How well do nurses know their patients? Agreement between patients' degree-of-worry and nurses' estimation of patients' degree-of-worry-An observational study

AIM

To assess the agreement between patients' self-reported degree-of-worry (DOW) and nurses' evaluation of patients' DOW.

DESIGN

An observational cohort study with patients and their primary nurses.

METHODS

Between 22 February and 27 March 2021, data collection among patients and their nurses in an emergency department was carried out. Patients ≥18 years, cognitively intact and Danish or English speaking were eligible to participate. Nurses regardless of seniority and gender were eligible for participation. The single-item degree-of-worry measure, 'how worried are you about the condition you are here today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried' as well as information on gender, age, co-morbidity, triage level and medical reason for encounter was collected from patients. The corresponding nurses were asked; 'how worried do you think your patient is about the condition he/she is there today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried?' Nurses also supplied data on gender, age, seniority as a Registered Nurse and in the ED. Agreement between patients' self-reported degree-of-worry and nurses' evaluation of patients' degree-of-worry was assessed with weighted Cohen's Kappa.

RESULTS

A total of 194 patient-nurse pairs were included for analysis. The agreement between patients' DOW and nurses' evaluation of patients' DOW categorised as DOWlow , DOWmiddle and DOWhigh was in total agreement in n = 85 pairs (43.8%) of the ratings, which corresponds to a weighted Cohen's Kappa of 0.19 (0.08-0.30; p < 0.001).

CONCLUSION

Nurses estimate of their patients' DOW was in very poor agreement. This indicates that nurses are not able to assess the patient's DOW to a satisfactory level. This result is troubling as it may have serious consequences for patient care as it indicates that the nurses do not know their patients' perspectives.

Determinants of anxiety and depression among pheochromocytoma patients: A case-control study

Phaeochromocytomas are catecholamine-producing neuroendocrine tumors that may manifest in many ways, specifically as sustained or paroxysmal hypertension. Data, including data from mental status screening, were prospectively collected from suspected patients. The Hospital Anxiety and Depression Scale was used as a screening tool to identify abnormal mental status. Results showed phaeochromocytoma patients were more likely to experience anxiety and depression. For future phaeochromocytoma treatment, early screening for anxiety and depression should be recommended.

Developing and testing a nurse-led intervention to support bereavement in relatives in the intensive care (BRIC study): a protocol of a pre-post intervention study

BACKGROUND

When a patient is approaching death in the intensive care unit (ICU), patients' relatives must make a rapid transition from focusing on their beloved one's recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Netherlands. The aim of this study is to develop and implement a multicomponent bereavement support intervention for relatives of deceased ICU patients and to evaluate the effectiveness of this intervention on complicated grief, anxiety, depression and posttraumatic stress in bereaved relatives.

METHODS

The study will use a cross-sectional pre-post design in a 38-bed ICU in a university hospital in the Netherlands. Cohort 1 includes all reported first and second contact persons of patients who died in the ICU in 2018, which will serve as a pre-intervention baseline measurement. Based on existing policies, facilities and evidence-based practices, a nurse-led intervention will be developed and implemented during the study period. This intervention is expected to use 1) communication strategies, 2) materials to make a keepsake, and 3) a nurse-led follow-up service. Cohort 2, including all bereaved relatives in the ICU from October 2019 until March 2020, will serve as a post-intervention follow-up measurement. Both cohorts will be performed in study samples of 200 relatives per group, all participants will be invited to complete questionnaires measuring complicated grief, anxiety, depression and posttraumatic stress. Differences between the baseline and follow-up measurements will be calculated and adjusted using regression analyses. Exploratory subgroup analyses (e.g., gender, ethnicity, risk profiles, relationship with patient, length of stay) and exploratory dose response analyses will be conducted.

DISCUSSION

The newly developed intervention has the potential to improve the bereavement process of the relatives of deceased ICU patients. Therefore, symptoms of grief and mental health problems such as depression, anxiety and posttraumatic stress, might decrease.

TRIAL REGISTRATION

Netherlands Trial Register Registered on 27/07/2019 as NL 7875, www.trialregister.nl.

Psychological Effects and Associated Factors of COVID-19 in a Mexican Sample

OBJECTIVES

The coronavirus disease 2019 (COVID 19) is a new viral zoonosis of global concern that could cause psychological sequelae. We examined the levels of psychological distress, anxiety, depression, and stress during the COVID-19 outbreak in a Mexican sample.

METHODS

An online survey was applied that collected information on demographic and financial status data, physical status, contact history, knowledge, concerns, and precautionary measures concerning COVID-19. Impact of Event Scale-Revised and Depression, Anxiety, and Stress Scale were included.

RESULTS

A total of 50.3% of respondents rated psychological distress as moderate-severe; 15.7% reported moderate-severe depressive symptoms; 22.6% reported moderate-severe anxiety symptoms; and 19.8% reported moderate-severe stress levels. Female gender, older age, divorced status, lack of confidence related to security of the test, lower satisfaction of health information concerning COVID-19, history of direct or indirect contact with a COVID-19 confirmed case, live with just 1 other person, and spent >9 h/d at home were associated with greater psychological distress and/or higher levels of stress, anxiety, and depression. By contrast, precautionary measures, such as hand hygiene and wearing masks, were associated with lower levels of psychological distress, depression, anxiety, and stress.

CONCLUSIONS

COVID-19 outbreak results in considerable psychological effects among the Mexican sample.

Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study

Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01-5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67-0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01-1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21-1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.

The effects of training with simulation on knowledge, skill and anxiety levels of the nursing students in terms of cardiac auscultation: A randomized controlled study

BACKGROUND

The use of simulation methods in nursing education is important in terms of decreasing anxiety of students in a safe and realistic environment due to the improvement of knowledge and skills of students in terms of cardiac auscultation and their attitudes to prepare for clinical applications.

OBJECTIVES

The aim of this study is to compare the effectiveness of high-fidelity simulator and traditional teaching method on nursing students' knowledge and skill development in terms of cardiac auscultation and their anxiety levels.

DESIGN

Randomized controlled study.

SETTING

The study was conducted in the simulation laboratory of the Nursing Department in the Health College and in the inpatient clinics of the Medicine Faculty Hospital.

PARTICIPANTS

72 first-year nursing students (simulation group = 36, control group = 36).

METHODS

The students were randomly distributed to the simulation and control groups. The students in the simulation group received a cardiac auscultation training by using a high-fidelity simulator while the students in the control group received training with the traditional teaching method. After the training sessions, all students practiced their skills in the laboratory and on real patients in clinical setting under the supervision of the researcher. The data were collected by using the Demographic Information Form, Knowledge Assessment Form for Cardiac Auscultation, Skill Evaluation Form for Cardiac Auscultation and State Anxiety Inventory (SAI).

