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Gandarela L, de A. Sampaio TP, Marçal L, Burdmann EA, Neto FL, Bernik MA. Inflammatory markers changes following acceptance-based behavioral psychotherapy in generalized anxiety disorder patients: Evidence from a randomized controlled trial. Brain Behav Immun Health 2024; 38:100779. [PMID: 38725444 PMCID: PMC11081778 DOI: 10.1016/j.bbih.2024.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Generalized anxiety disorder (GAD) has been associated with elevated levels of C-reactive protein (CRP) and proinflammatory cytokines. Despite robust evidence as an effective treatment for GAD, research on the effects of cognitive-behavioral therapies (CBT) in the inflammatory profile of patients with clinical anxiety has presented mixed results. Objective The present study aimed to investigate the effect of an acceptance-based behavior therapy (ABBT) on inflammatory biomarkers and their association with anxiety levels in GAD patients in comparison to supportive therapy as an active control. Methods Peripheral inflammatory biomarkers (CRP, IL-1β, IL-4, IL-6, IL-10, TNF-α) were measured in 77 GAD patients who participated in a 14-week 10-session randomized clinical trial of group ABBT (experimental, n = 37) or supportive group therapy (ST: active control group, n = 40). Results The concentrations of IL-1β decreased in the control group and the concentrations of IL-6 increased in the experimental group from baseline to post-treatment, whereas no difference was identified in IL-4, IL-10, TNF, or CRP. Although anxiety and depression levels decreased in both treatment conditions, no correlation with inflammation markers was found for most clinical and biological variables. A negative correlation between changes in IL-6 and IL-10 and anxiety symptom score changes was identified. Conclusions The present study results found that a short trial of acceptance-based behavior therapy did not change the proinflammatory profile which may be associated with GAD. Additional research is needed to evaluate the influence of other inflammation-related variables, longer periods of follow-up as well as the effect of supportive therapy on peripheral inflammatory biomarkers in GAD patients.
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Affiliation(s)
- Lucas Gandarela
- Experimental Pathophysiology Program, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department and Institute of Psychiatry, Anxiety Disorders Program, University of São Paulo, São Paulo, Brazil
| | - Thiago P. de A. Sampaio
- Department and Institute of Psychiatry, Anxiety Disorders Program, University of São Paulo, São Paulo, Brazil
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Lia Marçal
- LIM 12, Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Emmanuel A. Burdmann
- LIM 12, Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Francisco Lotufo Neto
- Department and Institute of Psychiatry, Anxiety Disorders Program, University of São Paulo, São Paulo, Brazil
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Marcio A. Bernik
- Experimental Pathophysiology Program, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department and Institute of Psychiatry, Anxiety Disorders Program, University of São Paulo, São Paulo, Brazil
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2
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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [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: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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3
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Parsons EM, Hiserodt M, Otto MW. Initial assessment of the feasibility and efficacy of a scalable digital CBT for generalized anxiety and associated health behaviors in a cardiovascular disease population. Contemp Clin Trials 2023; 124:107018. [PMID: 36414206 PMCID: PMC10132350 DOI: 10.1016/j.cct.2022.107018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
Generalized anxiety disorder (GAD) is a significant yet modifiable risk factor for worse cardiovascular disease (CVD) outcomes. The treatment of GAD in an accessible manner represents an unmet need in CVD, given that patients with CVD experience numerous barriers to in-person treatment engagement. This paper presents the rationale and design for an investigation of a strategy to enhance care for patients with CVD by introducing a scalable, affordable, and system-friendly digital intervention that targets a prominent modifiable risk factor (generalized anxiety and associated worry) for negative health behaviors in CVD. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the degree to which a digital cognitive behavior therapy (dCBT), relative to a waitlist control group, engages anxiety and worry outcomes in a sample of 90 adults who have experienced an acute CVD event and who have comorbid GAD symptoms. We also investigate the degree to which dCBT leads to greater changes in GAD symptoms compared to the control condition and whether reductions in these symptoms are associated with corresponding reductions in cardiac anxiety and cardiac health behaviors (including smoking, physical activity, heart-healthy diet, and medication adherence). We propose that by targeting GAD symptoms in CVD in a way that does not tax ongoing medical care provision, we have the potential to improve the uptake of effective care and address both GAD and associated health behaviors.
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Affiliation(s)
- E Marie Parsons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Michele Hiserodt
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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4
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Zhang WY, Nan N, He Y, Zuo HJ, Song XT, Zhang M, Zhou Y. Prevalence of depression and anxiety symptoms and their associations with cardiovascular risk factors in coronary patients. PSYCHOL HEALTH MED 2022; 28:1275-1287. [PMID: 35880259 DOI: 10.1080/13548506.2022.2104885] [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] [Indexed: 10/16/2022]
Abstract
This study aimed to assess the prevalence of depression and anxiety in CHD patients and to explore the association between established cardiovascular risk factors and depression as well as anxiety. 2,216 patients with CHD confirmed by angiography were included in this cross-sectional study. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety symptoms. The frequencies of individual depressive and anxiety symptoms grouped by age and gender were analyzed. Binary logistic regression analyses were used to identify cardiovascular risk factors associated with anxiety and depression. The overall prevalence rates of depression and anxiety in CHD patients were 8.2% and 5.4%, respectively. There were significant differences in the frequency of depression and anxiety symptoms between genders. However, age differences among individual depression and anxiety symptoms were insignificant. In multivariable analysis, female gender, smoking, and hyperlipidemia were associated with a more frequent depression occurrence, and female gender was associated with more frequent anxiety. Depression and anxiety were not associated with other cardiovascular risk factors. These findings suggest that a substantial proportion of CHD patients experienced anxiety and depression symptoms. Differences in depressive or anxiety symptoms among the distribution of individual symptoms need more attention. Depression was significantly associated with female gender, smoking, and hyperlipidemia. No anxiety symptom associations with cardiovascular risk factors were demonstrated to be significant except for the female. More research is needed to unravel the mechanisms of depression, anxiety, and cardiovascular disease.
