatric comorbidities were associated with unfavorable depression courses. Interventions targeting comorbidities could prevent depression incidence and persistence.
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Affiliation(s)
- Andre R Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil.
| | - Itamar S Santos
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
| | - Ives C Passos
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, 08830 Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain; ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
| | - Andre F Carvalho
- Department of Psychiatry, Faculty of Medicine, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Sandhi M Barreto
- School of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Brazil
| | - Maria Carmen Viana
- Departamento de Medicina Social, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Paulo A Lotufo
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
| | - Isabela M Benseñor
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), Av. Prof Lineu Prestes 2565, Butantã, CEP 05508-000 São Paulo, Brazil
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Gloster AT, Rinner MT, Ioannou M, Villanueva J, Block VJ, Ferrari G, Benoy C, Bader K, Karekla M. Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials. Clin Psychol Rev 2020; 75:101810. [DOI: 10.1016/j.cpr.2019.101810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/16/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022]
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Abstract
Abstract
Exposure therapy is consistently indicated as the first-line treatment for anxiety-related disorders. Unfortunately, therapists often deliver exposure therapy in an overly cautious, less effective manner, characterized by using their own ‘therapist safety behaviours’. Cognitive behavioural models postulate that beliefs about therapist safety behaviours are related to their use; however, little is known about the beliefs therapists hold regarding therapist safety behaviour use. The present study aimed to identify the beliefs exposure therapists have regarding the necessity of therapist safety behaviours and to examine the relationship between this construct and therapist safety behaviour use. Australian psychologists (n = 98) completed an online survey that included existing measures of therapist safety behaviour use, therapist negative beliefs about exposure therapy, likelihood to exclude anxious clients from exposure therapy, and use of intensifying exposure techniques. Participants also completed the Exposure Implementation Beliefs Scale (EIBS), a measure created for the present study which assesses beliefs regarding the necessity of therapist safety behaviours. Beliefs about the necessity of therapist safety behaviours – particularly in protecting the client – significantly predicted therapist safety behaviour use. Findings suggest that exposure therapy training media should aim to decrease therapist safety behaviour use by addressing beliefs about the necessity of therapist safety behaviours, especially in protecting the client.
Key learning aims
(1)
To understand what therapist safety behaviours are in the context of exposure therapy.
(2)
To identify common beliefs about therapist safety behaviours.
(3)
To understand how beliefs about therapist safety behaviours relate to therapist safety behaviour use.
(4)
To consider how exposure therapy delivery may be improved by modifying beliefs about therapist safety behaviours.
(5)
To explore how beliefs about therapist safety behaviours may be modified to reduce therapist safety behaviour use.
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Bandelow B. Current and Novel Psychopharmacological Drugs for Anxiety Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:347-365. [PMID: 32002937 DOI: 10.1007/978-981-32-9705-0_19] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anxiety disorders, including panic disorder/agoraphobia (PDA), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and others, are the most prevalent mental disorders. In this paper, recommendations are given for the psychopharmacological treatment of these disorders which are based on comprehensive treatment guidelines, meta-analyses, and systematic reviews of available randomized controlled studies. Anxiety disorders can effectively be treated with psychotherapy, pharmacotherapy, or a combination of both. First-line drugs are the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Benzodiazepines are not recommended for routine use due to their possible addiction potential. Other treatment options include the calcium modulator pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. Drug treatment can be combined with psychological treatments. Novel treatment strategies include medications that act on GABA, glutamate, and other neurotransmitter systems. After remission, medications should be continued for 6 to 12 months.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany.
