The relationship of asthma and anxiety disorders.

Katon WJ, Richardson L, Lozano P, McCauley E.

Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98195-6560, USA. wkaton u.washington.edu

OBJECTIVE: This article reviewed the child and adult medical literature on the prevalence of comorbid anxiety disorders in patients with asthma. Theoretical ideas regarding the relatively high comorbidity rates are presented along with a model describing putative interactions between anxiety disorders and asthma. METHOD: A search of the literature from the last 2 decades using MEDLINE by pairing the word, "asthma," with the following words: "anxiety," "depression," "panic," and "psychological disorders." We located additional research by screening the bibliographies of articles retrieved in the MEDLINE search. RESULTS: Both adult and child/adolescent populations with asthma appear to have a high prevalence of anxiety disorders. In child/adolescent populations with asthma, up to one third may meet criteria for comorbid anxiety disorders. In adult populations with asthma, the estimated rate of panic disorder ranges from 6.5% to 24%. However, most studies are limited by small samples, nonrepresentative populations, self-reported asthma status, and lack of controlling for important potential confounders such as smoking and asthma medications. There are also limited data on the impact of anxiety comorbidity in patients with asthma on symptom burden, self-care regimens (such as monitoring peak expiratory flow, taking medication, and quitting smoking), functional status, and medical costs. CONCLUSIONS: There appears to be a high comorbidity of anxiety disorders in patients with asthma. The prevalence and longitudinal impact of anxiety comorbidity needs to be examined in a large population-based sample of children, adolescents, and adults with asthma. If a high prevalence of comorbid anxiety disorder is documented and if this comorbidity adversely affects the self-efficacy and self-care, symptom burden, and functioning in persons with asthma, then it will be important to develop treatment trials.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15184694&dopt=Abstract anxiety medicine




The medical costs of migraine and comorbid anxiety and depression.

Pesa J, Lage MJ.

Health Economics and Outcomes Research, AstraZeneca, Willmington, DE, USA.

OBJECTIVE: To examine the direct medical costs associated with migraine, when diagnosed alone and in conjunction with anxiety and/or depression in adults and children. BACKGROUND: Migraine is a common disorder that can often be accompanied by comorbid anxiety and/or depression. Given the prevalence of migraine and the likelihood for comorbid conditions, it is not surprising that migraine is extremely costly for society. METHODS: Migraine cohorts were identified in a 1999-2000 database capturing inpatient, outpatient, and prescription drug services from approximately 45 large employers. Four cohorts of adults (migraine only, migraine and anxiety, migraine and depression, migraine and both conditions), and two cohorts of children (migraine only, migraine and anxiety and/or depression), were compared to respective "healthy" cohorts. t-statistics were used to capture differences in costs between the migraine cohorts and the healthy cohorts whereas ANOVA was used to test for differences in costs between subgroups of migraine sufferers. RESULTS: Compared to nonmigraineurs, adults and children with migraine had significantly higher total direct medical costs in all examined categories (P < .0001) (7,089 US Dollars vs US Dollars adults; 4,272 US Dollars vs 1,400 US Dollars children). For adults, the presence of depression and/or anxiety along with migraine equated to significantly greater total direct medical costs when compared to their matched healthy cohorts (P < .0001) (12,642 US Dollars vs 5,179 US Dollars anxiety; 11,290 US Dollars vs 3,135 US Dollars depression). Children with migraine and either anxiety or depression (or both) incurred an average of 9,875 US Dollars in total direct medical costs as compared with only 1,165 US Dollars for healthy comparators. For children and adults, the presence of comorbid anxiety or depression was associated with significantly higher medical costs when compared to migraine alone (P < .0001). CONCLUSIONS: This analysis quantifies the economic impact of a migraine diagnosis for both adults and children. The results of this analysis demonstrate that individuals identified as migraineurs have significantly higher medical costs than healthy comparators, with or without comorbid anxiety and/or depression. This study also suggests that clinicians should be aware that while proper treatment of migraine with effective acute and prophylactic therapy is important, attention must also be directed to comorbid conditions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15186300&dopt=Abstract anxiety medicine




Modulation of dental anxiety--the role of past experiences, psychopathologic traits and individual attachment patterns.

Eli I, Uziel N, Blumensohn R, Baht R.

Department of Occlusion and Behavioral Sciences, School of Dental Medicine, Tel Aviv University, Israel. elilana post.tau.ac.il

OBJECTIVE: To evaluate factors affecting modulation of dental anxiety among adults. METHODS: A total of 183 adult members of a closed communal society (Kibbutz), who have been treated since childhood only by the dentists employed in their community, were investigated concerning their past and present dental anxiety, evaluation of their past and present dentists, psychopathologic symptoms and individual pattern of attachment. RESULTS: The best predictor of subjects' evaluation of their present dental anxiety was the scale of anxiety as recorded by the SCL-90R questionnaire. The best predictors of the decrease in subjects' dental anxiety over time were the evaluation of their past and present dentists and the secure and avoidant patterns of attachment. Patterns of attachment (avoidant and ambivalent) were the best predictors of subjects' evaluation of their present dentist. CONCLUSIONS: While psychopathologic traits are involved in subjects' present dental anxiety, pattern of attachment may have a dominant affect as to whether anxiety persists throughout life or can be modulated through a corrective emotional experience.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15192734&dopt=Abstract anxiety medicine




Disease-specific quality of life is associated with anxiety and depression in patients with acne.