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Affiliation(s)
- Wen-Yi Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui-Juan Zuo
- Department of Community Health Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yuan Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Hsieh CH, Li D. Understanding how virtual reality forest experience promote physiological and psychological health for patients undergoing hemodialysis. Front Psychiatry 2022; 13:1007396. [PMID: 36590601 PMCID: PMC9794622 DOI: 10.3389/fpsyt.2022.1007396] [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: 07/30/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Growing research has found that exposing patients to forest landscapes through technology improves their health. However, studies on the effects of nature therapy sessions on particularly vulnerable groups that require frequent regular treatment such as patients of chronic kidney disease (CKD) is lacking. This study aims to understand the effects of watching panoramic videos of forest walks through virtual reality (VR) headsets on patients. We also examine the effects of the frequency of virtual exposure to forests on the physiological and psychological parameters of patients undergoing dialysis. Twenty-four dialysis patients with a mean age of 65.11 year underwent a virtual nature intervention over the course of 3 weeks. The intervention consists of 3 numbers of 6-min 360-degree nature videos delivered using VR headsets. We measured heart rate variability (HRV) and heart rate (HR) using continuous electrocardiographic (ECG) monitoring and assessed their emotional states using a questionnaire survey and in-depth interviews. The results showed that the initial 6 min of watching of the panoramic videos through VR headsets resulted in significantly reduced HR and sympathetic nerve activity and increased positive emotional responses. However, repeated VR exposure did not further improve the physiological health of the respondents. Considering these results, the use of VR headsets to watch 6-min nature videos indoors can be used to enhance the positive psychological responses among dialysis and bed-ridden patients. As this study is preliminary, future random controlled trials are needed to compare and determine the best dose, content, and delivery methods of such an intervention.
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Affiliation(s)
- Chung-Heng Hsieh
- Department of Landscape Architecture, College of Art, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Dongying Li
- Department of Landscape Architecture and Urban Planning, School of Architecture, Texas A&M University, College Station, TX, United States
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6
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Nuyen J, Bos EH, de Jonge P, van Dorsselaer S, Tuithof M, Kleinjan M, de Graaf R, Ten Have M. Longitudinal bidirectional associations between internalizing mental disorders and cardiometabolic disorders in the general adult population. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1611-1621. [PMID: 33399884 DOI: 10.1007/s00127-020-02007-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This prospective population-based study investigated whether having any internalizing mental disorder (INT) was associated with the presence and onset of any cardiometabolic disorder (CM) at 3-year follow-up; and vice versa. Furthermore, we examined whether observed associations differed when using longer time intervals of respectively 6 and 9 years. METHODS Data were used from the four waves (baseline and 3-, 6- and 9-year follow-up) of the Netherlands Mental Health Survey and Incidence Study-2, a prospective study of a representative cohort of adults. At each wave, the presence and first onset of INT (i.e. any mood or anxiety disorder) were assessed with the Composite International Diagnostic Interview 3.0; the presence and onset of CM (i.e. hypertension, diabetes, heart disease, and stroke) were based on self-report. Multilevel logistic autoregressive models were controlled for previous-wave INT and CM, respectively, and sociodemographic, clinical, and lifestyle covariates. RESULTS Having any INT predicted both the presence (OR 1.28, p = 0.029) and the onset (OR 1.46, p = 0.003) of any CM at the next wave (3-year intervals). Having any CM was not significantly related to the presence of any INT at 3-year follow-up, while its association with the first onset of any INT reached borderline significance (OR 1.64, p = 0.06), but only when examining 6-year intervals. CONCLUSIONS Our findings indicate that INTs increase the risk of both the presence and the onset of CMs in the short term, while CMs may increase the likelihood of the first onset of INTs in the longer term. Further research is needed to better understand the mechanisms underlying the observed associations.
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Affiliation(s)
- Jasper Nuyen
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands.
| | - Elisabeth H Bos
- Department of Developmental Psychology, Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Saskia van Dorsselaer
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | - Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | - Marloes Kleinjan
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands.,Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands
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7
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Newman MG, Jacobson NC, Rackoff GN, Bell MJ, Taylor CB. A randomized controlled trial of a smartphone-based application for the treatment of anxiety. Psychother Res 2021; 31:443-454. [PMID: 32662323 PMCID: PMC7855205 DOI: 10.1080/10503307.2020.1790688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/24/2020] [Indexed: 12/15/2022] Open
Abstract
AbstractIntroduction: Generalized anxiety disorder (GAD) is prevalent among college students. Smartphone-based interventions may be a low-cost treatment method. Method: College students with self-reported GAD were randomized to receive smartphone-based guided self-help (n = 50), or no treatment (n = 50). Post-treatment and six-month follow-up outcomes included the Depression Anxiety Stress Scales-Short Form Stress Subscale (DASS Stress), the Penn State Worry Questionnaire (PSWQ-11), and the State-Trait Anxiety Inventory-Trait (STAI-T), as well as diagnostic status assessed by the GAD-Questionnaire, 4th edition. Results: From pre- to post-treatment, participants who received guided self-help (vs. no treatment) experienced significantly greater reductions on the DASS Stress (d = -0.408) and a greater probability of remission from GAD (d = -0.445). There was no significant between-group difference in change on the PSWQ-11 (d = -0.208) or STAI-T (d = -0.114). From post to six-month follow-up there was no significant loss of gains on DASS Stress scores (d = -0.141) and of those who had remitted, 78.6% remained remitted. Yet rates of remitted participants no longer differed significantly between conditions at follow-up (d = -0.229). Conclusion: Smartphone-based interventions may be efficacious in treating some aspects of GAD. Methods for improving symptom reduction and long-term outcome are discussed.