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Kim SY, Jeon SW, Lee MY, Shin DW, Lim WJ, Shin YC, Oh KS. The Association between Physical Activity and Anxiety Symptoms for General Adult Populations: An Analysis of the Dose-Response Relationship. Psychiatry Investig 2020; 17:29-36. [PMID: 31856560 PMCID: PMC6992859 DOI: 10.30773/pi.2019.0078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/03/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The aim of this study is to determine the dose-response relationship between physical activity and anxiety symptoms. METHODS We included data of 124,434 participants who had comprehensive health-screening examinations from January 1st, 2012, to December 31st, 2016, in Kangbuk Samsung Hospital, Seoul and Suwon, South Korea. We measured the level of physical activity using the International Physical Activity Questionnaire-short form (IPAQ-SF) and estimated anxiety symptoms using the Beck Anxiety Inventory (BAI). BAI scores of 19 and above were defined as cases. Logistic regression was used to analyze the association between physical activity and BAI-defined anxiety. Furthermore, we assessed whether sex differences might affect the relationship between physical activity and BAI-defined anxiety by stratifying our data. RESULTS Compared with the sedentary group (0-600 METs-min/week), individuals achieving 600-6,000 METs-min/wk had a significantly lower risk of BAI-defined anxiety with a U-shaped relationship in general adults. After stratifying our data by sex, we found that optimal ranges of physical activity were 600-9,000 METs-min/wk for men, but 1,200-3,000 METs-min/wk for women. CONCLUSION We identified a U- or J-shaped association between physical activity and anxiety symptoms, suggesting an optimal dose and upper limit of physical activity for decreasing anxiety symptoms. Optimal levels and upper limits of physical activity for reducing anxiety symptoms were higher for men than for women.
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Affiliation(s)
- Sun-Young Kim
- Department of Psychiatry, Ewha Woman's University Seoul Hospital, Ewha Woman's University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Jeon
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Dong-Won Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Weon-Jeong Lim
- Department of Psychiatry, Ewha Woman's University Seoul Hospital, Ewha Woman's University College of Medicine, Seoul, Republic of Korea
| | - Young-Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kang-Seob Oh
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Sivolap Y. Systematics and treatment of anxiety disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:121-127. [DOI: 10.17116/jnevro2020120071121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Li KD, Wang QS, Zhang WW, Zhang WY, Fu SN, Xu D, Wu JR, Zhai JB, Cui YL. Gardenia fructus antidepressant formula for depression in diabetes patients: A systematic review and meta-analysis. Complement Ther Med 2020; 48:102248. [DOI: 10.1016/j.ctim.2019.102248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/26/2019] [Accepted: 11/17/2019] [Indexed: 12/30/2022] Open
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Sartori SB, Singewald N. Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacol Ther 2019; 204:107402. [PMID: 31470029 DOI: 10.1016/j.pharmthera.2019.107402] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
Current medication for anxiety disorders is suboptimal in terms of efficiency and tolerability, highlighting the need for improved drug treatments. In this review an overview of drugs being studied in different phases of clinical trials for their potential in the treatment of fear-, anxiety- and trauma-related disorders is presented. One strategy followed in drug development is refining and improving compounds interacting with existing anxiolytic drug targets, such as serotonergic and prototypical GABAergic benzodiazepines. A more innovative approach involves the search for compounds with novel mechanisms of anxiolytic action using the growing knowledge base concerning the relevant neurocircuitries and neurobiological mechanisms underlying pathological fear and anxiety. The target systems evaluated in clinical trials include glutamate, endocannabinoid and neuropeptide systems, as well as ion channels and targets derived from phytochemicals. Examples of promising novel candidates currently in clinical development for generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder or post-traumatic stress disorder include ketamine, riluzole, xenon with one common pharmacological action of modulation of glutamatergic neurotransmission, as well as the neurosteroid aloradine. Finally, compounds such as D-cycloserine, MDMA, L-DOPA and cannabinoids have shown efficacy in enhancing fear-extinction learning in humans. They are thus investigated in clinical trials as an augmentative strategy for speeding up and enhancing the long-term effectiveness of exposure-based psychotherapy, which could render chronic anxiolytic drug treatment dispensable for many patients. These efforts are indicative of a rekindled interest and renewed optimism in the anxiety drug discovery field, after decades of relative stagnation.
