Folate, vitamin B12, homocysteine, and the MTHFR 677C->T polymorphism in anxiety and depression: the Hordaland Homocysteine Study.

Bjelland I, Tell GS, Vollset SE, Refsum H, Ueland PM.

Department of Public Health and Primary Health Care, Locus for Homocysteine and Related Vitamins, University of Bergen, Norway. ingvar.bjelland uib.no

BACKGROUND: An association between depression and folate status has been demonstrated in clinical studies, whereas data are sparse on the relationship between depression and other components of 1-carbon metabolism such as vitamin B12, homocysteine, and the methylenetetrahydrofolate reductase 677C-->T polymorphism. The relationship between anxiety and these components is less well known. This study examined the associations between folate, total homocysteine, vitamin B12, and the methylenetetrahydrofolate reductase 677C-->T polymorphism, and anxiety and depression in a large population-based study. METHODS: Anxiety and depression, measured by the Hospital Anxiety and Depression Scale, were assessed in 5948 subjects aged 46 to 49 years (mean, 47.4 years) and 70 to 74 years (mean, 71.9 years) from the Hordaland Homocysteine Study cohort. By means of logistic regression models, anxiety and depression scores were examined in relation to the factors listed above. RESULTS: Overall, hyperhomocysteinemia (plasma total homocysteine level > or =15.0 micro mol/L [> or =2.02 mg/dL]) (odds ratio, 1.90; 95% confidence interval, 1.11-3.25) and T/T methylenetetrahydrofolate reductase genotype (odds ratio, 1.69; 95% confidence interval, 1.09-2.62), but not low plasma folate or vitamin B12 levels, were significantly related to depression without comorbid anxiety disorder. Plasma folate level was inversely associated with depression only in the subgroup of middle-aged women. None of the investigated parameters showed a significant relationship to anxiety. CONCLUSION: Our results provide further evidence of a role of impaired 1-carbon metabolism in depression.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12796225&dopt=Abstract anxiety medicine




Anxiety disorders and anxiety symptoms in a clinic sample of seasonal and non-seasonal depressives.

Levitt AJ, Joffe RT, Brecher D, MacDonald C.

Mood Disorders Program, Clarke Institute of Psychiatry, Toronto, Canada.

Thirty-eight patients with seasonal affective disorder (SAD) were compared with 33 non-seasonal recurrent major depressives (non-SAD) who presented during the winter months for differences in the prevalence of concurrent anxiety disorders and the impact of anxiety on treatment response. SAD patients received light therapy, whereas non-SAD patients received antidepressant medications. There was no differences in the prevalence of any anxiety disorder, or on scores of anxiety on the Hamilton Rating Scale for Depression between the SAD and non-SAD groups. The presence of any anxiety disorder was associated with a better response rate in SAD patients, and an inferior response rate in non-SAD patients. The findings refute previous suggestions that anxiety is more common in SAD than in non-SAD, but suggest that the presence of anxiety may be associated with differential treatment response rates.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8326080&dopt=Abstract anxiety medicine




Somatic symptoms and panic attacks: a retrospective study of learning experiences.

Ehlers A.

Department of Psychology, University of Gottingen, Germany.

Individuals with panic attacks evaluate physical anxiety symptoms as dangerous and tend to respond to them with fear. In a retrospective questionnaire study, we explored childhood and adolescent learning experiences with respect to somatic symptoms of panickers. Compared to normal controls (N = 61), patients with panic disorder (N = 121), infrequent panickers (N = 86) and patients with other anxiety disorders (N = 38) reported more frequent instances prior to age 18 when they had experienced symptoms like dizziness, shortness of breath, palpitations or nausea, accompanied by special attention from their parents and instructions to restrain from strenuous or social activities. The differences were due to higher symptom frequencies in the anxiety groups. All anxiety groups reported more frequent uncontrolled behavior of their parents than controls. Patients with panic disorder and infrequent panickers reported that their parents had suffered more frequently from physical symptoms typical of anxiety than patients with other anxiety disorders or normal controls. Panickers, but not patients with other anxiety disorders, had observed sick-role behavior related to panic symptoms in their parents more often than controls. Panic attack Ss reported a higher number of household members suffering from chronic illnesses than controls and patients with other anxiety disorders. No group differences were found in the reported behavior of parents when Ss had colds. Overall, the results point to the role of severe illnesses and physical symptoms typical of anxiety in significant others in the history of Ss with panic attacks. These experiences during childhood and adolescence may contribute to their belief that physical symptoms are dangerous. In contrast, there was no specificity for panic with respect to the Ss' own physical symptoms or cold-related symptoms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8476401&dopt=Abstract anxiety medicine




Effect of intensive care simulation on anxiety of nursing students in the clinical ICU.

