Individual Anxiety Disorders Research Articles

Silexan in anxiety, depression, and related disorders: pharmacological background and clinical data.

We present a narrative review of clinical trials investigating the anxiolytic and antidepressant effects of silexan, an active substance derived from lavender oil and summarize nonclinical findings from pharmacological studies supporting its therapeutic use. Six studies investigated the efficacy of the lavender oil in patients with subthreshold and generalized anxiety disorders as well as in mixed anxiety and depressive disorder (MADD). Furthermore, we present data indicating that silexan may influence sleep quality as well as anxiety or depressive disorders in individuals with post-COVID-19. Silexan taken orally at a daily dose of 80mg for 10 weeks was significantly superior to placebo in reducing psychic and somatic symptoms of anxiety and was as effective as 0.5mg/d lorazepam and 20mg/d paroxetine. In patients with mild or moderate major depression, silexan was superior to placebo and comparably effective to 50mg/d sertraline. Significant antidepressant effects were also observed in MADD and depression co-morbid with anxiety. The herbal product had a beneficial effect on activities of daily living and health-related quality of life. Adverse events associated with silexan in clinical trials were limited to eructation and mild, transient gastrointestinal complaints. The herbal product was not associated with drug interactions, sedation, sleep disturbance, dependence and abuse potential, sexual dysfunction, weight gain or withdrawal symptoms. Silexan was therefore safe and effective in subthreshold and syndromal anxiety disorders and in major depression.

The burden of brooding on neural error processing: The role of repetitive negative thinking in major depressive disorder with and without comorbid anxiety disorders

BackgroundRepetitive negative thinking (RNT), particularly its brooding aspect, is a prominent feature in Major Depressive Disorder (MDD) with and without comorbid anxiety. Error processing, an adaptive cognitive operation, seems to be impaired in individuals with exaggerated RNT. This study measured a post-error neural response, error-related negativity (ERN), during an inhibitory task to examine the mechanism underlying the relationship between RNT and faulty error processing. MethodsWe examined current MDD patients with (n = 61) and without comorbid anxiety disorders (COM; n = 38), propensity-matched into High- or Low-RNT groups according to Ruminative Response Scale Brooding subscale scores. Using 32-channel electroencephalography (EEG) during a stop-signal task, we measured baseline-corrected ERN amplitude at FCz 0–100 ms after an incorrect response. A between-subjects ANOVA was conducted with group (High RNT, Low RNT) and comorbidity (MDD, COM) as factors. ResultsA significant group-by-comorbidity interaction (η2 = 0.07) was found, with MDD participants exhibiting high RNT revealing smaller (more positive) ERN amplitudes compared to their COM counterparts with high RNT (d = 0.77) and MDD participants with low RNT (d = 0.92). ConclusionsNon-anxious individuals with MDD and high RNT showed blunted post-error neural responses, potentially indicating a diminished adaptive neural mechanism for recognizing and correcting errors. However, the presence of comorbid anxiety disorders in individuals with high RNT appears to counteract this reduction, potentially through an enhanced neural response to errors, thereby maintaining a higher level of error-processing activity. Further understanding of these relationships is essential for developing targeted interventions for MDD, with particular focus on the detrimental impact of brooding RNT.

Socioeconomic status, individual behaviors and risk of anxiety disorders: A Mendelian randomization study

