Discerning undifferentiated anxiety from syndromal anxiety in acute-phase schizophrenia

A community-based cross-sectional study of anxiety and metabolic syndrome

BACKGROUND

The prevalence of anxiety and other psychological disorders has increased during the COVID-19 pandemic, especially among the elderly. Anxiety and metabolic syndrome (MetS) may aggravate each other. This study further clarified the correlation between the two.

METHODS

Adopting a convenience sampling method, this study investigated 162 elderly people over 65 years of age in Fangzhuang Community, Beijing. All participants provided baseline data on sex, age, lifestyle, and health status. The Hamilton Anxiety Scale (HAMA) was used to assess anxiety. Blood samples, abdominal circumference, and blood pressure were used to diagnose MetS. The elderly were divided into MetS and control groups according to the diagnosis of MetS. Differences in anxiety between the two groups were analysed and further stratified by age and gender. Multivariate logistic regression analysis was used to analyse the possible risk factors for MetS.

RESULTS

Compared with the control group, anxiety scores of the MetS group were statistically higher (Z = 4.78, P < 0.001). There was a significant correlation between anxiety levels and MetS (r = 0.353, P < 0.001). Multivariate logistic regression revealed that anxiety (possible anxiety vs no anxiety: odds ratio [OR] = 2.982, 95% confidence interval [CI] 1.295-6.969; definite anxiety vs no anxiety: OR = 14.573, 95%CI 3.675-57.788; P < 0.001) and BMI (OR = 1.504, 95% CI 1.275-1.774; P < 0.001) were possible risk factors for MetS.

CONCLUSION

The elderly with MetS had higher anxiety scores. Anxiety may be a potential risk factor for MetS, which provides a new perspective on anxiety and MetS.

Impact of Childhood Trauma and Adult Separation Anxiety Disorder on Quality of Life in Individuals with Schizophrenia

Background

Childhood trauma and anxiety disorders are common in individuals with schizophrenia. This study aimed to investigate the effects of childhood trauma and adult separation anxiety disorder on the quality of life of individuals with schizophrenia.

Methods

This cross-sectional study included 111 individuals with schizophrenia and 85 control subjects. The separation anxiety symptom inventory (SASI), adult separation anxiety questionnaire (ASAQ), Positive and Negative Syndrome Scale (PANSS), childhood trauma questionnaire (CTQ), and World Health Organization quality of life questionnaire (WHOQoL-BREF) were administered to the participants.

Results

More individuals with schizophrenia than control subjects were unemployed and single (p<0.05). Individuals with schizophrenia scored significantly higher on the SASI, ASAQ, and CTQ (p<0.05), whereas the control subjects scored significantly higher on the WHOQoL-BREF (p<0.05). ASAQ scores had mild positive correlations with total PANSS and PANSS subscale scores, and moderate positive correlations with total CTQ, CTQ emotional subscale scores, and CTQ physical abuse subscale scores. A negative moderate correlation was found between ASAQ and total WHOQoL-BREF scores. Mediation analysis revealed that CTQ scores significantly affected total WHOQoL-BREF and ASAQ scores. The model pathway for ASAQ scores showed a significant direct and indirect effect of CTQ on the total WHOQoL-BREF scores.

Conclusion

Childhood trauma predicts adult separation anxiety disorder, which partially mediates the impact of childhood trauma on quality of life in individuals with schizophrenia. Therapeutic interventions for adult separation anxiety disorder in individuals with schizophrenia and a history of childhood trauma may help increase their quality of life.