Erler CJ, Rudman SD.

School of Nursing, Purdue University, West Lafayette, IN 47907.

OBJECTIVE: To determine the effect of a campus critical care simulation on anxiety of nursing students in the clinical intensive care unit. DESIGN: Quasi-experimental pretest-posttest design using a sample of convenience. SETTING: Large Midwestern university. SUBJECTS: Second semester, junior level nursing students enrolled in a generic baccalaureate nursing program. Students currently enrolled in an adult medical-nursing course with one allotted day for a campus critical care laboratory and a clinical day in affiliated community hospitals. OUTCOME MEASURES: Reduction in anxiety, as measured by the Spielberger State-Trait Anxiety Inventory, related to psychomotor skill performance in a highly technological clinical setting. INTERVENTION: Campus critical care simulation laboratory, which provided time for information, demonstration, discussion, practice, and validation of performance skills associated with technology in a usual critical care setting. RESULTS: There was no significant difference in anxiety scores of subjects who received a campus critical care simulation before attending an actual clinical critical care experience versus those students who did not (t = 1.70, p = 0.094). There was no significant difference in anxiety scores of the experimental group after attending a campus simulation (t = 1.18, p = 0.250). Attending a campus critical care experience did not result in a decrease in critical care clinical setting anxiety. CONCLUSIONS: There are numerous reasons why students experience anxiety in the clinical setting, one of which is anxiety related to task performance. Although familiarity with psychomotor skills is beneficial, study findings indicate that familiarity with psychomotor skills is not sufficient to decrease anxiety in the critical care clinical setting.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8491661&dopt=Abstract anxiety medicine




[Levels of maternal anxiety and their use in pediatric primary health care]

[Article in Spanish]

Sanchez Ruiz-Cabello FJ, Bellon Saameno JA, Castillo Castillo R.

Centro de Salud Zaidin-Sur, Unidad Docente de Medicina Familiar y Communitaria, Granada.

Of a total population of a pediatric office of the Zaidin South Health Care Center, all of the mothers that were frequent users (69) were chosen and compared with a random sample of normal users (82). Both groups carried out the anxiety scale STAI. Significant differences were found in that the high users have greater levels of anxiety about trait (p = 0.0003), as well as state (p = 0.000). The high levels of anxiety of trait are associated with being a house wife, having a child with a chronic illness, non maternal lactation, low levels of studies, health education and family income. Family income was the variable with the greatest association with the anxiety of trait (multiple regression). When we took into consideration the variables of predisposition, availability and ease of use, the maternal anxiety continued to have a significant influence. We point out the importance of maternal anxiety in the high frequency of pediatric health care use and we underline the modifiable characteristics of the anxiety factor, and therefore the possibility of reducing the high use of health care services addressed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8503585&dopt=Abstract anxiety medicine




A prospective study on the course of anxiety after vestibular neuronitis.

Godemann F, Linden M, Neu P, Heipp E, Dorr P.

Department of Psychiatry and Psychotherapy, Charite Hospital, Humboldt University at Berlin, Germany. frank.godemann medizin.fu-berlin.de

OBJECTIVE: Critical life events trigger intense emotions. Anxiety is one of the most frequent of these emotions. It is unclear which factors determine the intensity and course of anxiety after a critical life event. METHOD: Anxiety levels of 92 patients in the 6 weeks after experiencing an acute vestibular disorder were examined. The influence of cognitive, personality and illness variables on the course of their anxiety was analyzed. RESULTS: Acute vestibular disorder is accompanied by intensive anxiety. In most patients, anxiety decreased as vertigo regressed. Catastrophizing and dysfunctional cognitions and different personality styles predicted 17.6% of the anxiety 6 weeks after the functional loss of vestibular equilibrium. CONCLUSIONS: Acute vestibular disorder is a critical life event. Most individuals cope successfully with acute vestibular disorder. However, dysfunctional cognitions are risk factors for the persistence of anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15046973&dopt=Abstract anxiety medicine




Anxiety before and after surgical repair in patients with asymptomatic unruptured intracranial aneurysm.