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Affiliation(s)
- Simone B Sartori
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria.
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Pittig A, Kotter R, Hoyer J. The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability, Negative Beliefs, and Therapist Distress About Exposure-Based Interventions. Behav Ther 2019; 50:353-366. [PMID: 30824251 DOI: 10.1016/j.beth.2018.07.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 01/30/2023]
Abstract
Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.
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Affiliation(s)
- Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
| | - Roxana Kotter
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
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O'Connor PJ, Herring MP, McDowell CP, Dishman RK. Physical activity is indirectly associated with pain in college women through associations with somatization and panic disorder symptoms: a cross-sectional study. Ann Epidemiol 2019; 33:37-43. [PMID: 30905543 DOI: 10.1016/j.annepidem.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE This study tested whether the severity of somatization, panic, generalized anxiety, and depression symptoms mediated relationships between physical activity and pain using structural equation modeling. METHODS College women (n = 1036; mean = SD age of 19.7 ± 3.0 years) reported past week physical activity and the presence of persistent pain (≥1 month). The Psychiatric Diagnostic Screening Questionnaire assessed hypothesized mediators of physical activity effects on pain via symptoms of generalized anxiety, panic, major depressive disorder, and somatization disorder. RESULTS The percentage of the sample screening positive was 15.7% for generalized anxiety, 5.8% for panic, 11.0% for major depressive, and 16.0% for somatization. The hypothesized model had good fit and accounted for a significant amount of variance in pain (9.1%). Direct paths from physical activity to somatization, generalized anxiety, major depressive disorder, and panic disorder were significant. Paths to pain were significant from somatization and panic disorder. The path from physical activity to pain was not direct but indirect and through significant paths to pain from somatization and panic disorder. Each standard deviation increase in physical activity decreased the probability of pain by 11.0% through panic disorder and 10.7% through somatization disorder. CONCLUSIONS Physical activity is associated with pain indirectly through associations with panic disorder and somatization disorder symptoms in college women.
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Affiliation(s)
| | - Matthew P Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cillian P McDowell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
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Caldirola D, Alciati A, Riva A, Perna G. Are there advances in pharmacotherapy for panic disorder? A systematic review of the past five years. Expert Opin Pharmacother 2018; 19:1357-1368. [PMID: 30063164 DOI: 10.1080/14656566.2018.1504921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Several effective medications are available for treating panic disorder (PD). However, outcomes are unsatisfactory in a number of patients, suggesting the usefulness of expanding the array of antipanic drugs and improving the quality of response to current recommended treatments. AREAS COVERED The authors have performed an updated systematic review of pharmacological studies (phase III onwards) to examine whether advances have been made in the last five years. Only four studies were included. D-cycloserine no longer seemed promising as a cognitive-behavioral therapy (CBT) enhancer. Some preliminary findings concerning the optimization of recommended medications deserved consideration, including: the possibility that SSRIs are more effective than CBT alone in treating panic attacks, combined therapy is preferable when agoraphobia is present, and clonazepam is more potent than paroxetine in decreasing panic relapse. EXPERT OPINION Given the lack of novel treatments, expanding a personalized approach to the existing medications seems to be the most feasible strategy to improve pharmacotherapy outcomes regarding PD. Recent technological progress, including wearable devices collecting real-time data, 'big data' platforms, and application of machine learning techniques might help make outcome prediction more reliable. Further research on previously promising novel treatments is also recommended.
