Generalized Anxiety Disorder (generalized + anxiety_disorder)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Irritable bowel syndrome is strongly associated with generalized anxiety disorder: a community study

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009
S. LEE
Summary Background, No previous study has examined the comorbidity of Irritable Bowel Syndrome (IBS) and Generalized Anxiety Disorder (GAD) in a general population using standardized diagnostic methods. Aim, To examine the prevalence, comorbidity and risk correlates of IBS and GAD in a general population. Methods, A random community-based telephone survey was conducted. The questionnaire covered symptoms of IBS, GAD, core depressive symptoms, help-seeking behaviour and functional impairment on the Sheehan Disability Scale. Results, A total of 2005 participants completed the interview. The current prevalence of IBS was 5.4% and the 12-month prevalence of GAD was 4%. GAD was five times more common among IBS respondents than non-IBS respondents (OR: 5.84, P < 0.001), whereas IBS was 4.7 times more common among GAD respondents than among non-GAD respondents (OR: 6.32, P < 0.001). Core depressive symptoms (OR: 6.25, P < 0.01) and education level (OR: 5.918, P = 0.021) were risk correlates of GAD among IBS respondents. Comorbid respondents were more impaired than respondents having either disorder alone, but were not more likely to seek professional help than IBS-only respondents. Conclusion, Irritable Bowel Syndrome and GAD comorbidity was common and added to impairment in the community. The strong association between psychiatric morbidity and IBS observed in referral centres was not a consequence of increased help-seeking behaviour. [source]


Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study

PSYCHO-ONCOLOGY, Issue 3 2007
Anja Mehnert
Abstract This study aimed at the identification of acute and post-traumatic stress responses, and comorbid mental disorders in breast cancer patients. Structured clinical interviews for DSM-IV (SCID) were conducted post-surgery with 127 patients (t1). Screening measures were used to assess post-traumatic stress responses, anxiety, and depression at t1 and at 6 months follow-up (t2). Based on the SCID, prevalence rates were 2.4% for both, cancer-related ASD and PTSD. Experiences most frequently described as traumatic were the cancer diagnosis itself and subsequent feelings of uncertainty. Patients with lifetime PTSD (8.7%) were more likely to meet the criteria for cancer-related ASD or PTSD (OR=14.1). Prevalence estimates were 7.1% for Adjustment Disorder, 4.7% for Major Depression, 3.1% for Dysthymic Disorder and 6.3% for Generalized Anxiety Disorder. Using the screening instruments, IES-R, PCL-C and HADS, we found PTSD in 18.5% at t1 and 11.2,16.3% at t2. The estimates of anxiety and depression reveal rates of 39.6% (t1) and 32.7% (t2) for anxiety, as well as 16.0% (t1) and 13.3% (t2) for depression (t1) (cut-off,8). The diagnosis of a life-threatening illness has been included as a potential trauma in the DSM-IV. However, it has to be critically evaluated whether subjective feelings of uncertainty like fears of treatment count among traumatic stressors, and thus, whether the diagnosis of PTSD is appropriate in this group of cancer patients. However, a large number of women with emotional distress illustrate the need for psychosocial counseling and support in this early treatment phase. Copyright © 2006 John Wiley & Sons, Ltd. [source]


Are the dysfunctional beliefs that predict worry different from those that predict obsessions?

CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 6 2007
Amparo Belloch
Chronic worry present in Generalized Anxiety Disorder (GAD) and obsessions characteristic of the Obsessive,Compulsive Disorder (OCD) are cognitive phenomena that share some features, but they also differ on others. Based on current cognitive approaches, dysfunctional meta-cognitive beliefs underlie the development and/or maintenance of both GAD and OCD. However, to date, there has been little empirical evidence about the differences between the beliefs that predict the occurrence of obsessions and those that predict worry. This study focuses on the search for these differences and examines to what extent worry and obsessions are associated with a similar or different pattern of dysfunctional cognitive contents. One hundred and seventy-five community subjects completed measures of worry and obsessional intrusive thoughts, as well as questionnaires assessing obsession-related and worry-related meta-cognitive beliefs. Results showed that beliefs about uncontrollability and danger, as well as cognitive self-consciousness, play a central role in predicting worry, whereas the beliefs concerning the importance of thoughts and Thought,Action Fusion probability are relevant in accounting for the frequency of obsessive intrusive thoughts.,Copyright © 2007 John Wiley & Sons, Ltd. [source]


Applying an Emotion Regulation Framework to Integrative Approaches to Generalized Anxiety Disorder

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2002
Douglas S. Mennin
Integrative conceptualizations like that proposed by Roemer and Orsillo provide exciting new directions for understanding and treating generalized anxiety disorder (CAD). However, these approaches may be further strengthened by adoption of an emotion regulation perspective. Persons with CAD may have difficulty understanding their emotional experience and may possess few skills to modulate their emotions. They may experience emotions as subjectively aversive and use worry and maladaptive interpersonal behaviors as defensive strategies to control, avoid, or blunt emotional experience. An emotion regulation perspective suggests adding treatment components to help clients become more comfortable with arousing emotional experience, more able to access and utilize emotional information in adaptive problem solving, and better able to modulate emotional experience and expression according to contextual demands. [source]