Otawara Y, Ogasawara K, Kubo Y, Tomitsuka N, Watanabe M, Ogawa A, Suzuki M, Yamadate K.

Department of Neurosurgery, Iwate Medical University, Morioka, Japan.

BACKGROUND: Ruptured intracranial aneurysm is a serious condition with high mortality and morbidity. Patients notified of the presence of the unruptured intracranial aneurysm may become anxious because of the fear of rupture. We prospectively investigated the anxiety of patients with unruptured intracranial aneurysm before and after surgery. METHODS: Thirty-seven patients with an asymptomatic unruptured intracranial aneurysm were enrolled, 13 men and 24 women aged 32 to 70 years (mean age, 57.2 years), who underwent surgical repair of the aneurysm. The anxiety of patients was assessed one month before and after surgery using the Japanese version of the State-Trait Anxiety Inventory. RESULTS: The trait anxiety scores, which refer to stable personality factors reflecting the general level of fearfulness, did not change significantly after surgery. In contrast, the state anxiety scores, which refer to transient anxiety that varies according to the situation, decreased significantly after surgery (p = 0.001, paired t test). Only the preoperative high state anxiety scores among the multiple variables were associated with the significant decrease in state anxiety after surgery (p = 0.0183, logistic regression analysis). CONCLUSIONS: The anxiety of patients with asymptomatic unruptured intracranial aneurysm significantly decreased after surgery. Anxiety of patients with asymptomatic unruptured intracranial aneurysm may deserve attention in deciding whether to treat the aneurysm.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15226063&dopt=Abstract anxiety medicine




Objective psychological measurement and clinical assessment of anxiety in adverse drug reactions.

Ong D, Popat A, Knowles SR, Arrowood JS, Shear NH, Binkley KE.

Department of Pharmacology, University of Toronto,Toronto, Canada.

BACKGROUND: A confounding factor in the diagnosis of adverse drug reactions (ADRs) is the psychological state of the patient. Patients with underlying anxiety and related disorders may present with psychogenic reactions, which involve physiologic responses originating from psychological, rather than organic factors. OBJECTIVE: To examine the contribution of anxiety and related disorders to adverse drug events. METHODS: Participants from an adverse drug reaction clinic completed the Trauma Symptom Checklist-40 (TSC-40), a 40-item questionnaire consisting of six subscales: anxiety, depression, dissociation, sexual abuse trauma index (SATI), sexual problems, and sleep disturbance. Physicians assessed the likelihood that adverse events were due to anxiety or drug(s) by providing an anxiety score (0 to 10) and an ADR score (0 to 10), respectively, for each participant. RESULTS: Patients clinically assessed as having "high anxiety" (anxiety score 7-10 and ADR score 0-3; n = 11) scored higher than patients clinically assessed as having a "true ADR" (anxiety score 0-3 and ADR score 7-10; n = 19) on the TSC-40 total (P = 0.006) as well as anxiety (P = 0.012), depression (P = 0.007), and SATI subscales (P = 0.016). CONCLUSION: This study is the first to use a validated psychological measurement to indicate that a substantial percentage of reported adverse drug events may in fact be a manifestation of underlying anxiety and/or related disorders. We suggest that mechanisms of symptom generation may be analogous to those operative in idiopathic environmental intolerance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15226522&dopt=Abstract anxiety medicine




[Anxiety and depression among the epileptics in general population in Benin (Western Africa)]

[Article in French]

Nubukpo P, Houinato D, Preux PM, Avode G, Clement JP.

Doctorat de Sante Publique, Institut d'Epidemiologie Neurologique et de Neurologie Tropicale, Equipe EA 3174, Faculte de Medecine, 2, rue du Dr Marcland, 87025 Limoges.