BackgroundThe association between socioeconomic status and individual behaviors (SES/IB) and anxiety disorders has garnered increasing attention, yet the impact of SES/IB on anxiety disorders remains unclear. Therefore, we employed a Mendelian randomization (MR) design to evaluate the causal relationship between SES/IB and anxiety disorders. MethodsWe conducted a two-sample MR study to assess the causal effects of SES and IB (smoking behaviors, drinking behaviors, sleeping behaviors, habitual physical activity, leisure sedentary behaviors, and reproductive behaviors) on anxiety disorders. A series of filtering steps were taken to select eligible genetic instruments robustly associated with each of the traits. The inverse variance weighted was used for preliminary analysis, and multiple methods were used for sensitivity testing. ResultsAfter Bonferroni correction and rigorous quality control, we found that educational attainment (odds ratio [OR]:0.75; 95 % confidence interval [CI]:0.69–0.81; P = 9.21E-12), alcohol consumption per week (OR: 1.62; 95 % CI: 1.33–1.97; P = 1.80E-06), insomnia (OR: 1.68; 95 % CI: 1.43–1.97; P = 1.45E-10),age at first birth (OR: 0.59; 95 % CI: 0.50–0.68; P = 1.31E-11),and number of sexual partners (OR: 2.19; 95 % CI: 1.71–2.80; P = 6.64E-10) were causally associated with anxiety disorders. LimitationsThe subjects included in this study were all of European descent, and whether this finding can be generalized to other populations needs to be further demonstrated. ConclusionsThe MR Study provides strong evidence that some factors influence anxiety disorders.

Elevated GABAergic neurotransmission prevents chronic intermittent ethanol induced hyperexcitability of intrinsic and extrinsic inputs to the ventral subiculum of female rats

With the recent rise in the rate of alcohol use disorder (AUD) in women, the historical gap between men and women living with this condition is narrowing. While there are many commonalities in how men and women are impacted by AUD, an accumulating body of evidence is revealing sex-dependent adaptations that may require distinct therapeutic approaches. Preclinical rodent studies are beginning to shed light on sex differences in the effects of chronic alcohol exposure on synaptic activity in a number of brain regions. Prior studies from our laboratory revealed that, while withdrawal from chronic intermittent ethanol (CIE), a commonly used model of AUD, increased excitability in the ventral hippocampus (vHC) of male rats, this same treatment had the opposite effect in females. A follow-up study not only expanded on the synaptic mechanisms of these findings in male rats, but also established a CIE-dependent increase in the excitatory-inhibitory (E-I) balance of a glutamatergic projection from the basolateral amygdala to vHC (BLA-vHC). This pathway modulates anxiety-like behavior and could help explain the comorbid occurrence of anxiety disorders in individuals suffering from AUD. The present study sought to conduct a similar analysis of CIE effects on both synaptic mechanisms in the vHC and adaptations in the BLA-vHC pathway of female rats. Our findings indicate that CIE increases the strength of inhibitory neurotransmission in the vHC and that this sex-specific adaptation blocks, or at least delays, the increases in intrinsic vHC excitability and BLA-vHC synaptic transmission observed in males. Our findings establish the BLA-vHC pathway and the vHC as important circuitry to consider for future studies directed at identifying sex-dependent therapeutic approaches to AUD.

Cannabis Use and Its Interaction with Anxiety Disorders

Introduction Cannabis use has been reported to cause a myriad of acute adverse reactions, including those linked to anxiety disorders, such as panic attacks and derealization. Notably, in the emergency department, anxiety makes up a significant proportion of the complaints related to cannabinoid consumption. Several reports show these symptoms can persist after the cessation of cannabis consumption. Consequently, some questions have arisen regarding the role of cannabinoids as precipitators for anxiety disorders in vulnerable individuals. Alternatively, it has been hypothesized that patients with anxiety disorders are more prone to using cannabis.Objectives We aim to understand whether there is an established relationship between anxiety disorders and cannabis use. Moreover, we intend to identify what are the factors which make an individual more likely to experience anxiety following cannabis consumption.MethodsA search was conducted in the PubMed database using the MeSH terms “cannabis”, “panic disorder”, “anxiety”, “panic” and “generalized anxiety disorder”. Articles published in the last ten years were considered. Publications were selected after careful reading of their abstract. A non-systematic review of the selected articles was performed.ResultsEight articles were included in this review. While a majority of these publications did not find a significant association between cannabis use and anxiety disorders, a small subset of analyzed articles found that cannabis use may increase anxiety severity in general, devoid of specific diagnostic association. Individuals who presented to the emergency department with anxiety complaints after cannabis use were likely to be young and to have ingested edible cannabis. History of psychiatric disease, especially substance use disorder, was common in this population.Conclusions Most available data suggest cannabis use is not clearly linked to anxiety disorders. However, information around this topic is scarce and heterogenous. Further research is needed focusing on the natural evolution of acute anxiety after cannabis use. Factors such as young age, presence of psychiatric comorbidities and consumption of edible cannabis appear to contribute to a significantly increased risk of experiencing acute anxiety after cannabis use.Disclosure of InterestNone Declared