A Multicenter, Placebo-Controlled, Double-Blind, Randomized Study of Efficacy and Safety of Ocinaplon (DOV 273,547) in Generalized Anxiety Disorder

CNS: NEUROSCIENCE AND THERAPEUTICS, Issue 2 2010
Pál Czobor
Preclinical studies demonstrated that ocinaplon, a positive allosteric modulator of GABAA receptors, possesses anxiolytic-like actions at doses devoid of the side effects typically associated with benzodiazepines. The aim of this study was to evaluate the effects of ocinaplon in a multicenter, double-blind proof-of-concept trial of male and female outpatients who met DSM-IV criteria for GAD with no coexisting depression, and had a baseline score of ,20 on the Hamilton Scale for Anxiety (HAM-A). Patients with <20% reduction in HAM-A to placebo in a single-blind 7-day run-in period were randomly assigned to treatment with ocinaplon 90 mg t.i.d. (n = 31) or placebo for 28 days (n = 29). Ocinaplon was more effective than placebo in reducing HAM-A scores (P= 0.009). Patients assigned to ocinaplon exhibited a mean improvement of 14.2 points (SE = 2.6) on the total score of the HAM-A scale at the conclusion of the trial, while patients assigned to placebo obtained a mean improvement of 6.3 points (SE = 2.0). A significant (P= 0.023) difference in improvement between ocinaplon and placebo was observed beginning at and continuing from 1-week after the initiation of dosing. The proportion of patients with treatment-emergent adverse events (TEAE) was not statistically significant between ocinaplon and placebo. One serious adverse event (SAE) occurred in the ocinaplon group that was considered possibly related to study medication (icterus following transaminase elevations). The patient had preexisting medical conditions that may have contributed to this SAE. A full recovery was observed with no residual effects. The overall safety profile revealed no patterns of TEAEs, including those effects typically associated with other anxiolytic and/or benzodiazepine compounds, such as sedation. Ocinaplon appears to be a well-tolerated and effective treatment for GAD. It produces a rapid onset of anxiolytic action absent the side effects (e.g., dizziness, sedation) typically reported following anxiolytic doses of benzodiazepines. [source]


Clinical Evaluation of the Daily Assessment of Symptoms-Anxiety (DAS-A): A New Instrument to Assess the Onset of Symptomatic Improvement in Generalized Anxiety Disorder

CNS: NEUROSCIENCE AND THERAPEUTICS, Issue 1 2009
Douglas E. Feltner
Introduction: Rapid onset of symptomatic improvement is a desirable characteristic of new generalized anxiety disorder (GAD) treatments. A validated rating scale is needed to assess GAD symptoms during the first days of treatment. Aims: To provide clinical data to support the validation of the Daily Assessment of Symptoms-Anxiety (DAS-A), a new instrument to assess onset of symptomatic improvement in GAD. Methods: We assessed the ability of the DAS-A to detect onset of symptomatic improvement during the first week of therapy in 169 GAD patients randomized to paroxetine 20 mg/day, lorazepam 4.5 mg/day, or placebo for 4 weeks. Results: On the primary outcome measure, average change from baseline over the first 6 days of DAS-A assessments, lorazepam (,14.5 ± 1.8 [LS mean, SE]; P= 0.006 vs. placebo) showed a significant improvement versus placebo (,7.85 ± 1.7), whereas paroxetine (,8.3 ± 1.7; P= 0.83 vs. placebo) did not. Lorazepam produced a significant treatment effect on the DAS-A at 24 h (P= 0.0004), whereas paroxetine did not (P= 0.5666). Both active drugs produced statistically significant improvement versus placebo on the DAS-A total change score (last-observation carried forward method; LOCF, endpoint). On the DAS-A total change score (observed cases analysis), lorazepam produced statistically significant improvement versus placebo at weeks 1, 2, and 4 (P < 0.05; no week 3 visit), whereas paroxetine, separated from placebo at weeks 2 and 4 (P < 0.05). Both active drugs produced results on the Hamilton Anxiety Rating Scale (HAM-A) at weeks 1 through 4 that were similar to those found on the DAS-A. Conclusions: These data indicate that the DAS-A can detect symptomatic improvement in GAD patients treated with lorazepam during the first week of treatment, and, in a secondary analysis, as early as 24 h. [source]


