Does medical school cause health anxiety and worry in medical students?

Singh G, Hankins M, Weinman JA.

Psychology Unit, Guy's, King's & St. Thomas' School of Medicine, London, UK. gurminder.singh kcl.ac.uk

OBJECTIVES: The aim of this study was to investigate the self-reported experience of health anxiety and worry in medical students compared with control subjects. It was hypothesised that medical students would experience more health anxiety as a consequence of being exposed to medical education, compared to students who are not routinely exposed to such knowledge. DESIGN: The design was cross-sectional. SETTING: Participants were recruited from London University (Guy's, King's & St Thomas' School of Medicine and King's College). PARTICIPANTS: Medical students (n = 449) and non-medical students (n = 485) were recruited across Years 1-4. Questionnaires relating to health anxiety and worry were completed at the end of their lectures. MAIN OUTCOME MEASURES: Health anxiety was measured using a questionnaire known as the Health Anxiety Questionnaire (HAQ). Worry was assessed using the Anxious Thoughts Inventory (ANTI). RESULTS: Health anxiety was significantly lower in medical students in Years 1 and 4 than in controls (P = 0.017 and P < 0.001, respectively). Worry was significantly lower in the medical students in all years of study. CONCLUSIONS: Medical students are not a cohort of preselected health-anxious people, nor are they 'worriers'. Medical education at a clinical level was shown to mitigate health anxiety in the medical student population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15107081&dopt=Abstract anxiety medicine




Eating disorder symptoms among female anxiety disorder patients in clinical practice: the importance of anxiety comorbidity assessment.

Becker CB, DeViva JC, Zayfert C.

Department of Psychology, Trinity University, 715 Stadium Drive, San Antonio, TX 78212-7200, USA. carolyn.becker trinity.edu

This exploratory study investigated the relationship between anxiety disorders, anxiety comorbidity, and eating disorder (ED) symptoms in clinical practice, and examined the naturalistic detection of ED when diagnoses were based on the Anxiety Disorders Interview Schedule (ADIS). Two hundred and fifty-seven female patients completed an ED questionnaire and were assessed with the ADIS. Although ED frequency did not differ among anxiety disorder diagnoses, regression analyses revealed that social phobia (SP) and posttraumatic stress disorder (PTSD) accounted for unique variance in eating pathology. Questionnaire results indicated that almost 12% of patients met criteria for a possible ED. Clinicians using the ADIS evidenced good specificity but were not sensitive to detecting ED, missing 80% of possible cases. Results support possible links between ED, social phobia and PTSD and highlight the importance of assessing anxiety comorbidity when examining the relationship between ED and anxiety disorders. Results also suggest that formal screening for ED among female anxiety patients may be warranted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15125976&dopt=Abstract anxiety medicine




Balance dysfunction in childhood anxiety: findings and theoretical approach.

Erez O, Gordon CR, Sever J, Sadeh A, Mintz M.

Psychobiology Research Unit, Department of Psychology, Tel-Aviv University, Tel-Aviv 69978, Israel.

A recent special issue of the Journal of Anxiety Disorders, reviewed the experimental and clinical findings related to comorbidity of balance disorders and anxiety [J. Anxiety Disord. 15 (2001) 1.]. The studies mentioned in that issue were based mostly on adult subjects but prevalence of balance disorders in childhood anxiety is yet to be established. We have tested a small sample of children diagnosed for general or separation anxiety disorder and a control group of normal children. Extensive neurological examination revealed no clinically relevant vestibular impairment. Nevertheless, detailed questionnaires and balance tests confirmed an excessive sensitivity of anxiety disordered children to balance-challenging situations. Moreover, balance-challenging tasks triggered more balance mistakes and slower performance in anxiety versus control children. These findings support the notion of subclinical balance disorder in childhood anxiety. Results are discussed in terms of the two-stage theory of learning, which predicts that anxiety disorder may be an offshoot of lasting balance dysfunction.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15125981&dopt=Abstract anxiety medicine




The path from initial inquiry to initiation of treatment for social anxiety disorder in an anxiety disorders specialty clinic.

Coles ME, Turk CL, Jindra L, Heimberg RG.

Adult Anxiety Clinic of Temple, Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA 19122-6085, USA.