RESULTS

High-fidelity simulators and traditional teaching method were found to be effective in increasing the students' knowledge and skill levels in terms of cardiac auscultation. However, it was found that the high-fidelity simulator method was more effective than the traditional teaching method to increase the students' knowledge (p = 0.001) and skill (p < 0.001) levels; this increase was significant. In addition, it was found that the students in the high-fidelity simulator group showed a significant decrease in anxiety scores compared to the students who were trained with traditional education method (p < 0.001).

CONCLUSIONS

The results showed that the use of high-fidelity simulator in nursing education was more effective than traditional method in terms of improving the students' knowledge, skill levels for cardiac auscultation and reducing their anxiety.

Developmental Trajectories of Anxiety and Depression Symptoms from Early to Middle Childhood: a Population-Based Cohort Study in the Netherlands

Developmental patterns of anxiety and depression symptoms in early childhood have previously been related to anxiety and mood disorders in middle childhood. In the current study, trajectories of anxiety and depression symptoms (1.5-10 years) were related to children's broader psychosocial and school-related functioning at 10 years. We included a population-based sample of 7499 children, for whom primary caregivers reported anxiety and depression symptoms on the Child Behavior Checklist, at children's ages of 1.5, 3, 6, and 10. Growth Mixture Modeling identified four distinct, gender-invariant, trajectories of anxiety and depression symptoms: low (82.4%), increasing (7.4%), decreasing (6.0%), and increasing symptoms up to age 6 followed by a decrease to age 10 (preschool-limited, 4.2%). Children with a non-Dutch ethnicity had lower odds to be in the increasing trajectory and higher odds to be in the decreasing and pre-school limited trajectory. Also, low maternal education predicted the decreasing and pre-school limited trajectory. Higher levels of psychopathology during pregnancy for both mothers and fathers predicted the increasing, decreasing, and preschool-limited trajectory, compared to the low trajectory. At age 10, children in the increasing and preschool-limited trajectory had diminished psychosocial outcomes (friendship-quality and self-esteem) and worse school-related outcomes (school performance and school problems). This study adds to current knowledge by demonstrating that developmental patterns of anxiety and depression symptoms in early childhood are related to broader negative outcomes in middle childhood. Child and family factors could guide monitoring of anxiety and depression symptoms in the general population and provide targets for prevention programs.

How well do cancer survivor self-classifications of anxiety, depression and stress agree with a standardised tool? Results of a cross-sectional study

BACKGROUND

There is poor uptake of psychosocial interventions offered to people with cancer who record high scores on distress screening scales. Intervention uptake may be influenced by a mismatch between consumer (bottom-up) and professional (top-down) paradigms of wellbeing. The current research aims to compare cancer survivors' 'self-judgements' about their levels of anxiety, depression and stress, to classifications derived via a professional-driven measure, the Depression, Anxiety and Stress Scale (DASS-21).

METHODS

A cross-sectional study was undertaken with haematological cancer survivors recruited from three population-based cancer registries in Australia. Consenting participants were mailed a questionnaire package; and non-responders received a second questionnaire package after 3-weeks and a reminder call after 6-weeks. The consumer-driven perspective was assessed via three separate single items asking survivors to self-classify their levels of anxiety, depression and stress over the past week on a scale from 'normal' to 'extremely severe'. The professional-driven classification was assessed via the DASS-21. Kappa statistics were used to assess agreement between consumer- and professional-driven measures.

RESULTS

Of 2,971 eligible haematological cancer survivors, 1,239 (42%) provided written consent and were mailed a questionnaire package. Of these, 984 (79%) returned a completed questionnaire. The simple kappa for agreement between the DASS-21 and self-classified measures for anxiety was 0.47 (95% CI: 0.39 to 0.54, p<0.0001). The weighted kappa for agreement between the DASS-21 and self-classified measures of depression was 0.60 (95% CI: 0.53 to 0.67, p<0.0001) and for measures of stress was 0.51 (95% CI: 0.44 to 0.59, p<0.0001).

CONCLUSIONS

Moderate agreement between self-classification and professional-driven assessments was found. The value of screening is predicated on the assumption that those with identified needs will be offered and take up services that will benefit them. Our results suggest that to improve the utility of distress screening it may be important to include assessment of survivor views about their symptoms.

An open trial of meaning-centered grief therapy: Rationale and preliminary evaluation

OBJECTIVE

To determine the preliminary feasibility, acceptability, and effects of Meaning-Centered Grief Therapy (MCGT) for parents who lost a child to cancer.

METHOD

Parents who lost a child to cancer and who were between six months and six years after loss and reporting elevated levels of prolonged grief were enrolled in open trials of MCGT, a manualized, one-on-one cognitive-behavioral-existential intervention that used psychoeducation, experiential exercises, and structured discussion to explore themes related to meaning, identity, purpose, and legacy. Parents completed 16 weekly sessions, 60-90 minutes in length, either in person or through videoconferencing. Parents were administered measures of prolonged grief disorder symptoms, meaning in life, and other assessments of psychological adjustment preintervention, mid-intervention, postintervention, and at three months postintervention. Descriptive data from both the in-person and videoconferencing open trial were pooled.ResultEight of 11 (72%) enrolled parents started the MCGT intervention, and six of eight (75%) participants completed all 16 sessions. Participants provided positive feedback about MCGT. Results showed postintervention longitudinal improvements in prolonged grief (d = 1.70), sense of meaning (d = 2.11), depression (d = 0.84), hopelessness (d = 1.01), continuing bonds with their child (d = 1.26), posttraumatic growth (ds = 0.29-1.33), positive affect (d = 0.99), and various health-related quality of life domains (d = 0.46-0.71). Most treatment gains were either maintained or increased at the three-month follow-up assessment.Significance of resultsOverall, preliminary data suggest that this 16-session, manualized cognitive-behavioral-existential intervention is feasible, acceptable, and associated with transdiagnostic improvements in psychological functioning among parents who have lost a child to cancer. Future research should examine MCGT with a larger sample in a randomized controlled trial.

Alexithymic traits can explain the association between puberty and symptoms of depression and anxiety in adolescent females

Symptoms of internalizing disorders such as depression and anxiety increase in adolescence, especially in females. However, gender differences in depression and anxiety symptoms emerge only after puberty onset. Levels of alexithymia, characterized by difficulties identifying and describing one's emotions, are elevated in depression and anxiety, and fluctuate across adolescence in a gender-specific manner. This study investigated changes in alexithymia across adolescence, and explored the potential role of alexithymia in the development of depression and anxiety, separately for females and males. Accordingly, 140 adolescents aged 11 to 21 years (77 female) completed self-report measures of alexithymia, depression and anxiety, and pubertal development. For females alone, pubertal maturation was associated with alexithymic traits (specifically difficulties identifying and describing feelings), as well as symptoms of depression and anxiety. After accounting for alexithymia, the relationship between puberty and depression and anxiety was absent or reduced in females. Thus, alexithymic traits may have differential consequences for males and females, and possibly contribute towards increased depression and anxiety symptoms in females during adolescence. We propose that developmental changes in alexithymia should be considered when studying the onset and development of internalizing psychological disorders during adolescence.

Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18 to 38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits.

Determining Anxiety in Obsessive Compulsive Disorder through Behavioural Clustering and Variations in Repetition Intensity

BACKGROUND AND OBJECTIVES

Over the last decade, the application of computer vision techniques to the analysis of behavioural patterns has seen a considerable increase in research interest. One such interesting and recent application is the visual behavioural analysis of mental disorders. Despite the very recent surge in interest in this area, relatively little has been done thus far to assist individuals living with Obsessive Compulsive Disorder. The work proposed herein represents a proof of concept system designed to demonstrate the efficacy of such an approach, from the computational perspective. The specific focus of this work lies in demonstrating a mechanism for clustering different kinds of Obsessive Compulsive Disorder behaviours and then comparing new behaviours to existing behaviours to determine the approximate level of anxiety represented by a compulsive behaviour.

METHODS

The proposed system uses Temporal Motion Heat Maps, SURF descriptors, a visual bag of words model and SVM-based classification to categorise representations of various behaviours commonly seen in OCD. Moreover, we apply a set of statistical measures to the images in a given category in order to derive an approximate anxiety level for a given compulsive behaviour. This proof of concept is an essential step in the direction of integrating computational approaches into the treatment of psychiatric conditions such as Obsessive Compulsive Disorder, for more effective recovery.

RESULTS

Results gleaned from experimental simulations indicate that the proposed system is capable of correctly classifying different types of simulated Obsessive Compulsive Disorder behaviour classes 75% of the time, with the misclassifications almost exclusively occurring when two behavioural clusters appear highly similar. Based on this information the proposed system is then able to assign an approximate behavioural anxiety level to the compulsive behaviours that meets the approval of a mental health professional.

CONCLUSIONS

The proposed system demonstrates a good ability to categorise various types of simulated OCD behaviour, in addition to establishing an approximate anxiety level for a given compulsive behaviour. This research demonstrates strong potential for the use of such systems in assisting mental health professionals looking to better understand their patients' condition and treatment progress across time.

Profiles of internalizing and externalizing symptoms associated with bullying victimization

This study identified profiles of internalizing (anxiety and depression) and externalizing (delinquency and violence against peers) symptoms among bullying victims and examined associations between bullying victimization characteristics and profile membership. The sample consisted of 1196 bullying victims in grades 8-10 (Mage = 14.4, SD = 1.01) who participated in The Context Study in three North Carolina counties in Fall 2003. Five profiles were identified using latent profile analysis: an asymptomatic profile and four profiles capturing combinations of internalizing and externalizing symptoms. Associations between bullying characteristics and membership in symptom profiles were tested using multinomial logistic regression. More frequent victimization increased odds of membership in the two high internalizing profiles compared to the asymptomatic profile. Across all multinomial logistic regression models, when the high internalizing, high externalizing profile was the reference category, adolescents who received any type of bullying (direct, indirect, or dual) were more likely to be in this category than any others.

Anxiety After Stroke: The Importance of Subtyping

BACKGROUND AND PURPOSE

Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack.

METHODS

We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale.

RESULTS

Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45-0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94-9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3-5, [anxiety] 55% versus [no anxiety] 29%; P<0.0005), had poorer quality of life on EQ-5D5L, and restricted participation (Work and Social Adjustment Scale: median, interquartile range, [anxiety] 19.5, 10-27 versus [no anxiety] 0, 0-5; P<0.001).

CONCLUSIONS

Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety.

Subtypes of suicide attempters based on longitudinal childhood profiles of co-occurring depressive, anxious and aggressive behavior symptoms

Because suicide attempts are multi-determined events, multiple pathways to suicidal behaviors exist. However, as a low-frequency behavior, within group differences in trajectories to attempts may not emerge when examined in samples including non-attempters. We used longitudinal latent profile analysis to identify subtypes specific for suicide attempters based on longitudinal trajectories of childhood clinical symptoms (i.e., depression, anxiety, and aggression measured in 2nd, 4th-7th grades) for 161 young adults (35.6% male; 58.6% African American) who attempted suicide between ages 13-30 from a large, urban community-based, longitudinal prevention trial (n = 2311). Differences in psychiatric diagnoses, suicide attempt characteristics, criminal history and traumatic stress history were studied. Three subtypes emerged: those with all low (n = 32%), all high (n = 16%), and high depressive/anxious, but low aggressive (n = 52%) symptoms. Those with the highest levels of all symptoms were significantly more likely to report a younger age of suicide attempt, and demonstrate more substance abuse disorders and violent criminal histories. Prior studies have found that childhood symptoms of depression, anxiety and aggression are malleable targets; interventions directed at each reduce future risk for suicidal behaviors. Our findings highlight the link of childhood aggression with future suicidal behaviors extending this research by examining childhood symptoms of aggression in the context of depression and anxiety.

Urdu translation and validation of GAD-7: A screening and rating tool for anxiety symptoms in primary health care

OBJECTIVE

To translate and validate Generalized Anxiety Disorder -7scale in Urdu, for use in Pakistan in the primary healthcare setups.

METHODS

The validation study was conducted at the Combined Military Hospital, Gilgit, Pakistan, from February to May 2016.We followed a systematic six-step process to validate the Generalized Anxiety Disorder-7 scale in the target population. The instrument was translated independently and then fused together. Back-translation was followed by recommendations by an expert committee, and face validity improvement by a language expert. A pilot study was done to get user's feedback on the construct. Volunteers were administered the questionnaire for validation procedure, along with a well-being scale, at three different cities representing volunteers from four different administrative regions of Pakistan.

RESULTS

There were 285 volunteers in the study. Principal component exploratory factor analysis supported unidimensional structure of the scale with an eigenvalue of 5.18 and it explained 64.8% of the total variance. Total score on the scale was negatively correlated with positive effect (r = -0.44, p<0.001) and life satisfaction (r = -0.49, p<0.001) subscales of a the well-being scale, while it was positively correlated with the negative affect (r = 0.63, p<0.001) subscale of the same, indicating a good level of convergent and discriminate validity. Cronbach's alpha for the scale was 0.92 and split-half reliability was 0.82, revealing a good level of reliability.

CONCLUSIONS

The Generalized Anxiety Disorder -7 scale was found to be a validated, brief, self-administered Urdu tool to screen, rate, and monitor outcome of anxiety disorders in primary healthcare setups.