Generalized anxiety disorder with and without excessive worry in Hong Kong

DEPRESSION AND ANXIETY, Issue 10 2009
Sing Lee M.B.B.S.
Abstract Background: Two previous U.S. studies found that although generalized anxiety disorder (GAD) without self-perceived excessive worry was milder than GAD with excessive worry, its persistence, impairment, and risk for subsequent onset of other mental disorders were still substantial. This study examined the implications of relaxing the "excessiveness" criterion on the prevalence and socio-demographic profile of GAD in a Chinese population sample by considering both self and others' perception of excessive worry. Method: 2,005 respondents aged 15,65 years participated in a structured telephone interview that covered socio-demographic profile, 12-month DSM-IV diagnosis of GAD, core depressive symptoms, longest duration of worry episode, number of domains of worry, impairment measured by the Sheehan Disability Scale, and treatment-seeking. Excessive worry was assessed from the perception of both respondents and others as reported by respondents. Result: The 12-month prevalence of GAD increased from 3.4 to 4% when the excessiveness requirement was relaxed. Excessive GAD and nonexcessive GAD had similar socio-demographic, symptom, chronicity, impairment, depressive symptom, and treatment-seeking profiles. Conclusion: GAD without excessive worry was less common than GAD with excessive worry but was likely to be a valid nosological entity. Future iterations of the DSM-IV should clarify whether excessive worry should be retained and, if so, how individuals who only reported excessive worries perceived by others should be optimally assessed. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]


Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trial

DEPRESSION AND ANXIETY, Issue 3 2008
Moira Rynn M.D.
Abstract Generalized anxiety disorder (GAD), a prevalent and chronic illness, is associated with dysregulation in both serotonergic and noradrenergic neurotransmission. Our study examined the efficacy, safety, and tolerability of duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, for short-term treatment of adults with GAD. In a 10-week, double-blind, progressive-titration, flexible-dose trial, 327 adult outpatients with a DSM-IV,defined GAD diagnosis were randomized to duloxetine 60,120,mg (DLX, N=168) or placebo (PLA, N=159) treatment. The primary efficacy measure was mean change from baseline to endpoint in Hamilton Anxiety Scale (HAMA) total score. Secondary outcome measures included response rate (HAMA total score reduction ,50% from baseline), Clinician Global Impression,Improvement (CGI-I) scores, and Sheehan Disability Scale (SDS) scores. Patients who received duloxetine treatment demonstrated significantly greater improvement in HAMA total scores (P=.02); a higher response rate (P=.03), and greater improvement (P=.04) than patients who received placebo. Duloxetine-treated patients were also significantly more improved than placebo-treated patients on SDS global functional (P<.01) and work, social, and family/home impairment scores (P<.05). The rate of discontinuation due to adverse events (AEs) was higher for the duloxetine group compared with the placebo group (P=.002). The AEs most frequently associated with duloxetine were nausea, dizziness, and somnolence. Duloxetine was an efficacious, safe, and well-tolerated treatment that resulted in clinically significant improvements in symptom severity and functioning for patients with GAD. Depression and Anxiety 0:1,8, 2007. © 2007 Wiley-Liss, Inc. [source]


Selective attention in anxiety: Distraction and enhancement in visual search

DEPRESSION AND ANXIETY, Issue 1 2003
Mike Rinck
Abstract According to cognitive models of anxiety, anxiety patients exhibit an attentional bias towards threat, manifested as greater distractibility by threat stimuli and enhanced detection of them. Both phenomena were studied in two experiments, using a modified visual search task, in which participants were asked to find single target words (GAD-related, speech-related, neutral, or positive) hidden in matrices made up of distractor words (also GAD-related, speech-related, neutral, or positive). Generalized anxiety disorder (GAD) patients, social phobia (SP) patients afraid of giving speeches, and healthy controls participated in the visual search task. GAD patients were slowed by GAD-related distractor words but did not show statistically reliable evidence of enhanced detection of GAD-related target words. SP patients showed neither distraction nor enhancement effects. These results extend previous findings of attentional biases observed with other experimental paradigms. Depression and Anxiety 18:18,28, 2003. © 2003 Wiley-Liss, Inc. [source]


Improving homework compliance in the treatment of generalized anxiety disorder

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2002
Robert L. Leahy
Generalized anxiety disorder is a chronic condition characterized by beliefs that worry prepares and protects, but that excessive worry is out of control. In this article, I review the cognitive-behavioral model of generalized anxiety, focusing specifically on problems related to excessive worrying. Noncompliance in self-help homework is reflected in the patient's excessive focus on negative feelings, difficulty identifying automatic thoughts, demand for immediate results, and the belief that worries are realistic. Interventions for these problems are illustrated in the case of the treatment of a patient characterized by persistent worries, low self-confidence, procrastination, and avoidance. © 2002 Wiley Periodicals, Inc. J Clin Psychol/In Session 58: 499,511, 2002. [source]


Generalized anxiety disorder and irritable bowel syndrome

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
A. C. Ford
No abstract is available for this article. [source]


Generalized anxiety disorder and irritable bowel syndrome: authors' reply

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
S. Lee
No abstract is available for this article. [source]


Randomized, single-blind, trial of sertraline and buspirone for treatment of elderly patients with generalized anxiety disorder

