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Anichebe O, Anibueze AU, Anum V, Ohaja EU, Ezeugwu CA, Obasi NT, Onogwu EO, Gever VC. Effectiveness of drama and music therapies as health communication interventions for reducing anxiety and posttraumatic disorders among children-victims of flood. Complement Ther Clin Pract 2024; 57:101890. [PMID: 39106584 DOI: 10.1016/j.ctcp.2024.101890] [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: 03/03/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/09/2024]
Abstract
This study examined the usefulness of drama and music therapies as communication strategies for reducing symptoms of post-traumatic stress disorder (PTSD) and generalised anxiety disorder (GAD) among school children (aged 10-16) who were victims of the 2022 floods in Nigeria. The researchers randomly assigned the children to control (n = 122) drama therapy (n = 120) and music therapy (n = 120) groups. The result of the study revealed that after the intervention, school children in the drama and music therapies (unlike those in the control group) reported a significant reduction in their PTSD and GAD symptoms; the reduction achieved statistical significance (p = 0.001, ηp2 = 0.48). Further results revealed a significant interactive effect of gender (p = 0.001) with boys reporting a significant reduction more than girls. The results showed that drama therapy contributed more to reducing PTSD symptoms, while music therapy contributed more to reducing GAD symptoms. The difference did not achieve statistical significance (p = 0.23). The researchers conclude that both drama and music therapies were associated with reduced symptoms, indicating the interventions may be beneficial therapies.
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Affiliation(s)
- Obiora Anichebe
- Department of Philosophy, University of Nigeria, Nsukka, Nigeria.
| | - Anselm U Anibueze
- Department of Guidance and Counseling, Federal University, Oye-Ekiti, Nigeria.
| | - Victoria Anum
- Department of Mass Communication, Prince Abubakar Audu University, Anyigba, Nigeria.
| | - Edith Ugochi Ohaja
- Department of Mass Communication, University of Nigeria, Nsukka, Nigeria.
| | - Cindy Anene Ezeugwu
- Department of Theatre and Film Studies, University of Nigeria, Nsukka, Nigeria.
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Benchimol-Elkaim B, Khoury B, Tsimicalis A. Nature-based mindfulness programs using virtual reality to reduce pediatric perioperative anxiety: a narrative review. Front Pediatr 2024; 12:1334221. [PMID: 38283632 PMCID: PMC10820709 DOI: 10.3389/fped.2024.1334221] [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: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Over 75% of pediatric surgery patients experience preoperative anxiety, which can lead to complicated recoveries. Current interventions are less effective for children over 12 years old. New interventions, like mindfulness-based ones (MBIs), are needed to address this issue. MBIs work well for reducing mental health symptoms in youth, but they can be challenging for beginners. Virtual reality (VR) nature settings can help bridge this gap, providing an engaging 3-D practice environment that minimizes distractions and enhances presence. However, no study has investigated the combined effects of mindfulness training in natural VR settings for pediatric surgery patients, creating a significant gap for a novel intervention. This paper aims to fill that gap by presenting a narrative review exploring the potential of a nature-based mindfulness program using VR to reduce pediatric preoperative anxiety. It begins by addressing the risks of anxiety in children undergoing surgery, emphasizing its impact on physical recovery, and supporting the use of VR for anxiety reduction in hospitals. The review then delves into VR's role in nature and mindfulness, discussing theoretical concepts, clinical applications, and effectiveness. It also examines how the combination of mindfulness, nature, and VR can create an effective intervention, supported by relevant literature. Finally, it synthesizes the existing literature's limitations, findings, gaps, and contradictions, concluding with research and clinical implications.
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Affiliation(s)
| | - Bassam Khoury
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Shriners Hospital for Children, Montreal, QC, Canada
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Gálvez Escudero D, Reyes-Bossio M. Stress and Anxiety Reduction Effects of a Reiki Program During the COVID-19 Pandemic Among Employees in Lima, Peru. Holist Nurs Pract 2022; 36:E48-E56. [PMID: 35981119 PMCID: PMC9377362 DOI: 10.1097/hnp.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evidence has been found of how the coronavirus disease-2019 (COVID-19) pandemic has increased stress and anxiety indicators. Against this background, the present research aims to determine the effect of a distance Reiki intervention program on stress and anxiety during the period of isolation due to COVID-19 among people working in the city of Lima, Peru. The related hypothesis was that distance Reiki would generate a reduction in stress and anxiety levels. It was a quasiexperimental design with pre- and posttests, with nonprobabilistic purposive sampling. In total, 28 employees participated (12 in the experimental group and 16 in the control group). As part of the method, the following instruments were used: the EPGE, IDARE, and Coronavirus Anxiety Scale (CAS). There was a large decrease in the distress parameter (Cohen's d = 1.006), as well as in the state anxiety parameter (d = 1.678) and a large increase in eustress (d = 0.921). Similarly, there was an overall reduction in the trait anxiety parameter (d = 0.373) in all cases as compared with the control group. Coronavirus anxiety showed no major impact. These results provide initial evidence on the effects of distance Reiki among Peruvians and provide the basis for promoting this cost-effective therapy, generating a practical and social contribution.
