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Li J, Li R, Li D, Zhang J, Luo X, Zhang Y. Serum BDNF levels and state anxiety are associated with somatic symptoms in patients with panic disorder. Front Psychiatry 2023; 14:1168771. [PMID: 37533888 PMCID: PMC10393281 DOI: 10.3389/fpsyt.2023.1168771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Background We aimed to explore the predictive role of serum BDNF and anxiety-related variables in changes in somatic symptoms post-escitalopram treatment in panic disorder (PD) patients. Methods Ninety PD patients and 99 healthy controls (HCs) were enrolled. PD patients received an 8-week escitalopram treatment. All patients were administered the Panic Disorder Severity Scale-Chinese Version (PDSS-CV) and State-Trait Anxiety Inventory (STAI) to assess panic and anxiety-related symptoms, respectively. Patient Health Questionnaire 15-item scale (PHQ-15) was performed to measure somatic symptoms, and the blood sample was collected to detect serum BDNF levels in all participants. We performed partial correlation analysis and multiple linear regression to explore correlates of PHQ-15 and predictors of PHQ-15 changes post-escitalopram treatment after controlling for age, gender, education levels (set as a dummy variable), the current duration, comorbid AP, and/or GAD. Results Compared to HCs, PD patients had lower serum BDNF levels and higher PHQ-15 scores that could be improved post-escitalopram treatment. Lower baseline STAI state (b = -0.07, p = 0.004), and PDSS-CV scores (b = -0.25, p = 0.007), but higher baseline serum BDNF levels (b = 0.35, p = 0.007) contributed to the prediction of PHQ-15 changes post-escitalopram treatment. Conclusion State anxiety, serum BDNF levels, and panic severity could predict changes in somatic symptoms post-escitalopram treatment, our results highlighted that serum BDNF could serve as a biological indicator for improving somatic symptoms in PD patients.
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Affiliation(s)
- Jiaxin Li
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Ru Li
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Dazhi Li
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Jian Zhang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Yong Zhang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
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Kim HJ, Kim JE, Lee SH. Pathological Worry is Related to Poor Long-Term Pharmacological Treatment Response in Patients With Panic Disorder. Psychiatry Investig 2021; 18:904-912. [PMID: 34500504 PMCID: PMC8473858 DOI: 10.30773/pi.2021.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Several predictors of unfavorable pharmacological treatment response (PTR) in panic disorder (PD) patients have been suggested, such as the duration of the illness, presence of agoraphobia, depression, being a woman, and early trauma. This study aimed to examine whether pathological worry is associated with PTR in PD patients. METHODS This study included 335 PD patients and 418 healthy controls (HCs). The Penn State Worry Questionnaire (PSWQ), the Early Trauma Inventory Self Report-Short Form (ETISR-SF), Beck Depression Inventory (BDI), Panic Disorder Severity Scale (PDSS), and Anxiety Sensitivity Inventory-Revised (ASI-R) were administered. We measured the PTR at 8 weeks and 6 months. Student t-test, chisquare tests, Pearson's correlation analyses, and binary logistic regression model were used. RESULTS Our results showed that the total scores of the PSWQ correlated with the ETISR-SF, BDI, and ASI-R were significantly higher in patients with PD compared with HCs. The PSWQ and BDI could predict unfavorable PTR at 6 months in PD patients. CONCLUSION This is the first study to demonstrate that pathological worry may contribute to poor long-term PTR in PD patients. Therefore, our research suggests that clinicians must be aware of worry to optimize PTR for PD patients.
