[Social assessment of anxiety in primary health care]

[Article in Spanish]

Menarguez Puche JF, Alcantara Munoz PA, Martinez Martinez P, Aroca Garcia MD, Alcaraz Martinez J, Garcia Sanchez A, Cazorla Gonzalez MA.

Centro de Salud Molina de Segura, Murcia.

OBJECTIVE. Identification of the social profile of our anxious patients, and analysis of the usefulness of Bell's questionnaire for our area of work. DESIGN. A retrospective observation study of a crossover type. SETTING. Primary Care. PARTICIPANTS. 55 patients who consulted their Family Doctor and were diagnosed as suffering from Anxiety. MEASUREMENTS AND MAIN RESULTS. We confirmed the diagnosis with the DSM-III-R and then analysed the level of Anxiety with the Hamilton Scale. The social evaluation was done by means of Bell's profile. As test statistics we used the lineal correlation Coefficient, the Student's t and Xi2 tests and Variance Analysis. 65% of diagnoses were Generalised Anxiety. The Hamilton mean was 20.9 points (S = 9.2). Overall social adaptation was unsatisfactory, with the worst results being for the emotional aspects. We observed a higher level of Anxiety as age increased (p = 0.021), related to a worse adaptation to Health (p = 0.014). Dissatisfaction with work and the working environment took the form of professional adaptation being poorer as their work situation deteriorated (p = 0.006). Anxiety levels were higher among the unemployed. Social adaptation was less among people with higher Anxiety levels (p = 0.04), above all as a consequence of worse adaptation to Health (p = 0.002) and worse emotional (p = 0.00001) adaptation. CONCLUSIONS. 1) We must introduce social aspects into analysis of patients with Anxiety. 2) Bell's profile enables us to identify those social aspects which can be tackled when caring for our patients. Its fundamental use is in individual application.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7711223&dopt=Abstract anxiety medicine




The mental health of women with suspected breast cancer: the relationship between social support, anxiety, coping and defence in maintaining mental health.

Drageset S, Lindstrom TC.

Bergen University College, Faculty of Health and Social Sciences, Bergen, Norway. Sigrunn.Drageset hib.no

Relationships between anxiety, social support, coping, and defence, in connection to mental health, were studied among patients with suspected breast cancer, awaiting diagnosis. Data were collected by questionnaires from 117 women, 25-76 years of age (mean: 53.6 years) who had undergone breast biopsy. Instruments used were: the Social Provisions Scale (SPS); the state scale of State-Trait Anxiety Scale (STAI); and CODE [based on the Utrecht Coping List (UCL) and Defence Mechanisms Inventory (DMI)]. The results showed that patients reported elevated levels of anxiety and high levels of social support. Yet, anxiety was strongest and negatively related to 'instrumental coping', followed by 'cognitive defence'. 'Defensive hostility' was unrelated to anxiety. Unexpectedly, 'emotion-focused coping' and social provisions were unrelated to anxiety. Social provisions were somewhat related to 'instrumental coping', but sparsely related to 'emotion-focused coping', unrelated to 'cognitive defence' and partly negatively related to 'defensive hostility'. Hence, social support and 'emotion-focused coping' did not in themselves repress anxiety. 'Instrumental coping' did, even in a situation where nothing could be done. Social support is suggested to be the product of an 'instrumental coping style', not necessarily contributing to it. Clinical consequences for professional information and support to patients with different coping styles are suggested.

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Differential diagnosis of odontophobic patients using the DSM-IV.

Moore R, Brodsgaard I.

Royal Dental College, Department of Oral Epidemiology and Public Health, Arhus University, Denmark.

Categories of extreme anxiety for dental treatment were derived using DSM-IV psychiatric criteria. A sample of 40 men and 40 women patients with extreme dental anxiety were initially evaluated with Dental Anxiety Scale (DAS), Trait Anxiety Inventory (STAI-T) and Geer Fear Scale (GFS). Patients all had DAS scores > or = 15 indicating extreme dental anxiety and were further evaluated with clinical interviews, Dental Fear Survey (DFS), Dental Beliefs Survey (DBS) and Mood Adjective Checklist (MACL). Results showed that 46% of 80 patients complained mainly of powerlessness and embarrassment about dental treatment while also having greater DBS scores than other categories, i.e. social phobia. Another 19% reported conditioned specific phobias (pain, drilling, injection, etc.) most often and lower DBS and GFS scores than other groups; while 35% had broader general anxiety complications, such as multiple phobias and agoraphobia with or without general anxiety symptoms (higher GFS and STAI-T compared to others). Symptoms of general anxiety disorder (GAD) were present in 30 of 80 patients, who had greater STAI-T and GFS and lower MACL scores than non-GAD patients. These results have implications for appropriate treatment strategies.