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Affiliation(s)
| | - Mario Reyes-Bossio
- Faculty of Psychology, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Depression and Anxiety Disorders Impact in the Quality of Life of Patients with Inflammatory Bowel Disease. PSYCHIATRY JOURNAL 2021; 2021:5540786. [PMID: 34746297 PMCID: PMC8566083 DOI: 10.1155/2021/5540786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/28/2021] [Accepted: 10/16/2021] [Indexed: 01/08/2023]
Abstract
Objective Anxiety and depression have a negative influence in the quality of life. The aim of the study was to determinate the levels of sensitivity and specificity of the Anxiety and Hospital Depression Scale (HADS) and compare the quality of life in patients with inflammatory bowel disease (IBD) and depression or anxiety. Methods This study included 104 patients with diagnosis of IBD. Each patient received psychiatric intervention with SCID-I (Structured Clinical Interview for DSMIV Axis I Disorders) instrument as a gold standard to stablish the cut-off points of HADS. Quality of life was also evaluated with IBDQ-32. Demographic and clinical variables were collected. Results Most of the patients reported a high quality of life (73.1%, n = 76), while 25.0% (n = 26) express a moderate quality of life. The ROC curves for both psychiatric entities showed an adequate discriminative capacity of the HADS-anxiety dimension (AUC = 0.84, 95%CI = 0.76-0.92) with a limited discriminability of the HADS-depression dimension (AUC = 0.58, 95%CI = 0.46-0.70) using the proposed scoring of 8 as a cut-off point. Conclusions Anxiety and depression impact negatively in the quality of life in Mexican patients with IBD. The Mexican version of HADS had acceptable internal consistency and external validity, with moderate sensitivity and specificity for clearly identifying clinical cases of anxiety and depression in patients with IBD.
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Deep learning paired with wearable passive sensing data predicts deterioration in anxiety disorder symptoms across 17-18 years. J Affect Disord 2021; 282:104-111. [PMID: 33401123 PMCID: PMC7889722 DOI: 10.1016/j.jad.2020.12.086] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/01/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent studies have demonstrated that passive smartphone and wearable sensor data collected throughout daily life can predict anxiety symptoms cross-sectionally. However, to date, no research has demonstrated the capacity for these digital biomarkers to predict long-term prognosis. METHODS We utilized deep learning models based on wearable sensor technology to predict long-term (17-18-year) deterioration in generalized anxiety disorder and panic disorder symptoms from actigraphy data on daytime movement and nighttime sleeping patterns. As part of Midlife in the United States (MIDUS), a national longitudinal study of health and well-being, subjects (N = 265) (i) completed a phone-based interview that assessed generalized anxiety disorder and panic disorder symptoms at enrollment, (ii) participated in a one-week actigraphy study 9-14 years later, and (iii) completed a long-term follow-up, phone-based interview to quantify generalized anxiety disorder and panic disorder symptoms 17-18 years from initial enrollment. A deep auto-encoder paired with a multi-layered ensemble deep learning model was leveraged to predict whether participants experienced increased anxiety disorder symptoms across this 17-18 year period. RESULTS Out-of-sample cross-validated results suggested that wearable movement data could significantly predict which individuals would experience symptom deterioration (AUC = 0.696, CI [0.598, 0.793], 84.6% sensitivity, 52.7% specificity, balanced accuracy = 68.7%). CONCLUSIONS Passive wearable actigraphy data could be utilized to predict long-term deterioration of anxiety disorder symptoms. Future studies should examine whether these methods could be implemented to prevent deterioration of anxiety disorder symptoms.
