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Guthrie AJ, Paredes-Echeverri S, Bleier C, Adams C, Millstein DJ, Ranford J, Perez DL. Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework. J Affect Disord 2024; 358:222-249. [PMID: 38718945 PMCID: PMC11298870 DOI: 10.1016/j.jad.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/02/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood. METHODS We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with hypochondriasis, illness anxiety disorder, and PHA more broadly. RESULTS Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages. LIMITATIONS Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized. CONCLUSIONS Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments.
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Affiliation(s)
- Andrew J Guthrie
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina Bleier
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin Adams
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Ranford
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Pallati A, Singh A, Ranjan P, Rawat N, Sarkar S, Kaloiya G, Baitha U, Upadhyay AD, Prakash B, Jadon RS. Exploring the Link Between Somatic and Psychiatric Symptoms in Patients With Medically Unexplained Physical Symptoms: A Cross-Sectional Survey From North India. Cureus 2024; 16:e65984. [PMID: 39221380 PMCID: PMC11366069 DOI: 10.7759/cureus.65984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The association between somatic symptoms and psychiatric co-morbidities remains unexplored among patients with medically unexplained physical symptoms (MUPS) in Asian populations. This study aims to bridge this gap by investigating psychiatric morbidities and their determinants among patients presenting with MUPS in an Indian setup. METHODOLOGY This cross-sectional study, conducted in the outpatient department (OPD) of a tertiary care hospital in India, assessed 200 patients diagnosed with MUPS. Assessment tools, such as the Somatic Symptom Scale (SSS-8), Presumptive Stressful Life Event Scale (PSLES), and Depression, Anxiety, and Stress Scale (DASS), were administered to collect data. RESULTS The study examined patients (mean age 36.51±9.82 years), predominantly comprising females (67.5%), presenting with MUPS. Common presenting symptoms were general (96.3%), musculoskeletal pain (91.7%), and gastrointestinal symptoms reported by 81.7%. Medium somatic symptom severity (57%) was more prevalent in females. Prevalent psychiatric co-morbid conditions included depression (mild: 22.0%, moderate: 26.5%), moderate anxiety (41.5%), and moderate stress (26%). Strong associations were observed between the SSS-8 score and depression (χ²(6, N = 200) = 49.26, p < 0.001), anxiety (χ²(8, N = 200) = 37.90, p < 0.001), stress (χ²(6, N = 200) = 44.45, p < 0.001), and the experience of stressful life events (χ²(3, N = 200) = 6.5, p < 0.05). CONCLUSION The study indicates an intertwined association between MUPS and psychiatric disorders. Individuals with MUPS commonly experience heightened anxiety and depression, emphasizing the complex interplay between somatic symptoms and emotional well-being. Consideration of environmental and social factors may be crucial for a comprehensive understanding.
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Affiliation(s)
- Abhivandana Pallati
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Amandeep Singh
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Nandini Rawat
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Gaurishanker Kaloiya
- Clinical Psychology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Upendra Baitha
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ashish D Upadhyay
- Biostatistics, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Bindu Prakash
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Ranveer S Jadon
- Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Kikas K, Werner-Seidler A, Upton E, Newby J. Illness Anxiety Disorder: A Review of the Current Research and Future Directions. Curr Psychiatry Rep 2024; 26:331-339. [PMID: 38748190 PMCID: PMC11211185 DOI: 10.1007/s11920-024-01507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW We review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults. RECENT FINDINGS IAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited. IAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.
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Affiliation(s)
- Katarina Kikas
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Upton
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jill Newby
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia.
- School of Psychology, University of New South Wales, Sydney, Australia.
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Kim SI, Kim SM, Park SJ, Song J, Lee J, Kim KH, Park SM. Association of parental depression with adolescent children's psychological well-being and health behaviors. BMC Public Health 2024; 24:1412. [PMID: 38802817 PMCID: PMC11129386 DOI: 10.1186/s12889-024-18337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/12/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Parental depression is a significant problem that negatively affects parents' welfare and influences family dynamics, children's academic and health behaviors, and mental health. However, there is limited evidence regarding the impact of the parental depression into the children's' psychological and physical wellbeing on Asian cultures. This study examined the psychological burdens and health behaviors of adolescent children with parents with depression in the Republic of Korea. METHODS We conducted a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey (KNHANES) spanning 2013 to 2021 to compare health behaviors and mental health outcomes between 203 adolescent children with parents diagnosed with depression and 3,856 control adolescents aged 12-19 years. RESULTS Following multivariate adjustments, the risk of depressive mood for more than two weeks was significantly increased in boys with parental depression (adjusted Odds Ratio [aOR] = 2.05, 95% Confidence Interval [CI] = 1.91-3.52) and adolescents with parents with moderate-to-severe depression (aOR = 2.60, 95% CI = 1.17-5.77). Adolescents with parental depression reported significantly worse subjective health status (aOR = 1.88, 95% CI = 1.05-3.36) and higher stress levels (aOR = 1.91, 95% CI = 1.33-2.76). Additionally, when parental depression was present and the time since depression diagnosis was more than five years, adolescents with parental depression exhibited even poorer subjective health status and higher stress levels. CONCLUSIONS The study found that adolescents whose parents experienced depression had poorer mental health than those whose parents did not have mental health issues. These findings emphasize the importance of providing support for the mental health of adolescents in families affected by parental depression.
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Affiliation(s)
- Sung-In Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Min Kim
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Graduate School, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Jihun Song
- Department of Biomedical Sciences, Seoul National University Graduate School, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Jaewon Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
- Home Healthcare Clinic, Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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Rask CU, Duholm CS, Poulsen CM, Rimvall MK, Wright KD. Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences. J Child Psychol Psychiatry 2024; 65:413-430. [PMID: 37909255 DOI: 10.1111/jcpp.13912] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/03/2023]
Abstract
Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
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Fagnani C, Gigantesco A, Giacomini G, Medda E. Connecting psychosocial and personality characteristics with mental health outcomes. An Italian co-twin control study. Prev Med Rep 2024; 37:102559. [PMID: 38192297 PMCID: PMC10772814 DOI: 10.1016/j.pmedr.2023.102559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
Exposure to stressful life events is common, and it is linked to increased psychological issues. As most likely people respond to stressors depending on environmental and genetic factors, we assessed in a twin study the association of some personal characteristics such as resilience and self-perception with anxiety, depression and stress in the late Covid pandemic period, to verify the underlying genetic and shared familial components. With this design, the strength of the associations was compared between individual-level and intrapair-level analyses. From June 2020 to December 2021, the Italian Twin Registry conducted a three-wave longitudinal study among adult twins using validated questionnaires, and 1,763 adult twins participated in the study (mean age 46 years, 67 % females, 70 % monozygotic). A regression-based within-pair differences model was applied to control for genetic and shared environmental confounding. Results showed that anxiety was linked negatively with resilience, social support and perceived health, and positively with risk perception and hypochondria. Depression was associated negatively with resilience, social support and perceived health, and positively with financial concern and hypochondria. Stress was associated negatively with resilience and perceived health, and positively with financial concern, risk perception and hypochondria. These results suggest potential etiological effects of the above-mentioned risk factors. While our findings need to be confirmed by longitudinal studies, they propose potential etiological models for mental disorders, indicating that addressing in the clinical practice factors such as self-perception, personality traits (resilience), environmental resources (social support), and comorbid disorders (hypochondria) could have therapeutic benefits while treating certain common mental disorders.