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2010
Naghmeh Mokhber MD
Aim:, Generalized anxiety disorder (GAD) in elderly people is common, but few systematic studies regarding the best treatments have been performed. The aim of the present study was to evaluate the efficacy and safety of sertraline and buspirone in the treatment of elderly patients with GAD. Methods:, Based on selection criteria, 46 patients were recruited who met DSM-IV criteria for GAD. Patients were randomly assigned to sertraline (50,100 mg/day) or buspirone (10,15 mg/day) for 8 weeks in a single-blind trial. The primary outcome measure used in the present study was the Hamilton Rating Scale for Anxiety (HRSA). Results:, Both sertraline and buspirone had significant anxiolytic efficacy. A steady decrease in the total HRSA scores for both groups was observed throughout the study period. After 2 and 4 weeks, buspirone was found to be significantly superior to sertraline (P < 0.001), but at the end of study period this difference did not reach statistical significance (P = 0.16). The mean HRSA score after 8 weeks significantly decreased in subjects treated with sertraline (P < 0.001), and buspirone (P < 0.001). No clinically adverse events or changes in laboratory test results were observed during the study period. Conclusion:, Both sertraline and buspirone appear to be efficacious and well tolerated in the treatment of GAD in elderly patients. Further studies with larger sample size, evaluating the effect of medical illness, cognitive impairment, depression, and combined therapy with support and psychotherapy are needed. [source]


Emotion regulation therapy for generalized anxiety disorder

CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 1 2004
Douglas S. Mennin
Generalized anxiety disorder is increasingly being recognized as a considerable mental health concern. However, it remains a poorly understood and insufficiently treated chronic disorder. Recent conceptualizations have highlighted the role of emotion acceptance, utilization and management as a core feature of the disorder. An emotion regulation perspective may shed light on treatment approaches to GAD. An integrative approach to treating GAD, entitled Emotion Regulation Therapy (ERT) is presented through the case of a young woman. ERT addresses cognitive, emotional and contextual factors of GAD and is divided into four phases: (1) psychoeducation, monitoring and developmental history; (2) skills training in somatic awareness and emotional knowledge, utilization and regulation; (3) use of these skills to confront core thematic issues using experiential exposure exercises; (4) and progress review, relapse prevention and termination processing. ERT was shown to successfully treat symptomatic, functional and qualitative aspects of the case presented, suggesting a future direction for therapeutic investigation of GAD.,Copyright © 2004 John Wiley & Sons, Ltd. [source]


The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

DEPRESSION AND ANXIETY, Issue 9 2010
Josh Nepon M.D.
Abstract Background: Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face-to-face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. Results: Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40,2.08). Panic disorder (AOR=1.31, 95% CI: 1.06,1.61) and PTSD (AOR=1.81, 95% CI: 1.45,2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58,7.25) and with PTSD (AOR=6.90, 95% CI: 5.41,8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. Conclusion: Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]


Multicenter, randomized, double-blind, active comparator and placebo-controlled trial of a corticotropin-releasing factor receptor-1 antagonist in generalized anxiety disorder,

DEPRESSION AND ANXIETY, Issue 5 2010
Vladimir Coric M.D.
Abstract Background: Antagonism of corticotropin-releasing factor (CRF) receptors has been hypothesized as a potential target for the development of novel anxiolytics. This study was designed to determine the safety and efficacy of pexacerfont, a selective CRF-1 receptor antagonist, in the treatment of generalized anxiety disorder (GAD). Method: This was a multicenter, randomized, double-blind, placebo-controlled and active comparator trial. Two hundred and sixty patients were randomly assigned to pexacerfont 100,mg/day (after a 1 week loading dose of 300,mg/day), placebo or escitalopram 20,mg/day in a 2:2:1 ratio. The primary outcome was the mean change from baseline to end point (week 8) in the Hamilton Anxiety Scale total score. Results: Pexacerfont 100,mg/day did not separate from placebo on the primary outcome measure. The half-powered active comparator arm, escitalopram 20,mg/day, demonstrated efficacy with significant separation from placebo at weeks 1, 2, 3, 6, and 8 (P<.02). Response rates for pexacerfont, placebo, and escitalopram were 42, 42, and 53%, respectively. Genetic and psychometric rating scale data was obtained in 175 randomized subjects. There was a significant association between a single nucleotide polymorphism (SNP) of the gene encoding plexin A2 (PLXNA2-2016) with the HAM-A psychic subscale score for the entire cohort at baseline (FDR-adjusted P=.015). Conclusions: Pexacerfont did not demonstrate efficacy compared to placebo for the treatment of GAD. Whether these findings are generalizable to this class of agents remains to be determined. Our preliminary genetic finding of an association between a SNP for the gene encoding plexin A2 and an anxiety phenotype in this study merits further exploration. The trial was registered at clinicaltrials.gov (NCT00481325) before enrollment. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]


