Patients' perceptions of magnetic resonance imaging.

MacKenzie R, Sims C, Owens RG, Dixon AK.

Department of Radiology, Addenbrooke's Hospital.

There are several anxiety-related reactions associated with magnetic resonance imaging (MRI). Patients who experience such reactions may disrupt the examination or move so much that images are degraded. These experiences may also influence patients' perceptions of the quality of their care. The objective of this study was to further assess the subjective experiences of patients undergoing MRI in an attempt to identify those patients likely to have problems and factors affecting their experiences. Five hundred consecutive patients undergoing MRI were surveyed using questionnaires before and immediately after imaging. Anxiety was measured using the state anxiety component of the state-trait anxiety inventory. All patients exhibited some degree of pre-imaging anxiety. This was particularly associated with a previous 'unpleasant' imaging experience. Patients who experienced problems during MRI had pre-imaging anxiety levels equivalent to patients about to undergo surgery, were more likely to react badly when first seeing the scanner and were more likely to leave the MRI unit with even greater feelings of anxiety than when they arrived. In contrast to previous studies, anxiety was not associated with either the patient's understanding of the procedure or the duration of the examination. Several features have been identified which could improve the patient's experience (e.g. better information sheet). Awareness of MRI-related anxiety should also be considered when assessing the impact of MRI on outcome for the patient.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7889700&dopt=Abstract anxiety medicine




Bipolar comorbidity: from diagnostic dilemmas to therapeutic challenge.

Sasson Y, Chopra M, Harrari E, Amitai K, Zohar J.

Chaim Sheba Medical Centre, Division of Psychiatry, Tel Hashomer, Israel.

Comorbidity in bipolar disorder is the rule rather than the exception more than 60% of bipolar patients have a comorbid diagnosis and is associated with a mixed affective or dysphoric state; high rates of suicidality; less favourable response to lithium and poorer overall outcome. There is convincing evidence that rates of substance use and anxiety disorders are higher among patients with bipolar disorder compared to their rates in the general population. The interaction between anxiety disorders and substance use goes both ways: patients with bipolar disorder have a higher rate of substance use and anxiety disorder, and vice versa. Bipolar disorder is also associated with borderline personality disorder and ADHD, and to a lesser extent with weight gain. As more than 40% of bipolar patients have anxiety disorder, it is indicated that while diagnosing bipolar patients, systematic enquiry about different anxiety disorders is called for. This also presents a therapeutic challenge, since agents that effectively treat anxiety disorders are associated with the risk of induced mania. Therefore, the treating psychiatrist needs to carefully evaluate the potential benefit of treating the anxiety against the potential cost of inducing a manic episode. A possible solution would be to use, when possible, a non-pharmacological intervention, such as a cognitivebehavioural approach. Alternately, it is suggested that the clinician attempts to ensure that the patient receives adequate treatment with mood stabilizers before slowly and carefully attempting the addition of anti-anxiety compounds with a relatively lower risk of mania induction (e.g. SSRIs compared to TCAs).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12890307&dopt=Abstract anxiety medicine




Cognitive behavioural group treatment for social anxiety in schizophrenia.

Kingsep P, Nathan P, Castle D.

WA Institute for Psychotherapy Research, 223 James Street, Northbridge, Western Australia 6003, Australia. patrick.kingsep health.wa.gov.au

Anxiety symptoms reported by individuals with schizophrenia have been traditionally seen as symptoms associated with the principal disorder and therefore not requiring special attention. The primary aim of this paper is to therapeutically target social anxiety symptoms in individuals with schizophrenia in order to determine the effectiveness of the cognitive behavioural group treatment model as an intervention for social anxiety in this participant group. Thirty-three individuals with schizophrenia and co-morbid social anxiety were allocated to a group-based cognitive behaviour (CBGT) intervention or waitlist control (WLC). Baseline, completion and follow-up ratings consist of measures of social anxiety: the Brief Social Phobia Scale (BSPS), Brief Fear of Negative Evaluation scale (BFNE) and the Social Interaction Anxiety Scale (SIAS); measures of general psychopathology: the Calgary Depression Scale for Schizophrenia (CDSS) and Global Severity Index (GSI) from the Brief Symptom Inventory (BSI); and the Quality of Life, Enjoyment and Satisfaction Questionnaire (QLESQ). Pre- and post-treatment measures were subjected to statistical evaluation. All outcome measures displayed statistical improvement in the intervention group compared with no change in the control group. These treatment gains were maintained at follow-up. CBGT for social anxiety in schizophrenia was demonstrated to be effective as an adjunctive treatment for this population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12892866&dopt=Abstract anxiety medicine




Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study.