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Affiliation(s)
- Corrado Fagnani
- Centre of Reference for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome 00161, Italy
| | - Antonella Gigantesco
- Centre of Reference for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome 00161, Italy
| | - Gianmarco Giacomini
- Centre of Reference for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome 00161, Italy
- Department of Public Health Sciences and Pediatrics, University of Turin, via Santena 5 bis, 10126 Turin, Italy
| | - Emanuela Medda
- Centre of Reference for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome 00161, Italy
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Ingeman K, Wright KD, Frostholm L, Frydendal DH, Ørnbøl E, Rask CU. Measurement properties of the Health Anxiety by Proxy Scale (HAPYS): A new questionnaire to assess parents' worries about their child's health. J Psychosom Res 2024; 176:111555. [PMID: 38039620 DOI: 10.1016/j.jpsychores.2023.111555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Health anxiety by proxy refers to parents' excessive worries about their child's health. The Health Anxiety by Proxy scale (HAPYS) is a new self-report questionnaire to assess parents' worries and behaviors regarding their child's health. This study aimed to investigate the measurement properties of the HAPYS. METHODS Questionnaires were completed by 204 parents, and a HAPYS score was obtained for 200 parents: 39 parents diagnosed with health anxiety, 33 parents with different anxiety disorders, 33 parents with a Functional Somatic Disorder, and 95 healthy parents. We evaluated the following measurement properties: structural validity, reliability, convergent validity ((pain catastrophizing, parents' reports of child's emotional and physical symptoms), discriminant validity (parental reports of child's well-being), and known-groups validity (see compared groups above). RESULTS HAPYS demonstrated a one factor dimensionality, and excellent internal reliability (α = 0.95; CI: 0.93-0.97) and test-retest reliability after two weeks (ICC = 0.91; CI: 0.87-0.94). Convergent validity with the construct of parental catastrophizing about child pain was good (r = 0.72; CI: 0.64-0.78)). Good known-groups validity was demonstrated by the largest total HAPYS score observed in parents with health anxiety (median = 35; IQR: 9-53) and the lowest score in healthy parents (median = 9; IQR: 5-15) (p < 0.001). CONCLUSION The findings support that HAPYS is a useful measure of health anxiety by proxy. Future research should examine the measurement properties in larger samples and different languages with further statistical analyses of structural validity.
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Affiliation(s)
- Katrine Ingeman
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark.
| | - Kristi D Wright
- Department of Psychology, Faculty of Arts, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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Hawamdeh S, Moussa FL, Al-Rawashdeh S, Hawamdih SA, Moussa ML. Illness Anxiety Disorder and Distress among Female Medical and Nursing Students. Clin Pract Epidemiol Ment Health 2023; 19:e17450179277976. [PMID: 38655550 PMCID: PMC11037515 DOI: 10.2174/0117450179277976231115070100] [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: 08/18/2023] [Revised: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 04/26/2024]
Abstract
Objective This study aims to compare the prevalence of illness anxiety disorder (IAD) and distress between medical and nursing students and examine their associations with students' characteristics. Methods Cross-sectional data were collected using the Short Health Anxiety Inventory (SHAI, for measuring IAD) and the Medical Students' Disease (MSD) Perception and Distress Scales. Results Two hundred and sixteen Medical students and 250 Nursing students were recruited from a public female university in Saudi Arabia. Their mean age was 21.27 years. The findings showed that the overall prevalence of IAD (SHAI scores ≥18) among the total sample was 38.8%, with a significantly lower prevalence in medical students compared to the prevalence in nursing students (57.2% vs 17.6%, respectively, X2=45.26, p<.001). Nursing students had significantly higher SHAI scores and lower MSD Perception scores than medical college students, but there were no significant differences among them in the MSD Distress scale. Significant differences in the main study variables scores were reported among nursing students but not among medical students, with the fourth-year level nursing students having higher SHAI and lower MSD Perception and perception scores than other nursing students. Conclusion The highlights that medical and nursing students are susceptible to developing anxiety-related disorders and distress that may have negative impacts on their academic achievements and future careers. Both nursing and medical faculty should help in identifying strategies to support the students' mental health and well-being.
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Affiliation(s)
| | - Fatchima L. Moussa
- Academy of Vocal Arts, Medical Surgical Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sami Al-Rawashdeh
- Department of Community and Mental Health Nursing- Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Sajidah Al Hawamdih
- Applied Medical School- Luminus Technical University College (LTUC), Airport Road, Near Marj Al Hamam Bridge, Amman, Jordan
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Vismara M, Benatti B, Ferrara L, Colombo A, Bosi M, Varinelli A, Pellegrini L, Viganò C, Fineberg NA, Dell'Osso B. A preliminary investigation of Cyberchondria and its correlates in a clinical sample of patients with obsessive-compulsive disorder, anxiety and depressive disorders attending a tertiary psychiatric clinic. Int J Psychiatry Clin Pract 2022; 26:111-122. [PMID: 34032529 DOI: 10.1080/13651501.2021.1927107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives. This cross-sectional study aimed to investigate the frequency and presentation of cyberchondria (CYB) in patients with obsessive-compulsive disorder (OCD), anxiety disorders (ADs), and major depression disorder (MDD).Methods. Seventy-seven patients (OCD:25, ADs:26, MDD:26) referred to a tertiary psychiatry outpatient clinic and 27 healthy controls (HCs) were included. A 'working' definition of CYB was used to measure CYB frequency. CYB severity was measured with the Cyberchondria Severity Scale (CSS).Results. CYB as currently defined was present in just 1.3% of the combined patients' sample. Using a broader definition (omitting the disability criterion), we found a higher distribution (OCD:12%, ADs:19.2%, MDD:15.4%, HCs:3.7%) and greater CYB symptom severity. Patients with OCD (63.3 ± 18.9) and ADs (63.3 ± 25.9) showed a higher CYB severity, compared with HCs (48.4 ± 9.9, p<.05). In the combined patients' sample, a positive correlation was found between the CSS scores and measures of health anxiety or hypochondriasis. Higher CYB symptom severity emerged in patients with a positive family history of psychiatric disorders and in those prescribed benzodiazepines or mood-stabilisers.Conclusion. CYB represents a common transdiagnostic syndrome in patients with OCD, ADs, and MDD with a spectrum of severity and indicates a variable burden of illness, supporting the need for specific clinical considerations and interventions.Key pointsCyberchondria (CYB) represents a common transdiagnostic syndrome in patients with obsessive-compulsive disorder, anxiety, and depressive disorders.CYB's frequency as a syndrome of compulsive online health searches associated with an increased anxiety and distress was reported in 10-20% patients.Health anxiety/hypochondriasis showed a strong correlation with CYB.Patients with a positive family history of psychiatric disorders and those prescribed benzodiazepines or mood-stabilisers showed higher CYB symptom severity.Considering the spread of Internet use for health-related information, additional studies investigating CYB in clinical samples are encouraged.
