Anxiety Disorders In Outpatients Research Articles

Curative care expenditure of outpatient anxiety disorder in Liaoning Province, 2015-2020-based on "System of Health Accounts 2011".

Anxiety disorders are the most common mental disorder, experienced by more than a quarter of the population. This study examines total outpatient curative care expenditures (CCE) for anxiety disorders and changes in their composition based on the System of Health Accounts 2011 (SHA 2011). This study used multi-stage stratified random from a total of 9,318,513 outpatient sample data by 920 healthcare organizations, a total of 109,703 cases of anxiety disorders from 53 sample organizations (5.76%) from 2015 to 2020. Univariate analysis, multifactor analysis and structural equation modeling (SEM) were used to explore the influential factors affecting outpatient CCE for anxiety disorders. Anxiety disorder outpatient CCE from 2015 to 2020 continued to increase from CNY 99.39million in 2015 to CNY 233.84 million in 2020, mainly concentrated in western medicine costs, 15-64 years, general hospital, generalized anxiety disorder and public financing. The results of univariate analysis showed statistically significant differences in all subgroups, and the results of multivariate analysis and SEM showed that the choice to purchase western drugs, purchase prepared Chinese drugs, choice to have a checkup, urban employees' basic medical insurance, and 0-14 years old were associated with high anxiety disorder outpatient CCE. Initiatives to improve the essential drug system, reduce the out-of-pocket (OOP) ratio, and strengthen primary health care to effectively reduce the medical burden on patients.

False safety behaviour elimination therapy for social anxiety disorder in Japanese men

ABSTRACT Background Social anxiety disorder (SAD) is an excessive fear of social situations that can lead to serious functional impairment. The prevalence of SAD has increased over the past four decades, making it one of the most prevalent psychiatric disorders in Japan. Therefore, more effective interventions are needed to treat this disorder. False safety behavior elimination therapy (F-SET), which eliminates safety behavior (i.e., strategies that reduce anxiety), was administered in our study to six Japanese patients with SAD. This is the first adaptation of F-SET into Japanese. Patients were diagnosed using the Mini-International Neuropsychiatric Interview. The Liebowitz Social Anxiety Scale was used as the primary outcome measure to evaluate the change in symptoms. All patients received five weekly 60-minute F-SET sessions. Results and Conclusions Participants who completed the treatment exhibited a substantial decrease in SAD symptoms, providing preliminary support for the adapted treatment’s efficacy. We have discussed the cultural differences in SAD and the adaptation of F-SET. KEY POINTS What is already known about this topic: (1) Transdiagnostic group CBT is an effective treatment for anxiety disorders. (2) Few studies have examined the effectiveness of transdiagnostic group CBT in naturalistic settings. (3) Few studies have examined the effectiveness of treatments as implemented by clinicians in routine clinical practice. What this paper adds: (1) Eight to ten sessions of transdiagnostic group CBT developed by practising clinicians seemed sufficient in improving anxiety and depressive symptoms, daily functioning, and quality of life in patients from an outpatient anxiety disorders clinic in a hospital setting. (2) Patients that completed treatment reported significantly more impairment in daily functioning before treatment than participants who dropped out. (3) High attrition rates suggest that organisational factors need to be considered while implementing evidence-based treatments into routine clinical practice.

Integrated group treatment for anxiety disorders: a transdiagnostic effectiveness and feasibility study in a mental health hospital setting