Yazici K, Baz K, Yazici AE, Kokturk A, Tot S, Demirseren D, Buturak V.

Department of Psychiatry, Mersin University School of Medicine, Turkey. kemalyazici mersin.edu.tr

OBJECTIVE: We aimed to evaluate the relationships between acne severity, anxiety, depression and disease-specific quality of life in patients with acne. METHOD: A total of 61 patients with acne vulgaris and 38 healthy volunteers were included in the study. Acne severity was assessed by the Global Acne Grading System. All patients were asked to complete the Acne Quality of Life Scale (AQOL), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HAD), and healthy controls to fill only the HAD. RESULTS: The mean HAD anxiety subscale (HAD-A) and HAD depression subscale (HAD-D) scores of the patients were significantly higher than those of the controls. The rates of subjects at risk for anxiety (26.2%) and for depression (29.5%) were significantly higher in the patient group than in the control group (0% and 7.9%, respectively). We found no correlations between acne severity and scores of AQOL, DLQI, HAD-A and HAD-D. AQOL and DLQI scores were positively correlated with HAD-A and HAD-D scores in the patient group. The patients at risk for anxiety had significantly higher scores on AQOL and DLQI compared to those who were not at risk. There were no statistically significant differences between the female and male patients with respect to AQOL, DLQI, HAD-A and HAD-D scores. CONCLUSION: (1) Irrespective of the degree of severity, patients with acne are at increased risk for anxiety and depression compared to the normal population. (2) Acne negatively affects quality of life, and the greater the impairment of quality of life due to acne, the greater the level of anxiety and depression. (3) A greater impairment of dermatologic quality of life seems to put the patient at an increased risk for anxiety disorder.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15196157&dopt=Abstract anxiety medicine




Alpha oscillations as a correlate of trait anxiety.

Knyazev GG, Savostyanov AN, Levin EA.

State Research Institute of Physiology, Siberian Branch of the Russian Academy of Medical Sciences, Timakova Street, 4, Novosibirsk 630117, Russia. G.G.Knyazev iph.ma.nsc.ru

The associations among psychometric measures of anxiety and depression and individually adjusted electroencephalogram (EEG) spectral power measures registered in resting condition and during experimental settings were investigated in 30 males aged 18-25 years. During all stages of registration, Taylor Manifest Anxiety and Spielberger state anxiety (SA) and trait anxiety (TA) scores were positively related to alpha and negatively to delta relative power with these relations being independent of cortical site. Within-subject estimate of the strength of reciprocal relationship between alpha and delta oscillations (alpha-delta anticorrelation, or ADA) was positively related to trait anxiety and depression. Three minutes after an alarming event (unexpected loud sound), a further increase of alpha power was observed. In low-anxiety subjects, this increase was mostly associated with fast alpha (alpha 3), whereas in high-anxiety ones, it was mainly linked to slow alpha (alpha 2). SA mediated relationship between TA and EEG power, while ADA and alpha band reactivity showed trait-like features being associated with TA even after accounting for SA. These findings are interpreted as an indication of higher vigilance and higher reactivity of alpha system in anxious individuals.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15210292&dopt=Abstract anxiety medicine




Dental anxiety in patients seeking care at the University Dental Hospital in Sri Lanka.

Ekanayake L, Dharmawardena D.

Department of Community Dental Health, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka.

OBJECTIVE: The purpose of the study was to determine the prevalence and factors affecting dental anxiety in patients seeking dental care. DESIGN: A cross sectional study. PARTICIPANTS: 503 first visit patients attending the University Dental Hospital in Peradeniya, Sri Lanka. OUTCOME MEASURES: Corah's dental anxiety scale was used to assess the dental anxiety in these patients. RESULTS: The prevalence of dental anxiety was 32% (DAS score > or = 12) while 12% were considered to be extremely anxious (DAS score > or = 15). Females were found to be more dentally anxious than males. Level of education was associated with dental anxiety. Problem oriented attenders had a significantly higher mean DAS score than regular attenders. Those who had an extraction at the last dental visit were significantly more dentally anxious than those who had a restoration/scaling. Negative dental experience was not associated with dental anxiety. The logistic regression model revealed that gender, level of education and 'fear' which was cited as the reason for the delay in seeking care for the presenting complaint were significant predictors of dental anxiety. However, only 4% of the variation in dental anxiety could be explained by these independent variables. CONCLUSION: Socio-demographic factors and variables related to past dental experiences had a limited influence in explaining dental anxiety in this sample of dental patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12828272&dopt=Abstract anxiety medicine




Dyslipidemia and high waist-hip ratio in women with self-reported social anxiety.