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Affiliation(s)
- Matteo Vismara
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Beatrice Benatti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Luca Ferrara
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Anna Colombo
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Monica Bosi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Alberto Varinelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Caterina Viganò
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy.,Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA.,"Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy
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10
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Increased Risk Perception, Distress Intolerance and Health Anxiety in Stricter Lockdowns: Self-Control as a Key Protective Factor in Early Response to the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095098. [PMID: 35564492 PMCID: PMC9100473 DOI: 10.3390/ijerph19095098] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023]
Abstract
Studies provide evidence that distress, (health) anxiety, and depressive symptoms were high during the first weeks of COVID-19 lockdown restrictions, decreasing over time (possibly due to individuals’ protective psychological factors). Relations between different lockdown restrictions, mental health issues, and protective factors need to be explored, since even small lockdown effects might increase the risk of future mental health issues. We merged objective lockdown stringency data with individual data (N = 1001) to examine differences in lockdown effects in strict lockdown (Romania) and mild lockdown (Hungary) conditions between March and May 2020 on stressors and mental health symptoms, taking protective factors into account. The stricter lockdown in Romania revealed higher levels of perceived risk of infection, distress intolerance, and COVID-19 health anxiety. Protective psychological factors were not affected by the lockdown measures. Surpassing psychological flexibility and resilient coping, self-control proved to be the most promising protective factor. It is recommended that future research merge objective data with study data to investigate the effects of different COVID-19 lockdown measures on mental health and protective factors. Policy decisions should consider lockdown-dependent consequences of mental health issues. Intervention programs are suggested to mitigate mental health issues and to strengthen peoples’ protective psychological factors.
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Grande RAN, Berdida DJE, Paulino RRJC, Anies EA, Ebol RRT, Molina RR. The multidimensionality of anxiety among nursing students during COVID-19 pandemic: A cross-sectional study. Nurs Forum 2022; 57:267-276. [PMID: 34811767 PMCID: PMC9011543 DOI: 10.1111/nuf.12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/19/2021] [Accepted: 11/10/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND Over the past year, healthcare workers constantly report their COVID-19 anxiety. However, this concept remained understudied among nursing students (NSs). AIM This study investigated the difference between NSs' three types of anxiety and their profile variables during the COVID-19 pandemic. METHODS This study used a cross-sectional, descriptive-correlational design. Three instruments were used: COVID-19 anxiety scale (CAS), COVID-19 anxiety syndrome scale (COVID-19ASS), and short health anxiety inventory (SHAI) to collect data from 484 Saudi NSs. We applied the Mann-Whitney U test and linear regression to analyze the data. RESULTS Across the three instruments; CAS, Item 1 "I feel bad when thinking about COVID-19"; COVID-19ASS, Item 11 "I have imagined what could happen to my family members if they contracted COVID-19"; and SHAI, Item 17 "A serious illness could ruin many aspects of my life" yielded the highest means. COVID-19ASS showed a significant difference for the profiles "known positive" (p = 0.05) and "action taken after with testing" (p = 0.05). NS, who knew someone with COVID-19, was the only predictor of CAS. CONCLUSION Our study concludes NSs experience anxiety symptoms. Anxiety is specific to COVID-19 or a set of similar anxiety symptoms. Further research is needed to explore the anxiety state of NSs during the pandemic.
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Affiliation(s)
- Rizal Angelo N. Grande
- Mental Health Nursing Department, College of NursingUniversity of Ha'ilHa'ilSaudi Arabia
| | | | | | - Eric A. Anies
- Mental Health Nursing Department, College of NursingUniversity of Ha'ilHa'ilSaudi Arabia
| | | | - Roger R. Molina
- Medical‐Surgical Department, College of NursingUniversity of HailHa'il CitySaudi Arabia
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12
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Boudouda NE, Gana K. Validity Evidence for the Arabic Version of the Multidimensional Inventory of Hypochondriacal Traits (MIHT). CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00687-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Motsamai TB, Mhaka-Mutepfa M. Depression: Determinants That Influence the Mental Health of Older People (60 Years +) in Botswana. Gerontol Geriatr Med 2022; 8:23337214211053121. [PMID: 35237710 PMCID: PMC8883394 DOI: 10.1177/23337214211053121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
Correlates of depression in older people were explored in this study. The prevalence of depression was also calculated. Data were collected using a cross-sectional study stratified by district in urban and rural Botswana using the Patient Health Questionnaire. A snowballing technique was utilized to recruit older participants (N = 378; age = 71.8; SD = 9.1) with low to high incomes. Univariate and multivariate analyses were used to investigate the associations among demographics, individual, social, and environmental factors, and depression. The prevalence of depression and social impairment in older people was 7.8% and 20.6%. The correlates significantly associated with depression in Model 2 were education, income earned, resilience, and self-esteem (F (6, 358) = 19.5, p < .001; R2 = 23%) after adjusting for all influencing factors. Self-perceived health was associated with depression in Model 3 [F (11,340) = 12.5, p < .001; R2 = 28%]. In the final model, resilience, quality of life (QOL), and leisure were significantly associated with depression (p < .001), followed by anxiety, somatic symptoms, and social impairment (p < .05) [F (20,214) = 9.2, p < .001; R2 = 46%]. Findings provide preliminary information on the determinants of depression for further review by the research community. Stakeholders should also take cognizance of these correlates during their practice to curb depression in older people.
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Levine L, Kay A, Shapiro E. The anxiety of not knowing: Diagnosis uncertainty about COVID-19. CURRENT PSYCHOLOGY 2022; 42:1-8. [PMID: 35132299 PMCID: PMC8811589 DOI: 10.1007/s12144-022-02783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/12/2022]
Abstract
The emergence and swift global spread of COVID-19 brought increased anxiety worldwide (Santabárbara et al. (Progress in Neuro-Psychopharmacology & Biological Psychiatry, 109, 110207, 2021)). Research regarding the COVID-19 outbreak addressed factors that contribute to anxiety people experienced as they tried to handle the changes in their lives associated with COVID-19 (Holmes et al. (The Lancet Psychiatry, 7(6), 547-560, 2020)). This paper focuses on diagnosis uncertainty as a particular source of anxiety. We use self-reported anxiety measures to understand how different stressors, and particularly how being sick or being unsure if one or one's close friends or relatives are sick, relate to overall anxiety levels. Five-hundred and thirty-three participants from a country with a stringent COVID-19 testing policy were surveyed in the spring of 2020 on various aspects of their anxiety and risk for depression, as well as on whether they or their friends or family had COVID-19. Analysis of survey results found that anxiety related to uncertainty regarding whether the survey responder or their friends or family were carrying COVID-19 may be even greater than fear of the virus itself. This paper discusses directional issues related to this finding and offers policy implications for decreasing anxiety during pandemics for certain types of communities. In addition to the main findings regarding diagnosis uncertainty and anxiety, this paper's results also indicate the importance of providing participants with an option for "not sure" in closed questions and imply the increased knowledge that can be gained by analyzing an unsure response independently of "yes" or "no".