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Affiliation(s)
- Daniela Caldirola
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
| | - Alessandra Alciati
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
- b Humanitas Clinical and Research Center , Milan , Italy
| | - Alice Riva
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
| | - Giampaolo Perna
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
- c Department of Biomedical Sciences , Humanitas University , Rozzano, Milan , Italy
- d Department of Psychiatry and Neuropsychology, Faculty of Health , Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
- e Department of Psychiatry and Behavioral Sciences , Leonard Miller School of Medicine, Miami University , Miami , FL , USA
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Plag J, Petzold MB, Gechter J, Liebscher C, Ströhle A. Patients' characteristics and their influence on course of fear during agoraphobic symptom provocation: may SS(N)RI treatment compensate unfavorable individual preconditions? Nord J Psychiatry 2018; 72:325-335. [PMID: 29644923 DOI: 10.1080/08039488.2018.1457178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients' characteristics and antidepressants are discussed to be relevant in the context of phobic exposure. AIMS To identify patients characteristics associated with a differential course of fear during disorder-specific symptom provocation as well as to elucidate the effect of selective serotonin-(noradrenalin-) reuptake inhibitors [SS(N)RI] on development of fear in the context of re-exposure to the phobic stimuli. METHODS Twenty-eight clinically well-characterized patients with panic disorder and agoraphobia (PD/AG) were classified into subjects who show a reduction of fear ('Fear-') during a symptom provocation via a picture-based paradigm (T1) and those who did not ('Fear+'). Subsequently, SS(N)RI treatment was administered to all patients and subjects were re-exposed to the feared stimuli after 8 weeks of treatment (T2). Moreover, brain activity within the 'fear network' was measured via functional magnetic resonance imaging (fMRI) at T1 and T2. RESULTS Fear - were significantly younger and demonstrated increased exposure-related fear as well as stronger activity in several fear-related brain areas than Fear+. We found significant improvements in all clinical parameters after pharmacological intervention for the whole sample (T1-T2; all measures p < .02). However, reduction of fear as well as activation in (para)limbic structures during symptom provocation were now attenuated in Fear - but increased in Fear+. CONCLUSIONS Advanced age may predict a therapeutically unfavorable course of fear during agoraphobic symptom provocation. Since we found no negative impact of medication on fear development at all, there was some evidence that SS(N)RI treatment might improve the individual ability to get involved with the agoraphobic stimuli while conducting disorder-specific exposure.
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Affiliation(s)
- Jens Plag
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Moritz B Petzold
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Johanna Gechter
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Carolin Liebscher
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
| | - Andreas Ströhle
- a Department of Psychiatry and Psychotherapy , Campus Mitte, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health , Berlin , Germany
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Laurito LD, Loureiro CP, Dias RV, Vigne P, de Menezes GB, Freire RC, Stangier U, Fontenelle LF. Predictors of benzodiazepine use in a transdiagnostic sample of panic disorder, social anxiety disorder, and obsessive-compulsive disorder patients. Psychiatry Res 2018; 262:237-245. [PMID: 29475102 DOI: 10.1016/j.psychres.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/13/2018] [Accepted: 02/02/2018] [Indexed: 01/04/2023]
Abstract
We investigated the rates of current and past benzodiazepine (BZD) use in a sample of 102 subjects attending specialized anxiety disorder clinics, including panic disorder (PD; N = 36), social anxiety disorder (SAD; N = 28) and obsessive-compulsive disorder (OCD; N = 38) patients. Almost 56% of the entire sample was using BZDs at the moment of the assessment, and 74.5% described having used them at some point during their lifetimes. The duration of psychiatric treatment and a lifetime history of PD, but not any other "transdiagnostic" measure of severity (such as the Panic and Agoraphobia Scale, the Social Phobia Inventory, the Dimensional Obsessive-Compulsive Scale, the Anxiety Sensitivity Index-36, and the Beck Inventories) were independent risk factors for current prescription of BZDs. Patients who continued to use BZDs differed from patients who stopped them by being older (both currently and when firstly seen in the clinic), by having a later age at onset of their most significant anxiety disorder, by being more agoraphobic/avoidant, and by believing to be less capable of stopping their BZDs for the fear of not being able to sleep.
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Affiliation(s)
- Luana D Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Carla P Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafaela V Dias
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Paula Vigne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia.