The global prevalence of depression, anxiety, and sleep disorder among patients coping with Post COVID-19 syndrome (long COVID): a systematic review and meta-analysis

BackgroundPost COVID-19 syndrome, also known as "Long COVID," is a complex and multifaceted condition that affects individuals who have recovered from SARS-CoV-2 infection. This systematic review and meta-analysis aim to comprehensively assess the global prevalence of depression, anxiety, and sleep disorder in individuals coping with Post COVID-19 syndrome.MethodsA rigorous search of electronic databases was conducted to identify original studies until 24 January 2023. The inclusion criteria comprised studies employing previously validated assessment tools for depression, anxiety, and sleep disorders, reporting prevalence rates, and encompassing patients of all age groups and geographical regions for subgroup analysis Random effects model was utilized for the meta-analysis. Meta-regression analysis was done.ResultsThe pooled prevalence of depression and anxiety among patients coping with Post COVID-19 syndrome was estimated to be 23% (95% CI: 20%—26%; I2 = 99.9%) based on data from 143 studies with 7,782,124 participants and 132 studies with 9,320,687 participants, respectively. The pooled prevalence of sleep disorder among these patients, derived from 27 studies with 15,362 participants, was estimated to be 45% (95% CI: 37%—53%; I2 = 98.7%). Subgroup analyses based on geographical regions and assessment scales revealed significant variations in prevalence rates. Meta-regression analysis showed significant correlations between the prevalence and total sample size of studies, the age of participants, and the percentage of male participants. Publication bias was assessed using Doi plot visualization and the Peters test, revealing a potential source of publication bias for depression (p = 0.0085) and sleep disorder (p = 0.02). However, no evidence of publication bias was found for anxiety (p = 0.11).ConclusionThis systematic review and meta-analysis demonstrate a considerable burden of mental health issues, including depression, anxiety, and sleep disorders, among individuals recovering from COVID-19. The findings emphasize the need for comprehensive mental health support and tailored interventions for patients experiencing persistent symptoms after COVID-19 recovery.

27 Differentiating Attention-deficit/Hyperactivity Disorder (ADHD) Subtype Using Continuous Performance Tests Among Children with Comorbid ADHD and Anxiety

Objective:Continuous performance tests (CPT) are often considered the gold standard for the diagnosis attention-deficit/hyperactivity disorder (ADHD), particularly when parent and teacher rating scales are inconclusive. Prior work has indicated that CPT can also help differentiate between ADHD subtypes. However, the ability of CPT to differentiate ADHD subtype has not been examined among youth with comorbid ADHD and anxiety (ADHD+A). This is particularly concerning as the extant literature suggests that anxiety symptoms may exacerbate deficits associated with ADHD (e.g.. , working memory, attention) and attenuate others (e.g., inhibition); thus, anxiety may influence expected patterns on the CPT. This study therefore seeks to examine the role of ADHD subtype on the relationship between ADHD+A and performance on a CPT among youth with ADHD+A.Participants and Methods:Participants included 54 children ranging from 6 to 20 years old (Mage=11.83, 54% female) who were diagnosed with ADHD+A via neuropsychological evaluation. In terms of ADHD subtype, 51.9% (n=28) were diagnosed with ADHD combined or ADHD primarily hyperactive and 48.1% (n=26) were diagnosed with ADHD primarily inattentive. Approximately 46.30% (N=25) of participants were medication naive. Analyses were conducted using data from the Conners Kiddie Continuous Performance Test -Second Edition (KCPT-2), Conners Continuous Performance - Second Edition (CPT-2) and the Conners Continuous Performance - Third Edition (CPT-3), which are part of the same family of performance-based attention measures. Independent samples t-tests were conducted to examine performance differences in aspects of attention (e.g., inattentiveness, sustained attention) and hyperactivity (e.g., impulsivity, inhibition).Results:ADHD subtype was not significantly related to measures of inattentiveness. This includes the number of targets missed (omissions; (t(39)=-.532, p=.59)) and variability in response time (variability; (t(39)=-0.30, p=.77)). In terms of sustained attention, ADHD subtype was not related to variability in response speed across blocks (Hit SEBC/HRT Block Change; (t(39)=-0.26, p=.79)). Importantly, these results were consistent regardless of ADHD medication status. ADHD subtype was also not significantly related to impulsivity. This includes responses to nontargets (commissions; (t(39)=-1.05, p=.30)), random or anticipatory responding (perseverations; (t(39)=-0.19, p=.85)), and mean response speed of correct responses (HR; (t(39)=-0.72, p=.48)).Conclusions:The extant literature suggests that CPT can help clinicians differentiate between ADHD subtypes. However, the results of this study indicate that there are no performance differences on the CPT among youth with comorbid ADHD and anxiety. There are several limitations to consider. First, this study had a relatively small sample size, which also limited the ability to examine ADHD primarily hyperactive/impulsive as a distinct subtype. Additionally, this study did not examine the effect of individual anxiety disorders (i.e., generalized anxiety disorder, specific phobias). Finally, these findings may not generalize to other standardized measures of attention or more ecologically valid measures. Despite these limitations, this study is an important step in understanding the relationship between ADHD+A and performance on attention measures. Clinicians should be cautious in using results from CPT to distinguish between ADHD subtype among children with comorbid anxiety.