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Abstract
Although some studies have been conducted on the association between diabetes and anxiety symptoms, the data on this association remain controversial. The purpose of this meta-analysis was to examine the association between diabetes and anxiety symptoms. The authors systematically searched PubMed, Scopus, and Google Scholar databases until July 2018. After the screening process, 23 studies were included in the meta-analysis. Stata-14 was used for meta-analyzing. Forest plot was calculated for the whole 23 studies and subgroups, and publication bias was also examined. Overall, diabetes was positively associated with anxiety; pooled odds ratio was equal to1.48; 95% confidence interval was 1 .27-1.74. In cross-sectional study, the result was odds ratio = 1.50; 95% confidence interval = 1.26-1.77, and in prospective-cohort study, the result was odds ratio = 1.34; 95% confidence interval = 1.21-1.49. There was small evidence of publication bias. Overall, our findings indicate that diabetes is a risk factor for anxiety symptoms. Therefore, having a healthy medical condition can be an anxiety prevention agent.
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Navarro-Haro MV, Modrego-Alarcón M, Hoffman HG, López-Montoyo A, Navarro-Gil M, Montero-Marin J, García-Palacios A, Borao L, García-Campayo J. Evaluation of a Mindfulness-Based Intervention With and Without Virtual Reality Dialectical Behavior Therapy ® Mindfulness Skills Training for the Treatment of Generalized Anxiety Disorder in Primary Care: A Pilot Study. Front Psychol 2019; 10:55. [PMID: 30745888 PMCID: PMC6360930 DOI: 10.3389/fpsyg.2019.00055] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/09/2019] [Indexed: 12/27/2022] Open
Abstract
Generalized Anxiety Disorder (GAD) is a very prevalent disorder in primary care (PC). Most patients with GAD never seek treatment, and those who do seek treatment often drop out before completing treatment. Although it is an understudied treatment, Mindfulness-Based Interventions (MBIs) indicate preliminary efficacy for the treatment of GAD symptoms, but many patients with GAD present other associated symptoms (e.g., attention deficits) that complicate the treatment. Virtual Reality DBT® Mindfulness Skills learning has recently been developed to make learning mindfulness easier for patients with emotion dysregulation who have trouble concentrating. Virtual Reality (VR) might serve as a visual guide for practicing mindfulness as it gives patients the illusion of "being there" in the 3D computer generated world. The main goal of this study was to evaluate the effect of two MBIs (a MBI in a group setting alone and the same MBI plus 10 min VR DBT® Mindfulness skills training) to reduce GAD symptoms. A secondary aim was to explore the effect in depression, emotion regulation, mindfulness, and interoceptive awareness. Other exploratory aims regarding the use of VR DBT® Mindfulness skills were also carried out. The sample was composed of 42 patients (roughly half in each group) with GAD attending PC visits. After treatment, both groups of patients showed significant improvements in General Anxiety Disorder measured by the GAD-7 using mixed regression models [MBI alone (B = -5.70; p < 0.001; d = -1.36), MBI+VR DBT® Mindfulness skills (B = -4.38; p < 0.001; d = -1.33)]. Both groups also showed significant improvements in anxiety, depression, difficulties of emotion regulation and several aspects of mindfulness and interoceptive awareness. Patients in the group that received additional 10 min VR DBT Mindfulness Skills training were significantly more adherent to the treatment than those receiving only standard MBI (100% completion rate in MBI + VR vs. 70% completion rate in MBI alone; Fisher = 0.020). Although randomized controlled studies with larger samples are needed, this pilot study shows preliminary effectiveness of MBI to treat GAD, and preliminary evidence that adjunctive VR DBT® Mindfulness Skills may reduce dropouts.
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Affiliation(s)
- María V. Navarro-Haro
- Personality Disorders Unit, General University Hospital of Catalonia, University of Barcelona, Barcelona, Spain
| | | | - Hunter G. Hoffman
- Virtual Reality Research Center at the Human Photonics Lab, Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Alba López-Montoyo
- Edificio Investigación II, Universitat Jaume I, Castellón de la Plana, Spain
| | | | - Jesús Montero-Marin
- Primary Care Prevention and Health Promotion Network, RedIAPP, Zaragoza, Spain
| | | | - Luis Borao
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Javier García-Campayo
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Network, RedIAPP, Zaragoza, Spain
- Hospital Universitario Miguel Servet, Zaragoza, Spain
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Alrasheedi AA. Deficits in history taking skills among final year medical students in a family medicine course: A study from KSA. J Taibah Univ Med Sci 2018; 13:415-421. [PMID: 31435357 PMCID: PMC6695087 DOI: 10.1016/j.jtumed.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES History taking is considered an important diagnostic tool in medicine. Medical students should be competent in focused history-taking skills to reach initial diagnosis. The aim of this study was to identify deficits in history-taking skills among final year medical students in family medicine courses in Qassim University, KSA. METHODS All objective structured clinical examination (OSCE) sheets were collected and analysed to evaluate the history-taking component of the final examination from 2016 until January 2018. RESULTS A total of 94 OSCE sheets were evaluated. Achievement in some history taking skills of the students was low (differential diagnosis 31.9%, alarming symptoms of disease 39.4%, clarification of major complaint-associated symptoms 47.9%, and stress, anxiety, and depression screening 59.6%). However, the students' performances were better with respect to communication skills in general and exploration of the patients' ideas, concerns, and expectations. Significantly more male than female students had a better performance in some skills such as facilitating technique, appropriately exploring major complaint-associated symptoms, enquiring about differential diagnoses, and to rule out alarm symptoms. CONCLUSIONS In this study, the students' performance was generally better with respect to communication skills and psychosocial history. However, the students showed poor knowledge in other aspects of history-taking skills as they failed to formulate more than one hypothesis and to ask about alarm symptoms. Teaching communication and clinical reasoning skills and connecting physical and psychosocial aspects of patient care promotes understanding of the patient as a whole and should be taught in all courses of the clinical phase, with emphasis on bedside training.
