Multiple sclerosis: correlation of anxiety, physical impairment and cognitive dysfunction.

Stenager E, Knudsen L, Jensen K.

Clinical Neuro-Psychiatric Research Unit, Odense University Hospital, Denmark.

The aim of the study was to examine the correlation between anxiety and physical impairment and to discover whether anxiety correlated with specific forms of cognitive dysfunction. Ninety-four patients (42 females, 52 males) with definite MS entered the study. Anxiety was measured using the State-Trait Anxiety Inventory, physical impairment by means of the Kurtzke Disability Status scale, and cognitive impairment by using the Trail Making, Symbol Digit Modalities, Auditory Verbal Learning, Story Recall and the Recurring Figures tests. Moderately handicapped patients (DSS 4-5) showed signs of anxiety, and physical impairment correlated with anxiety (p < 0.05; d.f. 1.92). Trail Making also correlated with anxiety (p < 0.01; d.f. 1.86). On the basis of the results of this and previous studies, it is concluded that anxiety can be a sign of cognitive dysfunction, physical impairment or social strain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8056558&dopt=Abstract anxiety medicine




[A study of factors of anxiety and nursing intervention among cardiac surgical patients]

[Article in Japanese]

Majima T, Sato R.

The purposes of this study were to Investigate factors that related preoperative anxiety and postoperative recovery and to define the nursing intervention among the cardiac surgical patient. The sample was from 22 cardiac patients (over 40 years old) who underwent a surgical operation. The data was obtained through 1) the participant observation, 2) the State-Trait Anxiety Inventory (STAI), and 3) the individual interview. After the data was analyzed, results were indicated as follows. 1) Factors that related to preoperative anxiety were: 1: Stressful life events before hospitalization, 2: Difficulties of understanding the preoperative information, 3: Denial of the various information. 4: Negative evaluation in comparison with the others' situation, 5: Fear of growing worse, 6: Optimistical evaluation of ones' disease, 7: Calm of the preoperative condition, 8: An emergency operation. 2) Factors that related to postoperative recovery were: 1: Passive behavior. 2: Negative evaluation of ones' disease. 3: Concern about return to the life in society. 4: Calm of postoperative condition. The results concluded that as follows, 1) The cardiac surgical patients' anxiety level was not higher than chronic disease patients' anxiety level, 2) Postoperative stressors were concerned to the postoperative anxiety and psychological recovery and 3) Postoperative nursing intervention needed to asses for factors as related to preoperative anxiety and postoperative recovery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8061778&dopt=Abstract anxiety medicine




The effect of informed consent on the level of anxiety in patients given i.v. contrast material.

Hopper KD, Houts PS, TenHave TR, Matthews YL, Colon E, Haseman DB, Hartzel J.

Department of Radiology, Pennsylvania State University, Hershey 17033.

OBJECTIVE. A common reason given for not obtaining informed consent before the use of IV contrast material is that the anxiety created by informing patients of potential reactions will increase the possibility of their occurring. However, the idea that this is possible is debatable, and no study of this subject has used a standardized anxiety index. Accordingly, using the State-Trait Anxiety Inventory, we assessed the anxiety level among patients about to have an IV contrast procedure and measured the effect of informing them of the risks associated with the use of contrast material. SUBJECTS AND METHODS. Approximately 2050 adult outpatients at three separate medical centers were solicited for participation in this study. Each of the 1251 patients who volunteered to participate was placed into one of six groups. The majority were patients who were awaiting the injection of either ionic or nonionic contrast material and who were or were not informed of the risks associated with the use of IV contrast material. The last two groups were generally healthy outpatients reporting for routine X-rays who were not awaiting IV contrast administration but who were informed of the risks associated with the use of ionic and nonionic contrast material. Each patient informed of the risks was asked to read a standardized consent form, and all patients completed a standardized anxiety index. RESULTS. Patients who were informed of the risks associated with IV contrast material did not have measurably increased anxiety, and they did not have an increased prevalence of adverse reactions. Indeed, the only patients who had statistically significant increased anxiety compared with the other groups were among those awaiting the injection of ionic contrast material who were not informed of the risks (p = .04). The majority (51-78%) of patients in all six groups had measurable elevated anxiety scores. CONCLUSION. We conclude that it is not justified to fail to obtain informed consent in order to avoid anxiety-induced adverse reactions to IV contrast material. The majority of patients awaiting injection of IV contrast material have measurable increased anxiety levels regardless of whether they are informed of its risks.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8109491&dopt=Abstract anxiety medicine




Cognitive correlates of dental anxiety.