Validity and Reliability of the Staden Schizophrenia Anxiety Rating Scale

In schizophrenia, none of the standard anxiety measures exhibit strong psychometric properties, and all performed poorly against quality assessment criteria. Developed for the schizophrenia population, this study examined the validity and reliability of the Staden Schizophrenia Anxiety Rating Scale (S-SARS) that measures both specified and undifferentiated anxiety. Among 353 schizophrenia patients, strong correlations with anxiety parameters supported the S-SARS's convergent validity. Criterion-related validity testing yielded accuracy, sensitivity, and specificity rates of around 95%. Its discriminant validity was observed for measures of depression, psychosis, akathisia, fatigue, vigour, procrastination, behavioural inhibition and activation, and personal growth and initiative. Structural validity was found in a single-factor unidimensional model with a 0.953 factor score. Excellent results were found for internal consistency (Cronbach's alpha = 0.931; Spearman-Brown coefficient = 0.937; Guttman split-half coefficient = 0.928) and inter-rater reliability (Krippendorff's alpha = 0.852). It incurred no more than a small error of measurement whereby the observed scores were within 1.54 to 3.58 of a true score on a zero to 50 scale. These strong psychometric properties suggest that the S-SARS is a valid and reliable instrument for measuring specified and undifferentiated anxiety in schizophrenia, providing the means for the accurate measurement of anxiolytic treatment effects.

Testing the validity and reliability of the Chinese version of the Staden schizophrenia anxiety rating scale

Accurate assessment of anxiety disorders and their symptomatology in schizophrenic patients is important for prognosis and treatment. Measuring anxiety on the traditional anxiety assessment scales such as the Hamilton Anxiety Rating (HAMA) Scale or the self-rating depression scale (SAS) is challenging and often considered unsuitable for assessing anxiety symptoms in patients with schizophrenia. The Staden schizophrenia anxiety rating scale (S-SARS) has been shown to reliably measure specified and undifferentiated anxiety in schizophrenia. The present study aims to test the reliability and validity of the S-SARS version, thereby facilitating Chinese psychiatrists in assessing anxiety symptoms in schizophrenic patients. A total of 300 patients meeting ICD-10 diagnostic criteria of schizophrenia were recruited by convenience sampling. We used the exploratory factor analysis (EFA) to evaluate the structural validity of S-SARS and receiver operating characteristic (ROC) curves to acquire the cutoff point of S-SARS to define the severity of anxiety. Internal consistency was assessed using Cronbach's and Krippendorff's α scores. 1-week test-retest reliability was assessed using the intra-class correlation coefficient (ICC). Correlation analysis with HAMA was used to determine the Chinese version of S-SARS criterion validity. We have the following results: Our version of S-SARS showed Cronbach's α score as 0.899, Krippendorff's α as 0.874, and a correlation coefficient of 0.852 between S-SARS and HAMA. The EPA demonstrated that the contribution rate of major factors was 69.45%. All the items of S-SARS were located in one factor and showed a high factor load (0.415-0.837). The correlation coefficient of S-SARS and HAMA was 0.852. Our results indicated that Chinese version of S-SARS showed good constructive validity and reliability. It also showed better criterion validity compared to HAMA. The S-SARS and its Chinese version can thus serve as an effective tool for assessing anxiety symptoms in patients with schizophrenia.

Validity and reliability of the Vigour Assessment Scale in avolitional schizophrenia outpatients

A few items of existing schizophrenia scales measure avolition, but no research has been reported on vigour in schizophrenia, including whether avolition would be more or less the inverse of vigour. Such research requires a valid and reliable measure of vigour. In the absence of this, this study developed and examined the validity and the reliability of the Vigour Assessment Scale (VAS) among 242 avolitional schizophrenia outpatients in relation to measures of workplace vigour, behavioral inhibition and activation, procrastination, fatigue, anxiety, depressive features, and active involvement in personal growth. Convergent validity was found in moderate to strong correlations (r = 0.5 to 0.714) between the VAS and measures approximate to vigour. Discriminant validity was found in lower and/or inverse correlations with depression (r = -0.423), anxiety (r = -0.279), behaviour inhibition (r = -0.045), procrastination (r = -0.656), and fatigue (r = -0.684). Internal consistency was good with Cronbach's alpha coefficients above 0.8, and strong correlations for split-half (r = 0.71) and test-retest (r = 0.77) reliability. The standard error of measurement was seven on a scale of 145 points. An exploratory factor analysis yielded a 27-item version with a six-factor structure accounting for 61.9% of the cumulative variance. These results suggest that the VAS is a valid and reliable instrument in avolitional schizophrenia outpatients, suitable for use in further research on vigour and when vigour is pursued therapeutically or in efficacy studies. Subject to further validation, the VAS may be used in other clinical populations (e.g., in depression) and healthy populations where vigour may be pursued as a desirable attribute.