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Tully PJ, Higgins R. Depression Screening, Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide,
- Department of Medicine, Flinders Medical Centre and Flinders University of South Australia,
| | - Rosemary Higgins
- Heart Research Centre,
- Department of Physiotherapy, The University of Melbourne,
- Cabrini Health,
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Domhardt M, Letsch J, Kybelka J, Koenigbauer J, Doebler P, Baumeister H. Are Internet- and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis. J Affect Disord 2020; 276:169-182. [PMID: 32697696 DOI: 10.1016/j.jad.2020.06.059] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no meta-analysis that specifically evaluates the effectiveness of Internet- and mobile-based interventions (IMIs) in adults with diagnosed panic disorder and/or agoraphobia (PD/A) so far. The current meta-analysis aims to fill this gap (PROSPERO CRD 42016034016). METHODS Systematic literature searches in six databases for randomised and controlled clinical trials investigating IMIs in adults, who met diagnostic criteria for PD/A. Study selection and data extraction were conducted independently by two reviewers. Random-effects meta-analyses, pre-planned subgroup and sensitivity analyses were conducted when appropriate. Primary outcomes were PD and A symptom severity. In addition, adherence, response, remission, quality of life, anxiety and depression symptom severity were examined. RESULTS A total of 16 trials (1015 patients), with 21 comparisons (9 IMI vs. waitlist; 7 IMI vs. IMI; 5 IMI vs. active treatment condition), were included. IMIs revealed beneficial effects on panic (Hedges' g range -2.61 to -0.25) and agoraphobia symptom severity when compared to waitlist (pooled g = -1.15, [95%-CI = -1.56; -0.74]). Studies comparing IMIs to active controls (i.e., face-to-face CBT and applied relaxation) did not find significant differences for reductions in panic (g = -0.02, [95%-CI = -0.25; 0.21]) and agoraphobia symptom severity (g = -0.10, [95%-CI = -0.39; 0.19]). Furthermore, IMIs were superior to waitlist controls regarding anxiety and depression symptom severity and quality of life. LIMITATIONS Tests for publication bias were not feasible due to the limited number of trials per comparison, and the risk of bias assessment indicated some methodological shortcomings. CONCLUSIONS Findings from this meta-analytic review provide support for the effectiveness of IMIs in patients with verified PD/A. However, before IMIs can be included in treatment guidelines for PD/A, future high quality research is needed that substantiates and extends the evidence base, especially in regard to intervention safety.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany.
| | - Josefine Letsch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Germany
| | - Jonas Kybelka
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
| | - Josephine Koenigbauer
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
| | - Philipp Doebler
- Statistical Methods in the Social Sciences, Department of Statistics, TU Dortmund University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
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Care Dependency in Patients with Heart Failure: A Cross-Sectional Study in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197042. [PMID: 32993058 PMCID: PMC7579023 DOI: 10.3390/ijerph17197042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
Background: Heart failure (HF) is a progressive and debilitating condition that represents an ever-growing problem for health systems worldwide. HF patients feel that they are a burden on their families, they feel socially isolated and have a low perception of their health. Accordingly, the objectives of this study were to: (1) to explore the profile of care dependency in a representative sample of Spanish HF patients through the Care Dependency Scale (CDS), and (2) to identify correlates of care dependency in this population. Material and Methods: We performed a cross-sectional study of 187 patients admitted for HF decompensation to the Hospital Clínico of Zaragoza (Spain). Results: Only 15% of our sample was highly or completely dependent on care from others. More specifically, our results indicate that HF patients felt a greater level of dependency on care from others when it comes to moving, getting dressed and undressed, maintaining good personal hygiene, participating in daily and recreational activities and being continent. Conclusions: We find association between the CDS categories that present a low score for care dependency in HF patients and the patients' physical deterioration.