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Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Carmassi C, Cappelli A, Dell'Oste V, Amatori G, Bertelloni CA, Massimetti G, Nisita C, Dell'Osso L. A 3-Month Naturalistic Follow-Up Treatment With Selective Serotonin Reuptake Inhibitors in Frequent Attenders of General Medical Practice: What Correlates With a Good Response? J Nerv Ment Dis 2021; 209:275-282. [PMID: 33315798 DOI: 10.1097/nmd.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Frequent attenders (FAs), defined as patients repeatedly attending general practitioners, frequently exhibit underdiagnosed psychiatric comorbidities, leading to the hypothesis that frequent attendance may be related to an undetected psychiatric burden. This study explores the role of psychiatric comorbidities and psychopharmacological treatment on the clinical outcomes of a cohort of FAs of the general medical practice in Italy. The study included 75 FAs assessed by the Structured Clinical Interview for DSM-5, Clinical Global Impression, Global Assessment Functioning, and Illness Behavior Inventory, administered at baseline (T0) and after 3 months (T1). Data were analyzed on the bases of the presence of any mental disorder and selective serotonin reuptake inhibitor (SSRI) treatment, with respect to other psychopharmacological treatments. Results showed better outcomes among patients with a mental disorder, particularly anxiety, depression, and somatic symptoms disorders, and when under SSRI treatment. Our findings corroborate the role of psychiatric comorbidity on frequent attendance in the context of general clinical practice with a positive outcome when receiving appropriate treatment with SSRI.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Kim HJ, Kim JE, Lee SH. Early Trauma Is Associated with Poor Pharmacological Treatment Response in Patients with Panic Disorder. Psychiatry Investig 2021; 18:249-256. [PMID: 33735547 PMCID: PMC8016688 DOI: 10.30773/pi.2020.0380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Pharmacotherapy is established as an effective method for reducing symptoms of panic disorder (PD). However, about 20-40% of PD patients are treatment-resistant. Predictors of pharmacotherapy outcomes for PD patients are needed. METHODS This study included 152 PD patients to measure the clinical severities of PD symptoms and used the Early Trauma Inventory (ETI) to measure early trauma. Treatment response was defined as a 40% reduction in the total Panic Disorder Severity Scale score from baseline. We measured the treatment responses at 8 weeks and 6 months. Binary logistic regression was used to predict treatment response after controlling for confounding variables. RESULTS Early sexual trauma alone was associated with poor treatment response at 8 weeks. However, at 6 months, the total ETI score was associated with an unfavorable treatment response. CONCLUSION Therefore, our study suggests that clinicians need to be aware of a history of early trauma to optimize treatment outcomes for PD patients.
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Affiliation(s)
- Hyun-Ju Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Eun Kim
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Relationships Between Somatic Symptoms and Panic-Agoraphobic Spectrum Among Frequent Attenders of the General Practice in Italy. J Nerv Ment Dis 2020; 208:540-548. [PMID: 32205774 DOI: 10.1097/nmd.0000000000001163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Frequent attenders (FAs) of general practitioners (GPs) often complain of nonspecific physical symptoms that are difficult to define according to typical medical syndromes criteria but could be acknowledged as atypical manifestations of mental disorders. We investigated the possible correlation between somatic symptoms and panic-agoraphobic spectrum symptoms in a sample of 75 FAs of GPs in Italy, with particular attention to the impact on functional impairment. Assessments included the Patient Health Questionnaire, Panic-Agoraphobic Spectrum-Self-Report (PAS-SR) lifetime version, Global Assessment of Functioning, and Clinical Global Impression. The PAS-SR total and domains scores were significantly higher among low-functioning FAs, especially anxious somatizations, hypochondriasis, anxious expectation, and reassurance orientation domains, suggesting this undetected symptom may determine the selective attention to the physical symptoms, illness-phobic/hypochondriac elaboration, and GP frequent attendance, often aimed at searching for reassurance, leading to severe impact on overall functioning and often inefficacious treatments.
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Abstract
Panic disorder (PD) is often correlated with high neuroticism and low extraversion. This study aims to ascertain whether PD patients differ from healthy controls in regard to personality traits and determine if these traits are correlated with comorbid disorders, anxiety, and depression symptoms. Personality traits of 69 PD patients and 42 controls were compared using the Maudsley Personality Inventory. In PD patients, comorbidities, anxiety, and depression symptoms were also evaluated. PD patients showed higher neuroticism and lower extraversion compared with healthy controls. Patients without comorbidities presented similar results to controls, whereas those with comorbidities presented higher neuroticism and lower extraversion scores. PD per se may be unrelated to deviant personality traits, although comorbidities with major depressive disorder and agoraphobia are probably associated with high neuroticism and low extraversion. These traits show a strong correlation with the accumulation and severity of these disorders.