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Affiliation(s)
- Livia Levine
- Department of Business Management, Jerusalem College of Technology, Jerusalem, Israel
| | - Avi Kay
- Department of Business Management, Jerusalem College of Technology, Jerusalem, Israel
| | - Ephraim Shapiro
- Department of Health Systems Management, Ariel University, Ariel, Israel
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15
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Correlation between preoperative psychological personality traits of glioma patients and psychological distress in their primary caregivers. Clin Neurol Neurosurg 2022; 214:107144. [DOI: 10.1016/j.clineuro.2022.107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022]
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16
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Domhardt M, Nowak H, Engler S, Baumel A, Grund S, Mayer A, Terhorst Y, Baumeister H. Therapeutic processes in digital interventions for anxiety: A systematic review and meta-analytic structural equation modeling of randomized controlled trials. Clin Psychol Rev 2021; 90:102084. [PMID: 34610493 DOI: 10.1016/j.cpr.2021.102084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/13/2021] [Accepted: 09/08/2021] [Indexed: 01/14/2023]
Abstract
While the efficacy of Internet- and mobile-based interventions (IMIs) for treating anxiety disorders is well established, there is no comprehensive overview about the underlying therapeutic processes so far. Thus, this systematic review and meta-analysis evaluated research on mediators and mechanisms of change in IMIs for adult anxiety disorders (PROSPERO: CRD42020185545). A systematic literature search was performed in five databases (i.e., CENTRAL, Embase, MEDLINE, PsycINFO and ClinicalTrials.gov). Two reviewers independently screened studies for inclusion, assessed the risk of bias and adherence to quality criteria for process research. Overall, 26 studies (N = 6042) investigating 64 mediators were included. Samples consisted predominantly of participants with clinically relevant symptoms of generalized anxiety disorder and severe health anxiety, as well as of participants with non-clinically relevant anxiety symptoms. The largest group of examined mediators (45%) were cognitive variables, evincing also the second highest proportion of significance (19/29); followed in numbers by skills (examined: 22%; significant: 10/14) and a wide range of other (19%; 7/12), emotional/affective (11%; 2/7) and behavioral mediators (3%; 1/2). Meta-analytical synthesis of mediators, limited by a small number of eligible studies, was conducted by deploying a two-stage structural equation modeling approach, resulting in a significant indirect effect for negative thinking (k = 3 studies) and non-significant indirect effects for combined cognitive variables, both in clinical (k = 5) and non-clinical samples (k = 3). The findings of this review might further the understanding on presumed change mechanisms in IMIs for anxiety, informing intervention development and the concurrent optimization of outcomes. Furthermore, by reviewing eligible mediation studies, we discuss methodological implications and recommendations for future process research, striving for causally robust findings. Future studies should investigate a broader range of variables as potential mediators, as well as to develop and apply original (digital) process and engagement measures to gather qualitative and high-resolution data on therapeutic processes.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
| | - Hannah Nowak
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Sophie Engler
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Israel
| | - Simon Grund
- IPN - Leibniz Institute for Science and Mathematics Education, Kiel, Germany
| | - Axel Mayer
- Department of Psychological Methods and Evaluation, Bielefeld University, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany; Department of Psychological Research Methods, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
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Tyrer P, Wang D, Crawford M, Dupont S, Cooper S, Nourmand S, Lazarevic V, Philip A, Tyrer H. Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial. Psychol Med 2021; 51:1714-1722. [PMID: 32174296 DOI: 10.1017/s003329172000046x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. METHODS We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. RESULTS There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CONCLUSIONS CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.
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Affiliation(s)
- P Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - D Wang
- Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Crawford
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Dupont
- Central Northwest London Foundation NHS Trust, London, UK
| | - S Cooper
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Nourmand
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - V Lazarevic
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - A Philip
- South London and Maudsley NHS Foundation Trust, London, UK
| | - H Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
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18
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Saint SA, Moscovitch DA. Effects of mask-wearing on social anxiety: an exploratory review. ANXIETY STRESS AND COPING 2021; 34:487-502. [PMID: 34074171 DOI: 10.1080/10615806.2021.1929936] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A unique feature of the global coronavirus pandemic has been the widespread adoption of mask-wearing as a public health measure to minimize the risk of contagion. Little is known about the effects of increased mask-wearing on social interactions, social anxiety, or overall mental health. OBJECTIVES Explore the potential effects of mask-wearing on social anxiety. DESIGN We review existing literatures to highlight three preselected sets of factors that may be important in shaping the effects of mask-wearing on social anxiety. These are: (a) people's perceptions of the social norms associated with wearing masks; (b) people's experiences of the degree to which masks prevent accurate interpretation of social and emotional cues; and (c) people's use of masks as a type of safety behavior that enables self-concealment. METHODS APA PsycNet and PubMed were searched principally between September and November 2020 for articles describing the relationship between social anxiety, intolerance of uncertainty, ambiguous feedback, and safety behavior use and for research on the relationship between mask-wearing and social norms and social interactions. Information identified as relevant from articles of interest was extracted and included in our review. RESULTS & CONCLUSIONS The effects of mask-wearing on social anxiety are likely to be substantial and clinically relevant.
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Affiliation(s)
- Sidney A Saint
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
| | - David A Moscovitch
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
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Arnáez S, García-Soriano G, López-Santiago J, Belloch A. Illness-related intrusive thoughts and illness anxiety disorder. Psychol Psychother 2021; 94:63-80. [PMID: 31957211 DOI: 10.1111/papt.12267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/18/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Intrusive thoughts about health threats (illness-ITs) are a potential cognitive risk factor for the development and maintenance of illness anxiety disorder (IAD). This study analyzes the dimensionality of illness-ITs from normalcy to psychopathology, and it evaluates whether the appraisals instigated by the Its mediate between these thoughts and IAD symptoms. METHODS Two groups of individuals participated in the study and completed the Illness Intrusive Thoughts Inventory and the Whiteley Index. The first group was composed of 446 non-clinical community participants. Of them, 264 individuals (68.6% women; Mage = 30.03 [SD = 13.83]) reported having experienced an upsetting illness-IT in the past three months and were then included in the main analyses. The second group included 31 patients with a current main diagnosis of IAD based on DSM-5 criteria (51.6% women; Mage = 32.74 [SD = 9.69]). Their severity was assessed with the Hypochondriasis Yale-Brown Obsessive-Compulsive Scale -Modified version, with scores ranging from 15 to 58 (M = 46.12, SD = 9.41). RESULTS Illness-ITs are common in both non-clinical individuals and in patients with IAD, and they instigate dysfunctional emotional, cognitive, and behavioral consequences, although with greater intensity in patients than in non-clinical individuals. The relationship between illness-ITs and IAD is mediated by overestimation of threat and thought-action fusion-probability appraisals. CONCLUSION Illness-ITs are a dimensional cognitive experience. The way they are appraised facilitates their escalation into symptoms of IAD. PRACTITIONER POINTS Provides support for the cognitive explanatory model of IAD and its usefulness in clinical practice. Indicates that the way people interpret and react to naturally occurring intrusive thoughts about illness seems to be a vulnerability marker for developing an illness anxiety disorder. Emphasizes that the meaning that patients with IAD ascribe to their intrusive thoughts about illnesses must be a main target in the cognitive-behavioral treatment of IAD. Suggests that the importance of intrusive thoughts in IAD does not lie in the frequency with which they are experienced, but in the way, they are appraised/interpreted, which is what determines whether they become a clinically significant symptom. Indicates that the relationship between illness intrusive thoughts and IAD symptoms in non-clinical individuals is based on: overestimating the negative consequences of experiencing an illness intrusive thought; and the appraisal that having such a thought would increase its likelihood of coming true. Shows that the frequency of illness-related intrusive cognitions is associated with worse cognitive and behavioral consequences.
