Antiepileptic drugs in the treatment of anxiety disorders: role in therapy.

Van Ameringen M, Mancini C, Pipe B, Bennett M.

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. vanamer mcmaster.ca

Pharmacotherapy for anxiety disorders is an active area of research. A variety of drug groups have been shown to be effective in treating many of the anxiety disorders, with selective serotonin reuptake inhibitors (SSRIs) being considered first-line agents for virtually all anxiety disorders. There is a clinical need for alternative drug treatments, as many patients do not achieve a complete response and experience significant adverse effects. The successful use of antiepileptic drugs in mood disorders has led clinicians and researchers to investigate their potential efficacy in other psychiatric disorders, particularly in anxiety disorders. There have been a number of investigations conducted in the form of case reports, case series and open-label trials, suggesting the potential usefulness of antiepileptic drug treatment in a variety of anxiety disorders. More reliable evidence for the use of antiepileptic drugs in anxiety disorders can be gleaned from recent placebo-controlled trials. Thus far, the strongest placebo-controlled evidence has demonstrated the efficacy of pregabalin in treating social phobia and generalised anxiety disorder, while smaller or less robust controlled trials have suggested the potential efficacy of gabapentin in social phobia, lamotrigine in post-traumatic stress disorder, and valproic acid in panic disorder. Antiepileptic drugs may have a place in the treatment of anxiety disorders; however, further investigation is warranted to determine in what circumstances they should be used as monotherapy or as augmenting agents in individuals who are partially or non-responsive to conventional therapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15456335&dopt=Abstract anxiety medicine




Symptoms of depression and anxiety in post-myocardial infarction patients.

Akhtar MS, Malik SB, Ahmed MM.

Department of Psychiatry, Punjab Institute of Mental Health, Lahore. msakhtar65 hotmail.com

OBJECTIVE: To assess the frequency of symptoms of depression and/or anxiety following acute myocardial infarction (AMI) and to analyse their association with demographic variables. DESIGN: A cross-sectional analytical, non-interventional hospital based study. PLACE AND DURATION OF STUDY: The study was carried out at Punjab Institute of Cardiology (PIC), Lahore, from January 2000 to January 2001. PATIENTS AND METHODS: A total number of 100 inpatients suffering from AMI were studied. After a careful selection of the subjects the Urdu version of Hospital Anxiety and Depression Scale (HADS) was administered to each patient during the period of 5-7 days following AMI to assess symptoms of depression and anxiety. A semi-structured clinical interview was also conducted which included demographic information, psychiatric history and other variables. Results were analyzed by using Statistical Package for Social Sciences (SPSS version 8.0). RESULTS: Out of 100 subjects, 80 (80%) were males and 20 (20%) were females. Their ages ranged from 30-60 years (mean age, 50.92+/-8.53). Overall, symptoms of anxiety and/or depression were found in 50 (50%) patients. More specifically, symptoms of depression were found in 14%, anxiety symptoms in 18% and mixed symptoms (anxiety and depression) in 18% of the patients. Results revealed that patients above 45 years of age (i.e. 46-60 years) were more likely to experience symptoms of depression and/ or anxiety following AMI. A significant association was also found between female sex (p <0.02), lower socioeconomic status (p <0.05) and symptoms of depression and/ or anxiety in these patients. However, no significant association was found in relation to educational status, marital status and origin (urban/rural). CONCLUSION: The high proportion of patients with AMI found to be suffering from symptoms of depression and/ or anxiety one week after AMI highlights the essential need to assess these symptoms in all such patients during the post-MI period as they merit appropriate treatment along with the other complications of AMI.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15456553&dopt=Abstract anxiety medicine




Social anxiety in stuttering: measuring negative social expectancies.

Messenger M, Onslow M, Packman A, Menzies R.

Australian Stuttering Research Centre, The University of Sydney, P.O. Box 170, Lidcombe, NSW 1825, Australia.

Much research has suggested that those who stutter are likely to be anxious. However, to date, little research on this topic has addressed the role of expectancies of harm in anxiety, which is a central construct of anxiety in modern clinical psychology. There are good reasons to believe that the anxiety of those who stutter is related to expectancies of social harm. Therefore, in the present study, 34 stuttering and 34 control participants completed the Fear of Negative Evaluation (FNE) Scale and the Endler Multidimensional Anxiety Scales-Trait (EMAS-T). The FNE data showed a significant difference between the stuttering and control participants, with a large effect size. Results suggested that, as a group, a clinical population of people who stutter has anxiety that is restricted to the social domain. For the EMAS-T, significant differences between groups were obtained for the two subtests that refer specifically to people and social interactions in which social evaluation might occur (Social Evaluation and New/Strange Situations) but not for the subtests that contained no specific reference to people and social interactions (Physical Danger and Daily Routines). These results were taken to suggest that those who stutter differ from control subjects in their expectation of negative social evaluation, and that the effect sizes are clinically significant. The findings also suggest that the FNE and the EMAS-T are appropriate psychological tests of anxiety to use with stuttering clients in clinical settings. The clinical and research implications of these findings are discussed, in terms of whether social anxiety mediates stuttering or is a simple by-product of stuttering. Possible laboratory explorations of this issue are suggested, and potential Cognitive Behavior Therapy packages for stuttering clients who might need them are discussed. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) explain why expectancy of social threat or harm may be associated with stuttering; (2) name and describe two psychological tests that are suitable for assessment of the social threat or harm that may be associated with stuttering; and (3) explain how findings for the EMAS-T test in the present results suggest that expectancy of social threat or harm, but not other kinds of negative expectancy, are associated with stuttering.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15458831&dopt=Abstract anxiety medicine