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Affiliation(s)
- Michelle G Newman
- Department of Psychology, the Pennsylvania State University, University Park, PA, USA
| | - Nicholas C Jacobson
- Department of Psychology, the Pennsylvania State University, University Park, PA, USA
- Department of Biomedical Data Science and Psychiatry, Dartmouth College, Hanover, NH, USA
| | - Gavin N Rackoff
- Department of Psychology, the Pennsylvania State University, University Park, PA, USA
| | - Megan Jones Bell
- Headspace, Inc., San Francisco, CA, USA
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - C Barr Taylor
- Department of Psychiatry, Stanford University, Stanford, CA, USA
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
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Afsin A, Asoğlu R, Orum MH, Cicekci E. Evaluation of TP-E Interval and TP-E/QT Ratio in Panic Disorder. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E215. [PMID: 32353958 PMCID: PMC7279486 DOI: 10.3390/medicina56050215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The autonomic nervous system (ANS) is involved in panic disorders. ANS dysfunction has been shown to be associated with ventricular arrhythmia and increased heterogeneity of ventricular repolarization. However, there remains limited evidence of the relationship between panic disorders and ventricular depolarization markers, including the Tp-e interval and Tp-e/QT ratio. This study aimed to evaluate ventricular repolarization parameters in patients with panic disorder. Materials and Methods: In total, 40 patients with panic disorder, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, were included in the study group. The control group comprised of 50 age- and sex-matched healthy individuals. A standard 12 lead electrocardiogram was recorded on all participants, and heart rate, QT interval, QRS duration, Tp-e interval, and Tp-e/QT ratio were measured. Results: QRS durations and QT intervals were similar in the study and control groups. Compared to the control group, QTd, Tp-e, and cTp-e intervals as well as Tp-e/QT and Tp-e/QTc ratios were significantly increased in patients with panic disorder (p < 0.05 for all). In the study group, the Severity Measure for Panic Disorder-Adult score had a significant positive correlation with the Tp-e interval (r = 0.369, p < 0001), cTp-e interval (r = 0.531, p < 0.001), Tp-e/QT ratio (r = 0.358, p = 0.001), and Tp-e/QTc ratio (r = 0.351, p = 0.001). Conclusion: These findings indicate that panic disorders are associated with increased ventricular repolarization heterogeneity, which may be attributed to ANS dysregulation.
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Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, M.D, Kahta State Hospital, Adıyaman 02450, Turkey
| | - Ramazan Asoğlu
- Department of Cardiology, M.D, Adıyaman Training and Research Hospital, Adıyaman 02450, Turkey;
| | - Mehmet Hamdi Orum
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
| | - Elvan Cicekci
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
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9
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Shaito A, Thuan DTB, Phu HT, Nguyen THD, Hasan H, Halabi S, Abdelhady S, Nasrallah GK, Eid AH, Pintus G. Herbal Medicine for Cardiovascular Diseases: Efficacy, Mechanisms, and Safety. Front Pharmacol 2020; 11:422. [PMID: 32317975 PMCID: PMC7155419 DOI: 10.3389/fphar.2020.00422] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/19/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a significant health burden with an ever-increasing prevalence. They remain the leading causes of morbidity and mortality worldwide. The use of medicinal herbs continues to be an alternative treatment approach for several diseases including CVDs. Currently, there is an unprecedented drive for the use of herbal preparations in modern medicinal systems. This drive is powered by several aspects, prime among which are their cost-effective therapeutic promise compared to standard modern therapies and the general belief that they are safe. Nonetheless, the claimed safety of herbal preparations yet remains to be properly tested. Consequently, public awareness should be raised regarding medicinal herbs safety, toxicity, potentially life-threatening adverse effects, and possible herb–drug interactions. Over the years, laboratory data have shown that medicinal herbs may have therapeutic value in CVDs as they can interfere with several CVD risk factors. Accordingly, there have been many attempts to move studies on medicinal herbs from the bench to the bedside, in order to effectively employ herbs in CVD treatments. In this review, we introduce CVDs and their risk factors. Then we overview the use of herbs for disease treatment in general and CVDs in particular. Further, data on the ethnopharmacological therapeutic potentials and medicinal properties against CVDs of four widely used plants, namely Ginseng, Ginkgo biloba, Ganoderma lucidum, and Gynostemma pentaphyllum, are gathered and reviewed. In particular, the employment of these four plants in the context of CVDs, such as myocardial infarction, hypertension, peripheral vascular diseases, coronary heart disease, cardiomyopathies, and dyslipidemias has been reviewed, analyzed, and critically discussed. We also endeavor to document the recent studies aimed to dissect the cellular and molecular cardio-protective mechanisms of the four plants, using recently reported in vitro and in vivo studies. Finally, we reviewed and reported the results of the recent clinical trials that have been conducted using these four medicinal herbs with special emphasis on their efficacy, safety, and toxicity.
