Effect of short-term SSRI treatment on cognitive bias in generalised anxiety disorder.

Mogg K, Baldwin DS, Brodrick P, Bradley BP.

Centre for the Study of Emotion and Motivation, School of Psychology, University of Southampton, SO171BJ, Highfield, Southampton, UK.

RATIONALE. There is considerable evidence showing that individuals with generalised anxiety disorder (GAD) selectively process threat-related information, e.g. they have a bias to interpret ambiguous information in a threat-related manner. Cognitive theories of anxiety, which provide the basis of cognitive-behaviour therapy, propose that such processing biases play an important role in causing and maintaining anxiety. OBJECTIVES. Given that treatment with selective serotonin re-uptake inhibitors (SSRIs) appears to be effective for GAD, we examined whether it is successful in removing cognitive bias. METHODS. The clinical group included 19 patients with a diagnosis of GAD, and the control group consisted of a non-clinical sample of volunteers, matched for age, gender and years in education. The patients were assessed on measures of interpretative bias (homophone task), anxiety and depression before being prescribed an SSRI (paroxetine or citalopram). After 4 weeks, the cognitive task and mood measures were repeated in the patient group. RESULTS. Prior to treatment, the GAD group showed a significantly greater level of threat-related interpretive bias than controls. Following SSRI treatment, there were significant reductions in both interpretive bias and in anxiety levels in the GAD group. Furthermore, individuals who showed greater clinical improvement (e.g. reflected by reduced anxiety scores) showed a correspondingly greater reduction in their cognitive bias. CONCLUSION. The results suggest that SSRIs are effective in modifying both subjective anxiety levels and threat-related interpretive bias.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15133578&dopt=Abstract anxiety medicine




Pessimism as a predictor of emotional morbidity one year following breast cancer surgery.

Schou I, Ekeberg O, Ruland CM, Sandvik L, Karesen R.

Department of General Surgery, Ullevaal University Hospital, 0407 Oslo, Norway. inger.schou ulleval.no

The prevalence of and predictive factors for emotional morbidity (measured by the Hospital Anxiety and Depression Scale (HAD)) one year following surgery, with special focus on dispositional optimism/pessimism (measured by the Life Orientation Test (LOT-R), was examined in 165 women, newly diagnosed with breast cancer. Patients characteristics, appraisal of cancer diagnosis, beliefs about treatment efficacy, treatment decision-making participation, coping and emotional morbidity was assessed by self-rating questionnaires.Prevalence of anxiety and depression cases at time of diagnosis was 34 and 12%, respectively, and 26 and 9% after one year. Prevalence of emotional morbidity was significantly enlarged among pessimists at all assessments.Pessimism was the strongest predictor for anxiety (OR: 0.86 C.I. 95% 0.77 - 0.95) and depression (OR: 0.83, C.I. 95% 0.73 - 0.95) one year following breast cancer surgery. Optimists and pessimists differed not only in regard to coping styles, but also in regards to predictors of emotional morbidity. Optimists experiencing anxiety at time of breast cancer diagnosis had about six times higher risk of experiencing anxiety after one year, compared to optimists without preoperative anxiety. For pessimists, the more pessimistic one was about one's overall future the higher risk for developing anxiety following one year of breast cancer surgery. Pessimists, who endorse helpless/hopeless coping style when receiving a diagnosis of breast cancer, had three times greater risk for experiencing depression one year after breast cancer surgery, than pessimists who did not. Health care professionals should therefore provide intervention for pessimists, as well as for patients with high anxiety scores at time of diagnosis. Copyright 2003 John Wiley & Sons, Ltd.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15133772&dopt=Abstract anxiety medicine




Patient anxiety and experiences associated with an outpatient "one-stop" "see and treat" hysteroscopy clinic.

Gupta JK, Clark TJ, More S, Pattison H.