Worries and concerns of patients with multiple sclerosis: development of an assessment scale

This study examined the nature of worry in adult patients with multiple sclerosis (MS) in the UK. A measure of worry in MS was developed and the relationship between worry and standard scale measures of anxiety and depression was examined. Thirty-nine patients with MS and 40 controls completed the new worry scale (WQMS) that was psychometrically evaluated, together with the Penn State Worry Questionnaire (PSWQ), the Hospital Anxiety and Depression Scale (HAD) and a previously developed scale to assess self-efficacy in MS (SESMS). The scores for both anxiety ( t=2.34; p<0.05) and depression ( t=5.52; p<0.01) were higher in MS patients than controls, as was the new scale for worry - the WQMS. A factor analysis (explaining 65.73% of the variance) suggests that the worries of patients may be dichotomized into those concerned with the physical effects of the disease and those relating to the impact on social interaction, family relationships and daily activity in the home and/or work. Worry in patients with MS was associated with a decreased sense of being able to produce positive activities or effect positive outcomes (low self-efficacy). The questionnaire provides a framework for investigation in clinic of specific concerns and level of worry they engender.

A history of anxiety: from Hippocrates to DSM

This article describes the history of the nosology of anxiety disorders. Greek and Latin physicians and philosophers distinguished anxiety from other types of negative affect, and identified it as a medical disorder. Ancient Epicurean and Stoic philosophers suggested techniques to reach an anxiety-free state of mind that are reminiscent of modern cognitive psychology. Between classical antiquity and the late 19(th) century there was a long interval during which anxiety was not classified as a separate illness. However, typical cases of anxiety disorders kept being reported, even if under different names. In the 17(th) century, Robert Burton described anxiety in The Anatomy of Melancholy. Panic attacks and generalized anxiety disorder may be recognized in the "panophobias" in the nosology published by Boissier de Sauvages in the 18(th) century. Also, anxiety symptoms were an important component of new disease constructs, culminating in neurasthenia in the 19(th) century. Emil Kraepelin devoted much attention to the possible presence of severe anxiety in manic-depressive illness, thereby anticipating the "anxious distress" specifier of bipolar disorders in DSM-5. A pitfall to consider is that the meaning of common medical terms, such as melancholia, evolves according to places and epochs.

[An update on the conceptual and classification issues of anxiety, its neuroanatomy and problems of anxiolytic drug discovery]

Anxiety disorders are highly prevalent psychiatric diseases. In this short review we provide an overview of concepts of fear, anxiety and anxiety disorders. In addition, based on the recent literature, neuroanatomical structures involved in anxiety and functional/structural changes of these structures in anxiety disorders are also discussed. Furthemore, the pitfalls of anxiolytic drug discovery is also concerned in the paper.

Mood, anxiety and psychotic phenomena measure a common psychopathological factor

BACKGROUND

Psychotic phenomena are common in the general population but are excluded from diagnostic criteria for mild to moderate depression and anxiety despite their co-occurrence and shared risk factors. We used item response theory modelling to examine whether the co-occurrence of depressive, anxiety and psychotic phenomena is best explained by: (1) a single underlying factor; (2) two separate, uncorrelated factors; (3) two separate yet linked factors; or (4) two separate domains along with an underlying 'common mental distress' (CMD) factor. We defined where, along any latent continuum, the psychopathological items contributed most information.

METHOD

We performed a secondary analysis of cross-sectional, item-level information from measures of depression, anxiety and psychotic experiences in 6617 participants aged 13 years from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort and 977 participants aged 18 years from the ROOTS schools-based sample. We replicated results from one sample in the other and validated the latent factors against an earlier parental measure of mental state.

RESULTS

In both cohorts depression, anxiety and psychotic items were best represented as a bi-factor model with a single, unitary CMD factor on which psychotic items conveyed information about the more severe end (model 4); residual variation remained for psychotic items. The CMD factor was significantly associated with the prior parental measure.

CONCLUSIONS

Psychotic phenomena co-occur with depression and anxiety in teenagers and may be a marker of severity in a single, unitary dimension of CMD. Psychotic phenomena should be routinely included in epidemiological assessments of psychiatric morbidity, otherwise the most severe symptomatology remains unmeasured.

Pharmacotherapy of anxiety disorders in German-speaking countries: current status and changes between 1994 and 2011

Over the past years, international treatment guidelines have been established for the treatment of anxiety disorders. Nevertheless, little is known as to whether the actual inpatient treatment follows these guidelines. The main goal of this study was to answer the question whether patients with anxiety disorder are treated according to treatment guidelines. A total of 2,573 psychiatric inpatients with the diagnosis of anxiety disorder (920 men, 1,653 women) were identified on the basis of the data of the international drug safety programme in psychiatry AMSP. Of these patients, 25.3% presented with phobia, 26.6% with panic disorder, 18.7% with generalized anxiety disorder (GAD), and 29.4% with other diagnoses of anxiety. In all of the patients, 12.7% did not receive any psychotropic medication and 22.9% were not treated with antidepressants. Only 59.3% of patients with GAD, 73.9% of patients with panic disorder, and 52.1% of patients with phobia were treated according to diagnostic guidelines. The majority (60.3%) of all patients received one or two psychotropic drugs, and only 3.7% received five or more psychotropic drugs. In two groups of patients (one group with phobia and one with panic disorder), the annual prescription rate of antidepressants significantly increased over time. The prescription rate for anticonvulsants in patients with GAD increased from 0% in 1997 to 41.7% in 2011, and for antipsychotics, from 40.7% in 1997 to 47.2% in 2011. In particular, patients with GAD were commonly treated with antipsychotics.

Trajectories of depression and anxiety symptoms in adolescent girls: a comparison of parallel trajectory approaches

Longitudinal mixture models have become popular in the literature. However, modest attention has been paid to whether these models provide a better fit to the data than growth models. Here, we compared longitudinal mixture models to growth models in the context of changes in depression and anxiety symptoms in a community sample of girls from age 10 to 17. Model comparisons found that the preferred solution was a 5-class parallel process growth mixture model that differed in the course of depression and anxiety symptoms reflecting both ordering of symptoms and qualitative group differences. Comparisons between classes revealed substantive differences on a number of outcomes using this solution. Findings are discussed in the context of clinical assessment and implementation of growth mixture models.

Application of the tripartite model to a complicated sample of residential youth with externalizing problems

The tripartite model of anxiety and depression has received strong support among child and adolescent populations. Clinical samples of children and adolescents in these studies, however, have usually been referred for treatment of anxiety and depression. This study investigated the fit of the tripartite model with a complicated sample of residential youths with externalizing problems. Structural Equation Modeling was used to test the tripartite model relationships between negative affect, positive affect, and mood symptoms. Multiple fit indices were used to provide a reliable and conservative evaluation of the model. As predicted, the tripartite model provided a good fit for symptoms of emotional disorders in this complicated sample of children and adolescents. Implications of these findings are discussed in terms of the utility of the tripartite model in understanding anxiety and depression in more diverse populations and recommendations for residential assessment.