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Affiliation(s)
- Ahmad A. Alrasheedi
- Corresponding address: Department of Family and Community Medicine, College of Medicine, Qassim University, P.O. Box 6655, Buraidah 51452, KSA.
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Zhao FF, Suhonen R, Katajisto J, Leino-Kilpi H. The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study. Patient Prefer Adherence 2018; 12:1677-1686. [PMID: 30233148 PMCID: PMC6129026 DOI: 10.2147/ppa.s169826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Many people with type 2 diabetes (T2DM) do not sustain sufficient diabetes-related self-care activities (DRSCA) in their daily lives. To provide additional information about the positive influence of DRSCA, this study was conducted to examine whether DRSCA were associated with reduced perceived stress, anxiety, and fatigue among people with T2DM and to explore the level of DRSCA, perceived stress, anxiety, and fatigue and their association with background information. PATIENTS AND METHODS This study was a cross-sectional survey including 251 participants aged 18 years and older recruited from two hospitals in the eastern part of China. The study utilized self-report questionnaires that consisted of background information, DRSCA, perceived stress, anxiety, and fatigue. Hierarchical multiple regression analysis was conducted to explore the association of DRSCA with perceived stress, anxiety, and fatigue while adjusting for background information. RESULTS The results indicated that the level of self-care activities, stress, and fatigue was around middle level. The prevalence of anxiety was 19%. A high level of DRSCA was likely to reduce perceived stress but was not linked to anxiety and fatigue. Women were more susceptible to stress and anxiety, and people who had diabetes for >5 years were more likely to have anxiety. The background information included diabetes duration, standardized diabetes education, and high social support, all of which are factors that may influence DRSCA. CONCLUSION The findings suggest that improving the level of DRSCA might effectively reduce perceived stress. The potential benefits of DRSCA can provide both motivational and evaluative data for self-care programs. In addition, the findings show that DRSCA were not linked to anxiety and fatigue, which implies that their positive influence on anxiety and fatigue may be offset by the load of frequent DRSCA. It is suggested that helping patients to make tailored plans to integrate DRSCA into their daily lives is needed. Meanwhile, in the background information, it is suggested that standardized diabetes education and high social support can benefit DRSCA; in improving psychological health, more attention should be paid to women and patients with diabetes duration <5 years.
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Affiliation(s)
- Fang-Fang Zhao
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland,
- School of Nursing Science, Nantong University, Nantong, People's Republic of China,
| | - Riitta Suhonen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland,
- Turku University Hospital and City of Turku, Welfare Division, Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland,
- Turku University Hospital, Turku, Finland
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Electrical stimulation of the bed nucleus of the stria terminalis reduces anxiety in a rat model. Transl Psychiatry 2017; 7:e1033. [PMID: 28195571 PMCID: PMC5438032 DOI: 10.1038/tp.2017.2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/07/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022] Open
Abstract
We recently showed that deep brain stimulation (DBS) in the bed nucleus of the stria terminalis (BST) reduces obsessions, compulsions and associated anxiety in patients suffering from severe, treatment-refractory obsessive-compulsive disorder. Here, we investigated the anxiolytic effects of electrical BST stimulation in a rat model of conditioned anxiety, unrelated to obsessions or compulsions. Two sets of stimulation parameters were evaluated. Using fixed settings at 100 Hz, 40 μs and 300 μA (Set A), we observed elevated freezing and startle levels, whereas stimulation at 130 Hz, 220 μs and individually tailored amplitudes (Set B) appeared to reduce freezing. In a follow-up experiment, we evaluated the anxiolytic potential of Set B more extensively, by adding a lesion group and an additional day of stimulation. We found that electrical stimulation significantly reduced freezing, but not to the same extent as lesions. Neither lesions nor stimulation of the BST affected motor behavior or unconditioned anxiety in an open-field test. In summary, electrical stimulation of the BST was successful in reducing contextual anxiety in a rat model, without eliciting unwanted motor effects. Our findings underline the therapeutic potential of DBS in the BST for disorders that are hallmarked by pathological anxiety. Further research will be necessary to assess the translatability of these findings to the clinic.