Cheng C, Chan AO, Hui WM, Lam SK.

Division of Social Science, the Hong Kong University of Science and Technology, Hong Kong.

BACKGROUND: Functional constipation has important psychological elements. AIM: To investigate the prevalence of functional constipation in an Asian population, and the interplay among functional constipation, anxiety/depression, perception and coping strategies. METHODS: An interview of 3282 patients was made by telephone survey. Constipation was diagnosed by Rome II criteria. Coping ability and anxiety/depression were assessed by validated questionnaires. RESULTS: Fourteen percent of the interviewees had constipation. Anxiety and depression scores were higher in constipated than in healthy subjects (P < 0.0001 and < 0.0001), and in female than male patients (P = 0.02 and < 0.0001). Patients who were aware of their symptoms perceived greater impact on their lives (P < 0.001). Frequent use of coping strategies associated with lower anxiety scores (P < 0.0001). Female were more frequently aware of the symptoms (P = 0.004), less frequently used coping strategies (P = 0.008). Regression analysis showed that female and high anxiety level were the independent factors for predicting the perception of constipation, whereas anxiety was the only independent factor for predicting the use of coping strategies. CONCLUSION: Constipation associated with anxiety and depression is prevalent in the general Asian population. Female sex and anxiety are important aetiological factors in constipation, affecting perception and the use of coping strategies.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12895216&dopt=Abstract anxiety medicine




Acquisition and maintenance of dental anxiety: the role of conditioning experiences and cognitive factors.

de Jongh A, Muris P, ter Horst G, Duyx MP.

Department of Social Dentistry and Dental Health Education, Academic Centre for Dentistry, Amsterdam, The Netherlands.

This study presents a contribution to the understanding of the mechanisms that are involved in the development and maintenance of dental anxiety. Subjects were 224 undergraduate psychology students who completed questionnaires regarding dental anxiety, painful and traumatic experiences, negative cognitions, dental beliefs, and how their attitude to dental treatment had changed during their life. The results showed that both the extent to which earlier dental treatments were perceived as painful and the extent to which these incidents were reported as traumatic were significantly related to dental anxiety. Evidence was also found to support the latent inhibition hypothesis, which predicts that patients less easily acquire dental anxiety in case they received a number of relatively painless treatments prior to conditioning. Both findings confirmed those earlier obtained by Davey in a conceptually similar design (Behaviour Research and Therapy, 27, 51-58, 1989). In addition, frequency of negative cognitions about dental treatment and dental anxiety appeared to be positively related (r = 0.74; P < 0.001). Significant differences were found between highly anxious Ss and Ss showing low levels of anxiety on a variety of expectations and beliefs related to undergoing dental treatment. The results are discussed in terms of a cognitive-behavioural perspective of dental anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7887880&dopt=Abstract anxiety medicine




The relationship of cancer pain to anxiety.

Velikova G, Selby PJ, Snaith PR, Kirby PG.

Medical University of Cancer Chemotherapy, Varna, Bulgaria.

The interaction between pain and anxiety in the setting of somatic illness is a widely recognised association. More accurate knowledge about the association and also about the means of assessing anxiety in a clinical setting are of use to the clinician. The present study used the Hospital Anxiety and Depression Scale for assessment of anxiety, and the set of linear analogue scales for detecting the presence and severity of anxiety and pain in an oncology clinic, where patients were undergoing active treatment for cancer. The relationship between pain and anxiety was found to be significant, even when the possible mediating effect of the variables of illness severity and age were removed. The need for detecting anxiety in order to plan treatment strategy is emphasised.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7624464&dopt=Abstract anxiety medicine




Publication anxiety: conflict between communication and affiliation.