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Affiliation(s)
- Abdullah Shaito
- Department of Biological and Chemical Sciences, Lebanese International University, Beirut, Lebanon
| | - Duong Thi Bich Thuan
- Department of Biochemistry, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Hoa Thi Phu
- Department of Biochemistry, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thi Hieu Dung Nguyen
- Department of Physiology, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Hiba Hasan
- Institute of Anatomy and Cell Biology, Justus Liebig University Giessen, Giessen, Germany
| | - Sarah Halabi
- Biology Department, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Samar Abdelhady
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Gheyath K Nasrallah
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar
| | - Ali H Eid
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar.,Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon
| | - Gianfranco Pintus
- Department of Medical Laboratory Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Biomedical Sciences, Faculty of Medicine, University of Sassari, Sassari, Italy
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10
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Relationship between major depressive disorder, generalized anxiety disorder and coronary artery disease in the US general population. J Psychosom Res 2019; 119:8-13. [PMID: 30947822 DOI: 10.1016/j.jpsychores.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate whether the changes and persistence of major depressive disorder (MDD) and generalized anxiety disorder (GAD) affect the risk of incident coronary artery disease (CAD) in the US general population. METHODS Data was retrieved from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted in 2001/2002 (Wave 1) and 2004/2005 (Wave 2). At both Wave 1 and one year before Wave 2, MDD and GAD were measured using the Alcohol Use Disorders and Associated Disabilities Interview Schedule IV. CAD was considered present at Wave 1 or Wave 2 based on the participants' self-reported physician diagnosis. Relationship between MDD, GAD and CAD was examined using generalized linear regression model. RESULTS The study included 32,345 participants without CAD at Wave 1, with 3.3% developing CAD at Wave 2. After adjustment, persistence of MDD/GAD and GAD predicted highest risk of developing CAD respectively (MDD/GAD: RR = 2.01, 95% CI: 1.54-2.64; GAD: RR = 2.09, 95% CI: 1.22-3.58), while positive changes predicted lowest risk (MDD/GAD: RR = 1.43, 95% CI: 1.15-1.78; GAD: RR = 1.68, 95% CI: 1.21-2.33). Negative change of MDD is associated with highest risk of developing CAD (RR = 2.07, 95% CI: 1.69-2.54), while positive changes predicted lowest risk (RR = 1.38, 95% CI: 1.11-1.73). CONCLUSIONS Existence of MDD/GAD, MDD, or GAD increase the risk of new-onset CAD. Positive change in MDD and GAD is associated with reduced risk of incident CAD, which highlights the importance of treating MDD and GAD in preventing the development of CAD.
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11
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Ottaviani C. Brain-heart interaction in perseverative cognition. Psychophysiology 2018; 55:e13082. [PMID: 29607505 DOI: 10.1111/psyp.13082] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/28/2022]
Abstract
The move from the concept of homeostasis to that of allostasis has led reactivity stress research to widen the object of its investigation: from the brief physiological response that occurs when one is facing a stressor to what happens when one is anticipating or recovering from a stressor. A paradigmatic example is represented by perseverative cognition, during which human beings react "as if" they were constantly facing a concrete stressor. The core idea behind this review is that the cognitive inflexibility that characterizes perseverative cognition is reflected in both our body (by increased autonomic nervous system rigidity assessed by heart rate variability; HRV) and our brain (by reduced prefrontal-amygdala functional connectivity). This is a review of studies conducted in different settings (laboratory, daily life), populations (healthy, major depression, generalized anxiety), location (United States, Europe), and age groups (children, adults) that consistently replicated the association between autonomic, subjective, and behavioral measures of cognitive inflexibility during perseverative cognition. Moreover, compelling neuroimaging data suggest that HRV reduction from pre- to post-induction of perseverative cognition is associated with both structural and functional brain abnormalities reflecting impaired prefrontal inhibitory control over subcortical structures (e.g., diminished prefrontal-amygdala functional connectivity). The integration of neuroscience techniques with clinical autonomic research has advanced our understanding of the neurobiology of brain-heart interaction during perseverative cognition, potentially yielding to more effective treatment packages. This is clinically relevant if one considers that perseverative cognition is a pervasive transdiagnostic factor that carries prognostic risk for both psychological and somatic health.
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Affiliation(s)
- Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy
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12
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Abstract
Unrecognized anxiety is a difficult clinical presentation in cardiology. Anxiety leads to recurring emergency department visits and the need for numerous diagnostic evaluations to rule out cardiovascular disease (CVD). This review focuses broadly on anxiety and its subtypes in relation to the onset and progression of CVD while describing helpful guidelines to better identify and treat anxiety. Potential mechanisms of cardiopathogenesis are also described. An emerging literature demonstrates that anxiety disorders increase the risk for incident CVD but a causal relationship has not been demonstrated. Anxiety portends adverse prognosis in persons with established CVD that is independent from depression. The level of clinical priority received by depression should be extended to research and clinical intervention efforts in anxiety. Anxiety holds direct relevance for uncovering mechanisms of cardiopathogenesis, developing novel therapeutic strategies, and initiating clinical interventions in the population at risk of developing heart disease, or those already diagnosed with CVD.