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Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H. Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review. J Psychosom Res 2016; 87:70-80. [PMID: 27411754 DOI: 10.1016/j.jpsychores.2016.06.001] [Citation(s) in RCA: 347] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/21/2016] [Accepted: 06/03/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE An increasing number of studies have been conducted to look at anxiety and depression in IBD; however, there is no clear consensus on the prevalence of anxiety and depression in this population. The objective of this systematic review was to compile the existing data on the prevalence of all mood and anxiety disorders in Inflammatory Bowel Disease patients. METHODS A series of comprehensive literature searches of Medline, Cochrane Library, PsycINFO, CINAHL, Embase, AMED, and ProQuest Dissertations were performed through March 2014. Inclusion criteria included peer-reviewed, published scientific articles that reported a measurement of mood or anxiety among IBD patients. Only studies with adults (≥18years old) and with more than 10 patients were included. Methodological quality was assessed for all included studies. RESULTS 171 articles were identified with a total of 158,371 participants. Pooled prevalence estimate for anxiety disorders was 20.5% [4.9%, 36.5%] and 35.1% [30.5, 39.7%] for symptoms of anxiety. IBD patients in active disease had higher prevalence of anxiety of 75.6% [65.5%, 85.7%] compared to disease remission. Pooled prevalence of depression disorders was 15.2% [9.9%, 20.5%] and was 21.6% [18.7%, 24.3%] for symptoms of depression. The prevalence of depressive symptoms was higher in Crohn's disease (25.3% [20.7%, 30.0%]) compared to UC, and higher with active disease (40.7% [31.1%, 50.3%]) compared to IBD patients in remission. CONCLUSION Results from this systematic review indicate that patients with IBD have about a 20% prevalence rate of anxiety and a 15% prevalence rate of depression.
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Affiliation(s)
- Rachel Neuendorf
- Helfgott Research Institute, National College of Natural Medicine, Portland, OR, USA.
| | - Aubrey Harding
- Helfgott Research Institute, National College of Natural Medicine, Portland, OR, USA
| | - Noelle Stello
- Helfgott Research Institute, National College of Natural Medicine, Portland, OR, USA
| | - Douglas Hanes
- Helfgott Research Institute, National College of Natural Medicine, Portland, OR, USA
| | - Helané Wahbeh
- Helfgott Research Institute, National College of Natural Medicine, Portland, OR, USA; Department of Neurology, Oregon Health and Science University, Portland, OR, USA
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Burke DA, Koot HM, de Wilde A, Begeer S. Influence of Child Factors on Health-Care Professionals' Recognition of Common Childhood Mental-Health Problems. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:3083-3096. [PMID: 27656089 PMCID: PMC5016556 DOI: 10.1007/s10826-016-0475-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Early recognition of childhood mental-health problems can help minimise long-term negative outcomes. Recognition of mental-health problems, needed for referral and diagnostic evaluation, is largely dependent on health-care professionals' (HCPs) judgement of symptoms presented by the child. This study aimed to establish whether HCPs recognition of mental-health problems varies as a function of three child-related factors (type of problem, number of symptoms, and demographic characteristics). In an online survey, HCPs (n = 431) evaluated a series of vignettes describing children with symptoms of mental-health problems. Vignettes varied by problem type (Attention-Deficit/Hyperactivity Disorder (ADHD), Generalised Anxiety Disorder (GAD), Autism Spectrum Disorder (ASD), Conduct Disorder (CD) and Major Depressive Disorder), number of symptoms presented (few and many), and child demographic characteristics (ethnicity, gender, age and socio-economic status (SES)). Results show that recognition of mental-health problems varies by problem type, with ADHD best recognised and GAD worst. Furthermore, recognition varies by the number of symptoms presented. Unexpectedly, a child's gender, ethnicity and family SES did not influence likelihood of problem recognition. These results are the first to reveal differences in HCPs' recognition of various common childhood mental-health problems. HCPs in practice should be advised about poor recognition of GAD, and superior recognition of ADHD, if recognition of all childhood mental-health problems is to be equal.