Generalized anxiety disorder with and without excessive worry in Hong Kong

DEPRESSION AND ANXIETY, Issue 10 2009
Sing Lee M.B.B.S.
Abstract Background: Two previous U.S. studies found that although generalized anxiety disorder (GAD) without self-perceived excessive worry was milder than GAD with excessive worry, its persistence, impairment, and risk for subsequent onset of other mental disorders were still substantial. This study examined the implications of relaxing the "excessiveness" criterion on the prevalence and socio-demographic profile of GAD in a Chinese population sample by considering both self and others' perception of excessive worry. Method: 2,005 respondents aged 15,65 years participated in a structured telephone interview that covered socio-demographic profile, 12-month DSM-IV diagnosis of GAD, core depressive symptoms, longest duration of worry episode, number of domains of worry, impairment measured by the Sheehan Disability Scale, and treatment-seeking. Excessive worry was assessed from the perception of both respondents and others as reported by respondents. Result: The 12-month prevalence of GAD increased from 3.4 to 4% when the excessiveness requirement was relaxed. Excessive GAD and nonexcessive GAD had similar socio-demographic, symptom, chronicity, impairment, depressive symptom, and treatment-seeking profiles. Conclusion: GAD without excessive worry was less common than GAD with excessive worry but was likely to be a valid nosological entity. Future iterations of the DSM-IV should clarify whether excessive worry should be retained and, if so, how individuals who only reported excessive worries perceived by others should be optimally assessed. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]


Effectiveness of mindfulness-based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder

DEPRESSION AND ANXIETY, Issue 7 2009
Yong Woo Kim M.D.
Abstract Background: Mindfulness-based cognitive therapy (MBCT) has been widely used to treat patients with depressive disorder to prevent relapse. The objective of this study was to examine the effectiveness of newly developed MBCT program as an adjuvant to pharmacotherapy in the treatment of patients with panic disorder or generalized anxiety disorder. Methods: Forty-six patients with panic disorder or generalized anxiety disorder were assigned to either MBCT or an anxiety disorder education (ADE) program for a period of 8 weeks. The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Symptom Checklist-90-Revised (SCL-90-R) were used to assess the patients at 0 week and after the two programs had been running for 2, 4, and 8 weeks. Results: The MBCT group demonstrated significantly more improvement than the ADE group according to all anxiety (HAM-A, p<0.01; BAI, p<0.01; anxiety subscale of SCL-90-R, p=0.01) and depression (HAM-D, p<0.01; BDI, p<0.01; depression subscale of SCL-90-R, p<0.01) scale scores. The obsessive-compulsive and phobic subscales of the SCL-90-R also showed significantly more improvement in the MBCT group. However, no significant improvement was observed in the MBCT group versus the ADE group in terms of the somatization, interpersonal sensitivity, paranoid ideation, or psychoticism subscale scores of the SCL-90-R. Conclusions: MBCT may be effective at relieving anxiety and depressive symptoms in patients with panic disorder or generalized anxiety disorder. However, well-designed, randomized controlled trials are needed. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]


Pain interference impacts response to treatment for anxiety disorders

DEPRESSION AND ANXIETY, Issue 3 2009
Carrie Farmer Teh PhD
Abstract Background: Anxiety disorders and pain are commonly comorbid, though little is known about the effect of pain on the course and treatment of anxiety. Methods: This is a secondary analysis of a randomized controlled trial for anxiety treatment in primary care. Participants with panic disorder (PD) and/or generalized anxiety disorder (GAD) (N=191; 81% female, mean age 44) were randomized to either their primary-care physician's usual care or a 12-month course of telephone-based collaborative care. Anxiety severity, pain interference, health-related quality of life, health services use, and employment status were assessed at baseline, and at 2-, 4-, 8-, and 12-month follow-up. We defined response to anxiety treatment as a 40% or greater improvement from baseline on anxiety severity scales at 12-month follow-up. Results: The 39% who reported high pain interference at baseline had more severe anxiety (mean SIGH-A score: 21.8 versus 18.0, P<.001), greater limitations in activities of daily living, and more work days missed in the previous month (5.8 versus 4.0 days, P=.01) than those with low pain interference. At 12-month follow-up, high pain interference was associated with a lower likelihood of responding to anxiety treatment (OR=.28; 95% CI=.12,.63) and higher health services use (26.1% with ,1 hospitalization versus 12.0%, P<.001). Conclusions: Pain that interferes with daily activities is prevalent among primary care patients with PD/GAD and associated with more severe anxiety, worse daily functioning, higher health services use, and a lower likelihood of responding to treatment for PD/GAD. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]


The effect of social networks and social support on common mental disorders following specific life events

