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Sample records for generalized anxiety disorder-7

  1. The Psychometric Properties of the Generalized Anxiety Disorder-7 scale in Hispanic Americans with English or Spanish Language Preference

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    Mills, Sarah D; Fox, Rina S.; Malcarne, Vanessa L.; Roesch, Scott C.; Champagne, Brian R.; Sadler, Georgia Robins

    2014-01-01

    The Generalized Anxiety Disorder-7 scale (GAD-7) is a self-report questionnaire that is widely used to screen for anxiety. The GAD-7 has been translated into numerous languages, including Spanish. Previous studies evaluating the structural validity of the English and Spanish versions indicate a uni-dimensional factor structure in both languages. However, the psychometric properties of the Spanish language version have yet to be evaluated in samples outside of Spain, and the measure has not be...

  2. Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7 among Pregnant Women.

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    Qiu-Yue Zhong

    Full Text Available Generalized anxiety disorder (GAD during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7.Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI. The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM.The reliability of the GAD-7 was good (Cronbach's alpha = 0.89. A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7.The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis.

  3. The British Sign Language Versions of the Patient Health Questionnaire, the Generalized Anxiety Disorder 7-Item Scale, and the Work and Social Adjustment Scale

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    Rogers, Katherine D.; Young, Alys; Lovell, Karina; Campbell, Malcolm; Scott, Paul R.; Kendal, Sarah

    2013-01-01

    The present study is aimed to translate 3 widely used clinical assessment measures into British Sign Language (BSL), to pilot the BSL versions, and to establish their validity and reliability. These were the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the Work and Social Adjustment Scale (WSAS).…

  4. The psychometric properties of the generalized anxiety disorder-7 scale in Hispanic Americans with English or Spanish language preference.

    Science.gov (United States)

    Mills, Sarah D; Fox, Rina S; Malcarne, Vanessa L; Roesch, Scott C; Champagne, Brian R; Sadler, Georgia Robins

    2014-07-01

    The Generalized Anxiety Disorder-7 scale (GAD-7) is a self-report questionnaire that is widely used to screen for anxiety. The GAD-7 has been translated into numerous languages, including Spanish. Previous studies evaluating the structural validity of the English and Spanish versions indicate a unidimensional factor structure in both languages. However, the psychometric properties of the Spanish language version have yet to be evaluated in samples outside of Spain, and the measure has not been tested for use among Hispanic Americans. This study evaluated the reliability, structural validity, and convergent validity of the English and Spanish language versions of the GAD-7 for Hispanic Americans in the United States. A community sample of 436 Hispanic Americans with an English (n = 210) or Spanish (n = 226) language preference completed the GAD-7. Multiple-group confirmatory factor analysis (CFA) was used to examine the goodness-of-fit of the unidimensional factor structure of the GAD-7 across language-preference groups. Results from the multiple-group CFA indicated a similar unidimensional factor structure with equivalent response patterns and item intercepts, but different variances, across language-preference groups. Internal consistency was good for both English and Spanish language-preference groups. The GAD-7 also evidenced good convergent validity as demonstrated by significant correlations in expected directions with the Perceived Stress Scale, the Patient Health Questionnaire-9, and the Physical Health domain of the World Health Organization Quality of Life-BREF assessment. The unidimensional GAD-7 is suitable for use among Hispanic Americans with an English or Spanish language preference.

  5. Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7 scale as a screening tool

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    Pérez-Páramo María

    2010-01-01

    Full Text Available Abstract Background Generalized anxiety disorder (GAD is a prevalent mental health condition which is underestimated worldwide. This study carried out the cultural adaptation into Spanish of the 7-item self-administered GAD-7 scale, which is used to identify probable patients with GAD. Methods The adaptation was performed by an expert panel using a conceptual equivalence process, including forward and backward translations in duplicate. Content validity was assessed by interrater agreement. Criteria validity was explored using ROC curve analysis, and sensitivity, specificity, predictive positive value and negative value for different cut-off values were determined. Concurrent validity was also explored using the HAM-A, HADS, and WHO-DAS-II scales. Results The study sample consisted of 212 subjects (106 patients with GAD with a mean age of 50.38 years (SD = 16.76. Average completion time was 2'30''. No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. The scale was shown to be one-dimensional through factor analysis (explained variance = 72%. A cut-off point of 10 showed adequate values of sensitivity (86.8% and specificity (93.4%, with AUC being statistically significant [AUC = 0.957-0.985; p 0.001. Limitations Elderly people, particularly those very old, may need some help to complete the scale. Conclusion After the cultural adaptation process, a Spanish version of the GAD-7 scale was obtained. The validity of its content and the relevance and adequacy of items in the Spanish cultural context were confirmed.

  6. The British Sign Language versions of the Patient Health Questionnaire, the Generalized Anxiety Disorder 7-item Scale, and the Work and Social Adjustment Scale.

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    Rogers, Katherine D; Young, Alys; Lovell, Karina; Campbell, Malcolm; Scott, Paul R; Kendal, Sarah

    2013-01-01

    The present study is aimed to translate 3 widely used clinical assessment measures into British Sign Language (BSL), to pilot the BSL versions, and to establish their validity and reliability. These were the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the Work and Social Adjustment Scale (WSAS). The 3 assessment measures were translated into BSL and piloted with the Deaf signing population in the United Kingdom (n = 113). Participants completed the PHQ-9, GAD-7, WSAS, and Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) online. The reliability and validity of the BSL versions of PHQ-9, GAD-7, and WSAS have been examined and were found to be good. The construct validity for the PHQ-9 BSL version did not find the single-factor solution as found in the hearing population. The BSL versions of PHQ-9, GAD-7, and WSAS have been produced in BSL and can be used with the signing Deaf population in the United Kingdom. This means that now there are accessible mental health assessments available for Deaf people who are BSL users, which could assist in the early identification of mental health difficulties.

  7. Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample.

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    Sawaya, Helen; Atoui, Mia; Hamadeh, Aya; Zeinoun, Pia; Nahas, Ziad

    2016-05-30

    The Patient Health Questionnaire - 9 (PHQ-9) and Generalized Anxiety Disorder - 7 (GAD-7) are short screening measures used in medical and community settings to assess depression and anxiety severity. The aim of this study is to translate the screening tools into Arabic and evaluate their psychometric properties in an Arabic-speaking Lebanese psychiatric outpatient sample. The patients completed the questionnaires, among others, prior to being evaluated by a clinical psychiatrist or psychologist. The scales' internal consistency and factor structure were measured and convergent and discriminant validity were established by comparing the scores with clinical diagnoses and the Psychiatric Diagnostic Screening Questionnaire - MDD subset (PDSQ - MDD). Results showed that the PHQ-9 and GAD-7 are reliable screening tools for depression and anxiety and their factor structures replicated those reported in the literature. Sensitivity and specificity analyses showed that the PHQ-9 is sensitive but not specific at capturing depressive symptoms when compared to clinician diagnoses whereas the GAD-7 was neither sensitive nor specific at capturing anxiety symptoms. The implications of these findings are discussed in reference to the scales themselves and the cultural specificity of the Lebanese population.

  8. Generalized Anxiety Disorder

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    ... Anxiety, anxiety disorders, anxious, behavior therapy, GAD, generalized anxiety disorder, mental health neuroses, mood disorders, psychiatric disorder, psychotherapy Family Health, Men, Seniors, Women January 1996 Copyright © American Academy of Family PhysiciansThis ...

  9. Reliability and validity of Chinese version of the Generalized Anxiety Disorder 7-item (GAD-7) scale in screening anxiety disorders in outpatients from traditional Chinese internal department%广泛性焦虑量表中文版在中医内科门诊人群应用的信度和效度

    Institute of Scientific and Technical Information of China (English)

    曾庆枝; 何燕玲; 刘寒; 缪菊明; 陈建新; 徐海楠; 王静夷

    2013-01-01

    Generalized Anxiety Disorder (GAD-7) scale in screening out anxiety disorders and to identify the cut-off score for screening anxiety in outpatients from traditional Chinese internal department, thereby providing scientific evidence for its implication. Methods: Totally 2011 patients aged 18 -65 years old were selected from an internal department of traditional Chinese medicine. They were assessed with the GAD-7 and interviewed with the Mini International Neuropsy-chiatric Interview (M. I. N. I. ). Internal consistency, explosive factor analysis, receiver operating characteristic curve (ROC), and variance analysis were used to evaluate the reliability and validity of GAD-7. Results: The Cron-bach's coefficient of GAD-7 was 0. 91, and the range of correlation coefficient within the 7 items and between items and the total score of the scale was 0. 52 -0. 68 and 0. 75 -0. 85, respectively (P <0. 01). The Cronbach's coefficients were stable when any of the 7 items had been deleted. The scale was shown to be one dimensional through factor analysis (explained variance = 72%). The results of ROC analysis indicated that the area under the curve (AUC) was very good for both the generalized anxiety disorder (for GAD, AUC =0. 88) and panic disorder (for panic disorder, AUC = 0. 80), but not for agoraphobia (for agoraphobia, AUC = 0. 63). A cut point of 6 showed adequate values of sensitivity and specificity for GAD (0. 86, 0. 76), and panic disorder (0. 78, 0. 74), while inadequate for agoraphobia (0. 50, 0. 73) or mixed anxiety-depressive disorder (0. 61, 0. 74). The GAD-7 scores were higher in patients with depressive disorders, any anxiety disorders or chronic physical conditions than in those without (P <0. 05). There was a strong association between increasing GAD-7 severity scores and health service utilization or worsening function. And for outpatients without anxiety, or with mild, moderate and severe anxiety severity score, the doctor visits were 8. 09, 8. 34,13. 45 and 11. 97

  10. Screening for Generalized Anxiety Disorder (GAD)

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    ... Executive Director's Corner Resources Public Screening for Generalized Anxiety Disorder (GAD) If you suspect that you might suffer from generalized anxiety disorder, also known as GAD, answer the questions below, ...

  11. Neurobiology of generalized anxiety disorder.

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    Stein, Murray B

    2009-01-01

    Generalized anxiety disorder (GAD) is a common illness with diagnostic criteria that have changed substantially over time. Symptoms of GAD overlap with those of major depressive disorder to such an extent that studying one disorder without studying the other may be impossible. Such an overlap, combined with potentially inappropriate diagnostic criteria for GAD, makes diagnosing and researching GAD challenging. Recent research into the genetics and neural circuitry of GAD may suggest solutions for the disorder's diagnostic controversies and point the way to productive future studies of etiology and pathophysiology.

  12. Anxiety and Test Anxiety: General and Test Anxiety among College Students with Learning Disabilities

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    Custodero, Jeri Lyn

    2013-01-01

    This study compares the state, trait, and test anxiety scores of 145 college students with and without learning disabilities against categories such as demographics, general anxiety, test anxiety, and disability experience. This study used a questionnaire and compared answers among groups. The analysis indicated that students with learning…

  13. Determination of students’ general test anxiety and their test anxiety concerning English classes

    OpenAIRE

    Çiğdem Hürsen; İbrahim Tekman

    2014-01-01

    This study was conducted to determine the students’ general test anxiety and their test anxiety concerning English classes. The research was performed with 871 students. The results of the study reveal that students’ general test anxiety is in the boundaries of “rarely”. However, according to the results about students’ levels of test anxiety concerning English classes, their test anxiety level is in the boundaries of “sometimes”. Female students have a higher level of test anxiety and 15-18 ...

  14. Generalized Anxiety and Major Depressive syndrome ...

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    Objective: Environmental exposure to manganese (Mn) may cause generalized anxiety (GA) and major depression (MD) in residents living in Mn-exposed areas. Marietta and East Liverpool are two Ohio towns identified as having elevated levels of Mn. The objective was to determine if levels of Mn exposure were associated with levels of GA and MD.Participants and methods: 186 participants (Mean age: 55.0 ± 10.80) were examined. Levels of air-Mn were assessed over a period of ten years using U.S. EPA’s AERMOD dispersion model. Average air-Mn exposure was 0.53 μg/m3 in the two towns. The GA syndrome was comprised of anxiety, obsessive-compulsive, and phobic scales from the Symptom Checklist (SCL-90-R). The MD syndrome was comprised of depression, anxiety, and psychoticism scales also from the SCL-90-R. Linear regression models were used to determine the relationship between Mn and GA, MD and the specific components of each.Results: Elevated air-Mn was associated with GA (β= 0.240, p=0.002), and MD (β= 0.202, p=0.011). Air-Mn was associated with specific components of GA anxiety (β= 0.255, p=0.001), phobic anxiety (β= 0.159, p=0.046), and obsessive-compulsive (β= 0.197, p=0.013). Similarly, components of MD syndrome suggested an association as well: depression (β= 0.180, p=0.023), anxiety (β= 0.255, p=0.001), and psychoticism (β= 0.188, p=0.018). Conclusions: The results suggest that residents with elevated exposure to environmental Mn have elevated levels of

  15. Conditioned Fear Acquisition and Generalization in Generalized Anxiety Disorder.

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    Tinoco-González, Daniella; Fullana, Miquel Angel; Torrents-Rodas, David; Bonillo, Albert; Vervliet, Bram; Blasco, María Jesús; Farré, Magí; Torrubia, Rafael

    2015-09-01

    Abnormal fear conditioning processes (including fear acquisition and conditioned fear-generalization) have been implicated in the pathogenesis of anxiety disorders. Previous research has shown that individuals with panic disorder present enhanced conditioned fear-generalization in comparison to healthy controls. Enhanced conditioned fear-generalization could also characterize generalized anxiety disorder (GAD), but research so far is inconclusive. An important confounding factor in previous research is comorbidity. The present study examined conditioned fear-acquisition and fear-generalization in 28 patients with GAD and 30 healthy controls using a recently developed fear acquisition and generalization paradigm assessing fear-potentiated startle and online expectancies of the unconditioned stimulus. Analyses focused on GAD patients without comorbidity but included also patients with comorbid anxiety disorders. Patients and controls did not differ as regards fear acquisition. However, contrary to our hypothesis, both groups did not differ either in most indexes of conditioned fear-generalization. Moreover, dimensional measures of GAD symptoms were not correlated with conditioned fear-generalization indexes. Comorbidity did not have a significant impact on the results. Our data suggest that conditioned fear-generalization is not enhanced in GAD. Results are discussed with special attention to the possible effects of comorbidity on fear learning abnormalities.

  16. Anxiety Sensitivity Dimensions and Generalized Anxiety‏ ‏Severity: The ‎Mediating Role of Experiential Avoidance and Repetitive‏ ‏Negative Thinking

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    Parvaneh‏ ‏ Mohammadkhani

    2016-10-01

    Full Text Available Objective: Generalized anxiety disorder is one of the most common anxiety disorders in the general ‎population. Several studies suggest that anxiety sensitivity is a vulnerability factor in generalizedanxiety severity. However, some other studies suggest that negative repetitive thinking and ‎experiential avoidance as response factors can explain this relationship. Therefore, this study ‎aimed to investigate the mediating role of experiential avoidance and negative repetitive thinking ‎in the relationship between anxiety sensitivity and generalized anxiety severity.‎Method: This was a cross-sectional and correlational study. A sample of 475 university students was ‎selected through stratified sampling method. The participants completed Anxiety Sensitivity ‎Inventory-3, Acceptance and Action Questionnaire-II, Perseverative Thinking Questionnaire, and ‎Generalized Anxiety Disorder 7-item Scale. Data were analyzed by Pearson correlation, multiple ‎regression analysis and path analysis.‎Results: The results revealed a positive relationship between anxiety sensitivity, particularly cognitive ‎anxiety sensitivity, experiential avoidance, repetitive thinking and generalized anxiety severity. In ‎addition, findings showed that repetitive thinking, but not experiential avoidance, fully mediated ‎the relationship between cognitive anxiety sensitivity and generalized anxiety severity. α Level ‎was p<0.005.‎Conclusion: Consistent with the trans-diagnostic hypothesis, anxiety sensitivity predicts generalized anxiety‏ ‏severity, but its effect is due to the generating repetitive negative thought.‎

  17. Generalized Anxiety Disorder (GAD): When Worry Gets Out of Control

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    ... health, money, or family problems. But people with generalized anxiety disorder (GAD) feel extremely worried or feel nervous about ... I find more information? To learn more about generalized anxiety disorder, visit: MedlinePlus (National Library of Medicine) http: / / medlineplus. ...

  18. Psychometric properties of the Generalized Anxiety Disorder Inventory in a Canadian sample.

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    Henderson, Leigh C; Antony, Martin M; Koerner, Naomi

    2014-05-01

    The Generalized Anxiety Disorder Inventory is a recently developed self-report measure that assesses symptoms of generalized anxiety disorder. Its psychometric properties have not been investigated further since its original development. The current study investigated its psychometric properties in a Canadian student/community sample. Exploratory principal component analysis replicated the original three-component structure. The total scale and subscales demonstrated excellent internal consistency reliability (α = 0.84-0.94) and correlated strongly with the Penn State Worry Questionnaire (r = 0.41-0.74, all ps Generalized Anxiety Disorder-7 (r = 0.55-0.84, all ps generalized anxiety disorder diagnosis established by diagnostic interview. The somatic subscale in particular may require revision to improve predictive validity. Revision may also be necessary given changes in required somatic symptoms for generalized anxiety disorder diagnostic criteria in more recent versions of the Diagnostic and Statistical Manual of Mental Disorders (i.e. although major changes occurred from Diagnostic and Statistical Manual of Mental Disorders-III-R to Diagnostic and Statistical Manual of Mental Disorders-IV, changes in Diagnostic and Statistical Manual of Mental Disorders-5 were minimal) and the possibility of changes in the upcoming 11th revision of the International Classification of Diseases.

  19. Generalized Anxiety Disorder: When Worry Gets Out of Control

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    ... Where can I find more information? Share Generalized Anxiety Disorder: When Worry Gets Out of Control Download ... Order a free hardcopy What Is GAD? Occasional anxiety is a normal part of life. You might ...

  20. Generalized Anxiety Disorder: Connections with Self-Reported Attachment

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    Cassidy, Jude; Lichtenstein-Phelps, June; Sibrava, Nicholas J.; Thomas, Charles L., Jr.; Borkovec, Thomas D.

    2009-01-01

    Even though generalized anxiety disorder (GAD) is one of the most common of the anxiety disorders, relatively little is known about its precursors. Bowlby's attachment theory provides a framework within which these precursors can be considered. According to Bowlby, adult anxiety may be rooted in childhood experiences that leave a child uncertain…

  1. Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy

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    Rubinchik, Sofya M.; Kablinger, Anita S.; Gardner, J. Suzette

    2005-01-01

    Objective: Approximately 30% of women experience some type of anxiety disorder during their lifetime. In addition, some evidence exists that anxiety disorders can affect pregnancy outcomes. This article reviews the literature on the course of generalized anxiety disorder (GAD) and panic disorder during pregnancy and the postpartum period and presents guidelines for management.

  2. Episodic future thinking in generalized anxiety disorder.

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    Wu, Jade Q; Szpunar, Karl K; Godovich, Sheina A; Schacter, Daniel L; Hofmann, Stefan G

    2015-12-01

    Research on future-oriented cognition in generalized anxiety disorder (GAD) has primarily focused on worry, while less is known about the role of episodic future thinking (EFT), an imagery-based cognitive process. To characterize EFT in this disorder, we used the experimental recombination procedure, in which 21 GAD and 19 healthy participants simulated positive, neutral and negative novel future events either once or repeatedly, and rated their phenomenological experience of EFT. Results showed that healthy controls spontaneously generated more detailed EFT over repeated simulations. Both groups found EFT easier to generate after repeated simulations, except when GAD participants simulated positive events. They also perceived higher plausibility of negative-not positive or neutral-future events than did controls. These results demonstrate a negativity bias in GAD individuals' episodic future cognition, and suggest their relative deficit in generating vivid EFT. We discuss implications for the theory and treatment of GAD.

  3. Perinatal Generalized Anxiety Disorder: Assessment and Treatment.

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    Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-09-01

    Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

  4. How do we treat generalized anxiety disorder?

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    Latas Milan

    2014-01-01

    Full Text Available Introduction. In addition to significant prevalence of generalized anxiety disorder (GAD and related consequences, it seems that this disorder has not been studied sufficiently in Serbia. Objective. The aim of this study was to investigate the understanding of psychopathology and the adequate treatment of patients with GAD by psychiatrists in Serbia. Methods. The study comprised 84 doctors - psychiatrists and neuropsychiatrists who were engaged in treatment of patients with GAD. Anonymous survey was used as the basic instrument, which collected information about the socio-demographic and professional data, experience in treating GAD and understanding psychopathology of GAD, as well as the first and the second choice therapy for patients with GAD. Results. The majority of psychiatrists (62.2% indicated the symptoms of distress/tension and slightly lower percent (36.6% designated the symptoms of worry/anxiety as the key symptoms of GAD when it was diagnosed. The results showed that almost all patients (96.5% had been treated with benzodiazepines before coming to psychiatrists. Most psychiatrists preferred the use of SSRI/SNRI antidepressants (76.2%, usually in combination with benzodiazepines (71.4% for the treatment of patients with GAD; however, if these doctors got GAD, the preference of benzodiazepine use would be significantly lesser (45.2% than for the treatment of their patients. Preference for the use of SSRI/SNRI antidepressants was significantly more frequent in physicians with completed residency. Conclusion. The understanding of psychopathology and treatment practice for patients with GAD in this sample of psychiatrists in Serbia is mostly consistent with the current trends for GAD treatment.

  5. Alcohol use, anxiety, and insomnia in older adults with generalized anxiety disorder.

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    Ivan, M Cristina; Amspoker, Amber B; Nadorff, Michael R; Kunik, Mark E; Cully, Jeffrey A; Wilson, Nancy; Calleo, Jessica; Kraus-Schuman, Cynthia; Stanley, Melinda A

    2014-09-01

    To examine alcohol consumption among older primary care patients with generalized anxiety disorder (GAD); its relationship to demographic variables, insomnia, worry, and anxiety; and its moderating role on the anxiety-insomnia relationship. We expected alcohol use to be similar to previous reports, correlate with higher anxiety and insomnia, and worsen the anxiety-insomnia relationship. Baseline data from a randomized controlled trial. Michael E. DeBakey VA Medical Center and Baylor College of Medicine. 223 patients, 60 years and older, with GAD. Frequency of alcohol use, insomnia (Insomnia Severity Index), worry (Penn State Worry Questionnaire - Abbreviated, Generalized Anxiety Disorder Severity Scale), and anxiety (State-Trait Anxiety Inventory - Trait subscale, Structured Interview Guide for the Hamilton Anxiety Rating Scale [SIGH-A]). Most patients endorsed alcohol use, but frequency was low. Presence and frequency were greater than in previous reports of primary care samples. Alcohol use was associated with higher education, female gender, less severe insomnia, and lower worry (Generalized Anxiety Disorder Severity Scale) and anxiety (State-Trait Anxiety Inventory-Trait subscale; SIGH-A). Whites reported more drinks/week than African-Americans. More drinks/week were associated with higher education and lower anxiety (SIGH-A). Weaker relationships between worry/anxiety and insomnia occurred for those drinking. Drink frequency moderated the positive association between the Penn State Worry Questionnaire-Abbreviated and insomnia, which was lower with higher frequency of drinking. Older adults with GAD use alcohol at an increased rate, but mild to moderate drinkers do not experience sleep difficulties. A modest amount of alcohol may minimize the association between anxiety/worry and insomnia among this group. Published by Elsevier Inc.

  6. Generalized Anxiety Disorder in Referred Children and Adolescents.

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    Masi, Gabriele; Millepiedi, Stefania; Mucci, Maria; Poli, Paola; Bertini, Nicoletta; Milantoni, Luca

    2004-01-01

    Objective: There are insufficient data on generalized anxiety disorder in children and adolescents. Symptoms and comorbidity of generalized anxiety disorder are described as a function of age, gender, and comorbidity in a consecutive series of referred children and adolescents. Method: One hundred fifty-seven outpatients (97 males and 60 females,…

  7. The 7-Item Generalized Anxiety Disorder Scale as a Tool for Measuring Generalized Anxiety in Multiple Sclerosis

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    Terrill, Alexandra L.; Hartoonian, Narineh; Beier, Meghan; Salem, Rana; Alschuler, Kevin

    2015-01-01

    Background: Generalized anxiety disorder (GAD) is common in multiple sclerosis (MS) but understudied. Reliable and valid measures are needed to advance clinical care and expand research in this area. The objectives of this study were to examine the psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in individuals with MS and to analyze correlates of GAD.

  8. Biofeedback Approach in The Treatment of Generalized Anxiety Disorder

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    Jaspal Singh Sandhu

    2007-08-01

    Full Text Available  Objective: The present study compares the efficacy of two most commonly used biofeedback relaxation techniques in the treatment of Generalized Anxiety Disorder.  Method: 45 individuals with Generalized Anxiety Disorder were randomly assigned to three groups (n=15: Group I received electromyographic biofeedback relaxation training, Group II received alpha-electroencephalographic biofeedback relaxation training and Group III served as the control group.  Results: Both treatment groups resulted in more consistent pattern of generalized relaxation changes reflected in galvanic skin resistance, state and trait anxiety as compared to the control group. Significant changes were observed in galvanic skin resistance and trait anxiety in the electromyographic group as compared to the electroencephalographic group. At follow-up,maintenance of effects of treatment was observed in both treatment groups.  Conclusions: Both Biofeedback trainings are efficacious in the treatment of Generalized Anxiety Disorder.

  9. Generalized anxiety disorder -- self-care

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    ... An antidepressant, which can help with anxiety and depression. This kind of medicine can take weeks to work. It is a safe medium- to long-term treatment for GAD. A benzodiazepine, which acts faster than ...

  10. Over-generalization in youth with anxiety disorders.

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    El-Bar, Nurit; Laufer, Offir; Yoran-Hegesh, Roni; Paz, Rony

    2017-02-01

    Over-generalization of dangerous stimuli is a possible etiological account of anxiety. Recently, we demonstrated it could result from alterations in early perceptual mechanisms, i.e., a fundamental change in the way the stimulus is perceived. Yet it is still unclear if these mechanisms already exist in youth, or develop only later. The purpose of this study was therefore to explore the mechanism of generalization in youth suffering from anxiety disorders. Children and adolescents with anxiety disorders and age-matched control participants underwent a conditioning task where a loss or gain outcome was associated with two well-separated tones. A generalization probe then followed in which different surrounding tones were presented and classified. Generalization curves and changes in discrimination abilities were compared between groups and according to the background variables. We found that patients had lower perceptual discrimination thresholds after conditioning, and tended to have wider generalization curve. Relative enhanced generalization was observed in adolescents with anxiety, in males, and as the level of anxiety rose. Our results suggest that over-generalization in anxiety can start already during adolescence, and may suggest that an early perceptual source can give rise to later more cognitive over-generalization during adult anxiety.

  11. Anxiety Sensitivity and Its Factors in Relation to Generalized Anxiety Disorder among Adolescents.

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    Knapp, Ashley A; Blumenthal, Heidemarie; Mischel, Emily R; Badour, Christal L; Leen-Feldner, Ellen W

    2016-02-01

    Anxiety psychopathology, one of the most prevalent classes of disorder among youth, is linked to detrimental outcomes. Accordingly, identifying factors that influence vulnerability to anxiety disorders is important. One promising factor, given emerging evidence for its transdiagnostic nature, is anxiety sensitivity (AS); however, relatively little is known about the linkage between AS and indicators of generalized anxiety disorder (GAD), particularly among youth. The aim of the current investigation was to address this gap in the literature using a community-based sample of adolescents aged 10-17 years (n = 165; M age  = 14.49 years, SD = 2.26). Results indicated global AS and the AS-physical concerns dimension were significantly associated with worry, generalized anxiety symptoms, and GAD diagnosis assessed via a structured clinical interview, above and beyond key theoretically-relevant covariates. These findings add to a growing body of work underscoring the relevance of AS for multiple types of anxiety-related disorders among youth.

  12. Generalized Anxiety Disorder Across the Lifespan: An Integrative ...

    African Journals Online (AJOL)

    African Journal of Psychiatry • August 2009. 234. Two aspects of this ... generalized anxiety disorder (GAD) and its treatment. Although a larger part of ... Thus, this volume by Dr Portman, a clinical social worker and psychotherapist based in ...

  13. [Treatment of generalized anxiety disorder in terms of cognitive behavioral].

    Science.gov (United States)

    Kamrowska, Anna; Gmitrowicz, Agnieszka

    2016-02-01

    Risk of generalized anxiety disorder (GAD) within life is estimated at 2.6-5.1%. Amongst etiological factors that affect the development of the disorder are: biological and psychological problems, including cognitive models. There are known several cognitive models: metacognitive, Borkovec'c model and the model developed in Quebec. Key cognitive contents that occur with generalized anxiety disorder are focused on two aspects: metacognitive beliefs and intolerance of uncertainty. A primary purpose of cognitive-behavioural therapy (CBT) is the modification of dysfunctional beliefs about worry. Cognitive behavioural therapy is effective in reducing anxiety, makes it easier to operate in the professional sphere and improves the quality of life.

  14. German Anxiety Barometer—Clinical and Everyday-Life Anxieties in the General Population

    Science.gov (United States)

    Adolph, Dirk; Schneider, Silvia; Margraf, Jürgen

    2016-01-01

    The objective of this study was to test a time-efficient screening instrument to assess clinically relevant and everyday-life (e.g., economic, political, personal) anxieties. Furthermore, factors influencing these anxieties, correlations between clinical and everyday anxieties and, for the first time, anxiety during different stages of life were assessed in a representative sample of the general population (N = 2229). Around 30% of the respondents manifested at least one disorder-specific key symptom within 1 year (women > men), 8% reported severe anxiety symptoms. Two thirds of respondents reported minor everyday anxieties and 5% were strongly impaired, whereby persons with severe clinical symptoms were more frequently affected. A variety of potential influencing factors could be identified. These include, in addition to socioeconomic status, gender, general health, risk-taking, and leisure behavior, also some up to now little investigated possible protective factors, such as everyday-life mental activity. The observed effects are rather small, which, however, given the heterogeneity of the general population seems plausible. Although the correlative design of the study does not allow direct causal conclusions, it can, however, serve as a starting point for experimental intervention studies in the future. Together with time series from repeated representative surveys, we expect these data to provide a better understanding of the processes that underlie everyday-life and clinical anxieties. PMID:27667977

  15. German Anxiety Barometer-Clinical and Everyday-Life Anxieties in the General Population.

    Science.gov (United States)

    Adolph, Dirk; Schneider, Silvia; Margraf, Jürgen

    2016-01-01

    The objective of this study was to test a time-efficient screening instrument to assess clinically relevant and everyday-life (e.g., economic, political, personal) anxieties. Furthermore, factors influencing these anxieties, correlations between clinical and everyday anxieties and, for the first time, anxiety during different stages of life were assessed in a representative sample of the general population (N = 2229). Around 30% of the respondents manifested at least one disorder-specific key symptom within 1 year (women > men), 8% reported severe anxiety symptoms. Two thirds of respondents reported minor everyday anxieties and 5% were strongly impaired, whereby persons with severe clinical symptoms were more frequently affected. A variety of potential influencing factors could be identified. These include, in addition to socioeconomic status, gender, general health, risk-taking, and leisure behavior, also some up to now little investigated possible protective factors, such as everyday-life mental activity. The observed effects are rather small, which, however, given the heterogeneity of the general population seems plausible. Although the correlative design of the study does not allow direct causal conclusions, it can, however, serve as a starting point for experimental intervention studies in the future. Together with time series from repeated representative surveys, we expect these data to provide a better understanding of the processes that underlie everyday-life and clinical anxieties.

  16. No distinctions between different types of anxiety symptoms in pre-adolescents from the general population

    NARCIS (Netherlands)

    Ferdinand, RF; van Lang, NDJ; Ormel, J; Verhulst, FC

    2006-01-01

    Studies aimed at anxiety symptoms in children from the general population samples often make distinctions between symptoms of Separation Anxiety, Social Phobia, Panic Disorder, and Generalized Anxiety Disorder. Given the high comorbidity rates between these disorders, the usefulness of such

  17. Oxytocin in General Anxiety and Social Fear: A Translational Approach.

    Science.gov (United States)

    Neumann, Inga D; Slattery, David A

    2016-02-01

    The neuropeptide oxytocin (OXT) has been revealed as a profound anxiolytic and antistress factor of the brain, besides its many prosocial and reproductive effects. Therefore, there is substantial scientific and medical interest in its potential therapeutic use for the treatment of psychopathologies associated with anxiety, fear, and social dysfunctions, such as generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder, as well as autism and schizophrenia, among others. Focusing on preclinical studies, we review the existing evidence for the regulatory capacity of OXT to fine-tune general and social anxiety-related behaviors, as well as cued and social fear conditioning from a translational perspective. The available evidence from animal and human studies substantiates the hypothesis of an imbalance of the endogenous brain OXT system in the etiology of anxiety disorders, particularly those with a social component such as social anxiety disorder. In addition, such an imbalance of the OXT system is also likely to be the consequence of chronic OXT treatment resulting in a dose-dependent reduction in OXT receptor availability and increased anxiety.

  18. Generalized anxiety and mixed anxiety-depression: association with disability and health care utilization.

    Science.gov (United States)

    Roy-Byrne, P P

    1996-01-01

    Generalized anxiety and mixed anxiety-depression have received less attention than the major mood and anxiety disorders ith respect to their possible effects in increasing disability and health care utilization. A review of recent studies, however, indicates that these conditions are prevalent in primary care medical settings and are associated with significant social and occupational disability. Generalized anxiety disorder is also one of the most common diagnoses seen in patients presenting with medically unexplained somatic complaints such as chest pain, irritable bowel symptoms, and hyperventilation and in patients prone to overutilize health care services in general. It is poorly recognized by primary care physicians, possibly due to its chronicity, which may limit the ability of symptoms to "stand out" and be easily detected. However, it is disproportionately present in "high utilizer" samples found to be particularly "frustrating" to their physicians and is accompanied by a high rate of personality disorders, suggesting that maladaptive personality traits and styles of interaction in such patients may also contribute to underrecognition of symptoms by primary care physicians. These preliminary associations between generalized anxiety disorder/mixed anxiety-depression and both disability and increased health care utilization need to be confirmed with carefully designed and controlled studies.

  19. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification

    OpenAIRE

    Monique Aucoin; Sukriti Bhardwaj

    2016-01-01

    Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of ...

  20. Posttraumatic stress disorder's dysphoria dimension and relations with generalized anxiety disorder symptoms.

    Science.gov (United States)

    Durham, Tory A; Elhai, Jon D; Fine, Thomas H; Tamburrino, Marijo; Cohen, Gregory; Shirley, Edwin; Chan, Philip K; Liberzon, Israel; Galea, Sandro; Calabrese, Joseph R

    2015-07-30

    The present study investigated symptom relations between two highly comorbid disorders--posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD)--by exploring their underlying dimensions. Based on theory and prior empirical research it was expected that the dysphoria factor of PTSD would be more highly related to GAD. As part of a longitudinal project of mental health among Ohio National Guard Soldiers, 1266 subjects were administered the Posttraumatic Stress Disorder Checklist (PCL) and Generalized Anxiety Disorder-7 scale (GAD-7). Confirmatory factor analyses (CFAs) were conducted to examine two models of PTSD and to determine which PTSD factors were more related to the GAD factor. The results indicate that the GAD factor was significantly more highly correlated with PTSD's dysphoria factor than with all other PTSD factors, including PTSD's reexperiencing factor, avoidance factor, and hyperarousal factor. Results indicate GAD was not significantly more highly correlated with numbing than most other factors of PTSD. The results are consistent with prior research. Implications of the results are discussed in regards to PTSD in DSM-5, comorbidity and diagnostic specificity.

  1. German Anxiety Barometer – Clinical and Everyday-Life Anxieties in the General Population.

    Directory of Open Access Journals (Sweden)

    Dirk Adolph

    2016-09-01

    Full Text Available The objective of this study was to test a time-efficient screening instrument to assess clinically relevant and everyday-life (e.g.,economic,political,personalanxieties.Furthermore,factors influencing these anxieties, correlations between clinical and everyday anxieties and, for the first time, anxiety during different stages of life were assessed in a representative sample of the general population (N= 2229.Around 30% of the respondents manifested at least one disorder-specific key symptom within one year (women > men, 8% reported severe anxiety symptoms.Two thirds of respondents reported minor everyday anxieties and 5% were strongly impaired, whereby persons with severe clinical symptoms were more frequently affected.A variety of potential influencing factors could be identified. These include,in addition to socioeconomic status, gender, general health, risk-taking and leisure behaviour, also some up to now little investigated possible protective factors,such as everyday-life mental activity. The observed effects are rather small, which, however, given the heterogeneity of the general population seems plausible. Although the correlative design of the study does not allow direct causal conclusions, it can, however, serve as a starting point for experimental intervention studies in the future. Together with time series from repeated representative surveys, we expect these data to provide a better understanding of the processes that underlie everyday-life and clinical anxieties.

  2. Generalized anxiety modulates frontal and limbic activation in major depression

    Directory of Open Access Journals (Sweden)

    Schlund Michael W

    2012-02-01

    Full Text Available Abstract Background Anxiety is relatively common in depression and capable of modifying the severity and course of depression. Yet our understanding of how anxiety modulates frontal and limbic activation in depression is limited. Methods We used functional magnetic resonance imaging and two emotional information processing tasks to examine frontal and limbic activation in ten patients with major depression and comorbid with preceding generalized anxiety (MDD/GAD and ten non-depressed controls. Results Consistent with prior studies on depression, MDD/GAD patients showed hypoactivation in medial and middle frontal regions, as well as in the anterior cingulate, cingulate and insula. However, heightened anxiety in MDD/GAD patients was associated with increased activation in middle frontal regions and the insula and the effects varied with the type of emotional information presented. Conclusions Our findings highlight frontal and limbic hypoactivation in patients with depression and comorbid anxiety and indicate that anxiety level may modulate frontal and limbic activation depending upon the emotional context. One implication of this finding is that divergent findings reported in the imaging literature on depression could reflect modulation of activation by anxiety level in response to different types of emotional information.

  3. Women's empowerment and generalized anxiety in Minya, Egypt.

    Science.gov (United States)

    Yount, Kathryn M; Dijkerman, Sally; Zureick-Brown, Sarah; VanderEnde, Kristin E

    2014-04-01

    Gender disparities in mental health are global, with women experiencing higher rates than men of anxiety disorders, mood disorders, and attempted suicide. Women's low social status may partly explain these disparities, yet evidence from Arab and Middle Eastern settings is limited. We assessed whether women's empowerment - or acquisition of enabling resources, and in turn, enhanced agency - was associated with their lower generalized anxiety. For 539 ever-married women 22-65 years who participated in the 2005 Egypt Demographic Health Survey (EDHS) and a 2012 follow-up survey in rural Minya, we estimated linear reduced-form and mediation regression models to assess the associations of women's premarital enabling resources with their generalized anxiety in 2012, overall and through measures of their marital agency in 2005. Women's higher schooling attainment, premarital economic activity, later age at first marriage, and greater proximity to natal (or birth) family had significant, adjusted associations with lower generalized anxiety. Measures of women's agency in marriage had mixed associations with generalized anxiety, but their inclusion modestly reduced the coefficients for premarital resources. Parallel qualitative findings confirmed nuanced associations between women's exclusive decision-making and their mental health. Efforts to enhance women's education and premarital economic activity might be combined with efforts to delay first marriage and ensure women's extra-marital social support to maximize their empowerment and its mental-health benefits. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Diminished autonomic neurocardiac function in patients with generalized anxiety disorder

    Directory of Open Access Journals (Sweden)

    Kim K

    2016-12-01

    Full Text Available Kyungwook Kim,1 Seul Lee,2 Jong-Hoon Kim1–3 1Gachon University School of Medicine, 2Department of Psychiatry, Gil Medical Center, Gachon University School of Medicine, Gachon University, 3Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea Background: Generalized anxiety disorder (GAD is a chronic and highly prevalent disorder that is characterized by a number of autonomic nervous system symptoms. The purpose of this study was to investigate the linear and nonlinear complexity measures of heart rate variability (HRV, measuring autonomic regulation, and to evaluate the relationship between HRV parameters and the severity of anxiety, in medication-free patients with GAD. Methods: Assessments of linear and nonlinear complexity measures of HRV were performed in 42 medication-free patients with GAD and 50 healthy control subjects. In addition, the severity of anxiety symptoms was assessed using the State-Trait Anxiety Inventory and Beck Anxiety Inventory. The values of the HRV measures of the groups were compared, and the correlations between the HRV measures and the severity of anxiety symptoms were assessed. Results: The GAD group showed significantly lower standard deviation of RR intervals and the square root of the mean squared differences of successive normal sinus intervals values compared to the control group (P<0.01. The approximate entropy value, which is a nonlinear complexity indicator, was also significantly lower in the patient group than in the control group (P<0.01. In correlation analysis, there were no significant correlations between HRV parameters and the severity of anxiety symptoms. Conclusion: The present study indicates that GAD is significantly associated with reduced HRV, suggesting that autonomic neurocardiac integrity is substantially impaired in patients with GAD. Future prospective studies are required to investigate the effects of pharmacological or non-pharmacological treatment on

  5. Duloxetine in the treatment of generalized anxiety disorder

    Directory of Open Access Journals (Sweden)

    Trevor R Norman

    2009-01-01

    Full Text Available Trevor R Norman, James S OlverDepartment of Psychiatry, University of Melbourne, Austin Hospital, Heidelberg, Victoria, AustraliaAbstract: Duloxetine, a medication with effects on both serotonin and noradrenaline transporter molecules, has recently been approved for the treatment of generalized anxiety disorder. The evidence for its efficacy lies in a limited number of double blind, placebo controlled comparisons. Statistically significant improvements in the Hamilton Anxiety Rating Scale from baseline were demonstrated in all studies at doses of 60 to 120 mg per day. The significance of such changes in terms of clinical improvements compared to placebo is less certain, particularly when the effect size of the change is calculated. In comparative trials with venlafaxine, duloxetine was as effective in providing relief of anxiety symptoms. In addition to improvements in clinical symptoms duloxetine has also been associated with restitution of role function as measured by disability scales. Duloxetine use is associated with nausea, dizziness, dry mouth, constipation, insomnia, somnolence, hyperhidrosis, decreased libido and vomiting. These treatment emergent side effects were generally of mild to moderate severity and were tolerated over time. Using a tapered withdrawal schedule over two weeks in the clinical trials, duloxetine was associated with only a mild withdrawal syndrome in up to about 30% of patients compared to about 17% in placebo treated patients. Duloxetine in doses of up to 200 mg twice daily did not prolong the QTc interval in healthy volunteers. Like other agents with dual neurotransmitter actions duloxetine reduces the symptoms of generalized anxiety disorder in short term treatments. Further evidence for its efficacy and safety in long term treatment is required.Keywords: duloxetine, generalized anxiety disorder, Hamilton anxiety rating scale, withdrawal syndrome, psycho-social function

  6. Avoidance, Safety Behavior, And Reassurance Seeking In Generalized Anxiety Disorder

    NARCIS (Netherlands)

    Beesdo-Baum, K.; Jenjahn, E.; Höfler, M.; Lüken, U.; Becker, E.S.; Hoyer, J.

    2012-01-01

    Background The behavioral symptoms of Generalized Anxiety Disorder (GAD) are not well characterized. This study examines behavioral symptoms in patients with GAD compared to healthy participants, their change during behavioral therapy, and their role for predicting short- and long-term outcome. Meth

  7. Diminished autonomic neurocardiac function in patients with generalized anxiety disorder

    Science.gov (United States)

    Kim, Kyungwook; Lee, Seul; Kim, Jong-Hoon

    2016-01-01

    Background Generalized anxiety disorder (GAD) is a chronic and highly prevalent disorder that is characterized by a number of autonomic nervous system symptoms. The purpose of this study was to investigate the linear and nonlinear complexity measures of heart rate variability (HRV), measuring autonomic regulation, and to evaluate the relationship between HRV parameters and the severity of anxiety, in medication-free patients with GAD. Methods Assessments of linear and nonlinear complexity measures of HRV were performed in 42 medication-free patients with GAD and 50 healthy control subjects. In addition, the severity of anxiety symptoms was assessed using the State-Trait Anxiety Inventory and Beck Anxiety Inventory. The values of the HRV measures of the groups were compared, and the correlations between the HRV measures and the severity of anxiety symptoms were assessed. Results The GAD group showed significantly lower standard deviation of RR intervals and the square root of the mean squared differences of successive normal sinus intervals values compared to the control group (P<0.01). The approximate entropy value, which is a nonlinear complexity indicator, was also significantly lower in the patient group than in the control group (P<0.01). In correlation analysis, there were no significant correlations between HRV parameters and the severity of anxiety symptoms. Conclusion The present study indicates that GAD is significantly associated with reduced HRV, suggesting that autonomic neurocardiac integrity is substantially impaired in patients with GAD. Future prospective studies are required to investigate the effects of pharmacological or non-pharmacological treatment on neuroautonomic modulation in patients with GAD. PMID:27994467

  8. What's the Worry with Social Anxiety? Comparing Cognitive Processes in Children with Generalized Anxiety Disorder and Social Anxiety Disorder.

    Science.gov (United States)

    Hearn, Cate S; Donovan, Caroline L; Spence, Susan H; March, Sonja; Holmes, Monique C

    2016-12-05

    Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8-12 years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.

  9. Duloxetine in the treatment of generalized anxiety disorder

    Directory of Open Access Journals (Sweden)

    Alan Wright

    2009-08-01

    Full Text Available Alan Wright, Chad VanDenBergCenter for Clinical Research, Mercer University, Atlanta, GA, USAAbstract: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI which is FDA approved for the treatment of generalized anxiety disorder (GAD in doses of 30 mg to 120 mg daily. Duloxetine has been shown to significantly improve symptoms of GAD as measured through the Hamilton Anxiety Rating Scale (HAMA, the Clinical Global Impressions Scale (CGI-I, and other various outcome measures in several placebo-controlled, randomized, double blind, multi-center studies. Symptom improvement began within the first few weeks, and continued for the duration of the studies. In addition, duloxetine has also been shown to improve outcomes in elderly patients with GAD, and in GAD patients with clinically significant pain symptoms. Duloxetine was noninferior compared with venlafaxine XR. Duloxetine was found to have a good tolerability profile which was predictable and similar to another SNRI, venlafaxine. Adverse events (AEs such as nausea, constipation, dry mouth, and insomnia were mild and transient, and occurred at relatively low rates. It was found to have a low frequency of drug interactions. In conclusion, duloxetine, a selective inhibitor for the serotonin and norepinephrine transporters, is efficacious in the treatment of GAD, and has a predictable tolerability profile, with AEs generally being mild to moderate.Keywords: duloxetine, generalized anxiety disorder, anxiety, GAD

  10. Post Hoc Analyses of Anxiety Measures in Adult Patients With Generalized Anxiety Disorder Treated With Vilazodone.

    Science.gov (United States)

    Khan, Arif; Durgam, Suresh; Tang, Xiongwen; Ruth, Adam; Mathews, Maju; Gommoll, Carl P

    2016-01-01

    To investigate vilazodone, currently approved for major depressive disorder in adults, for generalized anxiety disorder (GAD). Three randomized, double-blind, placebo-controlled studies showing positive results for vilazodone (2,040 mg/d) in adult patients with GAD (DSM-IV-TR) were pooled for analyses; data were collected from June 2012 to March 2014. Post hoc outcomes in the pooled intent-to-treat population (n = 1,462) included mean change from baseline to week 8 in Hamilton Anxiety Rating Scale (HARS) total score, psychic and somatic anxiety subscale scores, and individual item scores; HARS response (≥ 50% total score improvement) and remission (total score ≤ 7) at week 8; and category shifts, defined as HARS item score ≥ 2 at baseline (moderate to very severe symptoms) and score of 0 at week 8 (no symptoms). The least squares mean difference was statistically significant for vilazodone versus placebo in change from baseline to week 8 in HARS total score (-1.83, P anxiety (-1.21, P anxiety (-0.63, P adult GAD patients, with significant differences between treatment groups found on both psychic and somatic HARS items. ClinicalTrials.gov identifiers: NCT01629966, NCT01766401, NCT01844115.

  11. A community-based epidemiological study of health anxiety and generalized anxiety disorder.

    Science.gov (United States)

    Lee, Sing; Lam, Ivy M H; Kwok, Kathleen P S; Leung, Candi M C

    2014-03-01

    This community-based study examined the frequency of worry about personal health in respondents with and without generalized anxiety disorder (GAD), and the impact of health anxiety on the disorder. A random community-based telephone survey of 5118 Chinese respondents aged 18-64 was conducted. A fully structured questionnaire covered the DSM-IV-TR criteria of GAD, major depressive episode (MDE), eight domains of worry, the seven-item Whiteley Index (WI-7), health service use, and socio-demographic information. Worry about personal health ranked fifth (75.6%) among eight domains of worries examined. GAD respondents with high level of health anxiety were significantly older, less educated, and had lower family income. High health anxiety significantly increased the occurrence of one-year MDE, previous persistent worry, previous persistent low mood, number of domains of worries, number of non-core DSM-IV-TR GAD symptoms, health service use, and mistrust of doctors. Health anxiety is common in GAD and may signify greater severity of the disorder. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. The hyperventilation syndrome in panic disorder, agoraphobia and generalized anxiety disorder

    NARCIS (Netherlands)

    de Ruiter, C.; Garssen, B.; Rijken, H.; Kraaimaat, F.

    1989-01-01

    The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome

  13. Virtual reality in the treatment of generalized anxiety disorders.

    Science.gov (United States)

    Gorini, Alessandra; Pallavicini, Federica; Algeri, Davide; Repetto, Claudia; Gaggioli, Andrea; Riva, Giuseppe

    2010-01-01

    Generalized anxiety disorder (GAD) is a common anxiety disorder characterized by 6 months of "excessive anxiety and worry" about a variety of events and situations. Anxiety and worry are often accompanied by additional symptoms like restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and disturbed sleep. GAD is usually treated with medications and/or psychotherapy. In particular, the two most promising treatments seem to be cognitive therapy and applied relaxation. In this study we integrated these approaches through the use of a biofeedback enhanced virtual reality (VR) system used both for relaxation and controlled exposure. Moreover, this experience is strengthened by the use of a mobile phone that allows patients to perform the virtual experience even in an outpatient setting. This paper describe the results of a controlled trial (NCT00602212) involving 20 GAD patients randomly assigned to the following groups: (1) the VR and Mobile group (VRMB) including biofeedback; (2) the VR and Mobile group (VRM) without biofeedback; (3) the waiting list (WL) group. The clinical data underlined that (a) VR can be used also in the treatment of GAD; (b) in a VR treatment, patients take advantage of a mobile device that delivers in an outpatient setting guided experiences, similar to the one experienced in VR.

  14. Fear Generalization and Anxiety: Behavioral and Neural Mechanisms.

    Science.gov (United States)

    Dunsmoor, Joseph E; Paz, Rony

    2015-09-01

    Fear can be an adaptive emotion that helps defend against potential danger. Classical conditioning models elegantly describe how animals learn which stimuli in the environment signal danger, but understanding how this learning is generalized to other stimuli that resemble aspects of a learned threat remains a challenge. Critically, the overgeneralization of fear to harmless stimuli or situations is a burden to daily life and characteristic of posttraumatic stress disorder and other anxiety disorders. Here, we review emerging evidence on behavioral and neural mechanisms of generalization of emotional learning with the goal of encouraging further research on generalization in anxiety disorders. We begin by placing research on fear generalization in a rich historical context of stimulus generalization dating back to Pavlov, which lays the foundation for theoretical and experimental approaches used today. We then transition to contemporary behavioral and neurobiological research on generalization of emotional learning in humans and nonhuman animals and discuss the factors that promote generalization on the one hand from discrimination on the other hand.

  15. Relations among Perceived Control over Anxiety-Related Events, Worry, and Generalized Anxiety Disorder in a Sample of Adolescents

    Science.gov (United States)

    Frala, Jamie L.; Leen-Feldner, Ellen W.; Blumenthal, Heidemarie; Barreto, Carolina C.

    2010-01-01

    This study examined the associations among perceived control over anxiety-related events, worry, and both symptoms and diagnoses of generalized anxiety disorder (GAD). The sample was comprised of 140 adolescents (60 girls) between the ages of 10 and 17 years (M[subscript age] = 14.6 years; SD = 2.25) recruited from the general community. Findings…

  16. First-line pharmacotherapy approaches for generalized anxiety disorder.

    Science.gov (United States)

    Davidson, Jonathan R

    2009-01-01

    Many patients with generalized anxiety disorder (GAD) do not receive adequate treatment. Several classes of drugs, including benzodiazepines, azapirones, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, antihistamines, alpha(2)delta Ca++ channel modulators, and atypical antipsychotics are consistently beneficial in patients with GAD. Cognitive therapy is also effective as a first-line treatment. When individualizing treatment, drug dose ranges and side effect profiles need to be considered, as well as the patient's comorbid conditions. Doses may need to be reduced for elderly or medically ill patients or those taking other medications. Doses may need to be increased for refractory cases. Common comorbid conditions with GAD include depression, alcohol or drug abuse, social anxiety disorder, and panic disorder. In patients with significant depression, an antidepressant is more likely to succeed than a benzodiazepine. Generalized anxiety disorder is a chronic illness that requires long-term treatment. Remission is attainable but can take several months, and stopping medication increases the risk of relapse within the first year of initiating treatment.

  17. A literature review of quetiapine for generalized anxiety disorder.

    Science.gov (United States)

    Kreys, Tiffany-Jade M; Phan, Stephanie V

    2015-02-01

    To evaluate the efficacy and tolerability of quetiapine for the treatment of generalized anxiety disorder (GAD), a literature search of the Medline database was conducted from inception to May 2014. The search was not restricted by language. Keywords used in the search were quetiapine and generalized anxiety disorder or anxiety. All studies assessing the use of quetiapine as monotherapy or adjunct therapy for the primary management of GAD in adults 18-65 years of age were included in this review. The nine studies included in this review were three studies evaluating the use of quetiapine extended release (XR) as monotherapy for acute GAD treatment, one study evaluating quetiapine XR monotherapy for maintenance treatment of GAD, and five studies evaluating quetiapine (2 XR, 3 immediate release) as adjunct therapy for acute GAD treatment. Quetiapine displayed both efficacy and tolerability in all monotherapy trials evaluating its use for acute and long-term treatment of GAD. Despite some limitations to and heterogeneity among the five adjunct therapy studies, three studies showed that quetiapine resulted in statistically significant changes in the Hamilton Anxiety Rating Scale or Clinical Global Impressions-Severity of Illness Scale scores. Although future studies of longer duration with broader inclusion criteria are needed to further evaluate the benefits and risks of quetiapine for GAD, in patients failing to respond to conventional antidepressant therapy, quetiapine may be a potential treatment option. With appropriate monitoring and management of adverse effects, the potential benefits of quetiapine in patients with treatment-refractory GAD may outweigh the risks associated with its use.

  18. Skill-Based L2 Anxieties Revisited: Their Intra-Relations and the Inter-Relations with General Foreign Language Anxiety

    Science.gov (United States)

    Pae, Tae-IL

    2013-01-01

    Recently, research in foreign language anxiety has extended to the examination of more language-skill-specific anxieties. Existing research findings on the language-skill-specific anxieties indicate a consistent negative relationship between individual skill-based anxieties (e.g. listening anxiety) and more general foreign language classroom…

  19. Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns.

    Science.gov (United States)

    Bernson, Jenny M; Elfström, Magnus L; Hakeberg, Magnus

    2013-06-01

    The aim of the present study was to investigate dental coping strategies, general anxiety, and depression in relation to regularity of dental treatment among persons with either regular dental care or phobic avoidance, whilst controlling for sociodemographic factors. Psychometric questionnaires on dental anxiety, dental coping strategies, general anxiety, and depression were delivered to 263 adult patients with dental phobic avoidance behavior who were seeking help from a specialized dental fear clinic and to 141 adult patients with dental anxiety who were receiving regular dental care from various public dental clinics. The results showed that the levels of dental and general anxiety and of depression were significantly higher among irregular attendees compared with regular attendees. Irregular attendees admitted fewer adaptive coping strategies. Predictive of irregular dental care were gender, dental anxiety, general anxiety, and the nonuse of the coping strategy 'optimism'. This study further confirms earlier preliminary results that the use of optimistic thinking is predictive for regular dental attendance habits and that male gender is a risk factor for irregular attendance. Moreover, this study adds that a high level of general anxiety indicates a higher risk for irregular dental care.

  20. No distinctions between different types of anxiety symptoms in pre-adolescents from the general population

    NARCIS (Netherlands)

    Ferdinand, RF; van Lang, NDJ; Ormel, J; Verhulst, FC

    2006-01-01

    Studies aimed at anxiety symptoms in children from the general population samples often make distinctions between symptoms of Separation Anxiety, Social Phobia, Panic Disorder, and Generalized Anxiety Disorder. Given the high comorbidity rates between these disorders, the usefulness of such distinct

  1. No distinctions between different types of anxiety symptoms in pre-adolescents from the general population

    NARCIS (Netherlands)

    Ferdinand, RF; van Lang, NDJ; Ormel, J; Verhulst, FC

    2006-01-01

    Studies aimed at anxiety symptoms in children from the general population samples often make distinctions between symptoms of Separation Anxiety, Social Phobia, Panic Disorder, and Generalized Anxiety Disorder. Given the high comorbidity rates between these disorders, the usefulness of such distinct

  2. The relationship between generalized anxiety disorder, depression and mortality in old age.

    NARCIS (Netherlands)

    Holwerda, T.J.; Schoevers, R.A.; Dekker, J.J.M.; Deeg, D.J.H.; Jonker, C.; Beekman, A.T.F.

    2007-01-01

    after adjustment for the different variables. Conclusions In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderl

  3. Anxiety Management Training and Relaxation as Self-Control in the Treatment of Generalized Anxiety in Medical Outpatients.

    Science.gov (United States)

    Cragan, Mary K.; Deffenbacher, Jerry L.

    1984-01-01

    Compared Anxiety Management Training (AMT) and Relaxation as Self-Control (RSC) in reducing stress in 55 anxious medical outpatients. At posttreatment and follow-up assessments, both AMT and RSC groups reported significantly less anxiety, stress reactivity, general physiological arousal, depression, and anger than controls. (JAC)

  4. Heart-related anxieties in relation to general anxiety and severity of illness in cardiology patients.

    Science.gov (United States)

    Muschalla, Beate; Glatz, Johannes; Linden, Michael

    2014-01-01

    Absence of an adequate reason for anxiety is a criterion for pathological anxiety. However, the presence of danger or fear-provoking stimuli may even be a risk factor for anxiety and does not exclude that there is additionally pathological anxiety too. The question is, to what degree can heart-related anxiety be explained by the severity of illness or trait anxiety? Two hundred and nine patients (37.8% women) from a cardiology inpatient unit completed the Heart-Anxiety-Questionnaire, Progression-Anxiety-Questionnaire, Job-Anxiety-Scale and the State-Trait-Anxiety-Inventory. The severity of cardiac illness was rated by the treating cardiologists using the Multidimensional Severity of Morbidity Rating. Time absent from work due to sickness was assessed as an indicator for illness-related impairment. Heart anxiety was significantly related to progression anxiety and, to a lesser extent, trait anxiety and indicators of subjective symptoms of somatic illness. No association was found with medical ratings for prognosis, multimorbidity, or reduction in life expectancy. Heart-related anxiety is a symptom of an anxiety disorder. Although partially dependent on subjective suffering, it cannot be explained by the severity of medical illness. Treatment of health-related anxieties should focus on how to cope with subjective symptoms of illness.

  5. Relation Between Frontal Alpha Asymmetry and Anxiety in Young Patients with Generalized Anxiety Disorder.

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    Demerdzieva, Aneta; Pop-Jordanova, Nada

    2015-01-01

    Frontal alpha asymmetry (the relative difference in power between two signals in different hemispheres) has been suggested as biomarker for anxiety. The goal of this study was to evaluate alpha asymmetry in the frontal region for young people (7-18 years) with generalized anxiety disorder, diagnosed according to two statistic manuals (DMS-IV-R and ICD-10), the medical history and the neuropsychological assessment. The QEEG recording and analysis of the obtained results from alpha spectra power and log of alpha spectra power are made in four conditions (eyes open, eyes closed, VCPT and ACPT). The obtained results for alpha power in general showed higher cortical activity in the right hemisphere, associated with negative emotions. The calculated alpha asymmetry separate for eyes open, eyes closed, VCPT and ACPT conditions showed the right activation in all four conditions. In addition, the right frontal asymmetry was specific for the Fp(1)-Fp(2) region, while a greater left frontal activation was recorded for the F(7)-F(8) region. The log of alpha power in general was additionally analyzed. The calculated asymmetry score in general (in a way that the left log transformed score was subtracted from the right) confirmed a greater right activation. Testing the power of the whole alpha band (μV(2)) in general, for all four conditions and for frontal region confirmed the right alpha asymmetries in all participants. The right alpha asymmetry in the frontal region was specific only for the Fp(1)-Fp(2) region (frontopolar region). The only greater left frontal activation was registered between the F(7)-F(8) region. Our findings are supported by many other studies using specific localization methods like fMRI or LORETA source localization.

  6. Children with Generalized Anxiety Disorder Do Not Have Peer Problems, Just Fewer Friends

    Science.gov (United States)

    Scharfstein, Lindsay; Alfano, Candice; Beidel, Deborah; Wong, Nina

    2011-01-01

    A common assumption is that all youth with anxiety disorders (AD) experience impaired peer relationships relative to healthy control children. Social impairments have been identified among youth with certain AD (e.g., social anxiety disorder; SAD), but less is known about the peer relationships of children with generalized anxiety disorder (GAD).…

  7. Employing Computer-Administered Exams in General Psychology: Student Anxiety and Expectations

    Science.gov (United States)

    Schult, Carolyn A.; McIntosh, John L.

    2004-01-01

    Computer-administered exams offer many advantages, but instructors may be reluctant to use them due to concerns that computer anxiety may increase student test anxiety. Introductory psychology students (N = 265) completed surveys prior to their first exam about their anxiety related to the upcoming exam, computers in general, and taking exams on…

  8. Children with Generalized Anxiety Disorder Do Not Have Peer Problems, Just Fewer Friends

    Science.gov (United States)

    Scharfstein, Lindsay; Alfano, Candice; Beidel, Deborah; Wong, Nina

    2011-01-01

    A common assumption is that all youth with anxiety disorders (AD) experience impaired peer relationships relative to healthy control children. Social impairments have been identified among youth with certain AD (e.g., social anxiety disorder; SAD), but less is known about the peer relationships of children with generalized anxiety disorder (GAD).…

  9. Impaired Retrieval Inhibition of Threat Material in Generalized Anxiety Disorder.

    Science.gov (United States)

    Kircanski, Katharina; Johnson, Douglas C; Mateen, Maria; Bjork, Robert A; Gotlib, Ian H

    2016-03-01

    Generalized Anxiety Disorder (GAD) is characterized by cognitive biases toward threat-relevant information, but the underlying mechanisms are unclear. We translated a retrieval-practice paradigm from cognitive science to investigate impaired inhibition of threat information as one such mechanism. Participants diagnosed with GAD and never-disordered control participants learned a series of cue-target pairs; whereas some cues were associated only with neutral targets, others were associated with both neutral and threat targets. Next, participants practiced retrieving neutral targets, which typically suppresses the subsequent recall of unpracticed associated targets (retrieval-induced forgetting; RIF). Finally, participants were tested on their recall of all targets. Despite showing intact RIF of neutral targets, the GAD group failed to exhibit RIF of threat targets. Furthermore, within the GAD group, less RIF of threat targets correlated with greater pervasiveness of worry. Deficits in inhibitory control over threat-relevant information may underlie the cognitive pathology of GAD, which has important treatment implications.

  10. Evaluation of oxidative and antioxidative parameters in generalized anxiety disorder.

    Science.gov (United States)

    Emhan, Ali; Selek, Salih; Bayazıt, Hüseyin; Fatih Karababa, İbrahim; Katı, Mahmut; Aksoy, Nurten

    2015-12-30

    Generalized anxiety disorder (GAD) is a prevalent psychiatric disorder. The exact causes of GAD still unknown, in addition to neurochemical and neuroanatomic disorders, genetic and environmental factors are discussed in etiology. In our study we aimed to evaluate the oxidative metabolism's status and investigate the role of oxidative metabolites in GAD. Blood samples were taken from enrolled subjects in appropriate way and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were studied in Harran University Biochemistry Labs. Results were compared between groups. The patients' TOS and OSI levels were significantly higher than control group. The patients' TAS levels were significantly lower than controls'. According to our findings, oxidative stress mechanism might have a role in GAD pathophysiology. In the future, total antioxidants may be used as a biologic marker in GAD etiology but more research is needed.

  11. Type D personality is associated with social anxiety in the general population.

    Science.gov (United States)

    Kupper, Nina; Denollet, Johan

    2014-06-01

    Research on the emotional processes associated with Type D personality is important for its further conceptualization. We examined the associations of Type D personality with social and general anxiety symptoms in a large community sample. The aim of the current study was to disentangle the associations of Type D personality and its components with social anxiety and general anxiety in a large sample from the general population. A random sample of 2,475 adults from the general population filled out questionnaires to assess Type D personality (DS-14), social anxiety (SIAS(10), SPS(11), BFNE-II), and general anxiety (HADS-A, GAD-7). Type D individuals were characterized by increased levels of both social and general anxiety. The social inhibition (SI) component of Type D personality was most strongly associated with social interaction anxiety (r = .63), while negative affectivity (NA) was strongly associated with general anxiety (GAD-7: r = .70; HADS-A: r = .66). Within social anxiety, SI was more strongly associated with facets of social interaction anxiety than with social phobia. Multiple regression analysis showed that the synergistic interaction of NA and SI was a predictor of social anxiety (SIAS(10): β = .32, p interaction was not a significant predictor of general anxiety. Logistic regression using the dichotomous Type D classification demonstrated a 9.1-fold (95%CI, 7.0-11.8) increased odds of a score in the highest quartile of social interaction anxiety and a 7.6-fold (95%CI, 5.8-9.8) increased odds of high social phobia. Odds ratios for clinically relevant levels of general anxiety were 8.3 (95%CI, 5.5-12.5) for GAD-7 and 6.5 (95%CI, 3.4-12.6) for HADS-A. In the general population, Type D individuals were characterized by both social and general anxiety. The SI component of Type D is strongly associated with social interaction anxiety and the synergistic interaction of NA and SI was associated with high social anxiety, above and beyond the main NA and

  12. The hyperventilation syndrome in panic disorder, agoraphobia and generalized anxiety disorder

    NARCIS (Netherlands)

    de Ruiter, C.; Garssen, B.; Rijken, H.; Kraaimaat, F.

    1989-01-01

    The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome (HVS)

  13. An Open Trial of an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder

    Science.gov (United States)

    Roemer, Lizabeth; Orsillo, Susan M.

    2007-01-01

    Research suggests that experiential avoidance may play an important role in generalized anxiety disorder (GAD; see Roemer, L., & Orsillo, S.M. (2002). "Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models." "Clinical…

  14. Bad dream frequency in older adults with generalized anxiety disorder: prevalence, correlates, and effect of cognitive behavioral treatment for anxiety.