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Affiliation(s)
- Delia A. Burke
- Department of Clinical Developmental Psychology and EMGO Institute of Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Hans M. Koot
- Department of Clinical Developmental Psychology and EMGO Institute of Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Amber de Wilde
- Department of Clinical Developmental Psychology and EMGO Institute of Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Sander Begeer
- Department of Clinical Developmental Psychology and EMGO Institute of Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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Roberge P, Normand-Lauzière F, Raymond I, Luc M, Tanguay-Bernard MM, Duhoux A, Bocti C, Fournier L. Generalized anxiety disorder in primary care: mental health services use and treatment adequacy. BMC FAMILY PRACTICE 2015; 16:146. [PMID: 26492867 PMCID: PMC4618956 DOI: 10.1186/s12875-015-0358-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022]
Abstract
PURPOSE Generalized Anxiety Disorder (GAD) is a common mental disorder in the primary care setting, marked by persistent anxiety and worries. The aims of this study were to: 1) examine mental health services utilisation in a large sample of primary care patients; 2) explore detection of GAD and minimal standards for pharmacological and psychological treatment adequacy based on recommendation from clinical practice guidelines; 3) examine correlates of treatment adequacy, i.e. predisposing, enabling and needs factors according to the Behavioural Model of Health Care Use. METHODS A sample of 373 adults meeting DSM-IV criteria for Generalized Anxiety Disorder in the past 12 months took part in this study. Data were drawn from the "Dialogue" project, a large primary care study conducted in 67 primary care clinics in Quebec, Canada. Following a mental health screening in medical clinics (n = 14833), patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). Multilevel logistic regression models were developed to examine correlates of treatment adequacy for pharmacological and psychological treatments. RESULTS Results indicate that 52.5 % of participants were recognized as having GAD by a healthcare professional in the past 12 months, and 36.2 % of the sample received a pharmacological (24.4 %) and/or psychological treatment (19.2 %) meeting indicators based on clinical practice guidelines recommendations. The detection of GAD by a health professional and the presence of comorbid depression were associated with overall treatment adequacy. CONCLUSIONS This study suggests that further efforts towards GAD detection could lead to an increase in the delivery of evidence-based treatments. Key targets for improvement in treatment adequacy include regular follow up of patients with a GAD medication and access to psychotherapy from the primary care setting.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada.
| | - François Normand-Lauzière
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada.
| | - Isabelle Raymond
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada.
| | - Mireille Luc
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada.
| | - Marie-Michèle Tanguay-Bernard
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada.
| | - Arnaud Duhoux
- Division of Neurology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada.
| | - Christian Bocti
- Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montreal, QC, H3C 3 J7, Canada.
| | - Louise Fournier
- CRCHUM (Centre de recherche du Centre Hospitalier de l'Université de Montréal), Université de Montréal, Pavillon Édouard-Asselin, 264, boul. René-Lévesque Est, Montréal, QC, H2X 1P1, Canada.
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Alschuler KN, Beier ML. Intolerance of Uncertainty: Shaping an Agenda for Research on Coping with Multiple Sclerosis. Int J MS Care 2015; 17:153-8. [PMID: 26300700 DOI: 10.7224/1537-2073.2014-044] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multiple sclerosis (MS) is a chronic and progressive neurologic condition that, by its nature, carries uncertainty as a hallmark characteristic. Although all patients face uncertainty, there is variability in how individuals cope with its presence. In other populations, the concept of "intolerance of uncertainty" has been conceptualized to explain this variability such that individuals who have difficulty tolerating the possibility of future occurrences may engage in thoughts or behaviors by which they attempt to exert control over that possibility or lessen the uncertainty but may, as a result, experience worse outcomes, particularly in terms of psychological well-being. This topical review introduces MS-focused researchers, clinicians, and patients to intolerance of uncertainty, integrates the concept with what is already understood about coping with MS, and suggests future steps for conceptual, assessment, and treatment-focused research that may benefit from integrating intolerance of uncertainty as a central feature.