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Davies SJC, Jacob B, Rudoler D, Zaheer J, de Oliveira C, Kurdyak P. Benzodiazepine prescription in Ontario residents aged 65 and over: a population-based study from 1998 to 2013. Ther Adv Psychopharmacol 2018; 8:99-114. [PMID: 29492258 PMCID: PMC5802639 DOI: 10.1177/2045125317743651] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/02/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although commonly used in anxiety and insomnia, recent guidelines recommend caution when prescribing benzodiazepines in the elderly. Here we examined rates of benzodiazepine prescribing to older adults in Ontario, Canada from 1998 to 2013 and impact of legislation that made prescribing regulations more strict. METHOD Annual benzodiazepine prescription rates for Ontario residents aged 65 and over were examined using the Ontario Drug Benefit database which captures all publicly funded prescriptions. Since most drugs, including benzodiazepines, are funded for residents aged ⩾65, data are essentially population-based. Weighted least squares regression methods were used to examine trends in prescribing rates (all benzodiazepines, anxiolytics, hypnotics, short- and long-acting drugs and individual drugs) from 1998 to 2013 for all Ontario residents aged ⩾65 and by sex and 5-year age bands. Impact on monthly prescribing rates of legislative changes (November 2011) which aimed to promote appropriate prescribing and dispensing practices for controlled substances, including requiring prescribers to record specified information, was assessed by constructing an interrupted time-series model. RESULTS Benzodiazepines were prescribed to 23.2% of the 1,412,638 Ontario residents aged ⩾65 in 1998, declining to 14.9% of 2,057,899 residents aged ⩾65 in 2013 (p < 0.001 for trend). Rates were significantly greater throughout in older age bands (p < 0.001) and 1.54-1.62 times greater in females than males (p < 0.001). Lorazepam was the most prescribed benzodiazepine throughout, but rates declined from 11.4% in 1998 to 8.5% in 2013. Diazepam rates fell from 2.3% to 0.7%. However, clonazepam prescription rates increased until 2011, 1.7-fold overall. After the November 2011 legal changes, downward shifts were observed in total benzodiazepine prescription rates and for each drug individually. The step function, conditional on covariates, suggested benzodiazepine rates after November 2011 were 2.89 per 1000 (p < 0.001) below rates observed previously, representing a relative reduction of 4.8% compared to the year before the intervention. CONCLUSION Benzodiazepine prescribing rates declined markedly in this population from 1998 to 2013. Targeted legislation may have reduced rates, but the effect, although statistically significant, was small.
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Affiliation(s)
- Simon J C Davies
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4, Canada Department of Psychiatry, University of Toronto, Canada
| | - Binu Jacob
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Rudoler
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Juveria Zaheer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Canada Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Canada Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Abstract
Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
| | - Sophie Michaelis
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, University Medical Center, Gottingen, Germany
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Latas M, Trajković G, Bonevski D, Naumovska A, Vučinić Latas D, Bukumirić Z, Starčević V. Psychiatrists' treatment preferences for generalized anxiety disorder. Hum Psychopharmacol 2018; 33. [PMID: 29266492 DOI: 10.1002/hup.2643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/07/2017] [Accepted: 11/14/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study is to ascertain psychiatrists' treatment preferences for generalized anxiety disorder (GAD) and compare them to the same psychiatrists' treatment preferences in the hypothetical scenario that treatment is to be administered to themselves as patients. METHODS A questionnaire was completed by 221 psychiatrists from 3 Balkan countries. They were asked to indicate their treatment preferences for patients with GAD and for themselves as patients. RESULTS A large majority of psychiatrists chose selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors as preferred treatment option for GAD patients. Fewer psychiatrists selected benzodiazepines and pregabalin and about one third chose psychotherapy. The majority of psychiatrists chose the same treatments for their patients and for themselves, with main differences being in terms of pharmacotherapy (especially benzodiazepines) being less frequently recommended and psychotherapy being more frequently recommended as preferred treatment option for psychiatrists as patients. CONCLUSIONS Treatment preferences for GAD by psychiatrists in the 3 West Balkan countries were mostly in accordance with treatment guidelines and treatment preferences for patients and for psychiatrists as patients were mostly concordant. However, some psychiatrists were more likely to choose pharmacotherapy for patients and psychotherapy for themselves as patients. These findings have implications for education of psychiatrists and for efforts to improve treatment guidelines and mental health services.