    Science.gov (United States)

    Nadorff, Michael R; Porter, Ben; Rhoades, Howard M; Greisinger, Anthony J; Kunik, Mark E; Stanley, Melinda A

    2014-01-01

    This study investigated the relation between generalized anxiety disorder (GAD) and frequency of bad dreams in older adults. A secondary analysis from a randomized clinical trial comparing cognitive behavioral therapy (CBT) for anxiety to enhanced usual care (EUC) assessed bad dream frequency at baseline, post treatment (3 months), and at 6, 9, 12, and 15 months. Of 227 participants (mean age = 67.4), 134 met GAD diagnostic criteria (CBT = 70, EUC = 64), with the remaining 93 serving as a comparison group. Patients with GAD had significantly more bad dreams than those without, and bad dream frequency was significantly associated with depression, anxiety, worry, and poor quality of life. CBT for anxiety significantly reduced bad dream frequency at post treatment and throughout follow up compared to EUC.

  15. Affective neuroimaging in generalized anxiety disorder: an integrated review.

    Science.gov (United States)

    Fonzo, Gregory A; Etkin, Amit

    2017-06-01

    Affective neuroimaging has contributed to our knowledge of generalized anxiety disorder (GAD) through measurement of blood oxygenation level-dependent (BOLD) responses, which facilitate inference on neural responses to emotional stimuli during task-based functional magnetic resonance imaging (fMRI). In this article, the authors provide an integrated review of the task-based affective fMRI literature in GAD. Studies provide evidence for variable presence and directionality of BOLD abnormalities in limbic and prefrontal regions during reactivity to, regulation of, and learning from emotional cues. We conclude that understanding the sources of this variability is key to accelerating progress in this area. We propose that the cardinal symptom of GAD-worry-predominantly reflects stimulus-independent mental processes that impose abnormal, inflexible functional brain configurations, ie, the overall pattern of information transfer among behaviorally relevant neural circuits at a given point in time. These configurations that are inflexible to change from the incoming flux of environmental stimuli may underlie inconsistent task-based findings.

  16. The latent structure of generalized anxiety disorder in midlife adults.

    Science.gov (United States)

    Marcus, David K; Sawaqdeh, Abere; Kwon, Paul

    2014-02-28

    Generalized anxiety disorder (GAD) is identified as a discrete disorder in the DSM-5, but evidence suggests that GAD and the related construct of pathological worry possesses a dimensional latent structure. The objective of this study was to ascertain the latent structure of GAD using taxometric methods. A subsample of adults (N=2061) from the Midlife in the United States Study, a national sample of Americans, provided the data. Additional data from individuals who were re-interviewed 10 year later (n=1228) were also analyzed. Items corresponding to the DSM-IV-TR diagnostic criteria for GAD were used to generate indicators for the taxometric analyses. Multiple taxometric procedures provided no evidence that GAD has a categorical or taxonic latent structure. Instead, the results were more consistent with the proposition that GAD exists on a continuum. Evidence that GAD is dimensional suggests that dichotomizing individuals into GAD versus non-GAD groups will typically result in decreased statistical power. They also suggest that any diagnostic thresholds for identifying GAD are likely to be arbitrary. The findings are consistent with models that locate GAD within the framework of extant dimensional models of personality and with research that emphasizes a multifactorial etiology for GAD. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Relationship of generalized anxiety symptoms to urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid.

    Science.gov (United States)

    Garvey, M J; Noyes, R; Woodman, C; Laukes, C

    1995-06-29

    Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 45 patients with generalized anxiety disorder. Multiple regression analysis demonstrated that the severity of several anxiety symptoms was predicted by levels of 5-HIAA and VMA. These data are consistent with the proposal that serotonin and norepinephrine may be involved in the pathophysiology of anxiety.

  18. Patterns of healthcare utilization in patients with generalized anxiety disorder in general practice in Germany

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    Ariel Berger

    2009-06-01

    Full Text Available Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD in general practitioner (GP settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1 between October 1, 2003 and September 30, 2004 ("GAD patients". We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57], substance abuse disorders (3.91 [2.89, 5.28], and digestive system disorders (2.62 [2.36, 2.91] (all p <0.01. GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7] (both p <0.01. Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics. Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

  19. Validation of the geriatric anxiety inventory in a duloxetine clinical trial for elderly adults with generalized anxiety disorder.

    Science.gov (United States)

    Ball, Susan G; Lipsius, Sarah; Escobar, Rodrigo

    2015-09-01

    The Generalized Anxiety Inventory (GAI) has been developed for use in the assessment of anxiety symptoms in older adults (≥ 65 years), but previous validation work has not examined the psychometric qualities of the instrument in relation to treatment. The objective of this study was to examine the performance of the GAI for its internal reliability, convergent and divergent validity, and its sensitivity to treatment. Elderly patients with generalized anxiety disorder (GAD) participated in a 10-week double-blind study of duloxetine treatment for patients with GAD. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale (HAMA), the Hospital Anxiety and Depression Scale (HADS) anxiety and depression subscales, and the GAI. Internal reliability of the GAI was assessed with Cronbach's α. Correlations among the HAMA, HADS, and GAI scores were analyzed to determine convergent and divergent validity. Patients were also compared on remission status using recommended cut-off scores for the GAI. Patients with GAD, who were at least 65 years of age, were randomly assigned to double-blind treatment with either duloxetine (N = 151) or placebo (N = 140) for 10 weeks acute therapy. The mean change on the GAI was significantly greater with duloxetine compared with placebo treatment (-8.36 vs. -4.96, respectively, p ≤ 0.001). The GAI demonstrated good internal consistency, good convergent and divergent validity, but suggested cut-off values for caseness with the GAI did not correspond to remission status as measured by the HAMA. Within an elderly patient population with GAD, the GAI demonstrated sound psychometric qualities and sensitivity to change with treatment.

  20. Fear Generalization in Humans: Systematic Review and Implications for Anxiety Disorder Research.

    Science.gov (United States)

    Dymond, Simon; Dunsmoor, Joseph E; Vervliet, Bram; Roche, Bryan; Hermans, Dirk

    2015-09-01

    Fear generalization, in which conditioned fear responses generalize or spread to related stimuli, is a defining feature of anxiety disorders. The behavioral consequences of maladaptive fear generalization are that aversive experiences with one stimulus or event may lead one to regard other cues or situations as potential threats that should be avoided, despite variations in physical form. Theoretical and empirical interest in the generalization of conditioned learning dates to the earliest research on classical conditioning in nonhumans. Recently, there has been renewed focus on fear generalization in humans due in part to its explanatory power in characterizing disorders of fear and anxiety. Here, we review existing behavioral and neuroimaging empirical research on the perceptual and non-perceptual (conceptual and symbolic) generalization of fear and avoidance in healthy humans and patients with anxiety disorders. The clinical implications of this research for understanding the etiology and treatment of anxiety is considered and directions for future research described.

  1. No effect of trait anxiety on differential fear conditioning or fear generalization.

    Science.gov (United States)

    Torrents-Rodas, David; Fullana, Miquel A; Bonillo, Albert; Caseras, Xavier; Andión, Oscar; Torrubia, Rafael

    2013-02-01

    Previous studies have shown that individuals with anxiety disorders exhibit deficits in fear inhibition and excessive generalization of fear, but little data exist on individuals at risk from these disorders. The present study examined the role of trait anxiety in the acquisition and generalization of fear in 126 healthy participants selected on the basis of their trait-anxiety scores. Measures of conditioning included fear-potentiated startle, skin conductance response and online risk ratings for the unconditioned stimulus. Contrary to our hypotheses, trait anxiety did not have any effect either on the acquisition or the generalization of fear. Our results suggest that these fear conditioning processes are not impaired in individuals at risk from anxiety.

  2. Efficacy of Self-Examination Therapy in the Treatment of Generalized Anxiety Disorder.

    Science.gov (United States)

    Bowman, Daniel; Scogin, Forrest; Floyd, Mark; Patton, Ellen; Gist, Lisa

    1997-01-01

    Examined the efficacy of self-examination therapy (SET) in the treatment of generalized anxiety disorder. Results, based on 38 adults who were randomly assigned to SET or to a delayed-treatment group, indicate that participants in SET had significantly fewer symptoms of anxiety than did participants in the delayed-treatment group. (RJM)

  3. Generalized Anxiety Disorder and Social Anxiety Disorder, but Not Panic Anxiety Disorder, Are Associated with Higher Sensitivity to Learning from Negative Feedback: Behavioral and Computational Investigation.

    Science.gov (United States)

    Khdour, Hussain Y; Abushalbaq, Oday M; Mughrabi, Ibrahim T; Imam, Aya F; Gluck, Mark A; Herzallah, Mohammad M; Moustafa, Ahmed A

    2016-01-01

    Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic anxiety disorder (PAD), are a group of common psychiatric conditions. They are characterized by excessive worrying, uneasiness, and fear of future events, such that they affect social and occupational functioning. Anxiety disorders can alter behavior and cognition as well, yet little is known about the particular domains they affect. In this study, we tested the cognitive correlates of medication-free patients with GAD, SAD, and PAD, along with matched healthy participants using a probabilistic category-learning task that allows the dissociation between positive and negative feedback learning. We also fitted all participants' data to a Q-learning model and various actor-critic models that examine learning rate parameters from positive and negative feedback to investigate effects of valence vs. action on performance. SAD and GAD patients were more sensitive to negative feedback than either PAD patients or healthy participants. PAD, SAD, and GAD patients did not differ in positive-feedback learning compared to healthy participants. We found that Q-learning models provide the simplest fit of the data in comparison to other models. However, computational analysis revealed that groups did not differ in terms of learning rate or exploration values. These findings argue that (a) not all anxiety spectrum disorders share similar cognitive correlates, but are rather different in ways that do not link them to the hallmark of anxiety (higher sensitivity to negative feedback); and (b) perception of negative consequences is the core feature of GAD and SAD, but not PAD. Further research is needed to examine the similarities and differences between anxiety spectrum disorders in other cognitive domains and potential implementation of behavioral therapy to remediate cognitive deficits.

  4. Current concept of anxiety: implications from Darwin to the DSM-V for the diagnosis of generalized anxiety disorder.

    Science.gov (United States)

    Coutinho, Fernanda Corrêa; Dias, Gisele Pereira; do Nascimento Bevilaqua, Mário Cesar; Gardino, Patricia Franca; Pimentel Rangé, Bernard; Nardi, Antonio Egidio

    2010-08-01

    This article proposes a revision of the historical evolution of the concepts of generalized anxiety disorder (GAD). Currently, Darwin's evolutionary theory is the hegemonic paradigm for modern science and influences research on mental disorders. Throughout the 20th Century, the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association) have changed the diagnostic criteria for GAD, reflecting the prevailing psychiatric understanding of this disorder. The prevalence and symptoms of major depression and GAD show the fragility of the categorical conception of these conditions. Differences in cultural views towards anxiety disorders also suggest that anxiety cannot have a uniform definition. This article provides contributions for reflecting future guidelines concerning the diagnostic criteria for GAD in DSM-V.

  5. The burden of generalized anxiety disorder in Canada

    Directory of Open Access Journals (Sweden)

    Louise Pelletier

    2017-02-01

    Full Text Available Introduction: Although generalized anxiety disorder (GAD is common and disabling, there are few Canadian studies on this mental illness. We compared the characteristics, health status, health services use and health care needs of Canadians with GAD to those with depression. Methods: Data are from the 2012 Canadian Community Health Survey—Mental Health, which surveyed a nationally representative sample of Canadians aged 15 years and older (n = 23 709; response rate of 68.9%. The respondents we studied had self-reported symptoms compatible with GAD and/or major depressive episode (MDE in the preceding 12 months (n = 1598. Estimates were weighted to represent the Canadian household population. We performed descriptive and multinomial multivariate logistic regression analyses. Results: In 2012, an estimated 700 000 (2.5% Canadians aged 15 years and older reported symptoms compatible with GAD in the previous 12 months. MDE symptoms co-occurred in 50% of these individuals. Those with GAD only reported fair/poor perceived health (29.7%, moderate to severe psychological distress (81.2% and moderate to severe disability (28.1% comparable to (or even slightly worse than those with MDE only (24.7%, 78.8% and 24.8% respectively. Those with comorbid GAD and MDE demonstrated the worst health outcomes; 47.3% of them reported fair/poor perceived health, 94.0% reported moderate to severe psychological distress and 52.4% reported moderate to severe disability. Nearly 50% of those with comorbid GAD and MDE reported that their need for health care was not met or only partially met, compared to about 30% of those with GAD or MDE only. Conclusion: While GAD is associated with levels of distress and disability comparable to (or slightly worse than those affected by MDE only, the health status of those with comorbid disease is significantly worse than those with GAD or MDE only. Improved diagnosis, screening for comorbidity and management are essential to minimize

  6. The Worry Behaviors Inventory : Assessing the behavioral avoidance associated with generalized anxiety disorder

    NARCIS (Netherlands)

    Mahoney, Alison E J; Hobbs, Megan J; Newby, Jill M; Williams, Alishia D; Sunderland, Matthew; Andrews, Gavin

    2016-01-01

    BACKGROUND: Understanding behavioral avoidance associated with generalized anxiety disorder (GAD) has implications for the classification, theoretical conceptualization, and clinical management of the disorder. This study describes the development and preliminary psychometric evaluation of a self-re

  7. Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: a meta-analysis.

    Science.gov (United States)

    Tully, Phillip J; Cosh, Suzanne M

    2013-12-01

    Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease patients remain unquantified. Systematic searching of Medline, Embase, SCOPUS and PsycINFO databases revealed 1025 unique citations. Aggregate generalized anxiety disorder prevalence (12 studies, N = 3485) was 10.94 per cent (95% confidence interval: 7.8-13.99) and 13.52 per cent (95% confidence interval: 8.39-18.66) employing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (random effects). Lifetime generalized anxiety disorder prevalence was 25.80 per cent (95% confidence interval: 20.84-30.77). In seven studies, modest correlation was evident between generalized anxiety disorder and depression, Fisher's Z = .30 (95% confidence interval: .19-.42), suggesting that each psychiatric disorder is best conceptualized as contributing unique variance to coronary heart disease prognosis.

  8. Overlap between Headache, Depression, and Anxiety in General Neurological Clinics: A Cross-sectional Study

    Institute of Scientific and Technical Information of China (English)

    Cui-Bai Wei; Jian-Ping Jia; Fen Wang; Ai-Hong Zhou; Xiu-Mei Zuo; Chang-Biao Chu

    2016-01-01

    Background:Many studies have reported that depression and anxiety have bidirectional relationship with headache.However,few researches investigated the roles of depression or anxiety in patients with headache.We surveyed the prevalence of depression and anxiety as a complication or cause of headache among outpatients with a chief complaint of headache at neurology clinics in general hospitals.Additional risk factors for depression and anxiety were also analyzed.Methods:A cross-sectional study was conducted at 11 general neurological clinics.All consecutive patients with a chief complaint of headache were enrolled.Diagnoses of depression and anxiety were made using the Chinese version of the Mini International Neuropsychiatric Interview,and those for headache were made according to the International Classification of Headache Disorders,2nd Edition.The headache impact test and an 11-point verbal rating scale were applied to assess headache severity and intensity.Logistic regression was used to analyze risk factors of patients with headache for depression or anxiety.Results:A total of 749 outpatients with headache were included.Among them,148 (19.7%) were diagnosed with depression and 103 (13.7%) with anxiety.Further analysis showed that 114 (15.2%) patients complaining headache due to somatic symptoms of psychiatric disorders and 82 (10.9%) had a depression or anxiety comorbidity with headache.Most patients with depression or anxiety manifested mild to moderate headaches.Poor sleep and severe headache-related disabilities were predictors for either depression or anxiety.Conclusion:Clinicians must identify the etiology of headache and recognize the effects of depression or anxiety on headache to develop specific treatments.

  9. The relationship between depression and generalized anxiety during intensive psychological and pharmacological treatment.

    Science.gov (United States)

    Aderka, Idan M; Beard, Courtney; Lee, Josephine; Weiss, Rachel B; Björgvinsson, Thröstur

    2015-09-15

    In the present study we examined the relationship between depressive symptoms and generalized anxiety symptoms during intensive cognitive-behavioral and pharmacological treatment. Individuals (n = 157) with major depressive disorder (MDD; n = 83), generalized anxiety disorder (GAD; n = 29) and their combination (n = 45) who attended an intensive partial hospital treatment program, completed daily self-report measures of depression and generalized anxiety. Treatment included empirically-based cognitive-behavioral interventions in both individual and group format, as well as pharmacotherapy. Multilevel linear modeling indicated that for all diagnostic groups, changes in depressive symptoms led to changes in generalized anxiety symptoms to a greater extent than vice versa during treatment. Moreover, changes in depressive symptoms fully mediated changes in generalized anxiety symptoms, whereas changes in generalized anxiety symptoms only partially mediated the changes in depressive symptoms. Partial hospital setting. Our results suggest that depressive symptoms may play a prominent role in the process of change in both MDD and GAD. This has implications for the classification of GAD as well as for choosing early treatment targets for individuals with comorbid MDD and GAD. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. General beliefs about the world as defensive mechanisms against death anxiety.

    Science.gov (United States)

    Hui, Victoria Ka-Ying; Bond, Michael Harris; Ng, Timmy Sze Wing

    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.

  11. Comparison of maternal anxiety scores in pediatric intensive care unit and general ward parents

    Directory of Open Access Journals (Sweden)

    Lie Affendi Kartikahadi

    2012-02-01

    Full Text Available Background Hospitalization of a child is known to be a dreadful and stressful situation for parents. One study reported that admitting a child to a general ward caused mild anxiety to mothers, while admitting a child to the pediatric intensive care unit (PICU caused moderate anxiety to mothers. Objective To compare Hamilton anxiety scores of mothers whose children were admitted to the PICU to those of mothers whose children were admitted to the general ward. Methods A cross-sectional study was done on mothers of children aged 1 month-12 years. Children were admitted to either the intensive care unit or the general ward from October 2010-January 2011. All subjects were assessed by Hamilton anxiety scores and questioned for risk factors and other causes of maternal anxiety. Consecutive sampling was used to allocate the subjects. Differences were considered statistically significant for P < 0.05. Results Of the 72 subjects, the median Hamilton anxiety score in mothers of children admitted to the PICU was 20.5 (interquartile range 14-29.75, higher than that of mothers of children admitted to the general ward (14, interquartile range 9-16.75. Mann-Whitney U test revealed a statistically significant difference in scores between the two groups (P = 0.001. Ancova multivariate analysis showed the admission location to be the only significant relationship to Hamilton anxiety score (P = 0.0001. Conclusion Hamilton anxiety scores were higher for mothers of children admitted to the PICU than that of mothers with children admitted to the general ward. [Paediatr Indones.2012;52:95-8].

  12. Prediction Error Representation in Individuals With Generalized Anxiety Disorder During Passive Avoidance.

    Science.gov (United States)

    White, Stuart F; Geraci, Marilla; Lewis, Elizabeth; Leshin, Joseph; Teng, Cindy; Averbeck, Bruno; Meffert, Harma; Ernst, Monique; Blair, James R; Grillon, Christian; Blair, Karina S

    2017-02-01

    Deficits in reinforcement-based decision making have been reported in generalized anxiety disorder. However, the pathophysiology of these deficits is largely unknown; published studies have mainly examined adolescents, and the integrity of core functional processes underpinning decision making remains undetermined. In particular, it is unclear whether the representation of reinforcement prediction error (PE) (the difference between received and expected reinforcement) is disrupted in generalized anxiety disorder. This study addresses these issues in adults with the disorder. Forty-six unmedicated individuals with generalized anxiety disorder and 32 healthy comparison subjects group-matched on IQ, gender, and age performed a passive avoidance task while undergoing functional MRI. Data analyses were performed using a computational modeling approach. Behaviorally, individuals with generalized anxiety disorder showed impaired reinforcement-based decision making. Imaging results revealed that during feedback, individuals with generalized anxiety disorder relative to healthy subjects showed a reduced correlation between PE and activity within the ventromedial prefrontal cortex, ventral striatum, and other structures implicated in decision making. In addition, individuals with generalized anxiety disorder relative to healthy participants showed a reduced correlation between punishment PEs, but not reward PEs, and activity within the left and right lentiform nucleus/putamen. This is the first study to identify computational impairments during decision making in generalized anxiety disorder. PE signaling is significantly disrupted in individuals with the disorder and may lead to their decision-making deficits and excessive worry about everyday problems by disrupting the online updating ("reality check") of the current relationship between the expected values of current response options and the actual received rewards and punishments.

  13. Information processing bias and pharmacotherapy outcome in older adults with generalized anxiety disorder.

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    Steiner, Amanda R W; Petkus, Andrew J; Nguyen, Hoang; Wetherell, Julie Loebach

    2013-08-01

    Information processing bias was evaluated in a sample of 25 older adults with generalized anxiety disorder (GAD) over the course of 12 weeks of escitalopram pharmacotherapy. Using the CANTAB Affective Go/No Go test, treatment response (as measured by the Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, and Generalized Anxiety Disorder Severity Scale) was predicted from a bias score (i.e., difference score between response latencies for negative and positive words) using mixed-models regression. A more positive bias score across time predicted better response to treatment. Faster responses to positive words relative to negative words were associated with greater symptomatic improvement over time as reflected by scores on the GADSS. There was a trend toward significance for PSWQ scores and no significant effects related to HAMA outcomes. These preliminary findings offer further insights into the role of biased cognitive processing of emotional material in the manifestation of late-life anxiety symptoms. Published by Elsevier Ltd.

  14. Two-year follow-up of self-examination therapy for generalized anxiety disorder.

    Science.gov (United States)

    Floyd, Mark; McKendree-Smith, Nancy; Bailey, Elaine; Stump, Jamie; Scogin, Forrest; Bowman, Daniel

    2002-01-01

    This study examined the stability of treatment gains after receiving self-examination therapy (SET) [Bowman, D. (1995). Innovations in clinical practice: a source book. Professional Resource Press.] for generalized anxiety disorder. A 2-year follow-up of 16 participants from Bowman, Scogin, Floyd, Patton, and Gist [J. Counsel. Psychol. 44 (1997) 267] was conducted by comparing pre- and post-treatment measures with follow-up measures from the Hamilton Anxiety Rating Scale-Revised (HARS-R), the State-Trait Anxiety Inventory (STAI), and the SET quiz. Results indicated treatment gains from baseline to the 2-year follow-up period were maintained on all measures, and there was not a significant decline from post-treatment to follow-up on the HARS-R and STAI. These results suggest that SET for treatment of generalized anxiety disorder (GAD) may be effective in both the immediate and long-term reduction of GAD symptoms.

  15. General and specific components of depression and anxiety in an adolescent population

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    Brodbeck Jeannette

    2011-12-01

    Full Text Available Abstract Background Depressive and anxiety symptoms often co-occur resulting in a debate about common and distinct features of depression and anxiety. Methods An exploratory factor analysis (EFA and a bifactor modelling approach were used to separate a general distress continuum from more specific sub-domains of depression and anxiety in an adolescent community sample (n = 1159, age 14. The Mood and Feelings Questionnaire and the Revised Children's Manifest Anxiety Scale were used. Results A three-factor confirmatory factor analysis is reported which identified a mood and social-cognitive symptoms of depression, b worrying symptoms, and c somatic and information-processing symptoms as distinct yet closely related constructs. Subsequent bifactor modelling supported a general distress factor which accounted for the communality of the depression and anxiety items. Specific factors for hopelessness-suicidal thoughts and restlessness-fatigue indicated distinct psychopathological constructs which account for unique information over and above the general distress factor. The general distress factor and the hopelessness-suicidal factor were more severe in females but the restlessness-fatigue factor worse in males. Measurement precision of the general distress factor was higher and spanned a wider range of the population than any of the three first-order factors. Conclusions The general distress factor provides the most reliable target for epidemiological analysis but specific factors may help to refine valid phenotype dimensions for aetiological research and assist in prognostic modelling of future psychiatric episodes.

  16. Perceived Emotion Control Moderates the Relationship between Neuroticism and Generalized Anxiety Disorder

    OpenAIRE

    Bourgeois, Michelle L.; Brown, Timothy A.

    2015-01-01

    The relationships between neuroticism, perceived emotion control, and generalized anxiety disorder (GAD) severity were examined in 293 individuals diagnosed with GAD at a specialty anxiety disorders clinic. Hierarchical regression analyses performed within a structural equation modeling framework revealed that (1) neuroticism and perceived emotion control both predicted a latent variable of GAD in the expected direction, and (2) perceived emotion control moderated the relationship between neu...

  17. The association of urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid in patients with generalized anxiety.

    Science.gov (United States)

    Garvey, M J; Noyes, R; Woodman, C; Laukes, C

    1995-01-01

    There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiology of anxiety disorders. Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 46 patients with generalized anxiety disorder. There was a significant association between urinary levels of 5-HIAA and VMA: r = 0.79; p = 0.0001. Possible implications of this finding are discussed.

  18. Disorder-specific cognitive profiles in major depressive disorder and generalized anxiety disorder

    OpenAIRE

    Hendriks, S.M.; Licht, C.M.M.; Spijker, J; Beekman, A T F; Hardeveld, F.; de Graaf, R.; Penninx, B.W.J.H.

    2014-01-01

    Background: This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose MDD and GAD. Cognitive profiles were measured using the Leiden Index of Depression S...

  19. Hospital Anxiety and Depression Scale (HADS: validation in a Greek general hospital sample

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    Patapis Paulos

    2008-03-01

    Full Text Available Abstract Background The Hospital Anxiety and Depression Scale (HADS has been used in several languages to assess anxiety and depression in general hospital patients with good results. Methods The HADS was administered to 521 participants (275 controls and 246 inpatients and outpatients of the Internal Medicine and Surgical Departments in 'Attikon' General Hospital in Athens. The Beck Depression Inventory (BDI and the State-Trait Anxiety Inventory (STAI were used as 'gold standards' for depression and anxiety respectively. Results The HADS presented high internal consistency; Cronbach's α cofficient was 0.884 (0.829 for anxiety and 0.840 for depression and stability (test-retest intraclass correlation coefficient 0.944. Factor analysis showed a two-factor structure. The HADS showed high concurrent validity; the correlations of the scale and its subscales with the BDI and the STAI were high (0.722 – 0.749. Conclusion The Greek version of HADS showed good psychometric properties and could serve as a useful tool for clinicians to assess anxiety and depression in general hospital patients.

  20. Age and sex dependencies of anxiety and depression in cardiologic patients compared with the general population

    Science.gov (United States)

    Hinz, Andreas; Kittel, Jörg; Karoff, Marthin; Schwarz, Reinhold

    2004-01-01

    Objective: The aim of this study was to test age and sex effects on anxiety and depression using the Hospital Anxiety and Depression Scale HADS. Method: Sample 1 consisted of 2037 subjects of the German general population, and sample 2 comprised 2696 cardiologic patients. Results: In the group of the general population we observed a linear increase of depression and (to a lower extent) of anxiety with age. In contrast to that, the patients reached their anxiety and depression maxima in the range of 50 to 60 years, with decreasing mean values for older patients. This effect was observed in both sexes and was proved by an ANOVA interaction between age category and population (P<0.001). In the age range over 70 years the mean depression scores of the patients were even lower than those of the general population. Especially high anxiety and depression scores were found for retired males under 60 years of age. Conclusion: Premature retirement is associated with anxiety and depression in cardiologic patients which partly accounts for the different age effects of the samples. Longitudinal studies are needed to explain the underlying mechanisms of the age effects in more detail. PMID:19742054

  1. General Versus Specific Trait Anxiety Measures in the Prediction of Fear of Snakes, Heights, and Darkness

    Science.gov (United States)

    Mellstrom, Martin, Jr.; And Others

    1976-01-01

    The relations between general and specific trait anxiety tests and fear measures in three actual situations were investigated. The results indicate that the specific tests were clearly superior to the general ones in predicting fear of snakes but only slightly superior in predicting fear of heights and darkness. (Author)

  2. Anxiety

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    ... Home & Community Home › Aging & Health A to Z › Anxiety Font size A A A Print Share Glossary Basic Facts & Information Causes & Symptoms Diagnosis & Tests Care & Treatment Lifestyle & Management Other Resources Caregiving How ...

  3. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults.

    Science.gov (United States)

    Wetherell, Julie Loebach; Petkus, Andrew J; White, Kamila S; Nguyen, Hoang; Kornblith, Sander; Andreescu, Carmen; Zisook, Sidney; Lenze, Eric J

    2013-07-01

    OBJECTIVE Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. METHOD Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10-20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. RESULTS Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. CONCLUSIONS This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy.

  4. Worry and Rumination in Generalized Anxiety Disorder and Obsessive Compulsive Disorder.

    Science.gov (United States)

    Dar, Kaiser A; Iqbal, Naved

    2015-01-01

    Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30-40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.

  5. Quality of Life Impairment in Generalized Anxiety Disorder, Social Phobia, and Panic Disorder

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    Barrera, Terri L.; Norton, Peter J.

    2009-01-01

    Interest in the assessment of quality of life in the anxiety disorders is growing. The present study examined quality of life impairments in individuals with Generalized Anxiety Disorder (GAD), Social Phobia, and Panic Disorder. Results showed that individuals with these disorders reported less satisfaction with their quality of life than non-anxious adults in the community. However, the degree of quality of life impairment is similar across these three disorders. Additionally, comorbid depression, but not anxiety, was found to negatively impact quality of life in these individuals. Finally, diagnostic symptom severity was not found to influence quality of life, indicating that subjective measures of quality of life offer unique information on the effects of anxiety disorders. PMID:19640675

  6. Targeted Behavioral Therapy for childhood generalized anxiety disorder: a time-series analysis of changes in anxiety and sleep.

    Science.gov (United States)

    Clementi, Michelle A; Alfano, Candice A

    2014-03-01

    This study examined the efficacy of Targeted Behavioral Therapy (TBT), a newly developed intervention targeting features of childhood generalized anxiety disorder (GAD). Using a time-series design, 4 children (7-12 years) with primary GAD were treated with TBT, which includes sleep improvement strategies, systematic desensitization for reducing intolerance of uncertainty, and in vivo exposures for anxiety. Diagnostic interviews and questionnaires were administered at baseline, post-treatment and 3 months follow-up. Anxiety symptoms and sleep characteristics/problems were rated weekly during a 4-week baseline and 14-weeks of treatment. Two children remitted at post-treatment and no child had a GAD diagnosis at follow-up. Child but not parent report revealed improvements in both worry and sleep. Despite improvements from pre- to post-assessment, considerable symptom fluctuation observed during the baseline period preclude conclusion that symptom changes are specifically attributable to the course of treatment. Overall, preliminary support is provided for the efficacy of TBT for childhood GAD.

  7. Resting-State Functional Connectivity in Generalized Anxiety Disorder and Social Anxiety Disorder: Evidence for a Dimensional Approach.

    Science.gov (United States)

    Rabany, Liron; Diefenbach, Gretchen J; Bragdon, Laura B; Pittman, Brian P; Zertuche, Luis; Tolin, David F; Goethe, John W; Assaf, Michal

    2017-06-01

    Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are currently considered distinct diagnostic categories. Accumulating data suggest the study of anxiety disorders may benefit from the use of dimensional conceptualizations. One such dimension of shared dysfunction is emotion regulation (ER). The current study evaluated dimensional (ER) and categorical (diagnosis) neurocorrelates of resting-state functional connectivity (rsFC) in participants with GAD and SAD and healthy controls (HC). Functional magnetic resonance imaging (fMRI) rsFC was estimated between all regions of the default mode network (DMN), salience network (SN), and bilateral amygdala (N = 37: HC-19; GAD-10; SAD-8). Thereafter, rsFC was predicted by both ER, (using the Difficulties in Emotion Regulation Scale [DERS]), and diagnosis (DSM-5) within a single unified analysis of covariance (ANCOVA). For the ER dimension, there was a significant association between impaired ER abilities and anticorrelated rsFC of amygdala and DMN (L.amygdala-ACC: p = 0.011, beta = -0.345), as well as amygdala and SN (L.amygdala-posterior cingulate cortex [PCC]: p = 0.032, beta = -0.409). Diagnostic status was significantly associated with rsFC differences between the SAD and HC groups, both within the DMN (PCC-MPFC: p = 0.009) and between the DMN and SN (R.LP-ACC: p = 0.010). Although preliminary, our results exemplify the potential contribution of the dimensional approach to the study of GAD and SAD and support a combined categorical and dimensional model of rsFC of anxiety disorders.

  8. Reductions in the diurnal rigidity of anxiety predict treatment outcome in cognitive behavioral therapy for generalized anxiety disorder.

    Science.gov (United States)

    Fisher, Aaron J; Newman, Michelle G

    2016-04-01

    Generalized anxiety disorder (GAD) is a chronic and disabling disorder which is characterized by worrisome mentation about future outcomes. Because the evocative stimuli in GAD are largely internally derived, the feared outcomes contained in worry episodes can be invoked--and responded to--regardless of external context. We hypothesized that individuals with GAD would be entrained to internally-regulated, fixed patterns of anxiety on a day-to-day basis and that successful therapeutic intervention would serve to mitigate this entrainment. Thus, the present study examined the constructs of flexibility and rigidity as they apply to the daily fluctuation of anxious symptoms in individuals with GAD. We aimed to demonstrate that an apparently variable system can be conceptualized as rigid when the variability maps onto stable and predictable periodic oscillations. Sixty-nine individuals completed cognitive-behavioral treatment for GAD. Average age was 36.62 years (SD = 11.56), and participants were mostly Caucasian (89.5%) and female (68.4%). Daily-diary data indicating level of anxiety on a 0 to 100-point scale and collected four times per day were subjected to spectral analysis in order to determine the spectral power attributable to daily oscillations--which was related to the degree of rigidity in daily anxiety. Diurnal rigidity decreased throughout therapy and the degree to which rigidity was reduced significantly predicted reliable change at post-treatment. Thus, symptom rigidity can be conceptualized as stable periodic fluctuation and is discernible from other metrics of volatility in repeated measures data. Moreover, diurnal rigidity is significantly reduced during treatment, facilitating flexible responding to environmental demands.

  9. Generalized anxiety disorder: clinical presentation, diagnostic features, and guidelines for clinical practice.

    Science.gov (United States)

    van der Heiden, Colin; Methorst, Gerda; Muris, Peter; van der Molen, Henk T

    2011-01-01

    Generalized anxiety disorder (GAD) is a prevalent and disabling disorder characterised by persistent worrying, anxiety symptoms, and tension. General practitioners and mental healthcare professionals frequently misdiagnose the presenting symptoms. This article addresses the clinical presentation of GAD and provides guidelines for discriminating GAD from other disorders, based on theoretical considerations and clinical experience. Debate relating to the validity of the definition of GAD is discussed, and suggestions are made for improving the criteria for GAD, which may guide future versions of classification systems such as the Diagnostic and Statistical Manual.

  10. Mindfulness and Self-Compassion in Generalized Anxiety Disorder: Examining Predictors of Disability

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Hoge

    2013-01-01

    Full Text Available Generalized anxiety disorder (GAD is a condition characterized by worry and physiological arousal symptoms that causes significant disabilities in patients’ lives. In order to improve psychotherapeutic interventions, a careful characterization of the deficiencies of this population as well as factors that ameliorate disability is crucial. Variables that have not traditionally been the focus of research should be considered, such as trait mindfulness and self-compassion. We investigated whether GAD patients would report lower mindfulness and self-compassion levels than healthy stressed individuals. Eighty-seven GAD patients and 49 healthy controls completed the Five Facet Mindfulness Questionnaire, the Self-Compassion Scale, and measures of anxiety. Patients with GAD also completed the Sheehan Disability Scale. Results showed that GAD patients had lower mindfulness and self-compassion than healthy stressed controls, and both were negatively correlated with levels of anxiety, worry, and anxiety sensitivity. In patients, mindfulness was a better predictor of disability than actual anxiety symptom scores. These findings highlight that in the presence of anxiety symptoms, mindfulness can be a factor that helps protect against feeling disabled by the disorder. The findings thereby add an important variable to the characterization of this disorder and should be taken into consideration for future treatment development.

  11. Attentional bias in older adults: effects of generalized anxiety disorder and cognitive behavior therapy.

    Science.gov (United States)

    Mohlman, Jan; Price, Rebecca B; Vietri, Jeff

    2013-08-01

    Attentional biases are known to play a contributing, and perhaps even causal role in the etiology of anxiety and other negative affective states. The prevalence of anxiety disorders in the older cohort is growing, and there are both theoretical and empirical reasons to suspect that age-related factors could moderate attentional bias effects in the context of late-life anxiety. The current study included one of the most widely-used measures of attentional bias, the dot-probe task (Mathews & MacLeod, 1985). Participants were older adults who were either nonanxious or diagnosed with generalized anxiety disorder. The patient subsample also completed cognitive behavior therapy (CBT) or an equivalent wait list condition, after which the dot probe was administered a second time. Results showed that clinical anxiety had no particular importance for the deployment of attention, casting doubt on the universality of biased attention in older anxiety patients. Although there were no maladaptive biases detected toward either threat or depression words at pretreatment, there was nevertheless a marginally significant differential reduction in bias toward threat words following CBT. This reduction did not occur among those in the wait list condition. Implications are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Neural correlates of speech anticipatory anxiety in generalized social phobia.

    Science.gov (United States)

    Lorberbaum, Jeffrey P; Kose, Samet; Johnson, Michael R; Arana, George W; Sullivan, Lindsay K; Hamner, Mark B; Ballenger, James C; Lydiard, R Bruce; Brodrick, Peter S; Bohning, Daryl E; George, Mark S

    2004-12-22

    Patients with generalized social phobia fear embarrassment in most social situations. Little is known about its functional neuroanatomy. We studied BOLD-fMRI brain activity while generalized social phobics and healthy controls anticipated making public speeches. With anticipation minus rest, 8 phobics compared to 6 controls showed greater subcortical, limbic, and lateral paralimbic activity (pons, striatum, amygdala/uncus/anterior parahippocampus, insula, temporal pole)--regions important in automatic emotional processing--and less cortical activity (dorsal anterior cingulate/prefrontal cortex)--regions important in cognitive processing. Phobics may become so anxious, they cannot think clearly or vice versa.

  13. Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder.

    Science.gov (United States)

    Heuzenroeder, Louise; Donnelly, Marie; Haby, Michelle M; Mihalopoulos, Cathrine; Rossell, Ruth; Carter, Rob; Andrews, Gavin; Vos, Theo

    2004-08-01

    To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filter criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs). Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater. Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

  14. The effects of music on the anxiety and some physiological indices of patients before general surgery

    Directory of Open Access Journals (Sweden)

    Neda Mirbagher Ajorpaz

    2011-05-01

    Full Text Available Background: Surgery is an important stressor, which causes some harmful physiological responses such as increased breath and heart rate and blood pressure. The aim of this study was to investigate the effects of music on the anxiety and some physiological responses of patients before general surgery. Methods: A clinical trial study designed and 60 patients who were scheduled to undergo general surgery were selected using convenience sampling method in Shahid Beheshty hospitals of Kashan in 2009. They were randomly allocated into intervention and control groups. The level of anxiety was measured using Spilberger questionnaire. Blood pressure measured using mercury sphygmomanometer, respiratory and heart rate determined before music intervention. The intervention group listened to non-speech music for 20 minutes in a quiet environment. The anxiety level and physiological responses were measured again after the intervention. The same measurements were carried out for the control group without music intervention. Results: The results showed a statistical significant differences in the anxiety level as well as the systolic blood pressure in the intervention group P=0.04. There was no significant difference in heart and respiratory rate between the two groups (P=0.2, P=0.11. Conclusion: Considering the alterations in physiological responses during listening to music, we suggest music listening to be considered as an intervention to relieve preoperative anxiety and fear.

  15. Pharmacotherapy for Pediatric Generalized Anxiety Disorder: A Systematic Evaluation of Efficacy, Safety and Tolerability

    Science.gov (United States)

    Dobson, Eric T.; Strawn, Jeffrey R.

    2016-01-01

    Background Randomized controlled trials consistently support the efficacy of antidepressants in treating youth with generalized anxiety disorder (GAD), although integrated examinations of efficacy, safety, and tolerability of psychotropic medications in GAD specifically are rare. With this in mind, we sought to describe the efficacy, safety and tolerability of psychopharmacologic interventions in youth with GAD. Methods Randomized, double-blind, placebo-controlled, prospective trials of psychopharmacologic interventions in youth with GAD were identified through a PubMed/Medline (1966–2015) search. Both authors manually reviewed trials and, to evaluate comparative efficacy and tolerability across medications, numbers needed to treat (NNT) (based on Pediatric Anxiety Rating Scale (PARS) remission criteria (PARS ≤8 [1]), and number needed to harm (NNH) for selected treatment-emergent adverse events (TEAEs) were calculated. Finally, treatment-emergent suicidality and taper-emergent/post-study adverse events are reported descriptively. Results Five trials that involved 1,186 patients and evaluated four medications were reviewed and efficacy data were extracted with regard to dimensional measures of anxiety. SSRI/SNRIs demonstrated efficacy in the reduction of anxiety symptoms with NNTs ranging from 2.8 to 9.3. TEAEs varied considerably between studies but tended to be mild and generally did not lead to discontinuation. Conclusions Data from five trials of SSRI/SNRI in youth with GAD, many of whom had co-occurring separation and social anxiety disorders, suggest superiority to placebo and favorable tolerability profiles. PMID:26660158

  16. Mediated Moderation in Combined Cognitive Behavioral Therapy versus Component Treatments for Generalized Anxiety Disorder

    Science.gov (United States)

    Newman, Michelle G.; Fisher, Aaron J.

    2013-01-01

    Objective: This study examined (a) duration of generalized anxiety disorder (GAD) as a moderator of cognitive behavioral therapy (CBT) versus its components (cognitive therapy and self-control desensitization) and (b) increases in dynamic flexibility of anxious symptoms during the course of psychotherapy as a mediator of this moderation. Degree of…

  17. The Metacognitive Model of Generalized Anxiety Disorder in Children and Adolescents

    Science.gov (United States)

    Ellis, Danielle M.; Hudson, Jennifer L.

    2010-01-01

    Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive…

  18. The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology

    NARCIS (Netherlands)

    Bekhuis, E.; Schoevers, R. A.; van Borkulo, C. D.; Rosmalen, J. G. M.; Boschloo, L.

    2016-01-01

    Background Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central

  19. Disorder-specific cognitive profiles in major depressive disorder and generalized anxiety disorder

    NARCIS (Netherlands)

    Hendriks, S.M.; Licht, C.M.; Spijker, J.; Beekman, A.T.; Hardeveld, F.; Graaf, R. de; Penninx, B.W.J.H.

    2014-01-01

    BACKGROUND: This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD). METHODS: Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the

  20. The embarrassed brain : towards a neurobiology of generalized socal anxiety disorder

    NARCIS (Netherlands)

    Veen, Jantien Frederieke van

    2010-01-01

    In this thesis, we report on our investigations regarding the involvement of several neurotransmitter and hormonal systems in generalized social anxiety disorder (gSAD), one of the most common psychiatric disorders. We found evidence of the involvement of serotonin, dopamine, and noradrenaline/the a

  1. A Case of Premature Termination in a Treatment for Generalized Anxiety Disorder

    Science.gov (United States)

    Boswell, James F.; Llera, Sandra J.; Newman, Michelle G.; Castonguay, Louis G.

    2011-01-01

    In this paper we present a case of failure in an integrative treatment for generalized anxiety disorder (GAD) combining cognitive-behavioral therapy, an empirically supported treatment for GAD, and interpersonal-emotional processing therapy. The client of focus dropped out of treatment after the 8th session. Based on our analysis of this case, we…

  2. Mediated Moderation in Combined Cognitive Behavioral Therapy versus Component Treatments for Generalized Anxiety Disorder

    Science.gov (United States)

    Newman, Michelle G.; Fisher, Aaron J.

    2013-01-01

    Objective: This study examined (a) duration of generalized anxiety disorder (GAD) as a moderator of cognitive behavioral therapy (CBT) versus its components (cognitive therapy and self-control desensitization) and (b) increases in dynamic flexibility of anxious symptoms during the course of psychotherapy as a mediator of this moderation. Degree of…

  3. Cognitive-Behavioral Therapy for Comorbid Generalized Anxiety Disorder and Panic Disorder with Agoraphobia

    Science.gov (United States)

    Labrecque, Joane; Dugas, Michel J.; Marchand, Andre; Letarte, Andree

    2006-01-01

    The goal of this study was to evaluate the efficacy of a cognitive-behavioral treatment package for comorbid generalized anxiety disorder (GAD) and panic disorder with agoraphobia (PDA). A single-case, multiple-baseline, across-subjects design was used with 3 primary GAD patients with secondary PDA. The efficacy of the treatment was evaluated with…

  4. Efficacy of Cognitive-Behavioral Therapy for Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder

    Science.gov (United States)

    Labrecque, Joane; Marchand, Andre; Dugas, Michel J.; Letarte, Andree

    2007-01-01

    The goal of this study was to evaluate the efficacy of cognitive-behavioral therapy for comorbid panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) by combining treatment strategies for both disorders. A single-case, multiple-baseline design across participants was used. Three participants with primary PDA and secondary…

  5. Intrinsic Functional Connectivity of Amygdala-Based Networks in Adolescent Generalized Anxiety Disorder

    Science.gov (United States)

    Roy, Amy K.; Fudge, Julie L.; Kelly, Clare; Perry, Justin S. A.; Daniele, Teresa; Carlisi, Christina; Benson, Brenda; Castellanos, F. Xavier; Milham, Michael P.; Pine, Daniel S.; Ernst, Monique

    2013-01-01

    Objective: Generalized anxiety disorder (GAD) typically begins during adolescence and can persist into adulthood. The pathophysiological mechanisms underlying this disorder remain unclear. Recent evidence from resting state functional magnetic resonance imaging (R-fMRI) studies in adults suggests disruptions in amygdala-based circuitry; the…

  6. Disorder-specific cognitive profiles in major depressive disorder and generalized anxiety disorder

    NARCIS (Netherlands)

    Hendriks, Sanne M.; Licht, Carmilla M. M.; Spijker, Jan; Beekman, Aartjan T. F.; Hardeveld, Florian; de Graaf, Ron; Penninx, Brenda W. J. H.

    2014-01-01

    Background: This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the Netherl

  7. Intrinsic Functional Connectivity of Amygdala-Based Networks in Adolescent Generalized Anxiety Disorder

    Science.gov (United States)

    Roy, Amy K.; Fudge, Julie L.; Kelly, Clare; Perry, Justin S. A.; Daniele, Teresa; Carlisi, Christina; Benson, Brenda; Castellanos, F. Xavier; Milham, Michael P.; Pine, Daniel S.; Ernst, Monique

    2013-01-01

    Objective: Generalized anxiety disorder (GAD) typically begins during adolescence and can persist into adulthood. The pathophysiological mechanisms underlying this disorder remain unclear. Recent evidence from resting state functional magnetic resonance imaging (R-fMRI) studies in adults suggests disruptions in amygdala-based circuitry; the…

  8. The Factor Structure and Dimensional Scoring of the Generalized Anxiety Disorder Questionnaire for "DSM-IV"

    Science.gov (United States)

    Rodebaugh, Thomas L.; Holaway, Robert M.; Heimberg, Richard G.

    2008-01-01

    Despite favorable psychometric properties, the Generalized Anxiety Disorder Questionnaire for the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) (GAD-Q-IV) does not have a known factor structure, which calls into question use of its original weighted scoring system (usually referred to as the dimensional score).…

  9. Are Children with "Pure" Generalized Anxiety Disorder Impaired? A Comparison with Comorbid and Healthy Children

    Science.gov (United States)

    Alfano, Candice A.

    2012-01-01

    Despite the approach of the "Diagnostic and Statistical Manual of Mental Disorders" (5th ed.), generalized anxiety disorder (GAD) of childhood continues to face questions as to whether it should be considered a distinct clinical disorder. A potentially critical issue embedded in this debate involves the role of functional impairment which has yet…

  10. A Case of Premature Termination in a Treatment for Generalized Anxiety Disorder

    Science.gov (United States)

    Boswell, James F.; Llera, Sandra J.; Newman, Michelle G.; Castonguay, Louis G.

    2011-01-01

    In this paper we present a case of failure in an integrative treatment for generalized anxiety disorder (GAD) combining cognitive-behavioral therapy, an empirically supported treatment for GAD, and interpersonal-emotional processing therapy. The client of focus dropped out of treatment after the 8th session. Based on our analysis of this case, we…

  11. The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology

    NARCIS (Netherlands)

    Bekhuis, E.; Schoevers, R. A.; van Borkulo, C. D.; Rosmalen, J. G. M.; Boschloo, L.

    2016-01-01

    Background Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central

  12. Disorder-specific cognitive profiles in major depressive disorder and generalized anxiety disorder

    NARCIS (Netherlands)

    Hendriks, Sanne M.; Licht, Carmilla M. M.; Spijker, Jan; Beekman, Aartjan T. F.; Hardeveld, Florian; de Graaf, Ron; Penninx, Brenda W. J. H.

    2014-01-01

    Background: This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the

  13. The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology

    NARCIS (Netherlands)

    Bekhuis, E.; Schoevers, R.A.; van Borkulo, C.D.; Rosmalen, J.G.M.; Boschloo, L.

    2016-01-01

    Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central in the proc

  14. Blood gene expression profiles suggest altered immune function associated with symptoms of generalized anxiety disorder.

    Science.gov (United States)

    Wingo, Aliza P; Gibson, Greg

    2015-01-01

    Prospective epidemiological studies found that generalized anxiety disorder (GAD) can impair immune function and increase risk for cardiovascular disease or events. Mechanisms underlying the physiological reverberations of anxiety, however, are still elusive. Hence, we aimed to investigate molecular processes mediating effects of anxiety on physical health using blood gene expression profiles of 336 community participants (157 anxious and 179 control). We examined genome-wide differential gene expression in anxiety, as well as associations between nine major modules of co-regulated transcripts in blood gene expression and anxiety. No significant differential expression was observed in women, but 631 genes were differentially expressed between anxious and control men at the false discovery rate of 0.1 after controlling for age, body mass index, race, and batch effect. Gene set enrichment analysis (GSEA) revealed that genes with altered expression levels in anxious men were involved in response of various immune cells to vaccination and to acute viral and bacterial infection, and in a metabolic network affecting traits of metabolic syndrome. Further, we found one set of 260 co-regulated genes to be significantly associated with anxiety in men after controlling for the relevant covariates, and demonstrate its equivalence to a component of the stress-related conserved transcriptional response to adversity profile. Taken together, our results suggest potential molecular pathways that can explain negative effects of GAD observed in epidemiological studies. Remarkably, even mild anxiety, which most of our participants had, was associated with observable changes in immune-related gene expression levels. Our findings generate hypotheses and provide incremental insights into molecular mechanisms mediating negative physiological effects of GAD.

  15. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

    OpenAIRE

    Hipólito Merino; Carmen Senra; Fátima Ferreiro

    2016-01-01

    This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroti...

  16. Implicit theories of intelligence and IQ test performance in adolescents with Generalized Anxiety Disorder.

    Science.gov (United States)

    Da Fonseca, D; Cury, F; Fakra, E; Rufo, M; Poinso, F; Bounoua, L; Huguet, P

    2008-04-01

    During the past decade, several studies have reported positive effects of cognitive-behavioral therapy (CBT) in the treatment of children and adolescents with mental disorders. One of the most important CBT interventions is to teach children and adolescents to challenge negative thoughts that lead to maladjusted behaviors. Based on the implicit theories of intelligence framework, the main purpose of this study was to test whether an incremental theory manipulation could be used to affect IQ test performance in adolescents with Generalized Anxiety Disorder (GAD). Results showed that patients demonstrated enhanced IQ performance and experienced less state anxiety when they were exposed to an incremental theory of intelligence manipulation. Our findings suggest that incremental theory manipulation provides a useful cognitive strategy for addressing school-related anxiety in adolescents with mental disorders such as GAD.

  17. Insomnia Symptoms Following Treatment for Comorbid Panic Disorder With Agoraphobia and Generalized Anxiety Disorder.

    Science.gov (United States)

    Cousineau, Héloïse; Marchand, André; Bouchard, Stéphane; Bélanger, Claude; Gosselin, Patrick; Langlois, Frédéric; Labrecque, Joane; Dugas, Michel J; Belleville, Geneviève

    2016-04-01

    Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD.

  18. Association between Level of Emotional Intelligence and Severity of Anxiety in Generalized Social Phobia

    Science.gov (United States)

    Jacobs, Madeline; Snow, Joseph; Geraci, Marilla; Vythilingam, Meena; Blair, R.J.R.; Charney, Dennis S.; Pine, Daniel S.; Blair, Karina S.

    2008-01-01

    Generalized Social Phobia (GSP) is characterized by a marked fear of most social situations. It is associated with an anomalous neural response to emotional stimuli, and individuals with the disorder frequently show interpretation bias in social situations. From this it might be suggested that GSP involves difficulty in accurately perceiving, using, understanding and managing emotions. Here we applied the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) to medication-free GSP (n=28) and no pathology (n=21) individuals. Patients with GSP performed within the normal range on the measure however severity of social anxiety significantly correlated with emotional intelligence (EI). Specifically, there was a negative correlation between social anxiety severity and Experiential (basic-level emotional processing) EI. In contrast, there was no significant correlation between social anxiety severity and Strategic (higher-level conscious emotional processing) EI. These results suggest that EI may index emotional processing systems that mitigate the impact of systems causally implicated in GSP. PMID:18439799

  19. Perceived Emotion Control Moderates the Relationship between Neuroticism and Generalized Anxiety Disorder.

    Science.gov (United States)

    Bourgeois, Michelle L; Brown, Timothy A

    2015-08-01

    The relationships between neuroticism, perceived emotion control, and generalized anxiety disorder (GAD) severity were examined in 293 individuals diagnosed with GAD at a specialty anxiety disorders clinic. Hierarchical regression analyses performed within a structural equation modeling framework revealed that (1) neuroticism and perceived emotion control both predicted a latent variable of GAD in the expected direction, and (2) perceived emotion control moderated the relationship between neuroticism and GAD severity, such that lower levels of perceived emotion control were associated with a stronger relationship between neuroticism and GAD severity. The other dimensions of perceived control (i.e., stress and threat control) did not moderate the effect of neuroticism on GAD severity. The findings are discussed with regard to their implications to conceptual models of the psychopathology of GAD, and theory-based differential relationships between dimensions of vulnerability, perceived control, and anxiety disorders.

  20. Association between level of emotional intelligence and severity of anxiety in generalized social phobia.

    Science.gov (United States)

    Jacobs, Madeline; Snow, Joseph; Geraci, Marilla; Vythilingam, Meena; Blair, R J R; Charney, Dennis S; Pine, Daniel S; Blair, Karina S

    2008-12-01

    Generalized social phobia (GSP) is characterized by a marked fear of most social situations. It is associated with an anomalous neural response to emotional stimuli, and individuals with the disorder frequently show interpretation bias in social situations. From this it might be suggested that GSP involves difficulty in accurately perceiving, using, understanding and managing emotions. Here we applied the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) to medication-free GSP (n=28) and no pathology (n=21) individuals. Patients with GSP performed within the normal range on the measure however severity of social anxiety significantly correlated with emotional intelligence (EI). Specifically, there was a negative correlation between social anxiety severity and Experiential (basic-level emotional processing) EI. In contrast, there was no significant correlation between social anxiety severity and Strategic (higher-level conscious emotional processing) EI. These results suggest that EI may index emotional processing systems that mitigate the impact of systems causally implicated in GSP.

  1. New advances in the treatment of generalized anxiety disorder: the multimodal antidepressant vortioxetine.

    Science.gov (United States)

    Orsolini, Laura; Tomasetti, Carmine; Valchera, Alessandro; Iasevoli, Felice; Buonaguro, Elisabetta Filomena; Vellante, Federica; Fornaro, Michele; Fiengo, Annastasia; Mazza, Monica; Vecchiotti, Roberta; Perna, Giampaolo; de Bartolomeis, Andrea; Martinotti, Giovanni; Di Giannantonio, Massimo; De Berardis, Domenico

    2016-05-01

    Generalized Anxiety Disorder (GAD) is a persistent condition characterized by chronic anxiety, exaggerated worry and tension, mainly comorbid with Major Depressive Disorder (MDD). Currently, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are recommended as first-line treatment of GAD. However, some patients may not respond to the treatment or discontinue due to adverse effects. Vortioxetine (VRX) is a multimodal antidepressant with a unique mechanism of action, by acting as 5-HT3A, 5-HT1D and 5-HT7 receptor antagonist, partial agonist at the 5-HT1A and 5-HT1B receptors and inhibitor at the 5-HT transporter. Preliminary clinical trials showed contrasting findings in terms of improvement of the anxiety symptomatology and/or cognitive impairment. Here, we aim to systematically review the evidence currently available on the efficacy, safety and tolerability of VRX in the treatment of GAD. The generalizability of results on the efficacy of VRX in patients with anxiety symptomatology and GAD is limited due to few and contrasting RCTs so far available. Only two studies, of which one prevention relapse trial, reported a significant improvement in anxiety symptomatology compared to three with negative findings.

  2. Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications.

    Science.gov (United States)

    Behar, Evelyn; DiMarco, Ilyse Dobrow; Hekler, Eric B; Mohlman, Jan; Staples, Alison M

    2009-12-01

    Theoretical conceptualizations of generalized anxiety disorder (GAD) continue to undergo scrutiny and refinement. The current paper critiques five contemporary models of GAD: the Avoidance Model of Worry and GAD [Borkovec, T. D. (1994). The nature, functions, and origins of worry. In: G. Davey & F. Tallis (Eds.), Worrying: perspectives on theory assessment and treatment (pp. 5-33). Sussex, England: Wiley & Sons; Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In: R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 77-108). New York, NY, US: Guilford Press]; the Intolerance of Uncertainty Model [Dugas, M. J., Letarte, H., Rheaume, J., Freeston, M. H., & Ladouceur, R. (1995). Worry and problem solving: evidence of a specific relationship. Cognitive Therapy and Research, 19, 109-120; Freeston, M. H., Rheaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791-802]; the Metacognitive Model [Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301-320]; the Emotion Dysregulation Model [Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85-90]; and the Acceptance-based Model of GAD [Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive behavioral models. Clinical Psychology: Science and Practice, 9, 54-68]. Evidence in support of each model is critically reviewed, and each model's corresponding evidence-based therapeutic interventions are discussed. Generally speaking, the models share an

  3. The Association between Generalized Anxiety Disorder, Subthreshold Anxiety Symptoms and Fear of Falling among Older Adults: Preliminary Results from a Pilot Study.

    Science.gov (United States)

    Payette, Marie-Christine; Bélanger, Claude; Benyebdri, Fethia; Filiatrault, Johanne; Bherer, Louis; Bertrand, Josie-Anne; Nadeau, Alexandra; Bruneau, Marie-Andrée; Clerc, Doris; Saint-Martin, Monique; Cruz-Santiago, Diana; Ménard, Caroline; Nguyen, Philippe; Vu, T T Minh; Comte, Francis; Bobeuf, Florian; Grenier, Sébastien

    2017-01-01

    A relationship between generalized anxiety disorder (GAD) and fear of falling (FOF) has long been proposed but never specifically studied. This study aimed at analyzing the relationship between FOF and GAD or anxiety symptoms, while controlling for major depressive episodes (MDE), depressive symptoms, fall risk, and sociodemographic variables. Twenty-five older adults participated in this pilot study. Assessments included the following: Anxiety Disorder Interview Schedule, Geriatric Anxiety Inventory, Geriatric Depression Scale, Falls-Efficacy Scale-International. A multidisciplinary team evaluated fall risk. FOF was significantly correlated with GAD, MDE, anxiety and depressive symptoms, and fall risk, but not with sociodemographic variables. Multiple regression analyses indicated that GAD and anxiety symptoms were significantly and independently associated with FOF. Although the results of this pilot study should be replicated with larger samples, they suggest that FOF is associated with GAD and anxiety symptoms even when considering physical factors that increase the risk of falling. Treatment of FOF in patients with GAD may present a particular challenge because of the central role of intolerance of uncertainty, which may prevent patients from regaining confidence despite the reduction of fall risk. Clinicians should screen for GAD and anxiety symptoms in patients with FOF to improve detection and treatment.

  4. Cognitive impairment in generalized anxiety disorder revealed by event-related potential N270

    Directory of Open Access Journals (Sweden)

    Yang Y

    2015-06-01

    Full Text Available Yingxue Yang,1,2 Xiating Zhang,1,2 Yu Zhu,1,2 Yakang Dai,3 Ting Liu,3 Yuping Wang1,2 1Department of Neurology, Xuanwu Hospital, Capital Medical University, 2Beijing Key Laboratory of Neuromodulation, Beijing, People’s Republic of China; 3Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, People’s Republic of China Background: Cognitive function in anxiety disorders has been the subject of limited investigation, especially in generalized anxiety disorder (GAD. The purpose of this study was to investigate the cognitive function in subjects with GAD using mismatch-triggered negativity N270.Methods: Fifteen medication-free patients with a DSM-IV diagnosis of GAD, and 15 well-matched healthy controls performed a dual-feature delayed matching task while event-related potentials were recorded from their scalp.Results: The GAD group was characterized by the decreased N270 amplitude in the left hemisphere. The smaller N270 amplitude was associated with greater symptoms of anxiety and depression.Conclusion: Since N270 is thought to index cognitive function in different domains, including attention and memory, our results suggest that individuals with GAD have an impaired cognitive function, particularly in selective attention and working memory. These cognitive deficits may have clinical significance in subjects with GAD and should be considered in treatment planning. Keywords: generalized anxiety disorder, N270, cognitive function, selective attention, working memory

  5. Relationships between irritable bowel syndrome, generalized anxiety disorder, and worry-related constructs

    Directory of Open Access Journals (Sweden)

    Amanda Drews

    2008-01-01

    Full Text Available This ex post facto study aimed to replicate previous research demonstrating an association between generalized anxiety disorder (GAD and irritable bowel syndrome (IBS and to extend this work by examining possible relationships between IBS and psychological constructs associated with the development of GAD. A total of 391 undergraduate psychology students completed self-report diagnostic measures of IBS and GAD as well as questionnaire measures of trait anxiety, worry, experiential avoidance, intolerance of uncertainty, and problem-solving confidence. Consistent with previous research, an association between IBS and GAD was found. Compared to participants without IBS, participants endorsing Rome II diagnostic criteria for IBS reported greater trait anxiety, worry, and experiential avoidance. No group differences on measures of intolerance of uncertainty and problem-solving confidence were found. Etiological factors considered specific to the development of GAD (i.e., increased intolerance of uncertainty and deficits in problem-solving confidence do not account for the observed relationships between IBS and general anxiety variables. However, experiential avoidance, or attempts to avoid unwanted bodily sensations, emotions, or other internal events, does appear elevated among IBS individuals. Implications of these findings are discussed within the context of a biopsychosocial model of IBS.

  6. Pregabalin reduces sleep disturbance in patients with generalized anxiety disorder via both direct and indirect mechanisms

    Directory of Open Access Journals (Sweden)

    Vamsi Bollu

    2010-03-01

    Full Text Available Background and Objectives: To characterize the impact of pregabalin on sleep in patients with generalized anxiety disorder (GAD and to determine whether the impact is a direct or an indirect effect, mediated through the reduction of anxiety symptoms. Methods: A post-hoc analysis of data from a randomized, double-blind, placebo- and active-controlled study in patients with GAD was conducted. Patients received pregabalin 300 mg/day, venlafaxine XR 75 mg/day or placebo for a week, followed by pregabalin 300-600 mg/day, venlafaxine XR 75-225 mg/day, or placebo for 7 weeks. Treatment effect on sleep was evaluated using the Medical Outcomes Study Sleep Scale. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale. A mediation model was used to estimate separately for both treatment arms the direct and indirect treatment effects on sleep disturbance. Results: Compared with placebo (n = 128, treatment with pregabalin (n = 121 significantly reduced scores on the sleep disturbance subscale and Sleep Problems Index II at both week 4 and week 8, and the sleep adequacy subscale at week 8. Venlafaxine XR (n = 125 had no significant effect on these measures. The mediation model indicated that 53% of the total pregabalin effect on sleep disturbance was direct (p < 0.01 and 47% indirect, mediated through anxiety symptoms (p < 0.05. Conclusions: Pregabalin decreased sleep disturbance in patients with GAD both directly, and indirectly by reducing anxiety symptoms. Given the drug specificity of the results, this study provides evidence of an additional important pathway of action for pregabalin and its efficacy in GAD.

  7. Agoraphobia, panic disorder and generalized anxiety disorder: some implications of recent advances.

    Science.gov (United States)

    Roth, M

    1984-01-01

    The nature of the relationship between 'panic disorder', agoraphobia and general anxiety disorder remains open. The aetiological theories which have tried to link them with the aid of biological and psychological concepts fail to take account of conflicting observations. 'Panic' attacks are not confined to agoraphobic and related disorders, being indistinguishable from the attacks of acute anxiety and phobic aversion manifest in a wide range of anxiety and affective disorders. There is continuity and discontinuity in the evolution of agoraphobia; those affected differ in respect of a range of premorbid features from patients with other disorders and control subjects. These variables include family history, life development, trait anxiety and other personality characteristics including introversion, neuroticism and probably emotional dependence on others. Not all the claims made on behalf of the efficacy of pharmacological treatment on the one hand and behavioural therapies on the other are substantiated. The success achieved by behavioural treatment appear to endure over some years. But the residual disabilities and defects that follow all forms of treatment and the problems posed by patient selection and high drop-out rates have received insufficient attention. Aetiological theories of agoraphobia and related conditions have been advanced along biomedical, psychological and psychodynamic lines. Some evidence supports each kind of theory. But none is wholly consistent with the findings regarding its phenomenology and evolution. Recent biological investigations have led to the formulation of hypotheses in relation to anticipatory and chronic anxiety in terms of changes in synaptic connections, enhancement of transmitter release as well as alterations in molecular configuration and regulation of gene expression. It would be premature to conclude that these findings can provide a unitary conceptual framework for the explanation of human anxiety disorders. The

  8. Differences in prescribing patterns for anxiety and depression between General Internal Medicine and Family Medicine.

    Science.gov (United States)

    Brieler, Jay A; Scherrer, Jeffrey F; Salas, Joanne

    2015-02-01

    Depression and anxiety are routinely managed by physicians in Family Medicine (FM) or General Internal Medicine (GIM). Because FM requires more behavioral health training than GIM, we sought to determine if prescribing patterns for patients with anxiety, depression, or both differed between FM vs. GIM providers. In a cross-sectional design, patient data and provider type were obtained from 2008 to 2013 electronic medical record patient data registry (n=27,225 (FM=10,994, GIM=16,231)) Prescription orders were modeled for specific benzodiazepines and antidepressants and by drug class. Covariates included gender, age, race, marital status and comorbidity index. Separate logistic regression models were computed, before and after adjusting for covariates, to estimate the odds of FM vs. GIM providers prescribing benzodiazepine or antidepressant medication to patients with anxiety, depression, and both disorders. After adjusting for covariates, patients with anxiety alone, depression alone, and both had significantly greater odds of receiving an antidepressant (OR=2.08;95%CI:1.46-2.96, OR=2.13;95%CI:1.48-3.06, and OR=2.26;95%CI:1.09-4.66, respectively) if treated by FM vs. GIM. Benzodiazepine prescription did not differ by physician type. It is not known if results will generalize to other regions of the United States. Patients with anxiety, depression, and both seen by FM providers, as compared to GIM providers, are more likely to receive antidepressant medications. Further investigation into the determinants of these differences is warranted. Under-treatment in GIM may result in less advantageous outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population.