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Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France. .,Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia. .,INSERM U1219, Université de Bordeaux, 146 rue Léo Saignat - Case 11, 33076, Bordeaux Cedex, France.
| | - Nathan J Harrison
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia.,Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Peter Cheung
- Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Suzanne Cosh
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France
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13
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Machado S, Sancassiani F, Paes F, Rocha N, Murillo-Rodriguez E, Nardi AE. Panic disorder and cardiovascular diseases: an overview. Int Rev Psychiatry 2017; 29:436-444. [PMID: 28893114 DOI: 10.1080/09540261.2017.1357540] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The association between panic disorder (PD) and cardiovascular diseases (CVD) has been extensively studied in recent years and, although some studies have shown anxiety disorders co-existing or increasing the risk of heart disease, no causal hypothesis has been well established. Thus, a critical review was performed of the studies that evaluated the association between PD and cardiovascular diseases; synthesizing the evidence on the mechanisms mediators that theoretically would be the responsible for the causal pathway between PD and CVD, specifically. This overview shows epidemiological studies, and discusses biological mechanisms that could link PD to CVD, such as pleiotropy, heart rate variability, unhealthy lifestyle, atherosclerosis, mental stress, and myocardial perfusion defects. This study tried to provide a comprehensive narrative synthesis of previously published information regarding PD and CVD and open new possibilities of clinical management and pathophysiological understanding. Some epidemiological studies have indicated that PD could be a risk factor for CVD, raising morbidity and mortality in PD, suggesting an association between them. These studies argue that PD pathophysiology could cause or potentiate CVD. However, there is no evidence in favour of a causal relationship between PD and CVD. Therefore, PD patients with suspicions of cardiovascular symptoms need redoubled attention.
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Affiliation(s)
- Sergio Machado
- a Physical Activity Neuroscience Laboratory , Salgado de Oliveira University (UNIVERSO) , Niterói , RJ , Brazil.,b Laboratory of Panic & Respiration (LABPR) , Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,c Intercontinental Neuroscience Research Group
| | - Federica Sancassiani
- d Department of Public Health and Clinical and Molecular Medicine , University of Cagliari , Italy
| | - Flavia Paes
- b Laboratory of Panic & Respiration (LABPR) , Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Nuno Rocha
- c Intercontinental Neuroscience Research Group.,e School of Allied Health Sciences , Polytechnic Institute of Porto , Porto , Portugal
| | - Eric Murillo-Rodriguez
- c Intercontinental Neuroscience Research Group.,f Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud , Universidad Anáhuac Mayab , Mérida , Yucatán , México.,g Grupo de Investigación en Envejecimiento, División Ciencias de la Salud , Universidad Anáhuac Mayab , Mérida , Yucatán , México
| | - Antonio Egidio Nardi
- a Physical Activity Neuroscience Laboratory , Salgado de Oliveira University (UNIVERSO) , Niterói , RJ , Brazil
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14
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van der Ploeg MM, Brosschot JF, Verkuil B, Gillie BL, Williams DP, Koenig J, Vasey MW, Thayer JF. Inducing unconscious stress: Cardiovascular activity in response to subliminal presentation of threatening and neutral words. Psychophysiology 2017; 54:1498-1511. [PMID: 28497544 DOI: 10.1111/psyp.12891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 11/29/2022]
Abstract
Stress-related cognitive processes may occur outside of awareness, here referred to as unconscious stress, and affect one's physiological state. Evidence supporting this idea would provide necessary clarification of the relationship between psychological stress and cardiovascular (CV) health problems. We tested the hypothesis that increases in mean arterial pressure (MAP) and total peripheral resistance (TPR) and decreases in heart rate variability (HRV) would be larger when threatening stimuli are presented outside of awareness, or subliminally, compared with neutral stimuli. Additionally, it was expected that trait worry and resting HRV, as common risk factors for CV disease, would moderate the effect. We presented a subliminal semantic priming paradigm to college students that were randomly assigned to the threat (n = 56) or neutral condition (n = 60) and assessed changes from baseline of MAP, TPR, and HRV. Level of trait worry was assessed with the Penn State Worry Questionnaire. The findings indicate that CV activity changed according to the hypothesized pattern: A higher MAP and TPR and a lower HRV in the threat condition compared with the neutral condition were found with practically meaningful effect sizes. However, these findings were only statistically significant for TPR. Furthermore, changes in CV activity were not moderated by trait worry or resting HRV. This is the first study to explicitly address the role of subliminally presented threat words on health-relevant outcome measures and suggests that unconscious stress can influence peripheral vascular resistance.
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Affiliation(s)
- Melanie M van der Ploeg
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Jos F Brosschot
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Bart Verkuil
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Brandon L Gillie
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | | | - Julian Koenig
- Department of Psychology, The Ohio State University, Columbus, Ohio.,Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael W Vasey
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, Columbus, Ohio
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15
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Roest AM, de Jonge P, Lim C, Stein DJ, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Ciutan M, de Girolamo G, Hu C, Levinson D, Nakamura Y, Navarro-Mateu F, Piazza M, Posada-Villa J, Torres Y, Wojtyniak B, Kessler RC, Scott KM. Fear and distress disorders as predictors of heart disease: A temporal perspective. J Psychosom Res 2017; 96:67-75. [PMID: 28545795 PMCID: PMC5674522 DOI: 10.1016/j.jpsychores.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Few studies have been able to contrast associations of anxiety and depression with heart disease. These disorders can be grouped in fear and distress disorders. Aim of this study was to study the association between fear and distress disorders with subsequent heart disease, taking into account the temporal order of disorders. METHODS Twenty household surveys were conducted in 18 countries (n=53791; person years=2,212,430). The Composite International Diagnostic Interview assessed lifetime prevalence and age at onset of disorders, and respondents were categorized into categories based on the presence and timing of fear and distress disorders. Heart disease was indicated by self-report of physician-diagnosed heart disease or self-report of heart attack, together with year of onset. Survival analyses estimated associations between disorder categories and heart disease. RESULTS Most respondents with fear or distress disorders had either pure distress or pure fear (8.5% and 7.7% of total sample), while fear preceded distress in the large majority of respondents with comorbid fear and distress (3.8% of total sample). Compared to the "no fear or distress disorder" category, respondents with pure fear disorder had the highest odds of subsequent heart disease (OR:1.8; 95%CI:1.5-2.2; p<0.001) and compared to respondents with pure distress disorder, these respondents were at a significantly increased risk of heart disease (OR:1.3; 95%CI:1.0-1.6; p=0.020). CONCLUSION This novel analytic approach indicates that the risk of subsequent self-reported heart disease associated with pure fear disorder is significantly larger than the risk associated with distress disorder. These results should be confirmed in prospective studies using objective measures of heart disease.