[A few unresolved and frequent questions concerning anxiety and anxiety disorders]

[Article in French]

Borgeat F, Zullino D.

Universite de Lausanne, Departement Universitaire de Psychiatrie Adulte, Lausanne.

The field of anxiety disorders shows a considerable evolution in the last decades concerning the overall conceptualization of the disorders and concerning their treatment. However many questions remain open. For instance, what is the importance of anxiety disorders in terms of public health? What is their influence on other factors affecting populations' health, e.g. substance abuse, and especially smoking? Questions also remain concerning the underlying mechanisms, whether biological or psychological. For instance, is it possible to identify cognitive schemas leading to pathological anxiety? What are the physiological manifestations of the hypervigilance and hyperreactivity that are described clinically? Despite the successive classifications, some issues are unsettled concerning the delimitation of anxiety disorders. For instance, do obsessive-compulsive disorders belong to anxiety disorders or preferably to a different family of mental disorders constituting a spectrum of obsessive-compulsive disorders? Several practical issues remain open for clinicians: what is the importance of specific therapeutic factors in cognitive-behavioral therapies? Is there a psychoanalytical method and a psychopharmacological therapy specific to anxiety disorders? Concrete questions also deserve attention in relation with therapeutic modalities. Are group treatments superior to individual ones? What is the role of emotion in cognitive-behavioral treatment? Is it useful to associate self-regulation strategies like meditation? Do self-help organizations, that are numerous and helpful in that field, have a role concerning psychotherapy?

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15470558&dopt=Abstract anxiety medicine




Music performance anxiety and occupational stress amongst opera chorus artists and their relationship with state and trait anxiety and perfectionism.

Kenny DT, Davis P, Oates J.

The Conservatorium of Music, The University of Sydney, East Street, P.O. Box 170, C4c, Lidcombe 1825, NSW, Australia. D.Kenny fhs.usyd.edu.au

This study explored the inter-relationships among state and trait anxiety, occupational stress, perfectionism, aspiration, and music performance anxiety in a group of elite operatic chorus artists employed full-time by a national opera company. The chorus artists reported higher trait anxiety, higher occupational role concerns, and higher occupational personal strain than normative samples. Higher scores on personal resources were associated with the higher scores on trait anxiety. It appears that these resources were used adaptively to manage anxiety. High trait anxiety was also associated with high personal strain in the work environment. Anxiety was not related to occupational roles or issues related to the physical environment or working conditions. These results suggest that while trait anxiety and music performance anxiety were closely associated, occupational stress makes a separate contribution to the quality of working life experienced by elite choral artists.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15474851&dopt=Abstract anxiety medicine




Late-life anxiety disorders among Puerto Rican primary care patients: impact on well-being, functioning, and service utilization.

Diefenbach GJ, Robison JT, Tolin DF, Blank K.

Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, USA. gdiefen harthosp.org

With the growing population of older Hispanic adults there is a need for additional research on the mental health care of this patient group. This study explored the impact of anxiety disorders on the health status of 291 older (>/=50 years) Puerto Rican primary care patients (n = 65 with anxiety disorders, n = 226 without anxiety disorders). All analyses controlled for potential confounding variables, including depression diagnosis and physical health burden. Logistic regression indicated that anxiety disorders were associated with higher psychological distress, suicidality, and emergency room service utilization, as well as lower instrumental functioning and perceived health quality. Analysis of covariance indicated that both anxiety disorder status and history of ataque de nervios were related to higher percentages of lifetime somatic symptoms. These data highlight the need for improved recognition and treatment of anxiety disorders in older Puerto Rican adults.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15474856&dopt=Abstract anxiety medicine




Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events.

Grace SL, Abbey SE, Irvine J, Shnek ZM, Stewart DE.