    Science.gov (United States)

    Jylhä, Pekka; Isometsä, Erkki

    2006-01-01

    Few studies have investigated the relationship of the personality dimensions of neuroticism and extraversion to the symptoms of depression and anxiety in the general population. A random general population sample (ages 20-70 years), from two Finnish cities was surveyed with the Eysenck Personality Inventory (EPI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). In addition, questions regarding diagnosed lifetime mental disorders, health care use for psychiatric reasons in the past 12 months, and history of mental disorders in first-degree relatives were posed. Among the 441 subjects who participated, neuroticism correlated strongly with symptoms of depression (r(s)=.71, Ppersonality dimensions to both self-reported lifetime mental disorders and use of health services for psychiatric reasons strengthens the clinical validity of these personality dimensions.

  10. Neurostructural abnormalities associated with axes of emotion dysregulation in generalized anxiety

    OpenAIRE

    Makovac, Elena; Meeten, Frances; David R Watson; Garfinkel, Sarah N; Critchley, Hugo D.; Ottaviani, Cristina

    2015-01-01

    Background: Despite the high prevalence of generalized anxiety disorder (GAD) and its negative impact on society, its neurobiology remains obscure. This study characterizes the neurostructural abnormalities associatedwith key symptoms of GAD, focusing on indicators of impaired emotion regulation (excessive worry, poor concentration, low mindfulness, and physiological arousal). Methods: These domainswere assessed in 19 (16women) GAD patients and 19 healthy controls matched for age and gender, ...

  11. Activation of Dopamine Neurons is Critical for Aversive Conditioning and Prevention of Generalized Anxiety

    OpenAIRE

    2011-01-01

    Generalized anxiety is thought to result, in part, from impairments in contingency awareness during conditioning to cues that predict aversive or fearful outcomes. Dopamine neurons of the ventral midbrain exhibit heterogeneous responses to aversive stimuli that are thought to provide a critical modulatory signal to facilitate orienting to environmental changes and assignment of motivational value to unexpected events. Here, we describe a mouse model in which activation of dopamine neurons in ...

  12. Parental Anxiety and Child Behaviour during Dental Sedation and General Anaesthesia

    Directory of Open Access Journals (Sweden)

    Angeline S. Y. Tan

    2015-09-01

    Full Text Available This study primarily sought to compare levels of child behavior and parental anxiety during tooth extraction under inhalation sedation (IS or general anaesthesia (GA. A prospective study was carried out within the Charles Clifford Dental Hospital, Sheffield, UK. The sample comprised 46 IS patients (mean age 11.5 years and 48 GA patients (mean age 9.4 years who attended the hospital for dental extractions. Child behavior was assessed before, during and after treatment using a Frankl Scale. After treatment, parents completed questionnaire, which sought a measure of parental anxiety before and during treatment, and parental satisfaction with the treatment outcome. Visual Analogues Scales (VAS were employed to grade the responses. The majority of children complied well throughout their treatment, with no significant differences in parental assessment of child anxiety levels between IS and GA patients. However, GA parents were significantly more anxious than IS parent before and during treatment. About a third of GA parents reported they were worried about the risks of GA. Conclusion; It would appear that parents of children undergoing a GA are significantly more anxious about the treatment than IS parents. Furthermore, IS has been shown to be a viable alternative to GA in alleviating anxiety in children and their parents during tooth extractions.

  13. A Case Series on the Effects of Kripalu Yoga for Generalized Anxiety Disorder.

    Science.gov (United States)

    Morgan, Jessica R; Sullivan, Marlysa; Masuda, Akihiko; Tully, Erin; Cohen, Lindsey L; Anderson, Page L

    2016-07-14

    Generalized anxiety disorder (GAD) is a prevalent psychiatric disorder associated with substantial impairment and poor treatment response. Yoga influences processes that are linked to the maintenance of GAD including mindfulness, anxiety, and heart rate variability, but has yet to be evaluated among people with the disorder. The present study is a first step toward documenting the efficacy of yoga for reducing worry among people with GAD using a single-subject AB design case series and daily ratings of worry. Standardized self-report measures of worry, trait anxiety, experiential avoidance, mindfulness, and heart rate variability were assessed pre- and post-intervention. Three participants with primary GAD received eight twice-weekly Kripalu yoga sessions following a baseline data collection period. All participants showed systematic improvement in daily worry ratings on at least one index and all scores on self-reported measures of worry, anxiety, experiential avoidance, and mindfulness changed in the expected direction following yoga (with one or two exceptions). Participants also showed improved heart rate variability during a worry period from pre- to post-intervention. Yoga has the potential to improve the processes linked to GAD and should stimulate further research in this area.

  14. Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression.

    Science.gov (United States)

    Funke, R; Eichler, A; Distler, J; Golub, Y; Kratz, O; Moll, G H

    2016-12-16

    Because chronic stress is an important risk factor for anxiety states and depressive disorders, we studied hypothalamus-pituitary-adrenal (HPA) axis and sympathetic system activity via changes in cortisol and alpha amylase activity levels in pediatric generalized anxiety disorder (GAD) patients (n = 26) with comorbid depression and a healthy comparison group (n = 26). Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA-axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in-patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.

  15. Generalized Anxiety Disorder: A Comparison of Symptom Change in Adults Receiving Cognitive-Behavioral Therapy or Applied Relaxation

    Science.gov (United States)

    Donegan, Eleanor; Dugas, Michel J.

    2012-01-01

    Objective: Generalized anxiety disorder (GAD) is characterized by excessive worry and somatic symptoms of anxiety (e.g., restlessness, muscle tension). Several psychological treatments lead to significant reductions in GAD symptoms by posttreatment. However, little is known about how GAD symptoms change over time. Our main goal was to examine how…

  16. A Fresh Look at Potential Mechanisms of Change in Applied Relaxation for Generalized Anxiety Disorder: A Case Series

    Science.gov (United States)

    Hayes-Skelton, Sarah A.; Usmani, Aisha; Lee, Jonathan K.; Roemer, Lizabeth; Orsillo, Susan M.

    2012-01-01

    Applied relaxation (AR), which involves noticing early signs of anxiety and responding with a relaxation response, is an empirically supported treatment for generalized anxiety disorder (GAD). However, research on hypothesized mechanisms of AR (e.g., reduced muscle tension) has been mixed, making it likely that additional mechanisms are…

  17. Generalized Anxiety Disorder: A Comparison of Symptom Change in Adults Receiving Cognitive-Behavioral Therapy or Applied Relaxation

    Science.gov (United States)

    Donegan, Eleanor; Dugas, Michel J.

    2012-01-01

    Objective: Generalized anxiety disorder (GAD) is characterized by excessive worry and somatic symptoms of anxiety (e.g., restlessness, muscle tension). Several psychological treatments lead to significant reductions in GAD symptoms by posttreatment. However, little is known about how GAD symptoms change over time. Our main goal was to examine how…

  18. Efficacy of an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder: Evaluation in a Randomized Controlled Trial

    Science.gov (United States)

    Roemer, Lizabeth; Orsillo, Susan M.; Salters-Pedneault, Kristalyn

    2008-01-01

    Generalized anxiety disorder (GAD) is a chronic anxiety disorder, associated with comorbidity and impairment in quality of life, for which improved psychosocial treatments are needed. GAD is also associated with reactivity to and avoidance of internal experiences. The current study examined the efficacy of an acceptance-based behavioral therapy…

  19. Mood regulation and quality of life in social anxiety disorder: An examination of generalized expectancies for negative mood regulation

    Science.gov (United States)

    Sung, Sharon C.; Porter, Eliora; Robinaugh, Donald J.; Marks, Elizabeth H.; Marques, Luana M.; Otto, Michael W.; Pollack, Mark H.; Simon, Naomi M.

    2014-01-01

    The present study examined negative mood regulation expectancies, anxiety symptom severity, and quality of life in a sample of 167 patients with social anxiety disorder (SAD) and 165 healthy controls with no DSM-IV Axis I disorders. Participants completed the Generalized Expectancies for Negative Mood Regulation Scale (NMR), the Beck Anxiety Inventory, and the Quality of Life Enjoyment and Satisfaction Questionnaire. SAD symptom severity was assessed using the Liebowitz Social Anxiety Scale. Individuals with SAD scored significantly lower than controls on the NMR. Among SAD participants, NMR scores were negatively correlated with anxiety symptoms and SAD severity, and positively correlated with quality of life. NMR expectancies positively predicted quality of life even after controlling for demographic variables, comorbid diagnoses, anxiety symptoms, and SAD severity. Individuals with SAD may be less likely to engage in emotion regulating strategies due to negative beliefs regarding their effectiveness, thereby contributing to poorer quality of life. PMID:22343166

  20. Hostility/anger as a mediator between college students' emotion regulation abilities and symptoms of depression, social anxiety, and generalized anxiety.

    Science.gov (United States)

    Asberg, Kia

    2013-01-01

    Internalizing problems are common among college students and have been linked consistently to deficits in emotion regulation (ER). Also, hostility/anger (animosity toward others, phenomenological aspect of anger) is an important feature of internalizing problems, but has received limited attention as a mediator between ER and outcomes. Results (N = 160) indicated that although college students' ER abilities corresponded with all three types of internalizing symptoms, hostility/anger mediated fully the relationship for symptoms of depression and social anxiety, but not generalized anxiety (GAD). The stronger interpersonal aspect inherent in depression and social anxiety relative to GAD may in part explain findings, but findings must be viewed in lieu of limitations, which include self-report, a non-clinical sample, and a cross-sectional design. Overall, hostility/anger may be important to address in interventions and programs aimed at reducing internalizing problems, especially among those who demonstrate ER deficits and are prone to depression and social anxiety.

  1. Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder in a longitudinal sample of African American adults.

    Science.gov (United States)

    Sibrava, Nicholas J; Beard, Courtney; Bjornsson, Andri S; Moitra, Ethan; Weisberg, Risa B; Keller, Martin B

    2013-12-01

    Anxiety disorders are the most common group of psychiatric disorders in adults. In addition to high prevalence, anxiety disorders are associated with significant functional impairment, and published research has consistently found them to have a chronic course. To date, very little research has explored the clinical characteristics and prospective course of anxiety disorders in racial and ethnic minority samples. The aims of this article are to present clinical and demographic characteristics at intake and prospective 2-year course findings in a sample of African American adults. Data are presented from 152 African Americans diagnosed with generalized anxiety disorder (GAD, n = 94), social anxiety disorder (SAD, n = 85), and panic disorder with agoraphobia (PDA, n = 77) who are participating in the Harvard/Brown Anxiety Research Project-Phase II (HARP-II). HARP-II is an observational, prospective, longitudinal study of the course of anxiety disorders. Participants were interviewed at intake and annually for 2 years of follow-up. Probabilities of recovery over 2 years of follow-up were calculated using standard survival analysis methods. Survival analyses revealed a chronic course for all anxiety disorders, with rates of recovery of 0.23, 0.07, and 0.00 over 2 years for GAD, SAD, and PDA, respectively. These rates of recovery were lower than those reported in predominantly non-Latino White longitudinal samples, especially for SAD and PDA, suggesting that anxiety disorders may have a more chronic course for African Americans, with increased psychosocial impairment and high rates of comorbid Axis-I disorders. Clinical implications of these findings are discussed.

  2. The Relation General Anxiety Levels, Anxiety of Writing, and Attitude for Turkish Course of Secondary School Students

    Science.gov (United States)

    Yaman, Havva

    2014-01-01

    This study analyzed whether secondary-school students' continuous and stationary anxieties predict their anxiety about writing and their attitudes about courses in Turkish. The research participants consisted of 281 students in Sakarya Province, 58% male and 42% female. The personal descriptive survey model was used for the research. As data…

  3. A PILOT STUDY ON CERTAIN YOGIC AND NATUROPATHIC PROCEDURES IN GENERALIZED ANXIETY DISORDER

    Directory of Open Access Journals (Sweden)

    Kshama Gupta

    2013-12-01

    Full Text Available Generalized Anxiety Disorder (GAD is one of the most common anxiety disorders characterized by persistent worrying, anxiety symptoms, and tension. Most community-based studies place the prevalence in the range of 2 to 5 percent, with a lifetime prevalence as high as 8 percent. Even though previous studies on yoga and naturopathy in anxiety disorders proved effective, there lack proper methodology and they are not specifically focused at GAD. The aim of this study was to assess the efficacy of certain yogic and naturopathic procedures in the management of GAD. A total of 12 patients with GAD satisfying the DSM IV TR diagnostic criteria were selected and allotted in to two groups, Yoga group and Naturopathic group by following randomization method. In Yoga group, various asana’s and pranayama were practiced one hour daily for 21 days. In Naturopathy group, full body massage and steam, diaphragmatic breathing and acupressure were done one hour daily for 21 days. Criteria of assessment were based on the scoring of Hamilton Anxiety Rating Scale (HARS. Statistical analysis was done by using paired and unpaired‘t’ test. In Yoga group (n = 6, 52.59 % relief was observed (P 0.05 found in between the two groups. Both Yoga and Naturopathic procedures are effective in the management of GAD. Even though Yoga and Naturopathy interventions proved effective on HARS total score of GAD, Yoga seems to be an attractive option because of its non pharmacological approach, cost effectiveness and international acceptance when compared to the other interventions.

  4. Major depressive disorder and generalized anxiety disorder and response to treatment in hepatitis C patients in Egypt.

    Science.gov (United States)

    MM, Bassiony; A, Yousef; U, Youssef; GM, Salah El-Deen; M, Abdelghani; H, Al-Gohari; E, Fouad; MM, El-Shafaey

    2015-01-01

    The aim of the study was to estimate the prevalence and associated correlates of major depressive disorder and generalized anxiety disorder in hepatitis C virus patients before and after treatment and to investigate the relationship between major depressive disorder and generalized anxiety disorder and treatment response. A total of 116 consecutive hepatitis C virus patients from hepatitis C virus treatment center in Zagazig city, Egypt, were included in the study and divided into treated group (N = 58) and untreated group (N = 58). All hepatitis C virus patients were screened for major depressive disorder and generalized anxiety disorder using hospital anxiety and depression scale, and those who screened positive were interviewed to confirm the diagnosis of major depressive disorder and generalized anxiety disorder using DSM-IV-TR diagnostic criteria. These measures were done at baseline and after 12 weeks of treatment or observation. At baseline, 3.5% and 12.1% of hepatitis C virus patients (treated group) had major depressive disorder and generalized anxiety disorder, respectively. After 12 weeks of treatment 37.9% of hepatitis C virus patients (treated group) had major depressive disorder and 46.6% had generalized anxiety disorder. There was a significant statistical difference between hospital anxiety and depression scale scores for depression (3.3 ± 2.3 vs. 6.4 ± 3.2, t = 9.6, p = 0.001) and for anxiety (4.6 ± 2.4 vs. 7.3 ± 3.0, t = 10.2, p = 0.001) before and after treatment. There was also significant statistical difference between treated group and untreated group regarding hospital anxiety and depression scale scores after treatment and observation (depression, treated group 6.4 ± 3.2 vs. untreated group 4.0 ± 2.4, t = 3.7, p = 0.001; anxiety, treated group 7.3 ± 3.0 vs. untreated group 4.5 ± 2.3, t = 4.4, p = 0.001). There was no association between major depressive disorder

  5. Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital.

    Science.gov (United States)

    Tran, Allen L

    2017-06-01

    This article examines two forms of the medicalization of worry in an outpatient psychiatric clinic in Ho Chi Minh City, Vietnam. Biomedical psychiatrists understand patients' symptoms as manifestations of the excessive worry associated with generalized anxiety disorder (GAD). Drawing on an ethnopsychology of emotion that reflects increasingly popular models of neoliberal selfhood, these psychiatrists encourage patients to frame psychic distress in terms of private feelings to address the conditions in their lives that lead to chronic anxiety. However, most patients attribute their symptoms to neurasthenia instead of GAD. Differences between doctors' and patients' explanatory models are not just rooted in their understandings of illness but also in their respective conceptualizations of worry in terms of emotion and sentiment. Patients with neurasthenia reject doctors' attempts to psychologize distress and maintain a model of worry that supports a sense of moral selfhood based on notions of obligation and sacrifice. © 2016 by the American Anthropological Association.

  6. The power of positive thinking: Pathological worry is reduced by thought replacement in Generalized Anxiety Disorder.

    Science.gov (United States)

    Eagleson, Claire; Hayes, Sarra; Mathews, Andrew; Perman, Gemma; Hirsch, Colette R

    2016-03-01

    Worry in Generalized Anxiety Disorder (GAD), takes a predominantly verbal form, as if talking to oneself about possible negative outcomes. The current study examined alternative approaches to reducing worry by allocating volunteers with GAD to conditions in which they either practiced replacing the usual form of worry with images of possible positive outcomes, or with the same positive outcomes represented verbally. A comparison control condition involved generating positive images not related to worries. Participants received training in the designated method and then practiced it for one week, before attending for reassessment, and completing follow-up questionnaires four weeks later. All groups benefited from training, with decreases in anxiety and worry, and no significant differences between groups. The replacement of worry with different forms of positive ideation, even when unrelated to the content of worry itself, seems to have similar beneficial effects, suggesting that any form of positive ideation can be used to effectively counter worry.

  7. An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method.

    Science.gov (United States)

    Slavin-Mulford, Jenelle; Clements, Alyssa; Hilsenroth, Mark; Charnas, Jocelyn; Zodan, Jennifer

    2016-06-30

    This study examined transdiagnostic features of generalized anxiety disorder (GAD) and dysthymia in an outpatient clinical sample. Fifteen patients who met DSM-IV criteria for GAD and twenty-one patients who met DSM-IV criteria for dysthymia but who did not have comorbid anxiety disorder were evaluated utilizing the Rorschach. Salient clinical variables were then compared. Results showed that patients with GAD scored significantly higher on variables related to cognitive agitation and a desire/need for external soothing. In addition, there was a trend for patients with GAD to produce higher scores on a measure of ruminative focus on negative aspects of the self. Thus, not surprisingly, GAD patients' experienced more distress than the dysthymic patients. The implications of these findings are discussed with regards to better understanding the shared and distinct features of GAD and dysthymia.

  8. Contacts to general practice and antidepressant treatment initiation after screening for anxiety and depression in patients with heart disease

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær; Vestergaard, Claus Høstrup; Schougaard, Liv Marit Valen;

    2016-01-01

    Introduction Anxiety and depression are found in 20-30% of all persons with heart disease, and depression is known to impact mortality. This paper aimed to describe the effect of systematic screening of this population in terms of use of general practice, psychological therapy and antidepressant...... symptoms had more general practitioner (GP) contact rates than patients without anxiety or depressive symptoms both before and after the screening. Furthermore, patients with depressive symptoms increased their GP contact rate significantly in the first month after the screening, while...... this was not the case for patients with anxiety symptoms. Finally, patients with heart disease and anxiety or depressive symptoms more frequently initiated treatment with antidepressants than patients with heart disease without anxiety or depressive symptoms, whereas therapy sessions with a psychologist were rarely...

  9. Effect of short-term practice of pranayamic breathing exercises on cognition, anxiety, general well being and heart rate variability.

    Science.gov (United States)

    Chandla, S S; Sood, S; Dogra, R; Das, S; Shukla, S K; Gupta, Sanjay

    2013-10-01

    There has been an increasing interest in pranayamic breathing exercises which have been known to improve the quality of life. Present study was conducted to find out the effect of Bhastrika and Anulom Vilom Pranayam and yogasana on heart rate variability, general well being, cognition and anxiety levels of the medical students. Ninety-six medical students were randomly divided into two groups. One group performed Bhastrika and Anulom Vilom Pranayam and the second Suryanamaskar for six weeks. The subjects were made to fill in PGI memory scale, Hamilton- anxiety scale and psychological general well being schedule and recording of heart rate variability parameters was done, before and after six weeks of pranayam practice. The results showed highly significant increase in high frequency (HF) components of heart rate variability and decrease in low frequency (LF) components and LF/HF inthe group practising pranayam. There was also highly significant improvement of cognition, general well being and anxiety as shown by the PGI memory scale, Hamilton- anxiety scale and psychological general well being schedule scores in this group. In the yogasana group no significant changes were observed in the heart rate variability, cognition and anxiety although psychological general well being schedule scores significantly improved after six weeks practice of yogasana. The study shows that practice of slow breathing type of pranayam for six weeks improves cognition, anxiety and general well being and Increases the parasympathetic activity. Whereas there was no effect of the yogasana on the above parameters except improvements in the general well being.

  10. Anxiety Sensitivity Dimensions and Generalized Anxiety‏ ‏Severity: The ‎Mediating Role of Experiential Avoidance and Repetitive‏ ‏Negative Thinking‎ ‎

    OpenAIRE

    Parvaneh‏ ‏ Mohammadkhani; Abbas Pourshahbaz; Maryam Kami; Mahdi Mazidi; Imaneh Abasi

    2016-01-01

    Objective: Generalized anxiety disorder is one of the most common anxiety disorders in the general ‎population. Several studies suggest that anxiety sensitivity is a vulnerability factor in generalizedanxiety severity. However, some other studies suggest that negative repetitive thinking and ‎experiential avoidance as response factors can explain this relationship. Therefore, this study ‎aimed to investigate the mediating role of experiential avoidance and negative repetitive thinking ‎in t...

  11. Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder with agoraphobia in a sample of Latino adults.

    Science.gov (United States)

    Bjornsson, Andri S; Sibrava, Nicholas J; Beard, Courtney; Moitra, Ethan; Weisberg, Risa B; Benítez, Carlos I Pérez; Keller, Martin B

    2014-12-01

    It is imperative to study the clinical course of anxiety disorders among Latinos, given the implications for culturally sensitive treatment in this population. The current study is the first prospective, observational, longitudinal study of anxiety disorders among Latinos. Data are reported on 139 adult Latinos (M age = 34.65 years, SD = 10.98, 70.5% female) diagnosed with social anxiety disorder (SAD; n = 86), generalized anxiety disorder (GAD; n = 90), or panic disorder with agoraphobia (PDA; n = 62). The participants were interviewed with standardized clinical interviews at intake and annually over 2 years of follow-up. Probabilities of recovery were calculated using standard survival analysis methods. The 2-year recovery rates in this study were 0.07 for SAD, 0.14 for GAD, 0.03 for PDA, and 0.50 for major depressive disorder (MDD). Overall functioning, social adjustment, and life satisfaction in this sample were poor. The recovery rates for anxiety disorders in this Latino sample were markedly low. Although caution must be used in comparing these data with prior longitudinal studies, these recovery rates seem to be much lower than in non-Latino White samples. However, the clinical course of MDD in this sample was similar to its course among non-Latino Whites, invoking the pressing question of whether there is something about the experience of anxiety disorders (but not MDD) among Latinos that makes them more impairing and persistent. The answer to that question should inform future treatment development for this population.

  12. Hyper-reactive human ventral tegmental area and aberrant mesocorticolimbic connectivity in overgeneralization of fear in generalized anxiety disorder.

    Science.gov (United States)

    Cha, Jiook; Carlson, Joshua M; Dedora, Daniel J; Greenberg, Tsafrir; Proudfit, Greg H; Mujica-Parodi, Lilianne R

    2014-04-23

    The ventral tegmental area (VTA) has been primarily implicated in reward-motivated behavior. Recently, aberrant dopaminergic VTA signaling has also been implicated in anxiety-like behaviors in animal models. These findings, however, have yet to be extended to anxiety in humans. Here we hypothesized that clinical anxiety is linked to dysfunction of the mesocorticolimbic circuit during threat processing in humans; specifically, excessive or dysregulated activity of the mesocorticolimbic aversion circuit may be etiologically related to errors in distinguishing cues of threat versus safety, also known as "overgeneralization of fear." To test this, we recruited 32 females with generalized anxiety disorder and 25 age-matched healthy control females. We measured brain activity using fMRI while participants underwent a fear generalization task consisting of pseudo-randomly presented rectangles with systematically varying widths. A mid-sized rectangle served as a conditioned stimulus (CS; 50% electric shock probability) and rectangles with widths of CS ±20%, ±40%, and ±60% served as generalization stimuli (GS; never paired with electric shock). Healthy controls showed VTA reactivity proportional to the cue's perceptual similarity to CS (threat). In contrast, patients with generalized anxiety disorder showed heightened and less discriminating VTA reactivity to GS, a feature that was positively correlated with trait anxiety, as well as increased mesocortical and decreased mesohippocampal coupling. Our results suggest that the human VTA and the mesocorticolimbic system play a crucial role in threat processing, and that abnormalities in this system are implicated in maladaptive threat processing in clinical anxiety.

  13. A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder

    OpenAIRE

    Dugas, Michel J.; Brillon, Pascale; Savard, Pierre; Turcotte, Julie; Gaudet, Adrienne; Ladouceur,Robert; Leblanc, Renée; Gervais, Nicole J.

    2009-01-01

    This randomized clinical trial compared cognitive-behavioral therapy (CBT), applied relaxation (AR), and wait-list control (WL) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder (GAD). The CBT condition was based on the intolerance of uncertainty model of GAD, whereas the AR condition was based on general theories of anxiety. Both manualized treatments were administered over 12 weekly 1-hour sessions. Standardized clinician ratings and self-report questionnaire...

  14. [Generalized anxiety disorders (GAD)--a neglected illness? Background und aims of the GAD-P study].

    Science.gov (United States)

    Wittchen, H U; Linden, M; Schwarzer, W; Riemann, D; Boerner, R J; Bandelow, B

    2001-01-01

    In the past Generalized anxiety disorder (GAD)--previously classified as anxiety neurosis--was regarded as not being a separate diagnostic entity. On the basis of new explicit criteria for GAD in the 90ies, GAD-specific pharmacological (i.e. SNRI) and psychological treatments with improved efficacy have become available. The Generalized Anxiety and Depression in Primary care study (GAD-P) investigates the prevalence of GAD in primary care settings and evaluates the patterns of care provided. Aims, methods and findings of the GAD-P study are described in this supplement.

  15. Profile of agomelatine and its potential in the treatment of generalized anxiety disorder

    Directory of Open Access Journals (Sweden)

    Levitan MN

    2015-05-01

    Full Text Available Michelle Nigri Levitan,1 Marcelo Papelbaum,1,2 Antonio Egidio Nardi1 1Laboratory of Panic and Respiration, Institute of Psychiatry of the Federal University of Rio de Janeiro, 2State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, Brazil Background: Although many generalized anxiety disorder (GAD patients respond to the available pharmacological treatments, nearly half of them do not present the expected results. Besides, the side effects associated to some drugs have a negative impact on treatment adherence. Therefore, the aim of this review was to report the clinical profile of agomelatine, a selective melatonergic MT1/MT2 receptor agonist with serotonin 5-HT2c receptor antagonist activities, as a potential pharmacological option in the treatment of GAD.Methods: We performed a literature review regarding studies that evaluated the use of agomelatine in GAD treatment. Results: Two short-term, double-blinded studies and one prevention-treatment trial evaluated the efficacy of agomelatine in the treatment of GAD. Agomelatine was associated with higher rates of clinical response and remission, when compared to placebo. In addition, the long-term use of agomelatine decreased the risk of relapse of anxiety symptoms, even for the severely ill patients. Besides, the tolerability was satisfactory with the absence of discontinuation symptoms, as observed in previous studies.Conclusion: The efficacy and tolerability profiles of agomelatine in the treatment of GAD were good. However, the scarce number of trials, the small sample sizes, and the use of patients without any comorbid conditions were some limitations that impaired the generalization of the results in the general population. Nevertheless, agomelatine is an attractive off-label option in the treatment of GAD that needs more conclusive evidences to establish its role in future guidelines. Keywords: agomelatine, generalized anxiety disorder, pharmacological treatment

  16. Testing a procedural variant of written imaginal exposure for generalized anxiety disorder.

    Science.gov (United States)

    Fracalanza, Katie; Koerner, Naomi; Antony, Martin M

    2014-08-01

    This experiment examined the degree to which it is more beneficial for individuals with generalized anxiety disorder (GAD) to engage in repeated exposure to mental imagery of the same feared scenario versus varying the exposure content. On three consecutive days, individuals with GAD (N=57) spent 20min writing about: (1) the same worst case scenario (consistent exposure; CE), (2) variations of their worst case scenario (varied exposure; VE), or (3) a neutral topic (neutral control; NC). Participants in the CE condition displayed significant decreases in worry, acute cognitive avoidance, and intolerance of uncertainty from baseline to 1-week follow-up; participants in the VE and NC conditions did not. Initial activation of self-reported anxiety (observed in the CE and VE conditions) and between-session reduction in anxiety (observed in the CE condition only) were associated with improvement in worry. Including more references to negative emotion and writing in the present tense were also associated with greater improvement in worry in the CE condition. These findings suggest that writing repeatedly about the same worst case scenario may benefit people with GAD. The study also provides information on potential mechanisms of change.

  17. Repetitive transcranial magnetic stimulation for treatment of major depressive disorder with comorbid generalized anxiety disorder.

    Science.gov (United States)

    White, Daniela; Tavakoli, Sason

    2015-08-01

    Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in treating individuals with behavioral disorders such as major depressive disorder (MDD), posttraumatic stress disorder, obsessive-compulsive disorder, and social anxiety disorder. A number of applications of rTMS to different regions of the left and right prefrontal cortex have been used to treat these disorders, but no study of treatment for MDD with generalized anxiety disorder (GAD) has been conducted with application of rTMS to both the left and right prefrontal cortex. We hypothesized that applying low-frequency rTMS to the right dorsolateral prefrontal cortex (DLPFC) before applying it to the left DLPFC for the treatment of depression would be anxiolytic in patients with MDD with GAD. Thirteen adult patients with comorbid MDD and GAD received treatment with rTMS in an outpatient setting. The number of treatments ranged from 24 to 36 over 5 to 6 weeks. Response was defined as a ≥ 50% reduction in symptoms from baseline, and remission was defined as a score of depressive symptoms on the 21-item Hamilton Rating Scale for Depression (HAM-D-21). At the end of the treatment period, for the GAD-7 scale, 11 out of 13 (84.6%) patients' anxiety symptoms were in remission, achieving a score of depressive symptoms. In this small pilot study of 13 patients with comorbid MDD and GAD, significant improvement in anxiety symptoms along with depressive symptoms was achieved in a majority of patients after bilateral rTMS application.

  18. Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report.

    Science.gov (United States)

    Wetherell, Julie Loebach; Afari, Niloofar; Ayers, Catherine R; Stoddard, Jill A; Ruberg, Joshua; Sorrell, John T; Liu, Lin; Petkus, Andrew J; Thorp, Steven R; Kraft, Alexander; Patterson, Thomas L

    2011-03-01

    Some evidence suggests that acceptance-based approaches such as Acceptance and Commitment Therapy (ACT) may be well-suited to geriatric generalized anxiety disorder (GAD). The primary goal of this project was to determine whether ACT was feasible for this population. Seven older primary-care patients with GAD received 12 individual sessions of ACT; another 9 were treated with cognitive-behavioral therapy. No patients dropped out of ACT, and worry and depression improved. Findings suggest that ACT may warrant a large-scale investigation with anxious older adults. Copyright © 2010. Published by Elsevier Ltd.

  19. Acceptance and Commitment Therapy for Generalized Anxiety Disorder in Older Adults: A Preliminary Report

    Science.gov (United States)

    Wetherell, Julie Loebach; Afari, Niloofar; Ayers, Catherine R.; Stoddard, Jill A.; Ruberg, Joshua; Sorrell, John T.; Liu, Lin; Petkus, Andrew J.; Thorp, Steven R.; Kraft, Alexander; Patterson, Thomas L.

    2012-01-01

    Some evidence suggests that acceptance-based approaches such as Acceptance and Commitment Therapy (ACT) may be well-suited to geriatric generalized anxiety disorder (GAD). The primary goal of this project was to determine whether ACT was feasible for this population. Seven older primary-care patients with GAD received 12 individual sessions of ACT; another 9 were treated with cognitive-behavioral therapy. No patients dropped out of ACT, and worry and depression improved. Findings suggest that ACT may warrant a large-scale investigation with anxious older adults. PMID:21292059

  20. Differences in clinical intrusive thoughts between obsessive-compulsive disorder, generalized anxiety disorder, and hypochondria.

    Science.gov (United States)

    Romero-Sanchiz, Pablo; Nogueira-Arjona, Raquel; Godoy-Ávila, Antonio; Gavino-Lázaro, Aurora; Freeston, Mark H

    2017-07-26

    Differences and similarities between intrusive thoughts typical of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non-clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive-compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire-Transdiagnostic Version (Romero-Sanchiz, Nogueira-Arjona, Godoy-Ávila, Gavino-Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed. Key Pratictioner Message The current study provides evidence about the discrimination between clinical obsessions, worries, and illness intrusions from a transdiagnostic perspective. The differentiation between them is crucial for the diagnosis, formulation, and psychological treatment of obsessive-compulsive disorder

  1. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress

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    Gulliver Amelia

    2012-07-01

    Full Text Available Abstract Background Depression and anxiety are treatable disorders, yet many people do not seek professional help. Interventions designed to improve help-seeking attitudes and increase help-seeking intentions and behaviour have been evaluated in recent times. However, there have been no systematic reviews of the efficacy or effectiveness of these interventions in promoting help-seeking. Therefore, this paper reports a systematic review of published randomised controlled trials targeting help-seeking attitudes, intentions or behaviours for depression, anxiety, and general psychological distress. Methods Studies were identified through searches of PubMed, PsycInfo, and the Cochrane database in November 2011. Studies were included if they included a randomised controlled trial of at least one intervention targeting help-seeking for depression or anxiety or general psychological distress, and contained extractable data on help-seeking attitudes or intentions or behaviour. Studies were excluded if they focused on problems or conditions other than the target (e.g., substance use, eating disorder. Results Six published studies of randomised controlled trials investigating eight different interventions for help-seeking were identified. The majority of trials targeted young adults. Mental health literacy content was effective (d = .12 to .53 in improving help-seeking attitudes in the majority of studies at post-intervention, but had no effect on help-seeking behaviour (d = −.01, .02. There was less evidence for other intervention types such as efforts to destigmatise or provide help-seeking source information. Conclusions Mental health literacy interventions are a promising method for promoting positive help-seeking attitudes, but there is no evidence that it leads to help-seeking behaviour. Further research investigating the effects of interventions on attitudes, intentions, and behaviour is required.

  2. Duloxetine versus placebo in the treatment of patients with generalized anxiety disorder in China

    Institute of Scientific and Technical Information of China (English)

    WU Wen-yuan; WANG Gang; Susan G Ball; Durisala Desaiah; ANG Qiu-qing

    2011-01-01

    Background Duloxetine is approved for the treatment of generalized anxiety disorder (GAD) in the United States and elsewhere.This study aimed to assess the efficacy,tolerability,and safety of duloxetine in Chinese patients with GAD.Methods This 9-site study consisted of double-blind treatment for 15 weeks either with duloxetine 60-120 mg or with placebo.Patients with at least moderately severe GAD and a Sheehan Disability Scale (SDS) global functioning impairment total score ≥12 were included in this study.Patients who were randomly assigned to duloxetine received 60 mg for 7 weeks; at that point,for nonresponders the dose was increased to 120 mg for the remaining 8 weeks.The primary efficacy measure was mean change from baseline to endpoint on the Hospital Anxiety and Depression Scale-Anxiety subscale score (HADS-A).Secondary efficacy measures included the Hamilton Anxiety Rating Scale (HAMA),the SDS,and pain measures.Safety and tolerability were assessed.Results Baseline characteristics did not differ significantly between treatment groups.Mean age of the subjects (n=210)was 37.6 years,50.5% were female,and 74.3% completed the 15 weeks treatment.Patients treated with duloxetine had significantly greater improvement compared to placebo on the HADS-A (mean change -6.6 vs.-4.9,respectively,P=0.022).Improvement in anxiety was greater with duloxetine treatment at 7 weeks and continued through 15 weeks for both the HADS-A and the HAMA total score (0.01 ≤ P <0.05).Compared with placebo,duloxetine was also associated with greater improvement on most secondary measures,but not on the SDS global functioning score.Nausea,dizziness,and somnolence occurred significantly more frequently as treatment-emergent adverse events with duloxetine treatment compared with placebo treatment.Conclusions Duloxetine 60-120 mg once daily is effective and well-tolerated for the treatment of patients with GAD in China.

  3. The Efficacy of the Training of Stress Management by Cognitive-Behavior Method on Addicts’ Anxiety of with Generalized Anxiety Disorder

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    Zahra Lak

    2013-01-01

    Full Text Available Aim: The purpose of this study was to investigate the effectiveness of cognitive–behavioral stress management on reduction of anxiety among addicts with GAD. Method: The design of the study is experimental with pretest -posttest and control group. The population of the study was all addicts with GAD in Tehran self-referred centers that scored the most points in GAD-7 test. 24 addicts were allocated into experimental group (N=12 and control group (N=12. The cognitive-behavioral stress management was demonstrated in 10 weekly sessions on the experimental group while there was no psychological treatment for the control group. DASS-21 questionnaire and GAD-7 questionnaire were completed by both groups before and after program. The data was analyzed using covariance. Results: There were no significant differences in anxiety between two groups before intervention. Results of this study demonstrated that cognitive –behavioral stress management led to significant decrease in anxiety in experimental group. Conclusion: Regarding to effectiveness of cognitive-behavioral stress management on anxiety, it may also be used as a supplement method decreasing generalized anxiety disorder among addicts.

  4. Yoga for generalized anxiety disorder: design of a randomized controlled clinical trial.

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    Hofmann, Stefan G; Curtiss, Joshua; Khalsa, Sat Bir S; Hoge, Elizabeth; Rosenfield, David; Bui, Eric; Keshaviah, Aparna; Simon, Naomi

    2015-08-06

    Generalized anxiety disorder (GAD) is a common disorder associated with significant distress and interference. Although cognitive behavioral therapy (CBT) has been shown to be the most effective form of psychotherapy, few patients receive or have access to this intervention. Yoga therapy offers another promising, yet under-researched, intervention that is gaining increasing popularity in the general public, as an anxiety reduction intervention. The purpose of this innovative clinical trial protocol is to investigate the efficacy of a Kundalini Yoga intervention, relative to CBT and a control condition. Kundalini yoga and CBT are compared with each other in a noninferiority test and both treatments are compared to stress education training, an attention control intervention, in superiority tests. The sample will consist of 230 individuals with a primary DSM-5 diagnosis of GAD. This randomized controlled trial will compare yoga (N=95) to both CBT for GAD (N=95) and stress education (N=40), a commonly used control condition. All three treatments will be administered by two instructors in a group format over 12 weekly sessions with four to six patients per group. Groups will be randomized using permuted block randomization, which will be stratified by site. Treatment outcome will be evaluated bi-weekly and at 6month follow-up. Furthermore, potential mediators of treatment outcome will be investigated. Given the individual and economic burden associated with GAD, identifying accessible alternative behavioral treatments will have substantive public health implications.

  5. Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder.

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    Marganska, Anna; Gallagher, Michelle; Miranda, Regina

    2013-01-01

    Differences in attachment style have been linked to both emotion regulation and psychological functioning, but the emotion regulatory mechanism through which attachment style might impact symptoms of depression and anxiety is unclear. The present study examined the explanatory role of emotion dysregulation in the relation between adult attachment style and symptoms of depression and generalized anxiety disorder (GAD) in a sample of 284 adults. Secure attachment was associated with lower depression and GAD symptoms and lower emotion dysregulation, whereas insecure attachment styles were generally associated with higher depression and GAD scores and higher emotion dysregulation. Perceived inability to generate effective emotion regulation strategies mediated the relation between insecure attachment and both depression and GAD symptoms. Nonacceptance of negative emotions and inability to control impulsive behaviors emerged as additional mediators of the relation between insecure attachment styles and GAD symptoms. The differential contribution of attachment style and emotion regulation to the prediction of depression and GAD symptoms may reflect differences in vulnerability to depression and GAD.

  6. Classification models for subthreshold generalized anxiety disorder in a college population: Implications for prevention.

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    Kanuri, Nitya; Taylor, C Barr; Cohen, Jeffrey M; Newman, Michelle G

    2015-08-01

    Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders on college campuses and often goes unidentified and untreated. We propose a combined prevention and treatment model composed of evidence-based self-help (SH) and guided self-help (GSH) interventions to address this issue. To inform the development of this stepped-care model of intervention delivery, we evaluated results from a population-based anxiety screening of college students. A primary model was developed to illustrate how increasing levels of symptomatology could be linked to prevention/treatment interventions. We used screening data to propose four models of classification for populations at risk for GAD. We then explored the cost considerations of implementing this prevention/treatment stepped-care model. Among 2489 college students (mean age 19.1 years; 67% female), 8.0% (198/2489) met DSM-5 clinical criteria for GAD, in line with expected clinical rates for this population. At-risk Model 1 (subthreshold, but considerable symptoms of anxiety) identified 13.7% of students as potentially at risk for developing GAD. Model 2 (subthreshold, but high GAD symptom severity) identified 13.7%. Model 3 (subthreshold, but symptoms were distressing) identified 12.3%. Model 4 (subthreshold, but considerable worry) identified 17.4%. There was little overlap among these models, with a combined at-risk population of 39.4%. The efficiency of these models in identifying those truly at risk and the cost and efficacy of preventive interventions will determine if prevention is viable. Using Model 1 data and conservative cost estimates, we found that a preventive intervention effect size of even 0.2 could make a prevention/treatment model more cost-effective than existing models of "wait-and-treat." Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Functional and morphological alterations associated with working memory dysfunction in patients with generalized anxiety disorder.

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    Moon, Chung-Man; Jeong, Gwang-Woo

    2017-03-01

    Background Generalized anxiety disorder (GAD) has been related to functional brain activities and structural brain abnormalities. Purpose To investigate the neural mechanism on working memory dysfunction in patients with GAD in terms of the combined functional and morphological brain abnormalities. Material and Methods Patients with GAD and healthy controls matched for age, sex, and education level underwent high-resolution T1-weighted (T1W) magnetic resonance imaging (MRI) and functional MRI (fMRI). In this study, fMRI and voxel-based morphometry (VBM) were used for assessing the differential brain activation patterns, as well as for comparing the morphological alterations between the two groups. Results In response to the neutral distractors, the patients showed significantly lower activities in the regions of the fusiform gyrus (FuG), superior parietal gyrus (SPG), precuneus (PCu), superior occipital gyrus (SOG), lingual gyrus (LiG), cuneus (Cun), calcarine cortex (CaC), parahippocampal gyrus (PHG) and cerebellar cortex (Cb) compared to the controls. In response to the anxiety-inducing distractors, the patients showed significantly higher activity in the hippocampus and lower activities in the regions of the dorsolateral prefrontal cortex (DLPFC), FuG, SPG, PCu, SOG, and Cb. Also, the patients showed a significant reduction of the white matter volumes in the DLPFC, anterior limb of the internal capsule (ALIC) and midbrain. Conclusion This study provides the first evidence for the association between the morphometric alterations and functional deficit in the working memory processing with the neutral and anxiety-inducing distractors in GAD patients. These findings would be helpful to understand the neural mechanisms on working memory impairment in connection with GAD symptoms.

  8. Insomnia and generalized anxiety disorder: effects of cognitive behavior therapy for gad on insomnia symptoms.

    Science.gov (United States)

    Bélanger, Lynda; Morin, Charles M; Langlois, Frédéric; Ladouceur, Robert

    2004-01-01

    Although clinical practice suggests that sleep complaints are frequent among patients with generalized anxiety disorder (GAD), frequency, severity, types of insomnia complaints, and relationship to GAD diagnosis severity in patients diagnosed using Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria are not well documented. Clinical data about the impact on insomnia symptoms of treating GAD worries are also lacking. The present study examined these aspects in 44 GAD patients who participated in a treatment study specifically addressing excessive worries through CBT interventions. All patients were assessed using a structured clinical interview and the Anxiety Disorder Interview Schedule-IV (ADIS-IV). They also completed anxiety and insomnia inventories, including the Insomnia Severity Index (ISI), a self-report measure which assesses insomnia type, severity and interference with daily life. Among this sample, 47.7% reported difficulties initiating sleep, 63.6% reported difficulties maintaining sleep, and 56.8% complained of waking too early in the morning. The majority of these patients (86.5%) reported never having experienced insomnia without having excessive worries. However, insomnia severity and GAD severity were not correlated. In this sample, patients with severe GAD did not necessarily report more severe insomnia symptoms. Regarding treatment impact on insomnia complaints, ISI post-treatment scores were significantly lower after treatment. Mean post-treatment scores almost reached ISI's "absence of clinical insomnia" category. Results indicate that this CBT package for GAD does have a significant impact on sleep quality even if sleep disturbances were not specifically addressed during treatment.

  9. [Influence of anxiety and depression status of family members on the general psychological status of perioperative patients with lung cancer].

    Science.gov (United States)

    Wu, Xianning; Chen, Mingjiu; Su, Dan; Yu, Fenglei

    2011-12-01

    Facing the double pressures caused by cancer and surgery, many patients will appear series psychological problems like nervous, fear, pessimism, anxiety and so on. The aim of this study is to explone the anxiety, depression status of family members, the general psychological status of perioperative patients with lung cancer and the influence of the former on the latter. Total 97 patients and 97 patient family members from the thoracic department of the Second Xiangya Hospital of Central South University were enrolled as the study subjects. The general information, the anxiety and depression status of the family members, and the general psychological status of perioperative patients with lung cancer were investigated using self-made general information questionnaire, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and symptom check-list 90 (SCL-90). The scores of seven factors, including total scores (153.28±41.98), somatization (1.78±0.42), compulsion (1.96±0.52), depression (1.77±0.67), anxiety (1.82±0.56), hostility (1.68±0.87), panic (1.44±0.75) and psychosis (1.56±0.51) in SCL-90 were remarkerbly higher than those in domestic norm (Pfamily members was positively correlated with the compulsion, anxiety and bigoted factors of SCL-90 in the patients (Pfamily members was negatively correlated with the compulsion and psychosis factors of SCL-90 in the patients (PFamily members have different degrees of anxiety and depression, which have certain effects on the general psychological status of perioperative patients with lung cancer.

  10. Cognitive Behavioral Treatment for Older Adults with Generalized Anxiety Disorder: A Therapist Manual for Primary Care Settings

    Science.gov (United States)

    Stanley, Melinda A.; Diefenbach, Gretchen J.; Hopko, Derek R.

    2004-01-01

    At least four academic clinical trials have demonstrated the utility of cognitive behavior therapy (CBT) for older adults with generalized anxiety disorder (GAD). These data may not generalize, however, to more heterogeneous and functionally impaired patients and the medical settings in which they typically receive care. A recent pilot project…

  11. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

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    Merino, Hipólito; Senra, Carmen; Ferreiro, Fátima

    2016-01-01

    This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.

  12. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

    Directory of Open Access Journals (Sweden)

    Hipólito Merino

    Full Text Available This study examines the relationships between neuroticism (higher-order vulnerability factor, the cognitive styles of worry, brooding and reflection (second-order vulnerability factors and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD, with Major Depressive Disorder (MDD and with Mixed Anxiety-Depressive Disorder (MADD. One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection, anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.

  13. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

    Science.gov (United States)

    Merino, Hipólito; Ferreiro, Fátima

    2016-01-01

    This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms. PMID:27243462

  14. Neural correlates of emotion acceptance vs worry or suppression in generalized anxiety disorder

    Science.gov (United States)

    Barlow, David H.; Whitfield-Gabrieli, Susan; Gabrieli, John D.E.; Deckersbach, Thilo

    2017-01-01

    Abstract Recent emotion dysregulation models of generalized anxiety disorder (GAD) propose chronic worry in GAD functions as a maladaptive attempt to regulate anxiety related to uncertain or unpredictable outcomes. Emotion acceptance is an adaptive emotion regulation strategy increasingly incorporated into newer cognitive behavioral therapy (CBT) approaches to GAD to counter chronic worry. The current study explores the mechanisms of emotion acceptance as an alternate emotion regulation strategy to worry or emotion suppression using functional magnetic resonance imaging. Twenty-one female participants diagnosed with GAD followed counterbalanced instructions to regulate responses to personally relevant worry statements by engaging in either emotion acceptance, worry or emotion suppression. Emotion acceptance resulted in lower ratings of distress than worry and was associated with increased dorsal anterior cingulate cortex (dACC) activation and increased ventrolateral prefrontal cortex (VLPFC)-amygdala functional connectivity. In contrast, worry showed significantly greater distress ratings than acceptance or suppression and was associated with increased precuneus, VLPFC, amygdala and hippocampal activation. Suppression did not significantly differ from acceptance in distress ratings or amygdala recruitment, but resulted in significantly greater insula and VLPFC activation and decreased VLPFC-amygdala functional connectivity. Emotion acceptance closely aligned with activation and connectivity patterns reported in studies of contextual extinction learning and mindful awareness. PMID:28402571

  15. Preliminary Evidence of White Matter Abnormality in the Uncinate Fasciculus in Generalized Social Anxiety Disorder

    Science.gov (United States)

    Phan, K. Luan; Orlichenko, Anton; Boyd, Erin; Angstadt, Mike; Coccaro, Emil F.; Liberzon, Israel; Arfanakis, Konstantinos

    2009-01-01

    Background Individuals with generalized social anxiety disorder (GSAD) exhibit exaggerated amygdala reactivity to aversive social stimuli. These findings could be explained by microstructural abnormalities in white matter (WM) tracts that connect the amygdala and prefrontal cortex, which is known to modulate the amygdala’s response to threat. The goal of this study was to investigate brain frontal WM abnormalities by using diffusion tensor imaging (DTI) in patients with social anxiety disorder. Method A Turboprop DTI sequence was used to acquire diffusion tensor images in thirty patients with GSAD and thirty matched healthy controls. Fractional anisotropy, an index of axonal organization, within WM was quantified in individual subjects and an automated voxel-based, whole-brain method was used to analyze group differences. Results Compared to healthy controls, patients had significantly lower fractional anisotropy localized to the right uncinate fasciculus WM near the orbitofrontal cortex. There were no areas of higher fractional anisotropy in patients than controls. Conclusions These findings point to an abnormality in the uncinate fasciculus, the major WM tract connecting the frontal cortex to the amygdala and other limbic temporal regions, in GSAD which could underlie the aberrant amygdala-prefrontal interactions resulting in dysfunctional social threat processing in this illness. PMID:19362707

  16. Dimensional indicators of generalized anxiety disorder severity for DSM-V.

    Science.gov (United States)

    Niles, Andrea N; Lebeau, Richard T; Liao, Betty; Glenn, Daniel E; Craske, Michelle G

    2012-03-01

    For DSM-V, simple dimensional measures of disorder severity will accompany diagnostic criteria. The current studies examine convergent validity and test-retest reliability of two potential dimensional indicators of worry severity for generalized anxiety disorder (GAD): percent of the day worried and number of worry domains. In study 1, archival data from diagnostic interviews from a community sample of individuals diagnosed with one or more anxiety disorders (n = 233) were used to assess correlations between percent of the day worried and number of worry domains with other measures of worry severity (clinical severity rating (CSR), age of onset, number of comorbid disorders, Penn state worry questionnaire (PSWQ)) and DSM-IV criteria (excessiveness, uncontrollability and number of physical symptoms). Both measures were significantly correlated with CSR and number of comorbid disorders, and with all three DSM-IV criteria. In study 2, test-retest reliability of percent of the day worried and number of worry domains were compared to test-retest reliability of DSM-IV diagnostic criteria in a non-clinical sample of undergraduate students (n = 97) at a large west coast university. All measures had low test-retest reliability except percent of the day worried, which had moderate test-retest reliability. Findings suggest that these two indicators capture worry severity, and percent of the day worried may be the most reliable existing indicator. These measures may be useful as dimensional measures for DSM-V.

  17. Preliminary evidence for a role of the adrenergic nervous system in generalized anxiety disorder.

    Science.gov (United States)

    Zhang, Xiaobin; Norton, Joanna; Carrière, Isabelle; Ritchie, Karen; Chaudieu, Isabelle; Ryan, Joanne; Ancelin, Marie-Laure

    2017-02-15

    Generalized anxiety disorder (GAD) is a common chronic condition that is understudied compared to other psychiatric disorders. An altered adrenergic function has been reported in GAD, however direct evidence for genetic susceptibility is missing. This study evaluated the associations of gene variants in adrenergic receptors (ADRs) with GAD, with the involvement of stressful events. Data were obtained from 844 French community-dwelling elderly aged 65 or over. Anxiety disorders were assessed using the Mini-International Neuropsychiatry Interview, according to DSM-IV criteria. Eight single-nucleotide polymorphisms (SNPs) involved with adrenergic function were genotyped; adrenergic receptors alpha(1A) (ADRA1A), alpha(2A) (ADRA2A), and beta2 (ADRB2) and transcription factor TCF7L2. Questionnaires evaluated recent stressful life events as well as early environment during childhood and adolescence. Using multivariate logistic regression analyses four SNPs were significantly associated with GAD. A 4-fold modified risk was found with ADRA1A rs17426222 and rs573514, and ADRB2 rs1042713 which remained significant after Bonferroni correction. Certain variants may moderate the effect of adverse life events on the risk of GAD. Replication in larger samples is needed due to the small case number. This is the first study showing that ADR variants are susceptibility factors for GAD, further highlighting the critical role of the adrenergic nervous system in this disorder.

  18. The Intrepid project - biosensor-enhanced virtual therapy for the treatment of generalized anxiety disorders.

    Science.gov (United States)

    Riva, Giuseppe; Gorini, Alessandra; Gaggioli, Andrea

    2009-01-01

    Generalized anxiety disorder (GAD) is a psychiatric disorder characterized by a constant and unspecific anxiety that interferes with daily-life activities. Together with the cognitive-behavioural treatments, relaxation represents a useful approach for the treatment of GAD, but it has the limitation that it is hard to be learned. To overcome this limitation we propose the use of biofeedback enhanced virtual reality (VR) to facilitate the relaxation process. The VR relaxation experience will be strengthened by the use of a mobile phone able to track and visualize, in an outpatient setting too, the physiological data of the patients. To test this concept, we planned a randomized controlled trial (NCT00602212), including three groups of 15 patients each (for a total of 75 patients): (1) the VR group, (2) the non-VR group and (3) the waiting list (WL) group. This controlled trial will be able to evaluate the effects of the use of VR in relaxation while preserving the benefits of randomization to reduce bias.

  19. Diagnosis and management of generalized anxiety disorder and panic disorder in adults.

    Science.gov (United States)

    Locke, Amy B; Kirst, Nell; Shultz, Cameron G

    2015-05-01

    Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.

  20. Prefrontal-limbic connectivity during worry in older adults with generalized anxiety disorder.

    Science.gov (United States)

    Mohlman, Jan; Eldreth, Dana A; Price, Rebecca B; Staples, Alison M; Hanson, Catherine

    2017-04-01

    Although generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders in older adults, very little is known about the neurobiology of worry, the hallmark symptom of GAD in adults over the age of 60. This study investigated the neurobiology and neural circuitry of worry in older GAD patients and controls. Twenty older GAD patients and 16 age-matched controls (mean age = 67.88) were compared on clinical measures and neural activity during worry using functional magnetic resonance imaging. As expected, worry elicited activation in frontal regions, amygdala, and insula within the GAD group, with a similar but less prominent frontal pattern was observed in controls. Effective connectivity analyses revealed a positive directional circuit in the GAD group extending from ventromedial through dorsolateral prefrontal cortices, converging on the amygdala. A less complex circuit was observed in controls with only dorsolateral prefrontal regions converging on the amygdala; however, a separate circuit passing through the orbitofrontal cortex converged on the insula. Results elucidate a different neurobiology of pathological versus normal worry in later life. A limited resource model is implicated wherein worry in GAD competes for the same neural resources (e.g. prefrontal cortical areas) that are involved in the adaptive regulation of emotion through cognitive and behavioral strategies.

  1. A Bowen Family Systems Model of Generalized Anxiety Disorder and Romantic Relationship Distress.

    Science.gov (United States)

    Priest, Jacob B

    2015-07-01

    Many individuals with generalized anxiety disorder (GAD) do not respond well to currently available treatments. Moreover, treatments are less effective when GAD is accompanied by romantic relationship distress. In order to develop effective treatments for GAD and relationship distress, it is necessary to conduct theory-based research to identify links common to both GAD and romantic relationship distress. Drawing on Bowen's family systems theory, the roles of family abuse/violence and differentiation in GAD and romantic relationship distress were examined using existing data from the National Comorbidity Survey Replication (n = 2,312; 2005). As predicted, family abuse/violence was directly linked to both GAD and romantic relationship distress. Differentiation mediated the relationship between family abuse/violence and GAD, and partially mediated the relationship between family abuse/violence and romantic relationship distress. Findings suggest that current and past relationship processes may help maintain chronic anxiety and that Bowen's theory may be a useful framework for developing couple therapy treatment of GAD and romantic relationship distress. © 2013 American Association for Marriage and Family Therapy.

  2. Preliminary evidence for a role of the adrenergic nervous system in generalized anxiety disorder

    Science.gov (United States)

    Zhang, Xiaobin; Norton, Joanna; Carrière, Isabelle; Ritchie, Karen; Chaudieu, Isabelle; Ryan, Joanne; Ancelin, Marie-Laure

    2017-01-01

    Generalized anxiety disorder (GAD) is a common chronic condition that is understudied compared to other psychiatric disorders. An altered adrenergic function has been reported in GAD, however direct evidence for genetic susceptibility is missing. This study evaluated the associations of gene variants in adrenergic receptors (ADRs) with GAD, with the involvement of stressful events. Data were obtained from 844 French community-dwelling elderly aged 65 or over. Anxiety disorders were assessed using the Mini-International Neuropsychiatry Interview, according to DSM-IV criteria. Eight single-nucleotide polymorphisms (SNPs) involved with adrenergic function were genotyped; adrenergic receptors alpha(1A) (ADRA1A), alpha(2A) (ADRA2A), and beta2 (ADRB2) and transcription factor TCF7L2. Questionnaires evaluated recent stressful life events as well as early environment during childhood and adolescence. Using multivariate logistic regression analyses four SNPs were significantly associated with GAD. A 4-fold modified risk was found with ADRA1A rs17426222 and rs573514, and ADRB2 rs1042713 which remained significant after Bonferroni correction. Certain variants may moderate the effect of adverse life events on the risk of GAD. Replication in larger samples is needed due to the small case number. This is the first study showing that ADR variants are susceptibility factors for GAD, further highlighting the critical role of the adrenergic nervous system in this disorder. PMID:28198454

  3. Line bisection performance in patients with generalized anxiety disorder and treatment-resistant depression

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    Wei HE, Hao CHAI, Yingchun ZHANG, Shaohua YU, Wei CHEN, Wei WANG

    2010-01-01

    Full Text Available Background and Objectives The line bisection error to the left of the true center has been interpreted as a relative right hemisphere activation, which might relate to the subject's emotional state. Considering that patients with generalized anxiety disorder (GAD or treatment-resistant depression (TRD often have negative emotions, we hypothesized that these patients would bisect lines significantly leftward. Methods We tried the line bisection task in the right-handed healthy volunteers (n = 56, GAD (n = 47 and TRD outpatients (n = 52. Subjects also completed the Zuckerman - Kuhlman Personality Questionnaire, the Zuckerman Sensation Seeking Scales, and the Plutchik-van Praag Depression Inventory. Results GAD patients scored highest on the Neuroticism-Anxiety trait, TRD patients scored highest on depression, and both patients scored lower on the Sociability trait. Patients with GAD also bisected lines significantly leftward compared to the healthy subjects. The Frequency of the bisection error was negatively correlated with Disinhibition-Seeking in the healthy subjects, and with Total sensation-seeking and Experience-Seeking in GAD patients, while the Magnitude of the line bisection error was negatively correlated with depression in TRD patients. Conclusions The study suggests a stronger right hemispheric activation, a weaker left activation, or both in the GAD, instead of TRD patients.

  4. Are Generalized Anxiety and Depression Symptoms Associated with Social Competence in Children with and without Autism Spectrum Disorder?

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    Johnston, Krista Haley Smith; Iarocci, Grace

    2017-02-20

    Generalized anxiety and depression symptoms may be associated with poorer social outcomes among children with Autism Spectrum Disorder (ASD) without intellectual disability. The goal of this study was to examine whether generalized anxiety and depression symptoms were associated with social competence after accounting for IQ, age, and gender in typically developing children and in children with ASD. Results indicated that for the TD group, generalized anxiety and depression accounted for 38% of the variance in social competence and for children with ASD, they accounted for 29% of the variance in social competence. However, only depression accounted for a significant amount of the variance. The findings underscore the importance of assessing the social impact of internalizing symptoms in children with ASD.

  5. The dual role of serotonin in defense and the mode of action of antidepressants on generalized anxiety and panic disorders.

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    Graeff, Frederico G; Zangrossi, Hélio

    2010-09-01

    Antidepressants are widely used to treat several anxiety disorders, among which generalized anxiety disorder (GAD) and panic disorder (PD). Serotonin (5-HT) is believed to play a key role in the mode of action of these agents, a major question being which pathways and receptor subtypes are involved in each type of anxiety disorder. The dual role of 5-HT in defense hypothesis assumes that 5-HT facilitates defensive responses to potential threat, like inhibitory avoidance, related to anxiety, whereas it inhibits defensive responses to proximal danger, like one-way escape, related to panic. The former action would be exerted at the forebrain, chiefly the amygdala and medial prefrontal cortex (PFC), while the latter would be exerted at the dorsal periaqueductal gray (DPAG) matter of the midbrain. The present review is focused on studies designed to test this hypothesis, performed in animal models of anxiety and panic, as well as in human experimental anxiety tests. The reviewed results suggest that chronic, but not acute, administration of antidepressants suppress panic attacks by increasing the release of 5-HT and enhancing the responsivity of post-synaptic 5-HT1A and 5-HT2A receptors in the DPAG. The attenuation of generalized anxiety, also caused by the same drug treatment, would be due to the desensitization of 5-HT2C receptors and, less certainly, to increased stimulation of 5-HT1A receptors in forebrain structures. This action would result in less activation of the amygdala, medial PFC and insula by warning signals, as shown by the reviewed results obtained with functional neuroimaging in healthy volunteers and patients with anxiety disorders.

  6. Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis.

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    Cuijpers, Pim; Gentili, Claudio; Banos, Rosa M; Garcia-Campayo, Javier; Botella, Cristina; Cristea, Ioana A

    2016-10-01

    Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58-16.07) were significantly (p=0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96-8.16) and SAD (5.92 points; 95% CI: 4.64-7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies.

  7. How do video-based demonstration assessment tasks affect problem-solving process, test anxiety, chemistry anxiety and achievement in general chemistry students?

    Science.gov (United States)

    Terrell, Rosalind Stephanie

    2001-12-01

    Because paper-and-pencil testing provides limited knowledge about what students know about chemical phenomena, we have developed video-based demonstrations to broaden measurement of student learning. For example, students might be shown a video demonstrating equilibrium shifts. Two methods for viewing equilibrium shifts are changing the concentration of the reactants and changing the temperature of the system. The students are required to combine the data collected from the video and their knowledge of chemistry to determine which way the equilibrium shifts. Video-based demonstrations are important techniques for measuring student learning because they require students to apply conceptual knowledge learned in class to a specific chemical problem. This study explores how video-based demonstration assessment tasks affect problem-solving processes, test anxiety, chemistry anxiety and achievement in general chemistry students. Several instruments were used to determine students' knowledge about chemistry, students' test and chemistry anxiety before and after treatment. Think-aloud interviews were conducted to determine students' problem-solving processes after treatment. The treatment group was compared to a control group and a group watching video demonstrations. After treatment students' anxiety increased and achievement decreased. There were also no significant differences found in students' problem-solving processes following treatment. These negative findings may be attributed to several factors that will be explored in this study.

  8. Prevention of post-stroke generalized anxiety disorder, using escitalopram or problem-solving therapy.

    Science.gov (United States)

    Mikami, Katsunaka; Jorge, Ricardo E; Moser, David J; Arndt, Stephan; Jang, Mijin; Solodkin, Ana; Small, Steven L; Fonzetti, Pasquale; Hegel, Mark T; Robinson, Robert G

    2014-01-01

    This study examined the efficacy of antidepressant treatment for preventing the onset of generalized anxiety disorder (GAD) among patients with recent stroke. Of 799 patients assessed, 176 were randomized, and 149 patients without evidence of GAD at the initial visit were included in this double-blind treatment with escitalopram (N=47) or placebo (N=49) or non-blinded problem-solving therapy (PST; 12 total sessions; N=53). Participants given placebo over 12 months were 4.95 times more likely to develop GAD than patients given escitalopram and 4.00 times more likely to develop GAD than patients given PST. Although these results should be considered preliminary, the authors found that both escitalopram and PST were effective in preventing new onset of post-stroke GAD.

  9. Neuroleptic Malignant Syndrome After the Use of Venlafaxine in a Patient with Generalized Anxiety Disorder

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    Tsung-Chien Lu

    2006-01-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a potentially lethal adverse reaction to neuroleptics, which is characterized by hyperthermia, extrapyramidal symptoms, altered consciousness and autonomic dysfunction. Although NMS is most commonly induced by the high-potency neuroleptics, its development has also been associated with the use of non-neuroleptic agents that block central dopamine pathways. A 68-year-old man with generalized anxiety disorder and depressive symptoms presented at the emergency department (ED with high fever, tremor, muscle rigidity, rhabdomyolysis and altered mental status. NMS was considered to have been caused by the recent addition and subsequent dose increase in his treatment regimen of venlafaxine, a serotonin norepinephrine reuptake inhibitor. He was successfully treated with bromocriptine, lorazepam, and fluid hydration in the ED and intensive care unit.

  10. Sympathetic and hypothalamic-pituitary-adrenal asymmetry in generalized anxiety disorder.

    Science.gov (United States)

    Reeves, Jonathan W; Fisher, Aaron J; Newman, Michelle G; Granger, Douglas A

    2016-06-01

    Physiologic investigations of generalized anxiety disorder (GAD) have skewed toward assessment of the autonomic nervous system, largely neglecting hypothalamic-pituitary-adrenal (HPA) axis variables. Although these systems coordinate-suggesting a degree of symmetry-to promote adaptive functioning, most studies opt to monitor either one system or the other. Using a ratio of salivary alpha-amylase (sAA) over salivary cortisol, the present study examined symmetry between the sympathetic nervous system (SNS) and HPA axis in individuals with GAD (n = 71) and healthy controls (n = 37). Compared to healthy controls, individuals with GAD exhibited greater baseline ratios of sAA/cortisol and smaller ratios of sAA/cortisol following a mental arithmetic challenge. We propose that the present study provides evidence for SNS-HPA asymmetry in GAD. Further, these results suggest that increased SNS suppression in GAD may be partially mediated by cortisol activity.

  11. Impact of Comorbid Depressive Disorders on Subjective and Physiological Responses to Emotion in Generalized Anxiety Disorder.

    Science.gov (United States)

    Seeley, Saren H; Mennin, Douglas S; Aldao, Amelia; McLaughlin, Katie A; Rottenberg, Jonathan; Fresco, David M

    2016-06-01

    Generalized anxiety disorder (GAD) and unipolar depressive disorders (UDD) have been shown to differ from each other in dimensions of affective functioning despite their high rates of comorbidity. We showed emotional film clips to a community sample (n = 170) with GAD, GAD with secondary UDD, or no diagnosis. Groups had comparable subjective responses to the clips, but the GAD group had significantly lower heart rate variability (HRV) during fear and after sadness, compared to controls. While HRV in the GAD and control groups rose in response to the sadness and happiness clips, it returned to baseline levels afterwards in the GAD group, potentially indicating lesser ability to sustain attention on emotional stimuli. HRV in the GAD + UDD group changed only in response to sadness, but was otherwise unvarying between timepoints. Though preliminary, these findings suggest comorbid UDD as a potential moderator of emotional responding in GAD.

