Antianxiety Medications Research Articles

A real-world assessment of healthcare costs associated with agitation in Alzheimer’s dementia

Aims To describe and compare clinical characteristics, healthcare costs, and institutionalization/mortality outcomes among patients with and without agitation associated with Alzheimer’s dementia (AAD). Methods Data from the Reliant Medical Group database (01/01/2016-03/31/2020) were used, including claims, electronic medical records, and clinical information/physician notes abstracted from medical charts. Patients aged ≥55 years with Alzheimer’s dementia (AD) were observed during a randomly selected 12-month study period after AD diagnosis. Using information recorded in medical charts, patients were classified into cohorts based on experiencing (agitation cohort) and not experiencing (no agitation cohort) agitated behaviours during the study period. Entropy balancing was used to create reweighted cohorts with similar characteristics. Study outcomes (patient demographic and clinical characteristics, treatments received, healthcare costs, institutionalization and death events) were compared between cohorts; agitation characteristics were described for the agitation cohort only. Results Among 711 patients included in the study, 240 were classified in the agitation cohort and 471 in the no agitation cohort. After reweighting, several comorbidities were more frequently observed in the agitation versus no agitation cohort, including infection, depression, and altered mental status. Use of antidepressants, anticonvulsants, antipsychotics, and antianxiety medications was more common in the agitation versus no agitation cohort. Common agitated behaviours included hitting (20.8%), pacing/aimless wandering (17.5%), and cursing/verbal aggression (15.0%). Total all-cause healthcare costs were $4287 per-patient-per-year higher in the agitation cohort versus no agitation cohort (p = 0.04), driven by higher inpatient costs. Death was more common and time to death and institutionalization were shorter in the agitation versus no agitation cohort. Limitations Results may not be generalizable to the US population with AD. Conclusions Among patients with AD, agitation was associated with shorter time to death/institutionalization and increased comorbidities, medication use, and healthcare costs, highlighting the additional clinical and economic burden that agitation poses to patients and the healthcare system.

A review of the prescribing culture of anti-depressants across government districts in Northern Ireland

Introduction: The COVID-19 pandemic has caused a significant increase in mental health issues which general practitioners are now witnessing and managing in communities across Northern Ireland. Unfortunately, this new tsunami of patients with mental health issues has put tremendous strain on our already overburdened health system. As a result, Northern Ireland currently holds the unenviable record for prescribing more anti-anxiety and anti-depressant medication than any other country in the world.Methods: Data was obtained from the Northern Ireland Statistics and Research Agency (NISRA), Family Practitioner Services, General Pharmaceutical Services, Annual Statistics 2020/2021 (published June 2021) and 2021/2022 (published June 2022). Data was analysed by age, gender, district, and socioeconomic class on prescription medication [according to the British National Formulary (BNF)].Results: From 2020/2021 to 2021/2022, the prescribing culture for anti-anxiety and/or anti-depressant medication in Northern Ireland did not abate (24% vs. 14%, female to male, respectively). The postcode and index of multiple deprivation (IMD) was analysed and a mean IMD for each constituency was taken as an estimate of the overall IMD to establish if money spent per patient was related to the IMD in each constituency. North Down, South Antrim, and East Antrim were least deprived, as indicated by their high IMD. Whereas, Foyle, and Belfast West were most deprived (low IMD). The cost of mood and anxiety medication per patient was compared against constituency; patients in Belfast West and Belfast North, followed by Foyle, had the highest costs per patient, and the lowest IMD (most deprived).Conclusion: This review concludes that there has been no change in the prescribing culture for anti-anxiety or anti-depressants across Northern Ireland (2020–2022). The cost of mood and anxiety medication per patient did not correlate with the index of multiple deprivation (IMD). Areas of low IMD trended to have higher spend. Is it now time to review the prescribing culture in Northern Ireland and offer greater support to our GPs to initiate a program of deprescribing and manage the wellbeing of our citizens?

