Security of mind: 20 years of attachment theory and its relevance to psychiatry

A cohort study comparing the effects of medical cannabis for anxiety patients with and without comorbid sleep disturbance

BACKGROUND

Research on cannabis-based medicinal products (CBMPs) in anxiety remains inconclusive due to a paucity of high-quality evidence. Studies indicate a bidirectional relationship between generalized anxiety disorder (GAD) and sleep disruption, but it is unclear how this affects CBMP treatment outcomes. This study aims to compare the patient-reported outcome measures (PROMs) of patients prescribed CBMPs for GAD, with and without impaired sleep.

METHODS

Changes in PROMs were recorded from baseline to 1, 3, 6, and 12 months between those with impaired or unimpaired sleep. Multivariate logistic regression was applied to compare factors associated with a clinically significant improvement in GAD-7 at 12 months. Secondary outcomes included adverse event incidence and frequency.

RESULTS

Of the 302 patients that fit the inclusion criteria, mean GAD-7, single-item sleep quality, and EQ-5D-5L index values improved at all time points (p < 0.001). A relationship between sleep impairment and clinically significant changes in GAD-7 at 1 and 3 months was identified (p ≤ 0.01). On multivariate regression, only baseline GAD severity was associated with an increased likelihood of observing a clinically significant improvement in anxiety (p < 0.001). Seven hundred and seven (234%) adverse events were reported by 55 (18.21%) participants.

CONCLUSIONS

This study observed an association between CBMP treatment and improvements in anxiety in patients with GAD. While patients with comorbid sleep disruption had greater improvements in anxiety, the differences were not maintained in a multivariate analysis. Baseline anxiety severity may be a predictor for CBMP treatment outcomes.

The Unholy Trinity: Childhood Trauma, Adulthood Anxiety, and Long-Term Pain

Background: Childhood trauma is considered to be a risk factor for developing anxiety as well as chronic pain. The aim of this study was to assess the association between childhood trauma and reporting anxiety and long-term pain conditions in the general and clinical populations. Methods: Respondents from a representative sample in the Czech Republic (n = 1800, mean age: 46.6 years, 48.7% male) and patients with a clinically diagnosed anxiety or adjustment disorder (n = 67, mean age: 40.5 years, 18.0% male) were asked to report anxiety, various chronic and pain-related conditions, and childhood trauma (The Childhood Trauma Questionnaire, CTQ) in a cross-sectional questionnaire-based survey conducted in 2016 and 2017. Results: Reporting emotional abuse (Odds ratio OR from 2.14 to 14.71), emotional neglect (OR from 2.42 to 10.99), or physical neglect (OR from 2.24 to 3.30) was associated with reporting anxiety and long-term pain both in the general and clinical populations and reporting physical abuse moreover with reporting anxiety or adjustment disorder with concurrent long-term pain (OR from 4.04 to 6.39). Conclusion: This study highlights the relevance of childhood trauma as a possible factor contributing to anxiety with concurrent pain conditions in adulthood in both the general and clinical populations.