  12. Neurobiological substrates of cognitive rigidity and autonomic inflexibility in generalized anxiety disorder.

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    Ottaviani, Cristina; Watson, David R; Meeten, Frances; Makovac, Elena; Garfinkel, Sarah N; Critchley, Hugo D

    2016-09-01

    Generalized anxiety disorder (GAD) is characterized by difficulties in inhibiting both perseverative thoughts (worry and rumination) and autonomic arousal. We investigated the neurobiological substrates of such abnormal inhibitory processes, hypothesizing aberrant functional coupling within 'default mode' (DMN) and autonomic brain networks. Functional imaging and heart rate variability (HRV) data were acquired from GAD patients and controls during performance of three tracking tasks interspersed with a perseverative cognition (PC) induction. After detection of infrequent target stimuli, activity within putative DMN hubs was suppressed, consistent with a redirection of attentional resources from internal to external focus. This magnitude of activity change was attenuated in patients and individuals with higher trait PC, but was predicted by individual differences in HRV. Following the induction of PC in controls, this pattern of neural reactivity became closer to that of GAD patients. Results support, at a neural level, the association between cognitive inflexibility and autonomic rigidity.

  13. Heightened reward learning under stress in generalized anxiety disorder: a predictor of depression resistance?

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    Morris, Bethany H; Rottenberg, Jonathan

    2015-02-01

    Stress-induced anhedonia is associated with depression vulnerability (Bogdan & Pizzagalli, 2006). We investigated stress-induced deficits in reward learning in a depression-vulnerable group with analogue generalized anxiety disorder (GAD, n = 34), and never-depressed healthy controls (n = 41). Utilizing a computerized signal detection task, reward learning was assessed under stressor and neutral conditions. Controls displayed intact reward learning in the neutral condition, and the expected stress-induced blunting. The GAD group as a whole also showed intact reward learning in the neutral condition. When GAD subjects were analyzed as a function of prior depression history, never-depressed GAD subjects showed heightened reward learning in the stressor condition. Better reward learning under stress among GAD subjects predicted lower depression symptoms 1 month later. Robust reward learning under stress may indicate depression resistance among anxious individuals.

  14. Distress and avoidance in generalized anxiety disorder: exploring the relationships with intolerance of uncertainty and worry.

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    Lee, Jonathan K; Orsillo, Susan M; Roemer, Lizabeth; Allen, Laura B

    2010-01-01

    Theory and research suggest that treatments targeting experiential avoidance may enhance outcomes for patients with generalized anxiety disorder (GAD). The present study examined the role of experiential avoidance and distress about emotions in a treatment-seeking sample with a principal diagnosis of GAD compared with demographically matched nonanxious controls and sought to explore their shared relationship with two putative psychopathological processes in GAD: intolerance of uncertainty and worry. Patients with GAD reported significantly higher levels of experiential avoidance and distress about emotions compared with nonclinical controls while controlling for depressive symptoms, and measures of these constructs significantly predicted GAD status. Additionally, experiential avoidance and distress about anxious, positive, and angry emotions shared unique variance with intolerance of uncertainty when negative affect was partialed out, whereas only experiential avoidance and distress about anxious emotions shared unique variance with worry. Discussion focuses on implications for treatment as well as future directions for research.

  15. The effectiveness of cognitive behavioral therapy for generalized anxiety disorder in a frontline service setting.

    Science.gov (United States)

    Kehle, Shannon M

    2008-01-01

    The goal of the current study was to test the generalizability of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) in a frontline service setting. Twenty-nine patients who presented to treatment clinics with problematic worry were provided CBT for GAD. Among the intent-to-treat sample, there were no significant changes in worry or depression from pre- to posttreatment. Treatment completers showed significant pre- to posttreatment reductions on measures of worry and depression. The magnitude of change was smaller than has been reported in randomized control trials (RCTs). Although the frontline service setting differed from RCT settings in multiple ways, treatment completers nonetheless achieved moderate to large decreases in self-reported worry and depression.

  16. Evaluating the Efficacy of Endoscopic Thoracic Sympathectomy for Generalized Social Anxiety Disorder with Blushing Complaints

    Science.gov (United States)

    Súarez, Claudio; Palacios, Estela; Palacios, Fernanda; Matus, Patricia

    2011-01-01

    Objective: No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, open-label, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment. Method: Three-hundred and thirty consecutive patients seeking treatment for their blushing were assessed by psychiatric interview and patient-rated scales. The Brief Social Phobia Scale was the primary outcome measure. Patients meeting Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria for generalized social anxiety disorder, scoring 20 points or more in the Brief Social Phobia Scale and 19 points or more in the Social Phobia Inventory were considered eligible and followed up for a mean of 11 months (range 1–64) after endoscopic thoracic sympathectomy or initiation of sertraline. Results: At baseline, 97 percent of the endoscopic thoracic sympathectomy-treated group, 87 percent of the sertraline-treated group, and 78 percent of the nontreated group rated their blushing as being “severe” or “extreme.” At follow up, 16 percent of endoscopic thoracic sympathectomy-treated patients, 32 percent of sertraline-treated patients, and 57 percent of untreated patients reported this degree of blushing. At endpoint, Brief Social Phobia Scale total scores exhibited a greater decline with either treatment than with no treatment. Nonetheless, in comparison to no treatment, only the results obtained with endoscopic thoracic sympathectomy achieved statistical significance (p=0.003). Compensatory sweating occurred in 99 percent of patients who underwent endoscopic thoracic sympathectomy. High degrees of satisfaction with treatment were reported by 89 percent of patients undergoing endoscopic thoracic sympathectomy and by 59 percent of patients taking medication. Conclusion

  17. Generalized Anxiety Symptoms and Identity Processes in Cross-Cultural Samples of Adolescents from the General Population

    NARCIS (Netherlands)

    Crocetti, Elisabetta; Hale, William W.; Dimitrova, Radosveta; Abubakar, Amina; Gao, Cheng Hai; Pesigan, Ivan Jacob Agaloos

    2015-01-01

    Background: Approximately 20 % of adolescents around the world experience mental health problems, most commonly depression or anxiety. High levels of anxiety disorder symptoms can hinder adolescent development, persist into adulthood, and predict negative mental outcomes, such as suicidal ideation a

  18. Generalized Anxiety Symptoms and Identity Processes in Cross-Cultural Samples of Adolescents from the General Population

    Science.gov (United States)

    Crocetti, Elisabetta; Hale, William W., III.; Dimitrova, Radosveta; Abubakar, Amina; Gao, Cheng-Hai; Agaloos Pesigan, Ivan Jacob

    2015-01-01

    Background: Approximately 20% of adolescents around the world experience mental health problems, most commonly depression or anxiety. High levels of anxiety disorder symptoms can hinder adolescent development, persist into adulthood, and predict negative mental outcomes, such as suicidal ideation and attempts. Objectives: We analyzed generalized…

  19. Zolpidem extended-release improves sleep and next-day symptoms in comorbid insomnia and generalized anxiety disorder.

    Science.gov (United States)

    Fava, Maurizio; Asnis, Gregory M; Shrivastava, Ram; Lydiard, Bruce; Bastani, Bijan; Sheehan, David; Roth, Thomas

    2009-06-01

    A multicenter, double-blind, parallel-group study was designed to assess the efficacy and safety of zolpidem extended-release coadministered with escitalopram in patients with insomnia and comorbid generalized anxiety disorder. Patients (N = 383) received open-label escitalopram 10 mg/d and were randomized to either adjunct zolpidem extended-release 12.5 mg or placebo. The primary efficacy measure was change from baseline to week 8 in subjective total sleep time. Secondary efficacy measures included subjective sleep onset latency, number of awakenings, wake time after sleep onset, sleep quality, the Hamilton Rating Scale for Anxiety, the Beck Anxiety Inventory, the Sleep Impact Scale, the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, and the Sheehan Disability Scale. The last-observation-carried-forward method was used to impute missing values for most efficacy measures. Safety was monitored at each visit. At week 8 and all time points, there was a significant improvement in the zolpidem extended-release/escitalopram group compared with placebo/escitalopram for total sleep time (P escitalopram, compared with placebo/escitalopram, significantly improved insomnia and sleep-related next-day symptoms, but not anxiety symptoms, in patients with comorbid insomnia and generalized anxiety disorder.

  20. Efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy in the treatment of generalized anxiety disorders

    Institute of Scientific and Technical Information of China (English)

    Ting Wang; Jing-Yuan Ding; Guang-Xing Xu; Yu Zeng; San-Rong Xiao

    2012-01-01

    Objective:To observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders. Methods: A total of 202 generalized anxiety disorders patients were randomly allocated to a control condition (Paroxetine combined with cognitive therapy) or a treatment condition (Yiqiyangxin Chinese medicine compound combined with cognitive therapy). Subsequently, scores of Hamilton Anxiety Scale (HAMA), Zung Self-rating Anxiety Scale (SAS) and blood routine, urine routine, liver function, renal function, electrocardiogram were detected before treatment, 3 months, 6 months after treatment and 6 months after medicine withdrawal, respectively. Results: HAMA and SAS scores were significantly reduced in two groups (P0.05). HAMA and SAS scores were significantly increased in two groups (P<0.05) after medicine withdrawal, and there were significant differences in HAMA and SAS scores, recurrent disease and adverse reaction (P<0.001). The incidence of recurrent disease and adverse reaction in treatment group was low. Both two groups showed no apparent abnormality in blood routine, urine routine, liver and renal function, and electrocardiogram. Conclusions: Yiqiyangxin Chinese medicine compound combined with cognitive therapy can significantly reduce the recurrence after medicine withdrawal and is effective on generalized anxiety disorders. Furthermore, the incidence of adverse reactions is low. The treatment program is worthy clinic application in the further.

  1. [The practice guideline 'Anxiety disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

    Science.gov (United States)

    van Weel-Baumgarten, E M; van Rijswijk, E

    2005-05-28

    The recommendations provided by the revised guideline 'Anxiety disorders' are well suited to every-day practice. The multidisciplinary approach reflects the increasing cooperation between primary and secondary care in the management of mental-health problems. The description of the various anxiety disorders and the questions that can be asked to elicit the symptoms will facilitate recognition. The indications for treatment with medication are clear: a limited number of antidepressants should be used. Although it is agreed that patient education is an important part of treatment, the guidelines could have described in more detail how this should be done. Cognitive-behavioural techniques may be used but this requires extra training; its effectiveness when used by general practitioners needs further study. This guideline will add to existing knowledge and improve the skills of general practitioners in dealing with anxiety.

  2. Pregabalin augmentation of antidepressants in older patients with comorbid depression and generalized anxiety disorder-an open-label study.

    Science.gov (United States)

    Karaiskos, Dimitrios; Pappa, Dimitra; Tzavellas, Elias; Siarkos, Kostas; Katirtzoglou, Everina; Papadimitriou, George N; Politis, Antonios

    2013-01-01

    The objective of this 12-week open-label study was to evaluate the efficacy, safety, and tolerability of pregabalin as an adjunctive treatment to antidepressants in older patients suffering from depression and comorbid generalized anxiety disorder (GAD). The initial sample of this open-label study consisted of 94 older patients fulfilling criteria for depression with comorbid GAD who were treated with antidepressants. Twenty of them who had received antidepressant monotherapy for an adequate time and shown partial response to the antidepressant prescribed, in terms of either anxiety or depressive symptomatology, followed the next phase. During the 12-week study period, pregabalin was gradually added to the previously prescribed antidepressant, reaching 225 mg/day over 4 weeks. Depression and anxiety scores as well as side effects were monitored. Within groups, differences of depression and anxiety scores at baseline and during the following 12 weeks of treatment were estimated with repeated-measure analysis of variance. A statistical significant reduction in depression scores was observed after the 4th week of treatment (p anxiety scores, a statistically significant improvement was noted between the 2nd and 4th weeks (p anxiety and depressive symptomatology significantly improved, and minimal side effects were observed. Copyright © 2012 John Wiley & Sons, Ltd.

  3. Clinical Observation on General Anxiety Disorder Treated by Acupuncture plus Herbal Medicine

    Institute of Scientific and Technical Information of China (English)

    沈莉; 颜红; 冯辉

    2007-01-01

    To investigate the efficacy of the formula composed of the herbal drugs to soothe the liver, regulate qi, clarify the heart and eliminate vexation plus acupuncture for general anxiety disorder. Methods: Forty cases in the treatment group were treated with acupuncture plus herbal formula and 38 cases in the control group were treated with oral Doxepin. The assessment was conducted by Self-rating Anxiety Scale (SAS) and the Treatment Emergent Symptom Scale (TESS) before, during and after treatment. Results: The total effective rate was respectively 82.50% in the treatment group and 84.21% in the control group, with a significant difference in SAS assessment (P<0.01) between the two groups before and after the treatment.There were no significant differences in the curative and remarkable effective rate, total effective rate and SAS assessment between the two groups (P>0.05), but the side effect was higher in the control group than in the treatment group (P<0.01). Conclusion: Acupuncture plus herbal formula can have a precise effective effect for extensive anxiety neurosis with mild toxic side effects.%目的:观察疏肝理气、清心除烦中药结合针刺治疗广泛性焦虑症的疗效.方法:治疗组用针刺结合中药治疗40例,对照组采用口服多虑平治疗38例,治疗前、中、后均作焦虑自评量表(SAS)、副反应量表(TESS)评定.结果:治疗组与对照组总有效率分别为82.5%和84.2%,两组治疗前后SAS组内比较差异有统计学意义(P<0.01),两组间痊愈显效率、总有效率及SAS评分比较无差异(P>0.05),但副反应对照组显著高于治疗组(P<0.01).结论:针刺结合中药治疗广泛性焦虑症疗效确切,且毒副反应轻微.

  4. Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training☆☆☆

    Science.gov (United States)

    Hölzel, Britta K.; Hoge, Elizabeth A.; Greve, Douglas N.; Gard, Tim; Creswell, J. David; Brown, Kirk Warren; Barrett, Lisa Feldman; Schwartz, Carl; Vaitl, Dieter; Lazar, Sara W.

    2013-01-01

    Mindfulness training aims to impact emotion regulation. Generalized anxiety disorder (GAD) symptoms can be successfully addressed through mindfulness-based interventions. This preliminary study is the first to investigate neural mechanisms of symptom improvements in GAD following mindfulness training. Furthermore, we compared brain activation between GAD patients and healthy participants at baseline. 26 patients with a current DSM-IV GAD diagnosis were randomized to an 8-week Mindfulness Based Stress Reduction (MBSR, N = 15) or a stress management education (SME, N = 11) active control program. 26 healthy participants were included for baseline comparisons. BOLD response was assessed with fMRI during affect labeling of angry and neutral facial expressions. At baseline, GAD patients showed higher amygdala activation than healthy participants in response to neutral, but not angry faces, suggesting that ambiguous stimuli reveal stronger reactivity in GAD patients. In patients, amygdala activation in response to neutral faces decreased following both interventions. BOLD response in ventrolateral prefrontal regions (VLPFC) showed greater increase in MBSR than SME participants. Functional connectivity between amygdala and PFC regions increased significantly pre- to post-intervention within the MBSR, but not SME group. Both, change in VLPFC activation and amygdala–prefrontal connectivity were correlated with change in Beck Anxiety Inventory (BAI) scores, suggesting clinical relevance of these changes. Amygdala–prefrontal connectivity turned from negative coupling (typically seen in down-regulation of emotions), to positive coupling; potentially suggesting a unique mechanism of mindfulness. Findings suggest that in GAD, mindfulness training leads to changes in fronto-limbic areas crucial for the regulation of emotion; these changes correspond with reported symptom improvements. PMID:24179799

  5. Deficient prefrontal attentional control in late-life generalized anxiety disorder: an fMRI investigation.

    Science.gov (United States)

    Price, R B; Eldreth, D A; Mohlman, J

    2011-10-04

    Younger adults with anxiety disorders are known to show an attentional bias toward negative information. Little is known regarding the role of biased attention in anxious older adults, and even less is known about the neural substrates of any such bias. Functional magnetic resonance imaging (fMRI) was used to assess the mechanisms of attentional bias in late life by contrasting predictions of a top-down model emphasizing deficient prefrontal cortex (PFC) control and a bottom-up model emphasizing amygdalar hyperreactivity. In all, 16 older generalized anxiety disorder (GAD) patients (mean age=66 years) and 12 non-anxious controls (NACs; mean age=67 years) completed the emotional Stroop task to assess selective attention to negative words. Task-related fMRI data were concurrently acquired. Consistent with hypotheses, GAD participants were slower to identify the color of negative words relative to neutral, whereas NACs showed the opposite bias, responding more quickly to negative words. During negative words (in comparison with neutral), the NAC group showed PFC activations, coupled with deactivation of task-irrelevant emotional processing regions such as the amygdala and hippocampus. By contrast, GAD participants showed PFC decreases during negative words and no differences in amygdalar activity across word types. Across all participants, greater attentional bias toward negative words was correlated with decreased PFC recruitment. A significant positive correlation between attentional bias and amygdala activation was also present, but this relationship was mediated by PFC activity. These results are consistent with reduced prefrontal attentional control in late-life GAD. Strategies to enhance top-down attentional control may be particularly relevant in late-life GAD treatment.

  6. Clinical efficacy and safety of fluoxetine in generalized anxiety disorder in Chinese patients

    Directory of Open Access Journals (Sweden)

    Zou C

    2013-11-01

    Full Text Available Chuan Zou,1 Xiang Ding,1 Joseph H Flaherty,2 Birong Dong1 1The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, People's Republic of China; 2St Louis University, St Louis, MO, USA Background: Generalized anxiety disorder (GAD is a prevalent, disabling disease and is highly comorbid with other psychiatric disorders both in Western countries and the People's Republic of China. Fluoxetine, a selective inhibitor of serotonin reuptake (SSRI, is widely utilized in the management of GAD in clinical practice despite the lack of strong evidence. This article reviews fluoxetine trials to investigate fluoxetine's efficacy and tolerability in Chinese patients with GAD. Methods: A literature review was conducted using the following databases up to and including April 2013: Chinese BioMedical Literature, China National Knowledge Infrastructure, EMBASE, MEDLINE, and PsycINFO. We selected clinical studies that utilized fluoxetine for GAD in which all participants were Chinese. Results: Fifteen open-label, non-placebo trials were identified and analyzed; eleven anxiolytics were compared with fluoxetine separately. Short-term efficacy of fluoxetine had been established in these open-label, head-to-head controlled trials. Fluoxetine had rapid onset of action (approximately 1–2 weeks and seemed to be effective in maintenance treatment. Fluoxetine was generally well-tolerated with the most common side effect of dry month and nausea. Compared to other anxiolytic agents, fluoxetine was equivalent with all of the comparative anxiolytics in terms of efficacy except mirtazapine which showed conflicting results with fluoxetine in two studies. In terms of side effects, fluoxetine was better tolerated than diazepam, doxepine, and amitriptyline, less tolerated than escitalopram, and had similar tolerability with duloxetine as well as alprazolam. Conclusion: Given the high risk of bias of the included studies, the overall small sample

  7. Generalized Anxiety Disorder, worry and attention to threat: A systematic review.

    Science.gov (United States)

    Goodwin, Huw; Yiend, Jenny; Hirsch, Colette R

    2017-06-01

    Among anxious populations, attention has been demonstrated to be preferentially biased to threatening material compared to neutral or other valenced material. Individuals who have high levels of trait worry, such as those with Generalized Anxiety Disorder (GAD), may be biased to threat but research has produced equivocal findings. This review aimed to systematically review the extant experimental literature to establish the current evidence of attentional bias to threat among trait worriers compared to healthy controls and other clinical populations. Twenty-nine published articles were included in the final review. There was strong evidence of a bias to threat among GAD patients compared to other groups and this was found across most experimental paradigms. Few studies had investigated this bias in non-clinical trait worriers. Among GAD patients this bias to threat was most strongly evidenced when visual threat material was in a verbal-linguistic format (i.e., words) rather than when in pictorial form (i.e., images or faces). The bias was also found across several domains of negative material, supporting the general nature of worry. Further research should look to examine the specific components of the threat bias in GAD, as well as investigating the bias to threat in trait worriers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Comparison of Younger and Older Adults' Acceptability of Treatment for Generalized Anxiety Disorder Co-Occurring with Parkinson's Disease

    Science.gov (United States)

    Lundervold, Duane A.; Ament, Patrick A.; Holt, Peter S.; Hunt, Lauren S.

    2013-01-01

    Acceptability ratings of medication or Behavioral Relaxation Training (BRT), for general anxiety disorder (GAD) co-occurring with Parkinson's Disease (PD) were obtained from younger ("n" = 79) and older ("n" = 54) adults. Participants read a case description of an older adult with PD and comorbid GAD followed by a description…

  9. The role of somatic health problems in the recognition of depressive and anxiety disorders by general practitioners

    NARCIS (Netherlands)

    Gerrits, Marloes M. J. G.; van Marwijk, Harm W. J.; van Oppen, Patricia; van der Horst, Henriette; Penninx, Brenda W. J. H.

    2013-01-01

    Background: Recognition of depression and anxiety by general practitioners (GPs) is suboptimal and there is uncertainty as to whether particular somatic health problems hinder or facilitate GP recognition. The objective of this study was to investigate the associations between somatic health problem

  10. Generalized Anxiety and Major Depressive syndrome measured by the SCL-90-R in Two Manganese (Mn) Exposed Ohio Towns

    Science.gov (United States)

    Objective: Environmental exposure to manganese (Mn) may cause generalized anxiety (GA) and major depression (MD) in residents living in Mn-exposed areas. Marietta and East Liverpool are two Ohio towns identified as having elevated levels of Mn. The objective was to determine if l...

  11. Longitudinal Associations between Perceived Parent-Adolescent Attachment Relationship Quality and Generalized Anxiety Disorder Symptoms in Adolescence

    Science.gov (United States)

    van Eijck, Fenna E. A. M.; Branje, Susan J. T.; Hale, William W., III; Meeus, Wim H. J.

    2012-01-01

    This longitudinal study examined the direction of effects between adolescents' generalized anxiety disorder (GAD) symptoms and perceived parent-adolescent attachment relationship quality, as well as the moderating role of gender and age. 1,313 Dutch adolescents (48.5% boys) from two age cohorts of early (n = 923, M[subscript age] = 12 at W1) and…

  12. The Effects of Expressive Writing on General and Mathematics Anxiety for a Sample of High School Students

    Science.gov (United States)

    Hines, Claudia L.; Brown, Nina W.; Myran, Steve

    2016-01-01

    Ninety-three (n = 93) students in grades 9-12 who failed the Virginia Standards of Learning mathematics test were placed into experimental and control groups. Pre and posttest measures for general and mathematics anxiety, and physical symptoms of stress were administered. The Expressive Writing intervention was used with both groups where the…

  13. Generalized Anxiety and Major Depressive syndrome measured by the SCL-90-R in Two Manganese (Mn) Exposed Ohio Towns

    Science.gov (United States)

    Objective: Environmental exposure to manganese (Mn) may cause generalized anxiety (GA) and major depression (MD) in residents living in Mn-exposed areas. Marietta and East Liverpool are two Ohio towns identified as having elevated levels of Mn. The objective was to determine if l...

  14. Associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder among men and women.

    Science.gov (United States)

    Zhang, Chenshu; Brook, Judith S; Leukefeld, Carl G; Brook, David W

    2016-01-01

    The objective of this study was to examine the associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder at the mean age of 43. Participants came from a community-based random sample of residents in 2 New York counties in 1975 (N = 548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (standard deviation = 2.8). Of the participants, 55% were females. Over 90% of the participants were Caucasian. The prevalence of substance dependence/abuse, major depressive episodes, and generalized anxiety disorder (during the past 5 years before the interviews) was 6.6, 13.7, and 11.5%, respectively. Logistic regression analyses showed that compulsive buying was significantly associated with substance dependence/abuse (adjusted odds ratio = 1.60), major depressive episodes (adjusted odds ratio = 1.70), and generalized anxiety disorder (adjusted odds ratio = 1.63), despite controlling for substance dependence/abuse, major depressive episodes, and generalized anxiety disorder, respectively, at the mean age of 37, and demographic factors. Since the study sample is limited to predominantly Caucasian participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, major depressive episodes, and generalized anxiety disorder consider the role of compulsive buying.

  15. Direct Aggression and Generalized Anxiety in Adolescence : Heterogeneity in Development and Intra-Individual Change

    NARCIS (Netherlands)

    Meeus, Wim; van de Schoot, Rens; Hawk, Skyler T.; Hale, William W.; Branje, Susan

    2016-01-01

    Co-occurrence of aggression and anxiety might change during adolescence, or stay stable. We studied change and stability of four types of co-occurrence regarding direct aggression and anxiety in adolescence: an anxious and non-aggressive type, an aggressive and non-anxious type, a comorbid aggressiv

  16. Science anxiety and social cognitive factors predicting STEM career aspirations of high school freshmen in general science class

    Science.gov (United States)

    Skells, Kristin Marie

    Extant data was used to consider the association between science anxiety, social cognitive factors and STEM career aspirations of high school freshmen in general science classes. An adapted model based on social cognitive career theory (SCCT) was used to consider these relationships, with science anxiety functioning as a barrier in the model. The study assessed the following research questions: (1) Do social cognitive variables relate in the expected way to STEM career aspirations based on SCCT for ninth graders taking general science classes? (2) Is there an association between science anxiety and outcomes and processes identified in the SCCT model for ninth graders taking general science classes? (3) Does gender moderate these relationships? Results indicated that support was found for many of the central tenants of the SCCT model. Science anxiety was associated with prior achievement, self-efficacy, and science interest, although it did not relate directly to STEM career goals. Gender was found to moderate only the relationship between prior achievement and science self-efficacy.

  17. Comparing attentional control and intrusive thoughts in obsessive-compulsive disorder, generalized anxiety disorder and non clinical population.

    Directory of Open Access Journals (Sweden)

    Mehri Moradi

    2014-06-01

    Full Text Available Attention is an important factor in information processing; obsessive- compulsive disorder (OCD and generalized anxiety disorder (GAD are two main emotional disorders with a chronic course. This research examined the relationship among attentional control and intrusive thoughts (worry, rumination and obsession in these disorders. It was hypothesized that attentional control is a common factor in OCD and GAD. In addition, we compared worry, rumination and obsession among OCD, GAD and non- clinical participants.The research sample included three groups: OCD (n = 25, GAD (n = 30 and non- clinical samples (n = 56. Data were collected using the Attentional Control Scale (ACS, Rumination Response Scale (RRS, Pennsylvania State Worry Questionnaire (PSWQ, Beck Depression Inventory (BDI, Beck Anxiety Inventory (BAI, Obsessive-Compulsive Inventory-Revised (OCI-R and General Health Questionnaire (GHQ-28. Data were analyzed using MANOVA and MANCOVA by SPSS-17.Multivariate Analysis of Variance revealed that the OCD and GAD groups reported greater deficits in attentional control, higher obsessive-compulsive symptoms, rumination, worry, anxiety and depression compared to the control group.This research indicated a great attentional deficit in obsessive- compulsive disorder and generalized anxiety disorder. However, no significant difference was found between these two disorders.

  18. Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder

    DEFF Research Database (Denmark)

    Bech, Per; Lönn, Sara L; Overø, Kerstin F

    2010-01-01

    -Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery...

  19. Impairment and quality of life in individuals with generalized anxiety disorder.

    Science.gov (United States)

    Henning, Eric R; Turk, Cynthia L; Mennin, Douglas S; Fresco, David M; Heimberg, Richard G

    2007-01-01

    Once considered to be a disorder associated with minimal impairment, the link between generalized anxiety disorder (GAD) and impairment across a broad constellation of domains is now well established. However, less is known about how comorbidity affects these relationships or how GAD impacts one's perceived life satisfaction or quality of life. To investigate these questions, data from 52 treatment-seeking individuals with GAD (33 with comorbid Axis I diagnoses) were compared to data from 55 nonanxious controls. Individuals with GAD reported more impairment at work and in their social functioning than they did with home and family responsibilities. They also reported lower quality of life than nonanxious controls, particularly in regard to self-esteem, goals and values, money, work, play, learning, creativity, friends, and relatives. Trait worry was positively correlated with impairment and inversely related to life satisfaction within the clinical sample. Individuals with GAD, with and without comorbid Axis I diagnoses, showed few differences on measures of impairment (differing only on impairment in social functioning). However, individuals with GAD and comorbid disorders perceived their lives as less satisfying than did individuals with GAD without comorbid diagnoses.

  20. Maternal criticism and adolescent depressive and generalized anxiety disorder symptoms: a 6-year longitudinal community study.

    Science.gov (United States)

    Nelemans, Stefanie A; Hale, William W; Branje, Susan J T; Hawk, Skyler T; Meeus, Wim H J

    2014-01-01

    This 6-year longitudinal study examined the direction of effects (i.e., parent effects, child effects, or reciprocal effects) between maternal criticism and adolescent depressive and Generalized Anxiety Disorder (GAD) symptoms, including adolescents' perceptions of criticism as a potential mediator. Consistent with recent empirical findings on associations between parenting and adolescent internalizing symptoms, we hypothesized stronger child effects than parent effects. A community sample of 497 adolescents (M age = 13.03 at T1, 57 % boys) reported annually on their depressive and GAD symptoms as well as their perceptions of parental criticism. Their mothers (M age = 44.41 at T1) also reported annually on their own critical behavior toward their adolescent. As expected, cross-lagged panel models demonstrated stronger child effects (i.e., adolescent psychopathology predicting maternal criticism) than parent effects (i.e., maternal criticism predicting adolescent psychopathology) for both adolescent depressive and GAD symptoms, including adolescent perceived criticism as a significant mediator. Our results emphasize the importance of considering (1) potential bidirectional influences over time, contrary to a focus on parent effects on adolescent mental health, as well as (2) adolescent perceptions of parenting as an important potential mediator in associations between aspects of the parent-adolescent relationship and adolescent internalizing psychopathological symptoms.

  1. Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety

    Science.gov (United States)

    Makovac, Elena; Watson, David R.; Meeten, Frances; Garfinkel, Sarah N.; Cercignani, Mara; Critchley, Hugo D.

    2016-01-01

    Generalized anxiety disorder (GAD) is characterized by excessive worry, autonomic dysregulation and functional amygdala dysconnectivity, yet these illness markers have rarely been considered together, nor their interrelationship tested longitudinally. We hypothesized that an individual’s capacity for emotion regulation predicts longer-term changes in amygdala functional connectivity, supporting the modification of GAD core symptoms. Sixteen patients with GAD (14 women) and individually matched controls were studied at two time points separated by 1 year. Resting-state fMRI data and concurrent measurement of vagally mediated heart rate variability were obtained before and after the induction of perseverative cognition. A greater rise in levels of worry following the induction predicted a stronger reduction in connectivity between right amygdala and ventromedial prefrontal cortex, and enhanced coupling between left amygdala and ventral tegmental area at follow-up. Similarly, amplified physiological responses to the induction predicted increased connectivity between right amygdala and thalamus. Longitudinal shifts in a distinct set of functional connectivity scores were associated with concomitant changes in GAD symptomatology over the course of the year. Results highlight the prognostic value of indices of emotional dysregulation and emphasize the integral role of the amygdala as a critical hub in functional neural circuitry underlying the progression of GAD symptomatology. PMID:27369066

  2. The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Algorithm for Generalized Anxiety Disorder.

    Science.gov (United States)

    Abejuela, Harmony Raylen; Osser, David N

    2016-01-01

    This revision of previous algorithms for the pharmacotherapy of generalized anxiety disorder was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. Algorithms from 1999 and 2010 and associated references were reevaluated. Newer studies and reviews published from 2008-14 were obtained from PubMed and analyzed with a focus on their potential to justify changes in the recommendations. Exceptions to the main algorithm for special patient populations, such as women of childbearing potential, pregnant women, the elderly, and those with common medical and psychiatric comorbidities, were considered. Selective serotonin reuptake inhibitors (SSRIs) are still the basic first-line medication. Early alternatives include duloxetine, buspirone, hydroxyzine, pregabalin, or bupropion, in that order. If response is inadequate, then the second recommendation is to try a different SSRI. Additional alternatives now include benzodiazepines, venlafaxine, kava, and agomelatine. If the response to the second SSRI is unsatisfactory, then the recommendation is to try a serotonin-norepinephrine reuptake inhibitor (SNRI). Other alternatives to SSRIs and SNRIs for treatment-resistant or treatment-intolerant patients include tricyclic antidepressants, second-generation antipsychotics, and valproate. This revision of the GAD algorithm responds to issues raised by new treatments under development (such as pregabalin) and organizes the evidence systematically for practical clinical application.

  3. Improvements in emotion regulation following repetitive transcranial magnetic stimulation for generalized anxiety disorder.

    Science.gov (United States)

    Diefenbach, Gretchen J; Assaf, Michal; Goethe, John W; Gueorguieva, Ralitza; Tolin, David F

    2016-10-01

    Generalized anxiety disorder (GAD) is characterized by emotion regulation difficulties, which are associated with abnormalities in neural circuits encompassing fronto-limbic regions including the dorsolateral prefrontal cortex (DLPFC). The aim of this study was to determine whether DLPFC neuromodulation improves emotion regulation in patients with GAD. This is a secondary analysis from a randomized-controlled trial comparing 30 sessions of low-frequency right-sided active (n=13) versus sham (n=12, sham coil) repetitive transcranial magnetic stimulation (rTMS) at the right DLPFC in patients with GAD. Results indicated statistically significant improvements in self-reported emotion regulation difficulties at posttreatment and 3-month follow-up in the active group only. Improvements were found primarily in the domains of goal-directed behaviors and impulse control and were significantly associated with a global clinician rating of improvement. These preliminary results support rTMS as a treatment for GAD and suggest improved emotion regulation as a possible mechanism of change. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Neuropsychological functioning in young subjects with generalized anxiety disorder with and without pharmacotherapy.

    Science.gov (United States)

    Tempesta, D; Mazza, M; Serroni, N; Moschetta, F S; Di Giannantonio, M; Ferrara, M; De Berardis, D

    2013-08-01

    The purpose of this study was to investigate the neuropsychological functioning and the effect of antidepressant drug intake on cognitive performance in a group of relatively young generalized anxiety disorder (GAD) patients. Forty patients with a DSM-IV diagnosis of GAD and 31 healthy subjects participated in the study (Control group, CON). None of the selected subjects had comorbid depression. GAD subjects were divided into two different subgroups: 18 were taking antidepressants [GAD-pharmacotherapy (GAD-p group)] and 22 were treatment-naïve (GAD group). Each group was administered with a comprehensive neuropsychological battery to assess attention, memory and executive functions. Performance on executive and non-verbal memory tasks of both GAD groups was largely worse than the CON group. However, these deficits seem to be more marked in patients taking antidepressants, especially in the domains of attention, non-verbal memory and executive functions. The present study indicates that GAD is associated with cognitive impairments among young adults. However, the observed association of neuropsychological deficits and the use of pharmacotherapy suggest a possible effect of antidepressant treatment on attention, executive functioning and non-verbal memory.

  5. Abnormal decision-making in generalized anxiety disorder: Aversion of risk or stimulus-reinforcement impairment?

    Science.gov (United States)

    Teng, Cindy; Otero, Marcela; Geraci, Marilla; Blair, R J R; Pine, Daniel S; Grillon, Christian; Blair, Karina S

    2016-03-30

    There is preliminary data indicating that patients with generalized anxiety disorder (GAD) show impairment on decision-making tasks requiring the appropriate representation of reinforcement value. The current study aimed to extend this literature using the passive avoidance (PA) learning task, where the participant has to learn to respond to stimuli that engender reward and avoid responding to stimuli that engender punishment. Six stimuli engendering reward and six engendering punishment are presented once per block for 10 blocks of trials. Thirty-nine medication-free patients with GAD and 29 age-, IQ and gender matched healthy comparison individuals performed the task. In addition, indexes of social functioning as assessed by the Global Assessment of Functioning (GAF) scale were obtained to allow for correlational analyzes of potential relations between cognitive and social impairments. The results revealed a Group-by-Error Type-by-Block interaction; patients with GAD committed significantly more commission (passive avoidance) errors than comparison individuals in the later blocks (blocks 7,8, and 9). In addition, the extent of impairment on these blocks was associated with their functional impairment as measured by the GAF scale. These results link GAD with anomalous decision-making and indicate that a potential problem in reinforcement representation may contribute to the severity of expression of their disorder.

  6. Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial.

    Science.gov (United States)

    Dahlin, Mats; Andersson, Gerhard; Magnusson, Kristoffer; Johansson, Tomas; Sjögren, Johan; Håkansson, Andreas; Pettersson, Magnus; Kadowaki, Åsa; Cuijpers, Pim; Carlbring, Per

    2016-02-01

    Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen's d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen's d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD.

  7. Gray and white matter volume abnormalities in generalized anxiety disorder by categorical and dimensional characterization.

    Science.gov (United States)

    Hilbert, Kevin; Pine, Daniel S; Muehlhan, Markus; Lueken, Ulrike; Steudte-Schmiedgen, Susann; Beesdo-Baum, Katja

    2015-12-30

    Increasing efforts have been made to investigate the underlying pathophysiology of generalized anxiety disorder (GAD), but only limited consistent information is available on gray (GM) and white matter (WM) volume changes in affected adults. Additionally, few studies employed dimensional approaches to GAD pathology. This study compares structural brain imaging data from n=19 GAD subjects and n=24 healthy comparison (HC) subjects, all medication-free and matched on age, sex and education. Separate categorical and dimensional models were employed using voxel-based morphometry for GM and WM. Significantly higher GM volumes were found in GAD subjects mainly in basal ganglia structures and less consistently in the superior temporal pole. For WM, GAD subjects showed significantly lower volumes in the dlPFC. Largely consistent findings in dimensional and categorical models point toward these structural alterations being reliable and of importance for GAD. While lower volume in the dlPFC could reflect impaired emotional processing and control over worry in GAD, basal ganglia alterations may be linked to disturbed gain and loss anticipation as implicated in previous functional GAD studies. As perturbations in anticipation processes are central to GAD, these areas may warrant greater attention in future studies.

  8. Attentional Bias of Individuals with Generalized Anxiety%广泛性焦虑个体的注意偏向

    Institute of Scientific and Technical Information of China (English)

    杨智辉; 王建平

    2011-01-01

    探讨广泛性焦虑个体在一般情境和不确定性情境下注意偏向的特点.采用点探测注意搜索任务研究了在一般情境下和不确定性情境下广泛性焦虑个体的注意偏向,结果表明高广泛性焦虑个体的注意偏向以对威胁性刺激的注意转移困难为主,不确定性情境会让广泛性焦虑个体更容易处于紧张焦虑的状态当中,从而对情绪性刺激尤其是消极刺激表现出更多的注意偏向和对情绪性刺激直接的注意敏感性.%Continuous attention to negative stimuli is a necessary condition for individuals to maintain their worries. Previous research has also shown that intolerance of uncertainty is one important factor that contributes to symptoms of generalized anxiery. A research question then emerges: do individuals with generalized anxiety pay particular attention to negative stimuli under uncertain situations? Little research has been conducted to answer this question. Consequently, the present research aims at demonstrating the attentional bias of individuals with Using the dot-probe task paradigm, two experiments were conducted to examine the attentional bias of individuals with generalized anxiety under ordinary versus uncertain situations. Using the Chinese version of Penn State Worry Questionnaire, we tested 1135 college students among which 60 students with generalized anxiety and 60 control students were selected. The 120 students participated in a test under ordinary situations in Experiment 1 and in another test under uncertain situations in Experiment 2. Results showed significant differences between students with generalized anxiety and control students in their attentional bias under uncertain, rather than ordinary situations. Under uncertain situations, students with generalized anxiety paid more attention to negative stimuli than their counterparts without generalized anxiety did. Additionally, they also felt more stressful and anxious under uncertain

  9. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial.

    Science.gov (United States)

    Mao, Jun J; Xie, Sharon X; Keefe, John R; Soeller, Irene; Li, Qing S; Amsterdam, Jay D

    2016-12-15

    Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders treated in primary care, yet current therapies have limited efficacy and substantial side effects. To evaluate long-term chamomile (Matricaria chamomilla L.) use for prevention of GAD symptom relapse. Outpatients from primary care practices and local communities with a primary diagnosis of moderate-to-severe GAD were enrolled for this two-phase study at a large US academic medical center. During Phase 1, eligible participants received 12 weeks of open-label therapy with chamomile pharmaceutical grade extract 1500mg (500mg capsule 3 times daily). During Phase 2, treatment responders were randomized to either 26 weeks of continuation chamomile therapy or placebo in a double-blinded, placebo-substitution design. The primary outcome was time to relapse during continuation therapy, analyzed using Cox proportional hazards. Secondary outcomes included the proportion who relapsed, treatment-emergent adverse events, and vital sign changes. This study is registered at ClinicalTrials.gov, identifier NCT01072344. Between March 1, 2010, and June 30, 2015, we enrolled 179 participants. Of those, 93 (51.9%) were responders and agreed to continue in the double-blind randomized controlled trial. A numerically greater number of placebo-switched (n=12/47; 25.5%) versus chamomile-continuation (n = 7/46; 15.2%) participants relapsed during follow-up. Mean time to relapse was 11.4 ± 8.4 weeks for chamomile and 6.3 ± 3.9 weeks for placebo. Hazard of relapse was non-significantly lower for chamomile (hazard ratio, 0.52; 95% CI, 0.20-1.33; P = 0.16). During follow-up, chamomile participants maintained significantly lower GAD symptoms than placebo (P = 0.0032), with significant reductions in body weight (P = 0.046) and mean arterial blood pressure (P = 0.0063). Both treatments had similar low adverse event rates. Long-term chamomile was safe and significantly reduced moderate

  10. Magnitude of potentially inappropriate prescribing in Germany among older patients with generalized anxiety disorder

    Science.gov (United States)

    Berger, Ariel; Mychaskiw, Marko; Dukes, Ellen; Edelsberg, John; Oster, Gerry

    2009-01-01

    Background Several medications commonly used to treat generalized anxiety disorder (GAD) have been designated "potentially inappropriate" for use in patients aged ≥65 years because their risks may outweigh their potential benefits. The actual extent of use of these agents in clinical practice is unknown, however. Methods Using a database with information from encounters with general practitioners (GP) in Germany, we identified all patients, aged ≥65 years, with any GP office visits or dispensed prescriptions with a diagnosis of GAD (ICD-10 diagnosis code F41.1) between 10/1/2003 and 9/30/2004 ("GAD patients"). Among GAD-related medications (including benzodiazepines, tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors, venlafaxine, hydroxyzine, buspirone, pregabalin, and trifluoperazine), long-acting benzodiazepines, selected short-acting benzodiazepines at relatively high dosages, selected TCAs, and hydroxyzine were designated "potentially inappropriate" for use in patients aged ≥ 65 years, based on published criteria. Results A total of 975 elderly patients with GAD were identified. Mean age was 75 years, and 72% were women; 29% had diagnoses of comorbid depression. Forty percent of study subjects received potentially inappropriate agents – most commonly, bromazepam (10% of all subjects), diazepam (9%), doxepin (7%), amitriptyline (5%), and lorazepam (5%). Twenty-three percent of study subjects received long-acting benzodiazepines, 10% received short-acting benzodiazepines at relatively high doses, and 12% received TCAs designated as potentially inappropriate. Conclusion GPs in Germany often prescribe medications that have been designated as potentially inappropriate to their elderly patients with GAD – especially those with comorbid depressive disorders. Further research is needed to ascertain whether there are specific subgoups of elderly patients with GAD for whom the benefits of these medications outweigh their risks. PMID

  11. Magnitude of potentially inappropriate prescribing in Germany among older patients with generalized anxiety disorder

    Directory of Open Access Journals (Sweden)

    Dukes Ellen

    2009-07-01

    Full Text Available Abstract Background Several medications commonly used to treat generalized anxiety disorder (GAD have been designated "potentially inappropriate" for use in patients aged ≥65 years because their risks may outweigh their potential benefits. The actual extent of use of these agents in clinical practice is unknown, however. Methods Using a database with information from encounters with general practitioners (GP in Germany, we identified all patients, aged ≥65 years, with any GP office visits or dispensed prescriptions with a diagnosis of GAD (ICD-10 diagnosis code F41.1 between 10/1/2003 and 9/30/2004 ("GAD patients". Among GAD-related medications (including benzodiazepines, tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors, venlafaxine, hydroxyzine, buspirone, pregabalin, and trifluoperazine, long-acting benzodiazepines, selected short-acting benzodiazepines at relatively high dosages, selected TCAs, and hydroxyzine were designated "potentially inappropriate" for use in patients aged ≥ 65 years, based on published criteria. Results A total of 975 elderly patients with GAD were identified. Mean age was 75 years, and 72% were women; 29% had diagnoses of comorbid depression. Forty percent of study subjects received potentially inappropriate agents – most commonly, bromazepam (10% of all subjects, diazepam (9%, doxepin (7%, amitriptyline (5%, and lorazepam (5%. Twenty-three percent of study subjects received long-acting benzodiazepines, 10% received short-acting benzodiazepines at relatively high doses, and 12% received TCAs designated as potentially inappropriate. Conclusion GPs in Germany often prescribe medications that have been designated as potentially inappropriate to their elderly patients with GAD – especially those with comorbid depressive disorders. Further research is needed to ascertain whether there are specific subgoups of elderly patients with GAD for whom the benefits of these medications outweigh

  12. [Anxiety--medical aspects].

    Science.gov (United States)

    Dosiak, M

    1997-01-01

    In this paper the author presented themes connected with anxiety disorder in general medical practice. Pathogenesis, classification, dependence between anxiety and somatic and psychical diseases were described there.

  13. General psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women.

    Science.gov (United States)

    El Kissi, Yousri; Romdhane, Asma Ben; Hidar, Samir; Bannour, Souhail; Ayoubi Idrissi, Khadija; Khairi, Hedi; Ben Hadj Ali, Bechir

    2013-04-01

    To compare measures of psychological distress between men and women undergoing ART in the Unit of Reproductive Medicine "UMR" in the Department of Obstetrics and Gynecology at "Farhat Hached" Hospital in Sousse, Tunisia. We conducted a gender comparative study of psychological profile in infertile couples. Recruitment was done during period from January to May 2009. 100 infertile couples with primary infertility were recruited. Scores of general psychopathology, depression, anxiety and self-esteem were evaluated. We administrated questionnaires on psychological factors among infertile couples before starting a new infertility treatment cycle. Psychological factors included the symptom check-list (SCL-90-R), the hospital anxiety and depression scale (HAD-S) and the Rosenberg self-esteem scale (RSE). Infertile women had higher scores than their spouses in the three global scores of the SCL-90-R and in several items such as somatisation, obsessive symptoms, interpersonal sensitivity and phobias. Scores of HADS were higher among women for both depression and anxiety. Scores of self-esteem were lower among women. Women endorsed higher psychological distress than men across multiple symptoms domains: general psychopathology, anxiety, depression and self esteem. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. Linguistic analysis of communication in therapist-assisted internet-delivered cognitive behavior therapy for generalized anxiety disorder.

    Science.gov (United States)

    Dirkse, Dale; Hadjistavropoulos, Heather D; Hesser, Hugo; Barak, Azy

    2015-01-01

    Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) involves elements of expressive writing through secure messaging with a therapist. Expressive writing has been associated with psychological and physical health benefits in past research; furthermore, certain linguistic dimensions in expressive writing have been identified as particularly beneficial to health, such as less frequent use of negative emotion words and greater use of positive emotion words. No research, to date, has analyzed linguistic dimensions in client communication over the course of therapist-assisted ICBT for individuals with symptoms of generalized anxiety. This naturalistic study examined messages sent to therapists during the course of ICBT using linguistic analysis, and explored covariation of word use with symptom improvement. Data were obtained from patients with symptoms of generalized anxiety (N = 59) who completed 12 modules of therapist-assisted ICBT and rated symptoms of anxiety, depression, and panic at the beginning of each module. Linguistic analysis categorized text submitted to therapists into different word categories. Results found that patients' use of negative emotion, anxiety, causation, and insight words reduced over the course of treatment, while past tense words increased. Furthermore, negative emotion words significantly covaried with symptom ratings over the course of treatment. While causal statements cannot be made, findings improve our understanding of patient communication in ICBT and suggest that the further study of linguistic dimensions as psychological indicators and the potential utility of expressive writing strategies in therapist-assisted ICBT may be worthwhile.

  15. Group cognitive behavioral therapy targeting intolerance of uncertainty: a randomized trial for older Chinese adults with generalized anxiety disorder.

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    Hui, Chen; Zhihui, Yang

    2016-09-03

    China has entered the aging society, but the social support systems for the elderly are underdeveloped, which may make the elderly feel anxiety about their health and life quality. Given the prevalence of generalized anxiety disorder (GAD) in the elderly, it is very important to pay more attention to the treatment for old adults. Although cognitive behavioral therapy targeting intolerance of uncertainty (CBT-IU) has been applied to different groups of patients with GAD, few studies have been performed to date. In addition, the effects of CBT-IU are not well understood, especially when applied to older adults with GAD. Sixty-three Chinese older adults with a principal diagnosis of GAD were enrolled. Of these, 32 were randomized to receive group CBT-IU (intervention group) and 31 were untreated (control group). GAD and related symptoms were assessed using the Penn State Worry Questionnaire, Intolerance of Uncertainty Scale-Chinese Version, Beck Anxiety Inventory, Beck Depression Inventory, Why Worry-II scale, Cognitive Avoidance Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and Generalized Anxiety Disorder Severity Scale across the intervention. The changes between pre and after the intervention were collected, as well as the six-month follow-up. F test and repeated-measures ANOVA were conducted to analyze the data. Compared to control group, the measures' scores of experimental group decreased significantly after the intervention and six-month follow-up. Besides the main effects for time and group were significant, the interaction effect for group × time was also significant. These results indicated the improvement of the CBT-IU group and the persistence of effect after six months. Group CBT-IU is effective in Chinese older adults with GAD. The effects of CBT-IU on GAD symptoms persist for at least six months after treatment.

  16. Genome-wide association study of generalized anxiety symptoms in the Hispanic Community Health Study/Study of Latinos.

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    Dunn, Erin C; Sofer, Tamar; Gallo, Linda C; Gogarten, Stephanie M; Kerr, Kathleen F; Chen, Chia-Yen; Stein, Murray B; Ursano, Robert J; Guo, Xiuqing; Jia, Yucheng; Qi, Qibin; Rotter, Jerome I; Argos, Maria; Cai, Jianwen; Penedo, Frank J; Perreira, Krista; Wassertheil-Smoller, Sylvia; Smoller, Jordan W

    2017-03-01

    Although generalized anxiety disorder (GAD) is heritable and aggregates in families, no genomic loci associated with GAD have been reported. We aimed to discover potential loci by conducting a genome-wide analysis of GAD symptoms in a large, population-based sample of Hispanic/Latino adults. Data came from 12,282 participants (aged 18-74) in the Hispanic Community Health Study/Study of Latinos. Using a shortened Spielberger Trait Anxiety measure, we analyzed the following: (i) a GAD symptoms score restricted to the three items tapping diagnostic features of GAD as defined by DSM-V; and (ii) a total trait anxiety score based on summing responses to all ten items. We first calculated the heritability due to common variants (h(2)SNP ) and then conducted a genome-wide association study (GWAS) of GAD symptoms. Replication was attempted in three independent Hispanic cohorts (Multi-Ethnic Study of Atherosclerosis, Women's Health Initiative, Army STARRS). The GAD symptoms score showed evidence of modest heritability (7.2%; P = 0.03), while the total trait anxiety score did not (4.97%; P = 0.20). One genotyped SNP (rs78602344) intronic to thrombospondin 2 (THBS2) was nominally associated (P = 5.28 × 10(-8) ) in the primary analysis adjusting for psychiatric medication use and significantly associated with the GAD symptoms score in the analysis excluding medication users (P = 4.18 × 10(-8) ). However, meta-analysis of the replication samples did not support this association. Although we identified a genome-wide significant locus in this sample, we were unable to replicate this finding. Evidence for heritability was also only detected for GAD symptoms, and not the trait anxiety measure, suggesting differential genetic influences within the domain of trait anxiety. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. REVISING THE INTOLERANCE OF UNCERTAINTY MODEL OF GENERALIZED ANXIETY DISORDER: EVIDENCE FROM UK AND ITALIAN UNDERGRADUATE SAMPLES

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    Gioia Bottesi

    2016-11-01

    Full Text Available The Intolerance of Uncertainty Model (IUM of Generalized Anxiety Disorder (GAD attributes a key role to Intolerance of Uncertainty (IU, and additional roles to Positive Beliefs about Worry (PBW, Negative Problem Orientation (NPO, and Cognitive Avoidance (CA, in the development and maintenance of worry, the core feature of GAD. Despite the role of the IUM components in worry and GAD has been considerably demonstrated, to date no studies have explicitly assessed whether and how PBW, NPO, and CA might turn IU into worry and somatic anxiety. The current studies sought to re-examine the IUM by assessing the relationships between the model’s components on two different non-clinical samples made up of UK and Italian undergraduate students. One-hundred and seventy UK undergraduates and 488 Italian undergraduates completed measures assessing IU, worry, somatic anxiety, depression, and refined measures of NPO, CA, and PBW. In each sample, two mediation models were conducted in order to test whether PBW, NPO, and CA differentially mediate the path from IU to worry and the path from IU to somatic anxiety. Secondly, it was tested whether IU also moderates the mediations. Main findings showed that, in the UK sample, only NPO mediated the path from IU to worry; as far as concern the path to anxiety, none of the putative mediators were significant. Differently, in the Italian sample PBW and NPO were mediators in the path from IU to worry, whereas only CA played a mediational role in the path from IU to somatic anxiety. Lastly, IU was observed to moderate only the association between NPO and worry, and only in the Italian sample. Some important cross-cultural, conceptual, and methodological issues raised from main results are discussed.

  18. Is there a relation between dental anxiety, fear and general psychological status?

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    Tuba Talo Yildirim

    2017-02-01

    Full Text Available Background Dental anxiety is a widespread problem in many populations. This problem can be a barrier to dental care and may lead to poor oral health. Dental anxiety may be related to psychological status. Aims The aim of the present study was to assess the levels of dental anxiety, dental fear, Beck Depression, and state-trait anxiety according to age, gender and education level in patients at the periodontology clinic in the Diyarbakır Mouth and Dental Health Center. Study Design A total of 231 patients (115 males, 116 females filled out dental fear scale (DFS, dental anxiety scale (DAS, Beck Depression Inventory (BDI, state-trait anxiety inventory-state (STAI-S, and state-trait anxiety inventory–trait (STAI-T questionnaires, and evaluations of DFS, DAS, BDI, STAI-S, and STAI-T were conducted according to age, gender, and education level. Results The mean DFS, DAS, BDI, STAI-T, and STAI –S were 45.64, 9.15, 13.16, 38.90, and 40.18, respectively. There was a significant association among DFS, DAS, BDI, STAI-S, and STAI-T (p < 0.05. These surveys scores were significantly higher in females than males (p < 0.05. The results of this study indicated that gender age and education level have important effects on DFS, DAS, BDI, STAI-S, and STAI-T (p < 0.05. Conclusion Dental anxiety and dental fear were found to be related to psychological status (BDI, STAI-S, and STAI-T over time. There are some patients with unaddressed psychological distress.

  19. Proteasome modulator 9 gene SNPs, responsible for anti-depressant response, are in linkage with generalized anxiety disorder.

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    Gragnoli, Claudia

    2014-09-01

    Proteasome modulator 9 (PSMD9) gene single nucleotide polymorphism (SNP) rs1043307/rs2514259 (E197G) is associated with significant clinical response to the anti-depressant desipramine. PSMD9 SNP rs74421874 [intervening sequence (IVS) 3 + nt460 G>A], rs3825172 (IVS3 + nt437 C>T) and rs1043307/rs2514259 (E197G A>G) are all linked to type 2 diabetes (T2D), maturity-onset-diabetes-of the young 3 (MODY3), obesity and waist circumference, hypertension, hypercholesterolemia, T2D-macrovascular and T2D-microvascular disease, T2D-neuropathy, T2D-carpal tunnel syndrome, T2D-nephropathy, T2D-retinopathy, non-diabetic retinopathy and depression. PSMD9 rs149556654 rare SNP (N166S A>G) and the variant S143G A>G also contribute to T2D. PSMD9 is located in the chromosome 12q24 locus, which per se is in linkage with depression, bipolar disorder and anxiety. In the present study, we wanted to determine whether PSMD9 is linked to general anxiety disorder in Italian T2D families. Two-hundred Italian T2D families were phenotyped for generalized anxiety disorder, using the diagnostic criteria of DSM-IV. When the diagnosis was unavailable or unclear, the trait was reported as unknown. The 200 Italians families were tested for the PSMD9 T2D risk SNPs rs74421874 (IVS3 + nt460 G>A), rs3825172 (IVS3 +nt437 T>C) and for the T2D risk and anti-depressant response SNP rs1043307/rs2514259 (E197G A>G) for evidence of linkage with generalized anxiety disorder. Non-parametric linkage analysis was executed via Merlin software. One-thousand simulation tests were performed to exclude results due to random chance. In our study, the PSMD9 gene SNPs rs74421874, rs3825172, and rs1043307/rs2514259 result in linkage to generalized anxiety disorder. This is the first report describing PSMD9 gene SNPs in linkage to generalized anxiety disorder in T2D families.

  20. Hair cortisol concentrations and cortisol stress reactivity in generalized anxiety disorder, major depression and their comorbidity.

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    Steudte-Schmiedgen, Susann; Wichmann, Susann; Stalder, Tobias; Hilbert, Kevin; Muehlhan, Markus; Lueken, Ulrike; Beesdo-Baum, Katja

    2017-01-01

    Studies investigating cortisol secretion in patients with generalized anxiety disorder (GAD) have reported heterogeneous findings. Further, current knowledge on the specificity of endocrine changes for GAD and/or comorbid major depression (MD) is limited. Hence, the current study investigated long-term integrated cortisol secretion, as indexed by hair cortisol concentrations (HCC), and experimentally-induced cortisol stress reactivity in relation to GAD, MD and their comorbidity. Carefully characterized groups of 17 GAD patients including 8 with comorbid MD (GAD-MD), 12 MD patients and 21 healthy controls were recruited. Alongside psychometric data, HCC (N = 43) and salivary cortisol stress reactivity in response to the Trier Social Stress Test (N = 45) were determined. Findings revealed that MD patients exhibited lower HCC compared to controls and GAD patients, with no differences between the latter two groups. Interestingly, when the GAD group was separated into two groups based on MD comorbidity, lower HCC in MD patients were found compared to controls and GAD-noMD patients, but did not show differences when compared to GAD-MD patients. No HCC differences were seen between GAD-MD or GAD-noMD patients and healthy controls. No TSST group differences emerged. Our findings suggest MD to be related to long-term attenuation in cortisol secretion. While no group differences emerged between patients with GAD, neither with nor without MD, and controls, the current results provide tentative evidence that MD determines long-term endocrine changes, with pure GAD showing a distinct pattern. Future studies are needed to confirm our findings in larger samples of pure and comorbid groups.

  1. Using the GAD-Q-IV to identify generalized anxiety disorder in psychiatric treatment seeking and primary care medical samples.

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    Moore, Michael T; Anderson, Nicholas L; Barnes, Jill M; Haigh, Emily A P; Fresco, David M

    2014-01-01

    The fourth edition of the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV) is a self-report measure that is commonly used to screen for the presence of generalized anxiety disorder (GAD). The current investigation attempted to identify an optimal cut score using samples obtained from an outpatient psychiatric (n=163) and primary care clinic (n=99). Results indicated that a cut score of 7.67 provided an optimal balance of sensitivity (.85) and specificity (.74) comparable to a previously identified cut score (5.7) across both samples (sensitivity=.90, specificity=.66). However, both cut scores were consistently outperformed by a score representing the criteria for GAD described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (sensitivity=.89, specificity=.82).

  2. Developmental Dynamics of General and School-Subject-Specific Components of Academic Self-Concept, Academic Interest, and Academic Anxiety

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    Katarzyna eGogol; Martin eBrunner; Franzis ePreckel; Thomas eGoetz; Romain eMartin

    2016-01-01

    The present study investigated the developmental dynamics of general and subject-specific (i.e., mathematics, French, and German) components of students’ academic self-concept, anxiety, and interest. To this end, the authors integrated three lines of research: (a) hierarchical and multidimensional approaches to the conceptualization of each construct, (b) longitudinal analyses of bottom-up and top-down developmental processes across hierarchical levels, and (c) ipsative developmental processe...

  3. Race and Ethnic Group Differences in Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Chronic Medical Conditions.

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    Watkins, Daphne C; Assari, Shervin; Johnson-Lawrence, Vicki

    2015-09-01

    This study tested whether race and ethnic group differences exist for lifetime major depressive disorder and/or general anxiety disorder with one or more chronic medical conditions. Data from the National Survey of American Life, which included 3570 African American, 1438 Caribbean Black, and 891 non-Hispanic White adults were analyzed. Outcomes included at least one and multiple chronic medical conditions, from a list of 14 medical conditions (e.g., arthritis, cancer, diabetes, kidney disease, stroke, heart disease, etc.). Logistic regressions were fitted to data to determine how the association between major depressive disorder, general anxiety disorder, and one or more chronic medical conditions vary across race and ethnicity. Lifetime major depressive disorder (but not lifetime general anxiety disorder) was associated with at least one chronic medical condition among African Americans and Caribbean Blacks, but not non-Hispanic Whites. Lifetime major depressive disorder was similarly associated with multiple chronic medical conditions among African Americans, Caribbean Blacks, and non-Hispanic Whites. For Caribbean Blacks, stronger associations were found between major depressive disorder and general anxiety disorder with one or more chronic medical conditions compared to African Americans and non-Hispanic Whites. Findings suggest that race and ethnicity may shape the links between comorbid psychiatric disorders and chronic medical conditions. Mental health screening of individuals with chronic medical conditions in primary health-care settings may benefit from tailoring based on race and ethnicity. More research is needed to understand why associations between physical and mental health vary among race and ethnic groups.

  4. Qualitative changes in symptomatology as an effect of treatment with escitalopram in generalized anxiety disorder and major depressive disorder.

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    Lecrubier, Yves; Dolberg, Ornah T; Andersen, Henning F; Weiller, Emmauelle

    2008-04-01

    The purpose of this article is to examine the similarities and differences between patients with Major Depressive Disorder (MDD) versus Generalized Anxiety Disorder (GAD) versus MDD with anxiety symptoms. Data were analysed from all randomized double-blind clinical studies with escitalopram that measured symptoms using either Hamilton Anxiety Scale (HAMA) or Montgomery-Asberg Depression Rating Scale (MADRS). The contribution of each item of a scale to the total score was calculated before and after treatment, in remitters. Most single items of the HAMA contribute nearly equally in patients with GAD. In patients with MDD, four symptoms (i.e. anxious mood, tension, insomnia and concentration) contribute to most to the HAMA total score. In patients with GAD, three symptoms (tension, sleep and concentration) contribute two-thirds of the MADRS total score. In contrast, most MADRS items contribute equally to the total score in patients with MDD. After treatment to remission, the profile of residual symptoms MDD or GAD was similar to the symptom profile before treatment. Anxiety symptoms are very common in patients with MDD or GAD, and the symptomatic pattern is similar. In both disorders, the symptomatic pattern of residual symptoms is similar to the pattern of symptoms before treatment.

  5. Maladaptive behavioral consequences of conditioned fear-generalization: a pronounced, yet sparsely studied, feature of anxiety pathology.

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    van Meurs, Brian; Wiggert, Nicole; Wicker, Isaac; Lissek, Shmuel

    2014-06-01

    Fear-conditioning experiments in the anxiety disorders focus almost exclusively on passive-emotional, Pavlovian conditioning, rather than active-behavioral, instrumental conditioning. Paradigms eliciting both types of conditioning are needed to study maladaptive, instrumental behaviors resulting from Pavlovian abnormalities found in clinical anxiety. One such Pavlovian abnormality is generalization of fear from a conditioned danger-cue (CS+) to resembling stimuli. Though lab-based findings repeatedly link overgeneralized Pavlovian-fear to clinical anxiety, no study assesses the degree to which Pavlovian overgeneralization corresponds with maladaptive, overgeneralized instrumental-avoidance. The current effort fills this gap by validating a novel fear-potentiated startle paradigm including Pavlovian and instrumental components. The paradigm is embedded in a computer game during which shapes appear on the screen. One shape paired with electric-shock serves as CS+, and other resembling shapes, presented in the absence of shock, serve as generalization stimuli (GSs). During the game, participants choose whether to behaviorally avoid shock at the cost of poorer performance. Avoidance during CS+ is considered adaptive because shock is a real possibility. By contrast, avoidance during GSs is considered maladaptive because shock is not a realistic prospect and thus unnecessarily compromises performance. Results indicate significant Pavlovian-instrumental relations, with greater generalization of Pavlovian fear associated with overgeneralization of maladaptive instrumental-avoidance.

  6. Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: a prospective study.

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    López-Jornet, Pia; Camacho-Alonso, Fabio; Sanchez-Siles, Mariano

    2014-01-01

    Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p=0.04), and in the MDAS between before and immediately after extraction (p=0.02), and between immediately after and 7 days after extraction (p=tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.

  7. The efficacy and safety of multiple doses of vortioxetine for generalized anxiety disorder: a meta-analysis

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    Fu J

    2016-04-01

    Full Text Available Jie Fu,1 Lilei Peng,2 Xiaogang Li1 1Department of Neurology, 2Department of Neurosurgery, The Affiliated Hospital of Luzhou Medical College, Luzhou, People’s Republic of China Objective: Vortioxetine is a novel antidepressant approved for the treatment of major depressive disorder by the US Food and Drug Administration in September 2013. This meta-analysis assessed the efficacy and safety of different doses of vortioxetine for generalized anxiety disorder of adults.Methods: PubMed, Cochrane Library, PsycINFO, and Clinical Trials databases were searched from 2000 through 2015. The abstracts of the annual meetings of the American Psychiatric Association and previous reviews were searched to identify additional studies. The search was limited to individual randomized controlled trials (RCTs, and there was no language restriction. Four RCTs met the selection criteria. These studies included 1,843 adult patients. Results were expressed as odds ratios (ORs and 95% confidence intervals (CIs. The data were pooled with a random-effects or fixed-effects model.Results: The results showed that multiple doses (2.5, 5, and 10 mg/d of vortioxetine did not significantly improve the generalized anxiety disorder symptoms compared to placebo (OR=1.16, 95% CI=0.84–1.60, Z=0.89, P=0.38; OR=1.41, 95% CI=0.82–2.41, Z=1.25, P=0.21; OR=1.05, 95% CI=0.76–1.46, Z=0.32, P=0.75, respectively. We measured the efficacy of 2.5 mg/d vortioxetine compared to 10 mg/d, and no significant differences were observed. The common adverse effects included nausea and headache. With increased dose, nausea was found to be more frequent in the vortioxetine (5 and 10 mg/d group (OR=2.99, 95% CI=1.31–6.84, Z=2.60, P=0.009; OR=2.80, 95% CI=1.85–4.25, Z=4.85, P<0.00001, respectively, but no significant differences were observed for headache.Conclusion: The results showed no significant improvement in the treatment of generalized anxiety disorder for vortioxetine compared to placebo

  8. Anxiety disorders.

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    Craske, Michelle G; Stein, Murray B; Eley, Thalia C; Milad, Mohammed R; Holmes, Andrew; Rapee, Ronald M; Wittchen, Hans-Ulrich

    2017-05-04

    Anxiety disorders constitute the largest group of mental disorders in most western societies and are a leading cause of disability. The essential features of anxiety disorders are excessive and enduring fear, anxiety or avoidance of perceived threats, and can also include panic attacks. Although the neurobiology of individual anxiety disorders is largely unknown, some generalizations have been identified for most disorders, such as alterations in the limbic system, dysfunction of the hypothalamic-pituitary-adrenal axis and genetic factors. In addition, general risk factors for anxiety disorders include female sex and a family history of anxiety, although disorder-specific risk factors have also been identified. The diagnostic criteria for anxiety disorders varies for the individual disorders, but are generally similar across the two most common classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Tenth Edition (ICD-10). Despite their public health significance, the vast majority of anxiety disorders remain undetected and untreated by health care systems, even in economically advanced countries. If untreated, these disorders are usually chronic with waxing and waning symptoms. Impairments associated with anxiety disorders range from limitations in role functioning to severe disabilities, such as the patient being unable to leave their home.

