An approach to the patient with anxiety

Factorial invariance of a computerized version of the GAD-7 across various demographic groups and over time in primary care patients

BACKGROUND

The Generalized Anxiety Disorder 7-item scale (GAD-7) is commonly used by clinicians and researchers to screen for anxiety disorders and to monitor anxiety symptoms in primary care. However, findings regarding its factor structure are mixed, with most studies reporting a best-fitting for a one-factor structure, whereas others indicate a two-factor model. To be valid for comparisons, the GAD-7 should measure the same latent construct with the same structure across groups and over time. We aimed to examine the best-fit factor structure model of the GAD-7 among primary care patients and to evaluate its measurement invariance.

METHODS

A total of 1255 patients completed the computerized version of GAD-7 and a subsample of 238 cases was assessed at the 3-month follow-up. A confirmatory factor analysis (CFA) was performed and analyses of multiple-group invariance were also conducted to determine the extent to which the factor structure was comparable across various sociodemographic groups and over time.

RESULTS

The results showed that both a one- and two-factor structure (representing somatic and cognitive-affective components) were invariant across sociodemographic groups and over time. The two-factor structure provided the best model fit.

LIMITATIONS

Results cannot be generalized to all primary care patients, as only patients whose general practitioners consider them to suffer emotional disorders were included.

CONCLUSIONS

Our study supports the reliability and validity of the one- and two-factor model of the GAD-7, both for screening purposes and for monitoring response to treatment.

Ansiedade Materna e Problemas Comportamentais de Crianças com Fissura Labiopalatina

Resumo Indicadores emocionais maternos como a ansiedade têm sido considerados como condições de adversidade ao desenvolvimento infantil. São observadas peculiaridades e uma diversidade de achados em relação a problemas de comportamento e a outros distúrbios debilitantes em crianças ao longo do ciclo vital. O presente estudo objetivou identificar e associar indicadores clínicos para a ansiedade materna com os indicadores de problemas de comportamento (internalizantes e externalizantes) de 83 crianças com fissura labiopalatina, com idade entre três e cinco anos. Os instrumentos utilizados foram: protocolo de entrevista, Idate e CBCL. Os resultados apontaram que as crianças que convivem com mães com indicadores clínicos para ansiedade apresentaram prevalência de comportamentos internalizantes (p < 0,001) e externalizantes (p < 0,001). Para os meninos (37,5%) seriam identificados mais problemas de comportamento externalizantes enquanto que para as meninas (60,0%), mais problemas de comportamento internalizantes. Das mães identificadas com ansiedade avaliaram suas crianças como clínicas em problemas externalizantes (p = 0,020 e < 0,001). Considera-se que tais dados podem contribuir para o planejamento de ações preventivas e interventivas, de modo a favorecer o suporte psicológico para as mães que apresentam indicadores clínicos para ansiedade, assim como propor medidas para os problemas comportamentais das crianças que convivem com mães ansiosas.

Loop diuretics have anxiolytic effects in rat models of conditioned anxiety

A number of antiepileptic medications that modulate GABA(A) mediated synaptic transmission are anxiolytic. The loop diuretics furosemide (Lasix) and bumetanide (Bumex) are thought to have antiepileptic properties. These drugs also modulate GABA(A) mediated signalling through their antagonism of cation-chloride cotransporters. Given that loop diuretics may act as antiepileptic drugs that modulate GABAergic signalling, we sought to investigate whether they also mediate anxiolytic effects. Here we report the first investigation of the anxiolytic effects of these drugs in rat models of anxiety. Furosemide and bumetanide were tested in adult rats for their anxiolytic effects using four standard anxiety models: 1) contextual fear conditioning; 2) fear-potentiated startle; 3) elevated plus maze, and 4) open-field test. Furosemide and bumetanide significantly reduced conditioned anxiety in the contextual fear-conditioning and fear-potentiated startle models. At the tested doses, neither compound had significant anxiolytic effects on unconditioned anxiety in the elevated plus maze and open-field test models. These observations suggest that loop diuretics elicit significant anxiolytic effects in rat models of conditioned anxiety. Since loop diuretics are antagonists of the NKCC1 and KCC2 cotransporters, these results implicate the cation-chloride cotransport system as possible molecular mechanism involved in anxiety, and as novel pharmacological target for the development of anxiolytics. In view of these findings, and since furosemide and bumetanide are safe and well tolerated drugs, the clinical potential of loop diuretics for treating some types of anxiety disorders deserves further investigation.