Anxiety and nighttime behavioral disturbances. Awakenings in patients with Alzheimer's disease.

McCurry SM, Gibbons LE, Logsdon RG, Teri L.

Department of Psychosocial and Community Health, University of Washington, Box 357263, Seattle, WA 98195-7263, USA.

This study was conducted to describe the relationship between anxiety and nighttime behavioral disturbance in a community-dwelling sample of patients with Alzheimer's disease (AD). Data from 153 patients with probable or possible AD and their family caregivers were analyzed using logistic regression modeling. Ratings of nighttime behavioral disturbance were based on caregiver reports of how often patients had awakened them at night during the past week. Standardized ratings for patient cognitive, functional, and behavioral status, and for caregiver sleep, depression, and burden were collected. Fifty-six percent of the patients with AD showed symptoms of anxiety, and 29% had awakened their caregiver at least once at night during the past week. Patient awakening was associated with higher levels of patient anxiety (odds ratio [OR] = 2.1; confidence Interval [CI] = 1.4, 2.9) and patient impairments in activities of daily living (OR = 1.6, CI = 1.2, 2.3). No other demographic, cognitive, functional, or behavioral variables were significant, including depression. In univariate analyses, individual patient anxiety symptoms (e.g., feeling anxious; showing physical signs of anxiety, agitation, and irritability) were significant risk factors for patient awakenings. Of these, showing physical signs of anxiety remained a significant risk factor in multivariate analyses. Results suggest that anxiety and nighttime awakening are highly interrelated in patients with moderate dementia due to AD, and treatments targeting both may be more efficacious than those focusing on anxiety or sleep alone. They also reveal the importance of assessing anxiety as well as depression in the research and clinical care of patients with AD.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14753054&dopt=Abstract anxiety medicine




Anxiety scores before and after prenatal testing for congenital anomalies.

Kowalcek I, Huber G, Lammers C, Brunk J, Bieniakiewicz I, Gembruch U.

Unit for Prenatal Medicine, Department of Obstetrics and Gynaecology, University of Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany. Kowalcek t-online-de

OBJECTIVE: Prenatal diagnosis has psychological effects on the pregnant woman. We studied the state of anxiety levels in 332 pregnant women presenting between the 12th and 20th week of gestation before and after prenatal examination with negative and positive prenatal findings. RESULTS: Prenatal examination produced a positive finding in 37 cases (11.1%). Both before and after prenatal examination pregnant women with a positive finding showed significantly higher anxiety-scales when compared to women with a negative result. After the examination state-anxiety levels were significantly reduced with a negative prenatal scan, whereas anxiety levels remained constant with a positive result. CONCLUSIONS:Prenatal testing for fetal anomalies presents an anxiety-inducing situation for the parents-to-be. If the results are negative, anxiety is reduced. Pregnant women who are confronted with a positive malformation scan show unchanged levels of anxiety after the examination.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12552321&dopt=Abstract anxiety medicine




Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders--findings from the Netherlands Mental Health Survey and Incidence Study.

de Graaf R, Bijl RV, Spijker J, Beekman AT, Vollebergh WA.

Monitoring and Epidemiology Department, Netherlands Institute of Mental Health and Addiction, P. O. Box 725, 3500 AS Utrecht, The Netherlands.

BACKGROUND: Little is known about the temporal sequencing of psychiatric disorders. The aim of this study was to obtain insight into patterns of co-occurrence of DSM-III-R mood disorders in relation to anxiety and substance use disorders, their temporal sequencing and the sociodemographic and long-term vulnerability predictors of this temporal sequencing. METHODS: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in a representative sample of 7,076 adults aged 18-64. RESULTS: Of those who had ever experienced a mood disorder, 46 % of males and 57 % of females had a history of anxiety disorders, and 43 % and 15 % of substance use disorders. Mood disorders were associated with all anxiety and substance use disorders, except with alcohol abuse among males. In the majority of anxiety-comorbid cases, the mood disorder arose after the anxiety disorder; the pattern for substance use-comorbid disorders was more variable. Deviation from the usual sequence of major depression and anxiety disorders was more often seen among females, subjects with a higher educational level, subjects who experienced childhood parental divorce, and subjects who experienced childhood emotional neglect. CONCLUSIONS: When comorbid with anxiety disorders, mood disorders clearly tend to be secondary. Few of the studied demographic factors, familial vulnerability factors and childhood life events predict the sequencing of mood disorders in relation to other disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12563553&dopt=Abstract anxiety medicine




Temperament in adolescents with anxiety and depressive disorders and in their families.