Academic Department of Obstetrics and Gynaecology, Minimal Access Surgical Training (MAST) Unit, University of Birmingham, Birmingham Women's Hospital, B15 2TG, Birmingham, United Kingdom. j.kgupta bham.ac.uk

BACKGROUND: "One-stop" outpatient hysteroscopy clinics have become well established for the investigation and treatment of women with abnormal uterine bleeding. However, the advantages of these clinics may be offset by patient factors such as anxiety, pain, and dissatisfaction. This study aimed to establish patients' views and experiences of outpatient service delivery in the context of a one-stop diagnostic and therapeutic hysteroscopy clinic, to determine the amount of anxiety experienced by these women and compare this with other settings, and to determine any predictors for patient preferences. METHODS: The 20-item State-Trait Anxiety Inventory was given to 240 women attending a one-stop hysteroscopy clinic: to 73 consecutive women before their appointment in a general gynecology clinic and to 36 consecutive women attending a chronic pelvic pain clinic. The results were compared with published data for the normal female population, for women awaiting major surgery, and for women awaiting a colposcopy clinic appointment. In addition, a questionnaire designed to ascertain patients' views and experiences was used. Logistic regression analysis was used to delineate the predictive values of diagnostic or therapeutic hysteroscopy, and to determine their effect on the preference of patients to have the procedure performed under general anesthesia in the future. RESULTS: Women attending the hysteroscopy clinic in this study reported significantly higher levels of anxiety than those attending the general gynecology clinic (median, 45 vs 39; p = 0.004), but the levels of anxiety were comparable with those of women attending the chronic pelvic pain clinic (median, 45 vs 46; p = 0.8). As compared with the data from the normal female population (mean, 35.7) and those reported for women awaiting major surgery (mean, 41.2), the levels of anxiety experienced before outpatient hysteroscopy clinic treatment were found to be higher (mean, 45.7). Only women awaiting colposcopy (6-item mean score, 51.1 +/- 13.3) experienced significantly higher anxiety scores than the women awaiting outpatient hysteroscopy (6-item mean score, 47.3 +/- 13.9; p = 0.002). Despite their anxiety, most women are satisfied with the outpatient hysteroscopy "see and treat" service. High levels of anxiety, particularly concerning pain but not operative intervention, were significant predictors of patients desiring a future procedure to be performed under general anesthesia. CONCLUSIONS: Outpatient hysteroscopy is associated with significant anxiety, which increases the likelihood of intolerance for the outpatient procedure. However, among those undergoing operative therapeutic procedures, dissatisfaction was not associated with the outpatient setting.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15136927&dopt=Abstract anxiety medicine




Dental anxiety in a students' paediatric dental clinic: children, parents and students.

Peretz B, Nazarian Y, Bimstein E.

Department of Pediatric Dentistry, Barzilai Medical Center, Ashkelon, Israel. benny cc.huji.ac.il

OBJECTIVE: The purpose of the present study was to investigate the dental anxieties of children, parents and student caregivers in a dental school environment. METHODS: Eighty-eight children, parents and the dental students who treated the children were included in the study. They were asked to complete questionnaires which gathered information about demographics and dental anxiety using the Dental Anxiety Scale (DAS). Students were also asked to respond to a visual analogue scale (VAS) to assess their anxiety prior to treating children. RESULTS: Significant differences were observed between the mean DAS of the children compared to the students (8.8 +/- 3.9 and 7.3 +/- 2.7, respectively), and between the scores of the parents and the students (8.3 +/- 2.9 and 7.3 +/- 2.7, respectively). No significance was noted between the mean DAS scores of the children and those of the parents. The number of children in family did not influence the mean DAS of the children. Parents' age, education or place of birth did not influence the mean DAS of the parents or the children. The mean DAS of children who reacted excellently in previous treatments scored significantly lower in DAS compared with children who were fearful. Female dental students demonstrated higher DAS and VAS scores than male students. Students' seniority, type of last treatment that they received, time since last treatment, parenthood or self-ranking in class did not seem to significantly influence their DAS or VAS scores. A strong correlation in DAS scores between parents and children was found (r = 0.41, P = 0.0001). No correlation between children's and students' DAS scores was found. CONCLUSIONS: Students' dental anxiety, or their anxiety prior to treating a child, may not be directly associated with the child's dental anxiety. However, a positive correlation exists between parental and children's dental anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15139954&dopt=Abstract anxiety medicine




Cognitive and somatic anxiety and self-confidence in athletic performance of beach volleyball.

Kais K, Raudsepp L.