  9. The potential of Virtual Reality as anxiety management tool: a randomized controlled study in a sample of patients affected by Generalized Anxiety Disorder

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    Gorini Alessandra

    2008-05-01

    Full Text Available Abstract Background Generalized anxiety disorder (GAD is a psychiatric disorder characterized by a constant and unspecific anxiety that interferes with daily-life activities. Its high prevalence in general population and the severe limitations it causes, point out the necessity to find new efficient strategies to treat it. Together with the cognitive-behavioural treatments, relaxation represents a useful approach for the treatment of GAD, but it has the limitation that it is hard to be learned. To overcome this limitation we propose the use of virtual reality (VR to facilitate the relaxation process by visually presenting key relaxing images to the subjects. The visual presentation of a virtual calm scenario can facilitate patients' practice and mastery of relaxation, making the experience more vivid and real than the one that most subjects can create using their own imagination and memory, and triggering a broad empowerment process within the experience induced by a high sense of presence. According to these premises, the aim of the present study is to investigate the advantages of using a VR-based relaxation protocol in reducing anxiety in patients affected by GAD. Methods/Design The trial is based on a randomized controlled study, including three groups of 25 patients each (for a total of 75 patients: (1 the VR group, (2 the non-VR group and (3 the waiting list (WL group. Patients in the VR group will be taught to relax using a VR relaxing environment and audio-visual mobile narratives; patients in the non-VR group will be taught to relax using the same relaxing narratives proposed to the VR group, but without the VR support, and patients in the WL group will not receive any kind of relaxation training. Psychometric and psychophysiological outcomes will serve as quantitative dependent variables, while subjective reports of participants will be used as qualitative dependent variables. Conclusion We argue that the use of VR for relaxation

  10. [A comparative study of N400 in generalized anxiety disorder versus obsessive compulsive disorder patients].

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    Zhang, Chen; Chen, Xing-shi; Ren, Qing-sheng; Yi, Zheng-hui; Chen, Chong; Fang, Yi-ru

    2012-09-18

    To explore the features of events-related potentials (ERP) component N400 in generalized anxiety disorder (GAD) versus obsessive compulsive disorder (OCD) patients and understand the cognitive pattern and processing characteristic for Chinese characters. ERP component N400 was recorded by Guangzhou Runjie WJ-1 ERP apparatus. And 41 GAD patients, 69 OCD patients and 58 normal controls (NC) were tested by the Chinese idioms ending with matching (congruent) or mismatching (incongruent) words. (1) Latencies: Significant differences were found of N400 latencies in ending words with the same pronunciation but different forms and meanings (NC: (377 ± 40) ms, OCD: (395 ± 43) ms, GAD: (396 ± 43) ms, congruent; NC: (415 ± 32) ms, OCD: (429 ± 35) ms, GAD: (430 ± 36) ms, incongruent), ending words with the same meaning but different pronunciations and forms (NC: (411 ± 32) ms, OCD: (424 ± 40) ms, GAD: (433 ± 39) ms, incongruent), ending words with different pronunciations, forms and meanings (NC: (399 ± 47) ms, OCD: (427 ± 53) ms, GAD: (434 ± 42) ms, congruent; NC: (442 ± 36) ms, OCD: (465 ± 35) ms, GAD: (474 ± 35) ms, incongruent) (P pronunciations, forms and meanings (incongruent situation). (2) Significant differences were found of N400 amplitudes in ending words with the same pronunciation but different forms and meanings (NC: (9 ± 5) µV, OCD: (6 ± 5) µV, GAD: (6 ± 5) µV, congruent; NC: (11 ± 6) µV, OCD: (5 ± 4) µV, GAD: (6 ± 4) µV, incongruent), ending words with similar forms but different pronunciations and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (7 ± 5) µV, congruent; NC: (14 ± 6) µV, OCD: (6 ± 5) µV, GAD: (9 ± 7) µV, incongruent), ending words with different pronunciations, forms and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (5 ± 3) µV, congruent; NC: (14 ± 6) µV, OCD: (9 ± 7) µV, GAD: (9 ± 7) µV, incongruent) (P pronunciations and meanings (congruent). The cognitive and emotional problems in GAD and OCD

  11. Predictors of persistence of comorbid generalized anxiety disorder among veterans with major depressive disorder.

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    Mittal, Dinesh; Fortney, John C; Pyne, Jeffrey M; Wetherell, Julie L

    2011-11-01

    A limited number of randomized clinical trials show that efficacious pharmacologic treatments exist for comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD). The aims of this effectiveness study were to describe the impact of a depression care management intervention on the persistence of comorbid GAD symptoms in a sample of primary care patients with MDD and to identify risk factors for persistent GAD. Data were collected from April 2003 to September 2005 for the Telemedicine-Enhanced Antidepressant Management (TEAM) study, a multisite, randomized effectiveness trial targeting US Department of Veterans Affairs (VA) primary care patients with depression. Veterans aged 26.59-88.36 years received either the TEAM intervention or usual care in small VA community-based outpatient clinics. The TEAM care management intervention focused on optimizing antidepressant therapy through patient education and activation, symptom monitoring, adherence promotion, and side-effect management. Veterans who screened positive for MDD using the Patient Health Questionnaire-9 (based on DSM-IV criteria) and who met the Mini-International Neuropsychiatric Interview criteria (maintaining consistency with DSM-IV-TR) for comorbid GAD at baseline were selected for the present study (N = 168). The primary outcome was persistence of GAD at 6 months and 12 months. All predictors available in the TEAM study data that were described in the literature to be associated with influencing GAD outcomes were examined. Persistence of depression was the strongest predictor of persistence of comorbid GAD at both 6 months (OR = 5.75; 95% CI, 2.38-13.86; P < .05) and 12 months (OR = 15.56; 95% CI, 6.10-39.68; P < .05). Although the TEAM intervention significantly reduced depression symptom severity, it was not significantly associated with GAD persistence. Insomnia was a significant protective factor for persistence of GAD at 6 months (OR = 0.66; 95% CI, 0.44-0.99; P < .05). Early

  12. General anxiety, depression, and physical health in relation to symptoms of heart-focused anxiety- a cross sectional study among patients living with the risk of serious arrhythmias and sudden cardiac death

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    Hamang Anniken

    2011-11-01

    Full Text Available Abstract Objective To investigate the role of three distinct symptoms of heart-focused anxiety (cardio-protective avoidance, heart-focused attention, and fear about heart sensations in relation to general anxiety, depression and physical health in patients referred to specialized cardio-genetics outpatient clinics in Norway for genetic investigation and counseling. Methods Participants were 126 patients (mean age 45 years, 53.5% women. All patients were at higher risk than the average person for serious arrhythmias and sudden cardiac death (SCD because of a personal or a family history of an inherited cardiac disorder (familial long QT syndrome or hypertrophic cardiomyopathy. Patients filled in, Hospital Anxiety and Depression Scale, Short-Form 36 Health Survey, and Cardiac Anxiety Questionnaire, two weeks before the scheduled counseling session. Results The patients experienced higher levels of general anxiety than expected in the general population (mean difference 1.1 (p Conclusion Avoidance and fear may be potentially modifiable symptoms. Because these distinct symptoms may have important roles in determining general anxiety, depression and physical health in at-risk individuals of inherited cardiac disorders, the present findings may have implications for the further development of genetic counseling for this patient group.

  13. Brain Activation Patterns Associated with the Effects of Emotional Distracters during Working Memory Maintenance in Patients with Generalized Anxiety Disorder.

    Science.gov (United States)

    Park, Jong-Il; Kim, Gwang-Won; Jeong, Gwang-Woo; Chung, Gyung Ho; Yang, Jong-Chul

    2016-01-01

    Few studies have assessed the neural mechanisms of the effects of emotion on cognition in generalized anxiety disorder (GAD) patients. In this functional MRI (fMRI), we investigated the effects of emotional interference on working memory (WM) maintenance in GAD patients. Fifteen patients with GAD participated in this study. Event-related fMRI data were obtained while the participants performed a WM task (face recognition) with neutral and anxiety-provoking distracters. The GAD patients showed impaired performance in WM task during emotional distracters and showed greater activation on brain regions such as DLPFC, VLPFC, amygdala, hippocampus which are responsible for the active maintenance of goal relevant information in WM and emotional processing. Although our results are not conclusive, our finding cautiously suggests the cognitive-affective interaction in GAD patients which shown interfering effect of emotional distracters on WM maintenance.

  14. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

    NARCIS (Netherlands)

    Bensing, J.M.; Verheul, W.; Dulmen, A.M. van

    2008-01-01

    Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an

  15. Anxiety and Depression Are Associated With Migraine and Pain in General : An Investigation of the Interrelationships

    NARCIS (Netherlands)

    Ligthart, Lannie; Gerrits, Marloes M. J. G.; Boomsma, Dorret I.; Penninx, Brenda W. J. H.

    2013-01-01

    There is a well-established comorbidity between migraine and anxiety and depression (A/D). Here, we investigate whether this relationship is specific for migraine and A/D or whether other types of pain are also consistently associated with A/D. In addition, we test whether there is a consistent asso

  16. The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis.

    Science.gov (United States)

    Piqueras, Jose A; Martín-Vivar, María; Sandin, Bonifacio; San Luis, Concepción; Pineda, David

    2017-08-15

    Anxiety and depression are among the most common mental disorders during childhood and adolescence. Among the instruments for the brief screening assessment of symptoms of anxiety and depression, the Revised Child Anxiety and Depression Scale (RCADS) is one of the more widely used. Previous studies have demonstrated the reliability of the RCADS for different assessment settings and different versions. The aims of this study were to examine the mean reliability of the RCADS and the influence of the moderators on the RCADS reliability. We searched in EBSCO, PsycINFO, Google Scholar, Web of Science, and NCBI databases and other articles manually from lists of references of extracted articles. A total of 146 studies were included in our meta-analysis. The RCADS showed robust internal consistency reliability in different assessment settings, countries, and languages. We only found that reliability of the RCADS was significantly moderated by the version of RCADS. However, these differences in reliability between different versions of the RCADS were slight and can be due to the number of items. We did not examine factor structure, factorial invariance across gender, age, or country, and test-retest reliability of the RCADS. The RCADS is a reliable instrument for cross-cultural use, with the advantage of providing more information with a low number of items in the assessment of both anxiety and depression symptoms in children and adolescents. Copyright © 2017. Published by Elsevier B.V.

  17. Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A Pilot Study

    Science.gov (United States)

    Dalrymple, Kristy L.; Herbert, James D.

    2007-01-01

    Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxiety disorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a…

  18. The Impact of Motivational Interviewing on Client Experiences of Cognitive Behavioral Therapy for Generalized Anxiety Disorder

    Science.gov (United States)

    Kertes, Angela; Westra, Henny A.; Angus, Lynne; Marcus, Madalyn

    2011-01-01

    Motivational Interviewing (MI) has recently been applied to the treatment of anxiety disorders in an effort to bolster engagement with and response rates to cognitive behavioral therapy (CBT). In a recent randomized control trial, the addition of MI as a pretreatment compared to no pretreatment was found to significantly improve response to CBT…

  19. Aversive learning and generalization predict subclinical levels of anxiety : a six-month longitudinal study

    NARCIS (Netherlands)

    Lenaert, Bert; Boddez, Yannick; Griffith, James W; Vervliet, Bram; Schruers, Koen; Hermans, Dirk

    2014-01-01

    The identification of premorbid markers of risk for psychopathology is one of the most important challenges for present-day psychiatric research. This study focuses on behavioral vulnerability factors that contribute to the development of anxiety. Little is known about the role of aversive learning

  20. Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A Pilot Study

    Science.gov (United States)

    Dalrymple, Kristy L.; Herbert, James D.

    2007-01-01

    Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxiety disorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a…

  1. Humor Styles and the Intolerance of Uncertainty Model of Generalized Anxiety

    Directory of Open Access Journals (Sweden)

    Nicholas A. Kuiper

    2014-08-01

    Full Text Available Past research suggests that sense of humor may play a role in anxiety. The present study builds upon this work by exploring how individual differences in various humor styles, such as affiliative, self-enhancing, and self-defeating humor, may fit within a contemporary research model of anxiety. In this model, intolerance of uncertainty is a fundamental personality characteristic that heightens excessive worry, thus increasing anxiety. We further propose that greater intolerance of uncertainty may also suppress the use of adaptive humor (affiliate and self-enhancing, and foster the increased use of maladaptive self-defeating humor. Initial correlational analyses provide empirical support for these proposals. In addition, we found that excessive worry and affiliative humor both served as significant mediators. In particular, heightened intolerance of uncertainty lead to both excessive worry and a reduction in affiliative humor use, which, in turn, increased anxiety. We also explored potential humor mediating effects for each of the individual worry content domains in this model. These analyses confirmed the importance of affiliative humor as a mediator for worry pertaining to a wide range of content domains (e.g., relationships, lack of confidence, the future and work. These findings were then discussed in terms of a combined model that considers how humor styles may impact the social sharing of positive and negative emotions.

  2. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

    NARCIS (Netherlands)

    Bensing, J.M.; Verheul, W.; Dulmen, A.M. van

    2008-01-01

    Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an a

  3. Maternal phobic anxiety and child anxiety.

    Science.gov (United States)

    Bernstein, Gail A; Layne, Ann E; Egan, Elizabeth A; Nelson, Lara P

    2005-01-01

    The present study examined the relation between maternal anxiety symptoms and child anxiety symptoms and evaluated whether a reporting bias is associated with maternal anxiety. Fifty-seven mother-child pairs participated. All children had features or diagnoses of separation anxiety disorder (SAD), generalized anxiety disorder, and/or social phobia. Measures of maternal symptomatology and child anxiety were administered. Higher levels of maternal phobic anxiety on the Brief Symptom Inventory were significantly associated with higher levels of separation anxiety in children. After controlling for clinician rating of SAD severity, maternal phobic anxiety emerged as a significant predictor of maternal ratings of child separation anxiety, accounting for 19% of the variance. Phobic mothers endorsed levels of separation anxiety in their children that exceeded levels endorsed by clinicians, suggesting maternal overreporting.

  4. A Test of the Effects of Acute Sleep Deprivation on General and Specific Self-Reported Anxiety and Depressive Symptoms: An Experimental Extension

    OpenAIRE

    Babson, Kimberly A; Trainor, Casey D.; Feldner, Matthew T.; Blumenthal, Heidemarie

    2010-01-01

    Evidence indicates acute sleep deprivation affects negative mood states. The present study experimentally tested the effects of acute sleep deprivation on self-reported symptoms of state anxiety and depression as well as general distress among 88 physically and psychologically healthy adults. As hypothesized, the effects of acute sleep deprivation increased state anxiety and depression, as well as general distress, relative to a normal night of sleep control condition. Based on the tripartite...

  5. “You don't immediately stick a label on them”: a qualitative study of influences on general practitioners' recording of anxiety disorders

    Science.gov (United States)

    Ford, Elizabeth; Campion, Alice; Chamles, Darleen Aixora; Habash-Bailey, Haniah; Cooper, Maxwell

    2016-01-01

    Objectives Anxiety is a common condition usually managed in general practice (GP) in the UK. GP patient records can be used for epidemiological studies of anxiety as well as clinical audit and service planning. However, it is not clear how general practitioners (GPs) conceptualise, diagnose and document anxiety in these records. We sought to understand these factors through an interview study with GPs. Setting UK National Health Service (NHS) General Practice (England and Wales). Participants 17 UK GPs. Primary and secondary outcome measures Semistructured interviews used vignettes to explore the process of diagnosing anxiety in primary care and investigate influences on recording. Interviews were transcribed verbatim and analysed using thematic analysis. Results GPs chose 12 different codes for recording anxiety in the 2 vignettes, and reported that history, symptoms and management would be recorded in free text. GPs reported on 4 themes representing influences on recording of anxiety: ‘anxiety or a normal response’, ‘granularity of diagnosis’, ‘giving patients a label’ and ‘time as a tool’; and 3 themes about recording in general: ‘justifying the choice of code’, ‘usefulness of coding’ and ‘practice-specific pressures’. GPs reported using only a regular selection of codes in patient records to help standardise records within the practice and as a time-saving measure. Conclusions We have identified a coding culture where GPs feel confident recognising anxiety symptoms; however, due to clinical uncertainty, a long-term perspective and a focus on management, they are reluctant to code firm diagnoses in the initial stages. Researchers using GP patient records should be aware that GPs may prefer free text, symptom codes and other general codes rather than firm diagnostic codes for anxiety. PMID:27338879

  6. Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life

    Directory of Open Access Journals (Sweden)

    Robert Johansson

    2013-07-01

    Full Text Available Background. Depression and anxiety disorders are major world-wide problems. There are no or few epidemiological studies investigating the prevalence of depression, generalized anxiety disorder and anxiety disorders in general in the Swedish population.Methods. Data were obtained by means of a postal survey administered to 3001 randomly selected adults. After two reminders response rate was 44.3%. Measures of depression and general anxiety were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9 and the 7-item Generalized Anxiety Disorder Scale (GAD-7. The PHQ-9 identified participants who had experienced clinically significant depression (PHQ-9 ≥ 10, and who had a diagnosis of major depression (defined by using a PHQ-9 scoring algorithm. Clinically significant anxiety was defined as having a GAD-7 score ≥ 8. To specifically measure generalized anxiety disorder, the Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV was used with an established cut-off. Health-related quality of life was measured using the EuroQol (EQ-5D. Experiences of treatments for psychiatric disorders were also assessed.Results. Around 17.2% (95% CI: 15.1–19.4 of the participants were experiencing clinically significant depression (10.8%; 95% CI: 9.1–12.5 and clinically significant anxiety (14.7%; 95% CI: 12.7–16.6. Among participants with either clinically significant depression or anxiety, nearly 50% had comorbid disorders. The point prevalence of major depression was 5.2% (95% CI: 4.0–6.5, and 8.8% (95% CI: 7.3–10.4 had GAD. Among those with either of these disorders, 28.2% had comorbid depression and GAD. There were, generally, significant gender differences, with more women having a disorder compared to men. Among those with depression or anxiety, only between half and two thirds had any treatment experience. Comorbidity was associated with higher symptom severity and lower health-related quality of life.Conclusions. Epidemiological data

  7. A pilot study of clonazepam versus psychodynamic group therapy plus clonazepam in the treatment of generalized social anxiety disorder

    Science.gov (United States)

    Knijnik, Daniela Z.; Blanco, Carlos; Salum, Giovanni Abrahão; Moraes, Carolina U.; Mombach, Clarissa; Almeida, Ellen; Pereira, Marília; Strapasson, Atahualpa; Manfro, Gisele G.; Eizirik, Cláudio L.

    2015-01-01

    Background Both Psychodynamic Group Therapy (PGT) and clonazepam are used as treatment strategies in reducing symptoms of generalized social anxiety disorder (GSAD). However, many individuals remain symptomatic after treatment with PGT or clonazepam. Method Fifty-eight adult outpatients with a diagnosis of GSAD according to DSM-IV were randomized to 12 weeks PGT plus clonazepam or clonazepam. The Clinical Global Impression-Improvement (CGI-I) Scale was the primary efficacy measure. Secondary efficacy measures included the Liebowitz Social Anxiety Scale (LSAS) total score, the World Health Organization Instrument to Assess Quality of Life-Bref (WHOQOL-Bref) Scale and the Beck Depression Inventory (BDI). Results CGI-I data from 57 patients (intent-to-treat population) showed that patients who received PGT plus clonazepam presented significantly greater improvement than those who received clonazepam (p=0.033). There were no significant differences between the two groups in the secondary efficacy measures. Conclusion/Discussion Our study suggests that the combination of PGT with clonazepam may be a promising strategy for the treatment of GSAD, regarding gains in the global functioning. However the present study failed to detect more specific changes in social anxiety symptomatology between the two groups. PMID:18774274

  8. Error-related brain activity in youth and young adults before and after treatment for generalized or social anxiety disorder.

    Science.gov (United States)

    Kujawa, Autumn; Weinberg, Anna; Bunford, Nora; Fitzgerald, Kate D; Hanna, Gregory L; Monk, Christopher S; Kennedy, Amy E; Klumpp, Heide; Hajcak, Greg; Phan, K Luan

    2016-11-03

    Increased error monitoring, as measured by the error-related negativity (ERN), has been shown to persist after treatment for obsessive-compulsive disorder in youth and adults; however, no previous studies have examined the ERN following treatment for related anxiety disorders. We used a flanker task to elicit the ERN in 28 youth and young adults (8-26years old) with primary diagnoses of generalized anxiety disorder (GAD) or social anxiety disorder (SAD) and 35 healthy controls. Patients were assessed before and after treatment with cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRI), and healthy controls were assessed at a comparable interval. The ERN increased across assessments in the combined sample. Patients with SAD exhibited an enhanced ERN relative to healthy controls prior to and following treatment, even when analyses were limited to SAD patients who responded to treatment. Patients with GAD did not significantly differ from healthy controls at either assessment. Results provide preliminary evidence that enhanced error monitoring persists following treatment for SAD in youth and young adults, and support conceptualizations of increased error monitoring as a trait-like vulnerability that may contribute to risk for recurrence and impaired functioning later in life. Future work is needed to further evaluate the ERN in GAD across development, including whether an enhanced ERN develops in adulthood or is most apparent when worries focus on internal sources of threat. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. The study of clinical value of repetitive transcranial magnetic stimulation combined with dutoxetine for patients with generalized anxiety disorder

    Institute of Scientific and Technical Information of China (English)

    Ji-Dong Ren

    2016-01-01

    Objective:To analyze the clinical value of repetitive transcranial magnetic stimulation (RTMS) combined with dutoxetine for patients with generalized anxiety disorder (GAD).Methods:A total of 180 cases of patients with GAD were randomly divided into two groups (the control group and the observation group) with 90 cases each group. Patients in control group were treated with dutoxetine, while those in observation group were treated by dutoxetine combined with RTMS. The Hamilton anxiety scale and the clinical global impression scale were used to evaluate the efficacy of both groups before and after treatment, then the characteristics of mismatch negativity and P300 were detected by using brain evoked potential, and meanwhile, plasma cortisol, brain derived neurotrophic factor and homocysteine levels were detected and compared too.Results:Analysis of variance of repeated measure data showed that the main effect of time, main effect between groups and interaction effect of Hamilton anxiety scale and the clinical global impression scale scores, MMN incubation period, MMN amplitude, target N2 incubation period, target P3 incubation period, P2 non-target amplitude, levels of plasma cortisol, brain derived neurotrophic factor and homocysteine of both groups were statistically significant (P < 0.05).Conclusions:The treatment of RTMS combined with dutoxetine for patients with GAD has a faster and better curative effect, which is worthy of clinical promotion.

  10. Childhood maltreatment is associated with larger left thalamic gray matter volume in adolescents with generalized anxiety disorder.

    Science.gov (United States)

    Liao, Mei; Yang, Fan; Zhang, Yan; He, Zhong; Song, Ming; Jiang, Tianzi; Li, Zexuan; Lu, Shaojia; Wu, Weiwei; Su, Linyan; Li, Lingjiang

    2013-01-01

    Generalized anxiety disorder (GAD) is a common anxiety disorder that usually begins in adolescence. Childhood maltreatment is highly prevalent and increases the possibility for developing a variety of mental disorders including anxiety disorders. An earlier age at onset of GAD is significantly related to maltreatment in childhood. Exploring the underpinnings of the relationship between childhood maltreatment and adolescent onset GAD would be helpful in identifying the potential risk markers of this condition. Twenty-six adolescents with GAD and 25 healthy controls participated in this study. A childhood trauma questionnaire (CTQ) was introduced to assess childhood maltreatment. All subjects underwent high-resolution structural magnetic resonance scans. Voxel-based morphometry (VBM) was used to investigate gray matter alterations. Significantly larger gray matter volumes of the right putamen were observed in GAD patients compared to healthy controls. In addition, a significant diagnosis-by-maltreatment interaction effect for the left thalamic gray matter volume was revealed, as shown by larger volumes of the left thalamic gray matter in GAD patients with childhood maltreatment compared with GAD patients without childhood maltreatment as well as with healthy controls with/without childhood maltreatment. A significant positive association between childhood maltreatment and left thalamic gray matter volume was only seen in GAD patients. These findings revealed an increased volume in the subcortical regions in adolescent GAD, and the alterations in the left thalamus might be involved in the association between childhood maltreatment and the occurrence of GAD.

  11. Resting-state theta band connectivity and graph analysis in generalized social anxiety disorder

    Directory of Open Access Journals (Sweden)

    Mengqi Xing

    2017-01-01

    Conclusions: Theta-dependent interconnectivity was associated with state anxiety in gSAD and an increase in information processing efficiency in gSAD (compared to controls. Results may represent enhanced baseline self-focused attention, which is consistent with cognitive models of gSAD and fMRI studies implicating emotion dysregulation and disturbances in task negative networks (e.g., default mode network in gSAD.

  12. Social anxiety is associated with general but not specific biases in emotion recognition.

    Science.gov (United States)

    Button, Katherine; Lewis, Glyn; Penton-Voak, Ian; Munafò, Marcus

    2013-11-30

    Misreading facial expressions as signals of social disapproval, such as anger and disgust, may maintain social anxiety. If so, manipulating face processing could be therapeutic. It remains unclear, however, whether socially anxious individuals are in fact more sensitive to disapproving emotions. We assessed decoding of, and cost attributions to, emotional expressions in high and low socially anxious females (n=102) using five emotions (anger, disgust, fear, happiness, and sadness) expressed at 15 intensities (9-65%), providing 75 stimuli (see Supplementary Material). The decoding task briefly presented the stimuli and participants identified the emotion. The cost attribution task asked individuals to rate each stimulus for how costly it would be for them to interact with the person. Random effects regression indicated that social anxiety was not associated with overall decoding accuracy but was associated with a response bias. High socially anxious individuals had a lower threshold for decoding emotions but also more frequently classified low intensity emotions incorrectly. These effects were not emotion-specific. Socially anxious individuals also attributed excessive social cost to expressions of negative valence. Our results provide a novel conceptual framework for understanding emotion decoding in social anxiety, indicating the importance of considering both accuracy and response bias.

  13. Nonorganic insomnia in generalized anxiety disorder. 1. Controlled studies on sleep, awakening and daytime vigilance utilizing polysomnography and EEG mapping.

    Science.gov (United States)

    Saletu-Zyhlarz, G; Saletu, B; Anderer, P; Brandstätter, N; Frey, R; Gruber, G; Klösch, G; Mandl, M; Grünberger, J; Linzmayer, L

    1997-01-01

    Objective and subjective sleep and awakening quality as well as daytime vigilance of insomniac patients with generalized anxiety disorder (GAD) were investigated, as compared with normal controls. Forty-four outpatients (25 females, 19 males), aged 24-65 (mean 43) years, diagnosed with non-organic insomnia (ICD-10: F 51.0), related to mild GAD (F 41.1), with a Hamilton anxiety (HAMA) score of 22 +/- 6 and a Zung self-rating anxiety (SAS) score of 37 +/- 6 were included. After 1 adaptation night, sleep induction, maintainance and architecture were measured objectively by polysomnography, subjective sleep and awakening quality were assessed by self-rating scales and visual analog scales, objective awakening quality was measured by a psychometric test battery, and diurnal tiredness was measured by a 3-min vigilance-controlled EEG (V-EEG) and a 4-min resting EEG mapping. In polysomnography patients demonstrated-as compared with normals-significantly increased wake time during the total sleep period and more early-morning awakening, decreased total sleep and sleep efficiency. Subjective sleep quality was deteriorated as well, as were well-being, drive, mood, and wakefulness in the morning. In noopsychic performance, GAD patients did rather well in attention, concentration, attention variability, and numerical memory, while fine-motor activity and reaction time were deteriorated. In psychophysiology, critical flicker frequency was decreased in the morning, while muscle strength, blood pressure and pulse rate showed no differences. EEG mapping during the late morning hours (10.00-12.00 h) demonstrated hypervigilance in the V-EEG, while in the resting recording an increased sleep pressure was detected. The latter was correlated significantly to the SAS score, but less so to the observer-rated Hamilton anxiety score. Our findings suggest that CNS hypervigilance and hyperarousal, as actual symptoms of GAD, lead to nocturnal insomnia, which in turn may cause-as a consequence

  14. A test of the effects of acute sleep deprivation on general and specific self-reported anxiety and depressive symptoms: an experimental extension.

    Science.gov (United States)

    Babson, Kimberly A; Trainor, Casey D; Feldner, Matthew T; Blumenthal, Heidemarie

    2010-09-01

    Evidence indicates acute sleep deprivation affects negative mood states. The present study experimentally tested the effects of acute sleep deprivation on self-reported symptoms of state anxiety and depression as well as general distress among 88 physically and psychologically healthy adults. As hypothesized, the effects of acute sleep deprivation increased state anxiety and depression, as well as general distress, relative to a normal night of sleep control condition. Based on the tripartite model of anxiety and depression, these findings replicate and extend prior research by suggesting sleep deprivation among individuals without current Axis I disorders increases both state symptoms of anxiety and depression specifically, and general distress more broadly. Extending this work to clinical samples and prospectively testing mechanisms underlying these effects are important future directions in this area of research.

  15. 文拉法辛治疗广泛性焦虑症%Venlafaxine in treatment of generalized anxiety disorder

    Institute of Scientific and Technical Information of China (English)

    郭春荣; 张晓红

    2001-01-01

    目的:观察文拉法辛治疗广泛性焦虑症的临床疗效及不良反应。方法:根据CCMD-Ⅱ-R诊断为广泛性焦虑症的21例病人,男性13例,女性8例,年龄33 a± s 16 a(18~65 a),病程14 mo±12 mo(1~60 mo),给文拉法辛50 mg*d-1,po×4 wk。治疗前后每周进行HAMA,TESS评定及常规的实验室检查。结论:文拉法辛抗焦虑作用,1 wk见效,4 wk显效率达76%。不良反应以口干、出汗、恶心、头痛等多见。结果:文拉法辛治疗广泛性焦虑症疗效确切,不良反应轻微。%AIM: To study the efficacy and adverse reactions of venlafaxine in the treatment of generalized anxiety disorder. METHODS: Twenty-one patients (M 13, F 8; age 33 a± s 16 a) with diagnosis of generalized anxiety disorder according to CCMD-Ⅱ-R were treated with venlafaxine 50 mg*d-1 for 4 wk. Patients were assessed with the HAMA and TESS and routine experimental examination before and after treatment. RESULTS: Venlafaxine was obvious effective to generalized anxiety disorder. The effectiveness appeared after 1 wk. The remarkable effective rate was 76% at 4 wk. The main adverse reactions of venlafaxine were thirst, sweating nausea and headache etc.  CONCLUSION: Venlafaxine is an effective and safe drug in the treatment of generalized anxiety disorder.

  16. The prevalence of anxiety and depression in patients with or without hyperhidrosis (HH).

    Science.gov (United States)

    Bahar, Rayeheh; Zhou, Pingyu; Liu, Yudan; Huang, Yuanshen; Phillips, Arlie; Lee, Tim K; Su, Mingwan; Yang, Sen; Kalia, Sunil; Zhang, Xuejun; Zhou, Youwen

    2016-12-01

    There are conflicting data about the correlation between hyperhidrosis (HH) and anxiety and depression. We sought to determine the prevalence of anxiety and depression in patients with or without HH. We examined 2017 consecutive dermatology outpatients from Vancouver, British Columbia, Canada, and Shanghai, China, using Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales for anxiety and depression assessments. Multivariable logistic regression analysis was performed to evaluate if the impact of HH on anxiety and depression is dependent on demographic factors and diagnoses of the patients' presenting skin conditions. The prevalence of anxiety and depression was 21.3% and 27.2% in patients with HH, respectively, and 7.5% and 9.7% in patients without HH, respectively (P value anxiety and depression. Multivariable analysis showed that HH-associated increase in anxiety and depression prevalence is independent of demographic factors and presenting skin conditions. The data from the questionnaires relied on the accuracy of patients' self-reports. Both single variant and multivariable analyses showed a significant association between HH and the prevalence of anxiety and depression in a HH severity-dependent manner. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  17. A randomized, controlled clinical trial: the effect of mindfulness-based cognitive therapy on generalized anxiety disorder among Chinese community patients: protocol for a randomized trial

    Directory of Open Access Journals (Sweden)

    Wong Samuel YS

    2011-11-01

    Full Text Available Abstract Background Research suggests that an eight-week Mindfulness-Based Cognitive Therapy (MBCT program may be effective in the treatment of generalized anxiety disorders. Our objective is to compare the clinical effectiveness of the MBCT program with a psycho-education programme and usual care in reducing anxiety symptoms in people suffering from generalized anxiety disorder. Methods A three armed randomized, controlled clinical trial including 9-month post-treatment follow-up is proposed. Participants screened positive using the Structure Clinical Interview for DSM-IV (SCID for general anxiety disorder will be recruited from community-based clinics. 228 participants will be randomly allocated to the MBCT program plus usual care, psycho-education program plus usual care or the usual care group. Validated Chinese version of instruments measuring anxiety and worry symptoms, depression, quality of life and health service utilization will be used. Our primary end point is the change of anxiety and worry score (Beck Anxiety Inventory and Penn State Worry Scale from baseline to the end of intervention. For primary analyses, treatment outcomes will be assessed by ANCOVA, with change in anxiety score as the baseline variable, while the baseline anxiety score and other baseline characteristics that significantly differ between groups will serve as covariates. Conclusions This is a first randomized controlled trial that compare the effectiveness of MBCT with an active control, findings will advance current knowledge in the management of GAD and the way that group intervention can be delivered and inform future research. Unique Trail Number (assigned by Centre for Clinical Trails, Clinical Trials registry, The Chinese University of Hong Kong: CUHK_CCT00267

  18. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder.

    Science.gov (United States)

    Dugas, Michel J; Brillon, Pascale; Savard, Pierre; Turcotte, Julie; Gaudet, Adrienne; Ladouceur, Robert; Leblanc, Renée; Gervais, Nicole J

    2010-03-01

    This randomized clinical trial compared cognitive-behavioral therapy (CBT), applied relaxation (AR), and wait-list control (WL) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder (GAD). The CBT condition was based on the intolerance of uncertainty model of GAD, whereas the AR condition was based on general theories of anxiety. Both manualized treatments were administered over 12 weekly 1-hour sessions. Standardized clinician ratings and self-report questionnaires were used to assess GAD and related symptoms at pretest, posttest, and at 6-, 12-, and 24-month follow-ups. At posttest, CBT was clearly superior to WL, AR was marginally superior to WL, and CBT was marginally superior to AR. Over follow-up, CBT and AR were equivalent, but only CBT led to continued improvement. Thus, direct comparisons of CBT and AR indicated that the treatments were comparable; however, comparisons of each treatment with another point of reference (either waiting list or no change over follow-up) provided greater support for the efficacy of CBT than AR. 2009. Published by Elsevier Ltd.

  19. Influence of Anxiety and Depression Status of Family Members on the General 
Psychological Status of Perioperative Patients with Lung Cancer

    OpenAIRE

    Xianning WU; Chen, Mingjiu; Su, Dan; Yu, Fenglei

    2011-01-01

    Background and objective Facing the double pressures caused by cancer and surgery, many patients will appear series psychological problems like nervous, fear, pessimism, anxiety and so on. The aim of this study is to explone the anxiety, depression status of family members, the general psychological status of perioperative patients with lung cancer and the influence of the former on the latter. Methods Total 97 patients and 97 patient family members from the thoracic department of the Second ...

  20. Self-efficacy, foreign language anxiety as predictors of academic performance among professional program students in a general English proficiency writing test.

    Science.gov (United States)

    Chen, M C; Lin, Huey-Ju

    2009-10-01

    Questionnaires were administered to 120 students. Cluster analysis was used to examine whether specific groups could be described by a writing self-efficacy scale, English writing anxiety scale, and a written General English Proficiency Test. Three clusters were observed. Demographic variables were compared for each cluster, including age, sex, program of study, years of English instruction, native language, and number of English speaking acquaintances. Efforts to reduce writing anxiety and promote writing self-efficacy could enhance writing scores of participants.

  1. Cognitive behavioral treatment for older adults with generalized anxiety disorder. A therapist manual for primary care settings.

    Science.gov (United States)

    Stanley, Melinda A; Diefenbach, Gretchen J; Hopko, Derek R

    2004-01-01

    At least four academic clinical trials have demonstrated the utility of cognitive behavior therapy (CBT) for older adults with generalized anxiety disorder (GAD). These data may not generalize, however, to more heterogeneous and functionally impaired patients and the medical settings in which they typically receive care. A recent pilot project suggested the potential benefits of a new version of CBT for GAD among older patients in primary care. The manual developed and tested in this pilot project is presented here. Treatment components include motivation and education, relaxation skills, cognitive therapy, problem-solving-skills training, exposure exercises, and sleep-management-skills training. Procedures are designed to be administered flexibly to maximize attention to individual patient needs. Examples of session summaries, patient handouts, and homework forms are provided.

  2. Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Maneeton N

    2016-01-01

    Full Text Available Narong Maneeton,1 Benchalak Maneeton,1 Pakapan Woottiluk,2 Surinporn Likhitsathian,1 Sirijit Suttajit,1 Vudhichai Boonyanaruthee,1 Manit Srisurapanont1 1Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand Background: Some studies have indicated the efficacy of quetiapine in the treatment of generalized anxiety disorder (GAD.Objective: The purpose of this study was to systematically review the efficacy, acceptability, and tolerability of quetiapine in adult patients with GAD.Methods: The SCOPUS, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched in April 2015. All randomized controlled trials (RCTs of GAD were considered to be included in this meta-analysis. All RCTs of quetiapine in GAD patients providing endpoint outcomes relevant to severity of anxiety, response rate, remission rate, overall discontinuation rate, or discontinuation rate due to adverse events were included. The version reports from suitable clinical studies were explored, and the important data were extracted. Measurement for efficacy outcomes consisted of the mean-changed scores of the rating scales for anxiety, and response rate.Results: A total of 2,248 randomized participants in three RCTs were included. The pooled mean-changed score of the quetiapine-treated group was greater than that of the placebo-treated group and comparable to selective serotonin reuptake inhibitors (SSRIs. Unfortunately, the response and the remission rates in only 50 and 150 mg/day of quetiapine-XR (extended-release were better than those of the placebo. Their response and remission rates were comparable to SSRIs. The rates of pooled overall discontinuation and discontinuation due to adverse events of quetiapine-XR were greater than placebo. Only the overall discontinuation rate of quetiapine-XR at 50 and

  3. Short-term open-label chamomile (Matricaria chamomilla L.) therapy of moderate to severe generalized anxiety disorder.

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    Keefe, John R; Mao, Jun J; Soeller, Irene; Li, Qing S; Amsterdam, Jay D

    2016-12-15

    Conventional drug treatments for Generalized Anxiety Disorder (GAD) are often accompanied by substantial side effects, dependence, and/or withdrawal syndrome. A prior controlled study of oral chamomile (Matricaria chamomilla L.) extract showed significant efficacy versus placebo, and suggested that chamomile may have anxiolytic activity for individuals with GAD. We hypothesized that treatment with chamomile extract would result in a significant reduction in GAD severity ratings, and would be associated with a favorable adverse event and tolerability profile. We report on the open-label phase of a two-phase randomized controlled trial of chamomile versus placebo for relapse-prevention of recurrent GAD. Subjects with moderate to severe GAD received open-label treatment with pharmaceutical-grade chamomile extract 1500mg/day for up to 8 weeks. Primary outcomes were the frequency of clinical response and change in GAD-7 symptom scores by week 8. Secondary outcomes included the change over time on the Hamilton Rating Scale for Anxiety, the Beck Anxiety Inventory, and the Psychological General Well Being Index. Frequency of treatment-emergent adverse events and premature treatment discontinuation were also examined. Of 179 subjects, 58.1% (95% CI: 50.9% to 65.5%) met criteria for response, while 15.6% prematurely discontinued treatment. Significant improvement over time was also observed on the GAD-7 rating (β=-8.4 [95% CI=-9.1 to -7.7]). A similar proportion of subjects demonstrated statistically significant and clinically meaningful reductions in secondary outcome ratings of anxiety and well-being. Adverse events occurred in 11.7% of subjects, although no serious adverse events occurred. Chamomile extract produced a clinically meaningful reduction in GAD symptoms over 8 weeks, with a response rate comparable to those observed during conventional anxiolytic drug therapy and a favorable adverse event profile. Future comparative effectiveness trials between chamomile and

  4. Whole-brain gray matter volume abnormalities in patients with generalized anxiety disorder: voxel-based morphometry.

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    Moon, Chung-Man; Kim, Gwang-Won; Jeong, Gwang-Woo

    2014-02-12

    Patients with generalized anxiety disorder (GAD) experience psychological distress because of excessive and uncontrollable anxiety in everyday life. Only a few morphological studies have so far focused on specific brain regions of interest as well as the gray matter volume changes in GAD patients. This study evaluated gray matter volume alterations in whole-brain areas between GAD patients and healthy controls, and sex differences between the specific brain areas with significant volume changes in GAD patients using voxel-based morphometry. Twenty-two patients with GAD (13 men and nine women), who were diagnosed using the DSM-IV-TR, and 22 age-matched healthy controls (13 men and nine women) participated in this study. The high-resolution MRI data were processed using voxel-based morphometry analysis on the basis of diffeomorphic anatomical registration through an exponentiated Lie algebra algorithm in Statistical Parametric Mapping 8. There was no significant difference in the total intracranial volume between GAD patients and controls, but a significant difference was observed between sexes (Psuperior temporal gyrus compared with the controls. As for the sex comparison, female patients showed a significant increase in the volume of the dorsolateral prefrontal cortex relative to male patients. Also, the volume of the dorsolateral prefrontal cortex in female patients was correlated positively with the Hamilton Anxiety Rating Scale score (γ=0.68, P=0.04). The specific morphological variations in patient with GAD will be helpful to understand the neural mechanism associated with a symptom of GAD. Furthermore, the findings would be valuable for the diagnostic accuracy of GAD using morphometric MRI analysis.

  5. Abnormalities in gray and white matter volumes associated with explicit memory dysfunction in patients with generalized anxiety disorder.

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    Moon, Chung-Man; Jeong, Gwang-Woo

    2017-03-01

    Background The neuroanatomical abnormalities associated with behavioral dysfunction on explicit memory in patients generalized anxiety disorder (GAD) have not yet been clearly identified. Purpose To investigate the regional gray matter (GM) and white matter (WM) volume alterations over the whole brain in patients with GAD, as well as the correlation between the brain structural abnormality and explicit memory dysfunction. Material and Methods Twenty patients with GAD and 20 healthy controls matched for age, sex, and education level underwent high-resolution T1-weighted magnetic resonance imaging (MRI). The participants performed the explicit memory tasks with the neutral and anxiety-inducing words. Results Patients with GAD showed significantly reduced GM volumes in the midbrain (MB), thalamus, hippocampus (Hip), insula, and superior temporal gyrus (STG); and reduced WM volumes in the MB, anterior limb of the internal capsule (ALIC), dorsolateral prefrontal cortex (DLPFC), and precentral gyrus (PrG). It is important to note that the GM volume of the Hip and the WM volume of the DLPFC were positively correlated with the recognition accuracy (%) in the explicit memory tasks with neutral and anxiety-inducing words, respectively. On the other hand, the WM volume of the PrG was negatively correlated with the reaction time in the same memory tasks. Conclusion This study demonstrated the regional volume changes on whole-brain GM and WM and the correlation between the brain structural alteration and explicit memory dysfunction in GAD patients. These findings would be helpful to understand the association between the brain structure abnormality and the functional deficit in the explicit memory in GAD.

  6. Practice-based learning and systems-based practice: detection and treatment monitoring of generalized anxiety and depression in primary care.

    Science.gov (United States)

    Zupancic, Melanie; Yu, Siegfried; Kandukuri, Rajeev; Singh, Shilpa; Tumyan, Anna

    2010-09-01

    Quality assurance/quality improvement projects are an important part of professional development in graduate medical education. The purpose of our quality improvement study was to evaluate whether (1) the Generalized Anxiety Disorder (GAD-7) scale questionnaire increases detection of anxiety and (2) the Quick Inventory for Depressive Symptomatology Self Report (QIDS-SR) increases detection of depression in a primary care setting. We also aimed to determine whether monitoring patients with depression or generalized anxiety using the QIDS-SR and GAD-7 scales influences treatment changes in the primary care setting. Patients seen in a general internal medicine clinic between August 2008 and March 2009 were asked to fill out the QID-SR questionnaire and GAD-7 as part of a resident quality improvement project. We measured the prevalence of anxiety and depression during 6 months prior to the use of the GAD-7 and QIDS-SR instruments during the intervention period. We also compared the frequency of treatment changes initiated both 12 months prior to and during the intervention period. The aforementioned measures were performed with use of a retrospective chart review. The prevalence of anxiety was 15.2% in the pre-intervention period and 33.3% in the intervention period, and the prevalence of depression was 38.9% in the prescreening period and 54.8% during the screening period (P value for both was <0.001). The change in anxiety therapy was 21.6% in the prescreening period and 62.2% in the screening period (P  =  .028). The change in depression therapy was 23.2% in the pre-intervention period and 52.1% in the intervention period (P  =  .025). Routine screening for depression and anxiety may help clinicians detect previously undiagnosed anxiety and depression and also may facilitate identification of needed treatment changes. Further work is needed to determine whether routine screening improves patient outcomes.

  7. Influence of Anxiety and Depression Status of Family Members on the General 
Psychological Status of Perioperative Patients with Lung Cancer

    Directory of Open Access Journals (Sweden)

    Xianning WU

    2011-12-01

    Full Text Available Background and objective Facing the double pressures caused by cancer and surgery, many patients will appear series psychological problems like nervous, fear, pessimism, anxiety and so on. The aim of this study is to explone the anxiety, depression status of family members, the general psychological status of perioperative patients with lung cancer and the influence of the former on the latter. Methods Total 97 patients and 97 patient family members from the thoracic department of the Second Xiangya Hospital of Central South University were enrolled as the study subjects. The general information, the anxiety and depression status of the family members, and the general psychological status of perioperative patients with lung cancer were investigated using self-made general information questionnaire, self-rating anxiety scale (SAS, self-rating depression scale (SDS and symptom check-list 90 (SCL-90. Results The scores of seven factors, including total scores (153.28±41.98, somatization (1.78±0.42, compulsion (1.96±0.52, depression (1.77±0.67, anxiety (1.82±0.56, hostility (1.68±0.87, panic (1.44±0.75 and psychosis (1.56±0.51 in SCL-90 were remarkerbly higher than those in domestic norm (P<0.05. The standard score in SAS of the family members was positively correlated with the compulsion, anxiety and bigoted factors of SCL-90 in the patients (P<0.05. The depression severity of the family members was negatively correlated with the compulsion and psychosis factors of SCL-90 in the patients (P<0.05. Conclusion Family members have different degrees of anxiety and depression, which have certain effects on the general psychological status of perioperative patients with lung cancer.

  8. The Yin and Yang of support from significant others: Influence of general social support and partner support of avoidance in the context of treatment for social anxiety disorder.

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    Rapee, Ronald M; Peters, Lorna; Carpenter, Leigh; Gaston, Jonathan E

    2015-06-01

    Support from social networks is generally considered to protect against mental disorder but in some circumstances support for negative behaviours (such as avoidance) may be counterproductive. Given the critical interplay between social anxiety disorder and social interactions, it is surprising that the relationship of support from significant others to this disorder has received so little attention. The current study evaluated the reciprocal relationships between perceived social support and perceived partner support for avoidance behaviours (avoidance support) among a sample of 131 participants with social anxiety disorder who were assessed three times within the context of a treatment outcome study. A new measure of partner support for avoidance behaviours was developed, called the Avoidance Support Measure, and showed adequate internal consistency and construct validity. Correlations at baseline showed significant negative relationships between perceived social support and social anxiety and significant positive relationships between avoidance support and social anxiety. Path analysis showed that perceived social support at Times 1 and 2 negatively predicted future social anxiety at Times 2 and 3. On the other hand, only a single predictive relationship involving avoidance support was significant and showed that social anxiety at Time 1 positively predicted avoidance support at Time 2. These early results point to the different ways that support from significant others might relate to social anxiety and suggest that further work in this area may be fruitful.

  9. Venlafaxine versus applied relaxation for generalized anxiety disorder: a randomized controlled study on clinical and electrophysiological outcomes.

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    Zullino, Daniele; Chatton, Anne; Fresard, Emmanuelle; Stankovic, Miroslava; Bondolfi, Guido; Borgeat, François; Khazaal, Yasser

    2015-03-01

    Some components of generalized anxiety disorder, such as physical symptoms, are thought to reflect autonomic nervous system arousal. This study primarily assessed the relationships between psychophysiological and clinical measures using venlafaxine extended release or applied relaxation, and secondarily, the impact of combination treatment in patients not remitting after 8 weeks. Fifty-eight patients were randomly assigned to 8 weeks of treatment with either venlafaxine or applied relaxation (Phase I). Non-remitted patients received combination treatment for an additional 8 weeks (Phase II). Assessments included the Hamilton Anxiety Scale (HAM-A), Beck Depression Inventory, Penn State Worry Questionnaire and the Stroop Color-Word Task coupled with electrophysiological measures (skin conductance and frontalis electromyography (EMG)). In Phase 1, a time effect was found for the clinical and skin conductance measures. Thirteen patients from each group were in remission. In Phase 2, seven additional patients remitted. Baseline psychophysiological measures were not associated with baseline clinical variables or with clinical outcomes. Independently of treatment allocation, a reduction in frontal EMG values at week 4 was significantly associated with a decrease in HAM-A scores at week 8. At week 4, responders from the applied relaxation group had lower electrophysiological activity than the venlafaxine group. Baseline psychophysiological measures were not linked with clinical measures at study inclusion or with treatment response. Frontal EMG response at week 4 is a possible predictor of treatment response. Treatment combination enhances treatment response after initial failure.

  10. Group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder: an effectiveness trial.

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    McEvoy, Peter M; Erceg-Hurn, David M; Anderson, Rebecca A; Campbell, Bruce N C; Swan, Amanda; Saulsman, Lisa M; Summers, Mark; Nathan, Paula R

    2015-04-01

    Generalized anxiety disorder (GAD) is a common and highly comorbid anxiety disorder characterized by repetitive negative thinking (RNT). Treatment trials tend to exclude individuals with non-primary GAD, despite this being a common presentation in real world clinics. RNT is also associated with multiple emotional disorders, suggesting that it should be targeted regardless of the primary disorder. This study evaluated the acceptability and effectiveness of brief group metacognitive therapy (MCT) for primary or non-primary GAD within a community clinic. Patients referred to a specialist community clinic attended six, two-hour weekly sessions plus a one-month follow-up (N=52). Measures of metacognitive beliefs, RNT, symptoms, positive and negative affect, and quality of life were completed at the first, last, and follow-up sessions. Attrition was low and large intent-to-treat effects were observed on most outcomes, particularly for negative metacognitive beliefs and RNT. Treatment gains increased further to follow-up. Benchmarking comparisons demonstrated that outcomes compared favorably to longer disorder-specific protocols for primary GAD. No control group or independent assessment of protocol adherence. Brief metacognitive therapy is an acceptable and powerful treatment for patients with primary or non-primary GAD. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Alexithymia, Suicide Ideation, C-Reactive Protein, and Serum Lipid Levels Among Outpatients with Generalized Anxiety Disorder.

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    De Berardis, Domenico; Serroni, Nicola; Campanella, Daniela; Marini, Stefano; Rapini, Gabriella; Valchera, Alessandro; Iasevoli, Felice; Mazza, Monica; Fornaro, Michele; Perna, Giampaolo; Di Iorio, Giuseppe; Martinotti, Giovanni; Di Giannantonio, Massimo

    2017-01-02

    The aim of the present study was to investigate the relationships between alexithymia, suicide ideation, C-Reactive Protein (CRP), and serum lipid levels in adult outpatients with a DSM-IV diagnosis of Generalized Anxiety Disorder (GAD). Seventy consecutive patients with GAD were recruited and evaluated. Measures were the Hamilton Anxiety Scale, the Toronto Alexithymia Scale (TAS-20), the Scale of Suicide Ideation (SSI), and the Montgomery Åsberg Depression Rating Scale (MADRS). All patients were assessed for: CRP, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG), and very-low-density lipoprotein cholesterol (VLDL-C). TC/HDL-C and LDL-C/HDL-C ratios were also evaluated. Alexithymic patients showed higher scores on almost all rating scales and altered serum CRP and lipid levels vs. non-alexithymics. In the hierarchical regression model, the presence of higher MADRS scores together with higher scores at the Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher rates of suicide ideation. Although alexithymic subjects with GAD may show a CRP and cholesterol dysregulation, this latter seems independent on increased suicide ideation, rather to Difficulty in Identifying Feelings, and subthreshold depressive symptoms. Study limitations and future research implications are discussed.

  12. Aberrant Functional Connectivity between the Amygdala and the Temporal Pole in Drug-Free Generalized Anxiety Disorder.

    Science.gov (United States)

    Li, Wei; Cui, Huiru; Zhu, Zhipei; Kong, Li; Guo, Qian; Zhu, Yikang; Hu, Qiang; Zhang, Lanlan; Li, Hui; Li, Qingwei; Jiang, Jiangling; Meyers, Jordan; Li, Jianqi; Wang, Jijun; Yang, Zhi; Li, Chunbo

    2016-01-01

    The amygdala and the dorsolateral prefrontal cortex (DLPFC) play important roles in "emotion dysregulation," which has a profound impact on etiologic research of generalized anxiety disorder (GAD). The present study analyzed both eyes-open and eyes-closed resting state functional MRI (rs-fMRI) of 43 subjects (21 GAD patients with medicine free and 22 matched healthy controls). The amygdala and the DLPFC were defined as regions of interest (ROI) to analyze functional connectivity (FC) in GAD patients compared with healthy controls. The main findings revealed GAD patients had increased FC between the amygdala and the temporal pole compared to healthy controls, which was found in both eyes-open and eyes-closed rs-fMRI. And altered FC between the ROIs and brain regions that mainly belonged to the default mode network (DMN) were found. These findings suggest that the abnormal FC between the amygdala and the temporal pole may contribute to the pathophysiology of GAD, and provide insights into the current understanding of the emotion dysregulation of anxiety disorders.

  13. Reduced white matter integrity and its correlation with clinical symptom in first-episode, treatment-naive generalized anxiety disorder.

    Science.gov (United States)

    Wang, Wei; Qian, Shaowen; Liu, Kai; Li, Bo; Li, Min; Xin, Kuolin; Sun, Gang

    2016-11-01

    The purpose of this study was to explore white matter microstructural alterations in the patients with generalized anxiety disorder (GAD) using diffusion tensor imaging (DTI) technique, and to assess neural associations with the symptom severity. Twenty-eight first-episode, treatment-naive GAD patients without co-morbidities and 28 matched healthy controls underwent DTI acquisition and clinical symptom assessments. Tract-based spatial statistics (TBSS) was used to analyze white matter microstructural abnormalities in patients with GAD, as well as their associations with clinical symptom scores in a voxel-wise manner. Compared to controls, patients showed decreased fractional anisotropy (FA) values in 7 clusters of white matter in bilateral uncinate fasciculus, body of corpus callosum, left middle cingulum (cingulate gyrus), bilateral anterior thalamic radiation and corona radiate, right anterior limb of internal capsule, bilateral inferior frontal-occipital fasciculus, bilateral superior and inferior longitudinal fasciculus, and increased mean diffusivity and radial diffusivity in widespread white matter regions. Reduced FA values in right uncinate fasciculus, left cingulum bundle showed significantly negative correlations with clinical symptom severity for Hamilton anxiety Rating Scale scores. Our findings suggest microstructural abnormalities in uncinate fasciculus and cingulum bundle play key roles in the underlying neural basis of GAD.

  14. Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder.

    Science.gov (United States)

    Bomyea, J; Ramsawh, H; Ball, T M; Taylor, C T; Paulus, M P; Lang, A J; Stein, M B

    2015-06-01

    Growing evidence suggests that intolerance of uncertainty (IU) is a cognitive vulnerability that is a central feature across diverse anxiety disorders, including generalized anxiety disorder (GAD). Although cognitive behavioral therapy (CBT) has been shown to reduce IU, it remains to be established whether or not reductions in IU mediate reductions in worry. This study examined the process of change in IU and worry in a sample of 28 individuals with GAD who completed CBT. Changes in IU and worry, assessed bi-weekly during treatment, were analyzed using multilevel mediation models. Results revealed that change in IU mediated change in worry (ab = -0.20; 95% CI [-.35, -.09]), but change in worry did not mediate change in IU (ab = -0.16; 95% CI [-.06, .12]). Findings indicated that reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment, suggesting that changes in IU are not simply concomitants of changes in worry. Findings support the idea that IU is a critical construct underlying GAD.

  15. Validity of the 12-item General Health Questionnaire (GHQ-12) in detecting depressive and anxiety disorders among high school students.

    Science.gov (United States)

    Baksheev, Gennady Nickolaevich; Robinson, Jo; Cosgrave, Elizabeth Mary; Baker, Kathryn; Yung, Alison Ruth

    2011-05-15

    Despite the common use of the 12-item General Health Questionnaire (GHQ-12) with adolescents, there is limited data supporting its validity with this population. The aims of the study were to investigate the psychometric properties of the GHQ-12 among high school students, to validate the GHQ-12 against the gold standard of a diagnostic interview, and to suggest a threshold score for detecting depressive and anxiety disorders. Six hundred and fifty-four high school students from years 10 to 12 (ages 15-18) completed the GHQ-12 (Likert scored) and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Test Revision (DSM-IV-TR). Receiver operating characteristic (ROC) curves were plotted. The mean GHQ-12 score for the total sample was 9.9 (S.D.=5.4). Results from the ROC curve indicated that the GHQ-12 performed better than chance at identifying depressive and anxiety disorders (area under the curve (AUC)=0.781). A GHQ-12 threshold score of 9/10 for males and 10/11 for females was found to be optimal. Given the significant proportion of mental illness among high school students, there may be a need to introduce screening for mental illnesses as part of the school curriculum. This can assist with the early identification and enable low stigma preventive intervention within the school environment.

  16. Which factors influence onset and latency to treatment in generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder?

    Science.gov (United States)

    Benatti, Beatrice; Camuri, Giulia; Dell'Osso, Bernardo; Cremaschi, Laura; Sembira, Ester; Palazzo, Carlotta; Oldani, Lucio; Dobrea, Cristina; Arici, Chiara; Primavera, Diego; Carpiniello, Bernardo; Castellano, Filippo; Carrà, Giuseppe; Clerici, Massimo; Baldwin, David S; Altamura, Alfredo Carlo

    2016-11-01

    Anxiety disorders are common, comorbid, and disabling conditions, often underdiagnosed and under-treated, typically with an early onset, chronic course, and prolonged duration of untreated illness. The present study aimed to explore the influence of sociodemographic and clinical factors in relation to onset and latency to treatment in patients with generalized anxiety disorder (GAD), panic disorder (PD), and obsessive-compulsive disorder (OCD). A total of 157 patients with a Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision (DSM-IV-TR) diagnosis of PD (n=49), GAD (n=68), and OCD (n=40) were recruited, and epidemiological and clinical variables were collected through a specific questionnaire. Statistical analyses were carried out to compare variables across diagnostic groups. PD, GAD, and OCD patients showed a duration of untreated illness of 53.9±81.5, 77.47±95.76, and 90.6±112.1 months, respectively. Significant differences between groups were found with respect to age, age of first diagnosis, age of first treatment, family history of psychiatric illness, onset-related stressful events, benzodiazepine prescription as first treatment, antidepressant prescription as first treatment, and help-seeking (self-initiated vs. initiated by others). Patients with GAD, PD, and OCD showed significant differences in factors influencing onset and latency to treatment, which may, in turn, affect condition-related outcome and overall prognosis. Further studies with larger samples are warranted in the field.

  17. Aberrant functional connectivity between the amygdala and the temporal pole in drug-free generalized anxiety disorder

    Directory of Open Access Journals (Sweden)

    Wei Li

    2016-11-01

    Full Text Available The amygdala and the dorsolateral prefrontal cortex (DLPFC play important roles in emotion dysregulation, which has a profound impact on etiologic research of generalized anxiety disorder (GAD. The present study analyzed both eyes-open and eyes-closed resting state functional MRI (rs-fMRI of 43 subjects (21 GAD patients with medicine free and 22 matched healthy controls. The amygdala and the DLPFC were defined as regions of interest (ROI to analyze functional connectivity (FC in GAD patients compared with healthy controls. The main findings revealed GAD patients had increased FC between the amygdala and the temporal pole compared to healthy controls, which was found in both eyes-open and eyes-closed rs-fMRI. And altered FC between the ROIs and brain regions that mainly belonged to the default mode network (DMN were found. These findings suggest that the abnormal FC between the amygdala and the temporal pole may contribute to the pathophysiology of GAD, and provide insights into the current understanding of the emotion dysregulation of anxiety disorders.

  18. Pregabalin for the treatment of patients with generalized anxiety disorder with inadequate treatment response to antidepressants and severe depressive symptoms.

    Science.gov (United States)

    Olivares, José M; Álvarez, Enrique; Carrasco, José L; Pérez Páramo, María; López-Gómez, Vanessa

    2015-09-01

    To evaluate the effectiveness of pregabalin in patients with resistant generalized anxiety disorder (GAD) and severe depressive symptoms, we carried out a post-hoc analysis of a multicenter, prospective, and observational 6-month study. We included patients who were at least 18 years old, fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for GAD, showed inadequate responses to previous courses of antidepressant treatment, had Montgomery-Asberg Rating Scale scores of at least 35, had not received pregabalin previously, and were prescribed pregabalin upon entry into this study. We included 1815 patients fulfilling the DSM-IV criteria for GAD, and 133 (7.3%) fulfilled the selection criteria for these analyses. Ninety-seven percent of the patients received pregabalin (mean dose: 222 mg/day) in combination with other psychotropics. The Hamilton Anxiety Scale total score was reduced by a mean of 20.3 points (95% confidence interval, 22.1-18.4) (57.2% reduction) at month 6. Pregabalin also ameliorated comorbid depressive symptoms, with a reduction in the mean score of the Montgomery-Asberg Rating Scale of 22.3 points (95% confidence interval, 24.2-20.4) (56.6% reduction). Our results suggest that pregabalin, as part of a combination regimen with antidepressants and/or benzodiazepines, might be effective for the treatment of patients with GAD who have shown inadequate response to previous antidepressants and have severe depressive symptoms.

  19. Early improvement with pregabalin predicts endpoint response in patients with generalized anxiety disorder: an integrated and predictive data analysis.

    Science.gov (United States)

    Montgomery, Stuart A; Lyndon, Gavin; Almas, Mary; Whalen, Ed; Prieto, Rita

    2017-01-01

    Generalized anxiety disorder (GAD), a common mental disorder, has several treatment options including pregabalin. Not all patients respond to treatment; quickly determining which patients will respond is an important treatment goal. Patient-level data were pooled from nine phase II and III randomized, double-blind, short-term, placebo-controlled trials of pregabalin for the treatment of GAD. Efficacy outcomes included the change from baseline in the Hamilton Anxiety Scale (HAM-A) total score and psychic and somatic subscales. Predictive modelling assessed baseline characteristics and early clinical responses to determine those predictive of clinical improvement at endpoint. A total of 2155 patients were included in the analysis (1447 pregabalin, 708 placebo). Pregabalin significantly improved the HAM-A total score compared with the placebo at endpoint, treatment difference (95% confidence interval), -2.61 (-3.21 to -2.01), Ppredictive of an endpoint greater than or equal to 50% improvement in the HAM-A total score. Pregabalin is an effective treatment option for patients with GAD. Patients with early response to pregabalin are more likely to respond significantly at endpoint.

  20. Developmental Dynamics of General and School-Subject-Specific Components of Academic Self-Concept, Academic Interest, and Academic Anxiety.

    Science.gov (United States)

    Gogol, Katarzyna; Brunner, Martin; Preckel, Franzis; Goetz, Thomas; Martin, Romain

    2016-01-01

    The present study investigated the developmental dynamics of general and subject-specific (i.e., mathematics, French, and German) components of students' academic self-concept, anxiety, and interest. To this end, the authors integrated three lines of research: (a) hierarchical and multidimensional approaches to the conceptualization of each construct, (b) longitudinal analyses of bottom-up and top-down developmental processes across hierarchical levels, and (c) developmental processes across subjects. The data stemmed from two longitudinal large-scale samples (N = 3498 and N = 3863) of students attending Grades 7 and 9 in Luxembourgish schools. Nested-factor models were applied to represent each construct at each grade level. The analyses demonstrated that several characteristics were shared across constructs. All constructs were multidimensional in nature with respect to the different subjects, showed a hierarchical organization with a general component at the apex of the hierarchy, and had a strong separation between the subject-specific components at both grade levels. Further, all constructs showed moderate differential stabilities at both the general (0.42 < r < 0.55) and subject-specific levels (0.45 < r < 0.73). Further, little evidence was found for top-down or bottom-up developmental processes. Rather, general and subject-specific components in Grade 9 proved to be primarily a function of the corresponding components in Grade 7. Finally, change in several subject-specific components could be explained by negative effects across subjects.

  1. Developmental Dynamics of General and School-Subject-Specific Components of Academic Self-Concept, Academic Interest, and Academic Anxiety

    Directory of Open Access Journals (Sweden)

    Katarzyna eGogol

    2016-03-01

    Full Text Available The present study investigated the developmental dynamics of general and subject-specific (i.e., mathematics, French, and German components of students’ academic self-concept, anxiety, and interest. To this end, the authors integrated three lines of research: (a hierarchical and multidimensional approaches to the conceptualization of each construct, (b longitudinal analyses of bottom-up and top-down developmental processes across hierarchical levels, and (c ipsative developmental processes across subjects. The data stemmed from two longitudinal large-scale samples (N = 3,498 and N = 3,863 of students attending Grades 7 and 9 in Luxembourgish schools. Nested-factor models were applied to represent each construct at each grade level. The analyses demonstrated that several characteristics were shared across constructs. All constructs were multidimensional in nature with respect to the different subjects, showed a hierarchical organization with a general component at the apex of the hierarchy, and had a strong separation between the subject-specific components at both grade levels. Further, all constructs showed moderate differential stabilities at both the general (.42 < r < .55 and subject-specific levels (.45 < r < .73. Further, little evidence was found for top-down or bottom-up developmental processes. Rather, general and subject-specific components in Grade 9 proved to be primarily a function of the corresponding components in Grade 7. Finally, change in several subject-specific components could be explained by negative, ipsative effects across subjects.