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Võhma Ü, Raag M, Tõru I, Aluoja A, Maron E. Association between personality traits and Escitalopram treatment efficacy in panic disorder. Nord J Psychiatry 2017; 71:433-440. [PMID: 28472591 DOI: 10.1080/08039488.2017.1316772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is strong evidence to suggest that personality factors may interact with the development and clinical expression of panic disorder (PD). A greater understanding of these relationships may have important implications for clinical practice and implications for searching reliable predictors of treatment outcome. AIMS The study aimed to examine the effect of escitalopram treatment on personality traits in PD patients, and to identify whether the treatment outcome could be predicted by any personality trait. METHOD A study sample consisting of 110 outpatients with PD treated with 10-20 mg/day of escitalopram for 12 weeks. The personality traits were evaluated before and after 12 weeks of medication by using the Swedish universities Scales of Personality (SSP). RESULTS Although almost all personality traits on the SSP measurement were improved after 12 weeks of medication in comparison with the baseline scores, none of these changes reached a statistically significant level. Only higher impulsivity at baseline SSP predicted non-remission to 12-weeks treatment with escitalopram; however, this association did not withstand the Bonferroni correction in multiple comparisons. LIMITATIONS All patients were treated in a naturalistic way using an open-label drug, so placebo responses cannot be excluded. The sample size can still be considered not large enough to reveal statistically significant findings. CONCLUSIONS Maladaptive personality disposition in patients with PD seems to have a trait character and shows little trend toward normalization after 12-weeks treatment with the antidepressant, while the association between impulsivity and treatment response needs further investigation.
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Affiliation(s)
- Ülle Võhma
- a North Estonia Medical Centre Foundation, Psychiatry Clinic , Tallinn , Estonia
| | - Mait Raag
- b Department of Public Health , University of Tartu , Tartu , Estonia
| | - Innar Tõru
- c Department of Psychiatry , University of Tartu , Tartu , Estonia
| | - Anu Aluoja
- c Department of Psychiatry , University of Tartu , Tartu , Estonia
| | - Eduard Maron
- a North Estonia Medical Centre Foundation, Psychiatry Clinic , Tallinn , Estonia.,c Department of Psychiatry , University of Tartu , Tartu , Estonia.,d Centre for Neuropsychopharmacology, Imperial College London , London , UK
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Finkler DC, Wesner AC, Heldt E. Temperamento e Caráter na Resposta à Terapia Cognitivo-Comportamental para Transtorno de Pânico. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102-3772e322217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O estudo investigou o impacto das características de temperamento e caráter na resposta à terapia cognitivo-comportamental (TCC) para pacientes com transtorno de pânico (TP). Um total de 55 pacientes realizou 12 sessões de TCC em grupo (TCCG). A gravidade dos sintomas foi verificada antes e após a intervenção, e o Inventário de Temperamento e Caráter de Cloninger foi aplicado no início do tratamento. Observou-se uma redução significativa na gravidade do TP após a intervenção. Análises de regressão indicaram que as características de temperamento (persistência) e caráter (autodirecionamento e cooperatividade) não se mostraram significativamente relacionadas à melhora da agorafobia e de sintomas depressivos, permanecendo a gravidade inicial desses sintomas como fatores independentes de resposta à TCCG.
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Klan T, Jasper F, Hiller W. Predictors of the application of exposure in vivo in the treatment of agoraphobia in an outpatient clinic: An exploratory approach. Psychother Res 2015; 27:64-73. [DOI: 10.1080/10503307.2015.1072284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Grubbs KM, Cheney AM, Fortney JC, Edlund C, Han X, Dubbert P, Sherbourne CD, Craske MG, Stein MB, Roy-Byrne PP, Sullivan JG. The role of gender in moderating treatment outcome in collaborative care for anxiety. Psychiatr Serv 2015; 66:265-71. [PMID: 25727114 PMCID: PMC4453769 DOI: 10.1176/appi.ps.201400049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to test whether gender moderates intervention effects in the Coordinated Anxiety Learning and Management (CALM) intervention, a 12-month, randomized controlled trial of a collaborative care intervention for anxiety disorders (panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder) in 17 primary care clinics in California, Washington, and Arkansas. METHODS Participants (N=1,004) completed measures of symptoms (Brief Symptom Inventory [BSI]) and functioning (mental and physical health components of the 12-Item Short Form [MCS and PCS] and Healthy Days, Restricted Activity Days Scale) at baseline, six, 12, and 18 months. Data on dose, engagement, and beliefs about psychotherapy were collected for patients in the collaborative care group. RESULTS Gender moderated the relationship between treatment and its outcome on the BSI, MCS, and Healthy Days measures but not on the PCS. Women who received collaborative care showed clinical improvements on the BSI, MHC, and Healthy Days that were significantly different from outcomes for women in usual care. There were no differences for men in collaborative care compared with usual care on any measures. In the intervention group, women compared with men attended more sessions of psychotherapy, completed more modules of therapy, expressed more commitment, and viewed psychotherapy as more helpful. CONCLUSIONS These findings contribute to the broader literature on treatment heterogeneity, in particular the influence of gender, and may inform personalized care for people seeking anxiety treatment in primary care settings.