PSYCHOTROPIC MEDICATION USE AND CHANGES DURING THE HOSPITAL STAY

Abstract The purpose of this study was to build on prior research and describe the current use of psychotropic medications among the first 365 older hospitalized patients living with dementia participating in a study focused on optimizing physical activity [The Function Focused Care for Acute Care Using the Evidence Integration Triangle Study (FFC-AC-EIT)] and consider the impact of current recommendations for decreasing use of psychotropics. It was hypothesized that controlling for age, gender, race, comorbidities, cognition, and hospital site (exposure or not to the Function Focused Care Intervention), that there would be a decrease in use of psychotropic medications from admission to discharge. Age, gender, race, comorbidities, admitting diagnosis, and medications (antidepressants, antianxiety medications, anticonvulsants, dementia drugs, antipsychotics, sedative-hypnotics, and opioids) were obtained at baseline and medications were obtained as well at discharge. To compare change over time generalized estimating equations were used. The participants were mostly female (63%), White (69%), and 83.06 years (SD=7.90) old. There was no treatment effect. Antidepressant, antianxiety, anticonvulsant, dementia medication, sedative hypnotic and opioid use remained unchanged. Antipsychotic medication use increased significantly from 16% to 21% at discharge. Some changes were made across drug groups such as change from haloperidol to second generation antipsychotics to decrease risk of side effects. A more focused deprescribing intervention is needed to best address psychotropic medication use among individuals living with dementia when hospitalized.

Chronic dizziness: modern treatment methods taking into account comorbidity

In most cases, chronic dizziness is persistent postural perceptual dizziness (PPPD), which is often combined with other diseases of the vestibular system and anxiety disorders. In real-life clinical practice, PPPD and comorbid disorders are rarely diagnosed and effective treatments are rarely prescribed, so the development of modern methods for managing patients with PPPD with comorbid diseases is important.Objective: to analyze the typical management practices and evaluate the effectiveness of complex therapy in patients with PPPD and comorbid disorders.Material and methods. We examined 60 patients (mean age – 42.5±13.8 years) with diagnosis of PPPD (according to the diagnostic criteria of the Barany Society) and comorbid diseases. All patients were examined twice: at the beginning and after completion of treatment, which lasted an average of 1 month. Treatment included antidepressants (serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors), anti-anxiety medications, vestibular exercises, an educational program, and cognitive behavioral therapy. Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. After one month of treatment in patients with PPPD and comorbid conditions, the severity of dizziness according to DHI decreased from 45.59±15.47 to 29.9±12.56 points (p<0.001), the severity of anxiety according to BAI from 27.50±6.38 to 15.66±4.07 points (p<0.001), the severity of depression according to BDI from 11.91±6.24 to 7.06±4.12 points (p<0.001), the severity of anxiety according to HADS from 13.47±4.16 to 8.60±2.86 points (p<0.001), the severity of depression according to HADS from 6.34±3.72 to 4.31±2.82 points (p<0.001), situational anxiety according to STAI from 50.69±7.13 to 41.26±6.24 points (p<0.001), personal anxiety according to STAI from 54.66±8.21 to 43.78±6.75 points (p<0.001).Conclusion. It was found that PPPD is rarely diagnosed, and anxiety disorders, migraine and peripheral vestibular disorders are very common in PPPD patients. The integrated approach in the treatment of patients with PPPG, taking into account concomitant disorders, has demonstrated high efficacy.

Generalized Anxiety Disorder Associated With Gastroesophageal Reflux Disease Among the Saudi Population.

Objectives In Saudi Arabia, the prevalence of generalized anxiety disorder (GAD) was reported to be 29%. As a result, our goal was to examine the association between GAD and gastroesophageal reflux disease (GERD) within the general Saudi Arabian population, as well as to access the risk factors for GAD in order to gain a better understanding. Method This cross-sectional study involved 4,224 participants who completed a questionnaire. Anxiety was assessed using the General Anxiety Disorder-7 (GAD-7) scale, and the GerdQ tool was used to evaluate GERD. Result The prevalence of anxiety among participants was 29% at cutoff 10, with 73% of anxiety-positive participants being female and only 26.9% being male. Furthermore, the associations between anxiety and GERD were significant as 31.4% of participants with anxiety had GERD, compared to 15.0% of those without anxiety. Conclusion In our finding, there was a significant association between anxiety and GERD among the general Saudi population. In terms of anxiety risk factors, female, younger age, social status, body mass index, eating fried food, caffeinated drinks, diabetes miletus, high blood cholesterol, NSAID use, antidepressants, and anti-anxiety medication were found to have a significant association.