Efficacious treatments for social anxiety disorder have become increasingly available, with approximately three-quarters of treatment completers showing significant improvement [Arch. Gen. Psychiatry 55 (1998) 1133.]. However, very few individuals with social anxiety disorder access these services. The present study reports on the path to initiation of treatment for social anxiety disorder among individuals contacting an anxiety disorder specialty clinic. Of 395 initial telephone inquiries, only 60 individuals (15%) started treatment. Three "critical points" associated with high pretreatment attrition were identified: scheduling an initial interview, attending a scheduled initial interview, and initiating a treatment program after receiving a principal diagnosis of social anxiety disorder. Several demographic variables (e.g., level of education, race) were related to attendance at the initial interview. However, no differences were found between those who did and did not initiate treatment on demographic variables, symptom severity, or quality of life. Given that most individuals who complete treatment for social phobia experience significant benefit, results of the current study suggest that future efforts should be devoted to increasing number of patients who access these services.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15125983&dopt=Abstract anxiety medicine




Anxiety sensitivity and modulation of the serotonergic system in patients with PD.

Romano P, van Beek N, Cucchi M, Biffi S, Perna G.

Anxiety Disorders Clinical and Research Unit, Department of Neuropsychiatric Sciences, Istituto Scientifico H.S. Raffaele, 29 via Prinetti 20127, Milan, Italy.

Anxiety sensitivity, i.e., the fear of anxiety-related bodily sensations, is one of the most studied cognitive variables in panic disorder (PD). However, the effects of selective serotonergic antipanic agents on this variable have not yet been investigated. The present study examines the effects of 6 weeks of treatment with citalopram on anxiety sensitivity in patients with PD. Twenty patients entered the study. On day 0, before starting drug treatment, after 1 week and after 6 weeks of treatment, each patient was evaluated with the Anxiety Sensitivity Index (ASI); the severity of clinical symptomatology was assessed with standardized psychometric scales. Results showed a significant reduction of anxiety sensitivity after 6 weeks of treatment. There was a significant correlation between decrease of anxiety sensitivity and anticipatory anxiety, while no correlations were found between panic attacks and agoraphobic avoidance. These results suggest that antipanic drug treatment decreases anxiety sensitivity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15125987&dopt=Abstract anxiety medicine




Gulf War veterans with anxiety: prevalence, comorbidity, and risk factors.

Black DW, Carney CP, Peloso PM, Woolson RF, Schwartz DA, Voelker MD, Barrett DH, Doebbeling BN.

Department of Psychiatry, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa 52242, USA. donaldblack uiowa.edu

BACKGROUND: Veterans of the first Gulf War have higher rates of medical and psychiatric symptoms than nondeployed military personnel. METHODS: To assess the prevalence of and risk factors for current anxiety disorders in Gulf War veterans, we administered a structured telephone interview to a population-based sample of 4886 military personnel from Iowa at enlistment. Participants were randomly drawn from Gulf War regular military, Gulf War National Guard/ Reserve, non-Gulf War regular military, and non-Gulf War National Guard/Reserve. Medical and psychiatric conditions were assessed through standardized interviews and questionnaires in 3695 subjects (76% participation). Risk factors were assessed using multivariate logistic regression models. RESULTS: Veterans of the first Gulf War reported a markedly higher prevalence of current anxiety disorders than nondeployed military personnel (5.9% vs. 2.8%; odds ratio = 2.1; 95% confidence interval = 1.3-3.1), and their anxiety disorders are associated with co-occurring psychiatric disorders. Posttraumatic stress disorder, panic disorder, and generalized anxiety disorder were each present at rates nearly twice expected. In our multivariate model, predeployment psychiatric treatment and predeployment diagnoses (posttraumatic stress disorder, depression, or anxiety) were independently associated with current anxiety disorder. Participation in Gulf War combat was independently associated with current posttraumatic stress disorder, panic disorder, and generalized anxiety disorder. CONCLUSIONS: Current anxiety disorders are relatively frequent in a military population and are more common among Gulf War veterans than nondeployed military personnel. Predeployment psychiatric difficulties are robustly associated with the development of anxiety. Healthcare providers and policymakers need to consider panic disorder and generalized anxiety disorder, in addition to posttraumatic stress disorder, to ensure their proper assessment, treatment, and prevention in veteran populations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15127904&dopt=Abstract anxiety medicine




Gastric emptying and intragastric distribution of a solid meal in functional dyspepsia: influence of gender and anxiety.

Lorena SL, Tinois E, Brunetto SQ, Camargo EE, Mesquita MA.

Disciplina de Gastroenterologia, Departamento de Clinica Medica, Universidade Estadual de Campinas, Sao Paulo, Brazil.