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Affiliation(s)
- Kathleen M Grubbs
- Dr. Grubbs and Dr. Dubbert are with the Mental Illness Research, Education, and Clinical Center (MIRECC) and Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock (e-mail: ). Dr. Cheney, Dr. Fortney, and Ms. Han are with the Center for Mental Health Outcomes Research, CAVHS. They are also with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, where Dr. Sullivan is affiliated. Ms. Edlund is with MIRECC and the Department of Psychiatry, University of Arkansas for Medical Sciences. Dr. Sherbourne is with the Health Program of RAND, Santa Monica, California. Dr. Craske is with the Department of Clinical Psychiatry, University of California, Los Angeles. Dr. Stein is with the Department of Psychiatry and the Department of Family and Preventive Medicine, University of California, San Diego. Dr. Roy-Byrne is with the Department of Psychiatry, Harborview Medical Center, University of Washington School of Medicine, Seattle
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Schat A, van Noorden MS, Noom MJ, Giltay EJ, van der Wee NJA, Vermeiren RRJM, Zitman FG. Predictors of outcome in outpatients with anxiety disorders: the Leiden routine outcome monitoring study. J Psychiatr Res 2013; 47:1876-85. [PMID: 24074517 DOI: 10.1016/j.jpsychires.2013.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/04/2013] [Accepted: 09/09/2013] [Indexed: 12/01/2022]
Abstract
Little is known about the predictors of outcome in anxiety disorders in naturalistic outpatient settings. We analyzed 2-year follow-up data collected through Routine Outcome Monitoring (ROM) in a naturalistic sample of 917 outpatients in psychiatric specialty care in order to identify factors predicting outcome. We included patients with panic disorder with or without agoraphobia, agoraphobia without panic, social phobia, or generalized anxiety disorder. Main findings from Cox regression analyses demonstrated that several socio-demographic variables (having a non-Dutch ethnicity [HR = 0.71)], not having a daily occupation [HR = 0.76]) and clinical factors (having a diagnosis of agoraphobia [HR = 0.67], high affective lability [HR = 0.80] and behavior problems [HR = 0.84]) decreased chances of response (defined as 50% reduction of anxiety severity) over the period of two years. Living with family had a protective predictive value [HR = 1.41]. These results may imply that factors that could be thought to limit societal participation, are associated with elevated risk of poor outcome. A comprehensive ROM screening process at intake may aid clinicians in the identification of patients at risk of chronicity.
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Affiliation(s)
- A Schat
- Leiden University Medical Centre, Department of Psychiatry, P.O. Box 7500, 2300 RC Leiden, The Netherlands.
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Joesch JM, Golinelli D, Sherbourne CD, Sullivan G, Stein MB, Craske MG, Roy-Byrne PP. Trajectories of change in anxiety severity and impairment during and after treatment with evidence-based treatment for multiple anxiety disorders in primary care. Depress Anxiety 2013; 30:1099-106. [PMID: 23801589 PMCID: PMC3902647 DOI: 10.1002/da.22149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/02/2013] [Accepted: 06/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coordinated Anxiety Learning and Management (CALM) is a model for delivering evidence-based treatment for anxiety disorders in primary care. Compared to usual care, CALM produced greater improvement in anxiety symptoms. However, mean estimates can obscure heterogeneity in treatment response. This study aimed to identify (1) clusters of participants with similar patterns of change in anxiety severity and impairment (trajectory groups); and (2) characteristics that predict trajectory group membership. METHODS The CALM randomized controlled effectiveness trial was conducted in 17 primary care clinics in four US cities in 2006-2009. 1,004 English- or Spanish-speaking patients age 18-75 with panic, generalized anxiety, social anxiety, and/or posttraumatic stress disorder participated. The Overall Anxiety Severity and Impairment Scale was administered repeatedly to 482 participants randomized to CALM treatment. Group-based trajectory modeling was applied to identify trajectory groups and multinomial logit to predict trajectory group membership. RESULTS Two predicted trajectories, representing about two-thirds of participants, were below the cut-off for clinically significant anxiety a couple of months after treatment initiation. The predicted trajectory for the majority of remaining participants was below the cut-off by 9 months. A small group of participants did not show consistent improvement. Being sicker at baseline, not working, and reporting less social support were associated with less favorable trajectories. CONCLUSIONS There is heterogeneity in patient response to anxiety treatment. Adverse circumstances appear to hamper treatment response. To what extent anxiety symptoms improve insufficiently because adverse patient circumstances contribute to suboptimal treatment delivery, suboptimal treatment adherence, or suboptimal treatment response requires further investigation.