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Affiliation(s)
- Milan Latas
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Goran Trajković
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dimitar Bonevski
- Psychiatric Hospital "Skopje", Centre for Mental Health "Centar", Skopje, Macedonia
| | - Andromahi Naumovska
- Psychiatric Hospital "Skopje", Centre for Mental Health "Centar", Skopje, Macedonia
| | - Dušanka Vučinić Latas
- Psychiatric Hospital, Clinical Centre "Dr Dragisa Misovic - Dedinje" and Department of Psychology, University Singidunum, Belgrade, Serbia
| | - Zoran Bukumirić
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Starčević
- Sydney Medical School - Nepean, Discipline of Psychiatry, University of Sydney, Sydney, Australia
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Pittig A, Neudeck P. Exposition. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pittig A, Hoyer J. Exposition aus Sicht niedergelassener Verhaltenstherapeutinnen und Verhaltenstherapeuten. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Expositionsbasierte Interventionen gehören zu den wirksamsten Methoden bei der Behandlung von Angststörungen. Dennoch legen vergangene Studien nahe, dass Exposition in der verhaltenstherapeutischen Routinepraxis nur selten eingesetzt wird. Barrieren, die eine Anwendung verhindern, wurden bisher nicht systematisch erfasst. Fragestellung und Methode: Hauptziel dieser Studie war eine praxis-orientierte Erhebung systemischer Barrieren und Veränderungswünschen bei der Anwendung von Exposition aus Sicht ambulant tätiger Verhaltenstherapeutinnen und -therapeuten. Mittels postalischer Befragung wurden diese Barrieren sowie die Anwendungshäufigkeit von expositionsbasierten Interventionen erfasst (N = 684). Ergebnisse: Gemäß Selbstbericht wurde bei weniger als der Hälfte der Behandlungen von Angststörungen eine Form der Exposition eingesetzt (46.8 %), wobei die Anwendungshäufigkeit stark zwischen den Behandelnden variierte. Exposition wurde hauptsächlich in der eigenen Praxis, durchschnittlich für eine Dauer von einer Stunde und mit einer wöchentlichen bis zweiwöchentlichen Frequenz eingesetzt. Eine häufigere Anwendung war mit jüngerem Alter, weniger Berufsjahren und mehr expositionsspezifischen Aus- und Weiterbildungsstunden assoziiert. Systemische Barrieren bezogen sich besonders auf finanzielle Aspekte und das Aufwand-Vergütungsverhältnis, Unklarheiten bezüglich Versicherungs- und Abrechnungsaspekten, sowie das begrenzte Stundenkontingent. Schlussfolgerung: Exposition bei Angststörungen scheint nicht so häufig und intensiv eingesetzt zu werden, wie in aktuellen evidenzbasierten Leitlinien empfohlen wird. Diverse systemische Barrieren erschweren die Anwendung in der ambulanten Routineversorgung.
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Affiliation(s)
- Andre Pittig
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Jürgen Hoyer
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
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Richter J, Pittig A, Hollandt M, Lueken U. Bridging the Gaps Between Basic Science and Cognitive-Behavioral Treatments for Anxiety Disorders in Routine Care. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1027/2151-2604/a000309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. As a core component of cognitive-behavioral therapies (CBT), behavioral exposure is an effective treatment for anxiety disorders. Still, recent treatment studies demonstrate relatively high rates of treatment dropout, nonresponse, and relapse, indicating a substantial need for optimizing and personalizing existing treatment procedures. In the present article, we aim to address current challenges and future demands for translational research in CBT for the anxiety disorders, including (a) a better understanding of those mechanisms conferring behavioral change, (b) identifying important sources of individual variation that may act as moderators of treatment response, and (c) targeting practical barriers for dissemination of exposure therapy to routine care. Based on a recursive process model of psychotherapy research we will describe distinct steps to systematically translate basic and clinical research “from bench to bedside” to routine care, but also vice versa. Some of these aspects may stimulate the future roadmap for evidence-based psychotherapy research in order to better target the treatment of anxiety disorders as one core health challenge of our time.