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Fortino M, Kulich RJ, Kaufman JA, Franca H. Comorbid Conditions in Relation to Controlled Substance Abuse. Dent Clin North Am 2020; 64:535-546. [PMID: 32448457 DOI: 10.1016/j.cden.2020.03.001] [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: 10/24/2022]
Abstract
Dental patients who experience comorbid psychiatric and medical conditions present an elevated risk of medication misuse, abuse, substance use disorders, and overdose. The authors review the role of notable comorbidities in predicting the development of substance use disorder, including medical, psychiatric, and other psychosocial factors that can be assessed in general dental practice. Psychiatric disorders commonly cooccur with substance abuse, and these typically include anxiety disorders, mood disorders (major depression, bipolar), posttraumatic stress, as well as sleep and eating disorders. Medical disorders commonly found to be present with substance use disorders are also reviewed, including common cardiovascular and pulmonary disorders.
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Affiliation(s)
- Matthew Fortino
- Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA; Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, 3rd Fl, Boston, MA 02114, USA.
| | - Ronald J Kulich
- Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA; Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, 3rd Fl, Boston, MA 02114, USA
| | - Joshua A Kaufman
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, 1051 Riverside Dr, New York, New York 10032, USA
| | - Hudson Franca
- Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA; Universidad Iberoamericana, Santo Domingo, Dominican Republic
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Tully PJ, Cosh SM. Post-traumatic Stress Disorder in Heart Failure Patients: A Test of the Cardiac Disease-induced PTSD Hypothesis. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666191113121558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background:Post-traumatic stress disorder (PTSD) is prevalent in approximately 12% of patients with cardiovascular disease (CVD) and such patients are at risk of further CVD morbidity and mortality. It is unknown whether CVD patients with cardiac and non-cardiac traumatic events leading to PTSD differ in medical comorbidities and psychiatric vulnerabilities. Our objective was to compare heart failure (HF) patients with cardiac and non-cardiac PTSD.Method:A population of HF patients from 3 hospitals underwent a two-step depression and anxiety screening process to identify potential mental health treatment needs. The post-traumatic stress disorder module of the Structured Clinical Interview for DSM-IV Axis-I disorders was used to classify trauma(s) exposure, and other disorders. The patients with PTSD were sub-divided by cardiac related traumas (e.g. myocardial infarction, sudden cardiac arrest) and non-cardiac related traumas (e.g. sexual abuse, interpersonal violence).Results:10 patients met criteria for non-cardiac trauma and 18 patients met criteria for cardiacinduced trauma. There were no significant differences in HF aetiology or severity nor cardiac comorbidities. Time since PTSD, onset was significantly longer for those with non-cardiac PTSD. Among psychiatric comorbidities, alcohol and substance abuse disorders, as well as depression were more prevalent in patients with non-cardiac PTSD.Conclusion:Cardiac related PTSD was associated with less alcohol and substance abuse disorders, and depression by comparison to their non-cardiac induced PTSD counterparts. Ongoing research is required to establish if cardiac-induced PTSD truly reflects a unique subtype of PTSD, and whether there are different treatment needs and therapeutic approaches for this subtype.
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Affiliation(s)
- Phillip J. Tully
- Freemasons Foundation Centre for Men’s Health, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, Australia
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A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Affiliation(s)
- Phillip J Tully
- Phillip J. Tully, psychologist, University of Adelaide, Australia.
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Affiliation(s)
- Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Germany.