Institute of Sport Pedagogy, University of Tartu, Estonia.

This study considered the influence of competitive anxiety and self-confidence state responses upon athletic performance. 66 male beach volleyball players completed the translated and modified Competitive State Anxiety Inventory-2 which included the original intensity scale and a direction scale of Jones and Swain. Players' performance was scored from the video records using a standard rating scales. Correlations indicated scores on Direction subscale of modified Competitive State Anxiety Inventory-2 and Self-confidence were moderately positively (r=.27 to .51) correlated with different skill components and sum of skill components of beach volleyball. Stepwise multiple regressions indicated that, as anticipated, directional perceptions of cognitive and somatic anxiety and self-confidence were significant predictors of beach volleyball performance but accounted for only 42% of variance. Original Intensity subscales of somatic and cognitive anxiety did not predict performance. Findings support the notion that direction of anxiety responses must be taken into consideration when examining anxiety-performance association in sport.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15141908&dopt=Abstract anxiety medicine




Prevalence of anxiety and depression among medical students of private university.

Inam SN, Saqib A, Alam E.

Department of Community Health Sciences, Ziauddin Medical University, Karachi.

OBJECTIVE: To assess anxiety and depression levels among medical students of a private university by using a self-administered anxiety and depression questionnaire. METHODOLOGY: A cross sectional study was done on the students of Ziauddin Medical University, who had spent more than six months in the medical school. A self-administered questionnaire was given to the students, present in the class and willing to participate in the study. During the survey students of 5th year were not available. The instrument used to asses the anxiety and depression levels was the, Aga Khan University Anxiety and Depression Scale (AKUADS). Additional questions regarding socioeconomic variables were also included in the survey instrument, such as student's birth order, monthly income, number of siblings, and monthly expenditure on education. Data analysis was done on Epi info version 6. RESULTS: There were 252 students in 4th year MBBS to 1st year MBBS. Of these 189 were present during the survey. Using anxiety and depression scale it was found out that 113 (60%) students had anxiety and depression. Prevalence of anxiety and depression in students of 4th year, 3rd year, 2nd year and 1st year was 49%, 47%, 73% and 66% respectively. It was significantly higher in 1st year and 2nd year, as compared to 3rd and 4th year (p < 0.05). It was seen that birth order, monthly income, number of siblings and monthly expenditure on education did not affect the prevalence of anxiety and depression. CONCLUSION: This study suggests that medical students experience anxiety and depression, the finding is consistent with other western studies, however there is no local data available to support our findings. The study finding highlights the need of psychiatric counseling and support services available to vulnerable students. These findings should be further explored in longitudinal studies to identify the stressors leading to these outcomes and appropriate interventions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12705482&dopt=Abstract anxiety medicine




The relationship of stress and anxiety with chronic periodontitis.

Vettore MV, Leao AT, Monteiro Da Silva AM, Quintanilha RS, Lamarca GA.

Department of Periodontology, Federal University of Rio de Janeiro, Brazil. maga compuland.com.br

AIM: This case-control study investigates the relationship of stress and anxiety with periodontal clinical characteristics. METHOD: Seventy-nine selected patients (mean age 46.8+/-8 years) were assigned to three groups in accordance with their levels of probing pocket depth (PPD): control group (PPD< or =3 mm, n=22), test group 1 (at least four sites with PPD > or =4 mm and < or =6 mm, n=27) and test group 2 (at least four sites with PPD >6 mm, n=30). An inclusion criterion of the study required that patients presented a plaque index (PI) with a value equal to or larger than 2 in at least 50% of dental surfaces. All subjects were submitted to stress and anxiety evaluations. Stress was measured by the Stress Symptom Inventory (SSI) and the Social Readjustment Rating Scale (SRRS), while the State-Trait Anxiety Inventory (STAI) was used to assess anxiety. Clinical measures such as PI, gingival index (GI), PPD and clinical attachment level (CAL) were collected. Patient's medical history and socioeconomic data were also recorded. RESULTS: The mean clinical measures (PI, GI, PPD and CAL) obtained for the three groups, were: control group, 1.56+/-0.32, 0.68+/-0.49, 1.72+/-0.54 and 2.04+/-0.64 mm; group 1, 1.56+/-0.39, 1.13+/-0.58, 2.67+/-0.67 and 3.10+/-0.76 mm, group 2, 1.65+/-0.37, 1.54+/-0.46, 4.14+/-1.23 and 5.01+/-1.60 mm. The three groups did not differ with respect to percentage of clinical stress, scores of the SRRS, trait and state anxiety. Frequency of moderate CAL (4-6 mm) and moderate PPD (4-6 mm) were found to be significantly associated with higher trait anxiety scores after adjusting for socioeconomic data and cigarette consumption (p<0.05). CONCLUSIONS: Based on the obtained results, individuals with high levels of trait anxiety appeared to be more prone to periodontal disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12716330&dopt=Abstract anxiety medicine