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Affiliation(s)
- Jan Richter
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Germany
| | - Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Germany
| | - Maike Hollandt
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Germany
| | - Ulrike Lueken
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
- Department of Psychology, Humboldt University of Berlin, Germany
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Zuardi AW, Rodrigues NP, Silva AL, Bernardo SA, Hallak JEC, Guimarães FS, Crippa JAS. Inverted U-Shaped Dose-Response Curve of the Anxiolytic Effect of Cannabidiol during Public Speaking in Real Life. Front Pharmacol 2017; 8:259. [PMID: 28553229 PMCID: PMC5425583 DOI: 10.3389/fphar.2017.00259] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/25/2017] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to investigate whether the anxiolytic effect of cannabidiol (CBD) in humans follows the same pattern of an inverted U-shaped dose-effect curve observed in many animal studies. Sixty healthy subjects of both sexes aged between 18 and 35 years were randomly assigned to five groups that received placebo, clonazepam (1 mg), and CBD (100, 300, and 900 mg). The subjects were underwent a test of public speaking in a real situation (TPSRS) where each subject had to speak in front of a group formed by the remaining participants. Each subject completed the anxiety and sedation factors of the Visual Analog Mood Scale and had their blood pressure and heart rate recorded. These measures were obtained in five experimental sessions with 12 volunteers each. Each session had four steps at the following times (minutes) after administration of the drug/placebo, as time 0: -5 (baseline), 80 (pre-test), 153 (speech), and 216 (post-speech). Repeated-measures analyses of variance showed that the TPSRS increased the subjective measures of anxiety, heart rate, and blood pressure. Student-Newman-Keuls test comparisons among the groups in each phase showed significant attenuation in anxiety scores relative to the placebo group in the group treated with clonazepam during the speech phase, and in the clonazepam and CBD 300 mg groups in the post-speech phase. Clonazepam was more sedative than CBD 300 and 900 mg and induced a smaller increase in systolic and diastolic blood pressure than CBD 300 mg. The results confirmed that the acute administration of CBD induced anxiolytic effects with a dose-dependent inverted U-shaped curve in healthy subjects, since the subjective anxiety measures were reduced with CBD 300 mg, but not with CBD 100 and 900 mg, in the post-speech phase.