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Affiliation(s)
- Jutta M. Joesch
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine and, Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically, Vulnerable Populations (CHAMMP), Seattle, Washington
| | | | | | - Greer Sullivan
- Department of Psychiatry and VA South Central Mental Illness Research, Education, and Clinical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Murray B. Stein
- Departments of Psychiatry and Family and Preventive Medicine, University of California, La Jolla, California
| | - Michelle G. Craske
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Peter P. Roy-Byrne
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine and, Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically, Vulnerable Populations (CHAMMP), Seattle, Washington
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13
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Hendriks SM, Spijker J, Licht CMM, Beekman ATF, Penninx BWJH. Two-year course of anxiety disorders: different across disorders or dimensions? Acta Psychiatr Scand 2013; 128:212-21. [PMID: 23106669 DOI: 10.1111/acps.12024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study compares diagnostic and symptom course trajectories across different anxiety disorders, and examines the role of anxiety arousal vs. avoidance behaviour symptoms in course prediction. METHOD Data were from 834 subjects with a current anxiety disorder from the Netherlands Study of Depression and Anxiety (NESDA) who were re-interviewed after 2 years. DSM-IV-based diagnostic interviews and Life Chart Interviews (LCI) were used to assess the diagnostic and symptom course trajectory over 2 years. Anxiety arousal and avoidance behaviour symptoms were measured with LCI, Beck Anxiety Inventory and Fear Questionnaire. RESULTS Prognosis varied across disorders, with favourable remittance rates of 72.5% for panic disorder without agoraphobia and 69.7% for generalized anxiety disorder; gradually declining to 53.5% for social phobia and 52.7% for panic disorder with agoraphobia. Only 42.9% of those with multiple anxiety disorder remitted, and this group showed a more chronic course than pure anxiety disorders. Both baseline duration and severity were course predictors. Avoidance behaviour symptoms predicted the outcome better than anxiety arousal symptoms. CONCLUSIONS These data suggest that the specific anxiety disorders such as recognized by DSM-IV are useful in predicting the outcome and that this may be determined largely by the relative severity of avoidance behaviour that patients have developed.
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Affiliation(s)
- Sanne M Hendriks
- Department of Psychiatry, Pro Persona Mental Health Care, Ede, The Netherlands.