Psychological Stress and Coping Strategy Profiles Among Frontline Medical Workers During the COVID-19 Pandemic.

This study aimed to explore coping strategy profiles used by frontline medical workers and the psychological stress reactions associated with each category, in the COVID-19 pandemic context. Participants were 651 frontline medical workers recruited between February and March 2020. Psychological stress reactions (e.g., anxiety, depression) and coping strategies were assessed and analyzed using latent profile analysis and linear regression. Participants had three coping strategy profiles: coping inadequately (28.9%), coping appropriately (64.4%), and coping excessively (6.7%). Compared with coping appropriately, those who coped inadequately and excessively had higher psychological stress reactions levels. Levels of anxiety, depression, and posttraumatic stress disorder in excessive-coping individuals were higher than those who coped inadequately. Our findings elucidate the effectiveness of different coping strategy profiles and provide insights for developing targeted interventions to mitigate stress among medical workers. In light of these results, we recommend implementing stress management programs tailored to specific coping strategy profiles.

Parental Anxiety and Children's Mediterranean Diet Quality Index during the COVID-19 pandemic

COVID-19, which affected the whole world in 2019, caused various psychosocial disorders, especially stress and anxiety disorders in individuals. Anxiety disorder, which is very common in parents, affects children's eating behaviors. The Mediterranean diet, which is one of the healthiest diets in the world thanks to its comprehensive vitamin and mineral content, has also been reported to be protective against COVID-19. In our study, we aimed to investigate the relationship between parents' anxiety levels and KIDMED scores, which measure their children's compliance with the Mediterranean diet. The questionnaire form, which was created using the Mediterranean Diet Quality Index (KIDMED), Beck Anxiety Inventory (BAI), and Coronavirus Anxiety Scale (CAS), was delivered to the parents by snowball method. In total, 589 parents were reached. Conditions such as parental gender, relationship status, number of children, and dietary supplement use before COVID-19 were only significantly associated with BAI. (p

A Cognitive Behavioral Therapy Intervention Study for Managing Social Anxiety Disorder in Pregnant Women

The present intervention study endeavors to cast a glance at the treatment of social
 anxiety disorder in a pregnant woman through cognitive behavior therapy. The case
 study focuses on the successful treatment of a 25-year-old pregnant woman who was
 experiencing severe anxiety triggered by social situations and traveling. The therapy
 sessions effectively addressed and managed her anxiety, taking into consideration the
 unique circumstances of her pregnancy. The case study highlights the significance of
 individualized interventions and evidence-based approaches in effectively treating
 anxiety disorders in pregnant individuals. The symptoms were significantly affecting
 her daily life. The study aimed to assess the efficacy of cognitive-behavioral therapy
 (CBT) for individuals with social anxiety disorder during pregnancy and involved 12
 sessions of therapy. Therapeutic techniques used for social anxiety disorder include
 psychoeducation, systematic desensitization, exposure and response prevention, and
 cognitive restructuring. At the end of the therapy, the patient’s symptoms were
 significantly reduced, and relapse prevention tactics were taught to help her manage
 herself in the future. The study suggests that CBT can effectively treat social anxiety
 disorder during pregnancy.