De Jongh A, Muris P, ter Horst G, Van Zuuren FJ, De Wit CA.

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

This study examined cognitive correlates of dental anxiety among 24 highly anxious patients and 17 low-anxious patients. In both groups, anxiety expectations, dental trait anxiety, and state anxiety (in the waiting room and in the dental chair) were rated. Negative cognitions and cognitive control were also assessed. It was found that dentally high-anxious patients claimed to experience more negative thoughts than those with low anxiety (p < 0.001). None of the highly anxious patients reported relatively few negative cognitions, and none of the patients in the low-anxiety group reported relatively numerous negative cognitions. While patients from both groups reported that cognitive control declined with the imminence of treatment, highly anxious patients were found to have less control over their negative thoughts (p < 0.001). A series of stepwise regression analyses revealed that both the number of negative cognitions and perceived cognitive control accounted for 75% of the variance in dental trait anxiety. The results of the present study suggest that cognitive activities, such as negative thinking (catastrophizing) and cognitive control, are important moderators of dental anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8120221&dopt=Abstract anxiety medicine




Computer-administered visual analogue mood scales: rapid and valid assessment of mood in HIV positive individuals.

Maruff P, Wood S, Currie J, McArthur-Jackson C, Malone V, Benson E.

Neurophysiology and Neurovisual Research Unit, Mental Health Research Institute of Victoria, Parkville, Australia.

Studies of cognition in patients with the human immunodeficiency virus must take into account the effects of mood. Standardised mood-rating questionnaires are oftentimes consuming and fatiguing for such patients and so may be omitted from experiments. Visual analogue rating scales for affective state are rapidly administered and are quite acceptable to subjects. In 64 HIV seropositive homosexual or bisexual males, measures of anxiety and depression derived from two computer-administered visual analogue scales were compared with anxiety and depression ratings from the Spielberger State-Trait Anxiety Inventory and the Center for Epidemiological Studies-Depression. Analogue ratings of anxiety correlated .80 with STAI State anxiety and .58 with STAI Trait anxiety measures and analogue ratings of depression correlated .78 with CES-Depression measures. Analogue ratings may differentiate situational anxiety and depression more effectively and so are valid tools in assessment of anxiety and depression in HIV seropositive subjects. These may be of particular value when limitations of time or patient illness require a rapid assessment of mood variables in neuropsychiatric research.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8153233&dopt=Abstract anxiety medicine




Subjective symptoms and cardiac reactivity to brief hyperventilation in individuals with high anxiety sensitivity.

Asmundson GJ, Norton GR, Wilson KG, Sandler LS.

Department of Psychology, University of Manitoba, Winnipeg, Canada.

Cognitive models maintain that panic attacks may be initiated by fear resulting from the interpretation of somatic sensations as personally threatening or harmful. Similarly, several researchers have proposed that the enhanced response of panickers to biological challenge may result from the fear of induced anxiety sensations rather than from direct stimulation of aberrant biochemical systems. The present study examined the effects of both panic history and fear of anxiety sensations on subjective and cardiac responses to biological challenge. Eighty nonclinical subjects were chosen on the basis of level of anxiety sensitivity and history of previous panic attacks. High and low anxiety-sensitive panickers and nonpanickers (four groups of 20 subjects) were subjected to a 90 sec period of voluntary hyperventilation, during which heart rate was assessed. Regardless of panic history, total symptom scores did not differ between high and low anxiety-sensitive subjects at baseline or pre-hyperventilation, but did differ at post-hyperventilation. There were, however, no significant differences in post-hyperventilation measures of heart rate. The apparent mismatch of subjective and physiological responsivity to the challenge in high anxiety-sensitive individuals (i.e. more severe symptom self-reports in the absence of increased cardiac activation) provides support for the hypothesis that high anxiety sensitivity is associated with an enhanced tendency to panic in response to biological challenge.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8155062&dopt=Abstract anxiety medicine




Reliability and validity of the Hamilton Anxiety Rating Scale in an adolescent sample.

Clark DB, Donovan JE.

Pittsburgh Adolescent Alcohol Research Center, Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213.