Masi G, Mucci M, Favilla L, Brovedani P, Millepiedi S, Perugi G.

Division of Child Neurology and Psychiatry, Scientific Institute of Child Neurology and Psychiatry, IRCCS Stella Maris, Via dei Giacinti 2 56018 Calambrone (Pisa), Italy. gabriele.masi inpe.unipi.it

Aim of this study was to investigate whether specific temperamental features were associated with anxiety and depressive disorders in adolescents, in their siblings and in their parents. Thirty adolescents with Anxiety disorders and 25 with both Anxiety and Depressive disorders were compared to 25 adolescents with learning disorders and to 28 normal subjects. Temperament in subjects and relatives was assessed by their parents with the EAS questionnaire. Subjects with Anxiety and Anxiety-Depression and their siblings showed higher scores on Emotionality and Shyness than Learning Disability and Normal subjects. Mothers and fathers of subjects from the Anxiety-Depression group had the highest Emotionality score. These findings suggest that both Emotionality and Shyness are prominent temperamental features in adolescents with anxiety with or without depression, and in their parents and siblings.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12564625&dopt=Abstract anxiety medicine




Interaction analysis of physician-patient communication: the influence of trait anxiety on communication and outcome.

Graugaard PK, Eide H, Finset A.

Department of Behavioral Sciences in Medicine, University of Oslo, PO Box 1111, Blindern, 0317 Oslo, Norway. p.k.graugaard basalmed.uio.no

Little attention has been paid to how patients' personality traits interfere with the communication and the outcome of physician-patient interaction. We performed an experimental study with students with high and low trait anxiety as patients. One physician conducted a single consultation with 41 students applying two beforehand-specified consultation styles. Patients completed questionnaires concerning emotional state and satisfaction. The actual content of the consultations was analyzed by Roter interaction analysis system (RIAS). The physician gave more biomedical information to low-anxiety students than high-anxiety students. Students who provided a lot of biomedical information themselves were less tense after the consultation. However, students with high anxiety were more dependent on the physician actively asking biomedical questions for them to be able to deliver that same information. In contrast to low-anxiety students, those with high anxiety were less satisfied after consultations involving many psychosocial questions posed by the physician and a good deal of emotional talk on their own part. Compared to low-anxiety students, students with high anxiety were less satisfied and tenser after consultations with much positive emotional talk on the part of the physician. We conclude that physicians and educators should be aware that psychological and emotional communication may be experienced as intrusive and inappropriate by patients with high trait anxiety when they present minor somatic problems. Copyright 2002 Elsevier Science Ireland Ltd.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12566209&dopt=Abstract anxiety medicine




Sex differences in anxiety, sensorimotor gating and expression of the alpha4 subunit of the GABAA receptor in the amygdala after progesterone withdrawal.

Gulinello M, Orman R, Smith SS.

Department of Physiology and Pharmacology, SUNY Downstate Medical Centre, Box 31, 450 Clarkson Ave, Brooklyn, NY 11203-2098, USA. maria.gulinello downstate.edu

In a progesterone withdrawal (PWD) model of premenstrual anxiety, we have previously demonstrated that increased hippocampal expression of the alpha4 subunit of the GABAA receptor (GABAA-R) is closely associated with higher anxiety levels in the elevated plus maze. However, several studies indicate that sex differences in regulation of the GABAA-R in specific brain regions may be an important factor in the observed gender differences in mood disorders. Thus, we investigated possible sex differences in GABAA-R subunit expression and anxiety during PWD. To this end, we utilized the acoustic startle response (ASR) to assess anxiety levels in male and female rats undergoing PWD as the ASR is also applicable to the assessment of human anxiety responses. We also investigated GABAA-R alpha4 subunit expression in the amygdala, as the amygdala directly regulates the primary startle circuit. Female rats exhibited a greater ASR during PWD than controls, indicating higher levels of anxiety and arousal. In contrast, male rats undergoing PWD did not demonstrate an increased ASR. The sex differences in the ASR were paralleled by sex differences in the expression of the GABAA-R alpha4 subunit in the amygdala such that alpha4 subunit expression was up-regulated in females during PWD whereas alpha4 levels in males undergoing PWD were not altered relative to controls. These findings might have implications regarding gender differences in human mood disorders and the aetiology of premenstrual anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12581182&dopt=Abstract anxiety medicine




Computer-related anxiety: examining the impact of technology-specific affect on the performance of a computerized neuropsychological assessment measure.