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Tully PJ, Baumeister H, Bennetts JS, Rice GD, Baker RA. Depression screening after cardiac surgery: A six month longitudinal follow up for cardiac events, hospital readmissions, quality of life and mental health. Int J Cardiol 2016; 206:44-50. [DOI: 10.1016/j.ijcard.2016.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/14/2015] [Accepted: 01/01/2016] [Indexed: 01/22/2023]
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Tully PJ, Turnbull DA, Horowitz JD, Beltrame JF, Selkow T, Baune BT, Markwick E, Sauer-Zavala S, Baumeister H, Cosh S, Wittert GA. Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial. Trials 2016; 17:18. [PMID: 26754447 PMCID: PMC4707770 DOI: 10.1186/s13063-015-1109-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/08/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Previous psychological and pharmacological interventions have primarily focused on depression disorders in populations with cardiovascular diseases (CVDs) and the efficacy of anxiety disorder interventions is only more recently being explored. Transdiagnostic interventions address common emotional processes and the full range of anxiety and depression disorders often observed in populations with CVDs. The aim of CHAMPS is to evaluate the feasibility of a unified protocol (UP) for the transdiagnostic treatment of emotional disorders intervention in patients recently hospitalized for CVDs. The current study reports the protocol of a feasibility randomized controlled trial to inform a future trial. METHODS/DESIGN This is a feasibility randomized, controlled trial with a single-center design. A total of 50 participants will be block-randomized to either a UP intervention or enhanced usual care. Both groups will receive standard CVD care. The UP intervention consists of 1) enhancing motivation, readiness for change, and treatment engagement; (2) psychoeducation about emotions; (3) increasing present focused emotion awareness; (4) increasing cognitive flexibility; (5) identifying and preventing patterns of emotion avoidance and maladaptive emotion-driven behaviors (EDBs, including tobacco smoking, and alcohol use); (6) increasing tolerance of emotion-related physical sensations; (7) interoceptive and situation-based emotion-focused exposure; and (8) relapse prevention strategies. Treatment duration is 12 to 18 weeks. Relevant outcomes include the standard deviation of self-rated anxiety, depression and quality of life symptoms. Other outcomes include intervention acceptability, satisfaction with care, rates of EDBs, patient adherence, physical activity, cardiac and psychiatric readmissions. Parallel to the main trial, a nonrandomized comparator cohort will be recruited comprising 150 persons scoring below the predetermined depression and anxiety severity thresholds. DISCUSSION CHAMPS is designed to evaluate the UP for the transdiagnostic treatment of emotional disorders targeting emotional disorder processes in a CVD population. The design will provide preliminary evidence of feasibility, attrition, and satisfaction with treatment to design a definitive trial. If the trial is feasible, it opens up the possibility for interventions to target broader emotional processes in the precarious population with CVD and emotional distress. TRIAL REGISTRATION ACTRN12615000555550 , registered on 29/05/2015.
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Affiliation(s)
- Phillip J Tully
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
- INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France.
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Deborah A Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia.
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - John F Beltrame
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - Terina Selkow
- Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital and The University of Adelaide, Adelaide, Australia.
| | - Bernhard T Baune
- Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia.
| | - Elizabeth Markwick
- Department of Psychiatry, The Queen Elizabeth Hospital, Woodville West, Australia.
| | - Shannon Sauer-Zavala
- Center for Anxiety & Related Disorders, Department of Psychology, Boston University, Boston, USA.
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, 79085, Germany.
| | - Suzanne Cosh
- School of Psychology, The University of Adelaide, Adelaide, Australia.
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
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Personality disorders in heart failure patients requiring psychiatric management: comorbidity detections from a routine depression and anxiety screening protocol. Psychiatry Res 2014; 220:954-9. [PMID: 25238983 DOI: 10.1016/j.psychres.2014.08.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/24/2014] [Accepted: 08/25/2014] [Indexed: 11/23/2022]
Abstract
Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than <3% of patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place.
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Iyngkaran P, Majoni W, Cass A, Sanders P, Ronco C, Brady S, Kangaharan N, Ilton M, Hare DL, Thomas MC. Northern Territory perspectives on heart failure with comorbidities – understanding trial validity and exploring collaborative opportunities to broaden the evidence base. Heart Lung Circ 2014; 24:536-43. [PMID: 25637942 DOI: 10.1016/j.hlc.2014.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 08/01/2014] [Accepted: 12/09/2014] [Indexed: 01/19/2023]
Abstract
Congestive Heart Failure (CHF) is an ambulatory care sensitive condition, associated with significant morbidity and mortality, rarely with cure. Outpatient based pharmacological management represents the main and most important aspect of care, and is usually lifelong. This narrative styled opinion review looks at the pharmacological agents recommended in the guidelines in context of the Northern Territory (NT) of Australia. We explore the concept of validity, a term used to describe the basis of standardising a particular trial or study and the population to which it is applicable. We aim to highlight the problems of the current guidelines based approach. We also present alternatives that could utilise the core principles from major trials, while incorporating regional considerations, which could benefit clients living in the NT and remote Australia.