[Characteristics of central nervous system activity in patients with complications of arterial hypertension and dependence on psychomotor status and treatment]

Changes in certain CNS characteristics were used as indicators of the efficacy of antihypertensive therapy (AHT) both targeted (T-AHT) and empirical (E-AHT) designed to suppress activity of the sympathetic component of vegetative nervous system (VNS) and renin-angiotensin-aldosterone system (RAAS) in patients of different psychic status and AH. A group of 835 men (mean age 54.2+-1.8yr) was divided into cholerics, sanguinics, melancholics and phlegmatics with a high and low anxiety level (HA and LA). 416 healthy men served as controls. The following parameters were estimated: mobility of cortical processes, balance between sympathetic and parasympathetic activities, blood corrisol and aldosterone levels, oxygen utilization coefficient, resistance to breath holding, severity of dyscirculatory encephalopathy and the fraction of patients with AH complications during 12 month T-AHT for the suppression of sympathetic activity in cholerics and sanguinics by beta-adrenoblockers and PAA C- ACE inhibitors in phlegmatics and melancholics and during E-AHT (ACE inhibitors in cholerics and sanguinics, BAB in phlegmatics and melancholics). The functional activity of CNS in phlegmatics and melancholics before and during AHT was lower and severity of encephalopathy and the number ofAH complications higher than in cholerics and sanguinics. . The changes wiere more pronounced in patients with HA than in those with LA. Unlike E-AHT T-AHT (anxiolytics for cholerics and sanguinics with HA, antidepressants for phlegmatics and melancholics with HA) normalized the study parameters and decreased the frequency of complications by 2-3 times.

Audiovisual material as educational innovation strategy to reduce anxiety response in students of human anatomy

This study presents the design, effect and utility of using audiovisual material containing real images of dissected human cadavers as an innovative educational strategy (IES) in the teaching of Human Anatomy. The goal is to familiarize students with the practice of dissection and to transmit the importance and necessity of this discipline, while modulating their anxiety. The study included 303 first-year Human Anatomy students, randomly assigned to two groups (Traditional and Educational Innovation). Their state of anxiety was measured using the State-Trait-Anxiety Inventory. Repeated measures ANOVA with between-subject factors was applied. The between-subject factor was Educational Innovation (EI). Two levels were established for this factor. The within-subject factor was Time, four levels being considered here. The results show that the effects of the Educational Innovation factor, Time factor and EI × Time interaction were statistically significant. These results provide an additional element of efficacy to the use of videos as an IES. That is, the use of video material as an introduction into an anxiety-provoking situation which resembles real-life viewing and interaction with human cadavers for the first time significantly diminishes the anticipatory reaction of dread against which novel students have not had the opportunity to develop any cognitive strategy of emotional control.

Effect of a procedural video CD and study guide on the practical fixed prosthodontic performance of Iranian dental students

Dental students in programs around the world typically pass preclinical courses before entering the clinic and working on actual patients. Since fixed prosthodontics is a preclinical course that requires a great deal of effort, students may experience a substantial amount of stress that may affect their self-confidence and/or clinical performance. In this study, an instructional video CD (VCD) and study guide depicting the step-by-step procedures involved in a metal-ceramic tooth preparation and provisional crown fabrication was prepared. Students at the Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran, were divided randomly into two groups. Group A students trained as usual with live patients, and Group B students were given a copy of the VCD and study guide following a lecture. The students in Group B were encouraged to read the study guide and watch the VCD after live demonstrations. Then, both groups practiced individually on mannequins. At the end of the course, the students completed a sixteen-item questionnaire about their stress level, self-confidence, and knowledge base. The results showed that the students exposed to the extra media performed significantly better on some practical phases, e.g., laboratory procedures. A moderate, insignificant correlation was detected between exposure to media and decreasing the students' stress and self-esteem. We concluded that supplementary teaching aids such as a VCD and study guide may improve the clinical performance of dental students to some extent, but the live demonstration is still preferred by students.

Utility of bispectral index monitoring during intravenous sedation in the dental office

PURPOSE

This research sought to compare two different systems to monitor sedated patients undergoing implant surgery in the dental office: the bispectral index (BIS) and the Ramsay scale. This information was used to establish an optimal BIS range for surgery in these patients and to calculate differences in drug consumption in both groups.

MATERIALS AND METHODS

Consecutive patients undergoing implant surgery were studied and randomly assigned to two groups. Patients were sedated using intravenous propofol, fentanyl, and midazolam. The sedation level in group A was measured using the Ramsay scale. In group B, the Ramsay scale and the BIS were used together. Heart rate, blood pressure, and peripheral oxygen saturation were monitored in all patients. The levels of anxiety, satisfaction, and drug consumption were compared between groups.

RESULTS

Forty-three patients were included; 20 were placed in group A and 23 were included in group B. There were no differences in the hemodynamic and respiratory parameters monitored or in anxiety or satisfaction levels in both groups. In group B patients, the BIS values stabilized around 85; the Ramsay scale stabilized around 3 in both groups and remained at these levels until the end of the procedure. Drug consumption was significantly lower in the BIS group.

CONCLUSION

The optimal BIS value during intravenous sedation in sedated ambulatory patients in dental surgery should be within the 80 to 85 range. BIS monitoring allows for reduced consumption of propofol, fentanyl, and midazolam.

Development of a measure of the concerns held by people with implanted cardioverter defibrillators: The ICDC

OBJECTIVES

To develop a questionnaire to measure the extent and severity of the concerns of people with an implanted cardioverter defibrillator.

DESIGN

Items were generated from patient interviews, expert review and the research literature on patients' worries and concerns. A pilot version was administered to a series of ICD patients and repeated for test-retest reliability 6 weeks later. Psychometric tests including the screen test, factor analysis and various reliability assessments were undertaken. It was predicted that the greater the extent and severity of concerns, the greater the anxiety experienced by the ICD patient. Scores were compared with a validated measure of anxiety and depression administered at the same time.

RESULTS

Fifty-seven (64%) patients completed and returned the questionnaire and a further 22 (100% of those asked) completed the 6-week retest. Reliability and validity appeared to be good and two factors were identified. Both total score and the individual factor scores correlated moderately with anxiety.

CONCLUSIONS

The questionnaire appears to reflect patients' concerns and, as predicted, these were associated with the patients' anxiety level. The scale requires further testing to reveal if it is of use both clinically and for research purposes.

[Anxiety, depression and polymorphism of the gene encoding superoxide dismutase in patients with chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is a severe systemic disease leading to circulatory and respiratory failure. COPD is also a risk factor for the onset of anxiety and mood disturbances. Identification of the correlates of emotional disturbances in the course of COPD can make it possible, on the one hand, to prevent mental and behavioral disorders early in the course of this serious somatic disease, and on the other hand, to institute appropriate treatment. The aim of the study was to determine the correlation between the polymorphism of manganese superoxide dismutase signal peptide and the severity of anxiety and depression in COPD patients.

MATERIAL AND METHODS

The study group consisted of 57 patients with grade I, II and III COPD according to GOLD criteria. The control group consisted of 63 healthy nicotine addicts. In all the subjects, the genotype of position 9 of manganese superoxide dismutase signal peptide was determined, depression severity was measured with Beck Depression Scale, and anxiety as a trait and as a state was measured with Spielberg State/Trait Anxiety Inventory (STAI).