OBJECTIVE: Although generalized anxiety is an important clinical problem among adolescents, there are no interview procedures to provide a global anxiety rating that have demonstrated reliability and validity for this population. The Hamilton Anxiety Rating Scale (HARS) is a general measure of anxiety that was developed for adults. The purpose of this study was to determine the reliability and validity of the HARS when used with adolescents. METHOD: The sample consisted of 257 adolescents aged 12 to 18 years from both clinical and community sources. The HARS interviews and ratings were conducted as part of an extensive psychiatric and medical assessment. Psychiatric diagnoses were determined by structured interview. Other questionnaire measures of anxiety were also obtained. RESULTS: The interrater reliability and internal consistency of the HARS were acceptable in this adolescent sample and were comparable to results reported for adults. The HARS exhibited good construct validity, showing statistically significant relationships with independent self-report measures of generalized anxiety and other anxiety variables. The factor structure of the HARS also was found to be similar to that found earlier with adults. CONCLUSIONS: These results demonstrate that the HARS is a reliable and valid measure for the assessment of global anxiety in the adolescent population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8169180&dopt=Abstract anxiety medicine




Effects of maternal anxiety on perception of fetal movements in late pregnancy.

Sjostrom K, Thelin T, Marsal K, Valentin L.

Department of Obstetrics and Gynecology, Malmo University Hospital, University of Lund, S-205 02 Malmo, Sweden. karin.sjostrom obst.mas.lu.se

BACKGROUND: To determine whether maternal state and trait anxiety levels affect maternal perception of fetal movements in the third trimester. METHOD: Forty healthy pregnant nulliparous women not on medication and with a singleton, uncomplicated pregnancy were studied. Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI, Form-Y) at 36 gestational weeks. At term (37- 40 gestational weeks), fetal movements were recorded simultaneously by the mother and by an ultrasound observer. The ultrasound transducer was positioned to include a cross-section of the fetal trunk and of at least one fetal limb. The ultrasound observer pressed a push-button for as long as she saw a fetal movement on the ultrasound screen. The screen was placed out of sight of the pregnant woman, who pressed another push-button for as long as she felt a fetal movement. The signals were fed into two different channels of a cardiotocograph. Fetal heart rate (FHR) was recorded throughout the examination and classified as FHR patterns A, B, C, or D. Examination time was 120 min. Agreement between maternally recorded and sonographically recorded fetal movements was determined manually for each FHR pattern and was compared between women with low and high state and trait anxiety. The low state anxiety group had STAI scores ranging from 20 to 31, and the high state anxiety group had STAI scores from 32 to 57. The corresponding values for the low and high trait anxiety groups were 20 to 29 and 30 to 54. RESULTS: The agreement between maternally perceived and ultrasonographically recorded fetal movements did not differ between women with low and high state and trait anxiety in any FHR pattern. CONCLUSION: This study does not support that maternal anxiety--within the normal range--affects perception of fetal movements in late pregnancy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12782423&dopt=Abstract anxiety medicine




The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems.

Nieuwenhuijsen K, de Boer AG, Verbeek JH, Blonk RW, van Dijk FJ.

Coronel Institute for Occupational and Environmental Health, Academic Medical Center, AmCOGG, University of Amsterdam, Netherlands TNO Work and Employment, Hoofddorp, Netherlands. K.Nieuwenhuijsen amc.uva.nl

AIMS: To (1) evaluate the psychometric properties and (2) examine the ability to detect cases with anxiety disorder and depression in a population of employees absent from work because of mental health problems. METHODS: Internal consistency, construct validity, and criterion validity of the Depression Anxiety Stress Scales (DASS) were assessed. Furthermore, the ability to identify anxiety disorders or depression was evaluated by calculating posterior probabilities of these disorders following positive and negative test results for different cut off scores of the DASS-Depression and DASS-Anxiety subscales. RESULTS: Internal consistency of the DASS subscales was high, with Cronbach's alphas of 0.94, 0.88, and 0.93 for depression, anxiety, and stress respectively. Factor analysis revealed a three factor solution, which corresponded well with the three subscales of the DASS. Construct validity was further supported by moderately high correlations of the DASS with indices of convergent validity (0.65 and 0.75), and lower correlations of the DASS with indices of divergent validity (range -0.22 to 0.07). Support for criterion validity was provided by a statistically significant difference in DASS scores between two diagnostic groups. A cut off score of 5 for anxiety and 12 for depression is recommended. The DASS showed probabilities of anxiety and depression after a negative test result of 0.05 and 0.06 respectively. Probabilities of 0.29 for anxiety disorder and 0.33 for depression after a positive test result reflect relatively low specificity of the DASS. CONCLUSION: The psychometric properties of the DASS are suitable for use in an occupational health care setting. The DASS can be helpful in ruling out anxiety disorder and depression in employees with mental health problems.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12782751&dopt=Abstract anxiety medicine