Review of psychopharmacology

In India, one of the primary causes of non-fatal disease burden is psychopharmacological diseases. The prevalence of psychopharmacological disorders in India was one in seven. Despite being used to treat psychological disorders like anxiety, psychosis, depression, and mania, psychopharmacological medications can have unwanted side effects, including tardive dyskinesia, weight gain, weight loss, muscle cramps, dysphoria, gastrointestinal upset, eye problems, and issues with blood tests. We exposed numerous screening techniques for assessing psychopharmacological diseases such anxiety, depression, psychosis, and mania in the context of preclinical investigations in this study. These techniques are highly helpful for assessing psychopharmacological medications such as anti-anxiety, anti-psychotic, anti-depressant, and anti-manic medications.

Lorazepam Detection with Urine Benzodiazepines Screening Tests: Not all Tests are Created Equal

Abstract Lorazepam belongs to the benzodiazepines family of drugs and is one of the commonly used anti-anxiety medications in the US. In clinical practice, immunoassay screening tests are used to monitor compliance, detect abuse and in cases of drug overdose. Many clinicians rely on benzodiazepine immunoassay screening tests to detect lorazepam due to the test availability on automated clinical analyzers, short turnaround time and cost efficiency. However, compromised test sensitivity often leads to erroneous results. In this study, we used mass spectrometry to establish the lorazepam cross-reactivity threshold in two commonly used benzodiazepine screening tests: the Abbott ARCHITECT cSystem 16000 and NexScreen Drug Screen Cup. Methods: Mass spectrometry testing was performed at a major reference laboratory. Lorazepam-positive patient urine at concentrations of 320 ng/mL and 4,895 ng/mL were tested concurrently by two immunoassay methods. The Abbott ARCHITECT is a semi-quantitative assay with a positivity cut-off of 200 ng/mL. According to the manufacturer’s instructions for use (IFUs), the cross-reactivity threshold of the test is equivalent to a lorazepam concentration of 650 ng/mL. The NexScreen Drug Screen Cup is a lateral flow immunoassay used as a point-of-care (POC) test. The positivity cut-off of this test is 300 ng/mL; per IFUs, the cross-reactivity threshold of this test to lorazepam is 3,900 ng/mL, and 5,000 ng/mL for lorazepam-glucuronide, a drug metabolite. To determine the test sensitivity of the NexScreen test, patient specimen (4,895 ng/mL) was diluted at 1:5, 1:10, 1:20, 1:50, and 1:100, targeting the lorazepam concentrations of 979, 490, 245, 98 and 49 ng/mL respectively. To determine the sensitivity of the immunoassays to the parent molecule vs the metabolite, pre-screened negative urine was spiked with lorazepam or lorazepam-glucuronide at a concentration of 650 ng/mL, 5000 ng/mL, and 10000 ng/mL. Results: Abbott ARCHITECT failed to detect lorazepam in both patients, while the NexScreen resulted in positive benzodiazepine screen results for both patient specimens. All lorazepam-spiked specimens tested positive on both methods. However, all lorazepam glucuronide-spiked specimens tested negative on Abbott ARCHITECT and positive on NexScreen cup. The highest dilution detected by NexScreen was 1: 20, equivalent to approximately 245 ng/mL of lorazepam. Conclusion: Our findings suggest that the ARCHITECT benzodiazepine assay should not be used to screen patients on lorazepam, given its inability to detect the major metabolite, lorazepam glucuronide. Whenever available, a mass spectrometry method is always preferred. The results of our study demonstrated that in a specific patient population, where the likelihood of positive lorazepam test is high, the NexScreen cup is a viable, cost-effective alternative due to its excellent sensitivity.