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Affiliation(s)
- Sandra Arnáez
- Department of Personality, Evaluation and Psychological Treatment, I'TOC Research Group, Universitat de València, Spain
| | - Gemma García-Soriano
- Department of Personality, Evaluation and Psychological Treatment, I'TOC Research Group, Universitat de València, Spain
| | | | - Amparo Belloch
- Department of Personality, Evaluation and Psychological Treatment, I'TOC Research Group, Universitat de València, Spain
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20
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Modelling the contribution of the Big Five personality traits, health anxiety, and COVID-19 psychological distress to generalised anxiety and depressive symptoms during the COVID-19 pandemic. J Affect Disord 2021; 279:578-584. [PMID: 33152562 PMCID: PMC7598311 DOI: 10.1016/j.jad.2020.10.053] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/29/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022]
Abstract
In the current study we sought to extend our understanding of vulnerability and protective factors (the Big Five personality traits, health anxiety, and COVID-19 psychological distress) in predicting generalised anxiety and depressive symptoms during the COVID-19 pandemic. Participants (n = 502), who were United States residents, completed a variety of sociodemographic questions and the following questionnaires: Big Five Inventory-10 (BFI-10), Whitley Index 7 (WI-7), Coronavirus Anxiety Scale (CAS), COVID-19 Anxiety Syndrome Scale (C19-ASS), and Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Results showed that extraversion, agreeableness, conscientiousness, and openness were negatively correlated with generalised anxiety and depressive symptoms and that neuroticism, health anxiety and both measures of COVID-19 psychological distress were positively correlated with generalised anxiety and depressive symptoms. We used path analysis to determine the pattern of relationships specified by the theoretical model we proposed. Results showed that health anxiety, COVID-19 anxiety, and the COVID-19 anxiety syndrome partially mediated the relationship between the Big Five personality traits and generalised anxiety and depressive symptoms. Specifically, extraversion, agreeableness, and conscientiousness were negatively associated with the three mediators, which, in turn, were positively associated with generalised anxiety and depressive symptoms, with COVID-19 anxiety showing the strongest effect. Conversely, neuroticism and openness were positively associated with COVID-19 anxiety and the COVID-19 anxiety syndrome, respectively. These relationships were independent of age, gender, employment status and risk status. The model accounted for a substantial variance of generalised anxiety and depression symptoms (R2 = .75). The implications of these findings are discussed.
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21
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Rias YA, Rosyad YS, Chipojola R, Wiratama BS, Safitri CI, Weng SF, Yang CY, Tsai HT. Effects of Spirituality, Knowledge, Attitudes, and Practices toward Anxiety Regarding COVID-19 among the General Population in INDONESIA: A Cross-Sectional Study. J Clin Med 2020; 9:E3798. [PMID: 33255406 PMCID: PMC7760717 DOI: 10.3390/jcm9123798] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, the determinants of anxiety and its related factors in the general population affected by COVID-19 are poorly understood. We examined the effects of spirituality, knowledge, attitudes, and practices (KAP) on anxiety regarding COVID-19. METHODS Online cross-sectional data (n = 1082) covered 17 provinces. The assessment included the Daily Spiritual Experiences Scale, the Depression, Anxiety, and Stress Scale, and the KAP-COVID-19 questionnaire. RESULTS Multiple linear regression revealed that individuals who had low levels of spirituality had increased anxiety compared to those with higher levels of spirituality. Individuals had correct knowledge of early symptoms and supportive treatment (K3), and that individuals with chronic diseases and those who were obese or elderly were more likely to be severe cases (K4). However, participants who chose incorrect concerns about there being no need for children and young adults to take measures to prevent COVID-19 (K9) had significantly lower anxiety compared to those who responded with the correct choice. Participants who disagreed about whether society would win the battle against COVID-19 (A1) and successfully control it (A2) were associated with higher anxiety. Those with the practice of attending crowded places (P1) had significantly higher anxiety. CONCLUSIONS Spirituality, knowledge, attitudes, and practice were significantly correlated with anxiety regarding COVID-19 in the general population.
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Affiliation(s)
- Yohanes Andy Rias
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan; (Y.A.R.); (R.C.)
- Faculty of Health and Medicine, College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri 64114, Indonesia
| | - Yafi Sabila Rosyad
- Faculty of Health and Medicine, College of Nursing, Sekolah Tinggi Ilmu Kesehatan Yogyakarta, Yogyakarta 55281, Indonesia;
| | - Roselyn Chipojola
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan; (Y.A.R.); (R.C.)
| | - Bayu Satria Wiratama
- Department of Epidemiology and Biostatistics, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia;
| | - Cikra Ikhda Safitri
- Department of Pharmacology, College of Pharmacology, Akademi Farmasi Mitra Sehat Mandiri Sidoarjo, Sidoarjo 61262, Indonesia;
| | - Shuen Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan;
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chyn Yng Yang
- Integrated Medical Examination Center, Taipei Medical University Hospital, Taipei 11031, Taiwan;
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan; (Y.A.R.); (R.C.)
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
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22
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Sauer KS, Witthöft M. Krankheitsängste und Hypochondrische Störung. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:730-744. [PMID: 33187009 DOI: 10.1055/a-1165-7461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fears of getting a severe disease (health anxiety) are widespread and their pathological manifestation as Hypochondriacal disorder (ICD-10) is cost-intensive for the health care system. In recent years advances in the research on and development of effective psychotherapeutic treatments have been made. Cognitive-behavioral therapy concepts currently are treatments of choice for Hypochondriacal disorder.
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Carstensen TBW, Ørnbøl E, Fink P, Pedersen MM, Jørgensen T, Dantoft TM, Benros ME, Frostholm L. Detection of illness worry in the general population: A specific item on illness rumination improves the Whiteley Index. J Psychosom Res 2020; 138:110245. [PMID: 32950761 DOI: 10.1016/j.jpsychores.2020.110245] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The Whiteley Index (WI) is the most widely used screening tool for health anxiety/illness worry. Diverse versions (different number of items and factors) have been used. We aimed to examine psychometric properties of 7 items of the WI besides adding a new item on obsessive illness rumination for better future detection of health anxiety. METHODS Data from a large population-based study in Denmark (N = 9656). Construct validity was examined by exploratory (EFA) and confirmatory factor analysis (CFA) plus hypothesis testing. Criterion validity was evaluated via Receiver Operating Characteristic curves and area under the curve (AUC) using a diagnostic criterion as gold standard. RESULTS Factor loadings of EFA revealed viable one-factor models (6, 7, or 8 items) and two-factor models (7 or 8 items). Factor one indicated a dimension of illness worry. Factor two indicated a somatic symptoms dimension. The new item on obsessive illness rumination merged well with the existing items. EFA of two-factor models and one-factor 6-item model showed good fit. CFA resembles these findings. A one-factor 6-item model (including the item on obsessive illness rumination and excluding two items concerning somatic symptoms) was chosen as the optimal model and presented good criterion validity: AUC 0.88 (95%CI(0.84;0.92)). Main hypotheses concerning associations with somatic symptoms, anxiety, and depression were met. CONCLUSIONS We found good psychometric properties for a new one-factor 6-item version of the WI. Through elimination of items concerning somatic symptoms and inclusion of obsessive illness rumination, we propose a clear, unidimensional and improved measure of illness worry: Whiteley-6-R.
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Affiliation(s)
- Tina Birgitte Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Majbritt Mostrup Pedersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark; Department of Public Health, Faculty of Medical Sciences, University of Copenhagen, Denmark; Faculty of Medicine, Aalborg University, Denmark.
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark.
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark.