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Affiliation(s)
- AM Roest
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - P de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - C Lim
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - DJ Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - A Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - J Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - C Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - R Bruffaerts
- Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg Leuven, Belgium
| | - B Bunting
- Psychology Research Institute, Ulster University, Northern Ireland
| | - JM Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - M Ciutan
- National School of public Health, Management and Professional Development, Bucharest, Romania
| | - G de Girolamo
- IRCCS St John of God Clinical Research Centre, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - C Hu
- Shenzhen Insitute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China
| | - D Levinson
- Ministry of Health Israel, Mental Health Services, Israel
| | - Y Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - F Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - M Piazza
- National Institute of Health, Peru, Universidad Cayetano Hereidia, Peru
| | - J Posada-Villa
- Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Y Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - B Wojtyniak
- Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - RC Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, United States
| | - KM Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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16
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Van Beek MHCT, Zuidersma M, Lappenschaar M, Pop G, Roest AM, Van Balkom AJLM, Speckens AEM, Voshaar RCO. Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction. Br J Psychiatry 2016; 209:400-406. [PMID: 27539297 DOI: 10.1192/bjp.bp.115.174870] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 04/23/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND General anxiety and depressive symptoms following a myocardial infarction are associated with a worse cardiac prognosis. However, the contribution of specific aspects of anxiety within this context remains unclear. AIMS To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction. METHOD We administered the Cardiac Anxiety Questionnaire (CAQ) during hospital admission (baseline, n = 193) and 4 months (n = 147/193) after discharge. CAQ subscale scores reflect fear, attention, avoidance and safety-seeking behaviour. Study end-point was a major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality. In Cox regression analysis, we adjusted for age, cardiac disease severity and depressive symptoms. RESULTS The CAQ sum score at baseline and at 4 months significantly predicted a MACE (HRbaseline = 1.59, 95% CI 1.04-2.43; HR4-months = 1.77, 95% CI 1.04-3.02) with a mean follow-up of 4.2 (s.d. = 2.0) years and 4.3 (s.d. = 1.7) years respectively. Analyses of subscale scores revealed that this effect was particularly driven by avoidance (HRbaseline = 1.23, 95% CI 0.99-1.53; HR4-months = 1.77, 95% CI 1.04-1.83). CONCLUSIONS Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an important prognostic factor for a MACE in patients after myocardial infarction, independent of cardiac disease severity and depressive symptoms.
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Affiliation(s)
- Maria H C T Van Beek
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Marij Zuidersma
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Martijn Lappenschaar
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Gheorghe Pop
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Anton J L M Van Balkom
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Anne E M Speckens
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
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Chen MH, Tsai SJ. Treatment-resistant panic disorder: clinical significance, concept and management. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:219-26. [PMID: 26850787 DOI: 10.1016/j.pnpbp.2016.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 12/17/2022]
Abstract
Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our imagination. Increasing evidence suggested existence of a chronic or remitting-relapsing clinical course in panic disorder. In this systematic review, we re-examine the definition of treatment-resistant panic disorder, and present the potential risk factors related to the treatment resistance, including the characteristics of panic disorder, other psychiatric and physical comorbidities, and psychosocial stresses. Furthermore, we summarize the potential pathophysiologies, such as genetic susceptibility, altered brain functioning, brain-derived neurotrophic factor, and long-term inflammation, to explain the treatment resistance. Finally, we conclude the current therapeutic strategies for treating treatment-resistant panic disorder from pharmacological and non-pharmacological views.
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Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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18
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Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease. Am J Cardiol 2016; 118:511-9. [PMID: 27324160 DOI: 10.1016/j.amjcard.2016.05.041] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 11/22/2022]
Abstract
Whether anxiety is a risk factor for a range of cardiovascular diseases is unclear. We aimed to determine the association between anxiety and a range of cardiovascular diseases. MEDLINE and EMBASE were searched for cohort studies that included participants with and without anxiety, including subjects with anxiety, worry, posttraumatic stress disorder, phobic anxiety, and panic disorder. We examined the association of anxiety with cardiovascular mortality, major cardiovascular events (defined as the composite of cardiovascular death, stroke, coronary heart disease, and heart failure), stroke, coronary heart disease, heart failure, and atrial fibrillation. We identified 46 cohort studies containing 2,017,276 participants and 222,253 subjects with anxiety. Anxiety was associated with a significantly elevated risk of cardiovascular mortality (relative risk [RR] 1.41, CI 1.13 to 1.76), coronary heart disease (RR 1.41, CI 1.23 to 1.61), stroke (RR 1.71, CI 1.18 to 2.50), and heart failure (RR 1.35, CI 1.11 to 1.64). Anxiety was not significantly associated with major cardiovascular events or atrial fibrillation although CIs were wide. Phobic anxiety was associated with a higher risk of coronary heart disease than other anxiety disorders, and posttraumatic stress disorder was associated with a higher risk of stroke. Results were broadly consistent in sensitivity analyses. Anxiety disorders are associated with an elevated risk of a range of different cardiovascular events, including stroke, coronary heart disease, heart failure, and cardiovascular death. Whether these associations are causal is unclear.