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010
P. K. Maulik
Maulik PK, Eaton WW, Bradshaw CP. The effect of social networks and social support on common mental disorders following specific life events. Objective:, This study examined the association between life events and common mental disorders while accounting for social networks and social supports. Method:, Participants included 1920 adults in the Baltimore Epidemiologic Catchment Area Cohort who were interviewed in 1993,1996, of whom 1071 were re-interviewed in 2004,2005. Generalized estimating equations were used to analyze the data. Results:, Social support from friends, spouse or relatives was associated with significantly reduced odds of panic disorder and psychological distress, after experiencing specific life events. Social networks or social support had no significant stress-buffering effect. Social networks and social support had almost no direct or buffering effect on major depressive disorder, and no effect on generalized anxiety disorder and alcohol abuse or dependence disorder. Conclusion:, The significant association between social support and psychological distress, rather than diagnosable mental disorders, highlights the importance of social support, especially when the severity of a mental health related problem is low. [source]


Hierarchical structures of affect and psychopathology and their implications for the classification of emotional disorders,

DEPRESSION AND ANXIETY, Issue 4 2008
David Watson
Abstract The Diagnostic and Statistical Manual of Mental Disorders,IV groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." The current mood and anxiety disorders reflect the logic of older models emphasizing the existence of discrete emotions and, consequently, are based on a fundamental distinction between depressed mood (central to the mood disorders) and anxious mood (a core feature of the anxiety disorders). This distinction, however, ignores subsequent work that has established the existence of a general negative affect dimension that (a) produces strong correlations between anxious and depressed mood and (b) is largely responsible for the substantial comorbidity between the mood and anxiety disorders. More generally, there are now sufficient data to eliminate the current rational system and replace it with an empirically based taxonomy that reflects the actual,not the assumed,similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching superclass of emotional disorders, which can be decomposed into three subclasses: the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia), and the bipolar disorders (bipolar I, bipolar II, cyclothymia). An empirically based system of this type will facilitate differential diagnosis and encourage the ultimate development of an etiologically based taxonomy. Depression and Anxiety 25:282,288, 2008. Published 2008 Wiley-Liss, Inc. [source]


Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trial

DEPRESSION AND ANXIETY, Issue 3 2008
Moira Rynn M.D.
Abstract Generalized anxiety disorder (GAD), a prevalent and chronic illness, is associated with dysregulation in both serotonergic and noradrenergic neurotransmission. Our study examined the efficacy, safety, and tolerability of duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, for short-term treatment of adults with GAD. In a 10-week, double-blind, progressive-titration, flexible-dose trial, 327 adult outpatients with a DSM-IV,defined GAD diagnosis were randomized to duloxetine 60,120,mg (DLX, N=168) or placebo (PLA, N=159) treatment. The primary efficacy measure was mean change from baseline to endpoint in Hamilton Anxiety Scale (HAMA) total score. Secondary outcome measures included response rate (HAMA total score reduction ,50% from baseline), Clinician Global Impression,Improvement (CGI-I) scores, and Sheehan Disability Scale (SDS) scores. Patients who received duloxetine treatment demonstrated significantly greater improvement in HAMA total scores (P=.02); a higher response rate (P=.03), and greater improvement (P=.04) than patients who received placebo. Duloxetine-treated patients were also significantly more improved than placebo-treated patients on SDS global functional (P<.01) and work, social, and family/home impairment scores (P<.05). The rate of discontinuation due to adverse events (AEs) was higher for the duloxetine group compared with the placebo group (P=.002). The AEs most frequently associated with duloxetine were nausea, dizziness, and somnolence. Duloxetine was an efficacious, safe, and well-tolerated treatment that resulted in clinically significant improvements in symptom severity and functioning for patients with GAD. Depression and Anxiety 0:1,8, 2007. © 2007 Wiley-Liss, Inc. [source]


Obstetrician-gynecologists' screening patterns for anxiety during pregnancy,

DEPRESSION AND ANXIETY, Issue 2 2008
Victoria H. Coleman M.A.
Abstract As obstetrician-gynecologists (ob-gyns) take on a greater role in women's healthcare, it is important that they are aware of the high prevalence of anxiety disorders in their patient population. Anxiety disorders present during pregnancy can have detrimental effects on both mother and child. In this study, we queried 1,193 ob-gyns on their screening rates, practice patterns, training, and knowledge as they relate to anxiety disorders during pregnancy. We achieved a 44% response rate (n=397) after three mailings. Physicians reported a moderate interest in screening for and diagnosing anxiety, but less interest in treatment. Only 20% of respondents (n=79) screen for anxiety during pregnancy, and they typically refer anxiety-disordered patients to mental health professionals. Ob-gyns with comprehensive or adequate training were significantly more likely to screen than those who stated that their training was inadequate. Having a friend who has been diagnosed with an anxiety disorder also significantly increased both the likelihood that these physicians would screen and the reported level of interest in screening of anxiety disorders during pregnancy. At present, the majority of ob-gyns feel that their training in this area was barely adequate to inadequate. Specifically, generalized anxiety disorder may be the least understood. Increased training in this area would allow ob-gyns to overcome what they list as the primary barrier to anxiety screening during pregnancy,that is, inadequate training about anxiety disorders. Depression and Anxiety 0:1,10, 2007. Published © 2007 Wiley-Liss, Inc. [source]