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
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Rask CU, Gehrt TB, Rimvall MK, Frostholm L. Health Anxiety. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Health anxiety, characterized by excessive concern about one’s health, is a serious and costly public health problem. The disorder might become chronic if left untreated. Unfortunately many patients do not receive timely or proper treatment due to sparse treatment resources. Also, existing treatment programs, though effective for many, do not work for all. This paper discusses the conceptualization of health anxiety and future directions based on novel research findings. These include: (i) the content and characteristics of autobiographical memories and episodic future thoughts in severe health anxiety, (ii) related concepts such as cyberchondria with excessive Internet browsing on health issues and health anxiety by proxy, where parents display and might confer health anxiety towards their children, (iii) an epidemiological perspective on the association between health anxiety and subclinical psychotic experiences in preadolescence. Exploring these new dimensions could have important implications for the further development of preventive strategies and effective treatment.
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Affiliation(s)
- Charlotte U. Rask
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B. Gehrt
- Center on Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
| | - Martin K. Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Ivanets NN, Shestakova RA, Goncharova EM, Antropova EA. [Non-delusional hypochondriac disorders in old age]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:109-115. [PMID: 31851181 DOI: 10.17116/jnevro2019119111109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review aims to present main concepts of hypochondria and 'hypochondriac mood' in old age. Attention is paid to historical and modern positions of old age hypochondria as a meta-syndromic pathology and as an independent mental disorder. Relationships of hypochondriac manifestations with affective variations and anxiety disorders, as well as somatic diseases, organic degenerative brain diseases and vascular disorders are discussed.
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Affiliation(s)
- N N Ivanets
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - R A Shestakova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E M Goncharova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E A Antropova
- Sechenov First Moscow State Medical University, Moscow, Russia
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Tyrer P, Cooper S, Tyrer H, Wang D, Bassett P. Increase in the prevalence of health anxiety in medical clinics: Possible cyberchondria. Int J Soc Psychiatry 2019; 65:566-569. [PMID: 31379243 DOI: 10.1177/0020764019866231] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health anxiety may be an increasing problem because of the focus on monitoring health and increasing use of the Internet for self-diagnosis (cyberchondria). There is very little information about changes in the prevalence of health anxiety. AIM We compared the prevalence of health anxiety in four medical clinics in one hospital over a 4-year period using the Health Anxiety Inventory (HAI) as a diagnostic marker. METHOD Patients attending cardiology, endocrine, gastroenterology and respiratory medicine clinics at King's Mill Hospital, North Nottinghamshire, completed the HAI while waiting for their appointments. There were eight research assistants involved in collecting data, two in the 2006-2008 period and six in the 2008-2010 period. As a consequence, more data were collected on the second occasion. RESULTS There was an increase in the prevalence of health anxiety from 14.9% in 2006-2008 (54 positive of 362 assessed) to 19.9% (1,132 positive out of 5,704 assessed) in 2008-2010. This increase was primarily noted in gastroenterology clinics (increase of 10%) and not shown in endocrine ones. CONCLUSION The prevalence of health anxiety is increasing in those who attend medical out-patient clinics. Reasons are given that this may be a possible result of cyberchondria, as the excessive use of the Internet to interpret troubling symptoms is growing. Further studies are needed in other populations, but there is reason to be concerned at this trend as it is likely to increase the number of medical consultations unnecessarily.
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Affiliation(s)
- Peter Tyrer
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Sylvia Cooper
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Helen Tyrer
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Duolao Wang
- 2 Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Bassett
- 3 Independent Statistical Consultant, Amersham, UK
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Dysfunctional beliefs as mediators between illness-related intrusive thoughts and health anxiety symptoms. Behav Cogn Psychother 2019; 48:315-326. [PMID: 31597585 DOI: 10.1017/s1352465819000535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs. AIM The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms. METHOD A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI). RESULTS Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms. CONCLUSIONS The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.
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Blackman G, Cherfi Y, Morrin H, Ellis CM, Bashford J, Ruths F, David AS. The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature. PSYCHOSOMATICS 2019; 60:499-507. [DOI: 10.1016/j.psym.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/14/2022]
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Zheng F, Duan Y, Li J, Lai L, Zhong Z, Hu M, Ding S. Somatic symptoms and their association with anxiety and depression in Chinese patients with cardiac neurosis. J Int Med Res 2019; 47:4920-4928. [PMID: 31448660 PMCID: PMC6833396 DOI: 10.1177/0300060519869711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective We sought to investigate somatic symptoms detected by the Somatic Self-rating Scale and to evaluate whether they were associated with the psychological symptoms of anxiety and depression in patients with cardiac neurosis. Methods A total of 180 patients with cardiac neurosis at the Third Xiangya Hospital, Changsha, China, were surveyed from January 2017 to July 2018. Participants completed a general information questionnaire, the Somatic Self-rating Scale, the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Scale-7. Results The mean (±standard deviation) somatic symptom score in patients with cardiac neurosis was 40.83 ± 7.12. The most severe symptoms were cardiovascular symptoms, fatigue and muscle soreness. A total of 90 patients (46.4%) had anxiety and 80 (50.0%) had depression. Multiple stepwise regression analysis showed that somatic symptoms in patients with cardiac neurosis were associated with both anxiety and depression. Conclusion Somatic symptoms in patients with cardiac neurosis were associated with both anxiety and depression. Therefore, it is important to provide effective emotional interventions to promote patient rehabilitation.
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Affiliation(s)
- Feng Zheng
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yinglong Duan
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jingle Li
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Lin Lai
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Manhui Hu
- Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
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Abstract
Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
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Pavithra N, Dahale AB, Desai G, Chaturvedi SK. Hypochondriasis: Clinical Profile in a Tertiary Care Psychiatry and Neurosciences Hospital in Southern India - A Retrospective Chart Review. Indian J Psychol Med 2019; 41:178-181. [PMID: 30983668 PMCID: PMC6436408 DOI: 10.4103/ijpsym.ijpsym_177_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Hypochondriasis is a complex disorder in the realm of psychosomatic medicine, yet understudied in India. The aim of this study was to assess the clinical profile of patients diagnosed with hypochondriasis. MATERIALS AND METHODS Retrospective chart review was done in a tertiary care psychiatry and neurosciences hospital in southern India. Medical records of adults diagnosed with hypochondriasis between 2000 and 2010 were analyzed. These patients were also rediagnosed retrospectively using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for illness anxiety disorder (IAD) and Diagnostic Criteria for Psychosomatic Research (DCPR) criteria for health anxiety and illness phobia. Data were organized and analyzed using PSPP for descriptive statistics of different variables. RESULTS There were 114 patients with hypochondriasis, with the most common belief being about dysmorphic appearance. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed medications. The median follow-up duration was only 2 months. Five percent of the cases fulfilled the criteria for DCPR health anxiety and 20.4% for DCPR illness phobia. DSM-5 criteria for IAD were fulfilled by 45.6% of the cases. CONCLUSION Dysmorphic appearance was the most common concern in patients with hypochondriasis and SSRIs the most common medications. The follow-up rate and the diagnostic concurrence with DSM-5 IAD and DCPR were low. Studies assessing the influence of psychopathology and culture on the presentation, course, and prognosis of hypochondriasis would be beneficial.