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19
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Klainin-Yobas P, Ng SH, Stephen PDM, Lau Y. Efficacy of psychosocial interventions on psychological outcomes among people with cardiovascular diseases: a systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2016; 99:512-521. [PMID: 27045976 DOI: 10.1016/j.pec.2015.10.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/20/2015] [Accepted: 10/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This systematic review aimed to examine empirical evidence concerning the efficacy of psychosocial interventions in ameliorating the psychosocial problems of people with cardiovascular diseases (CVDs). METHODS A comprehensive literature search was undertaken to identify both published and non-published English randomised controlled trials (RCTs) from 2000 to 2015. Two reviewers independently screened, assessed risks for bias, and extracted data. Comprehensive meta-analysis software was used to analyse the extracted data. Hedges's g effect size was used to determine the effects of psychosocial interventions. RESULTS Thirty studies were included in the review but only 18 studies reported significant short-term effects of psychosocial interventions in CVD patients. Most studies did not report long-term effects. Average effect sizes for stress, anxiety, depression, and combined depression/anxiety were 0.34, 1.04, 0.42 and 0.67 respectively at post-tests. Those numbers became 0.09, 0.65, 0.22 and 0.09 at follow-up assessments. Psychosocial programmes with psychoeducation and stress management helped reduce patients' stress and anxiety levels. Programmes including psychotherapy, counselling, mindfulness-based intervention (MBI), and stress management helped mitigate depression and anxiety. CONCLUSIONS The findings support the efficacy of some psychosocial interventions in people with CVDs. PRACTICE IMPLICATIONS Healthcare providers should monitor patients' psychological problems and may integrate psychosocial interventions as part of treatment plans.
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Affiliation(s)
| | | | | | - Ying Lau
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Batelaan NM, Seldenrijk A, Bot M, van Balkom AJLM, Penninx BWJH. Anxiety and new onset of cardiovascular disease: critical review and meta-analysis. Br J Psychiatry 2016; 208:223-31. [PMID: 26932485 DOI: 10.1192/bjp.bp.114.156554] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Anxiety has been associated with new-onset cardiovascular disease (CVD), but the quality of this relationship is unclear. Only if anxiety is a causal, independent cardiovascular risk factor might it be a target for CVD prevention. AIMS To determine and examine the independent association and causality between anxiety and incident CVD. METHOD PubMed, EMBASE and PsycINFO databases were searched up to October 2013. A review of Hill's criteria for causality and random effects meta-analysis were conducted of prospective, population-based studies examining anxiety and incident CVD in people free from CVD at baseline. RESULTS The meta-analysis comprised 37 papers (n = 1 565 699). The follow-up ranged from 1 to 24 years. Anxiety was associated with a 52% increased incidence of CVD (hazard ratio = 1.52, 95% CI 1.36-1.71). The risk seemed independent of traditional risk factors and depression. The evaluation of Hill's criteria largely argued in favour of causality. CONCLUSIONS Anxiety may be of interest for CVD prevention. Future research should examine biological and behavioural underpinnings of the association in order to identify targets for intervention.
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Affiliation(s)
- Neeltje M Batelaan
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Adrie Seldenrijk
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mariska Bot
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Neeltje M. Batelaan, MD, PhD, Adrie Seldenrijk, PhD, Mariska Bot, PhD, Anton J. L. M. van Balkom, MD, PhD, Brenda W. J. H. Penninx, PhD, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Langvik E, Hjemdal O, Nordahl HM. Personality traits, gender differences and symptoms of anhedonia: What does the Hospital Anxiety and Depression Scale (HADS) measure in nonclinical settings? Scand J Psychol 2016; 57:144-51. [DOI: 10.1111/sjop.12272] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/20/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Eva Langvik
- Department of Psychology; Norwegian University of Science and Technology, NTNU; Trondheim Norway
| | - Odin Hjemdal
- Department of Psychology; Norwegian University of Science and Technology, NTNU; Trondheim Norway
| | - Hans M. Nordahl
- Department of Psychology; Norwegian University of Science and Technology, NTNU; Trondheim Norway
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Depression, anxiety and 6-year risk of cardiovascular disease. J Psychosom Res 2015; 78:123-9. [PMID: 25454680 DOI: 10.1016/j.jpsychores.2014.10.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Depression and anxiety are considered etiological factors in cardiovascular disease (CVD), though their relative contribution and differentiation by clinical characteristics have not been studied intensively. We examined 6-year associations between depressive and anxiety disorders, clinical characteristics and newly-developed CVD. METHODS DSM-IV diagnoses were established in 2510 CVD-free participants of the Netherlands Study of Depression and Anxiety. Data on subtype, severity, and psychoactive medication were collected. The 6-year incidence of CVD was assessed using Cox regression analyses adjusted for sociodemographic, health and lifestyle factors. RESULTS One-hundred-six subjects (4.2%) developed CVD. Having both current depressive and anxiety disorders (HR=2.86, 95%CI 1.49-5.49) or current depression only (HR=2.30; 95%CI 1.10-4.80) was significantly associated with increased CVD incidence, whereas current anxiety only (HR=1.48; 95%CI 0.74-2.96) and remitted disorders (HR=1.48; 95%CI 0.80-2.75) were not associated. Symptom severity was associated with increased CVD onset (e.g., Inventory of Depressive Symptomatology per SD increase: HR=1.51; 95%CI 1.25-1.83). Benzodiazepine use was associated with additional CVD risk (HR=1.95; 95%CI 1.16-3.31). CONCLUSIONS Current depressive (but not anxiety) disorder independently contributed to CVD in our sample of initially CVD-free participants. CVD incidence over 6years of follow-up was particularly increased in subjects with more symptoms, and in those using benzodiazepines.