RESULTS

Among COPT patients, 16 subjects were found to have Ala/Ala genotype, 23 Val/Ala and 18 Val/Val. In the smokers' group Ala/Ala genotype was found in 29 cases, Val/Ala in 27 and Val/Val in 7. The distribution of genotype frequencies differed between the groups. In COPD patients, the mean depression severity assessed according to Beck Scale amounted to (16.52 +/- 5.63) and was higher than in smokers without COPD (13.85 +/- 4.24, p = 0.003828). The average severity of anxiety as a trait and as a state did not differ significantly in both groups. Among COPD patients, the mean severity of depressive disorders in subjects with Val/ Val genotype was 21.27 +/- 4.32 and was significantly higher than in those with Val/Ala (15.22 +/- 5.29) and Ala/Ala (12.87 +/- 3.72) genotypes. The severity of anxiety as a trait in COPD patients reached 7.72 +/- 1.21 in the subgroup with Val/Val genotype and was also higher than in those with Val/Ala genotype (6.69 +/- 1.48) and with Ala/Ala genotype (5.87 +/- 1.14). A similar correlation was observed for anxiety as a state (subjects with Val/Val genotype 6.78 +/- 1.06, with Val/Ala genotype 6.18 +/- 1.01 and with Ala/ Ala genotype 5.88 +/- 1.41). Among healthy smokers, the mean severities of depression, anxiety as a trait and anxiety as a state did not differ in subjects with different genotypes.

CONCLUSIONS

The study has demonstrated that the severity of depression is higher in COPD patients than in the group of healthy smokers. In the group of patients with COPD, Val/Val genotype at position 9 of MnSOD signal peptide is associated with more severe depression, anxiety as a trait and anxiety as a state in comparison with patients who have Val/Ala and Ala/Ala genotypes. No similar correlations were found in healthy smokers.

How an age of anxiety became an age of depression

CONTEXT

During the 1950s and 1960s, anxiety was the emblematic mental health problem in the United States, and depression was considered to be a rare condition. One of the most puzzling phenomena regarding mental health treatment, research, and policy is why depression has become the central component of the stress tradition since then.

METHODS

This article reviews statistical trends in diagnosis, treatment, drug prescriptions, and textual readings of diagnostic criteria and secondary literature.

FINDINGS

The association of anxiety with diffuse and amorphous conceptions of "stress" and "neuroses" became incompatible with professional norms demanding diagnostic specificity. At the same time, the contrasting nosologies of anxiety and depression in the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) extended major depressive disorder to encompass far more patients than any particular anxiety disorder. In addition, antidepressant drugs were not associated with the stigma and alleged side effects of the anxiolytic drugs.

CONCLUSION

Various factors combined between the 1970s and the 1990s to transform conditions that had been viewed as "anxiety" into "depression." New interests in the twenty-first century, however, might lead to the reemergence of anxiety as the signature mental health problem of American society.

[Distorted cognition of bodily sensations in subtypes of social anxiety]

The purpose of this study was to investigate the relationship between subtypes of social anxiety and distorted cognition of bodily sensations. The package of questionnaires including the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) was administered to 582 undergraduate students. To identify subtypes of social anxiety, cluster analysis was conducted using scores of the SPS and SIAS. Five clusters were identified and labeled as follows: Generalized type characterized by intense anxiety in most social situations, Non-anxious type characterized by low anxiety levels in social situations, Averaged type whose anxiety levels are averaged, Interaction anxiety type who feels anxiety mainly in social interaction situations, and Performance anxiety type who feels anxiety mainly in performance situations. Results of an ANOVA indicated that individuals with interaction type fear the negative evaluation from others regarding their bodily sensations whereas individuals with performance type overestimate the visibility of their bodily sensations to others. Differences in salient aspects of cognitive distortion among social anxiety subtypes may show necessity to select intervention techniques in consideration of subtypes.

Prediction of postoperative pain after mandibular third molar surgery

AIMS

To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS).

METHODS

Following ethical committee approval and informed consent, 40 consecutive patients scheduled for MTMS were included. Preoperative psychometric indicators of anxiety, depression, and vulnerability were evaluated by patient questionnaires. Thermal thresholds and heat pain perception (1 second phasic stimuli: 44 degrees C to 48 degrees C) were evaluated with quantitative sensory testing techniques. Standardized surgery was performed during local anesthesia. Postoperative pain management was with rescue paracetamol and ibuprofen. The patients were instructed to record each day their pain at rest and during dynamic conditions, and their requirement of analgesics for 14 days following surgery.

RESULTS

Thirty-eight patients completed the study. Eight patients were readmitted because of pain. During the postoperative period, one or more episodes of moderate to severe pain (> 30 on a visual analog scale) was reported by 60% (23/38) at rest, 63% (24/38) during mouth-opening, and 73% (28/38) during eating. In a multiple regression model, the combination of psychological vulnerability and heat pain perception rendered a predictive model that could account for 15 to 30% of the variance in postoperative pain during resting and dynamic conditions (P = .03 to .001).

CONCLUSION

Implementation of clinically relevant preoperative screening methods may offer more efficacious postoperative pain therapies to pain-susceptible individuals undergoing mandibular third molar surgery. J Orofac Pain 2010;24:189-196.

[Evaluation of anxiety and depression levels in patients with myocardial infarction]

OBJECTIVES

Patients with myocardial infarction (MI) may experience anxiety and depression. This study was designed to determine anxiety and depression levels in patients with MI.

STUDY DESIGN

The study included 506 patients (199 women, 307 men; mean age 55.7+/-6.9 years) who were admitted to the cardiology department for MI. Data were collected using a questionnaire to identify patient characteristics and the Hospital Anxiety and Depression Scale (HADS). The HADS has been validated as a sensitive screening tool for anxiety and depression in MI patients in the Turkish population.

RESULTS

Clinically severe anxiety was found in all the patients (100%). Depression scores showed a clinically normal level in 45 patients (8.9%), borderline level in 289 patients (57.1%), and severe level in 172 patients (34%). The mean HADS score was 11.4+/-2.9, being 12.2+/-4.1 and 10.6+/-4.1 for anxiety and depression, respectively. Among patient characteristics, age was significantly associated with both anxiety and depression subscales (p<0.001), and education level (p<0.05), total family income (p<0.01), health insurance (p<0.05), and the number of myocardial infarctions (p<0.05) were significantly associated with the depression subscale. In regression analysis, age (beta=-0.128), education level (beta=0.082), and working status (beta=-0.79) independently affected both anxiety and depression, and total family income (beta=-0.128) and health insurance (beta=-0.086) significantly affected depression.

CONCLUSION

Our data suggest that planning nursing interventions to decrease anxiety and depression levels and implementation of cardiac rehabilitation programs are of particular importance in patients with MI.