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15
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Hippocampal biomarkers of fear memory in an animal model of generalized anxiety disorder. Behav Brain Res 2014; 263:34-45. [DOI: 10.1016/j.bbr.2014.01.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/08/2014] [Accepted: 01/15/2014] [Indexed: 11/20/2022]
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16
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Edwards LE, Mezuk B. Anxiety and risk of type 2 diabetes: evidence from the Baltimore Epidemiologic Catchment Area Study. J Psychosom Res 2012; 73:418-23. [PMID: 23148808 PMCID: PMC3499773 DOI: 10.1016/j.jpsychores.2012.09.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/28/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depression is increasingly recognized as a risk factor for type 2 diabetes, and is also commonly comorbid with anxiety. However, few studies have examined whether anxiety is predictive of diabetes risk. The objectives of this study are to examine the prospective relationship between anxiety disorders (generalized anxiety disorder, panic disorder, social phobia, and agoraphobia) and risk of type 2 diabetes over an 11-year period, and to investigate the association between anxiety and risk of diabetes-related complications among those with prevalent type 2 diabetes. METHODS Data come from the 1993/6 and 2004/5 waves of the Baltimore Epidemiologic Catchment Area Study (N=1920), a population-based prospective cohort. Anxiety disorders were assessed using the Diagnostic Interview Schedule. The prospective association between anxiety and incident type 2 diabetes was evaluated using a series of nested multivariable logistic regression models. RESULTS At baseline, 315 participants (21.8%) had an anxiety disorder. The relationship between anxiety and risk of developing type 2 diabetes was not statistically significant after controlling for demographic characteristics (Odds Ratio (OR): 1.28, 95% Confidence Interval (CI): 0.75, 2.18). There was no relationship between anxiety and diabetes risk after controlling for health behaviors and depression status (OR: 1.00, 95% CI: 0.53, 1.89). There was no significant relationship between anxiety and development of diabetes-related complications among those with prevalent type 2 diabetes (OR: 2.02, 95% CI: 0.61, 6.74). CONCLUSION Anxiety disorders are not associated with increased risk of type 2 diabetes or risk of diabetes complications among those who have diabetes.
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Affiliation(s)
- Lauren E. Edwards
- Department of Epidemiology and Community Health Virginia Commonwealth University School of Medicine
| | - Briana Mezuk
- Department of Epidemiology and Community Health Virginia Commonwealth University School of Medicine
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Tello-Bernabé E, Sanz-Cuesta T, del Cura-González I, de Santiago-Hernando ML, Jurado-Sueiro M, Fernández-Girón M, García-de Blas F, Pensado-Freire H, Góngora-Maldonado F, de la Puente-Chamorro MJ, Rodríguez-Pasamontes C, Martín-Iglesias S. Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial. Implement Sci 2011; 6:123. [PMID: 22132861 PMCID: PMC3283530 DOI: 10.1186/1748-5908-6-123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/01/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low. METHOD/DESIGN This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion. The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling. The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive. TRIAL REGISTRATION ISRCTN: ISRCTN83365316.
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Affiliation(s)
- Eugenia Tello-Bernabé
- Centro de Salud El Naranjo. Gerencia Atención Primaria. Servicio Madrileño de Salud. Spain
| | - Teresa Sanz-Cuesta
- Unidad Apoyo a la Investigación. Gerencia Atención Primaria, Servicio Madrileño de Salud, Spain
| | | | | | - Montserrat Jurado-Sueiro
- Centro de Salud Castilla La Nueva. Gerencia Atención Primaria, Servicio Madrileño de Salud, Spain
| | - Mercedes Fernández-Girón
- Centro de Salud Mª Ángeles López Gómez. Gerencia Atención Primaria, Servicio Madrileño de Salud, Spain
| | - Francisca García-de Blas
- Centro de Salud Mendiguchía Carriche. Gerencia Atención Primaria, Servicio Madrileño de Salud, Spain
| | | | | | | | | | - Susana Martín-Iglesias
- Dirección Asistencial Sur. Gerencia Atención Primaria, Servicio Madrileño de Salud, Spain
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Vermani M, Marcus M, Katzman MA. Rates of detection of mood and anxiety disorders in primary care: a descriptive, cross-sectional study. Prim Care Companion CNS Disord 2011; 13:10m01013. [PMID: 21977354 DOI: 10.4088/pcc.10m01013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 08/13/2010] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine the incidence of major depressive disorder, bipolar disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder and to assess their detection rates in the Canadian primary care setting. METHOD The descriptive, cross-sectional study was conducted in 7 primary care clinics in 3 Canadian provinces, Ontario, British Columbia, and Nova Scotia, from December 6, 2005, to May 5, 2006. Patients in clinic waiting rooms who consented to participate in the study were administered the Mini International Neuropsychiatric Interview (MINI) (N = 840). These patients' medical charts were then reviewed for evidence of previous diagnosis of a mood or anxiety disorder. Misdiagnosis was defined as cases for which a diagnosis was reached on the MINI but not in the patient's chart. RESULTS Of the 840 primary care patients assessed, 27.2%, 11.4%, 12.6%, 31.2%, and 16.5% of patients met criteria for major depressive disorder, bipolar disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder, respectively. Misdiagnosis rates reached 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder. CONCLUSIONS With high prevalence rates and poor detection, there is an obvious need to enhance diagnostic screening in the primary care setting.