Exploring the Association of Burning Mouth Syndrome with Depressive and Anxiety Disorders in Middle-Aged and Older Adults: A Systematic Review.

Burning Mouth Syndrome (BMS) is an idiopathic condition mainly affecting middle-aged and older individuals with hormonal disturbances or psychiatric disorders and is characterized by chronic pain. The etiopathogenesis of this multifactorial syndrome is largely unknown. The objective of the present systematic review was therefore to evaluate the relationship of BMS with depressive and anxiety disorders in middle-aged and older individuals. We selected studies evaluating BMS and depressive and anxiety disorders assessed with validated tools, published from their inception up to April 2023, using PubMed, MEDLINE, EMBASE, Scopus, Ovid, and Google Scholar databases and adhering to the PRISMA 2020 guidelines/PRISMA 2020 27-item checklist. This study is registered on PROSPERO (CRD42023409595). The National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies were used to examine the risk of bias. Two independent investigators rated 4322 records against the primary endpoint and found 7 records meeting the eligibility requirements. Anxiety disorders were found to be the most common psychiatric disorders related to BMS (63.7%), followed by depressive disorders (36.3%). We found a moderate association of BMS with anxiety disorders, with multiple studies included (n = 7). Moreover, we found a low association of BMS with depressive disorders (included studies, n = 4). The role of pain appeared to be controversial in explaining these associations. In middle-aged and older subjects, anxiety and depressive disorders may be potentially related to the development of BMS. Furthermore, also in these age groups, females showed higher risk of developing BMS than males, even when taking into account multimorbidity such as sleep disorders, personality traits, and biopsychosocial changes as suggested by study-specific findings.

Sleep Apnea and Substance Use Disorders Associated with Co-Occurrence of Anxiety Disorder and Depression among U.S. Adults: Findings from the NSDUH 2008–2014

Few studies have focused on sleep apnea and substance use disorders with co-occurrence of anxiety disorder and depression. This study included a total of 270,227 adults, 9268 with co-occurrence of anxiety disorder and depression in the past year, from the combined 2008-2014 National Survey on Drug Use and Health (NSDUH) data, which are the latest datasets with measures of anxiety disorder and sleep apnea. Weighted multinomial logistic regression analyses were used to estimate the associations between anxiety disorder and depression and their co-occurrence. Comorbidity was highly prevalent: 40.4% of those with depression also met the criteria for anxiety disorder, whereas 51.8% of those with anxiety disorder also met the criteria for depression. The prevalences of anxiety only and co-occurrence increased from 2008 to 2014. The prevalences of anxiety disorder only, depression only, and co-occurrence of anxiety disorder and depression in individuals with sleep apnea were 4.4%, 12.9%, and 12.2%, respectively, and the prevalences in substance use disorders were 6.4%, 9.4%, and 10.7%, respectively. The results showed that sleep apnea, substance use disorders, and nicotine dependence were significantly associated with increased odds of anxiety disorder, depression, and co-occurrence (all p values < 0.0001). Furthermore, several chronic diseases (asthma, bronchitis, hypertension, and heart disease) were associated with the co-occurrence of anxiety disorder and depression. These findings suggest clinicians and other healthcare providers consider screening for depression and anxiety with sleep apnea and substance use disorders for improved therapeutic outcomes.

Impact of Childhood Trauma and Adult Separation Anxiety Disorder on Quality of Life in Individuals with Schizophrenia.