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Affiliation(s)
- N Pavithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ajit Bhalchandra Dahale
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Santosh Kumar Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Pan B, Zhang Q, Tsai H, Zhang B, Wang W. Hypochondriac concerns and correlates of personality styles and affective states in bipolar I and II disorders. BMC Psychiatry 2018; 18:398. [PMID: 30577769 PMCID: PMC6303968 DOI: 10.1186/s12888-018-1988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hypochondriac concerns are associated with the treatment-difficulty of bipolar disorder, which might be due to the personality styles and affective states. METHODS We invited outpatients with bipolar I disorder (BD I, n = 87), bipolar II disorder (BD II, n = 92) and healthy volunteers (n = 129) to undergo the Illness Attitude Scales and Parker Personality Measure tests, and measurements of concurrent affective states. RESULTS Compared to healthy volunteers, BD I and BD II patients scored significantly higher on mania, hypomania and depression. BD I and BD II patients also scored significantly higher on Symptom Effect and Treatment Seeking, and BD II patients scored higher on Patho-thanatophobia and Hypochondriacal Belief. BD II in addition scored higher on Patho-thanatophobia than BD I did. In controls, the Dependent style predicted Patho-thanatophobia and Symptom Effect, Schizoid with Hypochondriacal Belief; in BD I, Narcissistic (-) with Hypochondriacal Belief, Histrionic with Patho-thanatophobia and Hypochondriacal Belief, depression with Hypochondriacal Belief, and hypomania with Symptom Effect and Hypochondriacal Belief; in BD II, depression with Symptom Effect and Hypochondriacal Belief, mania with Symptom Effect. CONCLUSIONS Bipolar disorder, especially BD II, is associated with greater hypochondriac concerns, which relates to personality disorder functioning styles and concurrent affective states.
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Affiliation(s)
- Bing Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
| | - Qing Zhang
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Huitzong Tsai
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Bingren Zhang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
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Abstract
PURPOSE OF REVIEW To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome. RECENT FINDINGS Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality. Health anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.
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Tyrer P, Salkovskis P, Tyrer H, Wang D, Crawford MJ, Dupont S, Cooper S, Green J, Murphy D, Smith G, Bhogal S, Nourmand S, Lazarevic V, Loebenberg G, Evered R, Kings S, McNulty A, Lisseman-Stones Y, McAllister S, Kramo K, Nagar J, Reid S, Sanatinia R, Whittamore K, Walker G, Philip A, Warwick H, Byford S, Barrett B. Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years. Health Technol Assess 2018; 21:1-58. [PMID: 28877841 DOI: 10.3310/hta21500] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients. DESIGN Randomised controlled trial. SETTING Five general hospitals in London, Middlesex and Nottinghamshire. PARTICIPANTS A total of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not. INTERVENTIONS Cognitive-behaviour therapy for health anxiety - between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. MAIN OUTCOME MEASURES Primary - researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes - costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years. RESULTS Of the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overall p < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment. LIMITATIONS Many eligible patients were not randomised and the population treated may not be representative. CONCLUSIONS CBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings. TRIAL REGISTRATION Current Controlled Trials ISRCTN14565822. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | | | - Helen Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Simon Dupont
- Central and North West London NHS Foundation Trust, London, UK
| | - Sylvia Cooper
- Centre for Psychiatry, Imperial College London, London, UK
| | - John Green
- Central and North West London NHS Foundation Trust, London, UK
| | - David Murphy
- Imperial College Healthcare NHS Trust, London, UK
| | - Georgina Smith
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Valentina Lazarevic
- East Midlands & South Yorkshire Mental Health Research Network, Nottingham, UK
| | | | - Rachel Evered
- North London Hub, Mental Health Research Network, London, UK
| | - Stephanie Kings
- East Midlands & South Yorkshire Mental Health Research Network, Nottingham, UK
| | | | | | | | - Kofi Kramo
- Centre for Psychiatry, Imperial College London, London, UK
| | - Jessica Nagar
- North London Hub, Mental Health Research Network, London, UK
| | - Steven Reid
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Gemma Walker
- Centre for Psychiatry, Imperial College London, London, UK
| | - Aaron Philip
- Centre for Psychiatry, Imperial College London, London, UK
| | - Hilary Warwick
- Centre for Psychiatry, Imperial College London, London, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
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Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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López-Solà C, Bui M, Hopper JL, Fontenelle LF, Davey CG, Pantelis C, Alonso P, van den Heuvel OA, Harrison BJ. Predictors and consequences of health anxiety symptoms: a novel twin modeling study. Acta Psychiatr Scand 2018; 137:241-251. [PMID: 29336012 DOI: 10.1111/acps.12850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The question of how to best conceptualize health anxiety (HA) from a diagnostic and etiological perspective remains debated. The aim was to examine the relationship between HA and the symptoms of anxiety and obsessive-compulsive-related disorders in a normative twin population. METHOD Four hundred and ninety-six monozygotic adult twin pairs from the Australian Twin Registry participated in the study (age, 34.4 ± 7.72 years; 59% females). Validated scales were used to assess each domain. We applied a twin regression methodology-ICE FALCON-to determine whether there was evidence consistent with 'causal' relationships between HA and other symptoms by fitting and comparing model estimates. RESULTS Estimates were consistent with higher levels of obsessing ('unwanted thoughts') (P = 0.008), social anxiety (P = 0.03), and body dysmorphic symptoms (P = 0.008) causing higher levels of HA symptoms, and with higher levels of HA symptoms causing higher levels of physical/somatic anxiety symptoms (P = 0.001). CONCLUSION Obsessional thoughts, body dysmorphic concerns, and social anxiety symptoms may have a causal influence on HA. To report physical/somatic anxiety appears to be a consequence of the underlying presence of HA-related fears. Should our results be confirmed by longitudinal studies, the evaluation and treatment of HA may benefit from the consideration of these identified risk factors.
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Affiliation(s)
- C López-Solà
- Adult Mental Health Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain.,Carlos III Health Institute, CIBERSAM (Centro de Investigación en Red de Salud Mental), Barcelona, Spain
| | - M Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Vic, Australia
| | - J L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Vic, Australia.,Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnamgu, Seoul, South Korea
| | - L F Fontenelle
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.,Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Vic, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia.,Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
| | - C Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
| | - P Alonso
- Carlos III Health Institute, CIBERSAM (Centro de Investigación en Red de Salud Mental), Barcelona, Spain.,Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - O A van den Heuvel
- Department of Anatomy and Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands.,Department of Psychiatry, VUmc, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands.,The OCD team, Haukeland University Hospital, Bergen, Norway
| | - B J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
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Kaplan DM, Palitsky R, Carey AL, Crane TE, Havens CM, Medrano MR, Reznik SJ, Sbarra DA, O'Connor MF. Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review. J Clin Psychol 2018; 74:1126-1136. [DOI: 10.1002/jclp.22585] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 01/15/2023]
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Abstract
SUMMARYHealth anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards health, particularly excessive use of health information on the internet (cyberchondria). People with abnormal health anxiety become over-diligent monitors of their health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with health anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of health anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used.LEARNING OBJECTIVES•To be able to identify abnormal health anxiety with the aid of probe questions•To respond to people whom you have identified with excessive health anxiety in a way that facilitates its treatment•To learn a few simple techniques derived from cognitive–behavioural therapy that can lead to long-term benefitDECLARATION OF INTERESTNone.