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Affiliation(s)
- Monica Vermani
- START Clinic for Mood and Anxiety Disorders, Toronto (Drs Vermani and Katzman); University of Toronto and Northern Ontario School of Medicine, Thunder Bay (Dr Katzman); Lakehead University, Thunder Bay (Drs Vermani and Katzman); and York University, Toronto (Dr Marcus), Ontario, Canada
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Contextual conditioning in rats as an animal model for generalized anxiety disorder. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2011; 11:228-44. [PMID: 21302154 DOI: 10.3758/s13415-011-0021-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Animal models of psychiatric disorders are important translational tools for exploring new treatment options and gaining more insight into the disease. Thus far, there is no systematically validated animal model for generalized anxiety disorder (GAD), a severely impairing and difficult-to-treat disease. In this review, we propose contextual conditioning (CC) as an animal model for GAD. We argue that this model has sufficient face validity (there are several symptom similarities), predictive validity (it responds to clinically effective treatments), and construct validity (the underlying mechanisms are comparable). Although the refinement and validation of an animal model is a never-ending process, we want to give a concise overview of the currently available evidence. We suggest that the CC model might be a valuable preclinical tool to enhance the development of new treatment strategies and our understanding of GAD.
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Abbott JD, Kent S, Levay EA, Tucker RV, Penman J, Tammer AH, Paolini AG. The effects of calorie restriction olfactory cues on conspecific anxiety-like behaviour. Behav Brain Res 2009; 201:305-10. [DOI: 10.1016/j.bbr.2009.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 02/04/2009] [Accepted: 02/27/2009] [Indexed: 11/29/2022]
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Calleo J, Stanley MA, Greisinger A, Wehmanen O, Johnson M, Novy D, Wilson N, Kunik M. Generalized anxiety disorder in older medical patients: diagnostic recognition, mental health management and service utilization. J Clin Psychol Med Settings 2009; 16:178-85. [PMID: 19152056 DOI: 10.1007/s10880-008-9144-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 12/30/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. METHODS Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. RESULTS Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, chi(2) (2, N = 225) = 4.75, p < .05. CONCLUSIONS Most patients with anxiety do not have anxiety or symptoms documented in their medical records.
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Affiliation(s)
- Jessica Calleo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Levay EA, Govic A, Penman J, Paolini AG, Kent S. Effects of adult-onset calorie restriction on anxiety-like behavior in rats. Physiol Behav 2007; 92:889-96. [PMID: 17673267 DOI: 10.1016/j.physbeh.2007.06.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/25/2007] [Accepted: 06/25/2007] [Indexed: 11/20/2022]
Abstract
Calorie restriction (CR) has consistently been shown to increase lifespan and ameliorate disease outcomes. Its effects on behavior are less clear, although anxiolytic-like effects have been observed. Rats were subjected to 1 of 4 dietary regimens: control, CR25%, CR50% and, an acute episode of CR and tested in 3 tests of anxiety: the open field test, the elevated plus maze, and the modified open field test. In the open field test, the CR25% and CR50% groups made more central zone entries than the control and Acute groups, which was primarily due to differences in the initial 5 min of the test. Moreover, both CR groups engaged in greater exploration of the central zone than the control group in the initial 5 min of the test. The Acute group also exhibited significantly longer latencies to leave the central zone at test onset than the control and CR50% group. In the elevated plus maze, the Acute group also displayed longer latencies to open arm entry as compared to the control and CR50% group and showed a lower ratio of open to total arm entries compared to all other groups. There were no effects of CR on any variable of the modified open field test. Possible neurochemical mechanisms underlying the anxiolytic-like effect of CR are discussed.
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Affiliation(s)
- Elizabeth A Levay
- School of Psychological Science, La Trobe University, Bundoora, VIC 3086, Australia
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Fagenholz PJ, Murray AF, Gutman JA, Findley JK, Harris NS. New-Onset Anxiety Disorders at High Altitude. Wilderness Environ Med 2007; 18:312-6. [DOI: 10.1580/07-weme-br-102r1.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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