Demographic and clinical characteristics of motor vehicle accident victims in the community general health outpatient clinic: a comparison of PTSD and non-PTSD subjects

DEPRESSION AND ANXIETY, Issue 4 2007
Marina Kupchik M.D.
Abstract Motor vehicle accidents (MVAs) are the leading cause of posttraumatic stress disorder (PTSD) in the general population, often with enduring symptomatology. This study details epidemiological and clinical features that characterize PTSD among MVA victims living in a nonhospitalized community setting long after the MVA event, and includes exploration of premorbid and peritraumatic factors. MVA victims (n=60; 23 males, 37 females) identified from the registry of a community general health outpatient clinic during a 7-year period were administered an extensive structured battery of epidemiological, diagnostic and clinical ratings. Results indicated that 30 subjects (50%; 12 males, 18 females) had MVA-related PTSD (MVAR-PTSD). Among those with PTSD, 16 individuals exhibited PTSD in partial remission, and six, in full remission. There were no significant demographic or occupational function differences between PTSD and non-PTSD groups. The most common comorbid conditions with MVAR-PTSD were social phobia (20%), generalized anxiety disorder (7.8%) and obsessive,compulsive disorder (0.5%). Previous MVA's were not predictive of PTSD. Subjects with MVAR-PTSD scored worse on the Clinician-Administered Posttraumatic Stress Disorder Scale, Part 2 (CAPS-2), Impact of Event Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Impulsivity Scale, and Toronto Alexithymia Rating Scale. Study observations indicate a relatively high rate of PTSD following an MVA in a community-based sample. The relatively high rate of partially remitted MVAR-PTSD (N=16) underscores the importance of subsyndromal forms of illness. Alexithymia may be an adaptive method of coping with event stress. The development of PTSD appears not to be associated with the severity of MVA-related physical injury. Depression and Anxiety 24:244,250, 2007. © 2006 Wiley,Liss, Inc. [source]


Memory deficits in children with and at risk for anxiety disorders

DEPRESSION AND ANXIETY, Issue 2 2007
Roma A. Vasa M.D.
Abstract There are limited data on the neurocognitive correlates of childhood anxiety disorders. The objective of this study was to examine whether visual and verbal memory deficits of nonemotional stimuli are (1) a shared feature of three common childhood anxiety disorders (social phobia, separation anxiety disorder, and generalized anxiety disorder) or whether these deficits are restricted to specific anxiety disorders, and (2) present in offspring who possess at least one of the following established risk factors for anxiety disorders, parental history of panic disorder (PD), or major depressive disorder (MDD). One hundred and sixty offspring, ages 9,20 years, were recruited from parents with lifetime diagnoses of PD, MDD, PD plus MDD, or neither illness. Different clinicians blindly administered semistructured diagnostic interviews to offspring and parents. Verbal and visual memory subtests of the Wide Range Assessment of Memory and Learning were administered to offspring. The results showed that offspring with ongoing social phobia demonstrated reduced visual but not verbal memory scores compared to those without social phobia when controlling for offspring IQ, separation anxiety disorder, and generalized anxiety disorder. No other offspring anxiety disorder predicted memory performance. Neither parental PD nor parental MDD was associated with offspring memory performance. These findings are relevant to understanding the phenomenology of childhood anxiety disorders and may provide insights into the neural circuits underlying these disorders. Depression and Anxiety 24:85,94, 2007. Published 2006 Wiley-Liss, Inc. [source]


Early response and 8-week treatment outcome in GAD ,

DEPRESSION AND ANXIETY, Issue 8 2006
Moira Rynn M.D.
Abstract Our objective was to compare the predictive value of early response to treatment outcome in patients with generalized anxiety disorder (GAD) treated with benzodiazepines, serotonin receptor (5HT-1A) partial agonists, or placebo. Data from two double-blind GAD studies were combined. Subjects were evaluated with the Hamilton Anxiety Scale (HAM-A) and the Clinical Global Impression of Improvement (CGI-I) scale over 8 weeks. Categories of response at weeks 1 and 2 were defined by the HAM-A total score. Analyses of covariance and Kaplan,Meier survival analyses were the primary analyses used to assess 8-week end point treatment outcomes as a function of early improvement. HAM-A change from baseline to weeks 1 and 2 significantly predicted last observation carried forward (LOCF) response at week 8 for both medications and for placebo (P<.001). Early improvement was a strong predictor for treatment outcome irrespective of whether active medication or placebo was the treatment agent. Depression and Anxiety 23:461,465, 2006. Published 2006 Wiley-Liss, Inc. [source]