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Vanden Bogaerde A, De Raedt R. Internal sensations as a source of fear: exploring a link between hypoxia and flight phobia. ANXIETY STRESS AND COPING 2013; 26:343-54. [DOI: 10.1080/10615806.2012.673592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Ottoboni G, Iacono M. An integrative body therapy approach: The Neo-Functionalism approach. BODY MOVEMENT AND DANCE IN PSYCHOTHERAPY 2013. [DOI: 10.1080/17432979.2012.749813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Campbell-Sills L, Sherbourne CD, Roy-Byrne P, Craske MG, Sullivan G, Bystritsky A, Lang AJ, Chavira DA, Rose RD, Welch SS, Stein MB. Effects of co-occurring depression on treatment for anxiety disorders: analysis of outcomes from a large primary care effectiveness trial. J Clin Psychiatry 2012; 73:1509-16. [PMID: 23290323 PMCID: PMC3692282 DOI: 10.4088/jcp.12m07955] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Co-occurring depression is common in patients seeking treatment for anxiety; however, the literature on the effects of depression on anxiety treatment outcomes is inconclusive. The current study evaluated prescriptive and prognostic effects of depression on anxiety treatment outcomes in a large primary care sample. METHOD Data were analyzed from a randomized controlled effectiveness trial that compared coordinated anxiety learning and management (CALM) to usual care. The study enrolled 1,004 patients between June 2006 and April 2008. Patients were referred by their primary care provider and met DSM-IV criteria for generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and/or social anxiety disorder. They were treated for approximately 3 to 12 months with CALM (computer-assisted cognitive-behavioral therapy, medication management, or their combination) or usual care. Outcomes were evaluated by blinded assessment at 6, 12, and 18 months. Effects of baseline major depressive disorder (MDD) on anxiety symptoms, anxiety-related disability, and response/remission rates were evaluated using statistical models accounting for baseline anxiety and patient demographics. RESULTS MDD did not moderate the effects of CALM (relative to usual care) on anxiety symptoms, anxiety-related disability, or response/remission rates. Greater improvements in anxiety symptoms and anxiety-related disability were observed in depressed patients, regardless of treatment assignment (P values < .005). However, cross-sectionally depressed patients displayed higher anxiety symptom and anxiety-related disability scores at baseline and all subsequent assessments (P values < .001). Depressed patients also displayed lower remission rates at each follow-up (P values < .001). CONCLUSIONS CALM had comparable advantages over usual care for patients with and without MDD. Depressed patients displayed more severe anxiety symptoms and anxiety-related disability at baseline, but their clinical improvement was substantial and larger in magnitude than that observed in the nondepressed patients. Results support the use of empirically supported interventions for anxiety disorders in patients with co-occurring depression. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00347269.
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Affiliation(s)
- Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA.
| | | | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Greer Sullivan
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA,VA South Central Mental Illness Research, Education, and Clinical Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ariel J. Lang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,VA San Diego Health Care System Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Denise A. Chavira
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,California State University San Marcos, Department of Human Development, San Marcos, CA, USA
| | - Raphael D. Rose
- VA South Central Mental Illness Research, Education, and Clinical Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stacy Shaw Welch
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 457] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Psychological characteristics of early remitters in patients with panic disorder. Psychiatry Res 2012; 197:237-41. [PMID: 22370156 DOI: 10.1016/j.psychres.2011.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 01/05/2023]
Abstract
We aimed to examine whether anxiety sensitivity and agoraphobic fear could affect the time taken to remission after 24 weeks of open-label escitalopram treatment of patients with panic disorder (PD). We recruited 158 patients, and 101 patients completed the study. Clinical severity and psychological characteristics were assessed at baseline and 4, 12, and 24 weeks after the treatment, using the Clinical Global Impression-Severity (CGI-S), the Hamilton Rating Scales for Anxiety and Depression, the Anxiety Sensitivity Index-Revised (ASI-R), the Albany Panic and Phobia Questionnaire (APPQ), and the Panic Disorder Severity Scale (PDSS). Remission was defined as the absence of full panic attacks and PDSS scores of 7 or less. Completing patients were stratified according to the time taken to remit: early (n=20) and late (n=58) remission and non-remission groups (n=23). There were no significant differences among the three groups at baseline on the CGI-S and the PDSS mean scores. However, early remitters had significantly lower scores than late remitters and non-remitters on the ASI-R and APPQ. In conclusion, anxiety sensitivity and agoraphobic fear can affect the time to remission after pharmacotherapy, and clinicians should consider the psychological characteristics of PD patients in order to achieve an optimal response to pharmacotherapy.
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Beason-Smith M, Hiatt EL, Grubbs KM, Teng EJ. Managing the Approach-Avoidance Dialectic in Treating a Complex Veteran With Panic and Posttraumatic Stress Disorder. Clin Case Stud 2012. [DOI: 10.1177/1534650112442109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive-behavioral therapy (CBT) is the treatment of choice for panic disorder (PD); however, the effectiveness of the treatment is often thought to be diminished in the presence of comorbid conditions. PD and posttraumatic stress disorder (PTSD) commonly co-occur in veteran populations, potentially complicating the effective treatment of each disorder. The individual presented in this case is a female veteran in her mid-50s who received treatment for PD and presented with significant comorbidities (PTSD, histrionic personality traits, major depressive disorder, and chronic suicidality). She participated in an intensive weekend treatment for PD that involved psychoeducation, cognitive restructuring, and interoceptive exposure. This case illustrates the challenges in implementing a manualized treatment for panic with a diagnostically complex veteran and the improvement in panic symptoms despite comorbid presentation.