[Measurement of anxiety with C.D. Spielberger's test in patients with cardiac arrhythmias]

INTRODUCTION

Atrial fibrillation is a common supraventrical arrhythmia. The onset of fibrillation is marked by fear of loss of health or life. Symptoms of depression occur concurrently. This study was undertaken to measure anxiety in patients with atrial fibrillation grouped according to gender, age, and education.

MATERIAL AND METHODS

The test anxiety inventory of C.D. Spielberger was administered to 52 patients aged 41 to 80 years, treated for atrial fibrillation at the Internal Ward of the District Hospital in Białogard.

RESULTS

Anxiety as a state was observed more frequently in males and in patients with vocational and secondary education. Anxiety was not a trait of atrial fibrillation. Psychotherapeutic interventions used in cardiac rehabilitation are not recommended in atrial fibrillation. However, relaxation techniques could be of benefit in reducing the intensity of anxiety as a state.

[Assessment of anxiety in women during puerperium]

PURPOSE

Many women experience various emotional disorders during puerperium characterized by high levels of anxiety.

THE AIM OF THIS STUDY

To analyse the level of anxiety in women during puerperium depending on age, education, marital status, number of pregnancies, route of delivery, and family situation.

MATERIAL AND METHODS

We enrolled 120 women between day 10 and 15 of puerperium without any previous psychiatric disorders. Pregnancy, delivery, and puerperium were without any morbidity and the newborns were healthy. The level of anxiety was measured using C. D. Spilberger's State-Trait Anxiety Inventory (STAI).

RESULTS

The level of anxiety as a trait in women during puerperium was within normal limits, whereas the level of anxiety as a state was elevated. Primipara and women up to 20 years of age require special attention during psycho-preventive treatment due to increased level of anxiety as a trait during puerperium. Employment and family situation determine the level of anxiety as a state after delivery.

CONCLUSIONS

Identification of women with a higher level of anxiety as a state during puerperium may provoke early medical intervention in this group of women and thus contribute to improvement in the quality of life of the woman and conditions for future development of the neonate.

Will a 1-page informational handout decrease patients' most common fears of anesthesia and surgery?

OBJECTIVE

The objective of this study was to determine whether an informational handout alone could measurably reduce some of the most common fears patients have about anesthesia and surgery.

DESIGN

An anonymous, volunteer survey package consisting of demographic information, a 1-page informational handout discussing common fears that patients have, and 2 identical surveys that assessed the patients' level of fear before and after reading the handout.

SETTING

Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas.

PARTICIPANTS

A total of 387 random volunteer patients awaiting their clinic visit with a provider in the Anesthesiology Pre-Operation Clinic of Wilford Hall Medical Center properly filled out the survey package.

METHODS

Patients were asked to rate their fears with respect to (1) the qualification of their anesthesia providers, and the potential for (2) death or serious illness, (3) awareness, (4) postoperative pain, (5) access to pain medications postoperatively, and (6) postoperative nausea and vomiting. The patients rated their fears for each of the 6 categories using a Likert scale as either none, mild, moderate, or severe, which corresponded to scores of 0, 1, 2, or 3, respectively, for a maximum fear score of 18. The patients were then asked to read a 1-page objective informational handout that addressed each of these potential fears. After reading the informational handout, the patients then repeated the fear survey.

RESULTS

Three hundred eighty-seven patients properly completed the survey packages. There were 160 (41.3%) patients who demonstrated a reduction in fear scores, with a 49.6% (p < 0.001) reduction between the mean initial fear score of 6.81 (CI 6.11 to 7.52) and mean final scores of 3.43 (CI 2.84 to 4.02). The most commonly reported fear was death (n = 196, 50.6%), and those patients with no prior surgeries (n = 63, 17.3%) had the highest initial mean fear score of 5.13 (CI 3.79 to 6.37) and the largest reduction in their fear score with 36.1% (p < 0.001). Those patients between the ages of 26 years old and 39 years old had the high initial mean fear score of 5.39 (CI 4.37 to 6.30), whereas patients under the age of 25 years old had the largest reduction in their fear score with 37.6% (p < 0.001). Subset analysis of patients whose mean fear scores were reduced after reading the handout were found to have statistically significant higher initial mean fear scores and a larger overall reduction in fear scores. Neither initial fear scores nor a reduction in fears scores were found to correlate with the type of surgery a patient was planning to have.

CONCLUSION

With just over 40% of patients demonstrating a statistically significant reduction in their fear levels, consideration should given to making an informational handout available on a routine basis to patients in preoperative anesthesia and surgical clinics. Additionally, it seems that younger patients (under the age of 40 years old) and those with no prior surgeries are the most likely to benefit from such a handout.

A prospective test of anxiety sensitivity as a moderator of the relation between gender and posttraumatic symptom maintenance among high anxiety sensitive young adults

The primary aim of this study was to evaluate the individual and combined influence of anxiety sensitivity (AS) and gender on the longitudinal prediction of posttraumatic symptoms. A large nonclinical sample of young adults (n=404) was prospectively followed over approximately 18 months. The primary findings indicated that gender and AS were uniquely associated with posttraumatic symptom levels during the follow-up period. Moreover, AS appeared more strongly (positively) related to posttraumatic stress symptoms during the follow-up period among females than males. These data provide novel prospective evidence regarding the interplay of relatively well-established risk factors implicated in the maintenance of posttraumatic stress symptoms.

[Remitted anxiety states: a specific variant of generalized anxiety disorder]

Two hundreds and four patients with generalized anxiety disorder (GAD) have been divided into 2 groups: 107 patients with remitted course (a main group) and 97 patients with the typical development of GAD (a comparison group). It has been shown that the main group is characterized by the lower intensity of anxiety affect and reactivity and the lesser duration of exacerbations. The remissions, when the tension of anxiety is completely absent or has a subclinical character, last from 2-3 weeks to 2-3 months. In the treatment, patients with remitted disorders prefer psychotherapy (44,9%) or combined therapy (psychotherapy and pharmacotherapy) - 38,85% of cases. Despite of some peculiarities remitted anxiety disorders should be considered as a variant of GAD thus confirming their unity.

General beliefs about the world as defensive mechanisms against death anxiety

Death ideation and death anxiety represent the cognitive and affective dimensions of death attitudes, respectively. General beliefs about the world are proposed to be useful defensive mechanisms protecting persons against the death anxiety provoked by death ideation. SEM is employed to test the proposed mediation model, using a sample of 133 Hong Kong Chinese university students. Results showed that death ideation was significantly and inversely linked to belief in social cynicism, reward for application, and fate control. Moreover, higher levels of belief in fate control and lower levels of religiosity predicted greater death anxiety. Only belief in fate control partially mediated the relationship between death ideation and death anxiety. Discussion focused on how social axioms serve as useful defensive mechanisms against death anxiety.