Measuring the impact of therapy on medication use: data-linkage study.

The psychological therapies service (PTS) in the Northern Health and Social Care Trust, in Northern Ireland, provides therapies to adults with moderate or severe mental health difficulties. Psychometric outcomes data are routinely collected to assess if a patient demonstrates significant improvement in their main presenting problem area following therapy. The wider impact of therapy is not fully measured in the outcomes database as this would be disproportionately burdensome for both patient and therapist. The present study, to our knowledge, is the first to use data linkage to link patient therapy outcomes data with prescriptions data. To widen our understanding of patient medication use before and after therapy. Using Health and Care Number as a unique identifier, the Psychological Therapies Service - Routine Outcome Measurement Database (n = 3625) and data from 72 500 controls were linked with data from the Enhanced Prescribing Database (EPD). The EPD data were sourced from the Honest Broker Service. Key findings from the study were: (a) the odds of PTS clients using antipsychotics in the year before therapy were 25 times greater compared with controls (odds ratio (OR) = 24.53, 95% CI 20.16-29.84); (b) in the 1st year post discharge, PTS clients who clinically improved post therapy discharge were more likely than 'non-engagers' and 'non-improvers' to come off antianxiety medication (OR = 0.61, 95%, CI 0.38-0.98); and (c) therapy did not have an impact on antidepressant use. The results highlight the need for discussion between therapy services, GPs and psychiatry about whether more engagement and collaboration is needed to plan phased reduction in medication.

Anxiety severity and prescription medication utilization in first-time medical marijuana users

BackgroundAnxiety and post-traumatic stress disorder (PTSD) are qualifying psychiatric conditions for medical marijuana (MM) treatment in Pennsylvania. This study examined baseline prevalence and changes in prescription anxiety medication use three months following MM treatment initiation among individuals with these qualifying conditions. MethodsThe study sample was comprised of 108 adults with anxiety or PTSD as a referring condition; they were enrolled in a longitudinal study evaluating biopsychosocial outcomes in new MM patients. Consenting participants completed an assessment battery at baseline and Month 3 (n = 94, 87 % follow-up rate) that included a measure of anxiety severity and questions about current anxiety medication prescription and desired (baseline) and actual (Month 3) reductions in medication use. ResultsFindings indicated that 59 % of participants reported prescription medications for anxiety, with 70 % reporting at least a moderate desire to reduce medication use. Overall and within the medication sub-sample, participants displayed significant reductions in anxiety severity from baseline to Month 3 (p’s <0.0001). Furthermore, 32 % reported actual reductions in medication use at Month 3, and reductions were more likely among patients prescribed benzodiazepines than other drug classes. ConclusionsResults suggest that a significant number of MM patients with anxiety and/or PTSD diagnoses are currently being prescribed antianxiety medications and that MM may help to reduce their use of these medications. LimitationsLimitations include the observational study design and the lack of a PTSD-specific measure. More controlled longitudinal studies are necessary to better understand the role of MM in the treatment of anxiety and PTSD.

Intervention effect of community humanistic management combined with psychological education on community anxiety disorder patients

BackgroundAnxiety disorder, also known as anxiety neurosis, is a neurological disorder caused by anxiety, such as fear, insomnia, and anxiety. This study explores the intervention and management effects of community humanistic management combined with psychological education on patients with depression and anxiety disorder.Subjects and MethodsBased on 84 patients with anxiety disorder, there were 42 males and 42 females, and both groups of patients took the same anti-anxiety medication. The control group of patients received psychological education intervention. Two groups of patients were scored using the Self-Rating Anxiety Scale before and after intervention. The Self-Rating Anxiety Scale includes 20 items, and the symptom situation was evaluated using a 4-level scoring method. The higher the score, the more severe the anxiety situation. The results were tested using SPSS24.0 statistical software.ResultsThe difference in results was statistically significant (P&lt;0.05). The scores of the two groups of patients before and after intervention were significantly lower than those before the intervention, and the scores of the observation group after intervention were significantly better than those of the control group. The difference between the two groups was statistically significant. A comparison of trust and satisfaction in nursing between the two groups of patients showed that the intervention group had significantly higher trust and satisfaction in nursing quality than the control group.ConclusionsBy combining community humanistic management with psychological education, experience, and reference are provided for the innovation of management models for social anxiety disorder patients. Community psychological intervention has improved the depression and anxiety symptoms of anxiety disorder patients and improved their quality of life.