Britton R.

The author suggests that publication anxiety is ubiquitous and natural; it can produce inhibition, symptomatic disorders of the text, or simply overt anxiety. Anxiety-free publication occurs where anxiety is denied as part of a manic defence which produces complacent orthodoxy, triumphant iconoclasm, or an illusion of originality. A discriminating journal usually detects this and publication fails. If the anxiety is excessive, there may be an inhibition of publication such as afflicted Darwin. Lesser degrees of anxiety may result in distraction or distortion due to a compromise between the urge to communicate an idea and the desire to consolidate affiliation with a significant group through shared language, common belief systems, totemic figures or ritual utterances. The author sees this conflict as internal to the individual. It is shaped by Oedipal anxieties which are given different emphasis and intensity by the scientific contexts current at the time. If the 'paradigm', under the influence of which the analyst is writing is in the ascendant, publication is relatively free of anxiety for most writers who are content to add to its application. Some, however, suffer 'anxiety of influence', fearing that their existence as originators of ideas is threatened. When the stability of the paradigm is threatened, due to the accumulation of anomalies, publication anxiety, with both persecutory and depressive elements is intensified. This increases the conflict between the need for affiliation and the desire for communication and may result in defensive writing or distorted texts.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7713656&dopt=Abstract anxiety medicine




Children awaiting invasive medical procedures: do children and their mothers agree on child's level of anxiety?

Wachtel J, Rodrigue JR, Geffken GR, Graham-Pole J, Turner C.

Department of Clinical and Health Psychology, University of Florida, Gainesville 32610-0165.

Examined correspondence between mother and child reports of child anxiety immediately preceding a scheduled invasive medical procedure. The State-Trait Anxiety Inventory for Children (STAIC) was administered to 101 children ages 10-18 years. Mothers completed the STAIC and the State-Trait Anxiety Inventory to assess their perceptions of the child's anxiety and their own level of anxiety, respectively. Children were reported to have significantly more state anxiety as perceived by themselves and their mothers relative to the normative sample. Results also revealed low overall mother-child correspondence on child anxiety, particularly for mothers reporting more anxiety in themselves. Additionally, while age, gender, and socioeconomic status were not associated with mother-child correspondence, an unexpected relationship between race and correspondence emerged. Overall, our findings indicate that reliance on parents' perceptions of child anxiety prior to an invasive medical procedure is not sufficient.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7830213&dopt=Abstract anxiety medicine




Recalled anxiety: from discovery to diagnosis of a benign breast mass.

Benedict S, Williams RD, Baron PL.

College of Nursing, Medical University of South Carolina, Charleston.

PURPOSE/OBJECTIVES: To determine the amount of anxiety recalled by women who have had benign breast biopsies and to describe coping strategies used by these women during the time from discovery of the mass to definitive diagnosis. DESIGN: Descriptive, retrospective. SETTING: Surgical oncology practices, private and academic, treating patients living in five southern states. SAMPLE: 238 women who had excisional biopsies with benign results within the previous two years. Mean age of 52 years, 80% Caucasian, and 20% African American. METHODS: Subjects rated their anxiety from discovery to diagnosis on a 16-point visual analogue scale and answered a short-answer question about the coping strategies used to deal with the anxiety. MAIN RESEARCH VARIABLES: Anxiety and coping strategies. FINDINGS: The mean length of time from discovery to diagnosis was 35 days. No statistically significant relationship was found between the length of time from discovery to diagnosis and the amount of anxiety experienced. However, 58% of the women recalled severe amounts of anxiety during this time. Qualitative analysis grouped coping strategies into five patterns (themes): diversionary, spiritual, interpersonal, hopeful, and avoidance. CONCLUSIONS: The time between discovery of a breast mass and definitive diagnosis is a time of considerable anxiety for many women. Substantial time elapses between discovery and diagnosis, contributing to the possible morbidity associated with severe anxiety. IMPLICATIONS FOR NURSING PRACTICE: Nurses can work to decrease the time occupied by the diagnostic process, counsel women regarding the anxiety being experienced, and present coping strategies that may help.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7854934&dopt=Abstract anxiety medicine