A typology of behavior problems in preschool children

The purpose of this study was to produce a typology of behavior problems in preschool children. Distinct subtypes were identified through the use of cluster analytic techniques on data from the Behavior Assessment System for Children (BASC)-Parent Rating Scales. Analyses were based on archival data collected on a sample of 268 children, aged 2 to 5 years, who were referred to determine their suitability for a day treatment program. Five distinct and reliable subtypes of preschool children's behavior problems emerged. Ratings of adaptive and social skills based on the BASC Adaptive Scales and measures from the Parenting Stress Index served as external variables to assess the distinctiveness of the derived subtypes. The findings provide evidence for the reliability and validity of the subtypes identified in this study that are consistent with the findings of previous subtyping investigations focusing on school-aged children.

"The rust of life": impact of anxiety on cardiac patients

Anxiety has both functionally appropriate and inappropriate consequences. Among patients with cardiac disease, anxiety can be functionally appropriate when it prompts an individual to quickly seek treatment for acute cardiac signs and symptoms. But anxiety may have medical or psychological consequences when it is persistent or severe, including difficulty adhering to prescribed treatments and making recommended lifestyle changes, adoption of or failure to change risky behaviors, increased risk for acute cardiac events, and increased risk for in-hospital complications after admission for acute coronary syndrome. Yet, because anxiety is a universal emotion that is managed without consequence by many people, its importance is often ignored by healthcare providers. The impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes was examined systematically. The research included (1) examination and comparison of the intensity of anxiety in international samples of various critically, acutely, and chronically ill cardiac patients; (2) determination of differences between men and women in the expression of anxiety; (3) investigation of factors predictive of anxiety levels, including perceived control; (4) studies of healthcare providers' knowledge of anxiety assessment and providers' practices in assessing and managing anxiety; and (5) determination of the impact of anxiety on clinical outcomes in cardiac patients. The goal of this program of research is to improve patients' outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.

Child-rearing anxiety and its correlates among Japanese mothers screened at 18-month infant health checkups

OBJECTIVE

To examine the level of child-rearing anxiety and to explore the variables correlated with child-rearing anxiety in a city in Japan.

DESIGN

Cross-sectional study.

SAMPLE

From July to September 2003, 371 mothers who visited community health centers in a city in Tokyo Metropolis for their child's 18-month health checkups.

MEASUREMENTS

Child-rearing anxiety was measured by the child-rearing anxiety scale. Questions in a self-reported questionnaire were on maternal variables, including maternal background information, child variables, and family system variables such as the presence of social support, and utilization of parenting support services. Also included within the questionnaire was the General Health Questionnaire-12.

RESULTS

Hierarchical multiple linear regression analysis revealed that mothers with higher child-rearing anxiety had less childcare satisfaction, more depressive symptoms, more worries about the child, less support from the husband, and less social support.

CONCLUSION

To identify mothers with high child-rearing anxiety in Japan, the infant health checkups should be utilized as an opportunity for screening, focusing on variables regarding mothers. Public health nurses can provide the necessary support after gaining an understanding of issues confronting mothers to prevent child-rearing anxiety and child abuse.

Five-Factor Personality Dimensions, Mood States, and Cognitive Performance in Older Adults

In this study we examined the impact of personality traits and negative mood state on performance in several cognitive domains in a sample of 398 elderly community-dwelling individuals. Multiple linear regression analyses were used to examine the variance in cognitive measures explained by state depression and anxiety after controlling for the effects of demographic characteristics and five-factor model personality traits. Personality traits were found to contribute significantly to cognitive function, explaining 2-7% of the variance in ability across domains. Examination of the contributions of individual five-factor traits showed that Openness had a significant relationship with all indexes of verbal memory and with general cognitive ability. State anxiety and depression variables were found to play a very small part, however, in contributing to cognitive function.

The validity of DSM-IV passive-aggressive (negativistic) personality disorder

Passive-Aggressive (Negativistic) Personality Disorder (NEGPD), listed in Appendix B of the DSM-IV, is not an officially recognized personality disorder. Its future as a discrete disorder is uncertain (Widiger, 2003). Yet, NEGPD occupies a role in some theoretical formulations of personality pathology (Millon & Davis, 1996), and many clinicians believe that passive-aggressive traits are not adequately represented by other PDs (Westen, 1997). In this study, 1158 psychiatric outpatients were assessed for Axis I and Axis II disorders. Thirty-five (3.02%) met criteria for NEGPD. Participants with NEGPD did not differ significantly from those without NEGPD on demographic variables. The internal consistency of the DSM-IV's seven NEGPD items was 0.50. Corrected item- total correlations for the 7 criteria averaged 0.27. Participants with NEGPD had higher rates of lifetime anxiety disorders, and almost 90% had an additional PD. An exploratory factor analysis suggested a two- factor solution that accounted for 43.4% of the variance. The first factor reflected the belief that life is unfair, while the second factor seemed to reflect modes of anger expression. A confirmatory factor analysis showed that the two-factor model fit the data better than a unidimensional model. We discuss implications of these results for the future of the NEGPD diagnosis.

Development and validation of an Overall Anxiety Severity And Impairment Scale (OASIS)

Establishing severity and impairment associated with anxiety is important in many settings. We developed a brief (five-item) continuous measure, the Overall Anxiety Severity and Impairment Scale (OASIS), which can be used across anxiety disorders, with multiple anxiety disorders, and with subthreshold anxiety symptoms. Seven hundred eleven college students completed the OASIS and additional self-report assessments of anxiety-related concerns and symptoms. A subset of students completed several measures again 1 month later. Results of a split-sample analysis suggested a single-factor structure, with all five items having salient loadings. The OASIS demonstrated excellent 1-month test-retest reliability, and convergent and divergent validity. The OASIS merits consideration as a brief measure of anxiety-related severity and impairment that can be used across anxiety disorders.

Digital imaging of patterns of dental wear to diagnose bruxism in children

OBJECTIVE

The aim of this study was to evaluate and compare the area, perimeter, and form (D factor and fractal dimension) of the dental wear among bruxist and nonbruxist children with mixed dentition in order to determine if the dental wear may be used as criteria to diagnose bruxism.

METHODS

The children were 8 to 11 years old and were classified as bruxist or nonbruxist, according to anxiety level and temporomandibular disorders. Dental casts of the upper arch were obtained for the bruxist (n = 24) and the control (n = 29) group. The dental wear was measured in digital format and processed automatically. The complete and pathological dental wear was compared between the two groups, using the Student's t-test and Mann-Whitney test.

RESULTS

Statistically significant differences were observed between the two groups, with a higher area, perimeter, and more irregular form of the pathological dental wear among the bruxist group. Regarding complete dental wear, differences were only significant for the D factor (an un-dimensional quantitative parameter which produces a relation between the area and the perimeter of an object).

CONCLUSION

Digital imaging of dental wear may be used as criteria to diagnose bruxism in children with mixed dentition after making an analysis of the area, perimeter, and irregularity of the form of pathological dental wear.