  2. Self-reported social skills impairment explains elevated autistic traits in individuals with generalized social anxiety disorder.

    Science.gov (United States)

    Tonge, Natasha A; Rodebaugh, Thomas L; Fernandez, Katya C; Lim, Michelle H

    2016-03-01

    Screening for autism in individuals with generalized social anxiety disorder (GSAD) is complicated by symptom overlap between GSAD and autism spectrum disorder (ASD). We examined the prevalence of self-reported autistic traits within a sample of participants with a diagnosis of GSAD (n=37) compared to individuals without a GSAD diagnosis (NOSAD; n=26). Of the GSAD sample participants, 70.84% self-reported autistic traits above a cut-off of 65 on the Autism Quotient-Short (AQ-S) and reported significantly more autistic traits on 3 of 5 AQ-S subscales compared to the NOSAD group. Diagnosis uniquely predicted variation in the social skills subscale above and beyond the other subscales and other predictors. Furthermore, variation in the social skills subscale largely explained group differences on the other subscales. Our results suggest caution in utilizing measures like the AQ-S with clinical populations characterized by social difficulties such as individuals with a GSAD diagnosis.

  3. Inattention symptoms and the diagnosis of comorbid attention-deficit/hyperactivity disorder among youth with generalized anxiety disorder.

    Science.gov (United States)

    Elkins, R Meredith; Carpenter, Aubrey L; Pincus, Donna B; Comer, Jonathan S

    2014-12-01

    Generalized anxiety disorder (GAD) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur in childhood. Inattention symptoms can be hallmarks of both conditions, however assessment tools of inattention may not effectively distinguish between the two conditions. The present study used receiver operating characteristic (ROC) analyses to examine the high-end specificity of the Attention Problems Scale of the Child Behavior Checklist (CBCL) for detecting comorbid ADHD among youth with GAD (N=46). Results support the utility of the Attention Problems Scale for accurately distinguishing between the two groups (AUC=.84, SE=.06). Specifically, a cut score of 63 achieved the most favorable values across diagnostic utility indices; 74% of GAD youth with ADHD scored above this cutoff and 91% of GAD youth without ADHD scored below this cutoff. Findings provide support for the use of the CBCL Attention Problems Scale to supplement diagnostic interviews and identify inattention associated with ADHD among GAD youth.

  4. Client Retrospective Accounts of Corrective Experiences in Motivational Interviewing Integrated With Cognitive Behavioral Therapy for Generalized Anxiety Disorder.

    Science.gov (United States)

    Macaulay, Christianne; Angus, Lynne; Khattra, Jasmine; Westra, Henny; Ip, Jennifer

    2017-02-01

    A corrective experience (CE) is one "in which a person comes to understand or experience affectively an event or relationship in a different and unexpected way" (Castonguay & Hill, 2012, p. 5). CEs disconfirm clients' expectations based on past problematic experiences, and can be emotional, relational, behavioral, and/or cognitive. This qualitative study explored corrective shifts among recovered participants (N = 8) who had received motivational interviewing (MI) integrated with cognitive behavioral therapy (CBT) in a randomized controlled trial comparing CBT alone to MI-CBT for generalized anxiety disorder (Westra, Constantino, & Antony, 2016). We administered a posttherapy interview querying their experience of, and explanations for, any shifts in therapy. Grounded theory analysis yielded three core themes: in command of the worry train, experiencing myself in new ways in therapy, and oriented toward change. Findings are discussed in terms of MI theory, and clinical implications for therapists are provided.

  5. Screening for Generalized Anxiety Disorder Symptoms in the Wake of Terrorist Attacks: A Study in Primary Care

    Science.gov (United States)

    Ghafoori, Bita; Neria, Yuval; Gameroff, Marc J.; Olfson, Mark; Lantigua, Rafael; Shea, Steven; Weissman, Myrna M.

    2013-01-01

    Little is known about the mental health impact of terrorism beyond posttraumatic stress disorder (PTSD) and depression. The associations between exposure to the September 11, 2001 (9/11) attacks in New York City and generalized anxiety disorder (GAD) symptoms were examined in a sample of 929 primary care patients. After controlling for PTSD, depression, panic and substance use disorders, and pre-9/11 trauma, patients who screened positive (vs. negative) for GAD symptoms were roughly twice as likely to report having a loved one at the 9/11 disaster site, twice as likely to know someone who was killed by the attacks, and twice as likely to know someone who was involved with the rescue/recovery efforts after the disaster. Implications for treatment and future research are discussed. PMID:19475656

  6. Metacognitions mediate HIV stigma and depression/anxiety in men who have sex with men living with HIV

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    Esben Strodl

    2015-04-01

    Full Text Available The study examined whether the relationships between HIV stigma and depression and anxiety would be mediated by metacognitive beliefs and thought control strategies in men who have sex with men living with HIV. Men who have sex with men living with HIV completed an online survey that measured 30-item Metacognitions Questionnaire, thought control strategies (Thought Control Questionnaire, as well as symptoms of depression (Patient Health Questionnaire-9 and anxiety (generalized anxiety disorder-7. The relationships between internalised and anticipated HIV stigma with depressive symptoms were mediated by Negative Metacognitive Beliefs and the use of Worry and Social thought control strategies. Negative Metacognitive Beliefs mediated the association between internalised HIV stigma and anxiety symptoms.

  7. Telephone-delivered psychotherapy for rural-dwelling older adults with generalized anxiety disorder: study protocol of a randomized controlled trial.

    Science.gov (United States)

    Brenes, Gretchen A; Danhauer, Suzanne C; Lyles, Mary F; Miller, Michael E

    2014-02-08

    Generalized Anxiety Disorder (GAD), characterized by excessive and uncontrollable worry, has a negative impact on the health, well-being, and functioning of older adults. Cognitive behavioral therapy has demonstrated efficacy in reducing anxiety and worry in older adults, but the generalizability of these findings to community-dwelling older adults is unknown. The aim of the current study is to examine the efficacy of a cognitive-behavioral intervention delivered by telephone in reducing anxiety and worry in rural community-dwelling older adults with GAD. We propose a randomized controlled trial comparing telephone-delivered cognitive behavioral therapy (CBT-T) with nondirective supportive therapy (NST-T). One hundred seventy six adults 60 years and older diagnosed with GAD will be randomized to one of the two treatment conditions. The primary outcomes are self-report worry and clinician-rated anxiety. Secondary outcomes include depressive symptoms, sleep, quality of life, and functional status. It is hypothesized that CBT-T will be superior to NST-T in reducing anxiety and worry among older adults with GAD. Further, CBT-T is hypothesized to be superior to NST-T in reducing problems with depressive symptoms, sleep, functional status and quality of life. If this program is successful, it could be implemented as a low-cost program to treat late-life anxiety, especially in rural areas or in circumstances where older adults may not have access to qualified mental health providers. clinicaltrials.gov Identifier: NCT01259596.

  8. Immediate effect of mind sound resonance technique on state anxiety and cognitive functions in patients suffering from generalized anxiety disorder: A self-controlled pilot study

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    Vipin Dhansoia

    2015-01-01

    Conclusion: This pilot study suggests that MSRT may have a potential role in reducing state anxiety and enhancing psychomotor performance in patients suffering from GAD immediately after the practice. These findings need confirmation from studies with a larger sample size and randomized controlled design, which are implicated in the future.

  9. Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder

    Science.gov (United States)

    Zhou, Yongjie; Cao, Zhongqiang; Yang, Mei; Xi, Xiaoyan; Guo, Yiyang; Fang, Maosheng; Cheng, Lijuan; Du, Yukai

    2017-01-01

    The comorbidity of major depressive disorder (MDD) and generalized anxiety disorder (GAD) is common and often predicts poorer outcomes than either disorder alone. This study aimed to examine the prevalence of comorbid GAD and its association with quality of life (QOL) among MDD patients. A total of 1225 psychiatric outpatients were screened using the Hospital Anxiety and Depression Scale (HADS). Those who scored ≥8 on the HADS were interviewed using DSM-IV criteria by two senior psychiatrists. Patients diagnosed with MDD were further assessed using the 9-item Patient Health Questionnaire, Social Support Rating Scale, Pittsburgh Sleep Quality Index, and World Health Organization QOL Scale, brief version (WHOQOL-BREF). Ultimately, 667 patients were diagnosed with MDD, of 71.7% of whom had GAD. Compared to those with MDD alone, comorbid patients had lower scores on the physical (38.64 ± 10.35 vs.36.54 ± 12.32, P = 0.026) and psychological (35.54 ± 12.98 vs. 30.61 ± 14.66, P WHOQOL-BREF. The association between comorbid GAD and poor QOL on the two domains remained statistically significant in the multiple linear regression (unstandardized coefficients: −1.97 and −4.65, P < 0.001). In conclusion, the prevalence of comorbid GAD in MDD patients is high, and co-occurring GAD may exacerbate impaired physical and psychological QOL in Chinese MDD patients. PMID:28098176

  10. Effects of once-daily extended release quetiapine fumarate on patient-reported outcomes in patients with generalized anxiety disorder

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    Endicott J

    2012-07-01

    Full Text Available Jean Endicott,1 Henrik Svedsäter,2 Julie C Locklear21Department of Psychiatry, Columbia University, New York, NY; 2AstraZeneca Pharmaceuticals, Wilmington, DE, USABackground: We evaluated the effects of once-daily extended-release quetiapine fumarate (quetiapine XR on patient-reported outcomes in generalized anxiety disorder (GAD.Methods: This is a report of a pooled analysis from three acute 8-week, randomized, placebo-controlled, fixed-dose (50, 150, 300 mg/day studies and a 52-week maintenance flexible dose (50–300 mg/day study of quetiapine XR monotherapy in patients with GAD. Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF percent maximum total scores (items 1–14, item 15 ("satisfaction with medication", item 16 ("overall life satisfaction", and Pittsburgh Sleep Quality Index (PSQI global scores are reported. Sheehan Disability Scale (SDS total scores were also assessed (maintenance study only.Results: The acute studies showed significant improvements at week 8 in Q-LES-Q-SF percent maximum total score with quetiapine XR 150 mg/day (P < 0.001 and item 16 with quetiapine XR 50 (P < 0.05 and 150 mg/day (P < 0.001 versus placebo; PSQI global scores significantly improved with quetiapine XR 50, 150, and 300 mg/day versus placebo (P < 0.001. The maintenance study showed significant benefits versus placebo with quetiapine XR 50–300 mg/day in Q-LES-Q-SF percent total score, item 15 and item 16 scores, PSQI global score, and SDS total score.Conclusion: Quetiapine XR 150 mg/day (acute studies and 50–300 mg/day (maintenance study improved quality of life, overall functioning, and sleep quality in patients with GAD.Keywords: atypical antipsychotic, anxiety disorders, quality of life, sleep quality, functioning, randomized studies

  11. A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population--a meta-analysis of 31 studies.

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    Kedzior, Karina Karolina; Laeber, Lisa Tabata

    2014-05-10

    The aim of the current study was to investigate the association between anxiety and cannabis use/cannabis use disorders in the general population. A total of N = 267 studies were identified from a systematic literature search (any time- March 2013) of Medline and PsycInfo databases, and a hand search. The results of 31 studies (with prospective cohort or cross-sectional designs using non-institutionalised cases) were analysed using a random-effects meta-analysis with the inverse variance weights. Lifetime or past 12-month cannabis use, anxiety symptoms, and cannabis use disorders (CUD; dependence and/or abuse/harmful use) were classified according to DSM/ICD criteria or scores on standardised scales. There was a small positive association between anxiety and either cannabis use (OR = 1.24, 95% CI: 1.06-1.45, p = .006; N = 15 studies) or CUD (OR = 1.68, 95% CI: 1.23-2.31, p = .001; N = 13 studies), and between comorbid anxiety + depression and cannabis use (OR = 1.68, 95% CI: 1.17-2.40, p = .004; N = 5 studies). The positive associations between anxiety and cannabis use (or CUD) were present in subgroups of studies with ORs adjusted for possible confounders (substance use, psychiatric illness, demographics) and in studies with clinical diagnoses of anxiety. Cannabis use at baseline was significantly associated with anxiety at follow-up in N = 5 studies adjusted for confounders (OR = 1.28, 95% CI: 1.06-1.54, p = .01). The opposite relationship was investigated in only one study. There was little evidence for publication bias. Anxiety is positively associated with cannabis use or CUD in cohorts drawn from some 112,000 non-institutionalised members of the general population of 10 countries.

  12. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder.

    Science.gov (United States)

    Woelk, H; Schläfke, S

    2010-02-01

    Generalized and persistent anxiety, accompanied by nervousness and other symptoms (Generalised Anxiety Disorder, GAD) is frequent in the general population and leads to benzodiazepine usage. Unfortunately, these substances induce sedation and have a high potential for drug abuse, and there is thus a need for alternatives. As the anxiolytic properties of lavender have already been demonstrated in pharmacological studies and small-scale clinical trials, it was postulated that lavender has a positive effect in GAD. A controlled clinical study was then performed to evaluate the efficacy of silexan, a new oral lavender oil capsule preparation, versus a benzodiazepine. In this study, the efficacy of a 6-week-intake of silexan compared to lorazepam was investigated in adults with GAD. The primary target variable was the change in the Hamilton Anxiety Rating Scale (HAM-A-total score) as an objective measurement of the severity of anxiety between baseline and week 6. The results suggest that silexan effectively ameliorates generalized anxiety comparable to a common benzodiazepine (lorazepam). The mean of the HAM-A-total score decreased clearly and to a similar extent in both groups (by 11.3+/-6.7 points (45%) in the silexan group and by 11.6+/-6.6 points (46%) in the lorazepam group, from 25+/-4 points at baseline in both groups). During the active treatment period, the two HAM-A subscores "somatic anxiety" (HAM-A subscore I) and "psychic anxiety" (HAM-A subscore II) also decreased clearly and to a similar extent in both groups. The changes in other subscores measured during the study, such as the SAS (Self-rating Anxiety Scale), PSWQ-PW (Penn State Worry Questionnaire), SF 36 Health survey Questionnaire and Clinical Global Impressions of severity of disorder (CGI item 1, CGI item 2, CGI item 3), and the results of the sleep diary demonstrated comparable positive effects of the two compounds. In conclusion, our results demonstrate that silexan is as effective as lorazepam

  13. A Randomized Controlled Trial of Cognitive-Behavioral Therapy for Generalized Anxiety Disorder with Integrated Techniques from Emotion-Focused and Interpersonal Therapies

    Science.gov (United States)

    Newman, Michelle G.; Castonguay, Louis G.; Borkovec, Thomas D.; Fisher, Aaron J.; Boswell, James F.; Szkodny, Lauren E.; Nordberg, Samuel S.

    2011-01-01

    Objective: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal…

  14. Disability in anxiety disorders.

    Science.gov (United States)

    Hendriks, Sanne M; Spijker, Jan; Licht, Carmilla M M; Beekman, Aartjan T F; Hardeveld, Florian; de Graaf, Ron; Batelaan, Neeltje M; Penninx, Brenda W J H

    2014-09-01

    This study compares disability levels between different anxiety disorders and healthy controls. We further investigate the role of anxiety arousal and avoidance behaviour in disability, and whether differences in these symptom patterns contribute to disability differences between anxiety disorders. Data were from 1826 subjects from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose anxiety disorders. The World Health Organization Disability Assessment Schedule II was used to measure disability in six domains (cognition, mobility, selfcare, social interaction, life activities, participation). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire. All anxiety disorders were associated with higher disability. Disability was generally highest in multiple anxiety disorder (e.g. mean disability in cognition=33.7) and social anxiety disorder (mean=32.7), followed by generalized anxiety disorder (mean=27.2) and panic disorder with agoraphobia (mean=26.3), and lowest in panic disorder without agoraphobia (mean=22.1). Anxiety arousal was more associated with disability in life activities (B=8.5, panxiety disorders were not completely explained by anxiety arousal and avoidance behaviour. The cross-sectional study design precludes any causal interpretations. In order to examine the full range of comorbidity among anxiety, a greater range of anxiety disorders would have been preferable. Disability is highest in social anxiety disorder and multiple anxiety disorder. Both anxiety arousal and avoidance behaviour are associated with higher disability levels but do not fully explain the differences across anxiety disorders. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. [The practice guideline 'Anxiety disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice

    NARCIS (Netherlands)

    Weel-Baumgarten, E.M. van; Rijswijk, E. van

    2005-01-01

    The recommendations provided by the revised guideline 'Anxiety disorders' are well suited to every-day practice. The multidisciplinary approach reflects the increasing cooperation between primary and secondary care in the management of mental-health problems. The description of the various anxiety d

  16. General self-efficacy, pre-competitive anxiety and flow feeling in handball team players from Costa Rica’s nactional team

    OpenAIRE

    Gutiérrez Vargas, Juan Carlos; Gutiérrez Vargas, Randall; Ureña Bonilla, Pedro

    2013-01-01

    The purpose of this study was to describe and analyze the relationship between self-efficacy, pre-competitive anxiety and flow feeling in male and female handball team players from the  Costa Rica national teams. Participants were 28 players (14 male and 14 female) from both teams. The scales of general self-efficacy, flow feeling and competitive anxiety were used to collect data. The average score in relation to self-efficacy was high (> 8.40). Regarding flow sensation, the average scores we...

  17. Characterizing sexual function in patients with generalized anxiety disorder: a pooled analysis of three vilazodone studies

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    Clayton AH

    2016-06-01

    Full Text Available Anita H Clayton,1 Suresh Durgam,2 Xiongwen Tang,2 Changzheng Chen,2 Adam Ruth,3 Carl Gommoll2 1Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, 2Forest Research Institute, Jersey City, NJ, 3Prescott Medical Communications Group, Chicago, IL, USA Background: Vilazodone has been shown to reduce core symptoms of generalized anxiety disorder (GAD in three randomized, double-blind, placebo-controlled trials. Since sexual dysfunction (SD is not well characterized in GAD, a post hoc analysis of these trials was conducted to evaluate the effects of vilazodone on sexual functioning in GAD patients. Materials and methods: Data were pooled from one fixed-dose trial of vilazodone 20 and 40 mg/day (NCT01629966 and two flexible-dose studies of vilazodone 20–40 mg/day (NCT01766401, NCT01844115 in adults with GAD. Sexual functioning was assessed using the Changes in Sexual Functioning Questionnaire (CSFQ. Outcomes included mean change from baseline to end of treatment (EOT in CSFQ total score and percentage of patients shifting from SD at baseline (CSFQ total score ≤47 for males, ≤41 for females to normal functioning at EOT. Treatment-emergent adverse events related to sexual functioning were also analyzed. Results: A total of 1,373 patients were included in the analyses. SD at baseline was more common in females (placebo, 46.4%; vilazodone, 49% than in males (placebo, 35.1%; vilazodone, 40.9%. CSFQ total score improvement was found in both females (placebo, +1.2; vilazodone, +1.6 and males (placebo, +2.1; vilazodone, +1.0, with no statistically significant differences between treatment groups. The percentage of patients who shifted from SD at baseline to normal sexual functioning at EOT was higher in males (placebo, 40.6%; vilazodone, 35.7% than in females (placebo, 24.9%; vilazodone, 34.9%; no statistical testing was performed. Except for erectile dysfunction and delayed ejaculation in vilazodone

  18. Risky music listening, permanent tinnitus and depression, anxiety, thoughts about suicide and adverse general health.

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    Ineke Vogel

    Full Text Available OBJECTIVE: To estimate the extent to which exposure to music through earphones or headphones with MP3 players or at discotheques and pop/rock concerts exceeded current occupational safety standards for noise exposure, to examine the extent to which temporary and permanent hearing-related symptoms were reported, and to examine whether the experience of permanent symptoms was associated with adverse perceived general and mental health, symptoms of depression, and thoughts about suicide. METHODS: A total of 943 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their sociodemographics, music listening behaviors and health. Multiple logistic regression analyses were used to examine associations. RESULTS: About 60% exceeded safety standards for occupational noise exposure; about one third as a result of listening to MP3 players. About 10% of the participants experienced permanent hearing-related symptoms. Temporary hearing symptoms that occurred after using an MP3 player or going to a discotheque or pop/rock concert were associated with exposure to high-volume music. However, compared to participants not experiencing permanent hearing-related symptoms, those experiencing permanent symptoms were less often exposed to high volume music. Furthermore, they reported at least two times more often symptoms of depression, thoughts about suicide and adverse self-assessed general and mental health. CONCLUSIONS: Risky music-listening behaviors continue up to at least the age of 25 years. Permanent hearing-related symptoms are associated with people's health and wellbeing. Participants experiencing such symptoms appeared to have changed their behavior to be less risky. In order to induce behavior change before permanent and irreversible hearing-related symptoms occur, preventive measurements concerning hearing health are needed.

  19. Depression and anxiety in relation to catechol-O-methyltransferase Val158Met genotype in the general population: The Nord-Trøndelag Health Study (HUNT

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    Zwart John-Anker

    2008-06-01

    Full Text Available Abstract Background The catechol-O-methyltransferase (COMT gene contains a functional polymorphism, Val158Met, which has been linked to anxiety and depression, but previous results are not conclusive. The aim of the present study was to examine the relationship between the Val158Met COMT gene polymorphism and anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS in the general adult population. Methods In the Nord-Trøndelag Health Study (HUNT the association between the Val158Met polymorphism and anxiety and depression was evaluated in a random sample of 5531 individuals. Two different cut off scores (≥ 8 and ≥ 11 were used to identify cases with anxiety (HADS-A and depression (HADS-D, whereas controls had HADS-A Results The COMT genotype distribution was similar between controls and individuals in the groups with anxiety and depression using cut-off scores of ≥ 8. When utilizing the alternative cut-off score HADS-D ≥ 11, Met/Met genotype and Met allele were less common among men with depression compared to the controls (genotype: p = 0.017, allele: p = 0.006. In the multivariate analysis, adjusting for age and heart disease, depression (HADS-D ≥ 11 was less likely among men with the Met/Met genotype than among men with the Val/Val genotype (OR = 0.37, 95% CI = 0.18–0.76. Conclusion In this population-based study, no clear association between the Val158Met polymorphism and depression and anxiety was revealed. The Met/Met genotype was less likely among men with depression defined as HADS-D ≥ 11, but this may be an incidental finding.

  20. A study of depression and anxiety, general health, and academic performance in three cohorts of veterinary medical students across the first three semesters of veterinary school.

    Science.gov (United States)

    Reisbig, Allison M J; Danielson, Jared A; Wu, Tsui-Feng; Hafen, McArthur; Krienert, Ashley; Girard, Destiny; Garlock, Jessica

    2012-01-01

    This study builds on previous research on predictors of depression and anxiety in veterinary medical students and reports data on three veterinary cohorts from two universities through their first three semesters of study. Across all three semesters, 49%, 65%, and 69% of the participants reported depression levels at or above the clinical cut-off, suggesting a remarkably high percentage of students experiencing significant levels of depression symptoms. Further, this study investigated the relationship between common stressors experienced by veterinary students and mental health, general health, and academic performance. A factor analysis revealed four factors among stressors common to veterinary students: academic stress, transitional stress, family-health stress, and relationship stress. The results indicated that both academic stress and transitional stress had a robust impact on veterinary medical students' well-being during their first three semesters of study. As well, academic stress negatively impacted students in the areas of depression and anxiety symptoms, life satisfaction, general health, perception of academic performance, and grade point average (GPA). Transitional stress predicted increased depression and anxiety symptoms and decreased life satisfaction. This study helped to further illuminate the magnitude of the problem of depression and anxiety symptoms in veterinary medical students and identified factors most predictive of poor outcomes in the areas of mental health, general health, and academic performance. The discussion provides recommendations for considering structural changes to veterinary educational curricula to reduce the magnitude of academic stressors. Concurrently, recommendations are suggested for mental health interventions to help increase students' resistance to environmental stressors.

  1. General self-efficacy, pre-competitive anxiety and flow feeling in handball team players from Costa Rica’s nactional team

    Directory of Open Access Journals (Sweden)

    Juan Carlos Gutiérrez Vargas

    2013-12-01

    Full Text Available The purpose of this study was to describe and analyze the relationship between self-efficacy, pre-competitive anxiety and flow feeling in male and female handball team players from the  Costa Rica national teams. Participants were 28 players (14 male and 14 female from both teams. The scales of general self-efficacy, flow feeling and competitive anxiety were used to collect data. The average score in relation to self-efficacy was high (> 8.40. Regarding flow sensation, the average scores were range from 3.41 (autotelic experience  to 5,78 (control sense. Somatic anxiety was the lowest in men = 1.59 and women female = 1.98, and self-confidence was the highest score in men = 2.99 and women = 2.70 respectively.  No significant changes were observed throughout the game in relation to the flow feeling. The anxiety reported by men was significantly lower than women, and the self-confidence levels were higher in men than in women. No significant correlation was found between self efficacy and sense of flow.  Somatic anxiety showed significant correlations with some dimensions of the flow feeling. In conclusion, these data showed that there is a need to incorporate psychological interventions to ensure that athletes can reach optimal psychophysical states in order to perform better.

  2. Screening instruments for a population of older adults: The 10-item Kessler Psychological Distress Scale (K10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7).

    Science.gov (United States)

    Vasiliadis, Helen-Maria; Chudzinski, Veronica; Gontijo-Guerra, Samantha; Préville, Michel

    2015-07-30

    Screening tools that appropriately detect older adults' mental disorders are of great public health importance. The present study aimed to establish cutoff scores for the 10-item Kessler Psychological Distress (K10) and the 7-item Generalized Anxiety Disorder (GAD-7) scales when screening for depression and anxiety. We used data from participants (n = 1811) in the Enquête sur la Santé des Aînés-Service study. Depression and anxiety were measured using DSM-V and DSM-IV criteria. Receiver operating characteristic (ROC) curve analysis provided an area under the curve (AUC) of 0.767 and 0.833 for minor and for major depression when using K10. A cutoff of 19 was found to balance sensitivity (0.794) and specificity (0.664) for minor depression, whereas a cutoff of 23 was found to balance sensitivity (0.692) and specificity (0.811) for major depression. When screening for an anxiety with GAD-7, ROC analysis yielded an AUC of 0.695; a cutoff of 5 was found to balance sensitivity (0.709) and specificity (0.568). No significant differences were found between subgroups of age and gender. Both K10 and GAD-7 were able to discriminate between cases and non-cases when screening for depression and anxiety in an older adult population of primary care service users. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Alterations in white matter volume and its correlation with clinical characteristics in patients with generalized anxiety disorder

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    Moon, Chung-Man [Chonnam National University Hospital, Research Institute for Medical Imaging, Gwangju (Korea, Republic of); Jeong, Gwang-Woo [Chonnam National University Hospital, Research Institute for Medical Imaging, Gwangju (Korea, Republic of); Chonnam National University Medical School, Department of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2015-11-15

    Only a few morphological studies have focused on changes in white matter (WM) volume in patients with generalized anxiety disorder (GAD). We evaluated alterations in WM volume and its correlation with symptom severity and duration of illness in adults with GAD. The 44 subjects were comprised of 22 patients with GAD (13 males and nine females) diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and 22 age-matched healthy controls (13 males and nine females). High-resolution magnetic resonance imaging (MRI) data were processed by voxel-based morphometry (VBM) analysis based on diffeomorphic anatomical registration using the exponentiated Lie algebra (DARTEL) algorithm in SPM8. Patients with GAD showed significantly reduced WM volume, particularly in the dorsolateral prefrontal cortex (DLPFC), anterior limb of the internal capsule (ALIC), and midbrain. In addition, DLPFC volume was negatively correlated with GAD-7 score and illness duration. ALIC volume was negatively correlated with GAD-7 score. Female patients had significantly less orbitofrontal cortex volume compared to that in male patients. The findings demonstrate localized changes in WM volume associated with cognitive and emotional dysfunction in patients with GAD. The finding will be helpful for understanding the neuropathology in patients with GAD. (orig.)

  4. Working memory dysfunction associated with brain functional deficits and cellular metabolic changes in patients with generalized anxiety disorder.

    Science.gov (United States)

    Moon, Chung-Man; Sundaram, Thirunavukkarasu; Choi, Nam-Gil; Jeong, Gwang-Woo

    2016-08-30

    Generalized anxiety disorder (GAD) is associated with brain functional and morphological changes in connected with emotional dysregulation and cognitive deficit. This study dealt with the neural functional deficits and metabolic abnormalities in working memory (WM) task with emotion-inducing distractors in patients with GAD. Fourteen patients with GAD and 14 healthy controls underwent functional magnetic resonance imaging (fMRI) and proton magnetic resonance spectroscopy ((1)H-MRS) at 3T. In response to the emotional distractors in WM tasks, the patients concurrently showed higher activity in the hippocampus and lower activities in the superior occipital gyrus, superior parietal gyrus, dorsolateral prefrontal cortex (DLPFC) and precentral gyrus compared to the controls. MRS revealed significantly lower choline/creatine (Cho/Cr) and choline/N-acetylaspartate (Cho/NAA) ratios in the DLPFC. In particular, the Cho ratios were positively correlated with the brain activities based on blood oxygenation level-dependent signal change in the DLPFC. This study provides the first evidence for the association between the metabolic alterations and functional deficit in WM processing with emotion-inducing distractors in GAD. These findings will be helpful to understand the neural dysfunction in connection with WM impairment in GAD.

  5. Aberrant regional neural fluctuations and functional connectivity in generalized anxiety disorder revealed by resting-state functional magnetic resonance imaging.

    Science.gov (United States)

    Wang, Wei; Hou, Jingming; Qian, Shaowen; Liu, Kai; Li, Bo; Li, Min; Peng, Zhaohui; Xin, Kuolin; Sun, Gang

    2016-06-15

    The purpose of this study was to investigate the neural activity and functional connectivity in generalized anxiety disorder (GAD) during resting state, and how these alterations correlate to patients' symptoms. Twenty-eight GAD patients and 28 matched healthy controls underwent resting-state functional magnetic resonance (fMRI) scans. Amplitude of low-frequency fluctuation (ALFF) and seed-based resting-state functional connectivity (RSFC) were computed to explore regional activity and functional integration, and were compared between the two groups using the voxel-based two-sample t test. Pearson's correlation analyses were performed to examine the neural relationships with demographics and clinical symptoms scores. Compared to controls, GAD patients showed functional abnormalities: higher ALFF in the bilateral dorsomedial prefrontal cortex, bilateral dorsolateral prefrontal cortex and left precuneus/posterior cingulate cortex; lower connectivity in prefrontal gyrus; lower in prefrontal-limbic and cingulate RSFC and higher prefrontal-hippocampus RSFC were correlated with clinical symptoms severity, but these associations were unable to withstand correction for multiple testing. These findings may help facilitate further understanding of the potential neural substrate of GAD.

  6. Intolerance of uncertainty, causal uncertainty, causal importance, self-concept clarity and their relations to generalized anxiety disorder.

    Science.gov (United States)

    Kusec, Andrea; Tallon, Kathleen; Koerner, Naomi

    2016-06-01

    Although numerous studies have provided support for the notion that intolerance of uncertainty plays a key role in pathological worry (the hallmark feature of generalized anxiety disorder (GAD)), other uncertainty-related constructs may also have relevance for the understanding of individuals who engage in pathological worry. Three constructs from the social cognition literature, causal uncertainty, causal importance, and self-concept clarity, were examined in the present study to assess the degree to which these explain unique variance in GAD, over and above intolerance of uncertainty. N = 235 participants completed self-report measures of trait worry, GAD symptoms, and uncertainty-relevant constructs. A subgroup was subsequently classified as low in GAD symptoms (n = 69) or high in GAD symptoms (n = 54) based on validated cut scores on measures of trait worry and GAD symptoms. In logistic regressions, only elevated intolerance of uncertainty and lower self-concept clarity emerged as unique correlates of high (vs. low) GAD symptoms. The possible role of self-concept uncertainty in GAD and the utility of integrating social cognition theories and constructs into clinical research on intolerance of uncertainty are discussed.

  7. Rethinking the role of worry in generalized anxiety disorder: evidence supporting a model of emotional contrast avoidance.

    Science.gov (United States)

    Llera, Sandra J; Newman, Michelle G

    2014-05-01

    The Contrast Avoidance model (Newman & Llera, 2011) proposes that individuals with generalized anxiety disorder (GAD) are hypersensitive to sharp upward shifts in negative emotion that typically accompany negative events, and use worry to maintain sustained intrapersonal negativity in an attempt to avoid these shifts. Although research shows that worry increases negative emotionality and mutes further emotional reactivity to a stressor when compared to the worry period (e.g., Llera & Newman, 2010), no study has tracked changes in negative emotionality from baseline to worry inductions followed by a range of emotional exposures. Further, no study has yet assessed participants' subjective appraisals of prior worry on helping to cope with such exposures. The present study tested the main tenets of the Contrast Avoidance model by randomly assigning participants with GAD (n=48) and nonanxious controls (n=47) to experience worry, relaxation, and neutral inductions prior to sequential exposure to fearful, sad, and humorous film clips. Both physiological (nonspecific skin conductance responses [NS-SCRs]) and self-reported emotional changes were observed. Results indicated that worry boosted negative emotionality from baseline, which was sustained across negative exposures, whereas low negative emotionality during relaxation and neutral inductions allowed for sharp increases in response to exposures. Furthermore, GAD participants found worry to be more helpful than other conditions in coping with exposures, whereas control participants reported the opposite pattern. Results provide preliminary support for the Contrast Avoidance model. This suggests that treatment should focus on underlying avoidance patterns before attempting to reduce worry behavior.

  8. Associations Between Compulsive Buying and Substance Dependence/Abuse, Major Depressive Episode, and Generalized Anxiety Disorder Among Men and Women

    Science.gov (United States)

    Zhang, Chenshu; Brook, Judith S.; Leukefeld, Carl G.; Brook, David W.

    2016-01-01

    Aims The objective of this study was to examine the associations between compulsive buying (CB) and substance dependence/abuse, major depressive episode (MDE), and generalized anxiety disorder (GAD) at mean age 43. Methods Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. The prevalence of substance dependence/abuse, MDE, and GAD (during the past 5 years before the interviews) was 6.6%, 13.7, and 11.5%, respectively. Results Logistic regression analyses showed that CB was significantly associated with substance dependence/abuse [Adjusted Odds Ratio (A.O.R.) = 1.60], MDE (A.O.R. = 1.70), and GAD (A.O.R. = 1.63), despite controlling for substance dependence/abuse, MDE, and GAD, respectively, at mean age 37, and demographic factors. Discussion Since the study sample is limited to predominantly white participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, MDE, and GAD consider the role of CB. PMID:27215919

  9. Mechanisms of change during group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder.

    Science.gov (United States)

    McEvoy, Peter M; Erceg-Hurn, David M; Anderson, Rebecca A; Campbell, Bruce N C; Nathan, Paula R

    2015-10-01

    Repetitive negative thinking (RNT) is a transdiagnostic process that serves to maintain emotional disorders. Metacognitive theory suggests that positive and negative metacognitive beliefs guide the selection of RNT as a coping strategy which, in turn, increases psychological distress. The aim of this study was to test the indirect effect of metacognitive beliefs on psychological distress via RNT. Patients (N=52) with primary and non-primary generalized anxiety disorder attended a brief, six-week group metacognitive therapy program and completed measures of metacognitive beliefs, RNT, and symptoms at the first and final treatment sessions, and at a one-month follow-up. Prospective indirect effects models found that negative metacognitive beliefs (but not positive metacognitive beliefs) had a significant indirect effect on psychological distress via RNT. As predicted by metacognitive theory, targeting negative metacognitions in treatment appears to reduce RNT and, in turn, emotional distress. Further research using alternative measures at multiple time points during therapy is required to determine whether the absence of a relationship with positive metacognitive beliefs in this study was a consequence of (a) psychometric issues, (b) these beliefs only being relevant to a subgroup of patients, or (c) a lack of awareness early in treatment.

  10. Tratamento farmacológico do transtorno de ansiedade generalizada: perspectivas futuras Pharmacological treatment of generalized anxiety disorder: future perspectives

    Directory of Open Access Journals (Sweden)

    Roberto Andreatini

    2001-12-01

    Full Text Available O presente artigo apresenta uma visão atualizada e ampla do tratamento farmacológico do transtorno de ansiedade generalizada (TAG. São revistos os medicamentos com eficácia comprovada em estudos controlados e atualmente disponíveis na clínica (benzodiazepínicos, buspirona, antidepressivos, betabloqueadores, antipsicóticos e extrato de kava-kava. A seguir, baseados nesses dados, propõe-se um algoritmo de tratamento do TAG. São apresentadas as principais linhas de pesquisa de novos fármacos ansiolíticos, descrevendo os principais achados clínicos e pré-clínicos.This article presents an updated and broad perspective of the pharmacological treatment of generalized anxiety disorder (GAD. Medications proven to be efficacious in controlled studies and available in the clinic setting were reviewed (benzodiazepines, buspirone, antidepressives, beta-blocking agents, antipsychotics and kava-kava extract. From this data, an algorithm for GAD treatment is proposed. In addition, the main research lines on new anxiolytic drugs and their stage of clinical or pre-clinical development are presented.

  11. Assessment of anxiety frequency and its trigger factors in patients referred to general dental offices in the city of Hamedan in 2005

    Directory of Open Access Journals (Sweden)

    Farhadinasab A.

    2008-10-01

    Full Text Available "nBackground and Aim: Oral health is a sign of overall health. Sometimes fear of dental office deprives  patients from receiving proper care. This problem decreases the self-esteem of dentists and can also reduce health indices. Understanding anxiety factors may help solve this problem. The purpose of this study was to assess anxiety in patients undergoing treatment in dental offices in the city of Hamedan. "nMaterials and Methods: In this analytic cross sectional study patients above 9 years old and referred to general dental offices in Hamedan were randomly selected and surveyed with questionnaires in two stages. The first questionnaire included 17 standard items based on Dental Anxiety Scale (DAS and screened anxious patients. Then 400 anxious patients were evaluated with a questionnaire of 64 items based on Corah scale. Data were analyzed by SPSS 13 with multivariate analysis of variance. P<0.05 was considered as the level of significance. "nResults: Factors related to dental office environment with 31.1%, those related to personal imaginations with 19.4% and factor concerning office management and dental treatment each with 19.1% frequency showed to be most related to anxiety in patients. Improper rest-rooms (46.3%, blood stains in the environment (44.5% and dirty dentist's gowns (43.8% were reported to be the most prominent environmental factors. Among the factors originated from personal imaginations, the risk of disease transmission was accounted for the most justifiable source of anxiety (67.3%. Regarding factors concerning office management, dentist's nervous behavior (47.8% and his carelessness to the patient (46.8% were considered as the most significant anxiety sources. Extraction, injection and root canal therapy (48.3%, 44.5%, 44.3% were the treatment related factors of higher importance respectively. Previous painful treatment experience (47.3% and poor oral hygiene of the dentist (34.5% were reported to be among the

  12. The extended-release formulation of quetiapine fumarate (quetiapine XR) adjunctive treatment in partially responsive generalized anxiety disorder (GAD): An open label naturalistic study.

    Science.gov (United States)

    Gabriel, A

    2011-01-01

    To assess the effect of adjunctive treatment with extended-release formulation of quetiapine fumarate (quetiapine XR) to other antidepressants in the treatment of partially responsive, poorly functioning patients with generalized anxiety disorder was assessed. Twenty four consenting adult outpatients with confirmed DSM-IV diagnosis of generalized disorder were identified. All patients failed at least one 8-week treatment trial with SSRI or SNRI antidepressant. All were treated with quetiapine XR as an add on treatment to citalopram or vanlafaxine antidepressant for at least 12 weeks. The primary efficacy measure was the Clinical Global Impression Scale (CGI-S). Other scales included; the Hamilton Anxiety Scale (HAM-A) scale, Sheehan Disability Scale, and the Abnormal Involuntary Movement Scale (AIMS). Baseline measures prior to adding quetiapine XR were compared to those at 4, 8 and 12 weeks with the adjunctive treatment. Twenty three patients completed the trial. There was significant rapid resolution of the anxiety symptoms in all effectiveness measures, including the symptoms of anxiety as shown by changes from baseline in HAM-A, and CGI at four weeks. Improvement was maintained to week twelve. Impairments in work, social, and home responsibilities were also reduced significantly, and there were no significant changes in weight at 12 weeks. Patients tolerated the adjunctive treatment well. Quetiapine XR may have anxiolytic properties and could be used effectively as adjunctive treatment with SSRIs in GAD patients with partial response to SSRs or SNRISs. However double blind randomized trials are needed to support these results.

  13. The Effectiveness of Group Training of CBT-Based Stress Management on Anxiety, Psychological Hardiness and General Self-Efficacy Among University Students.

    Science.gov (United States)

    Molla Jafar, Hamdam; Salabifard, Seddigheh; Mousavi, Seyedeh Maryam; Sobhani, Zahra

    2015-09-28

    Admission to university is a very sensitive period of life for efficient, active, and young workforces in any country, and it is mostly associated with many changes in social and human relationships. These changes lead to anxiety in students. Moreover, humans need certain functions in order to adaptively deal with different life situations and challenges. By training stress management, these functions can help human acquire the required abilities. The present study was aimed at investigating the effectiveness of stress management training in anxiety, psychological hardiness, and general self-efficacy among university students. The study was a quasi-experimental intervention (pretest-posttest-follow-up) including a control group, it was a fundamental applied study. The statistical population consisted of all students of Islamic Azad University, Karaj, Iran. Convenient sampling was employed to select 30 students who were divided into an experimental group (n=15) and a control group (n=15). Before stress management training, both groups filled out Beck Anxiety Inventory, Long and Goulet scale of psychological hardiness, and General Self-efficacy Scale (GSE-10). Afterwards, the experimental group was provided with stress management training. And after the experiment, the abovementioned questionnaires and scales were responded by the two groups. Finally the collected data were analyzed and compared using one-way MANOVA. The results of MANOVA indicated that there was a significant difference between the two groups in terms of anxiety, hardiness, and general self-efficacy (pstress management among university students cause anxiety to drop; moreover, it enhances their psychological hardiness and self-efficacy. In regard with the role and importance of stress management, training this skill should be included in educational plans of university.

  14. Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of BID versus TID dosing.

    Science.gov (United States)

    Pohl, Robert B; Feltner, Douglas E; Fieve, Ronald R; Pande, Atul C

    2005-04-01

    Pregabalin is a new anxiolytic that acts as a presynaptic inhibitor of the release of excessive levels of excitatory neurotransmitters by selectively binding to the alpha2-delta subunit of voltage-gated calcium channels. The current study evaluated the anxiolytic efficacy of BID versus TID dosing of pregabalin in patients with generalized anxiety disorder. Outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition generalized anxiety disorder and having baseline Hamilton Anxiety (HAM-A) total scores > or =20 were randomized to 6 weeks of double-blind treatment with pregabalin 200 mg/d (BID; N = 78), 400 mg/d (BID; N = 89), or 450 mg/d (TID; N = 88) or placebo (N = 86). Mean improvement in HAM-A total score at last observation carried forward end point was significantly greater on pregabalin 200 (P = 0.006), 400 (P = 0.001), and 450 mg/d (P = 0.005) compared with placebo. Pairwise comparisons of BID versus TID dosing found no difference in HAM-A change score at end point. All 3 pregabalin dosage groups showed significantly greater efficacy versus placebo at end point on the HAM-A psychic and somatic anxiety factor scores. Improvement on both factors was rapid: significance versus placebo was achieved as early as the first assessment at week 1, with > or =30% reduction in HAM-A severity and equal or greater improvement for every subsequent visit in > or =38% of patients in all 3 pregabalin dosage groups (P < or = 0.001). Pregabalin was well tolerated, and despite the fixed-dose study design, discontinuations caused by adverse events ranged from 9% to 13%--comparable with that observed with placebo (8%). This study demonstrates that pregabalin is an effective treatment of generalized anxiety disorder, with BID dosing showing similar efficacy and comparable tolerability with TID dosing.

  15. Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder

    DEFF Research Database (Denmark)

    Bech, Per; Lönn, Sara L; Overø, Kerstin F

    2010-01-01

    -Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery......-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization. RESULTS: All studies showed a statistically significant (P needed to treat approximately 4. Patients with residual symptoms (MADRS score...... > 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill...

  16. How people evaluate others with social anxiety disorder: A comparison to depression and general mental illness stigma.

    Science.gov (United States)

    Anderson, Kristin N; Jeon, Andrew B; Blenner, Jordan A; Wiener, Richard L; Hope, Debra A

    2015-03-01

    Despite the availability of effective interventions, most individuals with social anxiety disorder do not seek treatment. Given their fear of negative evaluation, socially anxious individuals might be especially susceptible to stigma concerns, a recognized barrier for mental health treatment. However, very little is known about the stigma specific to social anxiety disorder. In a design similar to Feldman and Crandall (2007), university undergraduate students read vignettes about target individuals with a generic mental illness label, major depressive disorder, and social anxiety disorder. Subjects rated each of 3 people in the vignettes on social distance and 17 dimensions including dangerousness, heritability and prevalence of the disorder, and gender ratio. Results indicated that being male and not having experience with mental health treatment was associated with somewhat greater preferred social distance. Multiple regression analyses revealed that being embarrassed by the disorder and dangerousness predicted social distance across all 3 vignettes. The vignette for social anxiety disorder had the most complex model and included work impairment, more common among women, and more avoidable. These results have implications for understanding the specific aspects of the stigma associated with social anxiety disorder. Public service messages to reduce stigma should focus on more accurate information about dangerousness and mental illness, given this is an established aspect of mental illness stigma. More nuanced messages about social anxiety might be best incorporated into the treatment referral process and as part of treatment. (c) 2015 APA, all rights reserved).

  17. Explicit memory in anxiety disorders

    NARCIS (Netherlands)

    Becker, E.S.; Roth, W.T.; Andrich, M.; Margraf, J.

    1999-01-01

    Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned

  18. Generalized anxiety disorder

    Science.gov (United States)

    ... muscle tension, upset stomach, sweating, or difficulty breathing. Exams and Tests There is no test that can ... you can help yourself get better by: Reducing caffeine Not using street drugs or large amounts of ...

  19. Generalized anxiety disorder - children

    Science.gov (United States)

    ... as death of a loved one or parents' divorce Big life changes, such as moving to a ... learn about your child's medicine, including possible side effects and interactions. Be sure your child takes any ...

  20. [Separation anxiety in children].

    Science.gov (United States)

    Purper-Ouakil, Diane; Franc, Nathalie

    2010-06-20

    Separation anxiety disorder can be differentiated from developmental anxiety because of its intensity, persistence and negative impact on adaptive functioning. This disorder is closely linked to other anxiety and mood disorders and can also be associated with externalizing psychopathology in children and adolescents. Severe separation anxiety can result in school refusal and intra-familial violence. Cognitive behavioral therapies have the best evidence-based support for the treatment of separation anxiety disorder in children and adolescents. In addition, it is important to detect factors associated with persistence of anxiety such as systematic avoidance of separation and parental overprotection. The role of pediatricians and general practitioners in recognizing clinical separation anxiety and encouraging appropriate care and positive parental attitudes is essential, as separation anxiety is often associated with a variety of somatic symptoms.

  1. Should Excessive Worry Be Required for a Diagnosis of Generalized Anxiety Disorder? Results from the US National Comorbidity Survey Replication

    Science.gov (United States)

    Ruscio, Ayelet Meron; Lane, Michael; Roy-Byrne, Peter; Stang, Paul E.; Stein, Dan J.; Wittchen, Hans-Ulrich; Kessler, Ronald C.

    2007-01-01

    Background Excessive worry is required by DSM-IV, but not ICD-10, for a diagnosis of generalized anxiety disorder (GAD). No large-scale epidemiological study has ever examined the implications of this requirement for estimates of prevalence, severity, or correlates of GAD. Methods Data were analyzed from the US National Comorbidity Survey Replication, a nationally representative, face-to-face survey of adults in the US household population that was fielded in 2001–2003. DSM-IV GAD was assessed with Version 3.0 of the WHO Composite International Diagnostic Interview. Non-excessive worriers meeting all other DSM-IV criteria for GAD were compared with respondents who met full GAD criteria as well as with other survey respondents to consider the implications of removing the excessiveness requirement. Results The estimated lifetime prevalence of GAD increases by approximately 40% when the excessiveness requirement is removed. Excessive GAD begins earlier in life, has a more chronic course, and is associated with greater symptom severity and psychiatric comorbidity than non-excessive GAD. However, non-excessive cases nonetheless evidence substantial persistence and impairment of GAD as well as significantly elevated comorbidity compared to respondents without GAD. Non-excessive cases also have socio-demographic characteristics and familial aggregation of GAD comparable to excessive cases. Conclusions Although individuals who meet all criteria for GAD other than excessiveness have a somewhat milder presentation than those with excessive worry, their syndromes are sufficiently similar to those with excessive worry to warrant a GAD diagnosis. PMID:16300690

  2. Internalizing Disorders and Leukocyte Telomere Erosion: A Prospective Study of Depression, Generalized Anxiety Disorder and Post-Traumatic Stress Disorder

    Science.gov (United States)

    Shalev, Idan; Moffitt, Terrie E.; Braithwaite, Antony W.; Danese, Andrea; Fleming, Nicholas I.; Goldman-Mellor, Sidra; Harrington, HonaLee; Houts, Renate M.; Israel, Salomon; Poulton, Richie; Robertson, Stephen P.; Sugden, Karen; Williams, Benjamin; Caspi, Avshalom

    2013-01-01

    There is evidence that persistent psychiatric disorders lead to age-related disease and premature mortality. Telomere length has emerged as a promising biomarker in studies that test the hypothesis that internalizing psychiatric disorders are associated with accumulating cellular damage. We tested the association between the persistence of internalizing disorders (depression, generalized anxiety disorder and post-traumatic stress disorder) and leukocyte telomere length (LTL) in the prospective-longitudinal Dunedin Study (N=1037). Analyses showed that the persistence of internalizing disorders across repeated assessments from ages 11 to 38 years predicted shorter LTL at age 38 years in a dose-response manner, specifically in men (β= −.137, 95% CI: −.232, −.042, p=.005). This association was not accounted for by alternative explanatory factors, including childhood maltreatment, tobacco smoking, substance dependence, psychiatric medication use, poor physical health, or low socioeconomic status. Additional analyses using DNA from blood collected at two time points (ages 26 and 38 years) showed that LTL erosion was accelerated among men who were diagnosed with internalizing disorder in the interim (β= −.111, 95% CI: −.184, −.037, p=.003). No significant associations were found among women in any analysis, highlighting potential sex differences in internalizing-related telomere biology. These findings point to a potential mechanism linking internalizing disorders to accelerated biological aging in the first half of the life course, particularly in men. Because internalizing disorders are treatable, the findings suggest the hypothesis that treating psychiatric disorders in the first half of the life course may reduce the population burden of age-related disease, and extend health expectancy. PMID:24419039

  3. The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Derek Richards

    2015-09-01

    Full Text Available Generalized Anxiety Disorder (GAD is typically considered a chronic condition characterized by excessive worry. Lifetime prevalence is 4.3–5.9%, yet only a small percentage seeks treatment. GAD is treatable and in recent years internet-delivered treatment interventions have shown promise. This paper aims to systematically search for literature on internet-delivered psychological interventions for the treatment of GAD and conduct a meta-analysis to examine their efficacy. The purpose of the paper is to inform the community of researchers, program developers and practitioners in internet delivered interventions of the current state-of-the-art and research gaps that require attention. A systematic search of the literature was conducted to find all studies of internet-delivered treatments for GAD (N = 20. Using Review Manager 5 all Randomized Controlled Trials (RCTs; n = 11 that met our established eligibility criteria were included into a meta-analysis that calculated effect sizes via the standardized mean difference. Compared to the waiting-list controls, the results demonstrate positive outcomes for GAD symptoms (d = −0.91 and its central construct of pathological worry (d = −0.74. The meta-analysis supports the efficacy of internet-delivered treatments for GAD including the use of disorder-specific (4 studies and transdiagnostic treatment protocols (7 studies. Caution is advised regarding the results as the data is limited and highly heterogeneous, but revealing of what future research might be needed.

  4. Effectiveness of gaseous and intravenous inductions on children′s anxiety and distress during extraction of teeth under general anesthesia

    Directory of Open Access Journals (Sweden)

    Giath Gazal

    2015-01-01

    Full Text Available Context: Anxiety and distress regarding dental treatment is a major issue for dental patients and can be exaggerated in pediatric dental patients. Aims: The aim was to investigate how different methods of induction for general anesthesia affect children′s distress for dental procedures such as extraction of teeth. Subjects and Methods: This was an observational clinical study conducted at Manchester University Dental Hospital. The induction of anesthesia in children was achieved with either intravenous (I.V. or a gaseous induction. The Modified Child Smiley Faces Scales were completed for children at various times intervals. Statistical Analysis Used: There were statistically significant differences between the mean distress scores for the I.V. and inhalation groups (P values from independent t-test: P < 0.001 was applied. Results: In gaseous induction group, the number of children who scored severe and very severe distress was greater than those who were in I.V. group. Gaseous induction was used for 23 children. Preoperatively, 56.5% children were in very severe distress, 17.4% in severe distress, 13% in moderate distress, 8.7% in mild distress and only one (4.3% showed no distress. For I.V. induction, 11.2% children were in very severe distress, 9% in severe distress, and 9.6% in moderate distress, 24.2% in mild distress and 46.1% showed no distress. Conclusions: Gaseous induction anesthesia for extractions of teeth does produce high levels of distress than I.V. induction in children for dental extractions. There was no significant difference between both induction methods in terms of distress levels at the time of recovery and 15 min postoperatively.

  5. ANXIETY DISORDERS: A REVIEW

    Directory of Open Access Journals (Sweden)

    Arya Ashwani

    2011-05-01

    Full Text Available Anxiety disorders are a highly prevalent and disabling class of psychiatric disorders. Anxiety disorders are highly prevalent and associated with substantial distress, morbidity and mortality. Recent epidemiological studies of anxiety disorders provided evidence of their high frequency in the general population worldwide. Anxiety disorders afflict an estimated 15.7 million people in the United States each year. Anxiety disorders are highly prevalent in adults with females showing higher preponderance of 2:1 as compared to males. Anxiety disorders are a group of mental disorders characterized by various combinations of key features - Irritability, fear, Insomnia, Nervousness, Tachycardia, Inability to concentrate, poor coping skills, Palpitation, Sweating, Agoraphobia and Social Withdrawal. The anxiety disorders, including panic disorder (PD, generalized anxiety disorder (GAD, social anxiety disorder (SAD, and posttraumatic stress disorder (PTSD, are among the disabling medical disorders. The neurobiology of anxiety disorders is not fully understood, but several different biologic abnormalities have been implicated in their etiology. The GABA, NE and 5HT systems play crucial roles in mediating the affective circuitry underlying the highly related clinical disorders of anxiety. Anxiety is a common psychiatric condition characterized by unnecessary aggression, poor quality of life, fear, worry, avoidance, and compulsive rituals that are associated with significant distress.

  6. Modeling the longitudinal latent effect of pregabalin on self-reported changes in sleep disturbances in outpatients with generalized anxiety disorder managed in routine clinical practice

    Directory of Open Access Journals (Sweden)

    Ruiz MA

    2015-08-01

    Full Text Available Miguel A Ruiz,1 Enrique Álvarez,2 Jose L Carrasco,3 José M Olivares,4 María Pérez,5 Javier Rejas6 1Department of Methodology, School of Psychology, Universidad Autónoma de Madrid, Madrid, 2Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona, 3Department of Psychiatry, Hospital Clínico San Carlos, Madrid, 4Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo, 5Medical Department, Pfizer, S.L.U., Alcobendas, Madrid, 6Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas, Madrid, Spain Background: Anxiety disorders are among the most common psychiatric illnesses, with generalized anxiety disorder (GAD being one of the most common. Sleep disturbances are highly prevalent in GAD patients. While treatment with pregabalin has been found to be associated with significant improvement in GAD-related sleep disturbance across many controlled clinical trials, mediational analysis has suggested that a substantial portion of this effect could be the result of a direct effect of pregabalin. Thus, the objective of this study was to model the longitudinal latent effect of pregabalin or usual care (UC therapies on changes in sleep in outpatients with GAD under routine clinical practice. Methods: Male and female GAD outpatients, aged 18 years or above, from a 6-month prospective noninterventional trial were analyzed. Direct and indirect effects of either pregabalin or UC changes in anxiety symptoms (assessed with Hamilton Anxiety Scale and sleep disturbances (assessed with Medical Outcomes Study-Sleep Scale [MOS-S] were estimated by a conditional latent curve model applying structural equation modeling. Results: A total of 1,546 pregabalin-naïve patients were analyzed, 984 receiving pregabalin and 562 UC. Both symptoms of anxiety and sleep disturbances were significantly improved in both groups, with higher mean (95% confidence interval score reductions in subjects receiving

  7. The effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing pathological worry in patients with generalized anxiety disorder: a preliminary study

    OpenAIRE

    Farima Rezvani; Shiva Dowlatabadi; Safieh Behzadi

    2015-01-01

    Aim of the study The current study aimed to investigate the effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing pathological worry in patients with generalized anxiety disorder (GAD). Subject or material and methods Method. Three women with GAD were selected using a purposeful sampling method based on the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). A baseline single-case experimental design was used and participants were...

  8. Resistência ao tratamento nos transtornos de ansiedade: fobia social, transtorno de ansiedade generalizada e transtorno do pânico Treatment-resistant anxiety disorders: social phobia, generalized anxiety disorder and panic disorder

    Directory of Open Access Journals (Sweden)

    Gabriela Bezerra de Menezes

    2007-10-01

    , and finally, some strategies to deal with anxiety disorders (including social anxiety disorder, generalized anxiety disorder and panic disorder that do not respond to standard therapeutic interventions. CONCLUSION: Treatment resistance in anxiety disorders remains a challenge to clinical practice going from non standardized concepts of response and resistance to a paucity of controlled studies concerning therapeutic strategies.

  9. A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population- a meta-analysis of 31 studies

    Science.gov (United States)

    2014-01-01

    Background The aim of the current study was to investigate the association between anxiety and cannabis use/cannabis use disorders in the general population. Methods A total of N = 267 studies were identified from a systematic literature search (any time- March 2013) of Medline and PsycInfo databases, and a hand search. The results of 31 studies (with prospective cohort or cross-sectional designs using non-institutionalised cases) were analysed using a random-effects meta-analysis with the inverse variance weights. Lifetime or past 12-month cannabis use, anxiety symptoms, and cannabis use disorders (CUD; dependence and/or abuse/harmful use) were classified according to DSM/ICD criteria or scores on standardised scales. Results There was a small positive association between anxiety and either cannabis use (OR = 1.24, 95% CI: 1.06-1.45, p = .006; N = 15 studies) or CUD (OR = 1.68, 95% CI: 1.23-2.31, p = .001; N = 13 studies), and between comorbid anxiety + depression and cannabis use (OR = 1.68, 95% CI: 1.17-2.40, p = .004; N = 5 studies). The positive associations between anxiety and cannabis use (or CUD) were present in subgroups of studies with ORs adjusted for possible confounders (substance use, psychiatric illness, demographics) and in studies with clinical diagnoses of anxiety. Cannabis use at baseline was significantly associated with anxiety at follow-up in N = 5 studies adjusted for confounders (OR = 1.28, 95% CI: 1.06-1.54, p = .01). The opposite relationship was investigated in only one study. There was little evidence for publication bias. Conclusion Anxiety is positively associated with cannabis use or CUD in cohorts drawn from some 112,000 non-institutionalised members of the general population of 10 countries. PMID:24884989

  10. Test Anxiety

    Science.gov (United States)

    ... I Help Someone Who's Being Bullied? Volunteering Test Anxiety KidsHealth > For Teens > Test Anxiety Print A A ... with their concentration or performance. What Is Test Anxiety? Test anxiety is actually a type of performance ...

  11. Comparison of psychological placebo and waiting list control conditions in the assessment of cognitive behavioral therapy for the treatment of generalized anxiety disorder: a meta-analysis.

    Science.gov (United States)

    Zhu, Zhipei; Zhang, Li; Jiang, Jiangling; Li, Wei; Cao, Xinyi; Zhou, Zhirui; Zhang, Tiansong; Li, Chunbo

    2014-12-01

    There is ongoing debate about the efficacy of placebos in the treatment of mental disorders. In randomized control trials (RCTs) about the treatment of generalized anxiety disorder, the administration of a psychological placebo or placement on a waiting list are the two most common control conditions. But there has never been a systematic comparison of the clinical effect of these different strategies. Compare the change in symptom severity among individuals treated with cognitive behavioral therapy, provided a psychological placebo, or placed on a waiting list using data from RCTs on generalized anxiety disorder. The following databases were searched for RCTs on generalized anxiety disorder: PubMed, PsycInfo, EMBASE, The Cochrane Library, CNKI, Chongqing VIP, Wanfang, Chinese Biological Medical Literature Database, and Taiwan Electronic Periodical Services. Studies were selected based on pre-defined inclusion and exclusion criteria and the quality of each included study - based on the risk of bias and the level of evidence - was formally assessed. Meta-analysis was conducted using RevMan5.3 and network meta-analyses comparing the three groups were conducted using R. Twelve studies with a combined sample size of 531 were included in the analysis. Compared to either control method (placebo or waiting list), cognitive behavioral therapy was more effective for generalized anxiety disorder. Provision of a psychological placebo was associated with a significantly greater reduction of symptoms than placement on a waiting list. Eight of the studies were classified as 'high risk of bias', and the overall level of evidence was classified as 'moderate', indicating that further research could change the overall results of the meta-analysis. RCTs about the treatment of generalized anxiety disorders are generally of moderate quality; they indicate the superiority of CBT but the results cannot, as yet, be considered robust. There is evidence of a non-negligible treatment effect

  12. Factors Associated with Types of Mathematics Anxiety in College Students.

    Science.gov (United States)

    Bessant, Kenneth C.

    1995-01-01

    Factor analysis of a version of the Mathematics Anxiety Rating Scale (MARS) and the Study Process Questionnaire (SPQ) given to (n=173) introductory statistics students found 6 factors: general evaluation anxiety, everyday numerical anxiety, passive observation anxiety, performance anxiety, mathematics test anxiety, and problem-solving anxiety. (39…

  13. La preocupación como estrategia de afrontamiento en pacientes con trastornos de ansiedad generalizada Worry as coping strategy in patients with generalized anxiety disorder

    Directory of Open Access Journals (Sweden)

    Giselle Vetere

    2011-12-01

    Full Text Available El siguiente trabajo se enmarca dentro de un proyecto UBACyT sobre conductas de afrontamiento en trastornos de ansiedad. En el presente artículo se muestran los resultados de una revisión bibliográica sobre la utilización de la preocupación como estrategia de afrontamiento en pacientes con trastorno de ansiedad generalizada. El método utilizado consistió en una búsqueda de los trabajos disponibles en las bases de datos PubMed, Scielo, Lilacs y Ebsco utilizando como palabras clave afrontamiento, ansiedad generalizada y preocupación. En primer lugar se describen brevemente las características del cuadro y se define el concepto de afrontamiento y sus diversos tipos. Seguidamente, en base a los resultados obtenidos en la búsqueda se analiza el concepto de preocupación así como las consecuencias de su uso como estrategia de afrontamiento en pacientes con trastorno de ansiedad generalizada. Finalmente se discuten las implicancias de los resultados para el tratamiento del cuadro.The following work is part of a research project about coping behaviors in anxiety disorders. In this paper we show the results of a literature review focused on the use of worry as a coping strategy in patients with generalized anxiety disorder. The method used consisted of a bibliographic search of the available studies in the PubMed, Scielo, Lilacs and Ebsco databases using the terms coping strategies, generalized anxiety and concern as keywords. First, we briely describe the characteristics of the disorder and deine the concept of coping and its diverse forms. Then, following the results found in the search we explore the concept of worry and the consequences of its use as a coping strategy in patients with generalized anxiety disorder. Finally, we discuss the implications of the results for the treatment of the disorder.

  14. Comparative analysis of serum zinc, copper, manganese, iron, calcium, and magnesium level and complexity of interelement relations in generalized anxiety disorder patients.

    Science.gov (United States)

    Islam, Md Reazul; Ahmed, Maizbha Uddin; Mitu, Shahida Akter; Islam, Mohammad Safiqul; Rahman, G K M Mustafizur; Qusar, M M A Shalahuddin; Hasnat, Abul

    2013-07-01

    The purpose of the study was to determine the concentration of serum trace and other essential elements of generalized anxiety disorder patients and to find out the relationship between element levels and nutritional status or socioeconomic factors. The study was conducted among 50 generalized anxiety disorder patients and 51 healthy volunteers. Patients were selected and recruited in the study with the help of a clinical psychologist by random sampling. The concentrations of serum trace elements (Zn, Cu, Mn, and Fe) and other two essential elements (Ca and Mg) were determined by graphite furnace and flame atomic absorption spectroscopy. Data were analyzed by independent t test, Pearson's correlation analysis, regression analysis, and analysis of variance. The serum concentrations of Zn, Cu, Mn, Fe, Ca, and Mg in generalized anxiety disorder patients were 1.069 ± 0.40, 1.738 ± 0.544, 1.374 ± 0.750, 3.203 ± 2.065, 108.65 ± 54.455, and 21 ± 4.055 mg/L, while those were 1.292 ± 0.621, 0.972 ± 0.427, 0.704 ± 0.527, 1.605 ± 1.1855, 101.849 ± 17.713, and 21.521 ± 3.659 mg/L in control subjects. Significantly decreased (p  0.05). Socioeconomic data revealed that most of the patients were in the lower middle class group and middle-aged. Mean BMI of the control group (23.63 ± 3.91 kg/m(2)) and the patient group (23.62 ± 3.77 kg/m(2)) was within the normal range (18.5-25.0 kg/m(2)). The data obtained from different interelement relations in the generalized anxiety disorder patients and control group strongly suggest that there is a disturbance in the element homeostasis. So changes in the serum trace element level in generalized anxiety disorder patients occur independently and they may provide a prognostic tool for the diagnosis and treatment of this disease.