Beliefs about worry in community-dwelling older adults,

DEPRESSION AND ANXIETY, Issue 8 2006
Ignacio Montorio Ph.D.
Abstract This study examines the association between several kinds of beliefs about worry and generalized anxiety disorder (GAD) severity in a sample of older individuals recruited from a community setting (N=142, mean age=71.0 years, SD=6.0, range=55,88). Beliefs about worry were assessed with a 17-item scale designed for older adults, including three dimensions: Positive Beliefs, Negative Beliefs, and Responsibility. All three dimensions distinguished between people endorsing GAD symptoms and those without GAD symptoms, and only Negative Beliefs had a significant independent weight when regressed on GAD severity, even after controlling for level of trait worry. Results of this study suggest that negative beliefs appear to be strongly related to pathological worry in older adults. These results are consistent with empirical findings in younger adults and potentially support the use of particular interventions in clinical work with older adults with GAD. Depression and Anxiety 23:466,473, 2006. Published 2006 Wiley-Liss, Inc. [source]


Cognitive specificity of anxiety disorders: a review of selected key constructs

DEPRESSION AND ANXIETY, Issue 2 2006
F.R.A.N.Z.C.P., Ph.D., Vladan Starcevic M.D.
Abstract Cognitive models of anxiety disorders propose that certain cognitive constructs, that is, underlying beliefs and cognitive processes, may be specific for particular disorders. In this article, we review the specificity of four representative cognitive constructs,anxiety sensitivity, pathological worry, intolerance of uncertainty, and thought,action fusion,for particular disorders. Conceptual overlap, inconsistent definitions, and insufficient consideration of the components of these constructs are limitations of the existing literature. We suggest that the constructs are unlikely to be pathognomonic for any given disorder or to occur in isolation. Rather, the association of each cognitive construct is evident, to varying degrees, with different disorders. Relative to other disorders, anxiety sensitivity is to a certain extent specific for panic disorder, as are pathological worry for generalized anxiety disorder, intolerance of uncertainty for generalized anxiety disorder and obsessive,compulsive disorder, and thought,action fusion for obsessive,compulsive disorder. We discuss the implications of these findings for diagnostic systems and treatment, and suggest areas for further research. Depression and Anxiety 23:51,61, 2006. © 2006 Wiley-Liss, Inc. [source]


Panic disorder and suicidal ideation in primary care

DEPRESSION AND ANXIETY, Issue 1 2006
Daniel J. Pilowsky M.D., M.P.H.
Abstract The purpose of this study was to ascertain whether panic disorder (PD) and suicidal ideation are associated in an inner-city primary care clinic and whether this association remains significant after controlling for commonly co-occurring psychiatric disorders. We surveyed 2,043 patients attending a primary care clinic using the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire, a screening instrument that yields provisional diagnoses of selected psychiatric disorders. We estimated the prevalence of current suicidal ideation and of common psychiatric disorders including panic disorder and major depression. A provisional diagnosis of current PD was received by 127 patients (6.2%). After adjusting for potential confounders (age, gender, major depressive disorder [MDD], generalized anxiety disorder, and substance use disorders), patients with PD were about twice as likely to present with current suicidal ideation, as compared to those without PD (adjusted odds ratio [AOR]=1.84; 95% confidence interval [CI]: 1.06,3.18; P=.03). After adjusting for PD and the above-mentioned potential confounders, patients with MDD had a sevenfold increase in the odds of suicidal ideation, as compared to those without MDD (AOR=7.00; 95% CI: 4.42,11.08; P<.0001). Primary care patients with PD are at high risk for suicidal ideation, and patients with PD and co-occurring MDD are at especially high risk. PD patients in primary care thus should be assessed routinely for suicidal ideation and depression. Depression and Anxiety 23:11,16, 2006. © 2005 Wiley-Liss, Inc. [source]


Patterns of comorbidity in panic disorder and major depression: findings from a nonreferred sample

DEPRESSION AND ANXIETY, Issue 2 2005
Joseph Biederman M.D.
Abstract Previous findings in referred adult samples document major depression as having important moderating effects on the patterns of comorbidity for panic disorder and major depression. This study evaluated whether these patterns of comorbidity are moderated by referral bias. Panic disorder (PD) and major depression (MD) were used to predict the risk for comorbid psychiatric disorders and functional outcomes using data from a large sample of adults who had not been ascertained on the basis of clinical referral (N=1,031). Participants were comprehensively assessed with structured diagnostic interview methodology to evaluate childhood and adult comorbid psychiatric disorders. PD increased the risk for anxiety disorders, independently of MD. MD increased the risk for mania, antisocial personality disorder, psychoactive substance use disorder, disruptive behavior disorders, overanxious disorder, social phobia, and generalized anxiety disorder, independently of PD. These results extend to nonreferred samples' previously reported findings documenting that MD has important moderating effects on patterns of comorbidity for PD and indicate that patterns of comorbidity for PD are not due to referral bias. Depression and Anxiety 21:55,60, 2005. © 2005 Wiley-Liss, Inc. [source]