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Affiliation(s)
- Antonio W Zuardi
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,National Institute of Science and Technology for Translational Medicine, National Council for Scientific and Technological DevelopmentRio de Janeiro, Brazil
| | - Natália P Rodrigues
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil
| | - Angélica L Silva
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil
| | - Sandra A Bernardo
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil
| | - Jaime E C Hallak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,National Institute of Science and Technology for Translational Medicine, National Council for Scientific and Technological DevelopmentRio de Janeiro, Brazil
| | - Francisco S Guimarães
- National Institute of Science and Technology for Translational Medicine, National Council for Scientific and Technological DevelopmentRio de Janeiro, Brazil.,Department of Pharmacology, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil
| | - José A S Crippa
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São PauloSão Paulo, Brazil.,National Institute of Science and Technology for Translational Medicine, National Council for Scientific and Technological DevelopmentRio de Janeiro, Brazil
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Abstract
Anxiety disorders constitute the largest group of mental disorders in most western societies and are a leading cause of disability. The essential features of anxiety disorders are excessive and enduring fear, anxiety or avoidance of perceived threats, and can also include panic attacks. Although the neurobiology of individual anxiety disorders is largely unknown, some generalizations have been identified for most disorders, such as alterations in the limbic system, dysfunction of the hypothalamic-pituitary-adrenal axis and genetic factors. In addition, general risk factors for anxiety disorders include female sex and a family history of anxiety, although disorder-specific risk factors have also been identified. The diagnostic criteria for anxiety disorders varies for the individual disorders, but are generally similar across the two most common classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Tenth Edition (ICD-10). Despite their public health significance, the vast majority of anxiety disorders remain undetected and untreated by health care systems, even in economically advanced countries. If untreated, these disorders are usually chronic with waxing and waning symptoms. Impairments associated with anxiety disorders range from limitations in role functioning to severe disabilities, such as the patient being unable to leave their home.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California Los Angeles, 405 Hilgard Avenue, Los Angeles, California 90095, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Thalia C Eley
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mohammed R Milad
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Charleston, Massachusetts, USA
| | - Andrew Holmes
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland, USA
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Faculty of Science, Technische Universitaet Dresden, Dresden, Germany
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Goddard AW. Morbid Anxiety: Identification and Treatment. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:136-143. [PMID: 31975846 DOI: 10.1176/appi.focus.20160046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Due to their prevalence, chronicity, and poorly understood pathophysiology, anxiety disorders remain an important public health problem. Despite clear diagnostic guidelines and the availability of excellent evidence-based treatments, most anxiety patients remain underrecognized and inadequately treated. This clinical synthesis highlights changes to anxiety disorder diagnosis that became effective with DSM-5. The article also provides some clinical perspective on clarifying differential diagnostic problems and building an alliance with the anxious patient. The quality and strength of the evidence base for current anxiolytic medications options (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, benzodiazepines, and other agents), antianxiety psychotherapies (cognitive-behavioral therapy and brief dynamic therapies), and combination treatments are discussed. A brief update on newer treatment strategies, such as cognitive enhancement, complementary therapies, and neuromodulation, is included. Future directions for anxiety nosology and treatment are summarized, including the National Institute of Mental Health Research Domain Criteria initiative and the promising role of personalized medicine.
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Affiliation(s)
- Andrew W Goddard
- Dr. Goddard is professor of psychiatry with the University of California, San Francisco, Fresno Medical Education and Research Program, Fresno
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Kirk A, Broman-Fulks J, Bergquist J. National attitudes towards mental health treatment: the importance of research evidence. Cogn Behav Ther 2016; 45:458-72. [PMID: 27352993 DOI: 10.1080/16506073.2016.1201847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Most conceptualizations of evidence-based practice view it as a "three legged stool" consisting of: the use of best available research evidence, clinical expertise, and client preferences. Although empirical evidence and clinical expertise have received greater empirical attention, relatively little research has systematically explored client preferences. The present study analyzed self-reported treatment preferences for various clinical and non-clinical presentations. Adult participants (n = 1262) residing in the United States were presented with diagnostic vignettes and rated their relative preferences among 5 treatment variables, including: use of an empirically supported treatment (EST), quality of the client-therapist relationship, therapist empathy, therapist experience, and client speaking for the majority of therapy sessions. Results indicated that participants endorsed significant preference for receiving an EST over other treatment variables for all clinical disorders, with effect sizes ranging from small to large depending on the diagnosis. There was slightly greater variability in treatment preferences for non-clinical issues, though participants generally reported greater preference for receiving an EST. Follow-up questions provided further evidence for EST preferences. The implications of these results are discussed.
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Affiliation(s)
- Alex Kirk
- a Department of Psychology and Neuroscience , University of Colorado Boulder , Boulder , CO , USA
| | - Joshua Broman-Fulks
- b Department of Psychology , Appalachian State University , Boone , NC , USA
| | - John Bergquist
- b Department of Psychology , Appalachian State University , Boone , NC , USA
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