The role of community services in the treatment of anxiety disorders: a study on residents under psychology

BackgroundAnxiety disorder is a common psychological disorder that seriously affects the quality of life and social function of patients. In addition to medication treatment, community service innovation provides more direct and convenient treatment pathways for patients by providing professional mental health support and resources within the community.Subjects and MethodsThe study focused on a population aged 18 to 70 within a community. Using EEG and Self Rating Anxiety Scale (SAS) tests, 30 individuals were diagnosed with anxiety disorders. These participants were evenly divided into two groups: the experimental group and the control group. The experimental group received anti-anxiety medication treatment alone, while the control group received regular psychological counseling at the community service center in addition to medication. After six months of treatment, the two groups were statistically analyzed for treatment effectiveness using electroencephalogram examination and the SAS test. SPSS23.0 was used for data analysis.ResultsIn the experimental group, 5 patients recovered, 4 patients made significant progress, and 6 patients did not recover. In the control group, 9 people recovered, 6 people made significant progress, and 1 person did not recover. There was a statistically significant difference between the experimental group and the control group, P&lt;0.05.ConclusionsThrough community mental health centers, patients can receive more direct and convenient treatment pathways and mental support, which is of great significance in the treatment of anxiety disorders.

The Physiological Effects of ASMR on Anxiety

Purpose: Autonomous Sensory Meridian Response is a novel phenomenon that is very popular these days on Youtube and Reddit to its anti-anxiety effects. As the name suggests, ASMR is a relaxing warm sensation that begins on the scalp and spreads throughout the body. This technique is also known as "brain massage," and it relies on soothing sights and sounds, like whispers and slow movements. Investigating these videos is primarily motivated by the desire to determine their scientific origins, which can be derived from a variety of approaches.&#x0D; Materials and Methods: In this paper, we intended to examine the physiological changes such as Heart Rate (HR) as well as Galvanic Skin Conductance (GSC) levels before and after watching a single session ASMR video.&#x0D; Results: The dependent t-test statistical analysis by SPSS results with P-value &lt;=0.01 indicated that after a single session of ASMR watching, the heart rate decreased significantly comparing the baseline data. In addition, the skin conductance was slightly reduced as well, but not significantly.&#x0D; Conclusion: These physiological findings prove that ASMR could be an affordable, portable, and immediate anxiety relief for those struggling with anxiety-based disorders, especially for patients who do not respond well to medication or seek alternatives to anti-anxiety medications due to the wide range of side effects or would like to try it for better results along with the prescribed drugs.

Opioids for acute and chronic pain when receiving psychiatric medications.

People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012-2019) for adults aged 21-64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50-64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.

Escitalopram Personalized Dosing: A Population Pharmacokinetics Repository Method.

Escitalopram (SCIT) represents a first-line antidepressant and antianxiety medication. Pharmacokinetic studies of SCIT have demonstrated considerable interindividual variability, emphasizing the need for personalized dosing. Accordingly, we aimed to create a repository of parametric population pharmacokinetic (PPK) models of SCIT to facilitate model-informed precision dosing. In November 2022, we searched PubMed, Embase, and Web of Science for published PPK models and identified eight models. All the structural models reported in the literature were either one- or two-compartment models. In order to investigate the variances in model performance, the parameters of all PPK models were derived from the literature published. A representative virtual population, characterized by an age of 30, a body weight of 70 kg, and a BMI of 23 kg/m2, was generated for the purpose of replicating these models. To accomplish this, the rxode2 package in the R programming language was employed. Subsequently, we compared simulated concentration-time profiles and evaluated the impact of covariates on clearance. The most significant covariates were CYP2C19 phenotype, weight, and age, indicating that dosing regimens should be tailored accordingly. Additionally, among Chinese psychiatric patients, SCIT showed nearly double the exposure compared to other populations, specifically when considering the same CYP2C19 population restriction, which is a knowledge gap that needs further investigation. Furthermore, this repository of parametric PPK models for SCIT has a wide range of potential applications, like design miss or delay dose remedy strategies and external PPK model validation.