  15. PERSONALITY ANALYSIS FOR PATIENTS WITH GENERALIZED ANXIETY DISORDER%广泛性焦虑障碍病人的人格分析

    Institute of Scientific and Technical Information of China (English)

    周田田; 刘春文; 牛娟

    2012-01-01

    Objective To study personality characteristics in patients with generalized anxiety disorder (GAD). Methods Thirty-eight patients with GAD were evaluated for their anxiety, mental health and personality characteristics by using Hamilton Anxiety Scale (HAMA), Symptom Checklist-90 (SCL-90), and Eysenck Personality Questionnaire (EPQ), respectively. Results The SCL-90 total score and nine sub-scores in the patients and their EPQ-N score were significantly higher than that of the norm (t=2. 975 - 28. 285,P<0. 01). The N score was positively correlated with scores of HAMA, SCL-90, somatization, obsessive state, interpersonal relations, depression, anxiety and phobia (r = 0. 393 - 0. 977, P<0. 05). Conclusion Patients with generalized anxiety disorder possess a personality characteristic of neuroticism, which is likely to affect the severity of anxiety and mental health.%目的 研究广泛性焦虑障碍病人的人格特征.方法 对38例广泛性焦虑障碍病人使用汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)、艾森克人格问卷评估其焦虑程度、心理健康水平及人格特征.结果 广泛性焦虑障碍病人的SCL-90总分及9个因子分显著高于常模(t=2.975~17.531,P<0.01).广泛性焦虑障碍病人的N分显著高于常模(t=28.285,P<0.01),N分与HAMA总分、SCL-90总分及躯体化、强迫状态、人际关系敏感、抑郁、焦虑、恐怖各因子评分均呈显著正相关(r=0.393~0.977,P<0.05).结论 广泛性焦虑障碍病人具有神经质倾向的个性特征,神经质可能影响焦虑症状的严重程度,并且影响心理健康水平.

  16. Broadening the Definition of Generalized Anxiety Disorder: Effects on Prevalence and Associations with Other Disorders in the National Comorbidity Survey Replication

    Science.gov (United States)

    Ruscio, Ayelet Meron; Chiu, Wai Tat; Roy-Byrne, Peter; Stang, Paul E.; Stein, Dan J.; Wittchen, Hans-Ulrich; Kessler, Ronald C.

    2008-01-01

    Concerns have been raised that the DSM-IV requirements of six-month duration, excessive worry, and three associated symptoms exclude a substantial number of people with clinically significant anxiety from a diagnosis of generalized anxiety disorder (GAD). We examined the implications of relaxing these three criteria for the estimated prevalence and predictive validity of GAD using nationally representative data from the US National Comorbidity Survey Replication. Relaxing all three criteria more than doubles the estimated prevalence of GAD. Broadly-defined GAD significantly predicts the subsequent first onset of a wide range of temporally secondary disorders. The odds of secondary disorders are somewhat smaller for broadly-defined than DSM-IV GAD, though few of these differences are statistically significant. Results suggest that subthreshold manifestations of GAD are significantly related to elevated risk of subsequent psychopathology. Further research is needed to determine whether broadening the current diagnostic criteria results in a more valid characterization of GAD. PMID:17118626

  17. Culture-general and -specific associations of attachment avoidance and anxiety with perceived parental warmth and psychological control among Turk and Belgian adolescents.

    Science.gov (United States)

    Güngör, Derya; Bornstein, Marc H

    2010-10-01

    Both the adolescent peer attachment and perceived parenting style literatures emphasize the role of the quality of the parent-child relationship in children's healthy adjustment beyond the family, but few studies have investigated links between adolescents' peer attachment and perceptions of parenting. We investigate relations of adolescents' perceptions of warmth and psychological control from parents with avoidance and anxiety in attachment to close friends in two contrasting cultures. Altogether, 262 Turk and 263 Belgian youth between 14 and 18 years of age participated. Cross-culturally, attachment avoidance was negatively related to maternal warmth, and attachment anxiety positively related to maternal and paternal control and negatively to paternal warmth. Beyond these general relations, attachment avoidance was associated with paternal psychological control in Belgians but not in Turks. The study provides cross-cultural evidence for specific relations between peer attachment and perceived parenting and suggests a culture-specific pathway for the development of attachment avoidance.

  18. Generalized anxiety disorder and the Hamilton Anxiety Rating Scale in Parkinson's disease Transtorno de ansiedade generalizada e a Escala de Ansiedade de Hamilton na doença de Parkinson

    Directory of Open Access Journals (Sweden)

    Arthur Kummer

    2010-08-01

    Full Text Available Anxiety is common in Parkinson's disease (PD, but studies concerning specific anxiety disorders are scarce. Essential psychometric properties of anxiety rating scales are also lacking. OBJECTIVE: To investigate general anxiety disorder (GAD in PD and psychometric properties of the Hamilton Anxiety Rating Scale (Ham-A. METHOD: Ninety-one PD patients underwent neurological and psychiatric examination, which included the MINI-Plus, the Ham-A and the Hamilton Depression Rating Scale (Ham-D. RESULTS: GAD was present in 30.8% of PD patients. Patients with GAD had longer disease duration (p=0.044 and were in use of higher doses of levodopa (p=0.034. They also tended to have more motor fluctuations and dyskinesias. The group with GAD scored higher in Ham-A (pAnsiedade é comum na doença de Parkinson (DP, mas estudos sobre transtornos de ansiedade específicos são ainda escassos. Faltam também estudos sobre propriedades psicométricas essenciais das escalas de ansiedade. OBJETIVO: Investigar o transtorno de ansiedade generalizada (TAG na DP e propriedades psicométricas da Escala de Ansiedade de Hamilton (Ham-A. MÉTODO: Noventa e um pacientes com DP se submeteram a exames neurológico e psiquiátrico, que incluiu o MINI-Plus, a Ham-A e a Escala de Depressão de Hamilton (Ham-D. RESULTADOS: TAG esteve presente em 30,8% dos participantes. Pacientes com TAG tinham maior duração de doença (p=0,044 e estavam em uso de maiores doses de levodopa (p=0,034. Também havia uma tendência desses pacientes terem mais flutuações motoras e discinesias. O grupo com TAG pontuou mais alto na Ham-A (p<0,001, nas subescalas somática (p<0,001 e psíquica da Ham-A (p<0,001, e na Ham-D (p=0,004. A Ham-A mostrou boa consistência interna (alfa de Cronbach=0,893 e um ponto de corte de 10/11 é sugerido para triar o TAG. CONCLUSÃO: TAG é freqüente na DP e a Ham-A pode ser um instrumento útil para triar esse transtorno.

  19. Treatment of Depression and Anxiety by Naturopathic Physicians: An Observational Study of Naturopathic Medicine Within an Integrated Multidisciplinary Community Health Center.

    Science.gov (United States)

    Breed, Cindy; Bereznay, Catherine

    2017-05-01

    This project was designed to assess the quality of care received by patients with depression and anxiety who were seen by naturopathic physicians in a community health center. The Natural Medicine Quality Improvement Project for the Treatment of Depression and Anxiety (NMQP-DA) was conducted over a 26-month period from December 2009 through February 2012 at HealthPoint, a non-profit, consumer-governed, community health center network located in suburban King County, Washington. A total of 112 patients enrolled in the NMQP-DA, and 60 were seen for two or more visits, thus meeting eligibility criteria for inclusion in the study. The mean number of visits was 3.3. The Patient Health Questionnaire (PHQ-9) depression screener and the Generalized Anxiety Disorder 7-item scale (GAD-7) anxiety screener were the outcome measures. The overall improvement in symptoms of depression and anxiety was highly significant (p anxiety (12.4 vs. 7.2). The response rate, as measured by a 50% decrease in scores, for those with initial scores ≥10 was 58.6% for depression (PHQ-9) and 50% for anxiety (GAD-7). This study adds new data to the limited literature on the nature and effectiveness of naturopathic medicine to treat anxiety and depression in the context of an integrative community health center.

  20. Creating Low-anxiety Learning Atmosphere

    Institute of Scientific and Technical Information of China (English)

    潘若芸

    2008-01-01

    Researches show that language class can be anxiety-provoking for students. This paper discusses from a general explanations of language anxiety, to five potential sources of students for language anxiety, to an argument of ways in which anxiety is manifested in learners, and finally to list of suggestions for reducing anxiety.

  1. Effects of PRX-00023, a novel, selective serotonin 1A receptor agonist on measures of anxiety and depression in generalized anxiety disorder: results of a double-blind, placebo-controlled trial.

    Science.gov (United States)

    Rickels, Karl; Mathew, Sanjay; Banov, Michael D; Zimbroff, Daniel L; Oshana, Scott; Parsons, Edward C; Donahue, Stephen R; Kauffman, Michael; Iyer, Ganesh R; Reinhard, John F

    2008-04-01

    PRX-00023, a serotonin 1A receptor agonist, was designed to provide high potency and selectivity for its target. To assess the possible therapeutic utility in anxiety, a randomized, double-blind, placebo-controlled trial was conducted in 311 subjects who met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for generalized anxiety disorder. All subjects underwent a 1-week placebo run-in and were randomized to receive once-daily capsules containing either PRX-00023 (80 mg/d) or placebo for an additional 8 weeks. The primary outcome measure was the Hamilton Anxiety Scale (HAM-A). The Montgomery-Asberg Depression Rating Scale was used as a secondary endpoint to measure depressive symptoms. Statistical testing was performed with analysis of covariance, between baseline and week 8, with baseline values as a covariate. The anxiolytic effect of PRX-00023, compared with placebo, showed trends across all anxiolytic measures but failed to reach significance on the primary endpoint (HAM-A total score). Among the components of the HAM-A total score, the anxious mood item was significantly different from placebo in the PRX-00023-treated group (-1.015 vs -0.748; P = 0.02). The scores of the Montgomery-Asberg Depression Rating Scale were significantly improved compared with placebo at week 8 (-4.5 vs -1.6; P = 0.0094 in the last observation carried forward analysis). PRX-00023 was well tolerated; of note, there were no drug-related serious adverse events, and more patients discontinued due to adverse events in the placebo group (2.9%) than in the PRX-00023 group (1.4%). The most common adverse event was headache, observed in 15.7% and 10.9% of PRX-00023- and placebo-treated patients, respectively. Furthermore, there was no evidence of impaired sexual function, as measured by the Massachusetts General Hospital Sexual Function Scale. Collectively, these results support further clinical investigation of higher doses of PRX-00023 in anxiety

  2. Assessment of child behavior in dental operatory in relation to sociodemographic factors, general anxiety, body mass index and role of multi media distraction

    Directory of Open Access Journals (Sweden)

    Gyanendra Mishra

    2016-01-01

    Full Text Available Background and Objectives: Children and adolescents comprise a group of individuals representing a large variation in size, competence, maturity, personality, temperament and emotions experience, oral health, family background, culture, etc. Furthermore, a growing child is in a constant state of flux as he grows up and actively interacts with the environment. Many factors contribute to the dental behavior of the child. The aim of this study was to evaluate the effect of sociodemographic factors, general anxiety, body mass index (BMI, and role of multimedia on the child behavior (CB in the dental operatory. Materials and Methods: Three hundred and one children aged 3-14 years and their parents participated in the study. In the first visit, the questionnaire was filled by the parent and general examination was done. During the second visit, the required dental procedure was rendered, and the behavior was recorded by a single examiner. Results: Among sociodemographic factors, increasing age is directly related to child′s positive behavior, whereas other factors such as gender and socioeconomic status (SES are not significantly related. General anxiety significantly affects the child′s behavior. BMI of the child is not related to child′s behavior in dental operatory. Multimedia was not found to be significantly affecting the behavior of the child in dental operatory. Interpretations and Conclusion: The principle conclusion of this study is that there is a significant association of age and treatment procedure rendered with the CB in the dental operatory whereas gender, SES, general anxiety, BMI, and multimedia do not show any significant association with the CB in the dental operatory.

  3. An investigation of general predictors for cognitive behavioral therapy outcome for anxiety disorders in a routine clinical setting

    DEFF Research Database (Denmark)

    Nielsen, Sara Kerstine Kaya; Vangkilde, Signe; Wolitzky-Taylor, Kate B.

    2016-01-01

    INTRODUCTION: Cognitive-behavioural therapy (CBT) is effective for treating anxiety disorders and is offered in most mental health services around the world. However, a relatively large number of patients with anxiety disorders do not benefit from CBT, experience relapses or drop out. Reliable......-based attentional control task based on theory of visual attention. Data will be analysed using multilevel mixed-effects modelling. ETHICS AND DISSEMINATION: The study is approved by the Danish National Ethical Board, the Department of Psychology Ethical Board, University of Copenhagen and by the Danish Data...... Protection Agency. Study findings will be disseminated through peer-reviewed journal publications and conference presentations. The Danish Committee System on Health Research Ethics has been notified about the project. TRIAL REGISTRATION NUMBER: NCT02638363....

  4. Changes in risk-taking over the course of an internet-delivered cognitive behavioral therapy treatment for generalized anxiety disorder.

    Science.gov (United States)

    Lorian, Carolyn N; Titov, Nickolai; Grisham, Jessica R

    2012-01-01

    It has been proposed that a persistent and pervasive tendency to avoid risks is involved in the development and maintenance of clinically significant anxiety. Few studies, however, have examined the clinical implications of risk-aversion, and particularly the association between risk-aversion and treatment outcome. The current study investigated how risk-aversion in specific domains (Social and Recreational) related to treatment outcome in a clinical sample of patients with generalized anxiety disorder (GAD) undergoing internet-delivered cognitive-behavioral therapy (CBT). We hypothesized that: (i) risk-taking would increase as a result of treatment and (ii) risk-taking would mediate changes in symptom severity and impairment as a result of treatment. Individuals recruited online (N=44) meeting diagnostic criteria for GAD were randomized to the treatment (n=24) or control group (n=20). Participants completed measures of symptom severity, impairment and risk-taking before and after treatment. Results partially confirmed our hypotheses, demonstrating that participants in the treatment group significantly increased social and recreational risk-taking scores relative to the control group and risk-taking mediated treatment outcome for depression, but not for anxiety symptoms. The results of this study suggest that social and recreational risk-avoidance decreases following CBT treatment, and this change may mediate treatment outcome for depression. Clinical implications of these findings are discussed.

  5. Screening for type 2 diabetes is feasible, acceptable, but associated with increased short-term anxiety: A randomised controlled trial in British general practice

    Directory of Open Access Journals (Sweden)

    Prevost A Toby

    2008-10-01

    Full Text Available Abstract Background To assess the feasibility and uptake of a diabetes screening programme; to examine the effects of invitation to diabetes screening on anxiety, self-rated health and illness perceptions. Methods Randomised controlled trial in two general practices in Cambridgeshire. Individuals aged 40–69 without known diabetes were identified as being at high risk of having undiagnosed type 2 diabetes using patient records and a validated risk score (n = 1,280. 355 individuals were randomised in a 2 to 1 ratio into non-invited (n = 238 and invited (n = 116 groups. A stepwise screening programme confirmed the presence or absence of diabetes. Six weeks after the last contact (either test or invitation, a questionnaire was sent to all participants, including non-attenders and those who were not originally invited. Outcome measures included attendance, anxiety (short-form Spielberger State Anxiety Inventory-STAI, self-rated health and diabetes illness perceptions. Results 95 people (82% of those invited attended for the initial capillary blood test. Six individuals were diagnosed with diabetes. Invited participants were more anxious than those not invited (37.6 vs. 34.1 STAI, p-value = 0.015, and those diagnosed with diabetes were considerably more anxious than those classified free of diabetes (46.7 vs. 37.0 STAI, p-value = 0.031. Non-attenders had a higher mean treatment control sub-scale (3.87 vs. 3.56, p-value = 0.016 and a lower mean emotional representation sub-scale (1.81 vs. 2.68, p-value = 0.001 than attenders. No differences in the other five illness perception sub-scales or self-rated health were found. Conclusion Screening for type 2 diabetes in primary care is feasible but may be associated with higher levels of short-term anxiety among invited compared with non-invited participants. Trial registration ISRCTN99175498

  6. A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: the discrete effects of cognitive behavioral therapy, exercise, and psychotropic medication.

    Science.gov (United States)

    Tully, Phillip J; Selkow, Terina; Bengel, Jürgen; Rafanelli, Chiara

    2015-01-01

    No previous study has reported upon comorbid depression and anxiety disorders and their treatment in heart failure (HF), which the current study has sought to document. Total 29 HF patients under psychiatric management underwent primary depression cognitive behavioral therapy (CBT; n = 15) or primary generalized anxiety disorder (GAD) CBT (n = 14), and participated in a community exercise program and standard physician care. Repeated measures analysis of variance assessed Patient Health Questionnaire (PHQ-9) and GAD-7 symptom change pre- and post-CBT treatment, and assessed the interaction effects of treatment type, exercise, anti-depressant and anxiolytic. There was a significant time and treatment interaction effect that favored the primary GAD CBT group for reduction in PHQ symptoms (F(1, 24) = 4.52, p = 0.04). Analysis of PHQ-somatic symptoms also showed a significant main effect for participation in the exercise program (F(1, 24) = 4.21, p = 0.05) and a significant time and anxiolytic interaction (F(1, 24) = 3.98, p = 0.05). The average number of cardiac hospital readmissions favored the primary GAD CBT group (p = 0.05). The findings support the use of multifaceted interventions in the rehabilitation of HF patients with comorbid psychiatric needs. Implications for Rehabilitation Comorbid depression and anxiety disorders are a clinical and research focus that deserves more attention in the treatment of heart failure patients. Cognitive behavioral therapy, exercise, and anxiolytic use was associated with significant changes in depression and anxiety though discrete effects were evident. Multifaceted interventions are most likely to be successful in the rehabilitation of HF patients with psychiatric needs.

  7. Heterogeneity in development of adolescent anxiety disorder symptoms in an 8-year longitudinal community study

    NARCIS (Netherlands)

    Nelemans, S.A.; Hale III, W.W.; Branje, S.T.J.; Raaijmakers, Q.A.W.; Frijns, T.; van Lier, P.A.C.; Meeus, W.H.J.

    2014-01-01

    In this study, we prospectively examined developmental trajectories of five anxiety disorder symptom dimensions (generalized anxiety disorder, panic disorder, school anxiety, separation anxiety disorder, and social anxiety disorder) from early to late adolescence in a community sample of 239 adolesc

  8. Telephone-Delivered Cognitive Behavioral Therapy and Telephone-Delivered Nondirective Supportive Therapy for Rural Older Adults With Generalized Anxiety Disorder: A Randomized Clinical Trial.

    Science.gov (United States)

    Brenes, Gretchen A; Danhauer, Suzanne C; Lyles, Mary F; Hogan, Patricia E; Miller, Michael E

    2015-10-01

    Generalized anxiety disorder (GAD) is common in older adults; however, access to treatment may be limited, particularly in rural areas. To examine the effects of telephone-delivered cognitive behavioral therapy (CBT) compared with telephone-delivered nondirective supportive therapy (NST) in rural older adults with GAD. Randomized clinical trial in the participants' homes of 141 adults aged 60 years and older with a principal or coprincipal diagnosis of GAD who were recruited between January 27, 2011, and October 22, 2013. Telephone-delivered CBT consisted of as many as 11 sessions (9 were required) focused on recognition of anxiety symptoms, relaxation, cognitive restructuring, the use of coping statements, problem solving, worry control, behavioral activation, exposure therapy, and relapse prevention, with optional chapters on sleep and pain. Telephone-delivered NST consisted of 10 sessions focused on providing a supportive atmosphere in which participants could share and discuss their feelings and did not provide any direct suggestions for coping. Primary outcomes included interviewer-rated anxiety severity (Hamilton Anxiety Rating Scale) and self-reported worry severity (Penn State Worry Questionnaire-Abbreviated) measured at baseline, 2 months' follow-up, and 4 months' follow-up. Mood-specific secondary outcomes included self-reported GAD symptoms (GAD Scale 7 Item) measured at baseline and 4 months' follow-up and depressive symptoms (Beck Depression Inventory) measured at baseline, 2 months' follow-up, and 4 months' follow-up. Among the 141 participants, 70 were randomized to receive CBT and 71 to receive NST. At 4 months' follow-up, there was a significantly greater decline in worry severity among participants in the telephone-delivered CBT group (difference in improvement, -4.07; 95% CI, -6.26 to -1.87; P = .004) but no significant differences in general anxiety symptoms (difference in improvement, -1.52; 95% CI, -4.07 to 1.03; P = .24). At 4 months

  9. Likelihood of Attending Treatment for Anxiety Among Veteran Primary Care Patients: Patient Preferences for Treatment Attributes.

    Science.gov (United States)

    Shepardson, Robyn L; Funderburk, Jennifer S

    2016-09-01

    Anxiety is common, but under-treated, in primary care. Behavioral health providers embedded in primary care can help address this treatment gap. Guidance on anxiety treatment preferences would help inform tailoring of clinical practice and new interventions to be more patient-centered and increase treatment engagement. We surveyed 144 non-treatment seeking Veteran primary care patients (82.6 % male, 85.4 % White, age M = 59.8 years, SD = 13.9) reporting current anxiety symptoms (M = 13.87, SD = 3.66, on the Generalized Anxiety Disorder-7 Questionnaire) on their likelihood of attending anxiety treatment featuring various levels of 11 attributes (modality, type, location, format, provider, visit frequency, visit length, treatment duration, type of psychotherapy, symptom focus, and topic/skill). Participants indicated clear preferences for individual, face-to-face treatment in primary care, occurring once a month for at least 30 min and lasting at least three sessions. They also tended to prefer a stress management approach focused on trouble sleeping or fatigue, but all topics/skills were rated equivalently. For most attributes, the highest rated options were consistent with characteristics of integrated care. Implications for research and practice are discussed.

  10. Anxiety Disorders

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Anxiety Disorders KidsHealth > For Teens > Anxiety Disorders A A ... Do en español Trastornos de ansiedad What Is Anxiety? Liam had always looked out for his younger ...

  11. A Longitudinal Investigation of Anxiety and Depressive Symptomatology and Exercise Behaviour Among Adults With Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Ivanova, Elena; Burns, Rachel J; Deschênes, Sonya S; Knäuper, Bärbel; Schmitz, Norbert

    2017-02-01

    Evidence suggests that symptoms of depression and anxiety predict lower exercise behaviour and, inversely, that less exercise predicts higher symptomatology. The present longitudinal study examined this reciprocal association in adults with type 2 diabetes mellitus. We predicted that symptoms of anxiety or depression would intensify over time as a consequence of lower exercise frequency and, similarly, that exercise frequency would decrease as a consequence of greater symptoms of anxiety or depression. We studied 1691 adults with type 2 diabetes who provided baseline measures in 2011 and 2 subsequent annual assessments (Follow-up 1 and Follow-up 2). Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. A single item assessed exercise frequency in the past month (in days). Separate 3-wave cross-lagged path models for symptoms of anxiety and depression tested the reciprocal associations. Contrary to our hypotheses, the reciprocal associations were not supported and, by extension, the predicted secondary associations were not tested. In sum, only depressive symptoms negatively predicted subsequent exercise frequency (Follow-up 1 and Follow-up 2). Symptoms of depression were prospectively associated with lower exercise frequency, which is consistent with evidence from population-based studies that identify depressive symptoms as a barrier to exercise participation. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  12. Characteristics of Anxiety Disorder in General Hospitals' Outpatient Department%综合医院门诊焦虑障碍患者的特点分析

    Institute of Scientific and Technical Information of China (English)

    鲁文兴; 陈星; 姜荣环; 马弘; 娄英男; 何燕玲; 杨蕾

    2014-01-01

    Objective To explore the characteristics of anxiety disorder in outpatient of general hospitals. Methods The outpatients in Neurology,Gastroenterology,Cardiology,and Gynecology department were screened using general information questionnaire,Hospital Anxiety and Depression Scale( HADS),Patient Health Questionnaire somatic symptom severity scale (PHQ - 15). All the patients who's HADS score were 8 or above were examined by psychiatrists using the Mini International Neuropsychiatry Interview(MINI)and were determined the psychiatric diagnosis. Results All in all 2 074 outpatients completed the investigation:110 with anxiety disorder(anxiety disorder group)among which 57(51. 8% )with comorbid anxiety depres-sion,1 538 cases without anxiety disorder(normal group)(915 cases' HADS were under 8,623 cases were determined by MINI). The depression group was younger than the normal control〔(45. 3 ± 14. 1)vs. (49. 7 ± 16. 8),t = 2. 667,P 0. 05).The total score in PHQ - 15 of anxiety patient were higher than those of normal controls〔(12. 5 ± 5. 7)vs. (7. 1 ± 4. 3),t =12. 371,P 0.05)。焦虑障碍组的 PHQ -15总分为(12.5±5.7)分,正常组为(7.1±4.3)分,两组间比较差异有统计学意义(t =12.371,P <0.01)。焦虑障碍组患者 PHQ -15中出现频率前三位的条目为:感到疲劳37.3%(41例);睡眠问题37.3%(41例);虚弱感30.0%(33例)。正常组和焦虑障碍组的误工天数、目前疾病造成的功能损害(对家庭生活和家庭责任的影响、对工作和学习的影响、对社交生活的影响)间差异有统计学意义(P <0.05)。焦虑障碍组患者有自杀倾向者占32.7%(36例),只有22例患者(20.0%)被建议转诊到精神科(16例,14.5%)或予以精神类药物(6例,5.5%)。结论综合医院门诊的焦虑障碍患者共病抑郁障碍的比例高、躯体主诉多、生活质量差、自杀倾向高,但被识别的比例较低。

  13. Clinical Treatment Analysis of 103 Patients with Generalized Anxiety Disorder%103例广泛性焦虑症患者的临床治疗分析

    Institute of Scientific and Technical Information of China (English)

    张蓉

    2013-01-01

    目的观察两种治疗广泛性焦虑障碍药物的临床疗效和安全性。方法将103例广泛性焦虑障碍的患者随机分为两组,分别给予口服枸橼酸坦度螺酮(剂量为30~60mg/d)和帕罗西汀(剂量为20~40mg/d),疗程为6w。采用汉密尔顿焦虑量表(HAMA)评定治疗效果,副反应量表(TESS)、实验室检查评定安全性。结果治疗后两组HAMA分值较治疗前明显下降,差异均具有统计学意义(P<0.01);坦度螺酮组显效率为90.2%,帕罗西汀组显效率为86.5%,治疗后两组间 HAMA分值差异无显著性(P>0.05);坦度螺酮组不良反应少于帕罗西汀组。结论坦度螺酮与帕罗西汀均能有效治疗广泛性焦虑障碍。%Objective To observer the ef icacy and safety of two medicine applied in generalized anxiety disorder. Methods 103 patients with generalized anxiety disorder were randomly divided into two groups, respectively administrating tandospiron (30-60mg/d)and paroxetine (20-40mg/d) treatment for 6 weeks. Ef icacy was assessed with the Hamilton Anxiety Scale ( HAMA ) assessment;adverse reaction scale ( TESS ), laboratory examination were used to evaluate safety. Results The HAMA scores of both group were significantly decreased after 6 weeks` treatment (P<0.01) and there was no dif erence between the two groups. The ef icacy ratio of Tandospirone treatment was 90.2%, and the ratio of Tandospirone treatment was 86.5%. The Tandospirone treatment had less adverse reaction. Conclusion Tandospirone and paroxetine can be ef ective in treatment of generalized anxiety disorder.

  14. Affective and Self-Esteem Instability in the Daily Lives of People with Generalized Social Anxiety Disorder

    OpenAIRE

    2014-01-01

    Research on affect and self-esteem in social anxiety disorder (SAD) has focused on trait or average levels, but we know little about the dynamic patterns of these experiences in the daily lives of people with SAD. We asked 40 adults with SAD and 39 matched healthy controls to provide end-of-day reports on their affect and self-esteem over two weeks. Compared to healthy adults, participants with SAD exhibited greater instability of negative affect and self-esteem, though the self-esteem effect...

  15. Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial.

    Science.gov (United States)

    Rosnick, Christopher B; Wetherell, Julie L; White, Kamila S; Andreescu, Carmen; Dixon, David; Lenze, Eric J

    2016-04-01

    Elevated cortisol in stress and aging, such as has been seen in late-life anxiety disorders, is postulated to accelerate cognitive and physiological decline in this large and increasing population. Selective serotonin-reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are both effective treatments for generalized anxiety disorder (GAD) in older adults. On the other hand, there is very little research examining the effect of combining these therapies on peak cortisol levels. For the current analyses, we examined the effectiveness of CBT augmentation on peak cortisol levels in older adults diagnosed with GAD. The sample consisted of 42 individuals with late-life GAD who received an acute course of the SSRI escitalopram and then entered a 16-week randomized phase. Twenty-one participants were randomized to receive 16 sessions of CBT in addition to continuing escitalopram and the remaining 21 participants continued on escitalopram without CBT. Generalized estimating equations were performed to assess the effectiveness of CBT augmentation on peak cortisol levels (30 min after waking). Older adults with GAD who received both escitalopram and CBT demonstrated a significant reduction in peak cortisol levels at posttreatment compared to the group who received escitalopram without CBT augmentation. CBT augmentation of SSRI treatment reduced peak cortisol levels for older adults with GAD. Since persistently high cortisol levels in aging are thought to increase age-related cognitive and medical problems, our findings suggest that there may be a benefit to health and cognition of CBT augmentation for late-life anxiety disorders. (c) 2016 APA, all rights reserved).

  16. Treatment of generalized anxiety disorder with "Anshen Huatan Decoction"%安神化痰汤治疗广泛性焦虑症疗效观察

    Institute of Scientific and Technical Information of China (English)

    朱冬胜

    2011-01-01

    Objective To observe the clinical efficacy of " Anshen Huatan Decoction" in the treatment of generalized anxiety disorder. Methods Seventy-six subjects were randomized into two groups: control group in which 39 cases were treated with Deanxit and treatment group in which 37 cases were treated with " Anshen Huatan Decoction" , with a course of six months; the Hamilton anxiety( HAMA) scale score and clinical efficacy were evaluated. Results The overall effective rate was 92.31 % in the control group and 91.89% in the treatment group, with no difference between them( P >0.05); the HAMA scores were reduced in both groups(P0.05). Conclusion "Anshen Huatan Decoction" is quite effective for generalized anxiety disorder.%目的 观察安神化痰汤治疗广泛性焦虑症的临床疗效.方法 将76例广泛性焦虑症患者随机分为对照组(39例)和治疗组(37例);对照组用黛安神片治疗.治疗组给予安神化痰汤治疗,疗程6个月;观察两组Hamilton焦虑量表(HAMA)评分及临床疗效.结果 对照组总有效率为92.31%,治疗组为91.89%,两组总有效率比较无显著性差异(P>0.05);治疗后两组HAMA评分均显著降低(P0.05).结论 安神化痰汤治疗广泛性焦虑症疗效确切.

  17. Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules: substance abusers and others in the general population*

    Science.gov (United States)

    Hasin, Deborah S.; Shmulewitz, Dvora; Stohl, Malka; Greenstein, Eliana; Aivadyan, Christina; Morita, Kara; Saha, Tulshi; Aharonovich, Efrat; Jung, Jeesun; Zhang, Haitao; Nunes, Edward V.; Grant, Bridget F.

    2016-01-01

    Background Little is known about the procedural validity of lay-administered, fully-structured assessments of depressive, anxiety and post-traumatic stress (PTSD) disorders in the general population as determined by comparison to clinical re-appraisal, and whether this differs between current regular substance abusers and others. We evaluated the procedural validity of the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5) assessment of these disorders through clinician re-interviews. Methods Test-retest design among respondents from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III): (264 current regular substance abusers, 447 others). Clinicians blinded to AUDADIS-5 results administered the semi-structured Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5). AUDADIS-5/PRISM-5 concordance was indicated by kappa (κ) for diagnoses and intraclass correlation coefficients (ICC) for dimensional measures (DSM-5 symptom or criterion counts). Results were compared between current regular substance abusers and others. Results AUDADIS-5 and PRISM-5 concordance for DSM-5 depressive disorders, anxiety disorders and PTSD was generally fair to moderate (κ =0.24–0.59), with concordance on dimensional scales much better (ICC=0.53–0.81). Concordance differed little between regular substance abusers and others. Conclusions AUDADIS-5/PRISM-5 concordance indicated procedural validity for the AUDADIS-5 among substance abusers and others, suggesting that AUDADIS-5 diagnoses of DSM-5 depressive, anxiety and PTSD diagnoses are informative measures in both groups in epidemiologic studies. The stronger concordance on dimensional measures supports the current movement towards dimensional psychopathology measures, suggesting that such measures provide important information for research in the NESARC-III and other datasets, and possibly for clinical purposes as well. PMID

  18. A Review of Research on Language Anxiety

    Institute of Scientific and Technical Information of China (English)

    WANG Tian-jian

    2013-01-01

    This paper is a review literature on language anxiety. It begins with a discussion of the concepts of general anxiety and language anxiety, and then continues with an introduction of the techniques for identifying language anxiety. Subsequently, litera-ture on the relationships of language anxiety to learner variables and language learning/using are covered. Finally the dispute and theories concerning language anxiety are presented.

  19. Features of the Generalized Anxiety Symptoms and Their Influencing Factors%广泛性焦虑症状的特点及其影响因素

    Institute of Scientific and Technical Information of China (English)

    杨智辉

    2012-01-01

    Objective: To explore the features of the generalized anxiety symptoms in university students and their influencing factors. Methods: The Penn State Worry Questionnaire, Meta-worry Questionnaire, Eysenck Personality Questionnaire-revised and Intolerance of Uncertainty Questionnaire were used to investigate the generalized anxiety symptoms and their influencing factors in 1135 undergraduates. Results: Path analysis showed that neuroticism had the most important direct effect on the generalized anxiety symptoms, and also had indirect effect on the generalized anxiety symptoms through uncertainty-caused stress and meta-worry frequency. Conclusion: The influencing factors were neuroticism, uncertainty-caused stress and meta-worry frequency ordinally. And neuroticism also had indirect effect on generalized anxiety symptoms through uncertainty-caused stress and meta-worry frequency.%目的:考察大学生广泛性焦虑症状的特点及其影响因素.方法:采用宾州忧虑问卷、艾森克人格问卷简式量表、对不确定性的忍受力问卷、元担忧问卷对1135名大学生进行调查.结果:①大学生宾州忧虑问卷均分为2.54±0.64,男性焦虑总分显著低于女性;独生子女焦虑总分显著低于非独生子女;不同家庭经济状况大学生在在焦虑总分上存在显著差异.②路径分析表明:神经质、不确定性所带来的压力、元担忧频率对宾州忧虑问卷总分有直接效应,同时,神经质还通过不确定性所带来的压力、元担忧频率对宾州忧虑问卷总分起到间接效应.对宾州忧虑问卷总分影响由大到小依次是:神经质、不确定性所带来的压力和元担忧频率.结论:①大学生的广泛性焦虑症状处在中等水平,女生的广泛性焦虑症状高于男生,非独生子女的广泛性焦虑症状显著高于独生子女,家庭经济状况越差则广泛性焦虑症状也越高.②神经质对广泛性焦虑症状既有直接作用,又通过不确定性

  20. 广泛性焦虑障碍中医针灸治疗的研究进展%Research Progress of Acupuncture in the Treatment of Generalized Anxiety Disorder

    Institute of Scientific and Technical Information of China (English)

    郑笑; 赵瑞珍; 唐启盛

    2015-01-01

    Ther paper summarizes the key problems of the research on acupuncture in the treatment of general-ized anxiety disorder .It points out the main research progress on acupuncture in the treatment of generalized anxiety disorders .On this basis , the prospect of the research on acupuncture for generalized anxiety disorder is analyzed .%本研究归纳广泛性焦虑障碍针灸治疗研究中的关键问题,指出广泛性焦虑障碍针刺治疗研究的主要进展,在此基础上,对广泛性焦虑障碍的针刺治疗规律的研究前景进行了展望.

  1. The effect of a combined versus a conventional cognitive-behavioral therapy on quality of life for comorbid panic disorder with agoraphobia and generalized anxiety disorder: preliminary results.

    Science.gov (United States)

    Primiano, Sandra; Marchand, André; Gosselin, Patrick; Langlois, Frédéric; Bouchard, Stéphane; Bélanger, Claude; Labrecque, Joane; Dugas, Michel; Dupuis, Gilles

    2014-01-01

    Concurrent panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are the most common diagnostic occurrences among anxiety disorders. This particular comorbidity is associated with significant impairments in quality of life (QOL). The current study sought to investigate the efficacy of a combined cognitive-behavioral psychotherapy that addressed both conditions compared with a conventional psychotherapy, which attends solely to the primary disorder. The hypotheses postulated firstly, that both treatment conditions would lead to improvements in participants' QOL and secondly, that the combined therapy would lead to greater QOL ameliorations. Twenty-five participants with comorbid PDA/GAD diagnoses were evaluated with a number of clinical interviews and self-report questionnaires, and were provided with either conventional or combined cognitive-behavioral psychotherapy, which consisted of 14 one-hour weekly sessions. Participants were once again evaluated in the same fashion 2-weeks after the completion of the psychotherapy. The results revealed that both conditions led to significant improvements in participants' QOL, but that the two groups did not significantly differ in terms of the effect on QOL. The results also reveal that the two conditions did not significantly differ in terms of their effect on PDA and GAD symptomatology or psychiatric comorbidity. The results demonstrate that the combined psychotherapy, which addresses both conditions simultaneously, is similar to the conventional psychotherapy employed for the primary disorder in terms of QOL enhancement, symptom severity, and comorbidity reduction.

  2. Investigating the Overlap of Padua Inventory and Worry among Patients with Obsessive-Compulsive Disorder, Generalized Anxiety Disorder and Normal People

    Directory of Open Access Journals (Sweden)

    Samad Shirinzadeh Dastgiri

    2008-08-01

    Full Text Available "n Objective: "n  The present study aimed to explore the relationship between worry and obsessive compulsive symptoms. We examined the correlations between the Padua Inventory (PI and the Penn State Worry Questionnaire (PSWQ to further explore the distinctiveness of the PI. "nMethod: Seventy-five subjects (n=40 male, n= 35 female were selected from Hafez Hospital (Iran for this study: the subjects included twenty-five patients with obsessive-compulsive disorder (OCD, 25 with generalized anxiety disorder (GAD and 25 normal participants. The PI and PSWQ were used in order to measure the obsessive beliefs and worry. "nResults: Results indicated a significant correlation between the PI scores and worry. The Results of the Kruskal-Wallis test showed that the PI scores were able to differentiate OCD and GAD patients from normal people, however, it failed to differentiate between OCD and GAD patients. In addition, when the worry scores were controlled, the PI scores were able to differentiate between OCD and GAD patients . "nConclusion: The PI appears to be a useful measure for differentiating OCD patients and nonclinical OCD cases from normal people. However, its usefulness in differentiating between OCD patients and patients with anxiety disorder (GAD has not been supported by our findings.

  3. Lavender oil preparation Silexan is effective in generalized anxiety disorder--a randomized, double-blind comparison to placebo and paroxetine.

    Science.gov (United States)

    Kasper, Siegfried; Gastpar, Markus; Müller, Walter E; Volz, Hans-Peter; Möller, Hans-Jürgen; Schläfke, Sandra; Dienel, Angelika

    2014-06-01

    The anxiolytic efficacy of the orally administered lavender oil preparation Silexan was investigated in generalized anxiety disorder (GAD) in comparison to placebo and paroxetine. In this randomized, double-blind, double-dummy trial 539 adults with GAD according to DSM-5 criteria and a Hamilton Anxiety Scale (HAMA) total score ⩾ 18 points participated and received 160 or 80 mg Silexan, 20 mg paroxetine, or placebo once daily for 10 wk. The primary efficacy endpoint was the HAMA total score reduction between baseline and treatment end. The HAMA total score decreased by 14.1 ± 9.3 points for Silexan 160 mg/d, 12.8 ± 8.7 points for Silexan 80 mg/d, 11.3 ± 8.0 points for paroxetine, and 9.5 ± 9.0 points for placebo (mean ± s.d.). Silexan 160 and 80 mg/d were superior to placebo in reducing the HAMA total score (p mental health and health-related quality of life. Incidence densities of adverse events (AEs) were 0.006 AEs/d for Silexan 160 mg/d, 0.008 AEs/d for 80 mg/d, 0.011 AEs/d for paroxetine, and 0.008 AEs/d for placebo. In GAD Silexan is more efficacious than placebo. AE rates for Silexan were comparable to placebo and lower than for the active control paroxetine.

  4. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial.

    Science.gov (United States)

    Dear, B F; Staples, L G; Terides, M D; Karin, E; Zou, J; Johnston, L; Gandy, M; Fogliati, V J; Wootton, B M; McEvoy, P M; Titov, N

    2015-12-01

    Generalized anxiety disorder (GAD) can be treated effectively with either disorder-specific cognitive behavior therapy (DS-CBT) or transdiagnostic CBT (TD-CBT). The relative benefits of DS-CBT and TD-CBT for GAD and the relative benefits of delivering treatment in clinician guided (CG-CBT) and self-guided (SG-CBT) formats have not been examined. Participants with GAD (n=338) were randomly allocated to receive an internet-delivered TD-CBT or DS-CBT intervention delivered in either CG-CBT or SG-CBT formats. Large reductions in symptoms of GAD (Cohen's d ≥ 1.48; avg. reduction ≥ 50%) and comorbid major depressive disorder (Cohen's d ≥ 1.64; avg. reduction ≥ 45%), social anxiety disorder (Cohen's d ≥ 0.80; avg. reduction ≥ 29%) and panic disorder (Cohen's d ≥ 0.55; avg. reduction ≥ 33%) were found across the conditions. No substantive differences were observed between DS-CBT and TD-CBT or CG-CBT and SG-CBT, highlighting the public health potential of carefully developed TD-CBT and SG-CBT.

  5. Association between serum C-reactive protein and DSM-IV generalized anxiety disorder in adolescence: Findings from the ALSPAC cohort

    Directory of Open Access Journals (Sweden)

    Golam M. Khandaker

    2016-10-01

    Conclusions: The findings are consistent with a role of inflammation in anxiety disorders. Longitudinal studies of inflammatory markers, subsequent anxiety taking into account current and past psychological stress are required to understand this association further.

  6. Comparative effectiveness and costs of generic and brand-name gabapentin and venlafaxine in patients with neuropathic pain or generalized anxiety disorder in Spain

    Directory of Open Access Journals (Sweden)

    Sicras-Mainar A

    2015-06-01

    Full Text Available Antoni Sicras-Mainar,1 Javier Rejas-Gutiérrez,2 Ruth Navarro-Artieda3 1Planning Directorate, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain; 2Department of Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Madrid, Spain; 3Medical Documentation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Objective: To explore adherence/persistence with generic gabapentin/venlafaxine versus brand-name gabapentin/venlafaxine (Neurontin®/Vandral® in peripheral neuropathic pain (pNP or generalized anxiety disorder (GAD, respectively, and whether it is translated into different costs and patient outcomes in routine medical practice. Methods: A retrospective, new-user cohort study was designed. Electronic medical records (EMR of patients included in the health plan of Badalona Serveis Assistencials SA, Barcelona, Spain were exhaustively extracted for analysis. Participants were beneficiaries aged 18+ years, followed between 2008 and 2012, with a pNP/GAD International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM code, who initiated treatment with generic or brand-name gabapentin or venlafaxine. Assessments included 1-year treatment persistence and adherence (medication possession ratio, health care costs, and reduction in severity of pain and anxiety symptoms. Results: A total of 2,210 EMR were analyzed; 1,369 on gabapentin (brand 400; generic 969 and 841 on venlafaxine (brand 370 and generic 471. Brand-name gabapentin and venlafaxine were both significantly associated with longer persistence than generic: 7.3 versus 6.3 months, P<0.001; and 8.8 versus 8.1 months, P<0.05, respectively. Brand-name was associated with higher adherence: 86.5% versus 81.3%, P<0.001; and 82.1% versus 79.0%, P<0.05, respectively. Adjusted average costs were higher with generic compared with brand: €1,277 versus €1,057 (difference of €220 per patient; P<0.001 for gabapentin; and €1,110 versus €928

  7. Epidemiological survey of generalized anxiety disorder in Yunfu City%云浮市广泛性焦虑障碍流行病学调查

    Institute of Scientific and Technical Information of China (English)

    钟书铭; 肖垚南; 陈妙扬; 郑洪波; 张璐璐; 陈丁玲; 卢冬艳

    2015-01-01

    目的:了结云浮市15岁以上人群广泛性焦虑障碍的患病率及分布特点。方法采用初级单位含量比例分层整体随机抽样方法,以美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴障碍定式临床检查患者版(SCID-Ⅰ/P)对全市5县区2373人进行入户面访调查。结果广泛性焦虑障碍的时点患病率为0.46%,其中男性为0.30%,女性为0.69%,该疾病与无业或失业状态关系密切,精神科就诊率为18.18%。结论广泛性焦虑障碍在云浮市患病率较高,就诊率较低,健全社区精神卫生服务有利于降低其发生发展。%Objective To describe the prevalence and distribution of generalized anxiety disorder among people aged above 15 years in Yunfu city. Methods A total of 2 373 subjects were randomly selected from 5 rural and rural-urban fringe zone by the elementary unit stratified cluster sampling method. They were assessed by face to face interview with United States Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-Ⅳ) AxisⅠDisorders-style version of the clinical examination of patients (SCID-Ⅰ/P). Results The current prevalence of gen-eralized anxiety disorder was 0.46%. It was 0.30%of male and 0.69%of female. The disease was closely associated with unemployed status, and its rate of visiting the doctors was 18.8%. Conclusion The prevalence of generalized anxiety disorder in Yunfu city was relatively high, while the visiting rate was low. Occurrence and development of the disease could be reduced by improving mental health service.

  8. Insomnia and Relationship with Anxiety in University Students: A Cross-Sectional Designed Study.

    Directory of Open Access Journals (Sweden)

    Nour Choueiry

    Full Text Available Sleep disorders (SDs are now recognized as a public health concern with considerable psychiatric and societal consequences specifically on the academic life of students. The aims of this study were to assess SDs in a group of university students in Lebanon and to examine the relationship between SDs and anxiety.An observational cross-sectional study was conducted at Saint-Joseph University, Lebanon, during the academic year 2013-2014. Four questionnaires were face-to-face administered to 462 students after obtaining their written consent: Insomnia Severity Index (ISI, Pittsburgh Sleep Quality Index (PSQI, Epworth Sleepiness Scale (ESS, and Generalized Anxiety Disorder 7-item scale (GAD-7.The prevalence of clinically significant insomnia was 10.6% (95% CI: 7.8-13.4%, more frequent in first year students. ISI mean score was 10.06 (SD = 3.76. 37.1% of the participants were poor sleepers. Excessive daytime sleepiness (EDS and poor sleep were significantly more frequent among participants with clinical insomnia (p = 0.031 and 0.001 respectively. Clinically significant anxiety was more frequent in students suffering from clinical insomnia (p = 0.006 and in poor sleepers (p = 0.003. 50.8% of the participants with clinically significant anxiety presented EDS versus 30.9% of those with no clinically significant anxiety (p<0.0001.The magnitude of SDs in this sample of Lebanese university students demonstrate the importance of examining sleep health in this population. Moreover, the link between SD and anxiety reminds us of the importance of treating anxiety as soon as detected and not simply targeting the reduction of sleep problems.

  9. Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

    Directory of Open Access Journals (Sweden)

    De Salas-Cansado M

    2012-06-01

    Full Text Available Marina De Salas-Cansado,1 José M Olivares,2 Enrique Álvarez,3 Jose L Carrasco,4 Andoni Barrueta,5 Javier Rejas,51Trial Form Support Spain, Madrid; 2Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo; 3Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona; 4Department of Psychiatry, Hospital Clínico San Carlos, Madrid; 5Health Outcomes Research Department, Medical Unit, Pfizer Spain, Alcobendas, Madrid, SpainBackground: Generalized anxiety disorder (GAD is a prevalent health condition which seriously affects both patient quality of life and the National Health System. The aim of this research was to carry out a post hoc cost-effectiveness analysis of the effect of pregabalin versus selective serotonin reuptake inhibitors (SSRIs/serotonin norepinephrine reuptake inhibitors (SNRIs in treated benzodiazepine-refractory outpatients with GAD.Methods: This post hoc cost-effectiveness analysis used secondary data extracted from the 6-month cohort, prospective, noninterventional ADAN study, which was conducted to ascertain the cost of illness in GAD subjects diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Benzodiazepine-refractory subjects were those who claimed persistent symptoms of anxiety and showed a suboptimal response (Hamilton Anxiety Rating Scale ≥16 to benzodiazepines, alone or in combination, over 6 months. Patients could switch to pregabalin (as monotherapy or addon or to an SSRI or SNRI, alone or in combination. Effectiveness was expressed as quality-adjusted life years gained, and the perspective was that of the National Health System in the year 2008. A sensitivity analysis was performed using bootstrapping techniques (10,000 resamples were obtained in order to obtain a cost-effectiveness plane and a corresponding acceptability curve.Results: A total of 282 subjects (mean Hamilton Anxiety Rating Scale score 25.8 were

  10. Dispositional optimism and self-esteem as competing predictors of acute symptoms of generalized anxiety disorders and dissociative experiences among civilians exposed to war trauma.

    Science.gov (United States)

    Weinberg, Michael; Besser, Avi; Zeigler-Hill, Virgil; Neria, Yuval

    2015-01-01

    Although previous studies have rarely examined predictors of acute emotional responses to war trauma, this "natural laboratory" study aimed to examine the role that individual differences in dispositional optimism and self-esteem play in the development of acute symptoms of generalized anxiety disorder (GAD) and dissociative experiences. A sample of 140 female adults exposed to missile and rocket fire during an eruption of violence in the Middle East in November 2012 was assessed during real-time exposure. The results demonstrate inverse associations between dispositional optimism and acute symptoms of GAD and dissociation. The associations were accounted for by individual differences in self-esteem. In addition, individuals with low levels of dispositional optimism demonstrated a higher risk for acute GAD and dissociative experiences, in part because of their low levels of self-esteem. Theoretical and clinical implications of the findings are discussed. (c) 2015 APA, all rights reserved).

  11. The Progress of Pharmacotherapy of Generalized Anxiety Disorder%广泛性焦虑障碍药物治疗进展

    Institute of Scientific and Technical Information of China (English)

    赵靖平; 瞿金国

    2004-01-01

    广泛性焦虑障碍(generalized anxiety disorder,GAD)是精神科常见疾病,终身患病率为4.1%~6.6%,常就诊于综合医院各科室,易被漏诊误诊,被确诊时往往已存在慢性功能损害,治疗更具难度。近年来其药物治疗进展较快,本文对药物治疗GND的有关进展进行综述。

  12. A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry☆,☆☆

    Science.gov (United States)

    Newman, Michelle G.; Llera, Sandra J.

    2011-01-01

    An important emphasis of the literature on generalized anxiety disorder (GAD) has been to achieve a greater understanding of the function of emotion (e.g., avoidance, dysregulation) in the etiology and maintenance of this disorder. The purpose of the following paper is to propose a new way of conceptualizing emotional sequelae in GAD by detailing the Contrast Avoidance Model of Worry. In presenting this model, we review theory and data that led to our current position, which is that individuals with GAD are more sensitive to feeling emotionally vulnerable to unexpected negative events, and that worry (the key pathological feature of GAD) is employed to prolong and maintain a negative emotional state thereby avoiding an unexpected negative emotional shift, or contrast experience. We also discuss implications for treatment given the presence of a new target for emotional exposure techniques. Finally, we establish the Contrast Avoidance Model within the framework of extant theories and models of pathogenic processes of GAD. PMID:21334285

  13. The effects of lacosamide on depression and anxiety in patients with epilepsy.

    Science.gov (United States)

    Moseley, Brian D; Cole, Devlin; Iwuora, Ogonna; Strawn, Jeffrey R; Privitera, Michael

    2015-02-01

    Depression and anxiety are common in patients with epilepsy. Moreover, some antiepileptic drugs (AEDs) have mood stabilizing and anxiolytic effects, while others may worsen psychiatric symptoms. The effects of lacosamide, a third generation AED approved for the treatment of focal onset seizures, on depressive and anxiety symptoms are unknown. We evaluated changes in depression and anxiety following the initiation of lacosamide. We compared patients' scores on the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, n = 91) and Generalized Anxiety Disorder 7-item (GAD-7, n = 20) scales prior to and following lacosamide treatment. Following the initiation of lacosamide, there were no significant changes in NDDI-E scores when all patients were analyzed aggregately (baseline: 12.14 ± 4.64 vs post-treatment: 11.91 ± 4.14, p = 0.51). Similarly, the mean GAD-7 scores at baseline (4.10 ± 4.52) and after treatment (4.75 ± 5.51) did not differ (p = 0.23). In the 25 patients with initial NDDI-E scores of >15, lacosamide was associated with a significant decrease in depressive symptoms (baseline: 17.60 ± 1.63 vs post-treatment: 14.64 ± 2.78, p lacosamide initiation were not significantly affected by a history of mood disorders, concomitant psychiatric medications, or concomitant AEDs with mood-stabilizing effects.

  14. Cognitive bias measurement and social anxiety disorder: Correlating self-report data and attentional bias

    Directory of Open Access Journals (Sweden)

    Alexander Miloff

    2015-09-01

    Full Text Available Social anxiety disorder (SAD and attentional bias are theoretically connected in cognitive behavioral therapeutic models. In fact, there is an emerging field focusing on modifying attentional bias as a stand-alone treatment. However, it is unclear to what degree these attentional biases are present before commencing treatment. The purpose of this study was to measure pre-treatment attentional bias in 153 participants diagnosed with SAD using a home-based Internet version of the dot-probe paradigm. Results showed no significant correlation for attentional bias (towards or away from negative words or faces and the self-rated version of the Liebowitz Social Anxiety Scale (LSAS-SR. However, two positive correlations were found for the secondary measures Generalized Anxiety Disorder 7 (GAD-7 and Patient Health Questionnaire 9 (PHQ-9. These indicated that those with elevated levels of anxiety and depression had a higher bias towards negative faces in neutral–negative and positive–negative valence combinations, respectively. The unreliability of the dot-probe paradigm and home-based Internet delivery are discussed to explain the lack of correlations between LSAS-SR and attentional bias. Changes to the dot-probe task are suggested that could improve reliability.

  15. Psychotherapy for Anxiety in Children With Autism Spectrum Disorder

    Science.gov (United States)

    2016-11-28

    Autism Spectrum Disorders; Autism; Asperger's Syndrome; Pervasive Developmental Disability - Not Otherwise Specified; Obsessive-compulsive Disorder; Social Phobia; Generalized Anxiety Disorder; Specific Phobia; Separation Anxiety Disorder

  16. Anxiety Disorders

    Science.gov (United States)

    Klein, Rachel G.

    2009-01-01

    Because of their high prevalence and their negative long-term consequences, child anxiety disorders have become an important focus of interest. Whether pathological anxiety and normal fear are similar processes continues to be controversial. Comparative studies of child anxiety disorders are scarce, but there is some support for the current…

  17. Test Anxiety

    Science.gov (United States)

    ... A A What's in this article? What Is Test Anxiety? What Causes It? Who's Likely to Have Test Anxiety? What Can You Do? en español Ansiedad ante ... prevent them from doing their best on a test. continue What Causes It? All anxiety is a reaction to anticipating something stressful. Like ...

  18. Anxiety Disorders

    Science.gov (United States)

    Klein, Rachel G.

    2009-01-01

    Because of their high prevalence and their negative long-term consequences, child anxiety disorders have become an important focus of interest. Whether pathological anxiety and normal fear are similar processes continues to be controversial. Comparative studies of child anxiety disorders are scarce, but there is some support for the current…

  19. Relationships between General Self-efficacy, Intolerance of Uncertainty and Test Anxiety%高中生一般自我效能感、无法忍受不确定性与考试焦虑的关系

    Institute of Scientific and Technical Information of China (English)

    张荣娟

    2016-01-01

    Objective: The paper is to explore the relationship between general self-efficacy and test anxiety and the mediation of intolerance of uncertainty between them. Methods:400 senior middle school students at campus were measured with General Self-efficacy Scale, brief version of Intolerance of Uncer⁃tainty Scale and Test Anxiety Scale, and then the correlationship was analysized. Results:General self-ef⁃ficacy was negatively correlated with test anxiety, intolerance of uncertainty and its factors, while test anxi⁃ety was positively correlated with intolerance of uncertainty and its factors, and all the correlation coeffi⁃cients were significant. Linear regression analysis revealed that intolerance of uncertainty and its factors could entirely mediate the effect of general self-efficacy on test anxiety, and IUS-12 prospective anxiety factor accounted for much more variance of test anxiety than IUS-12 prohibitory anxiety factor. Conclu⁃sion:General self-efficacy could predict test anxiety directly or indirectly through the mediation of intoler⁃ance of uncertainty.%采用一般自我效能感量表、无法忍受不确定性简易量表及考试焦虑量表测量400名在校高中生,分析其相关性,探讨一般自我效能感、无法忍受不确定性和考试焦虑的关系。结果表明:一般自我效能感和考试焦虑、IU及其因子负相关显著,考试焦虑和无法忍受不确定性及其因子正相关显著;回归分析表明,无法忍受不确定性在一般自我效能感和考试焦虑之间起完全中介作用,在预测考试焦虑时,无法忍受不确定性的认知预期因子比行动抑制因子能解释更多的变异。一般自我效能感对考试焦虑有直接作用,并能通过无法忍受不确定性这一中介来影响考试焦虑。

  20. 广泛性焦虑障碍的治疗进展%The Recent Advances in the Treatment of Generalized Anxiety Disorder (GAD)

    Institute of Scientific and Technical Information of China (English)

    沈鑫华; 沈仲夏

    2013-01-01

    The treatment options of generalized anxiety disorder include psychological therapies and pharmacological treatments. The highly utilized type of psychotherapy is CBT. Antidepressants include Selective serotonin reuptake inhibitors ( SSRIs) and serotonin - norepinephrine reuptake inhibitors ( SNRIs) are considered first line treatment options, and Sertraline is recommended by NICE as the initial treatment for GAD. The second generation antip-sychotics such as Quetiapine monotherapy can be used in refractory GAD. If a particular drug is effective, the optimal treatment duration is generally one year.%广泛性焦虑障碍心理治疗、药物治疗均可选择.心理治疗主要是CBT.药物治疗主要是抗抑郁药物,SSRI、SNRI是一线选择,NICE推荐舍曲林作为初始治疗药物.对于难治性的患者,可以试用第二代抗精神病药物,如喹硫平.如果药物治疗有效,最佳治疗时间为一年.

  1. Recalled Test Anxiety in Relation to Achievement, in the Context of General Academic Self-Concept, Study Habits, Parental Involvement and Socio-Economic Status among Grade 6 Ethiopian Students

    Science.gov (United States)

    Raju, P. Mohan; Asfaw, Abebech

    2009-01-01

    The study investigated the predictive nature of test anxiety on achievement in the presence of perceived general academic self-concept, study habits, parental involvement in children's learning and socio-economic status. From a population of 2482 Grade 6 students from seven government primary schools of a sub-city in Addis Ababa, 497 participants…

  2. Evaluating the Efficacy of Endoscopic Thoracic Sympathectomy for Generalized Social Anxiety Disorder with Blushing Complaints: A Comparison with Sertraline and No Treatment—Santiago de Chile 2003–2009

    OpenAIRE

    Jadresic, Enrique; Súarez, Claudio; Palacios, Estela; Palacios, Fernanda; Matus, Patricia

    2011-01-01

    Objective: No study has yet compared the efficacy of endoscopic thoracic sympathectomy for treating facial blushing with other treatment or no treatment. We conducted a prospective, observational, open-label, clinical study to compare endoscopic thoracic sympathectomy for blushing with generalized social anxiety disorder versus sertraline treatment and no treatment.

  3. Survey on the prevalence of anxiety disorders in internal medical outpatients at general hospital%综合医院内科门诊患者焦虑障碍的患病状况调查

    Institute of Scientific and Technical Information of China (English)

    梅力; 肖泽萍; 何燕玲; 范青

    2010-01-01

    Objective To investigate the prevalence of anxiety disorder in internal medical outpatients at general hospital,explore some susceptible factors of anxiety disorder patients and assess the outpatients from cardiac medicine,digestive medicine,endocrinology and hypertension at Shanghai Ruijin Hospital were selected during November 2007 to January 2008.Hospital anxiety and depression scale (HADS) was used to screen the subjects.Those whose anxiety sub-score was higher or equal to 8 were interviewed with M.I.N.I.investigators further.The information of the physician diagnosis and treatment was collected from the history cards.Results The prevalence of anxiety disorders was 2.51%,panic attack 0.9%,agoraphobe 0.47%,social phobia 0.25%,specific phobia 0.31%,obsessive-compulsive disorder 0.28% and general anxiety disorder 1.47%.Women and widows were more susceptible to anxiety disorders ( P <0.01 ).And 23% of anxiety disorder patients received treatment.But the physician diagnosis rate of anxiety disorders was only 3.2%.Conclusion The prevalence of anxiety disorders in internal medical outpatients at general hospital is still high and general anxiety disorders are commonly encountered.Women and widows are more susceptible to anxiety disorders than others.The physician diagnosis rate of anxiety disorders remains low.%目的 调查综合性医院内科门诊患者焦虑障碍的患病状况以及了解内科医生对焦虑障碍的诊断和治疗情况.方法 按10∶1随机抽取2007年11月至2008年1月间于上海瑞金医院4个内科门诊的就诊者,使用综合性医院焦虑/抑郁情绪测定表(HAD)作为筛查工具,对焦虑分值≥8分的患者进行M.I.N.I.检查并作出诊断,再根据患者的门诊卡了解内科医生关于焦虑障碍的诊断和治疗.结果 所有焦虑障碍的患病率为2.51%,广泛性焦虑最多为1.47%;女性、丧偶者焦虑障碍的患病比例较高(P<0.01);23%的焦虑障碍患者得到相应的治疗,但

  4. Foreign Language Reading Anxiety: Does It Really Exist?

    Science.gov (United States)

    Subasi, Gonca

    2014-01-01

    Recent research on foreign language anxiety appears to support the existence of language skill specific anxiety. The principal goal of the present study is to confirm empirically that foreign language (FL) reading anxiety is a specific anxiety type distinguishable from the more general types of FL anxiety (FLA) in the Turkish EFL context. There is…

  5. Anxiety and threat perception abnormalities in normal children.

    NARCIS (Netherlands)

    P. Muris; M. Kindt; S. Boegels; H. Merckelbach; B, Gadet; V. Moulaert

    2000-01-01

    Examined the relationship between childhood anxiety and threat perception abnormalities. 105 children (aged 8-13 yrs) were exposed to stories reflecting 3 types of anxiety: social anxiety, separation anxiety, and generalized anxiety. From children's reactions to the stories, a number of threat perce

  6. Reading Anxiety in L1: Reviewing the Concept

    Science.gov (United States)

    Piccolo, Luciane R.; Giacomoni, Claudia Hofheinz; Julio-Costa, Annelise; Oliveira, Susani; Zbornik, John; Haase, Vitor G.; Salles, Jerusa F.

    2017-01-01

    Elevated levels of anxiety have been associated with students' poor academic performance. Research on domain-specific anxiety patterns in reading has demonstrated that reading anxiety is associated with, yet distinctive from, general anxiety. Reading anxiety is an unpleasant emotional reaction experienced by students when reading; it is a specific…

  7. Irritability and Anxiety Severity Among Youth With Anxiety

    Science.gov (United States)

    Cornacchio, Danielle; Crum, Kathleen I.; Coxe, Stefany; Pincus, Donna B.; Comer, Jonathan S.

    2015-01-01

    Objective Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations. Method Structural equation modeling (SEM) examined associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N=663, ages 7–19 years, M=12.25), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status. Results There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Further, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety–irritability link is relevant across child anxiety disorders and not circumscribed to youth with GAD. Conclusion Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Further, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Moreover, treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability. PMID:26703910

  8. O que nossos pacientes querem e necessitam saber sobre transtorno de ansiedade generalizada? What our patients want and need to know about generalized anxiety disorder?

    Directory of Open Access Journals (Sweden)

    Christer Allgulander

    2007-06-01

    Full Text Available Pessoas com transtorno de ansiedade generalizada geralmente não procuram tratamento e, se o fazem, é mais devido aos sintomas somáticos (tensão muscular, insônia ou a uma depressão secundária do que por causa da característica central do transtorno de ansiedade generalizada: preocupação. O aspecto da preocupação torna-se aparente quando se propõe que o paciente tome uma medicação ansiolítica. O clínico terá então que estar preparado para responder a muitas perguntas sobre os riscos e benefícios potenciais de tal medicação. Esses pacientes tendem a ter uma atitude cética, por terem obtido informações em websites que apresentam afirmações que não têm nenhum embasamento científico ou alegações distorcidas, equivocadas e infundadas. Quais são as perguntas freqüentes que os pacientes preocupados colocam ao clínico antes de aceitarem a farmacoterapia ansiolítica? Tendo atendido a pacientes ansiosos em meu consultório por 25 anos, e tendo realizado vários ensaios clínicos com ansiolíticos, reuni neste artigo, em linguagem simples, as respostas baseadas em evidências a essas perguntas.Persons with generalized anxiety disorder often do not seek treatment, and if they do, it is more often for the somatic symptoms (muscle tension, insomnia or for a secondary depression than because of the cardinal feature of generalized anxiety disorder: worry. The worry aspect becomes apparent when the patient is proposed to try anxiolytic medication. The physician will then need to be prepared to answer many questions regarding the potential hazards and benefits of such medication. These patients tend to have a sceptical attitude, having informed themselves on websites that display claims that are based on anything from evidence-based scientific guidelines to distorted, erroneous and unfounded allegations. Which are the frequent questions that worried patients pose to the physician before accepting anxiolytic pharmacotherapy

  9. Number needed to treat to harm for discontinuation due to adverse events in the treatment of bipolar depression, major depressive disorder, and generalized anxiety disorder with atypical antipsychotics.

    Science.gov (United States)

    Gao, Keming; Kemp, David E; Fein, Elizabeth; Wang, Zuowei; Fang, Yiru; Ganocy, Stephen J; Calabrese, Joseph R

    2011-08-01

    To estimate the number needed to treat to harm (NNTH) for discontinuation due to adverse events with atypical antipsychotics relative to placebo during the treatment of bipolar depression, major depressive disorder (MDD), and generalized anxiety disorder (GAD). English-language literature published and cited in MEDLINE from January 1966 to May 2009 was searched with the terms antipsychotic, atypical antipsychotic, generic and brand names of atypical antipsychotics, safety, tolerability, discontinuation due to adverse events, somnolence, sedation, weight gain, akathisia, or extrapyramidal side effect; and bipolar depression, major depressive disorder, or generalized anxiety disorder; and randomized, placebo-controlled clinical trial. This search was augmented with a manual search. Studies with a cumulative sample of ≥ 100 patients were included. The NNTHs for discontinuation due to adverse events, somnolence, sedation, ≥ 7% weight gain, and akathisia relative to placebo were estimated with 95% confidence intervals to reflect the magnitude of variance. Five studies in bipolar depression, 10 studies in MDD, and 4 studies in GAD were identified. Aripiprazole and olanzapine have been studied in bipolar depression and refractory MDD. Only quetiapine extended release (quetiapine-XR) has been studied in 3 psychiatric conditions with different fixed dosing schedules. For aripiprazole, the mean NNTH for discontinuation due to adverse events was 14 in bipolar depression, but was not significantly different from placebo in MDD. For olanzapine, the mean NNTHs were 24 in bipolar depression and 9 in MDD. The risk for discontinuation due to adverse events during quetiapine-XR treatment appeared to be associated with dose. For quetiapine-XR 300 mg/d, the NNTHs for discontinuation due to adverse events were 9 for bipolar depression, 8 for refractory MDD, 9 for MDD, and 5 for GAD. At the same dose of quetiapine-XR, patients with GAD appeared to have a lower tolerability than

  10. 提高综合医院焦虑障碍与抑郁障碍的识别率%General Hospital to improve the recognition rate of anxiety disorders and depression disorder

    Institute of Scientific and Technical Information of China (English)

    苏文英; 陈芸; 赵新宇; 杨欣

    2014-01-01

    目的:通过对南充综合医院门诊病人的抑郁障碍和焦虑障碍的发生率及共病现象研究,提高焦虑障碍与抑郁障碍的识别率。方法:随机抽取1000例门诊患者进行焦虑自评量表(SAS)和抑郁自评量表(SDS)的问卷调查,通过数据统计分析,阳性筛查焦虑障碍和抑郁障碍的患病情况。结果:门诊中有8.56%的患者存在焦虑障碍,6.03%的患者存在抑郁障碍,2.96%的患者存在焦虑障碍与抑郁障碍共病现象。女性焦虑障碍患病率大于男性患病率,女性抑郁障碍患病率大于男性患病率。结论:综合医院提高焦虑障碍与抑郁障碍的识别率的过程中应注意性别的影响,加强综合门诊对焦虑障碍及抑郁障碍的识别率。%Through Nanchong depression and anxiety disorders in general hospitals and outpatient incidence of comorbidity research, improving the recognition rate of anxiety disorders and depression. Methods: 1000 cases were randomly selected outpatients Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) questionnaire, through statistical analysis, positive screening for anxiety disorders and depressive disorders prevalence. Results: The patient had 8.56% of patients with anxiety disorders, 6.03% of patients with major depressive disorder, anxiety disorders and depressive disorders exist Comorbidity 2.96%of patients. Women prevalence of anxiety disorders than men prevalence of women than men prevalence of depressive disorder prevalence. Conclusion: General Hospital to improve the recognition rate of anxiety disorders and depressive disorders in the process should pay attention to the impact of gender, strengthen the comprehensive clinic for anxiety disorders and depression recognition rate.