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Affiliation(s)
- P Iyngkaran
- Royal Darwin Hospital, Flinders University, Darwin Private Hospital, Tiwi, NT 0811.
| | - W Majoni
- Royal Darwin Hospital, Department of Nephrology Division of Medicine.
| | - A Cass
- Menzies School of Health Research, Casuarina NT 0811.
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
| | - C Ronco
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute (IRRIV) San Bortolo Hospital, Vicenza, Italy.
| | - S Brady
- Alice Springs Hospital, Alice Springs NT 0871.
| | - N Kangaharan
- Division of Medicine, Royal Darwin Hospital, Royal Darwin Hospital, Tiwi, NT 0810.
| | - M Ilton
- Royal Darwin Hospital, Royal Darwin Hospital, Tiwi, NT 0810.
| | - D L Hare
- Coordinator, Cardiovascular Research, University of Melbourne; Director of Heart Failure Services, Austin Health, Vic 3084.
| | - M C Thomas
- Baker IDI Heart and Diabetes Institute, Central Melbourne Victoria 3004, Australia.
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Tully PJ, Cosh SM, Baumeister H. The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. J Psychosom Res 2014; 77:439-48. [PMID: 25455809 DOI: 10.1016/j.jpsychores.2014.10.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD. METHODS A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible). RESULTS Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio=1.94, 95% CI 1.45-2.60, P<.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies. CONCLUSIONS The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.
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Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany.
| | - Suzanne M Cosh
- Clinic of Psychiatry and Psychotherapy II, University of Ulm, Gunzburg, Germany
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
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Tully PJ, Selkow T, Bengel J, Rafanelli C. A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: the discrete effects of cognitive behavioral therapy, exercise, and psychotropic medication. Disabil Rehabil 2014; 37:585-92. [PMID: 24981015 DOI: 10.3109/09638288.2014.935493] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE No previous study has reported upon comorbid depression and anxiety disorders and their treatment in heart failure (HF), which the current study has sought to document. MATERIALS AND METHODS Total 29 HF patients under psychiatric management underwent primary depression cognitive behavioral therapy (CBT; n = 15) or primary generalized anxiety disorder (GAD) CBT (n = 14), and participated in a community exercise program and standard physician care. Repeated measures analysis of variance assessed Patient Health Questionnaire (PHQ-9) and GAD-7 symptom change pre- and post-CBT treatment, and assessed the interaction effects of treatment type, exercise, anti-depressant and anxiolytic. RESULTS There was a significant time and treatment interaction effect that favored the primary GAD CBT group for reduction in PHQ symptoms (F(1, 24) = 4.52, p = 0.04). Analysis of PHQ-somatic symptoms also showed a significant main effect for participation in the exercise program (F(1, 24) = 4.21, p = 0.05) and a significant time and anxiolytic interaction (F(1, 24) = 3.98, p = 0.05). The average number of cardiac hospital readmissions favored the primary GAD CBT group (p = 0.05). CONCLUSION The findings support the use of multifaceted interventions in the rehabilitation of HF patients with comorbid psychiatric needs. Implications for Rehabilitation Comorbid depression and anxiety disorders are a clinical and research focus that deserves more attention in the treatment of heart failure patients. Cognitive behavioral therapy, exercise, and anxiolytic use was associated with significant changes in depression and anxiety though discrete effects were evident. Multifaceted interventions are most likely to be successful in the rehabilitation of HF patients with psychiatric needs.
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Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide , Adelaide , Australia
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