University Health Network Women's Health Program, Toronto, Canada. sherry.grace uhn.on.ca

BACKGROUND: The current study builds on previous research demonstrating a link between anxiety and inhospital recurrent ischemic and arrhythmic events, by examining the effects of persistent anxiety on recurrent events 1 year later. METHODS: 913 patients with unstable angina (UA) and myocardial infarction (MI) from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months after the event. Measures included cardiac symptomatology, healthcare utilization, the anxiety subscale of the Primary Care Evaluation of Mental Disorders , the phobic anxiety subscale of the Middlesex Hospital Questionnaire, and the Beck Depression Inventory. RESULTS: Over one third of participants with UA and MI experienced elevated anxiety at the time of the ischemic event, and these symptoms persisted for 1 year in 50% of anxious participants. Although participants with anxiety reported more atypical cardiac symptomatology, the prevalence of typical cardiac symptoms such as chest pain did not differ based on anxiety. After controlling for the severity of the coronary event, family income, sex, diabetes, and smoking, the following variables were significantly predictive of self-reported recurrent cardiac events at 6 months or 1 year: older age, family history of cardiovascular disease, greater depressive symptomatology at baseline, and anxiety at 6 months. Only 38% of anxious patients were asked about such symptoms, indicating underutilization of effective psychotherapeutic treatment. CONCLUSIONS: Over and above the effects of depressive symptomatology (among other confounding variables), nonphobic anxiety appears to have a negative effect on self-reported outcome following an ischemic coronary event. Anxiety symptomatology is underrecognized and undertreated, and examination of effects of treatment on secondary prevention must be pursued.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15479989&dopt=Abstract anxiety medicine




Different pathways mediated by CCK1 and CCK2 receptors: effect of intraperitonal mrna antisense oligodeoxynucleotides to cholecystokinin on anxiety-like and learning behaviors in rats.

Cohen H, Kaplan Z, Matar MA, Buriakovsky I, Bourin M, Kotler M.

Ministry of Health Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. hagitc bgumail.ac.il

Cholecystokinin (CCK) and its analogs generate anxiety in humans and measurable anxiety-like behaviors in rats. CCK receptor blockers have been reported to have variable effects in the treatment of anxiety disorders. In a prior study, intracerebroventricular administration of CCK-antisense oligodeoxynucleotides (ASODN) for 3 days significantly diminished anxiety-like behavior in rats. Counter to our expectations, intraperitoneal (i.p.) administration of CCK-ASODN significantly increased anxiety-like behavior and impaired retention performance in the Morris water maze. The aim of the present study was to manipulate CCK-mediated anxiety-like behavior and spatial memory in rats by peripheral (i.p.) administration of ASODN to preproCCK in the presence of antagonists to CCK1 and CCK2 receptor subtypes to further elucidate the roles of these two receptors and better understand the effects of i.p. CCK-ASODN. CCK-ASODN was injected i.p. to rats five times at 24-hr intervals with and without administration of CCK1R antagonist PD135158 or CCK2 antagonist benzotrip. Control groups received injections of either a scrambled oligodeoxynucleotide (ScrODN) or vehicle. On Day 6, the rats were assessed in the elevated plus maze paradigm and in the Morris water maze. The rats were sacrificed and their blood was assessed for corticosterone, ACTH, and prolactin levels. The results show that i.p. CCK-ASODN significantly increased anxiety-like behavior and impaired retention performance in the Morris water maze, compared to both control groups, accompanied by increased plasma corticosterone and plasma ACTH concentrations. In contrast, administration of CCK-ASODN together with CCK2R antagonist, but not with CCK1R antagonist, significantly decreased anxiety-like behavior in rats, but still impaired retention performance in the Morris water maze paradigm. Lower levels of plasma corticosterone and ACTH in CCK-ASODN+CCK2R antagonist-treated rats accompanied the reduced anxiety-like behavior. The present study showed an anxiolytic effect of i.p. CCK-ASODN in the presence of CCK2R, but not CCK1R.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15487014&dopt=Abstract anxiety medicine




Social anxiety and agoraphobia in the eating disorders: associations with eating attitudes and behaviours.

Hinrichsen H, Waller G, van Gerko K.

Department of Mental Health, St. George's Hospital Medical School, University of London, Cranmer Terrace, London SW17 0RE, UK. hendrik.hinrichsen gmx.net

BACKGROUND: While eating disorders have a high comorbidity with anxiety disorders, little is presently known about how anxiety links to eating attitudes and behaviours and other related characteristics of eating-disordered individuals. The present study aimed to determine whether social anxiety and agoraphobia in eating-disordered individuals are linked to different eating attitudes and behaviours and levels of ego functioning. METHOD: The participants were 70 women who met DSM-IV criteria for an eating disorder. The Eating Disorder Inventory (EDI) was used as a measure of eating attitudes and ego-functioning characteristics, while the Social Phobia and Anxiety Inventory (SPAI) was used as a measure of levels of social anxiety and agoraphobia. RESULTS: High scores on the eating attitude scales of the EDI were associated with higher levels of social anxiety in eating-disordered individuals. High scores on the ego-dysfunction scales of the EDI were associated with higher levels of social anxiety and agoraphobia. CONCLUSIONS: The present findings suggest that eating-related attitudes and behaviours are associated with high levels of social anxiety, while psychological characteristics not specifically related to eating are associated with anxiety more broadly. The results highlight the importance of identifying and addressing comorbid anxiety in eating-disordered individuals, and suggestions are made for the treatment of such cases. Implications for future research are also discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15488443&dopt=Abstract anxiety medicine