Depression and anxiety in chronic hepatitis B: effect of hepatitis B virus infection on psychological state in childhood.

Arslan N, Buyukgebiz B, Ozturk Y, Akay AP.

Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.

We aimed to evaluate the effect of chronic hepatitis B virus infection on the psychological state of children. Children who were carriers of hepatitis B virus (n:20) and those with chronic hepatitis B virus infection (n:20) for at least one year formed study Groups 1 and 2, respectively. Healthy children with similar demographic characteristics (n:43) were enrolled as the control group. The "Children's Depression Inventory" and "State-Trait Anxiety Inventory for Children" were used for the assessment of the extent of depression and anxiety, respectively. Then, mean depression and anxiety scores of the study and control groups were compared. In addition, the children in each group were further evaluated for depression and anxiety with respect to gender and age as prepubertal and postpubertal. The mean depression and anxiety scores of study Groups 1 and 2 and of the control group were 8.35 +/- 5.6, 8.22 +/- 6.85, 9.12 +/- 5.2 (depression scores) and 32.7 +/- 6.85, 33.4 +/- 10 and 34 +/- 6.5 (anxiety scores), respectively. These three groups did not differ significantly from each other with respect to anxiety and depression scores (p>0.05). Athough there was no child with overt depression (with a depression score over 19) in study Group 2, two children in study Group 1 and one child in the control group were determined to be in overt depression. Children with chronic hepatitis B virus infection were not different with respect to depression and anxiety from children who were carriers of hepatitis B virus nor from the healthy controls.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12718367&dopt=Abstract anxiety medicine




Genetic dissection of anxiety in autoimmune disease.

Nakamura K, Xiu Y, Ohtsuji M, Sugita G, Abe M, Ohtsuji N, Hamano Y, Jiang Y, Takahashi N, Shirai T, Nishimura H, Hirose S.

Second Department of Pathology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.

Systemic lupus erythematosus (SLE), a complex multigenic disease, is characterized by hypergammaglobulinemia, autoantibody production and immune complex-type lupus nephritis. In addition to these signs and symptoms in SLE, there can be symptoms of neurological disorders, including anxiety. To clarify mechanisms governing the anxiety seen in lupus, we carried out genome-wide scans, and found that the region including interferon-alpha (IFN-alpha) on NZB chromosome 4 is significantly linked to the anxiety-like behavior seen in SLE-prone New Zealand Black (NZB) x New Zealand White (NZW) F(1) (B/W F(1)) mice. This finding was confirmed by anxiety-like performances of mice with heterozygous NZB/NZW alleles in the susceptibility region onto the NZW background. In B/W F(1) mice, neuronal IFN-alpha levels were elevated, and blockade of the micro (1) opioid receptor or corticotropin-releasing hormone receptor 1, possible downstream effectors for IFN-alpha in the brain partially overcame the anxiety-like behavior seen in the B/W F(1) mice. Consistently, neuronal corticotropin-releasing hormone levels were higher in B/W F(1) than NZW mice. Furthermore, pretreatment of micro (1) opioid receptor antagonist abolished anxiety-like behaviour seen in IFN-alpha-treated NZW mice. Anxiety is shown to be mediated by multiple mediators. Our data suggest that a genetically determined endogenous excess amount of IFN-alpha in the brain may form one aspect of anxiety-like behavior seen in SLE-prone mice.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12719372&dopt=Abstract anxiety medicine