  11. Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: The TRAILS study

    NARCIS (Netherlands)

    Janssens, Karin A. M.; Rosmalen, Judith G. M.; Ormel, Johan; van Oort, Floor V. A.; Oldehinkel, Albertine J.

    Background: It is well known that functional somatic symptoms (FSS) are associated with anxiety and depression. However, evidence is lacking about how they are related to FSS. The aim of this study was to clarify these relationships and examine whether anxiety and depression are distinctly related

  12. Valerian for anxiety disorders.

    Science.gov (United States)

    Miyasaka, L S; Atallah, A N; Soares, B G O

    2006-10-18

    Anxiety disorders are very common mental health problems in the general population and in primary care settings. Herbal medicines are popular and used worldwide and might be considered as a treatment option for anxiety if shown to be effective and safe. To investigate the effectiveness and safety of valerian for treating anxiety disorders. Electronic searches: The Cochrane Collaboration Depression, Anxiety and Neurosis Cochrane Controlled Trials Register (CCDANCTR-Studies and CCDANCTR-References) searched on 04/08/2006, MEDLINE, Lilacs. References of all identified studies were inspected for additional studies. First authors of each included study, manufacturers of valerian products, and experts in the field were contacted for information regarding unpublished trials. Randomised controlled trials (RCTs) and quasi-randomised trials of valerian extract of any dose, regime, or method of administration, for people with any primary diagnosis of general anxiety disorder, anxiety neurosis, chronic anxiety status, or any other disorder in which anxiety is the primary symptom (panic disorder, obsessive compulsive disorder, social phobia, agoraphobia, other types of phobia, postraumatic stress disorder). Effectiveness was measured using clinical outcome measures and other scales for anxiety symptoms. Two review authors independently applied inclusion criteria, extracted and entered data, and performed the trial quality assessments. Where disagreements occurred, the third review author was consulted. Methodological quality of included trials was assessed using Cochrane Handbook criteria. For dichotomous outcomes, relative risk (RR) was calculated, and for continuous outcomes, the weighted mean difference (WMD) was calculated, with their respective 95% confidence intervals. One RCT involving 36 patients wih generalised anxiety disorder was eligible for inclusion. This was a 4 week pilot study of valerian, diazepam and placebo. There were no significant differences between the

  13. Effects of Passion Flower Extract, as an Add-On Treatment to Sertraline, on Reaction Time in Patients ‎with Generalized Anxiety Disorder: A Double-Blind Placebo-Controlled Study.

    Science.gov (United States)

    Nojoumi, Mandana; Ghaeli, Padideh; Salimi, Samrand; Sharifi, Ali; Raisi, Firoozeh

    2016-07-01

    Objective: Because of functional impairment caused by generalized anxiety disorder and due to cognitive side ‎effects of many anti-anxiety agents, in this study we aimed to evaluate the influence of Passion ‎flower standardized extract on reaction time in patients with generalized anxiety disorder.‎ Method: Thirty patients aged 18 to 50 years of age, who were diagnosed with generalized anxiety disorder and ‎fulfilled the study criteria, entered this double-blind placebo-controlled study. Reaction time was ‎measured at baseline and after one month of treatment using computerized software. Correct ‎responses, omission and substitution errors and the mean time of correct responses (reaction time) in ‎both visual and auditory tests were collected. The analysis was performed between the two groups ‎and within each group utilizing SPSS PASW- statics, Version 18. P-value less than 0.05 was ‎considered statistically significant.‎ Results: All the participants were initiated on Sertraline 50 mg/day, and the dosage was increased to 100 ‎mg / day after two weeks. Fourteen patients received Pasipy (Passion Flower) 15 drops three times ‎daily and 16 received placebo concurrently. Inter-group comparison proved no significant difference ‎in any of the test items between assortments while a significant decline was observed in auditory ‎omission errors in passion flower group after on month of treatment using intra-group analysis.‎‎ Conclusion: This study noted that passion flower might be suitable as an add-on in the treatment of generalizedanxiety disorder with low side effects. Further studies with longer duration are recommended to ‎confirm the results of this study.‎.

  14. Effects of Passion Flower Extract, as an Add-on Treatment to Sertraline, on Reaction Time in Patients ‎with Generalized Anxiety Disorder: a Double-blind Placebo-Controlled Study

    Directory of Open Access Journals (Sweden)

    Mandana Nojoumi

    2016-10-01

    Full Text Available Objective: Because of functional impairment caused by generalized anxiety disorder and due to cognitive side ‎effects of many anti-anxiety agents, in this study we aimed to evaluate the influence of Passion ‎flower standardized extract on reaction time in patients with generalized anxiety disorder.‎Method: Thirty patients aged 18 to 50 years of age, who were diagnosed with generalized anxiety disorder and ‎fulfilled the study criteria, entered this double-blind placebo-controlled study. Reaction time was ‎measured at baseline and after one month of treatment using computerized software. Correct ‎responses, omission and substitution errors and the mean time of correct responses (reaction time in ‎both visual and auditory tests were collected. The analysis was performed between the two groups ‎and within each group utilizing SPSS PASW- statics, Version 18. P-value less than 0.05 was ‎considered statistically significant.‎Results: All the participants were initiated on Sertraline 50 mg/day, and the dosage was increased to 100 ‎mg / day after two weeks. Fourteen patients received Pasipy (Passion Flower 15 drops three times ‎daily and 16 received placebo concurrently. Inter-group comparison proved no significant difference ‎in any of the test items between assortments while a significant decline was observed in auditory ‎omission errors in passion flower group after on month of treatment using intra-group analysis.‎‎Conclusion: This study noted that passion flower might be suitable as an add-on in the treatment of generalizedanxiety disorder with low side effects. Further studies with longer duration are recommended to ‎confirm the results of this study.‎

  15. Brain morphological alterations and cellular metabolic changes in patients with generalized anxiety disorder: A combined DARTEL-based VBM and (1)H-MRS study.

    Science.gov (United States)

    Moon, Chung-Man; Jeong, Gwang-Woo

    2016-05-01

    Generalized anxiety disorder (GAD) is characterized by emotional dysregulation and cognitive deficit in conjunction with brain morphometric and metabolic alterations. This study assessed the combined neural morphological deficits and metabolic abnormality in patients with GAD. Thirteen patients with GAD and 13 healthy controls matched for age, sex, and education level underwent high-resolution T1-weighted MRI and proton magnetic resonance spectroscopy ((1)H-MRS) at 3Tesla. In this study, the combination of voxel-based morphometry (VBM) and (1)H-MRS was used to assess the brain morphometric and metabolic alterations in GAD. The patients showed significantly reduced white matter (WM) volumes in the midbrain (MB), precentral gyrus (PrG), dorsolateral prefrontal cortex (DLPFC) and anterior limb of the internal capsule (ALIC) compared to the controls. In MRS study, the choline/creatine (Cho/Cr) and choline/N-acetylaspartate (Cho/NAA) ratios in the DLPFC were significantly lower in the patients. Particularly, the WM volume variation of the DLPFC was positively correlated with both of the Cho/Cr and Cho/NAA ratios in patients with GAD. This study provides an evidence for the association between the morphometric deficit and metabolic changes in GAD. This finding would be helpful to understand the neural dysfunction and pathogenesis in connection with cognitive impairments in GAD.

  16. What's in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder.

    Science.gov (United States)

    Koerner, Naomi; Mejia, Teresa; Kusec, Andrea

    2017-03-01

    A number of studies have examined the association of intolerance of uncertainty (IU) to trait worry and generalized anxiety disorder (GAD). However, few studies have examined the extent of overlap between IU and other psychological constructs that bear conceptual resemblance to IU, despite the fact that IU-type constructs have been discussed and examined extensively within psychology and other disciplines. The present study investigated (1) the associations of IU, trait worry, and GAD status to a negative risk orientation, trait curiosity, indecisiveness, perceived constraints, self-oriented and socially prescribed perfectionism, intolerance of ambiguity, the need for predictability, and the need for order and structure and (2) whether IU is a unique correlate of trait worry and of the presence versus absence of Probable GAD, when overlap with other uncertainty-relevant constructs is accounted for. N = 255 adults completed self-report measures of the aforementioned constructs. Each of the constructs was significantly associated with IU. Only IU, and a subset of the other uncertainty-relevant constructs were correlated with trait worry or distinguished the Probable GAD group from the Non-GAD group. IU was the strongest unique correlate of trait worry and of the presence versus absence of Probable GAD. Indecisiveness, self-oriented perfectionism and the need for predictability were also unique correlates of trait worry or GAD status. Implications of the findings are discussed, in particular as they pertain to the definition, conceptualization, and cognitive-behavioral treatment of IU in GAD.

  17. Behavioural effects of rapid intravenous administration of meta-chlorophenylpiperazine (m-CPP) in patients with generalized social anxiety disorder, panic disorder and healthy controls.

    Science.gov (United States)

    Van Veen, J F; Van der Wee, N J A; Fiselier, J; Van Vliet, I M; Westenberg, H G M

    2007-10-01

    Findings from epidemiological, pharmacotherapeutical, genetic and neurobiological studies suggest a possible overlap in the neurobiology of generalized social anxiety disorder (gSAD) and panic disorder (PD). Previously we have found a rapid intravenous m-CPP challenge of 0.1 mg/kg to be highly sensitive and selective in the provocation of panic attacks in patients with PD. We therefore directly compared the behavioural, neuroendocrine and physiological effects of this rapid m-CPP challenge in a small sample of patients with gSAD, patients with PD and matched healthy controls. Panic attacks were significantly more provoked in patients with PD (85%), but not in patients with gSAD (14%) as compared to healthy controls (0%). Effects on the other behavioural parameters, but not on the neuroendocrine and physiological parameters, were significantly greater in patients with PD compared to patients with gSAD and controls. Our preliminary data do not support a shared neurobiology of gSAD and PD.

  18. Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria.

    Science.gov (United States)

    Price, Matthew; van Stolk-Cooke, Katherine

    2015-11-01

    Exposure to traumatic events places individuals at high risk for multiple psychiatric disorders, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). The high rates of comorbidity among these conditions merit evaluation in order to improve diagnosis and treatment approaches. The current study evaluated the association between PTSD, MDD, and GAD factors as presented in the DSM 5. 602 trauma-exposed individuals who experienced an event that met Criterion A for the DSM 5 PTSD diagnosis were recruited through Amazon.com, Inc.'s Mechanical Turk (MTurk) to complete an assessment of the impact of stressful events on their lives. High interrelations were detected among the 4 PTSD factors, 2 MDD factors that corresponded to somatic and affective symptoms, and the single GAD factor. The affective factor of MDD was most strongly related to the emotional numbing factor of PTSD, whereas the somatic factor of MDD was most strongly related to the hyperarousal factor of PTSD. The GAD factor was most strongly related to the hyperarousal factor of PTSD, relative to the other PTSD factors. The strength of the interrelations between factors of the three disorders is largely a function of the overlap in symptoms and calls into question the uniqueness of negative affective symptoms of PTSD, MDD and GAD. Results suggest that improved understanding of the trauma reaction requires a focus on the unique presentation of each individual and assessment of multiple disorders.

  19. Statistics anxiety, state anxiety during an examination, and academic achievement.

    Science.gov (United States)

    Macher, Daniel; Paechter, Manuela; Papousek, Ilona; Ruggeri, Kai; Freudenthaler, H Harald; Arendasy, Martin

    2013-12-01

    A large proportion of students identify statistics courses as the most anxiety-inducing courses in their curriculum. Many students feel impaired by feelings of state anxiety in the examination and therefore probably show lower achievements. The study investigates how statistics anxiety, attitudes (e.g., interest, mathematical self-concept) and trait anxiety, as a general disposition to anxiety, influence experiences of anxiety as well as achievement in an examination. Participants were 284 undergraduate psychology students, 225 females and 59 males. Two weeks prior to the examination, participants completed a demographic questionnaire and measures of the STARS, the STAI, self-concept in mathematics, and interest in statistics. At the beginning of the statistics examination, students assessed their present state anxiety by the KUSTA scale. After 25 min, all examination participants gave another assessment of their anxiety at that moment. Students' examination scores were recorded. Structural equation modelling techniques were used to test relationships between the variables in a multivariate context. Statistics anxiety was the only variable related to state anxiety in the examination. Via state anxiety experienced before and during the examination, statistics anxiety had a negative influence on achievement. However, statistics anxiety also had a direct positive influence on achievement. This result may be explained by students' motivational goals in the specific educational setting. The results provide insight into the relationship between students' attitudes, dispositions, experiences of anxiety in the examination, and academic achievement, and give recommendations to instructors on how to support students prior to and in the examination. © 2012 The British Psychological Society.

  20. 安神方治疗广泛性焦虑障碍临床观察%Observation of Anshenfang in treating general anxiety disorder

    Institute of Scientific and Technical Information of China (English)

    张雪; 黄仕营; 谭为; 张燊; 王洋; 陈宝田

    2012-01-01

    Objectivce To investigate the efficacy of Anshenfang(ASF) for patients with general anxiety disorder (GAD). Methods 80 patients with GAD were entered a 4-week randomized controlled trial. They were divided into 2 groups. 40 patients of control group were given diazepam and other 40 of treatment group were given ASF. Efficacy and side effects were evaluated with Hamilton Anxiety Scale (HAMA) and treatment emergent symptom scale (TESS). Results After 4 weeks of treatment the HAMA decrease values in two groups were less than those before the treatment (P<0.01). There was on significant difference in response rate between the 2 groups. There was significant difference in TESS between the 2 groups. Conclusion ASF is one of the effective therapies with less emergent symptom in treating GAD, which is worth studying and spreading further more.%目的 观察安神方治疗广泛性焦虑障碍(GAD)的临床疗效.方法 将120例GAD患者随机分为治疗组和对照组,每组60例,分别给予口服安神方和地西泮治疗,疗程均为4周.以汉密尔顿焦虑量表(HAMA)和副反应量表(TESS)评价疗效和不良反应.结果 治疗4周后,两组HAMA分值均比治疗前明显降低,差异有统计学意义(P均<0.01);但两组间比较差异无统计学意义.治疗组与对照组TESS量表评分比较差异有统计学意义(P<0.05).结论 安神方治疗GAD安全、有效且不良反应较小,值得进一步研究推广.

  1. A placebo controlled study of quetiapine-XR in bipolar depression accompanied by generalized anxiety with and without a recent history of alcohol and cannabis use.

    Science.gov (United States)

    Gao, Keming; Ganocy, Stephen J; Conroy, Carla; Brownrigg, Brittany; Serrano, Mary Beth; Calabrese, Joseph R

    2017-08-01

    This study aims to compare treatment response in bipolar I or II depression and generalized anxiety disorder (GAD) with and without recent alcohol and/or cannabis use disorder (ALC/CAN) to quetiapine-XR (extended release) or placebo. A randomized, double-blind, 8-week study of quetiapine-XR versus placebo in patients with bipolar I or II depression and GAD with or without a recent ALC/CAN was used to compare changes in Hamilton Depression Rating Scale-17, Hamilton Anxiety Rating Scale, the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR-16), Clinical Global Impression for Bipolar Disorder-Severity (CGI-BP-S), and Timeline Follow Back within and between groups. In the quetiapine-XR group, patients with a recent ALC/CAN (n = 22) had significant decreases in QIDS-SR-16 (-9.6 ± 1.6 vs. -3.7 ± 1.7) and CGI-BP-S (-1.6 ± 0.4 vs. -0.8 ± 0.03) than those without a recent ALC/CAN (n = 24). In the placebo group, both patients with a recent ALC/CAN (n = 23) and those without (n = 21) had similar reductions in these measures. The reduction of QIDS-SR-16 scores in patients with a recent ALC/CAN was also significantly different from that of their counterparts in the placebo group. Patients who received quetiapine-XR had larger decreases in the number of drinking days/week (p = 0.17) and number of cannabis joints/week (p = 0.09) compared to those who received placebo. Quetiapine-XR was superior to placebo in reducing QIDS-SR-16 total score in patients with a recent ALC/CAN. Patients taking quetiapine-XR used less alcohol and cannabis than patients on placebo, suggesting that quetiapine-XR may be of use in patients with bipolar disorder accompanied by GAD and other comorbidities.

  2. Initial design of culturally informed behavioral intervention technologies: developing an mHealth intervention for young sexual minority men with generalized anxiety disorder and major depression.

    Science.gov (United States)

    Burns, Michelle Nicole; Montague, Enid; Mohr, David C

    2013-12-05

    To our knowledge, there is no well-articulated process for the design of culturally informed behavioral intervention technologies. This paper describes the early stages of such a process, illustrated by the methodology for the ongoing development of a behavioral intervention technology targeting generalized anxiety disorder and major depression among young sexual minority men. We integrated instructional design for Internet behavioral intervention technologies with greater detail on information sources that can identify user needs in understudied populations, as well as advances in the understanding of technology-specific behavioral intervention technology dimensions that may need to be culturally tailored. General psychological theory describing how to effect change in the clinical target is first integrated with theory describing potentially malleable factors that help explain the clinical problem within the population. Additional information sources are then used to (1) evaluate the theory, (2) identify population-specific factors that may affect users' ability to relate to and benefit from the behavioral intervention technology, and (3) establish specific skills, attitudes, knowledge, etc, required to change malleable factors posited in the theory. User needs result from synthesis of this information. Product requirements are then generated through application of the user needs to specific behavioral intervention technology dimensions (eg, technology platform). We provide examples of considerations relevant to each stage of this process and how they were applied. This process can guide the initial design of other culturally informed behavioral intervention technologies. This first attempt to create a systematic design process can spur development of guidelines for design of behavioral intervention technologies aimed to reduce health disparities.

  3. Test Anxiety Reduction. Curriculum Guide.

    Science.gov (United States)

    Silverman, Eda; Hanna, Joyce

    This curriculum guide is intended to assist teachers in helping their adult and teenage students learn to cope with their test anxiety. The introduction examines some of the causes of test anxiety and its negative ramifications from the standpoint of class placement, class grades, employment opportunities, and job advancement. General guidelines…

  4. [Cognitive behavior therapy for anxiety disorders].

    Science.gov (United States)

    Sakano, Yuji

    2012-01-01

    It is necessary to take the psychological characteristics of anxiety into account when we consider the improvement of anxiety. Anxiety is generally observed basic emotion in human and never extinguishable. Therefore, it is important for patients with anxiety disorders to learn how to manage their daily anxious responses, even after their pathological anxiety is successfully treated and improved. Considering these points, comprehensive psychological treatment, including not only effective intervention to pathological anxiety but also anxiety management program, is needed in treating anxiety disorders effectively. Reviewing previous studies on effectiveness of psychotherapy for anxiety disorders shows that the cognitive behavior therapy is the most effective intervention in terms of extinction of pathological anxiety, prolonged effectiveness of the treatment, prognosis, prevention of recurrence, and improvement of patients' quality of life. In this article, firstly, basic conceptualization and case formulation of anxiety disorders are discussed theoretically. Secondly, effectiveness of cognitive behavior therapy for anxiety disorders, including panic disorder, obsessive compulsive disorder, social anxiety disorder, post-traumatic stress disorder, general anxiety disorder, and specific phobia, is reviewed. And finally, challenges of cognitive behavior therapy are discussed in terms of further development and dissemination of cognitive behavior therapy in Japan.

  5. Developmental trajectories of anxiety symptoms in early adolescence: the influence of anxiety sensitivity.

    Science.gov (United States)

    Allan, Nicholas P; Capron, Daniel W; Lejuez, Carl W; Reynolds, Elizabeth K; MacPherson, Laura; Schmidt, Norman B

    2014-05-01

    Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M age = 11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.

  6. Clinical Observation on Traditional Chinese Medicine Differentiation in the Treatment of the Generalized Anxiety Disorder%中医辨证治疗广泛性焦虑症的临床观察

    Institute of Scientific and Technical Information of China (English)

    李鸿娜

    2013-01-01

    目的:探讨中药治疗广泛性焦虑症的临床疗效及安全性。方法:依据CCMD-3诊断标准选择96例广泛性焦虑症患者,根据患者的中医证候,辨证分型给予中药方剂治疗,疗程6周。治疗前后分别评定汉密尔顿焦虑量表(HAMA)、副反应量表(TESS)来判定疗效和副反应。结果:治疗的总有效率为82.8%,HAMA总分较治疗前明显下降(P<0.05),无明显不良反应。结论:中医辨证治疗广泛性焦虑症的疗效肯定,安全性良好,具有积极的临床意义。%Objective:To explore the clinical efficacy and safety of TCM treating generalized anxiety disorder .Methods:Ninety six pa-tients with generalized anxiety disorder were selected in light of CCMD-3 diagnostic criteria.Patients were given TCM formulas of differ-ent syndrome patterns according to their syndrome differentiation for 6 weeks.Hamilton anxiety scale (HAMA) and Treatment Emergent Symptom Scale (TESS) were assessed before and after treatment in order to determine the efficacy and adverse reaction .Results:After the treatment, the total effective rate was 82.8%, and the total score of HAMA were significantly decreased (P<0.05).There was no obvious side reaction.Conclusion:TCM is effective in the treatment of general anxiety disorder with high safety , and it is worth general-izing.

  7. Anxiety Disorders and Cardiovascular Disease.

    Science.gov (United States)

    Celano, Christopher M; Daunis, Daniel J; Lokko, Hermioni N; Campbell, Kirsti A; Huffman, Jeff C

    2016-11-01

    Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.

  8. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  9. Therapist empathy, homework compliance, and outcome in cognitive behavioral therapy for generalized anxiety disorder: partitioning within- and between-therapist effects.

    Science.gov (United States)

    Hara, Kimberley M; Aviram, Adi; Constantino, Michael J; Westra, Henny A; Antony, Martin M

    2016-11-15

    Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients' subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist-client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients' ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist's caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.

  10. 万拉法新与氯硝安定治疗广泛性焦虑症的效果比较%A COMPARATIVE STUDY OF VENLAFAXINE AND CLONAZEPAM IN THE TREATMENT OF PATIENTS WITH GENERALIZED ANXIETY DISORDER

    Institute of Scientific and Technical Information of China (English)

    杨君宏; 刘河

    2014-01-01

    Objective To evaluate the efficacy and side effects of venlafaxine in the treatment of general anxiety disorder.Methods 76 patients who met the criteria of CCMD-3 for generalized anxiety disorder were randomly assigned into venlafaxine group and clonazepam group for treatment of 6 weeks.The effects and side effects of two groups were assessed by HAMD,SAS and TESS Results Both drugs had marked efficacy in the treatment of generalized anxiety disorder. Conclusion Venlafaxine is a safe and efficient drug with fewer side effects for the treatment of generalized anxiety disorder.%目的:评价万拉法新治疗广泛性焦虑症的临床疗效和副作用。方法将76例符合CCMD--3诊断标准的广泛性焦虑症病人,随机分为两组,分别应用万拉法新(38例)、氯硝安定(38例)进行治疗,疗程6周。采用焦虑自评量表(SAS)、Hamilton焦虑量表(HAMA)和副作用量表(TESS)评定疗效和副作用。结果万拉法新与氯硝安定对广泛性焦虑症均有显著疗效,两组间疗效差异无显著性(P>0.05),万拉法新副作用明显少于氯硝安定仲(P<0.01)。结论万拉法新治疗广泛性焦虑症安全有效,副作用少。

  11. Intrinsic personality traits in patients with generalized anxiety disorder%广泛性焦虑症患者的自身内在人格特质

    Institute of Scientific and Technical Information of China (English)

    瞿玮; 覃园园

    2005-01-01

    强性、兴奋性与Zung焦虑自评量表评分呈显著负相关(r=-0.273,P<0.01;r=-0.217,P<0.05;r=-0.217,P<0.05),紧张性与Zung焦虑自评量表评分呈显著正相关(r--0.248,P<0.05).结论:焦虑症的发生与其自身人格特质有关,有稳定性、持强性、兴奋性低分和紧张性高分特征.这4种人格特质,可能是罹患焦虑症的易感人格特征,同时还影响着焦虑症的严重程度.%BACKGROUND: According to Eysenck's theory of personality, trait level belongs tolow-grade personality, which can better reflect characteristics of individual habitual behavior reaction.OBJECTIVE: To explore the correspondent relationship between generalized anxiety patient and internal personality trait through adopting Cattell's 16 Personality Factor Questionnaire (16PFQ) and Zung's Self-rating Anxiety Scale (SAS) to test generalized anxiety patients.DESIGN: A transectional sampling survey and data was compared with that of health adult norms.SETTING: Counseling clinic of out-patient in the Southwest Hospital of the Third Military Medical University of Chinese PLA.PARTICIPANTS: Totally 100 patients with generalized anxiety disorders who visited the clinical counseling clinic of out-patient in the Southwest Hospital, Third Military Medical University of Chinese PLA for the first time from August 2003 to March 2004 were included, including 40 men and 60 women.METHODS: Catell's 16PFQ was tested with Psychometric Toolbox Standard Edition V2.3 developed by the Insight Group of Peking University.The patients filled out the forms independently after the method being explained clearly by professional staff members. These 16 personality factors included warmth (reserved vs. warm; Factor A), reasoning (concrete vs.abstract; Factor B), emotional stability (reactive vs. emotionally stable;Factor C), dominance (deferential vs. dominant; Factor E), liveliness (serious vs. lively; Factor F), rule-consciousness (expedient vs. rule-conscious;Factor G

  12. Computer Anxiety and Instruction.

    Science.gov (United States)

    Baumgarte, Roger

    While the computer is commonly viewed as a tool for simplifying and enriching lives, many individuals react to this technology with feelings of anxiety, paranoia, and alienation. These reactions may have potentially serious career and educational consequences. Fear of computers reflects a generalized fear of current technology and is most…

  13. Effect of Jin-3-Needling Therapy on Plasma Corticosteroid, Adrenocorticotrophic Hormone and Platelet 5-HT Levels in Patients with Generalized Anxiety Disorder

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To observe the therapeutic efficacy of Jin-3-needling therapy(J3N)on generalized anxiety disorder(GAD)through clinical global impression scale(CGI),and to explore the mechanism by measuring the plasma levels of corticosteroid(CS),adrenocorticotrophic hormone (ACTH),and platelet 5-hydroxytryptamine(5-HT)before and after treatment.Methods:Eightysix GAD patients with the diagnosis agreeing with the inclusion criteria were assigned,according to the sequence of visiting time,to three groups.The 29 patients in the Western medicine group were treated mainly with fluoxetine or paroxetine,Alprazolam might be given additionally in severe conditions if necessary;the 29 patients in the needling group received J3N therapy with Sishenzhen,Dingshenzhen,Neiguan(PC6),Shenmen(HT7)and Sanyinjiao(SP6)as the chief acupoints selected;and the 28 patients in the combined treatment group were treated with both drugs and needling in the same way as applied in the above two groups.The therapeutic course for all was 6weeks.Conditions of patients were evaluated before and after treatment with CGI,and levels of CS,ACTH as well as 5-HT were measured by high performance liquid chromatography-electrochemistry.Results:By CGI scoring,the scores of severity index and the general index were not different significantly in the three groups,but the efficacy index proved to be the highest in the needling group,the second in the combined trentment group,and the lowest in the drug group.Plasma level of ACTH and platelet content of 5-HT were lowered in all the three groups after treatment,showing statistical significance(P<0.05),but no significant change was found in CS level(P>0.05).Conclusion:The therapeutic efficacy of J3N in treating GAD is equivalent to,but with the efficacy index significantly higher than,that of conventional treatment.Moreover,when combined with drugs,needling might effectively prevent the side effect of the routinely used Western drugs.The regulatory action of needling

  14. [Pharmacotherapy of Anxiety Disorders].

    Science.gov (United States)

    Zwanzger, P

    2016-05-01

    Anxiety disorders belong to the most frequent psychiatric disorders according to epidemiological studies and are associated with a high economic burden. Panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia belong to the most important clinical disorders. The etiology is complex, including genetic, neurobiological as well as psychosocial factors. With regard to treatment, both psychotherapy and medication can be employed according to current treatment guidelines. With regard to psychotherapy, cognitive behavioral therapy (CBT) represents the treatment of choice. As for pharmacological treatment, in particular modern antidepressants and pregabalin are recommended. However, several recommendations have to be considered in daily clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

  15. 广泛性焦虑障碍的病因机制与治疗综述%A Review of the Pathogenesis and Treatment of Generalized Anxiety Disorder

    Institute of Scientific and Technical Information of China (English)

    杨杰霖; 李鹤展

    2015-01-01

    Generalized anxiety disorder(GAD) is a chronic anxiety disorder,receiving more academic attention recently because of its high incidence, low cure rate and high probability of relapse.This paper briefly expounds the different theories on the pathogenesis of GAD as well as the corresponding treatment methods and on this basis puts forward personal views on the pathogenesis of GAD and corresponding therapy.%广泛性焦虑障碍(GAD)作为一种慢性焦虑障碍,因其发病率高,治愈率较低,且易复发而受到学界重视,本文简要阐述了各大学派对GAD发病机制的观点和相应的治疗方法,并在此基础上提出个人对GAD发病机制的观点及对应的疗法。

  16. Cross-sectional study of anxiety disorders among non-psychiatric outpatients in general hospitals%综合医院非精神/心理科门诊焦虑障碍现况调查

    Institute of Scientific and Technical Information of China (English)

    倪英; 黄悦勤; 刘肇瑞; 魏镜; 唐牟尼; 尼春萍; 罗晓敏; 程辉

    2011-01-01

    目的:调查综合医院非精神/心理科门诊患者焦虑障碍的检出率及其危险因素.方法:采用分层抽样方法,应用复合性国际诊断交谈表(CIDI-3.0)对北京、西安、广州3城市3级别的9家综合医院非精神科门诊≥15岁的1083例患者进行筛查与诊断,调查综合医院非精神科门诊焦虑障碍的检出率,并分析焦虑障碍发生的危险因素.结果:共检出焦虑障碍患者82例,检出率为7.6%,其中合并特殊恐惧症(3.2%)和强迫症(2.8%)较多见.多因素非条件Logistic回归分析显示内科就诊(OR=1.93)、年龄15~39岁(OR =2.56)、受教育年限≤6年(OR =3.38)的患者更易患焦虑障碍.结论:综合医院非精神科门诊患者中合并焦虑障碍多见,年轻、受教育程度低可能为焦虑障碍的危险因素,内科患者较多合并有焦虑障碍.%Objective: To investigate the occurrence and risk factors of anxiety disorders among non-psychiatric outpatients in general hospitals. Methods: A hospital-based cross-sectional study was conducted in 9 three-ranked general hospitals in Beijing, Xi'an and Guangzhou through August 2009 to December2010, using the World Health Organization Composite International Diagnostic Interview Version 3.0 (CIDI-3.0). A sample of 1083 non-psychiatric outpatients aged 15 years and older were selected by stratified sampling and analyzed to describe the distribution of anxiety disorder and related risk factors. Results: Eighty-two patients (7.6%) were diagnosed as anxiety disorders. Specific phobia (3. 2%) and obsessive-compulsive disorder (2. 8%) were most common anxiety disorders among non-psychiatric outpatients in general hospitals. Multivariate non-conditional logistic regress analysis showed that non-psychiatric outpatients who visited department of internal medicine (OR = 1.93), being under 40 years old (OR =2. 56), education years ≤6 (OR =3.38) had more risk to have anxiety disorders. Conclusion: It indicates anxiety

  17. Intolerance of uncertainty and adult separation anxiety.

    Science.gov (United States)

    Boelen, Paul A; Reijntjes, Albert; Carleton, R Nicholas

    2014-01-01

    Intolerance of uncertainty (IU)-the tendency to react negatively to situations that are uncertain-is involved in different anxiety disorders and depression. No studies have yet examined the association between IU and symptoms of adult separation anxiety disorder. However, it is possible that greater difficulties tolerating uncertainties that can occur in relationships with attachment figures inflate fears and worries about the consequences of being separated from these attachment figures. The current study examined the possible role of IU in symptoms of adult separation anxiety disorder, relative to its role in symptoms of generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), social anxiety, and depression, using self-reported data from 215 undergraduates (92% women) with elevated separation anxiety. Findings showed that IU was significantly associated with symptom levels of separation anxiety disorder, GAD, OCD, social anxiety, and depression (rs > .30). IU continued to explain variance in OCD, social anxiety, and depression (but not GAD and separation anxiety) when controlling for the association of neuroticism, attachment anxiety, and attachment avoidance with these symptoms. Additional findings indicated that IU is more strongly associated with symptoms of GAD, OCD, and social anxiety than symptoms of adult separation anxiety disorder and depression.

  18. Trichotillomania and Co-occurring Anxiety

    Science.gov (United States)

    Grant, Jon E.; Redden, Sarah A.; Leppink, Eric W.; Chamberlain, Samuel R.

    2017-01-01

    Background Trichotillomania appears to be a fairly common disorder, with high rates of co-occurring anxiety disorders. Many individuals with trichotillomania also report that pulling worsens during periods of increased anxiety. Even with these clinical links to anxiety, little research has explored whether trichotillomania with co-occurring anxiety is a meaningful subtype. Methods 165 adults with trichotillomania were examined on a variety of clinical measures including symptom severity, functioning, and comorbidity. Participants also underwent cognitive testing assessing motor inhibition and cognitive flexibility. Clinical features and cognitive functioning were compared between those with current co-occurring anxiety disorders (i.e. social anxiety, generalized anxiety disorder, panic disorder, and anxiety disorder NOS) (n=38) and those with no anxiety disorder (n=127). Results Participants with trichotillomania and co-occurring anxiety reported significantly worse hair pulling symptoms, were more likely to have co-occurring depression, and were more likely to have a first-degree relative with obsessive compulsive disorder. Those with anxiety disorders also exhibited significantly worse motor inhibitory performance on a task of motor inhibition (stop-signal task). Conclusions This study suggests that anxiety disorders affect the clinical presentation of hair pulling behavior. Further research is needed to validate our findings and to consider whether treatments should be specially tailored differently for adults with trichotillomania who have co-occurring anxiety disorders, or more pronounced cognitive impairment. PMID:27668531

  19. Survey of depressive and / or anxiety disorders among outpatients in general hospitals of Chengdu%成都市综合医院门诊抑郁和焦虑障碍调查

    Institute of Scientific and Technical Information of China (English)

    黄雨兰; 李晓佳; 褚成静; 李斌; 张岚; 孙红斌

    2011-01-01

    目的:调查成都市综合医院门诊患者抑郁和焦虑障碍的患病率.方法:对成都市3所综合医院神经内科、消化科、心内科及妇科门诊的1 780例就诊者使用医院焦虑抑郁量表(HADS)进行筛查.HADS评分≥8分者使用国际神经精神科简式访谈问卷(MINI5.0.0)进行诊断评定,最后根据美国精神障碍诊断和统计手册第四版(DSM-IV)进行精神科临床诊断.结果:HADS量表评分≥8分的共有845例(47.47%),进入精神科访谈的有618例(73.14%).抑郁障碍、焦虑障碍、焦虑抑郁共病加权终身患病率分别为24.61%、15.17%,10.11%.结论:成都地区综合医院门诊患者焦虑、抑郁障碍患病率较高,但医生的识别率和诊治率偏低.%Objective: To investigate the prevalence rate of depressive and anxiety disorders of outpafients in general hospitals of Chengdu. Method:A total of 1780 outpatients from departments of Neurology,Gastroenterology, Cardiology and Obstetrics and Gynecology in three general hospitals of Chengdu were screened with hospital anxiety and depression scale (HADS). The patients with the HADS score of≥8 were investigated with the mini - international neuropsychiatric interview ( MINI5.0. 0. ), and diagnosed in terms of DSM-IV.Results :845 patients (47.47%) had a HADS score of ≥8,618 of whom were investigated with MINI5.0.0.The lifetime adjusted prevalence rate of depressive disorders, anxiety disorders, and depressive-anxiety comorbid disorders were 24.61%, 15.17%, 10. 11%, respectively. Conclusion: The prevalence rate of anxiety and depression disorders are quite high, but few were well-diagnosed and treated among outpatients in general hospitals of Chengdu.

  20. Exposure-Focused Family-Based CBT for Youth With ASD and Comorbid Anxiety

    Science.gov (United States)

    2016-03-07

    Autism; Asperger's Syndrome; Pervasive Developmental Disorder Not Otherwise Specified; Generalized Anxiety Disorder; Social Phobia; Separation Anxiety Disorder; Obsessive-compulsive Disorder; Specific Phobia

  1. Effect of Fluoxetine Administration on Clinical and Echocardiographic Findings in Patients with Mitral Valve Prolapse and Generalized Anxiety Disorder: Randomized Clinical Trial

    Science.gov (United States)

    Esfehani, Reza Jafarzadeh; Kamranian, Homan; Jalalyazdi, Majid

    2017-01-01

    Background Mitral valve prolapse (MVP) is accompanied by mental disorders including anxiety, which has similar presentations as MVP. It is hypothesised that treatment of anxiety might reduce the symptoms of MVP. Objective The aim of this study was to assess the clinical and echocardiographic effects of fluoxetine administration in patients with MVP and anxiety. Methods This randomized clinical trial was conducted on patients with documented MVP and generalised anxiety disorder (GAD) who were referred to Mashhad University of Medical Sciences cardiology clinics, Mashhad, Iran in 2015. Subjects were randomly assigned to intervention group who received propranolol and fluoxetine (both at 10 mg/day) and control group who received 10 mg/day propranolol. Assessments included echocardiography and GAD-7 questionnaire and rating of chest pain, that were performed at baseline and then weekly for 4 weeks. Analysis was performed using the Mann-Whitney U test and Two-way Repeated Measures Analysis of Variance (ANOVA). Results Sixty patients (25 male/ 35 female) with a mean age of 22.9 ± 2.5 years were studied in two groups of intervention (n = 30) and control (n = 30). GAD score was significantly higher in the intervention group (17.37 ± 1.61) compared with the control group (14.17 ± 0.83) (p0.05). Pain severity was reduced significantly more in control group (3.27 ± 1.26) compared to intervention group (2.80 ± 0.85) after treatment (p<0.001). Conclusions This study revealed that the co-administration of fluoxetine and propranolol may not only have no effective in improving echocardiographic changes of MVP but may also aggravate subjective findings of patients with MVP and GAD. Trial registration The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2014102819721N1. Funding This research has been financially supported by Research Council of Sabzevar University of Medical Sciences.

  2. Culture–General and –Specific Associations of Attachment Avoidance and Anxiety with Perceived Parental Warmth and Psychological Control among Turk and Belgian Adolescents

    OpenAIRE

    Güngör, Derya; Bornstein, Marc H.

    2010-01-01

    Both the adolescent peer attachment and perceived parenting style literatures emphasize the role of the quality of the parent–child relationship in children's healthy adjustment beyond the family, but few studies have investigated links between adolescents' peer attachment and perceptions of parenting. We investigate relations of adolescents' perceptions of warmth and psychological control from parents with avoidance and anxiety in attachment to close friends in two contrasting cultures. Alto...

  3. IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety

    Science.gov (United States)

    Tomasino, Kathryn Noth; Lattie, Emily G; Palac, Hannah L; Kwasny, Mary J; Weingardt, Kenneth; Karr, Chris J; Kaiser, Susan M; Rossom, Rebecca C; Bardsley, Leland R; Caccamo, Lauren; Stiles-Shields, Colleen; Schueller, Stephen M

    2017-01-01

    Background Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions. Objective The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety. Methods Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US $90 for completing all assessments; compensation was not for app use or treatment engagement. Results Of the 99 participants who initiated treatment, 90.1% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (Pstrategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model. Trial Registration Clinicaltrials.gov NCT02176226; http://clinicaltrials.gov/ct2/show/NCT02176226 (Archived by WebCite at http://www.webcitation/6mQZuBGk1) PMID:28057609

  4. A study of duloxetine in the treatment of general anxiety disorder%度洛西汀治疗广泛性焦虑症的对照研究

    Institute of Scientific and Technical Information of China (English)

    陈巧平

    2009-01-01

    目的 探讨度洛西汀对广泛性焦虑症的治疗效果及药物的不良反应.方法 对52例诊断为广泛性焦虑症的患者,随机分为治疗组(27例)和对照组(25例),治疗组给予度洛西汀,对照组给予阿米替林,治疗6周.在治疗前后分别给予汉密尔顿焦虑量表(HAMA)、临床疗效总评量表(CGI)和副反应量表(TESS)评定疗效和不良反应.结果 两种药物的疗效相仿.度洛西汀不良反应少而轻.结论 度洛西汀是治疗广泛性焦虑症安全有效的药物.%Objective To study the efficacy and side effects of duloxetine in treatment of general anxiety disorder.Methods 52 patients were randomly assigned to therapeutic group(n=27)and control group(n=25)for 6 weeks.Therapeutic group were give.duloxetine and control group were given amitriptyline.The clinical effect was assessed with HAMA.CGI and side effects were assessed by TESS.Results Both drugs showed similar efficacy in the treatment of general anxiety disorder.Duloxetine had less and slighter side effects.Conclusion Duloxetine is a safe and efficient drug in the treatment of general anxiety disorder.

  5. Contrast Analysis of Generalized Anxiety Patients on Galvanic Skin Response of Electroencephalo-Biofeedback%生物反馈治疗广泛性焦虑前后皮电检测数据对照分析

    Institute of Scientific and Technical Information of China (English)

    林淄; 余银亮

    2014-01-01

    目的:探讨生物反馈治疗广泛性焦虑的疗效。方法:通过对52例就诊于福州神经精神病防治院福州医学心理咨询中心的符合ICD-10广泛性焦虑诊断的患者,使用GSR脑电生物反馈治疗仪检测生物反馈治疗广泛性焦虑前后皮电反应的变化情况。结果:测试后广泛性焦虑患者的HAMA分数和疲劳因子显著下降,同时放松、注意力、记忆力等因子显著上升( p<0.05),有统计学意义。结论:GSR脑电生物反馈对广泛性焦虑患者具有一定的治疗效果。%Objective:To explore the effect of Electroencephalo -Biofeedback on Generalized Anxiety Patients .Methods:52 patients with generalized anxiety disorder ( ICD-10 ) , which took treatment in Medical Counseling Center of Fuzhou neuropsychiatry Treatment Centers,participated in the use of Electroencephalo -Biofeedback test .Results:The result of HAMA and fatigue were obviously lower , while relaxation, attention, memory improved significantly(P<0.05).Conclusion:Electro encephalo -Biofeedback is beneficial for the treatment of generalized anxiety disorder .

  6. Early Life Experiences and Exercise Associate with Canine Anxieties

    OpenAIRE

    2015-01-01

    Personality and anxiety disorders across species are affected by genetic and environmental factors. Shyness-boldness personality continuum exists across species, including the domestic dog, with a large within- and across-breed variation. Domestic dogs are also diagnosed for several anxiety-related behavioral conditions, such as generalized anxiety disorders, phobias, and separation anxiety. Genetic and environmental factors contributing to personality and anxiety are largely unknown. We coll...

  7. Effect of cognitive behavior therapy to quality of life of patients with generalized anxiety disorder%认知行为治疗对广泛性焦虑症患者生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    卢世臣; 刘琳

    2010-01-01

    Objective To explore the effect of cognitive behavior therapy to quality of life of patients with generalized anxiety disorder. Methods 72 patients with generalized anxiety disorder were randomly divided into observation group (36) and control group (36) .They were treated with paroxetine and the patients of observation group were given cognitive behavior therapy. The study was conducted for 12weeks, Hamilton Anxiety Scale (HAMA) and Generic Quality of Life Inventory (GQOLI -74 ) were evaluated. Results The total score of HAMA, scores of physical anxiety and mental anxiety of observation group were lower than those of control group before and after treatment ( P < 0. 05 or P < 0. 01 ) , but the total score of GQOLI-74, scores of physical function, mental function and social function of observation group were higher than those of control group before and after treatment ( P < 0. 05 or P < 0. 01 ) . Conclusions Cognitive behavior therapy could improve anxiety symptoms of patients with generalized anxiety disorder and higher quality of life.%目的 探讨认知行为治疗对广泛性焦虑症患者生活质量的影响.方法 将72例广泛性焦虑症患者随机分为观察组和对照组各36例.两组均予以帕罗西汀系统治疗,观察组在此基础上予以认知行为治疗,疗程均为12周.采用Hailton焦虑量表(HAMA)及生活质量综合评定问卷(GQOLI-74)分别于治疗前及治疗12周末进行评定.结果 治疗12周末,观察组患者的HAMA总分及躯体性焦虑、精神性焦虑评分均显著低于对照组(t=2.85、2.02、2.79,P<0.05或P<0.01);而GQOLI-74总分及躯体功能、心理功能、社会功能3个维度评分则均显著高于对照组(t=3.88、2.68、2.99、2.1l,P<0.05或P<0.01).结论 认知行为治疗不仅有助于改善广泛性焦虑症患者的焦虑症状,而且有助于提高广泛性焦虑症患者的生活质量.

  8. Observation on the Clinical Efficacy of Duloxetine for Treatment of Generalized Anxiety Disorder%度洛西汀治疗广泛性焦虑障碍的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    毕波; 刘力; 魏媛; 秦晓霞

    2012-01-01

    [目的]探讨度洛西汀治疗广泛性焦虑障碍的临床疗效和安全性.[方法]使用度洛西汀门诊治疗49 例广泛性焦虑患者,疗程8 周,并用汉密尔顿焦虑量表(HAMA) 、临床疗效总评量表(CGI) 、药物不良反应评定量表(TESS) 分别在治疗前、治疗第2、4、8周进行评分.依据HAMA总分减分率判定疗效.[结果]治疗第2周起,患者的HAMA评分,CGI评分与治疗前相比均有显著下降(P<0.05),治疗第8周有效率为88.49%.不良反应最常见的是头晕、头痛、便秘、恶心,但不影响正常治疗.[结论]度洛西汀治疗广泛性焦虑症有效、安全,不良反应轻.%[Objective] To explore the clinical efficacy and safety of duloxctinc for the treatment of generalized anxiety disorder. [Methods] Totally 49 patients with generalized anxiety disorder were treated with duloxetinc for 8 weeks. Hamilton anxiety scale(HAMA) , clinical global impression scale(CGI) and treatment emergent symptom scale(TKSS) before treatment and 2, 4 and 8 weeks after treatment were used for the evaluation. According to the reducing score rate of general score of HAMA, the efficacy was assessed. [Results] Compared with before the treatment, HAMA scores and CGI scores decreased dramatically from the second week of the treatmcnt (P<0.05). The effective rate at 8 weeks was 88. 49%. The common adverse effects were dizziness, headache, constipation and nausea, dizziness, but had no influence on the normal treatment. [Conclusion] Duloxetinc for the treatment of generalized anxiety disorder is effective and safe, and has slight adverse reaction.

  9. The Characteristic of Cognitive Function in Patients with the First-episode Generalized Anxiety Disorder%首发广泛性焦虑障碍患者认知功能特点

    Institute of Scientific and Technical Information of China (English)

    叶刚; 汤臻; 李歆; 潘明志; 朱峰; 付佳林; 伏天; 刘期春; 高振勇

    2016-01-01

    目的:探讨首发广泛性焦虑障碍患者认知功能的特点.方法:应用广泛性焦虑障碍量表(GAD-7)、状态-特质焦虑问卷(STAI)、剑桥神经心理自动化成套测试软件(CANTAB)中RVP、DMS、IED 3项测验对48名首发广泛性焦虑障碍患者及48名正常对照施测,分析两组被试注意能力、工作记忆能力、执行功能的差异,并了解上述认知功能和总体焦虑水平、状态焦虑、特质焦虑的相关性.结果:首发广泛性焦虑障碍组RVP测验正确率显著低于对照组(t=-4.38,P<0.05),平均反应时显著长于对照组(t=4.66,P<0.05);DMS测验中多项延迟测试任务正确数都显著低于对照组(t=-6.31~-3.62,P<0.05),平均反应时都显著长于对照组(t=3.45~4.17,P<0.05);IED测验中总错误数(t=3.33,P<0.05)、外维转换错误数(t=2.48,P<0.05)、完成测试数(t=2.59,P<0.05)显著大于对照组.首发广泛性焦虑障碍组DMS多项延迟测试反应时、IED外维转换错误数与GAD-7、SAI、TAI得分呈显著正相关(P<0.05),RVP正确率与GAD-7、SAI得分成呈显著负相关(P<0.05).结论:首发广泛性焦虑障碍患者存在多项认知功能异常.%Objective:To study the characteristic of cognitive function in patients with the first-episode generalized anxiety disorder.Methods:48 patients with the first-episode generalized anxiety disorder and 48 healthy subjects (control group)were recruited.Generalized Anxiety Disorder Scale(GAD-7)and State-Trait Anxiety Inventory (STAI)were used to assess the levels of overall anxiety,state anxiety and trait anxiety.Rapid Visual Information Processing (RVP),Delayed Matching To Sample(DMS)and Intra/Extradimensional Set Shift(IED)from Cambridge Neuropsychological Test Automatic Battery(CANTAB)were administered to assess the characteristic of attention, working memory and executive function,analysis of variance and covariance were conducted.Results:Compared with normal controls,patients with the first-episode generalized

  10. Anxiety Distorders: Types, Diagnosis and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Anxiety Disorders Types, Diagnosis and Treatment Past Issues / Summer ... Table of Contents There are several kinds of anxiety disorders. The major types include: Generalized anxiety disorder ( ...

  11. Pharmacology of human experimental anxiety.

    Science.gov (United States)

    Graeff, F G; Parente, A; Del-Ben, C M; Guimarães, F S

    2003-04-01

    This review covers the effect of drugs affecting anxiety using four psychological procedures for inducing experimental anxiety applied to healthy volunteers and patients with anxiety disorders. The first is aversive conditioning of the skin conductance responses to tones. The second is simulated public speaking, which consists of speaking in front of a video camera, with anxiety being measured with psychometric scales. The third is the Stroop Color-Word test, in which words naming colors are painted in the same or in a different shade, the incongruence generating a cognitive conflict. The last test is a human version of a thoroughly studied animal model of anxiety, fear-potentiated startle, in which the eye-blink reflex to a loud noise is recorded. The evidence reviewed led to the conclusion that the aversive conditioning and potentiated startle tests are based on classical conditioning of anticipatory anxiety. Their sensitivity to benzodiazepine anxiolytics suggests that these models generate an emotional state related to generalized anxiety disorder. On the other hand, the increase in anxiety determined by simulated public speaking is resistant to benzodiazepines and sensitive to drugs affecting serotonergic neurotransmission. This pharmacological profile, together with epidemiological evidence indicating its widespread prevalence, suggests that the emotional state generated by public speaking represents a species-specific response that may be related to social phobia and panic disorder. Because of scant pharmacological data, the status of the Stroop Color-Word test remains uncertain. In spite of ethical and economic constraints, human experimental anxiety constitutes a valuable tool for the study of the pathophysiology of anxiety disorders.

  12. Pharmacology of human experimental anxiety

    Directory of Open Access Journals (Sweden)

    F.G. Graeff

    2003-04-01

    Full Text Available This review covers the effect of drugs affecting anxiety using four psychological procedures for inducing experimental anxiety applied to healthy volunteers and patients with anxiety disorders. The first is aversive conditioning of the skin conductance responses to tones. The second is simulated public speaking, which consists of speaking in front of a video camera, with anxiety being measured with psychometric scales. The third is the Stroop Color-Word test, in which words naming colors are painted in the same or in a different shade, the incongruence generating a cognitive conflict. The last test is a human version of a thoroughly studied animal model of anxiety, fear-potentiated startle, in which the eye-blink reflex to a loud noise is recorded. The evidence reviewed led to the conclusion that the aversive conditioning and potentiated startle tests are based on classical conditioning of anticipatory anxiety. Their sensitivity to benzodiazepine anxiolytics suggests that these models generate an emotional state related to generalized anxiety disorder. On the other hand, the increase in anxiety determined by simulated public speaking is resistant to benzodiazepines and sensitive to drugs affecting serotonergic neurotransmission. This pharmacological profile, together with epidemiological evidence indicating its widespread prevalence, suggests that the emotional state generated by public speaking represents a species-specific response that may be related to social phobia and panic disorder. Because of scant pharmacological data, the status of the Stroop Color-Word test remains uncertain. In spite of ethical and economic constraints, human experimental anxiety constitutes a valuable tool for the study of the pathophysiology of anxiety disorders.

  13. The Course of Childhood Anxiety Symptoms: Developmental Trajectories and Child-Related Factors in Normal Children

    Science.gov (United States)

    Broeren, Suzanne; Muris, Peter; Diamantopoulou, Sofia; Baker, Jess R.

    2013-01-01

    This three-wave longitudinal study explored developmental trajectories for various types of childhood anxiety symptoms (i.e., specific fears, social anxiety, generalized anxiety, and separation anxiety) and examined how these trajectories were associated with several factors thought to be involved in the pathogenesis of anxiety. Parents of a…

  14. Usefulness of antidepressants in anxiety disorders

    National Research Council Canada - National Science Library

    Ansseau, M

    2006-01-01

    ...: panic disorder, specific phobias, social phobia and generalized anxiety. After a brief description of their clinical characteristics and prevalence, it provides the general principles of treatment and mainly the specific role of antidepressant...

  15. A multicomponent yoga-based, breath intervention program as an adjunctive treatment in patients suffering from generalized anxiety disorder with or without comorbidities

    Directory of Open Access Journals (Sweden)

    Martin A Katzman

    2012-01-01

    Materials and Methods: Forty-one patients were enrolled in an open-label trial of the SKY course as an adjunct to standard treatment of GAD at the START Clinic for Mood and Anxiety Disorders, a tertiary care mood and anxiety disorder clinic in Toronto. The SKY course was administered over five days (22 h total. Subjects were encouraged to practice the yoga breathing techniques at home for 20 min per day after the course and were offered group practice sessions for 2 h once a week led by certified yoga instructors. The primary outcome measure was the mean change from pre-treatment on the HAM-A scale. Psychological measures were obtained at baseline and four weeks after completing the intervention. Results:Thirty-one patients completed the program (mean age 42.6 ± 13.3 years. Among completers, significant reductions occurred in the pre- and post-intervention mean HAM-A total score (t=4.59; P<0.01 and psychic subscale (t=5.00; P≤0.01. The response rate was 73% and the remission rate 41% as measured on the HAM-A. Conclusion: The results of this small pilot trial suggest that the SKY course represents a potentially valuable adjunct to standard pharmacotherapy in patients with GAD or treatment-resistant GAD, and warrants further investigation. In particular, changes in worry and body symptoms showed significant improvements that may further our understanding of the mechanism of change in the tolerance of anxiety and worry.

  16. Differentiation of Generalized Anxiety Disorders Based on the Modern Literature%基于现代文献的广泛性焦虑障碍辨证分型分析

    Institute of Scientific and Technical Information of China (English)

    熊航; 王玉来; 郭蓉娟; 王革生

    2014-01-01

    Objective:To investigate the characteristics and trend of clinical differentiation in generalized anxiety disorder syndrome in the recent 15 years.Methods:Use the computer retrieval and manual retrieval method combined ,and relevant literatures published during the course of 15 years on the anxiety of generalized anxiety disorder were collected .Results:148 qualified papers were selected from it .The type of syndrome of high fre-quency was Xinpi Liangxu ,Ganyu Huahuo , and Xinshen Bujiao in turn .Conclusion:It summarizes the distri-bution of traditional Chinese medicine in recent 15 years for generalized anxiety disorder syndrome , the type of syndrome of high frequency in excessive syndrome is Ganyu Huahuo , Ganqi Yujie , and Danre Tanrao .The type of syndrome of high frequency in deficiency syndrome is Xinpi Liangxu , Xingan Yinxu , and Xingan Xuexu.The type of syndrome of high frequency in both excessive and deficiency syndrome is Xinshen Bujiao , Ganyu Pixu and Ganyang Shangkang .%目的:探讨近15年来临床研究广泛性焦虑障碍的辨证分型的特点及趋势。方法:采用计算机和人工检索相结合的方法,对近15年来发表的关于广泛性焦虑障碍的相关文献进行收集整理。结果:共收集合格文献148篇,对所收集的文献用统计学方法进行分析,发现中医治疗广泛性焦虑障碍的文献中,频率位于前三位的证型依次为心脾两虚证、肝郁化火证和心肾不交证。结论:初步总结出近15年来广泛性焦虑障碍中医证型的分布情况,即实证以肝郁化火证、肝气郁结证和胆热痰扰证为主,虚证以心脾两虚证、心肝阴虚证和心肝血虚证为主,虚实夹杂则以心肾不交证、肝郁脾虚证和肝阳上亢证为主。

  17. Clinical Efficacy Observation on Jiuwei Zhenxin Granules in the Treatment of Generalized Anxiety Disor-der%九味镇心颗粒治疗广泛性焦虑障碍疗效观察

    Institute of Scientific and Technical Information of China (English)

    梁杰

    2014-01-01

    目的::探讨九味镇心颗粒治疗广泛性焦虑障碍的疗效与安全性。方法:112例广泛性焦虑障碍患者随机分为研究组和对照组,每组56例,分别给予九味镇心颗粒和帕罗西汀治疗,疗程6周。采用汉密尔顿焦虑量表( HAMA)观察两组疗效,采用副反应量表(TESS)观察两组药品不良反应。结果:两组治疗后2周HAMA评分均较前明显下降(P0.05)。两组治愈率、有效率比较,差异均无统计学意义(P>0.05)。研究组不良反应发生率为14.8%,低于对照组的22.6%(P0.05)。结论:九味镇心颗粒治疗广泛性焦虑障碍疗效与帕罗西汀相仿,但不良反应较少,安全性好。%Objective:To explore the curative effect and security of Jiuwei Zhenxin granules in the treatment of generalized anxiety disorder. Methods:Totally 112 patients with generalized anxiety disorder were randomly divided into the research group and the control group with 56 ones in each. The research group was given Jiuwei Zhenxin granules while the control group was given paroxetine with the treatment course of 6 weeks. The curative effect of the two groups was observed using Hamilton anxiety scale ( HAMA) , and the side effects were observed using treatment energent eymptom scale( TESS) . Results:After the 2-week treatment, HAMA scores were signifi-cantly lower than those before the treatment (P0. 05). The recovery rate and effective rate of the two groups also showed no statistically significant differences (P >0.05). The incidence of adverse drug reactions in the research group was 14. 8%, which was lower than that in the control group (22. 6%, P0. 05). Conclusion:Jiuwei Zhenxin granules show similar effect with paroxetine in the treat-ment of generalized anxiety disorder with lower adverse reaction incidence and promising safety.

  18. Study on the effect of nursing intervention on 49 patients with generalized anxiety disorder due to the initial hospitalization%首次入院广泛性焦虑49例护理干预效果研究

    Institute of Scientific and Technical Information of China (English)

    周卓娅; 王向阳; 罗思欢

    2011-01-01

    目的:探讨护理干预对首次入院广泛性焦虑患者临床疗效的影响.方法:将98例首次入院广泛性焦虑住院患者随机分为常规组和干预组各49例,常规组行安全护理、日常生活护理、饮食护理等常规护理措施,干预组在常规组护理基础上给予心理护理、特殊护理、睡眠护理等特殊护理干预措施.结果:4周后干预组患者汉密顿焦虑量表(HAMA)评分、睡眠质量及临床疗效明显优于常规组,差异均有统计学意义(P<0.05).结论:对首次入院广泛性焦虑患者实施特殊护理干预措施可显著提高临床疗效.%Objective: To investigate the effect of nursing intervention on the patients with generalized anxiety disorder due to the initial hospitalization.Methods: 98 patients with generalized anxiety disorder due to the initial hospitalization were randomly divided into routine nursing care group and intervention group ( 49 cases for each group ).The routine nursing measures were taken in the routine nursing care, including safety care, daily living care and diet care.The nursing intervention measures were applied in the intervention group based on routine nursing care , such as psychological care, special care and sleep care.Results:The scores of Hamilton Anxiety Scale ( HAMA), sleep quality and clinical efficacy were superior to in the intervention group to the routine nursing care group after the intervention for 4 weeks and the differences were statistically significant between the two groups ( P < 0.05 ).Conclusion: The special nursing intervention measures applied to the patients with generalized anxiety disorder due to the initial hospitalization can significantly improve the clinical efficacy of treatment.

  19. Perceived risk, anxiety, and behavioural responses of the general public during the early phase of the Influenza A (H1N1 pandemic in the Netherlands: results of three consecutive online surveys

    Directory of Open Access Journals (Sweden)

    van Steenbergen Jim E

    2011-01-01

    Full Text Available Abstract Background Research into risk perception and behavioural responses in case of emerging infectious diseases is still relatively new. The aim of this study was to examine perceptions and behaviours of the general public during the early phase of the Influenza A (H1N1 pandemic in the Netherlands. Methods Two cross-sectional and one follow-up online survey (survey 1, 30 April-4 May; survey 2, 15-19 June; survey 3, 11-20 August 2009. Adults aged 18 years and above participating in a representative Internet panel were invited (survey 1, n = 456; survey 2, n = 478; follow-up survey 3, n = 934. Main outcome measures were 1 time trends in risk perception, feelings of anxiety, and behavioural responses (survey 1-3 and 2 factors associated with taking preventive measures and strong intention to comply with government-advised preventive measures in the future (survey 3. Results Between May and August 2009, the level of knowledge regarding Influenza A (H1N1 increased, while perceived severity of the new flu, perceived self-efficacy, and intention to comply with preventive measures decreased. The perceived reliability of information from the government decreased from May to August (62% versus 45%. Feelings of anxiety decreased from May to June, and remained stable afterwards. From June to August 2009, perceived vulnerability increased and more respondents took preventive measures (14% versus 38%. Taking preventive measures was associated with no children in the household, high anxiety, high self-efficacy, more agreement with statements on avoidance, and paying much attention to media information regarding Influenza A (H1N1. Having a strong intention to comply with government-advised preventive measures in the future was associated with higher age, high perceived severity, high anxiety, high perceived efficacy of measures, high self-efficacy, and finding governmental information to be reliable. Conclusions Decreasing trends over time in perceived

  20. [Social anxiety].

    Science.gov (United States)

    Mirabel-Sarron, Christine

    2010-06-20

    Social anxiety disorders are various, frequent and invalidant. Social phobia is characterized by marked and persistent fear of social or performance situations in which embarrassment may occur including, for example, fear of public speaking. In clinical setting, the majority of social phobics report fears of more than one type of social situation. Social phobia tends to develop early in life, with a life time prevalence of 2-4%. Pharmacotherapy and behavioural and cognitive therapy are communly used.

  1. Attentional Bias in Math Anxiety

    Directory of Open Access Journals (Sweden)

    Orly eRubinsten

    2015-10-01

    Full Text Available Cognitive theory from the field of general anxiety suggests that the tendency to display attentional bias toward negative information results in anxiety. Accordingly, the current study aims to investigate whether attentional bias is involved in math anxiety as well (i.e., a persistent negative reaction to math. Twenty seven participants (14 with high levels of math anxiety and 13 with low levels of math anxiety were presented with a novel computerized numerical version of the well established dot probe task. One of 6 types of prime stimuli, either math related or typically neutral, were presented on one side of a computer screen. The prime was preceded by a probe (either one or two asterisks that appeared in either the prime or the opposite location. Participants had to discriminate probe identity (one or two asterisks. Math anxious individuals reacted faster when the probe was at the location of the numerical related stimuli. This suggests the existence of attentional bias in math anxiety. That is, for math anxious individuals, the cognitive system selectively favored the processing of emotionally negative information (i.e., math related words. These findings suggest that attentional bias is linked to unduly intense math anxiety symptoms.

  2. 护理干预老年广泛性焦虑症患者睡眠质量的影响%Impact of Nursing Intervention on Sleep Quality in Geriatric Generalized Anxiety Disorder

    Institute of Scientific and Technical Information of China (English)

    石云

    2016-01-01

    Objective To study the influence of nursing intervention on sleep quality in geriatric generalized anxiety disorder. Methods We divided 88 patients into two groups. Control group used routine nursing,the observation group used nursing intervention,compared clinical efficacy of two groups. Results The SAS score,PSQI scores of observation group were significantly better than control group(P < 0.05). Conclusion Nursing intervention can effectively improve the sleep quality of elderly patients with generalized anxiety disorder.%目的:探讨护理干预对老年广泛性焦虑症患者睡眠质量的影响。方法随机将88例老年广泛性焦虑症患者平均分为两组。对照组行常规护理,观察组行护理干预,比较两组护理效果。结果观察组 SAS 评分、PSQI 评分等均优于对照组(P <0.05)。结论护理干预可有效改善老年广泛性焦虑症患者的睡眠质量。

  3. Sex differences in anxiety and emotional behavior

    Science.gov (United States)

    Donner, Nina C.; Lowry, Christopher A.

    2013-01-01

    Research has elucidated causal links between stress exposure and the development of anxiety disorders, but due to the limited use of female or sex-comparative animal models, little is known about the mechanisms underlying sex differences in those disorders. This is despite an overwhelming wealth of evidence from the clinical literature that the prevalence of anxiety disorders is about twice as high in women compared to men, in addition to gender differences in severity and treatment efficacy. We here review human gender differences in generalized anxiety disorder, panic disorder, posttraumatic stress disorder and anxiety-relevant biological functions, discuss the limitations of classic conflict anxiety tests to measure naturally occurring sex differences in anxiety-like behaviors, describe sex-dependent manifestation of anxiety states after gestational, neonatal, or adolescent stressors, and present animal models of chronic anxiety states induced by acute or chronic stressors during adulthood. Potential mechanisms underlying sex differences in stress-related anxiety states include emerging evidence supporting the existence of two anatomically and functionally distinct serotonergic circuits that are related to the modulation of conflict anxiety and panic-like anxiety, respectively. We discuss how these serotonergic circuits may be controlled by reproductive steroid hormone-dependent modulation of crfr1 and crfr2 expression in the midbrain dorsal raphe nucleus and by estrous stage-dependent alterations of γ-aminobutyric acid (GABAergic) neurotransmission in the periaqueductal gray, ultimately leading to sex differences in emotional behavior. PMID:23588380