Chronic administration of a norepinephrine antagonist prevents and partially reverses escalation of cocaine self-administration.

Anxiety is a critical component of the development and maintenance of drug addiction; however, anti-anxiety medications such as benzodiazepines and beta-blockers (β-adrenergic receptor antagonists) are not used for the treatment of substance use disorder, except for the management of acute withdrawal syndrome. Preclinical studies have shown that beta-blockers may reduce stress-induced relapse; however, the effect of beta blockers on the escalation and maintenance of drug intake has not been tested. To address this issue, we chronically administered the β-adrenergic receptor antagonist propranolol during the escalation or maintenance of cocaine intake in a model of extended access (6h) to cocaine self-administration (0.5mg/kg). The behavioural specificity of propranolol was tested using a non-drug reward (saccharin). Daily administration of propranolol (15 mg/kg) prevented the development of escalation of cocaine self-administration and partially reversed self-administration after the establishment of escalation of intake. Moreover, propranolol dose-dependently decreased the motivation for cocaine tested under a progressive ratio schedule of reinforcement during the development of escalation and after maintenance. Finally, propranolol administration had no effect on the escalation and maintenance of saccharin self-administration. These results demonstrate that chronic treatment with propranolol provides therapeutic efficacy in reducing cocaine self-administration during the development and after the establishment of escalation of cocaine self-administration in an animal model relevant to cocaine use disorder. These results suggest that beta blockers should be further investigated as a target for medication development for the treatment of cocaine use disorder.

Reproductive experience alters the effects of diazepam and fluoxetine on anxiety-like behaviour, fear extinction, and corticosterone levels in female rats

OverviewReproductive experience (pregnancy and motherhood) leads to long-term changes in the neurobiological and hormonal features of anxiety in rats and humans. The aim of this study was to examine whether reproductive experience alters the effects of two pharmacological treatments for anxiety, a benzodiazepine (diazepam) and a selective serotonin reuptake inhibitor (fluoxetine), on animal models of anxiety.MethodsIn Experiment 1, virgin (n = 47) and age-matched mother (n = 50) rats at 1-month post-weaning were injected with diazepam (1.3 mg/kg or 1.7 mg/kg, i.p.) or vehicle, in the proestrus (high estradiol/progesterone/allopregnanolone) or metestrus (low estradiol/progesterone/allopregnanolone) phase of the estrous cycle 30 min prior to the elevated plus maze (EPM). In Experiment 2, virgin (n = 25) and mother rats (n = 20) were administered fluoxetine (10 mg/kg) or vehicle for 2 weeks prior to being tested on a Pavlovian fear conditioning and extinction protocol, and the EPM.ResultsReplicating past research, in virgin rats, the low dose of diazepam produced anxiolytic-like effects in proestrus, but only the high dose was anxiolytic-like in metestrus. In contrast, in mother rats, both doses of diazepam were anxiolytic-like irrespective of estrous phase. Fluoxetine produced anxiogenic-like effects in virgin rats during fear extinction and the EPM, but had no behavioural effects in mothers. In contrast, fluoxetine increased plasma corticosterone levels measured 30-min post-EPM in mothers, but not virgin rats.ConclusionsReproductive experience alters the dose responsivity and efficacy of common anti-anxiety medications in female rats. These findings highlight the importance of considering reproductive status in studies on anxiety and its treatment.

Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study.

The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.