Childhood trauma and anxiety disorders are common in individuals with schizophrenia. This study aimed to investigate the effects of childhood trauma and adult separation anxiety disorder on the quality of life of individuals with schizophrenia. This cross-sectional study included 111 individuals with schizophrenia and 85 control subjects. The separation anxiety symptom inventory (SASI), adult separation anxiety questionnaire (ASAQ), Positive and Negative Syndrome Scale (PANSS), childhood trauma questionnaire (CTQ), and World Health Organization quality of life questionnaire (WHOQoL-BREF) were administered to the participants. More individuals with schizophrenia than control subjects were unemployed and single (p<0.05). Individuals with schizophrenia scored significantly higher on the SASI, ASAQ, and CTQ (p<0.05), whereas the control subjects scored significantly higher on the WHOQoL-BREF (p<0.05). ASAQ scores had mild positive correlations with total PANSS and PANSS subscale scores, and moderate positive correlations with total CTQ, CTQ emotional subscale scores, and CTQ physical abuse subscale scores. A negative moderate correlation was found between ASAQ and total WHOQoL-BREF scores. Mediation analysis revealed that CTQ scores significantly affected total WHOQoL-BREF and ASAQ scores. The model pathway for ASAQ scores showed a significant direct and indirect effect of CTQ on the total WHOQoL-BREF scores. Childhood trauma predicts adult separation anxiety disorder, which partially mediates the impact of childhood trauma on quality of life in individuals with schizophrenia. Therapeutic interventions for adult separation anxiety disorder in individuals with schizophrenia and a history of childhood trauma may help increase their quality of life.

META-ANALISIS PENGARUH INTERVENSI VIRTUAL REALITY THERAPY UNTUK MENURUNKAN SOCIAL ANXIETY DISORDER

This study aims to see the effectiveness of appropriate virtual reality therapy methods to reduce level of social anxiety disorder in individuals. This research method is a meta-analysis based on the PRISMA-P 2020 procedure. This research involved 7 previous experimental studies that used virtual reality therapy as an intervention in reducing social anxiety disorder. The result of this study is that the virtual reality therapy method has a large effect size in reducing individual social anxiety disorder. Virtual reality therapy should be combined with other interventions such as cognitive behavior therapy (CBT) or mindfulness-based warm-ups and individuals are encouraged to do self-reflection to reduce the level of social anxiety disorder they experience.

SYSTEMATIC REVIEW OF THE PREVALENCE OF ANXIETY AND DEPRESSION DISORDERS AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Background: Mental health is an important but often disregarded part of inflammatory bowel disease (IBD) patient care, with difficulties defining effective medications and psychological health services. Anxiety and sadness are the most frequent psychosocial problems among IBD patients. The rising frequency of these mental problems calls for mental screening of all IBD patients at the initial appointment. Objective: A growing number of research on anxiety and depression in IBD have been undertaken nevertheless, there is no clear consensus on the prevalence of anxiety and depression in this group. The goal of this systematic review was to consolidate current data on the prevalence of depression and anxiety disorders in individuals with IBD. Methods: Authors began with recognizing the important examination proof that spots light on the prevalence of anxiety and depression among IBD patients. We led electronic writing look in the accompanying data sets: Ovid Medline (2010 to present), Ovid Medline Daily Update, Ovid Medline in process and other non-filed references, Ovid Embase (2010 to present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language will be incorporated. The precise selection was acted in close collaboration with a clinical examination curator. Results: There were 10 articles found, with a total of 26097 participants. The pooled prevalence estimate for anxiety disorders was 20.3%, and 13.3% for depression. When compared to those in remission, IBD patients in active illness showed a 75.6% greater prevalence of anxiety. Depressive symptoms were more common in Crohns disease than in UC (P0.001), and more common in active illness than in IBD patients in remission (P= 0.004). Conclusion: Results from this systematic review indicate that patients with IBD have about a 20.3% prevalence rate of anxiety and a 13.3% prevalence rate of depression.

Artificial intelligence assisted tools for the detection of anxiety and depression leading to suicidal ideation in adolescents: a review.