Landen M, Baghaei F, Rosmond R, Holm G, Bjorntorp P, Eriksson E.

Department of Psychiatry, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Goteborg University, SE 431 80 Molndal, Sweden. mikael.landen neuro.gu.se

Previous research has indicated that phobic anxiety is associated with coronary heart disease. In this study, the possible association between social anxiety and various anthropometric, metabolic, and endocrine measurements known to be associated with cardiovascular disease were studied in a population-based cohort of 216 women 41-42 years old. Each participant was assessed by means of a DSM-IV based self-report questionnaire regarding social anxiety and related psychiatric diagnoses. Waist-to-hip ratio (WHR), body mass index (BMI), and serum levels of lipids and hormones were assessed. The prevalence of social anxiety was 14% (n=31). The social anxiety group displayed higher serum levels of triglycerides (1.3+/-0.9 vs. 1.0+/-0.5, P=0.003) and low-density lipoprotein (LDL) (3.3+/-0.8 vs. 3.0+/-0.7, P=0.03), but lower high-density lipoprotein (HDL) (1.4+/-0.3 vs. 1.6+/-0.4, P=0.04) and HDL/LDL ratio (0.46+/-0.15 vs. 0.57+/-0.22, P=0.008) than the other women. Serum levels of total testosterone (1.6+/-0.8 vs. 2.2+/-1.1, P=0.013) and free thyroxin (14+/-2 vs. 16+/-4, P=0.04) were lower in subjects confirming social anxiety. While WHR was significantly higher in the social anxiety group (0.83+/-0.06 vs. 0.80+/-0.07, P=0.016), BMI did not differ between the groups. Our data suggest that self-reported social anxiety is associated with two established risk factors for cardiovascular disease: dyslipidemia and increased WHR.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15219655&dopt=Abstract anxiety medicine




Decreased social interaction in aged rats may not reflect changes in anxiety-related behaviour.

Salchner P, Lubec G, Singewald N.

Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Innsbruck, Peter-Mayr-Strasse 1, A-6020 Innsbruck, Austria.

There is evidence that ageing both in humans and animals is accompanied by changes in emotional behaviour. Behavioural studies in rats point to an increase in emotional reactivity and/or anxiety-related behaviour with age. Here we studied social interaction in young adult (3 months) and aged (30 months old) rats using an established test system for anxiety-related behaviour. Using Fos expression as a marker of neuronal activation, we aimed to investigate whether age-related differences in anxiety would be reflected by changes in neuronal activity in brain regions known to be sensitive to fear- and anxiety-related stimuli. Aged rats spent significantly less time (75%) in active social interaction than young rats, without concomitant changes in general locomotor activity. Social interaction enhanced Fos expression both in young and aged rats in several anxiety-related brain areas. Lower Fos response in aged versus young rats was noted in the dorsomedial, dorsolateral and ventrolateral part of the periaqueductal grey, the medial and basolateral amygdala and parvocellular region of the paraventricular hypothalamic nucleus, while no differences in Fos expression were observed in the other regions examined, including the hippocampus, septum or locus coeruleus. These results demonstrate age-related reduction in social interaction, indicative of enhanced anxiety-related behaviour in aged rats. However, since the supposedly increased anxiety level was not accompanied by augmented Fos expression in any of the key brain areas of the fear/anxiety circuitry known to be activated by anxiogenic stimuli, it is suggested that reduced social interaction does not reflect enhanced anxiety in aged rats. Copyright 2003 Elsevier B.V.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15084415&dopt=Abstract anxiety medicine




The course of anxiety and depression through pregnancy and the postpartum in a community sample.

Heron J, O'Connor TG, Evans J, Golding J, Glover V; The ALSPAC Study Team.

University of Bristol, UK.

BACKGROUND: Postnatal and antenatal depression are a focus of considerable clinical and research attention, but little is known about the patterns of anxiety across this period. METHODS: Self-reported anxiety and depression were assessed at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally in a prospective longitudinal study of a community sample of women in England (n=8323). RESULTS: The majority of cases of postnatal depression were preceded by antenatal depression; similarly, postnatal anxiety was preceded by antenatal anxiety. Despite the stability of anxiety and depression across this period, there was a mean decrease in both anxiety and depression. Finally, antenatal anxiety predicted postnatal depression at 8 weeks and 8 months, even after controlling for antenatal depression (OR=3.22, p<0.001). Limitations: Data were based on self-report only and there was evidence of selective attrition. CONCLUSION: The findings confirm that antenatal anxiety occurs frequently, overlaps with depression and increases the likelihood of postnatal depression.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15094259&dopt=Abstract anxiety medicine