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[EEG power and coherence in presenile and senile depression. Characteristic findings related to differences between anxiety type and retardation type]

[Article in Japanese]

Yamada M, Kimura M, Mori T, Endo S.

Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan.

Quantitative EEG analysis was done on 29 medicated right-handed depressive patients at age over 45 and age and sex matched right-handed 20 normal controls. The patients were all diagnosed as major depression with melancholia by DSM-III-R and were divided into anxiety type (n = 17) and retardation type (n = 12) evaluated with the Hamilton rating scale for depression. Eye closed resting EEGs were recorded on a data recorder from the 16 electrode leads (10-20 system). Artifact rejected 3 minutes EEGs were analyzed by off-line with Fast Fourier Transform from the bilateral frontal (F3, F4), parietal (P3, P4) and occipital (O1, O2) regions. The mean values of absolute amplitude power (microV) and the mean Z scores of inter-, and intrahemispheric coherence were obtained in theta 1 (4.0-6.0 Hz), theta 2 (6.0-8.0 Hz), alpha 1 (8.0-10.5 Hz), alpha 2 (10.5-13.0 Hz), beta 1 (13.0-20.0 Hz), and beta 2 (20.0-40.0 Hz) frequency bands respectively. The main findings were: 1) Beta 1 and beta 2 power were greater in patients with anxiety type depression than in normal controls, and the differences were statistically significant over the parietal and occipital regions in beta 1 and the frontal region in beta 2. The anxiety type was distinguished from the retardation type with the increase of beta 2 power. The retardation type showed higher alpha 1 power over the frontal region and lower alpha 2 power over the occipital region than normal controls. 2) Both types showed greater frontal predominant ratio to the parietal in beta 2 power than did normal controls. The retardation type was distinguished from the anxiety type with the right predominance in beta 1 power over the frontal region. 3) Both groups of patients showed lower frontal interhemispheric coherences than normal controls in each band. In particular, the anxiety type showed significantly lower alpha 2 band and lower beta 1 and beta 2 bands. The parietal interhemispheric coherence was lower in the anxiety type but higher in the retardation type than in normal controls in each band, and this difference was prominent in theta 2 band. 4) The two groups of patients showed higher fronto-parietal intrahemispheric coherences in both hemispheres than the normal controls in each band. Especially, the anxiety type showed higher in theta two and alpha 1 bands.(ABSTRACT TRUNCATED AT 400 WORDS)

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Anxiety disorders after stroke: results from the Perth Community Stroke Study.

Burvill PW, Johnson GA, Jamrozik KD, Anderson CS, Stewart-Wynne EG, Chakera TM.

Department of Psychiatry and Behavioural Science, University of Western Australia, Perth.

BACKGROUND. The prevalence of anxiety disorders in 294 patients who survived to four months in the Perth Community Stroke Study (Perth, Australia), and a follow-up of these patients at 12 months, are presented. METHOD. Diagnoses are described both in the usual DSM hierarchic format and by a non-hierarchic approach. Adoption of the hierarchic approach alone greatly underestimates the prevalence of anxiety disorders. RESULTS. Most cases were of agoraphobia, and the remainder were generalised anxiety disorder. The prevalence of anxiety disorders alone was 5% in men and 19% in women; in community controls, it was 5% in men and 8% in women. Adopting a non-hierarchic approach to diagnosis gave a prevalence of 12% in men and 28% in women. When those who showed evidence of anxiety disorder before stroke were subtracted, the latter prevalence was 9% in men and 20% in women. CONCLUSION. One-third of the men and half of the women with post-stroke anxiety disorders showed evidence of either depression or an anxiety disorder at the time of the stroke. At 12 month follow-up of 49 patients with agoraphobia by a non-hierarchic approach, 51% had recovered, and equal proportions of the remainder had died or still had agoraphobia. The only major difference in outcome between those with anxiety disorder alone and those with comorbid depression was the greater mortality in the latter.

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Behavioural inhibition, attachment and anxiety in children of mothers with anxiety disorders.

Manassis K, Bradley S, Goldberg S, Hood J, Swinson RP.

Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario.