In order to assess prevalence of depression and anxiety among epileptic patients and to compare it to a control population, a matched case-control survey was performed in 196 persons above 18 Year old (98 epileptics and 98 controls matched according to sex, age 10 and social environment) in Republic of Benin (West Africa), using Goldberg's Depression and Anxiety scale. Two main investigators helped by 5 sociology students were trained on a questionnaire by a psychiatrist skilled with public health matters. People taking part in the survey are epileptic patients who already used health services. Inclusions took place within 17 communes of four departments (Mono, Zou, Oueme, Atlantique) located in Southern part of Benin. The questionnaire used an Identity sheet and the Goldberg Depression Scale. Results are shown as mean standard deviations, for quantitative values, and percents for qualitative ones. Comparisons of proportions in qualitative variables are carried out using c2 test or Fisher's exact test. Comparisons of means rates between subject's groups are carried out with a Student t test or variance analysis. The correlations between two quantitative variables were assessed by linear correlation coefficient. Significance threshold chosen for the whole set of statistics analysis is 0.05. The majority of interviewed epileptic patients is young (average 32.6 11.5 Years old). A male predominance exists (sex ratio 1.28). 93% of interviewed persons live within their family, are married or cohabit (controls: 98.2%; cases: 87.9%); 57.4% are married (controls: 70%; cases: 44%). The most represented professional categories are craftsmen and shopkeepers (29.2%) as well as farmers (19.5%). Most of recruited patients live in an urban setting (55.4%) and 63.6% of interviewed persons had been living in the area of survey for over 10 Years. The most represented religion within the sample is Christian religion (67.7%), Animists (23.3%) and Muslims (5.8%). 97% of epileptic patients reported they had one fit during the two Years before the survey; roughly one half (48%) had 2 to 5 fits and 41.5% of them had more than 10 fits; only 14% say they have had an EEG. Presence of an Anti Epileptic Drug (77.5%) reduces anxiety and depression. Considering a severity threshold of 5 for anxiety and 2 for depression (8), proportions of epileptic patients displaying a severe anxiety (79.8%) or a severe depression (89.6%) are significantly higher (p<0.0001) than in control subjects (12.3% and 46.9%). Comparison of average scores confirms the difference (p<0.0001) between cases (5.8 2.0 and 2.3 1.9) and controls (4.7 2.4 and 2.0 2.1) regarding anxiety and depression. Neither the sex, nor age, nor life environment (urban/rural), nor frequency of fits hold significant influence over an-xiety and depression. However, results in this survey include higher average rates of anxiety and depression for women (6.3 1.8) than men (5.5 1.8), though such statement is only nearly significant (p=0.06). Results of the survey confirm the other works on this topic about characteristics of depression for epileptic patients, though results here are higher than usual. Anxiety and depression are common troubles found in epileptic patient, both often occurring at the same time. Two distinct theories about this fact are opposed, first explain the connection of anxiety and depression with epilepsy because of the social and cultural burden upon an epileptic patient in those countries, the second theory is about depression and epilepsy sharing some neuroaminergical dysfunctions; these facts were not considered in this survey. When taking into account the thresholds of seriousness on Goldberg's scale, proportion of controls displaying a probably deeper depression is high (46.9%) compared to usual hospital prevalence rates (4 to 25%) found in Western Africa where survey in general population are scarce. It could either be a bias in the selection or the confirmation that family and relatives of an epileptic patient are enduring a great psychic pain too; finally, this high rate o, this high rate of severe depression within controls may suggest a need to adapt thresholds of Goldberg's scale to match African populations. This hypothesis is interesting regarding the results of some Authors who validated this scale in population of aged people; they highlighted the fewer precision of two items (lost of interest, focus difficulties) and also a slight discriminatory weight for other few items. However the psychometric characteristics of Goldberg's scale are accurate (for depression subscale, a sensitivity of 88% and a specificity of 68%; for the whole scale, a sensitivity of 84% and a specificity of 68%). It would be pertinent to carry out a study to validate Goldberg's scale within some African populations. This study also highlights the importance of psychological factors in epilepsy and suggests a specific global care of the disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15235518&dopt=Abstract anxiety medicine