BACKGROUND: Gastric dysmotility and psychological factors have been implicated in the pathophysiology of functional dyspepsia. GOALS: To investigate the influence of gender and anxiety on gastric emptying and intragastric food distribution in patients with functional dyspepsia. METHODS: A standard gastric emptying test was used to study total and compartmental gastric emptying of a solid meal in 22 patients with functional dyspepsia (16 women). Comparisons of the data for dyspeptic men and women were made with 2 respective subgroups of controls (9 men; 9 women). The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. RESULTS: Delayed gastric emptying was observed in 32% of patients with functional dyspepsia. As a group, dyspeptic women had a significantly longer half-emptying time as compared with dyspeptic men ( 19 +/- 41 min vs. 78 +/- 22 min) and to female controls (96 +/- 17 min). There was no difference in half-emptying times between male patients and controls. The initial activity in the proximal stomach was significantly lower for both men and women with functional dyspepsia in comparison with their respective controls. In addition, meal retention in the distal stomach of dyspeptic women was significantly greater than that in female controls. Sixteen (72%) functional dyspepsia patients had anxiety when evaluated by the Hospital Anxiety and Depression scale. Those patients who scored for anxiety showed significantly greater antral meal retention than patients without anxiety. CONCLUSION: Our study confirmed that prolonged gastric emptying in patients with functional dyspepsia is related to the female sex, while the abnormalities of the meal intragastric distribution appear to occur in dyspeptic males and females. Anxiety is frequent in functional dyspepsia and seems to be related to abnormal antral retention of food in these patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15128068&dopt=Abstract anxiety medicine




[The assessment of anxiety levels in patients with posttraumatic stress disorder]

[Article in Turkish]

Sinici E, Yildiz C, Tunay S, Ozkan H, Altinmakas M.

Department of Orthopedics and Traumatology, Gulhane Military School of Medicine, Ankara, Turkey. esinici mynet.com

OBJECTIVES: The purpose of this study was to measure state and trait anxiety levels of veterans who developed posttraumatic stress disorder following combat or landmine injuries, or vehicle accidents. METHODS: The anxiety levels of 98 veterans (mean age 20 years; range 18 to 25 years) were measured with the use of the State-Trait Anxiety Scale (STAI I-II). Diagnosis of posttraumatic stress disorder was made on the basis of the Structured Clinical Interview for DSM III-R. RESULTS: The number of patients with high levels of anxiety was not in significant relationship with education level and trauma type (p>0.05). Regardless of education levels and trauma types, the number of patients with high trait anxiety significantly outweighed the number of patients with high state anxiety (p<0.05). Trait anxiety levels differed significantly between primary school and high school graduates (p=0.03). CONCLUSION: Veterans should be under close supervision to determine and treat increased anxiety which worsens the quality of life. Special attention should be paid to appropriate psychological rehabilitation throughout the treatment plan.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15129034&dopt=Abstract anxiety medicine




Depression and anxiety before and after temporal lobe epilepsy surgery.

Reuber M, Andersen B, Elger CE, Helmstaedter C.

University Hospital of Epileptology, Sigmund-Freud Str. 25, 53105 Bonn, Germany.

PURPOSE: To examine the course of depression and anxiety in patients with temporal lobe epilepsy (TLE) treated with epilepsy surgery (and anticonvulsant drugs) or medical means alone. METHODS: Of 94 TLE patients evaluated for epilepsy surgery, 76 underwent a resective procedure, 18 continued on medical treatment alone. Depression (Beck Depression Inventory (BDI)) and anxiety scores (Self-Rating Anxiety Scale (SRAS)) were examined during presurgical evaluation (T1) and after a mean of 16 months (T2), or 12 months after surgery. Depression and anxiety scores were related to type of intervention, underlying epileptogenic lesion, change of seizure control and anticonvulsant therapy. RESULTS: At T1, depression and anxiety scores were higher in patients with TLE than scores in published normal populations. At T2, depression but not anxiety scores were significantly lower than at T1. Change of depression scores interacted with improvements of seizure control. CONCLUSIONS: Evidence of depression and anxiety is commonly found in patients with TLE. Depression improves not because of epilepsy surgery per se, but because of improved seizure control. This is more commonly achieved by surgery than medical treatment. The results are consistent with the hypothesis that depression in TLE is caused by pathological epileptic activity rather than a fixed structural defect.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15129842&dopt=Abstract anxiety medicine