Epidemiological studies report high levels of anxiety and depression amongst adolescents. These psychiatric conditions and complex interplays of biological, social and environmental factors are important risk factors for suicidal behaviours and suicide, which show a peak in late adolescence and early adulthood. Although deaths by suicide have fallen globally in recent years, suicide deaths are increasing in some countries, such as the US. Suicide prevention is a challenging global public health problem. Currently, there aren't any validated clinical biomarkers for suicidal diagnosis, and traditional methods exhibit limitations. Artificial intelligence (AI) is budding in many fields, including in the diagnosis of medical conditions. This review paper summarizes recent studies (past 8 years) that employed AI tools for the automated detection of depression and/or anxiety disorder and discusses the limitations and effects of some modalities. The studies assert that AI tools produce promising results and could overcome the limitations of traditional diagnostic methods. Although using AI tools for suicidal ideation exhibits limitations, these are outweighed by the advantages. Thus, this review article also proposes extracting a fusion of features such as facial images, speech signals, and visual and clinical history features from deep models for the automated detection of depression and/or anxiety disorder in individuals, for future work. This may pave the way for the identification of individuals with suicidal thoughts.

Anxiety and cognitive functioning in the Maastricht study: A cross-sectional population study

BackgroundHigher anxiety levels in older adults are associated with worse executive functioning and an increased risk for dementia. In this study individual anxiety disorders and clinically relevant generalized anxiety symptoms are studied in relation to multiple cognitive domains. MethodThis cross-sectional study includes 7344 community-dwelling participants of The Maastricht Study aged 40–75 years and oversampling of type 2 diabetes. Panic disorder with and without agoraphobia, agoraphobia and lifetime panic disorder were measured with the Mini International Neuropsychiatric Interview. Generalized anxiety symptoms were measured with the Generalized Anxiety Disorder 7-item scale (GAD-7). Multiple cognitive domains (executive functioning, memory and processing speed) and cognitive impairment were assessed. Multivariable linear and logistic regression analyses were used with adjustment for potential confounders. Interaction analyses were performed to test the moderation of age, sex and type 2 diabetes (due to oversampling). ResultsAgoraphobia was associated with worse scores on all cognitive domains (range B = −0.12 to −0.10; range 95%CI = −0.20 to −0.04) and with higher odds of cognitive impairment (OR = 1.51, 95%CI = 1.18–1.93). High scores on the GAD-7 were associated with worse scores on processing speed (B = −0.11, 95%CI = −0.20 to −0.03) and higher odds of cognitive impairment (OR = 1.42, 95%CI = 1.02–1.97). Panic disorder was significantly associated with worse scores on memory tasks (B = −0.25, 95%CI = −0.48 to −0.02). Associations were stronger in the younger participants and for agoraphobia and GAD-7 scores also in those with type 2 diabetes. ConclusionMultiple anxiety disorders and generalized anxiety symptoms were associated with worse cognitive functioning on several cognitive domains.

Risk for Mood, Anxiety, and Psychotic Disorders in Individuals at High and Low Genetic Liability for Bipolar Disorder and Major Depression