Browndyke JN, Albert AL, Malone W, Schatz P, Paul RH, Cohen RA, Tucker KA, Gouvier WD.

Department of Psychiatry Human Behavior, Miriam Hospital, Brown Medical School, Providence, Rhode Island 02903, USA.

This study was conducted to examine the effect of impairment status and computer-specific anxiety on the performance of a computerized neuropsychological assessment measure. Computer related anxiety was measured using a standardized self-report measure tapping anxiety specific to computers and technology. Outcome on this measure was compared with error scores and response timing variables on a computerized version of the Category Test (CT) in both normal individuals and individuals with neurological, psychiatric, or substance abuse histories. Multivariate analysis results, controlling for psychomotor performance, revealed significant main effects for group status and computer-related anxiety. CT performance was significantly related to the level of computer-related anxiety, in that high anxiety resulted in higher CT error scores and longer response times, and the negative impact of computer-related anxiety on computerized neuropsychological assessment performance was stronger in individuals with impairment histories. Our results suggest that as computer-related anxiety increases, performance on computer administered neuropsychological assessment measures tends to decrease. Key words: computers, anxiety, computer-based task performance, clinical neuropsychology, Category Test

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12584075&dopt=Abstract anxiety medicine




[Comparison study on child anxiety disorder with different family characteristics]

[Article in Chinese]

Wang JY, Zhu H, Zhou JF, He HX, Hong YP.

The Affiliated Children's Hospital, College of Medical Sciences, Zhejiang University, Hangzhou 310003, China.

OBJECTIVE: To investigate the relations between child anxiety disorder with different family characte ristics. METHODS Family characteristics were measured by family environment scale. 144 mothers of child with anxiety disorder and 100 mothers of health children were invited to fill out questionnaires. RESULTS There were obviously different family characteristics between health children and those with anxiety disorder except phobic anxiety disorder. The scores of cohesion, independence, achievement orientation and active recreational orientation in children with anxiety disorder were significantly lower than those in health children P<0.01). In 4 groups of children with anxiety disorder cohesion showed correlation with intellectual- cultural orientation r=0.9219, 0.8348, 0.8935, 0.9550 respectively, P<0.001). CONCLUSION: The importance of family characteristics must be emphasized for children with anxiety disorder.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12601890&dopt=Abstract anxiety medicine




Depression and anxiety disorders associated with headache frequency. The Nord-Trondelag Health Study.

Zwart JA, Dyb G, Hagen K, Odegard KJ, Dahl AA, Bovim G, Stovner LJ.

Department of Clinical Neuroscience, Section of Neurology, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. john-anker.zwart medisin.ntnu.no

The aim of this large cross-sectional population-based study was to examine the association between migraine, non-migrainous headache and headache frequency with depression, and anxiety disorders. From 1995 to 1997, all 92 566 inhabitants aged 20 years and above in Nord-Trondelag County in Norway were invited to participate in the Nord-Trondelag Health Study ('Helseundersokelsen i Nord-Trondelag' = HUNT-2). A total of 64 560 participated, whereof 51 383 subjects (80%) completed a headache questionnaire that was included. Of these 51 383 individuals, 47 257 (92%) completed the depression subscale items and 43 478 (85%), the anxiety subscale items of the Hospital Anxiety and Depression Scale (HADS). Associations were assessed in multivariate analyses, estimating prevalence odds ratios (OR) with 95% confidence intervals (CI). Depression and anxiety disorders as measured by HADS, were significantly associated with migraine (OR = 2.7, 95% CI 2.3-3.2; OR = 3.2, 95% CI 2.8-3.6) and non-migrainous headache (OR = 2.2, 95% CI 2.0-2.5; OR = 2.7, 95% CI 2.4-3.0) when compared with headache-free individuals. The association was stronger for anxiety disorders than for depression. The ORs for depression and anxiety disorders amongst both migraine and non-migrainous sufferers increased with increasing headache frequency. Depression and anxiety disorders are associated with both migraine and non-migrainous headache, and this association seems more dependent on headache frequency than diagnostic category.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12603289&dopt=Abstract anxiety medicine