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Klainin-Yobas P, Koh KWL, Ambhore AA, Chai P, Chan SWC, He HG. A study protocol of a randomized controlled trial examining the efficacy of a symptom self-management programme for people with acute myocardial infarction. J Adv Nurs 2014; 71:1299-309. [PMID: 25522762 DOI: 10.1111/jan.12594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
AIM To report a study protocol of a randomized controlled trial examining if a symptom self-management programme helps patients with acute myocardial infarction self-manage their physical and psychological symptoms. BACKGROUND In addition to physical conditions, people with acute myocardial infarction often experience psychological symptoms. However, there is limited empirical evidence on how to help individuals self-manage these psychological symptoms. DESIGN A single-blinded, randomized controlled trial is proposed. METHODS A convenience sample of 90 will be recruited. Eligible participants will be adult patients with acute myocardial infarction hospitalized at a tertiary hospital in Singapore. Participants will be randomly assigned to one of the three treatment groups: Intervention 1 and standard care (n = 30), Intervention 2 and standard care (n = 30) and standard care alone (n = 30). Data will be collected by self-reported questionnaires, physiological measures and open-ended questions. Quantitative data will be analysed by descriptive statistics, t-test, analysis of covariance and repeated measures analysis of variance. Open-ended questions will be analysed by content analysis. DISCUSSION This study will identify a potentially efficacious symptom self-management programme for patients with acute myocardial infarction. If the efficacy of the programme is demonstrated, the programme can be integrated into hospital services to improve patient care. A new teaching method (virtual reality-based teaching) and new teaching materials (virtual reality videos and relaxation videos) derived from this study can be offered to patients. Future research with larger samples and multi-centre recruitment can be undertaken to further test the efficacy of the interventions.
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Affiliation(s)
| | | | - Anand Adinath Ambhore
- Cardiac Department, National University Heart Centre, National University Hospital, Singapore
| | - Ping Chai
- Cardiac Department, National University Heart Centre, National University Hospital, Singapore
| | - Sally Wai-Chi Chan
- School of Nursing and Midwifery, University of New Castle, Callaghan, New Castle, Australia
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Langvik E, Hjemdal O. Symptoms of depression and anxiety before and after myocardial infarction: The HUNT 2 and HUNT 3 study. PSYCHOL HEALTH MED 2014; 20:560-9. [PMID: 25495669 DOI: 10.1080/13548506.2014.989864] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The long-term effect of having a myocardial infarction (MI) and to what extent post-MI anxiety and depression can be attributed to pre-MI anxiety and depression are not known. Anxiety as an independent risk factor for the onset of MI is not clear and studies treating anxiety and depression as continuous variables are lacking. Baseline data in this prospective study were obtained from the Health Study of Nord-Trøndelag County (HUNT 2). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS) at HUNT 2. Age, gender, waist circumference, hypertension, total cholesterol, diabetes, and years of daily smoking were included as control variables. In the sample of 28,859 participants, 770 MI were reported in the follow-up study 5-8 years later (HUNT 3). The level of depressive symptoms at HUNT 2 was a significant and independent predictor of MI at HUNT 3, while symptoms of anxiety were not. Level of anxiety and depression at HUNT 3 was best predicted by baseline anxiety and depression. Having an MI had only a marginal effect on the levels of anxiety and depressive symptoms at HUNT 3. In the MI group, time since MI was not a significant predictor of anxiety and depression.
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Affiliation(s)
- Eva Langvik
- a Department of Psychology , Norwegian University of Science and Technology , Trondheim , Norway
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Langvik E, Nordahl HM. Anhedonic depression, history of depression, and anxiety as gender-specific risk factors of myocardial infarction in healthy men and women: The HUNT study. Health Psychol Open 2014; 1:2055102914557658. [PMID: 28070344 PMCID: PMC5193285 DOI: 10.1177/2055102914557658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This prospective study examines gender-specific psychological risk factors of myocardial infarction. Out of 41,248 participants free of coronary heart disease at baseline, 822 cases of myocardial infarction were identified in the Nord-Trøndelag Health Study or the mortality register. The participants completed the Hospital Anxiety and Depression Scale. Cholesterol, blood pressure, and waist–hip ratio were measured by medical staff. Smoking, diabetes, non-fatal myocardial infarction, and history of depressive episode were self-reported. Anhedonic depression (Hospital Anxiety and Depression Scale-D ≥8) was a significant predictor of myocardial infarction in women but not in men. Gender difference in risk estimate based on Hospital Anxiety and Depression Scale-D was significant (p < .01). History of depressive episode was a significant predictor of myocardial infarction in men. Symptoms of anxiety (Hospital Anxiety and Depression Scale-A ≥8) reduced the risk of having a myocardial infarction.
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Abstract
The neurovascular unit is a key player in brain development, homeostasis, and pathology. Mental stress affects coagulation, while severe mental illnesses, such as recurrent depression and schizophrenia, are associated with an increased thrombotic risk and cardiovascular morbidity. Evidence indicates that the hemostatic system is involved to some extent in the pathogenesis, morbidity, and prognosis of a wide variety of psychiatric disorders. The current review focuses on emerging data linking coagulation and some psychiatric disorders.
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Affiliation(s)
- Silvia Hoirisch-Clapauch
- Department of Hematology, Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine (INCT-TM), Brazil
| | | | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus and Technion Institute of Technology, Haifa, Israel
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