The nature of the genetic relationship between major depression and bipolar disorder remains unclear and might be clarified by considering disorders outside of the mood spectrum. To better understand the relationship between genetic liabilities for major depression (MD) and bipolar disorder (BD). A cohort study was conducted with data for individuals born in Sweden to Swedish parents from 1960 to 1990, with follow-up through December 31, 2018. The data included family genetic risk scores for MD and BD and International Classification of Diseases codes for a range of disorders as reported in primary care, specialist, and hospital registries. Data analysis was conducted from April 2022 to July 2022. High and low genetic liability were defined as being in the upper and lower 2 risk deciles. Risk was compared in individuals at high genetic liability to (1) MD only, (2) BD only, and (3) both MD and BD and those at (4) high genetic liability to BD and low genetic liability to MD and (5) high genetic liability to MD and low genetic liability to BD. Risk for nonpsychotic MD and BD, psychotic MD and BD, anxiety disorders, obsessive-compulsive disorder, schizoaffective disorder (SAD), schizophrenia, and other nonaffective psychosis. Data were included for 2 736 950 individuals with a mean (SD) age at follow-up of 43.9 (9.1) years. High genetic liability to only BD increased risk for nonpsychotic BD, psychotic BD, and SAD. High genetic liability to only MD augmented risk for nonpsychotic MD, anxiety disorders, and nonpsychotic BD. High genetic liability to both BD and MD had the strongest association with risk for nonpsychotic BD, anxiety disorders, and nonpsychotic MD. High genetic liability to BD and low genetic liability to MD increased risk for psychotic BD, nonpsychotic BD, and SAD with no increased risk for nonpsychotic MD or anxiety disorders. High genetic liability to MD and low genetic liability to BD increased risk for nonpsychotic MD, nonpsychotic BD, and anxiety disorders with no increased risk for psychotic BD. In this study, hypotheses that BD and MD are either genetically distinct or genetically closely interrelated were not supported. Both BD and MD were associated with a genetic vulnerability to mood disorders, but even that liability was partially selective. However, compared with individuals at high liability to MD, those at elevated genetic liability for BD had a substantially increased risk for psychosis. Compared with individuals at elevated genetic liability to BD, those at high genetic risk for MD had a considerably augmented risk for anxiety disorders. Clarifying genetic relationships between psychiatric syndromes can be substantially aided by the consideration of profiles of risk for a range of disorders.

Childbirth Pain, Labor Epidural Analgesia, and Postpartum Depression: Recent Evidence and Future Directions.

Pregnancy and childbirth are major life events for women and their families, characterized by physical, psychological, and emotional changes that can trigger anxiety, depression, and mental disorders in susceptible individuals. Acute labor pain is an independent risk factor for persistent pain in the postpartum period and is associated with depressive disorders. Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in pain management during labor. Although the relationships between labor pain, labor epidural analgesia, and postpartum depression have been studied by many investigators, the results of these studies are conflicting. Some literature suggest that labor epidural analgesia is associated with a reduction in the incidence of postpartum depression; however, other studies have failed to demonstrate this association. Unmet analgesic needs expectations, unmet birth expectations, and/or the quality of social support during labor may contribute to postpartum depression. The limitations of the published studies included differential misclassification of study variables and residual confounding, variations in the diagnosis of depression, and incomplete history data. Thus, future studies should include information on sociodemographic and patient-level variables and assessments of pain during labor or in the postpartum period. Better management of labor pain should be provided to prevent long-term morbidity and improve maternal and neonatal outcomes. Anesthesiologists could collaboratively work with obstetricians and perinatal psychiatrists to ensure that hospitals prioritize screening and treatment for postpartum depression.

The circadian rhythm of blood pressure in patients with panic disorder and generalized anxiety disorder

BackgroundAnxiety disorders affect blood pressure both during the day and at night. Little is known about the effect of individual anxiety disorders on the circadian rhythm of blood pressure.Objectives: The purpose of this study is to compare the nocturnal drop in blood pressure in patients with panic disorder (PD), generalized anxiety disorder (GAD), and healthy individuals. MethodsThe study was conducted on fifty consecutive outpatients with anxiety disorders and personality disorders who participated in intensive group psychotherapy. Diagnoses were made according to DSM-IV-TR criteria using the PSE-10 questionnaire. Out of 50 patients under study, 17 were diagnosed with PD and 21 with GAD. The control group consisted of 40 healthy people recruited in the course of other studies. The resulting three groups were compared in terms of circadian blood pressure using the ABPM method. ResultsMean nocturnal falls in systolic and diastolic blood pressure were the following: 2% and 3% (PD), 11% and 12% (GAD), 27% and 23% (control). Four people out of PD group had higher systolic and diastolic blood pressure at night than during the day. The ratios between non-dippers/dippers were: 0/15 (PD), 8/21 (38% - GAD) and 40/40 (100% - control). ConclusionsThe patients with PD were characterized by an almost flat course of circadian blood pressure. The patients with GAD had a lower mean nocturnal fall in blood pressure than the control group, but significantly higher than the patients with PD. The differences in the circadian course of blood pressure between PD and GAD are so large that the impact of these disorders should be investigated separately.