OBJECTIVE: This study examined the relationship between behavioural inhibition, insecure mother-child attachment and evidence of anxiety in the offspring of mothers with anxiety disorders. METHOD: Twenty children aged 18 to 59 months who were born to 18 mothers with diagnosed anxiety disorders were examined for behavioural inhibition (Kagan's measures) and mother-child attachment (Strange Situation Procedure). Child anxiety was assessed using DSM-III-R criteria and the Child Behavior Checklist (CBCL). RESULTS: Sixty-five percent of the children were behaviourally inhibited. They showed more somatic problems and fewer destructive behaviours than those who were not inhibited. Eighty percent of the children were insecurely attached. They had higher CBCL internalizing scores than secure children and three of them met diagnostic criteria for anxiety disorders. CONCLUSION: Though preliminary, this work suggests a need to identify children of anxious mothers as being at risk for anxiety, especially in the presence of inhibited temperament or attachment difficulties.

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[Changes in the brain's electrical activity during habituation to verbal stimulus in subjects with high and low levels of personal anxiety]

[Article in Russian]

Savost'ianov AN, Savost'ianova DA.

Institute of Physiology, Siberian Division, Russian Academy of Medical Sciences, Novosibirsk. sava novosoft.ru

Brain electrical activity during habituation to repeated verbal stimulus was recorded in subjects with high and low levels of personal anxiety. During habituation of subjects with low anxiety, the spectral power of EEG alpha and theta bands increased in the frontal cortical areas. Such a reaction was not observed in subjects with high anxiety level. Moreover, during habituation traces, the latency of P300 of the auditory evoked potential increased. This parameter did not depend on anxiety level. The amplitude of P300 in the right temporal region was shown to be related to anxiety level: it increased after habituation in subjects with low anxiety and did not change in subjects with high anxiety.

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Brain corticotropin-releasing factor mediates 'anxiety-like' behavior induced by cocaine withdrawal in rats.

Sarnyai Z, Biro E, Gardi J, Vecsernyes M, Julesz J, Telegdy G.

Department of Pathophysiology, Albert Szent Gyorgyi Medical University, Szeged, Hungary.

Anxiety is a key symptom of the cocaine withdrawal syndrome in human addicts, and it is considered to be one of the major factors in precipitating relapse to chronic cocaine abuse. Corticotropin-releasing factor (CRF) plays an important role in the pathophysiology of anxiety and depression, and it may also be involved in the acute behavioral and neuroendocrine actions of cocaine. The role of endogenous CRF in cocaine withdrawal-induced anxiety was investigated in the present study. Animals were subjected to chronic cocaine (20 mg/kg, intraperitoneally, once a day for 14 days) administration. Rats tested 30 min after the last cocaine injection did not show withdrawal anxiety on the elevated plus maze or any alterations in brain CRF levels. Withdrawal (48 h) from chronic cocaine administration produced an intense anxiety-like behavior characterized by decreased open arm exploration. Immunoreactive CRF (CRF-LI) levels were selectively altered in the hypothalamus, in the amygdala and in the basal forebrain structures at the time of the behavioral anxiety, reflecting an increased activity of brain CRF systems. Daily intracerebroventricular (i.c.v.) pretreatment with an immunoserum raised against CRF completely prevented the development of anxiety induced by cocaine withdrawal. These data suggest that extrahypothalamic-limbic CRF hypersecretion may be involved in the development of anxiety related to cocaine withdrawal and that the CRF system may be a useful target for new pharmacotherapies for cocaine withdrawal and relapse.

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Multivariate investigation of anxiety in a psychiatric population.

Trent NH 3rd, Templer DI, Gandolfo R, Corgiat M, Trent AP.

United States Disciplinary Barracks, Fort Leavenworth, Kansas, USA.

The purpose of the present research was to interrelate dimensions of anxiety in a psychiatric population, based primarily on the conceptual formulation of Templer, Corgiat, and Brooner (1984). Two hundred twenty outpatients served as subjects. The Fear Survey Schedule, State-Trait Anxiety Inventory, Hamilton Anxiety Scale, and a Likert-formated criterial symptom checklist for Generalized Anxiety Disorder (GAD) were employed to derive measures of Severity, Stimulus Specificity, Subjective Component (Cognitive vs. Somatic), Chronicity, and Temporal Constancy (Sometimes vs. Always present). Principal components factor analysis yielded three distinct dimensions of anxiety: Morbidity, Subjective Component, and Chronicity. Clinical and theoretical relevance of these findings are discussed specific to construction of a working model of anxiety, clinical assessment of anxiety response systems, and the feasibility of a dimensional approach to understanding psychopathology.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7797642&dopt=Abstract anxiety medicine