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Affiliation(s)
| | - Emily L. Hiatt
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine
| | | | - Ellen J. Teng
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center
- Baylor College of Medicine
- Health Services Research & Development Center of Excellence, Houston, TX, USA
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Glashouwer KA, de Jong PJ, Penninx BWJH. Prognostic value of implicit and explicit self-associations for the course of depressive and anxiety disorders. Behav Res Ther 2012; 50:479-86. [PMID: 22659157 DOI: 10.1016/j.brat.2012.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 04/25/2012] [Accepted: 05/06/2012] [Indexed: 02/05/2023]
Abstract
Dysfunctional self-beliefs are assumed to play an important role in maintaining depression and anxiety. Current dual-process models emphasize the relevance of differentiating between implicit and explicit self-beliefs. Therefore, this study tested the prognostic value of automatic and explicit self-associations for the naturalistic course of depressive and anxiety disorders over two years follow-up. Both self-depressed and self-anxious associations were measured in unipolar depressed patients (n = 313), anxious patients (n = 566), and patients with comorbid depressive and anxiety disorders (n = 577) as part of the Netherlands Study of Depression and Anxiety. Outcomes showed that in single predictor models specifically automatic self-anxious associations were related to a reduced chance of remission from anxiety, whereas automatic self-depressed associations were related to a reduced chance of remission from depression. Explicit self-anxious associations and fearful avoidance behaviour showed independent predictive validity for remission from anxiety, whereas explicit self-depressed associations and having both major depressive disorder and dysthymia showed independent predictive validity for remission from depression. These findings are not only consistent with the view that both implicit and explicit dysfunctional self-associations are related to the course of anxiety and unipolar depressive disorders, but also suggest that both types of self-beliefs are proper targets for therapeutic interventions.
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Affiliation(s)
- Klaske A Glashouwer
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
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The moderational role of anxiety sensitivity in flight phobia. J Anxiety Disord 2011; 25:422-6. [PMID: 21163616 DOI: 10.1016/j.janxdis.2010.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 11/22/2022]
Abstract
Anxiety sensitivity (AS) is the tendency to interpret anxiety-related bodily sensations in a threatening way. Previous research in a subclinical population identified AS as a vulnerability factor in flight phobia: AS moderates the relationship between somatic sensations and flight anxiety. The present study aimed at gaining further evidence for the moderational role of AS in a large clinical population with flight phobia. The data were obtained from 103 participants: 54 flight phobic participants and 49 controls. Just before taking a flight participants were asked to complete the Anxiety Sensitivity Index and to report their level of anxiety and bodily sensations. Results showed that AS moderates the relationship between somatic sensations and flight phobia: somatic sensations significantly predicted flight anxiety in subjects with higher AS scores, while this was not the case for subjects scoring lower on AS. Present findings implicate that treatment protocols should be supplemented by interventions specifically aimed at reducing AS, especially for individuals high in AS.
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Chaison AD, Dunn NJ, Teng EJ. Treating Panic in a Veteran With Comorbid Combat-Related Posttraumatic Stress Disorder. Clin Case Stud 2010. [DOI: 10.1177/1534650110372252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research indicates that psychiatric comorbidity can limit the effectiveness of evidence-based psychotherapy interventions. Panic disorder (PD) can be effectively treated with panic control treatment. However, the effectiveness of this intervention with comorbid posttraumatic stress disorder (PTSD) is not well established. This case is about a 57-year-old Vietnam Veteran diagnosed with PD with agoraphobia and comorbid PTSD and depression. The veteran participates in 10 sessions of panic control treatment after limited success with pharmacotherapy. He completed a structured clinical interview and self-report measures at pretreatment, 1-week posttreatment and 3-month follow-up. The veteran’s panic attacks were eliminated prior to completing the protocol. He remained panic free at posttreatment and follow-up but continued to meet criteria for PTSD and depression. These findings indicate that comorbid PTSD and depression do not limit the success of panic control treatment for PD. However, treatment effects do not generalize across anxiety disorders. Implications and recommendations are presented.
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Affiliation(s)
- Angelic D. Chaison
- Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine
| | - Nancy Jo Dunn
- Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine
| | - Ellen J. Teng
- Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston Center for Quality of Care and Utilization Studies,
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