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DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. J Psychosom Res 2017; 101:31-37. [PMID: 28867421 DOI: 10.1016/j.jpsychores.2017.07.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the reliability, validity and utility of DSM-5 illness anxiety disorder (IAD) and somatic symptom disorder (SSD), and explore their overlap with DSM-IV Hypochondriasis in a health anxious sample. METHODS Treatment-seeking patients with health anxiety (N=118) completed structured diagnostic interviews to assess DSM-IV Hypochondriasis, DSM-5 IAD, SSD, and comorbid mental disorders, and completed self-report measures of health anxiety, comorbid symptoms, cognitions and behaviours, and service utilization. RESULTS IAD and SSD were more reliable diagnoses than Hypochondriasis (kappa estimates: IAD: 0.80, SSD: 0.92, Hypochondriasis: 0.60). 45% of patients were diagnosed with SSD, 47% with IAD, and 8% with comorbid IAD/SSD. Most patients with IAD fluctuated between seeking and avoiding care (61%), whereas care-seeking (25%) and care-avoidant subtypes were less common (14%). Half the sample met criteria for DSM-IV Hypochondriasis; of those, 56% met criteria for SSD criteria, 36% for IAD, and 8% for comorbid IAD/SSD. Compared to IAD, SSD was characterized by more severe health anxiety, somatic symptoms, depression, and higher health service use, and higher rates of major depressive disorder, panic disorder and agoraphobia. CONCLUSIONS DSM-5 IAD and SSD classifications reliably detect more cases of clinically significant health anxiety than DSM-IV Hypochondriasis. The differences between IAD and SSD appear to be due to severity. Future research should explore the generalizability of these findings to other samples, and whether diagnostic status predicts treatment response and long-term outcome.
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Fergus TA, Griggs JO, Cunningham SC, Kelley LP. Health anxiety and medical utilization: The moderating effect of age among patients in primary care. J Anxiety Disord 2017; 51:79-85. [PMID: 28689676 DOI: 10.1016/j.janxdis.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/05/2017] [Accepted: 06/11/2017] [Indexed: 11/27/2022]
Abstract
Health anxiety is commonly seen in medical clinics and is related to the overutilization of primary care services, but existing studies have not yet considered the possible moderating effect of age. We examined if age moderated the association between health anxiety and medical utilization. A secondary aim was to examine potential racial/ethnic differences in health anxiety. An ethnoracially diverse group of patients (N=533) seeking treatment from a primary care clinic completed a self-report measure of health anxiety. Three indices of medical utilization were assessed using medical records, including the number of: (a) clinic visits over the past two years, (b) current medications, and (c) lab tests over the past two years. Age moderated the effect of health anxiety on multiple indices of medical utilization. Supplemental analyses found that the moderating effect of age was specific to a somatic/body preoccupation, rather than health worry, dimension of health anxiety. Mean-level differences in health anxiety were either not supported (health anxiety composite, somatic/body preoccupation) or were small in magnitude (health worry) among self-identifying Black, Latino, and White participants. Results indicate that assessing for health anxiety could be particularly important for older adult patients who frequently seek out medical services.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, 76798 TX, USA.
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | | | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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Weck F, Nagel LC, Richtberg S, Neng JMB. Personality Disorders in Hypochondriasis: A Comparison to Panic Disorder and Healthy Controls. J Pers Disord 2017; 31:567-576. [PMID: 27749185 DOI: 10.1521/pedi_2016_30_271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies found high prevalence rates of personality disorders (PDs) in patients with hypochondriasis; however, assessment was often based only on questionnaires. In the current study, a sample of 68 patients with hypochondriasis was compared to 31 patients with panic disorder and to 94 healthy controls. Participants were investigated with the Structured Clinical Interview for DSM-IV Personality Disorders questionnaire (SCID-II questionnaire) and the SCID-II interview. Based on the cut-off scores of the SCID-II questionnaire, we found a prevalence rate of 45.6% for PD in patients with hypochondriasis. In comparison to healthy controls, patients with hypochondriasis showed characteristics of paranoid, borderline, avoidant, and dependent PDs in the dimensional assessment significantly more often. However, no significant differences were found between the clinical samples. Based on the SCID-II interview, only 2.9% of the patients with hypochondriasis fulfilled the criteria for a PD. These results suggest that PDs are not a specific characteristic of hypochondriasis.
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Affiliation(s)
- Florian Weck
- Department of Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Laura Carlotta Nagel
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| | - Samantha Richtberg
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| | - Julia M B Neng
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
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Taylor JB, Stern TA. Meeting Its Mission: Does Psychosomatics Align With the Mission of Its Parent Organization, the Academy of Psychosomatic Medicine? PSYCHOSOMATICS 2017; 58:375-385. [PMID: 28449827 DOI: 10.1016/j.psym.2017.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The vision and mission statements of the Academy of Psychosomatic Medicine (APM) indicate that the APM should promote excellence in clinical care for patients with comorbid psychiatric and general medical conditions by seeking to influence research, public policy, and interdisciplinary education. OBJECTIVE As the APM owns the journal, Psychosomatics, we sought to assess whether the APM's journal was fulfilling the vision and mission of its parent organization by reviewing the content of articles published in the journal to determine whether it sufficiently addresses the various clinical care knowledge areas it seeks to influence. METHODS We categorized content in all review articles, case reports, and original research articles published in Psychosomatics in 2015 and 2016. Each article was assigned to as many categories that it covered. RESULTS In the 163 articles reviewed, the most frequently covered fund of knowledge area was psychiatric morbidity in medical populations (44.2%); among psychiatric disorders, mood disorders (22.1%), psychiatric disorders due to a general medical condition or toxic substance (21.5%), anxiety disorders (14.7%), and delirium (13.5) were the most frequently covered. Of the medical and surgical topics, neurology (19.6%), coping with chronic illness/psychological response to illness (17.8%), toxicology (11.7%), outpatient medicine (10.4%), and cardiology (9.8%) appeared most often. CONCLUSIONS Psychosomatics appears to be successfully providing content relevant to the APM's vision and mission statements and to practitioners of psychosomatic medicine.
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Affiliation(s)
- John B Taylor
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Theodore A Stern
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Grossi D, Longarzo M, Quarantelli M, Salvatore E, Cavaliere C, De Luca P, Trojano L, Aiello M. Altered functional connectivity of interoception in illness anxiety disorder. Cortex 2016; 86:22-32. [PMID: 27871020 DOI: 10.1016/j.cortex.2016.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/22/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022]
Abstract
Interoception collects all information coming from the body and is sustained by several brain areas such as insula and cingulate cortex. Here, we used resting-state functional magnetic resonance imaging to investigate functional connectivity (FC) of networks implied in interoception in patients with Illness anxiety disorders (IADs). We observed significantly reduced FC between the left extrastriate body area (EBA) and the paracentral lobule compared to healthy controls. Moreover, the correlation analysis between behavioural questionnaires and ROI to ROI FC showed that higher levels of illness anxiety were related to hyper-connectivity between EBA and amygdala and hippocampus. Scores on a questionnaire for interoceptive awareness were significantly correlated with higher FC between right hippocampus and nucleus accumbens bilaterally, and with higher connectivity between left anterior cingulate cortex (ACC) and left orbitofrontal cortex (OFC). Last, patients showed increased interoceptive awareness, measured by Self-Awareness Questionnaire (SAQ), and reduced capability in recognizing emotions, indicating inverse correlation between interoception and emotional awareness. Taken together our results suggested that, in absence of structural and micro-structural changes, patients with IADs show functional alteration in the neural network involved in the self-body representation; such functional alteration might be the target of possible treatments.
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Affiliation(s)
- Dario Grossi
- Department of Psychology, Second University of Naples, Italy
| | | | - Mario Quarantelli
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Elena Salvatore
- Department of Neuroscience Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | | | | | - Luigi Trojano
- Department of Psychology, Second University of Naples, Italy
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