Polypharma Fiction

Abstract This article examines how the rise of polypharmacy changes the novel genre’s response to the pain of anxiety and its narrative interest. Necessarily focusing its scope while also registering the fluidity, complexity, and exigency of contemporary psychopharmacological experience, it focuses specifically on how anti-anxiety and anti-depressant medications are activating an ongoing reassessment among contemporary novelists of ingrained assumptions regarding the centrality of mental suffering to aesthetics. The books I discuss as “polypharma fictions”—by Sheila Heti, Ottessa Moshfegh, and Anelise Chen—each challenge the idea of psychic pain as a precondition of narrative development—whether the pain of existential anxiety (Heti), capitalist aspiration (Moshfegh), or willful determination (Chen). Moving beyond the extremes of alarmism and advocacy that have largely structured scholarly responses to the rise of psychotropics, I attend to the formal significance of psychotropics for narrative temporality, tension, and plot. In this more recent fiction, the question is not whether psychotropics presage the end of the novel genre but, rather, what kind of novel it is that incorporates psychopharmaceuticals and, yet . . . goes on.

Survey of physicians' and patients' understanding, perceptions, and attitudes toward depressive state in atrial fibrillation.

Atrial fibrillation (AF) is the most common sustained arrhythmia among older people and has a significant impact on quality of life. However, it is not always perceived as a serious mental health risk. This study investigated the understanding, perceptions, and attitudes toward the risk of depressive state associated with older patients with AF. We conducted a quantitative survey in April-June 2021 among patients with AF aged ≥65 years (n = 156), and physicians or cardiologists attending at least 10 older patients with AF annually (n = 158). In total, 45% of patients considered AF a cause of a depressive state. In contrast, 16% of physicians reported that they considered AF a cause of a depressive state. Fifty-two percent of the patients had experienced a depressive state. Of these, 98% expressed that a depressive state lowered their quality of life. Two of the three patients reported that they would consult their physicians if they felt depressed. By contrast, 30% of physicians responded that even if they perceived their patients as depressed, they prescribe anti-anxiety medication but do not refer the patient to psychiatrists. Of the physicians, 50% stated that they did not regard the association of AF and depressive state as serious, although both physicians and patients understood that negative anxiety, such as fear of AF attacks, strokes, or heart failure, was the most important contributor to a depressive state. Establishing mental healthcare involving physicians together with psychiatrists is necessary to improve the mental and physical health outcomes for older patients with AF. Geriatr Gerontol Int 2023; 23: 543-548.

Evaluation of different methods of environmental enrichment to control anxiety in dogs undergoing hemilaminectomy after acute intervertebral disc extrusion: a randomized double-blinded study.

The goal of this randomized, double-blinded, placebo-controlled study was to evaluate the effect of environmental enrichment (EE) on post-operative pain and anxiety in dogs following hemilaminectomy for acute intervertebral disc extrusion (IVDE). Twenty healthy client-owned dogs undergoing a hemilaminectomy for IVDE with the same immediate post-operative analgesia protocol were randomly assigned to either the EE or standard environment (SE) group post-operatively. Recovery was achieved in an intensive care room (SE) or a separate quiet room (EE) equipped with white noise and classical music. EE dogs were also exposed to dog-appeasing pheromones, essential oil scents, and positive human interactions and were provided meals through food toys. A blinded evaluator assessed all dogs using the modified Glasgow Composite Pain Scale (mGCPS) on presentation and at several time points post-operatively. A rescue injection of the opioid methadone was given to the dogs with an mGCPS score of ≥5/20. Dogs received the antidepressant trazodone when anxious behaviors (5 mg/kg) were observed. The mGCPS scores, the latencies to receive the first methadone and trazodone doses and to eat the first meal, the number of methadone and trazodone doses, and the number of meals ingested in the first 24 and 48 h post-surgery were compared using Wilcoxon tests, and Benjamini-Hochberg correction for false discovery rate was applied. Although median mGCPS scores did not differ between the groups, compared to SE dogs (n = 10), EE dogs (n = 6) received trazodone earlier (p = 0.019), were administered fewer methadone injections at 24 h (p = 0.043), and ate more at 48 h post-surgery (p = 0.007). Therefore, EE and anti-anxiety medications could be beneficial in improving the wellbeing of dogs post-operatively.