ABSTRACT Objective The development of transdiagnostic cognitive-behavioural therapy (T-CBT) is a promising avenue for the treatment of anxiety disorders. This study aimed at evaluating the feasibility and effectiveness of a group T-CBT, developed by practising clinicians, for patients with principal and comorbid anxiety disorders in a pragmatic quasi-experimental trial. Method Clinician-rated and self-rated measures were used to assess principal (anxiety) and secondary (depression, daily functioning, quality of life) outcomes. Forty-two participants from an anxiety outpatient clinic of a mental health hospital with at least one primary anxiety disorder took part in the study. The intervention consisted of 8 to 10 weekly group T-CBT sessions of 120 minutes. Results Among the 42 participants recruited, 37 completed baseline measures. Attrition was high (35%) as only 24 participants completed the treatment as intended. Significant improvements were observed on anxiety, depression, and daily functioning as well as physical and psychological quality of life measures. Gains were maintained up to three months after the end of treatment. Conclusion Findings support the effectiveness of a group T-CBT for anxiety disorders in an outpatient clinic. However, feasibility was only partially supported highlighting the need for further research on the transportability of group T-CBT in to clinical practice. KEY POINTS What is already known about this topic: (1) Transdiagnostic group CBT is an effective treatment for anxiety disorders. (2) Few studies have examined the effectiveness of transdiagnostic group CBT in naturalistic settings. (3) Few studies have examined the effectiveness of treatments as implemented by clinicians in routine clinical practice. What this paper adds: (1) Eight to ten sessions of transdiagnostic group CBT developed by practising clinicians seemed sufficient in improving anxiety and depressive symptoms, daily functioning, and quality of life in patients from an outpatient anxiety disorders clinic in a hospital setting. (2) Patients that completed treatment reported significantly more impairment in daily functioning before treatment than participants who dropped out. (3) High attrition rates suggest that organisational factors need to be considered while implementing evidence-based treatments into routine clinical practice.

Application of a Quality Improvement Process to Evaluate Self-Directed Therapy for Patients on a Waitlist in an Outpatient Anxiety Disorders Specialty Clinic

The demand for psychological services in the United States is higher than the available supply of qualified mental health professionals. As a result, there is a substantial need for low-cost interventions that are more accessible and amenable to scale-up independent of the availability of clinicians. Previous studies have found that self-directed bibliotherapy can be an effective intervention with minimal therapist contact. Using the Plan-Do-Study-Act (PDSA) improvement process framework, we implemented self-directed therapy in our outpatient anxiety disorders specialty clinic. We identified four self-directed therapy resources (two books and two smartphone apps) based on cognitive behavioral or acceptance and mindfulness principles. We conducted initial 30-minute billable bibliotherapy consultations with six patients on our waitlist, where we provided the rationale for self-guided treatment, introduced the four resources, helped the patient identify one resource to use, and answered any questions. Eight weeks later, we met with five of these patients for a second billable 30-minute consultation (one had already started individual therapy) and gathered information regarding feasibility and acceptability of these resources as well as helped the patient make continued or better use of the resource until beginning therapy. This case series suggests that self-directed interventions can be effectively implemented in this manner, though with mixed outcomes and effects on patients and their course of care. We describe improvements we intend to implement in future iterations of self-directed therapy.

Diverticular disease is associated with an increased incidence rate of depression and anxiety disorders

BackgroundDiverticular disease represents a gastrointestinal disorder of high prevalence in developed countries that often leads to psychological distress. Here, we aimed at evaluating a potential association between diverticular disease and depression or anxiety disorders in outpatients in Germany.MethodsUsing the Disease Analyzer database featuring data of over 8 million patients treated in German general practices, we identified 61.556 patients with diverticular disease (ICD-10: K57) who were 1:1 matched by age, sex, index year, and the Charlson Comorbidity Index to 61.556 patients without diverticular disease. The association between diverticular disease and depression or anxiety disorders was evaluated in Cox regression models.ResultsWithin 5 years after the initial diagnosis of diverticular disease, 14.0% of patients with and 10.6% of individuals without diverticular disease were diagnosed with depression (HR 1.34, 95%CI 1.29–1.39, p < 0.001). Similarly, the incidence of anxiety disorder was significantly higher in patients with diverticular disease (HR 1.55, 95%CI 1.46–1.64, p < 0.001). Finally, the prescription rate for antidepressant drugs was significantly higher in diverticular disease patients compared to individuals without diverticular disease (9.4% vs. 6.1%, HR 1.56, 95%CI 1.49–1.62, p < 0.001). These associations were confirmed for different age groups and both sexes.ConclusionOur data provide evidence that diverticular disease is associated with an increased incidence of depression and anxiety disorders. Despite that fact that confounding factors such as deprivation and patient personality have to be taken into account, we suggest that patients with diverticular disease are regularly screened for symptoms of depression and anxiety disorders.

Shyness and anxiety: Protective role of extraversion

The present study examined the moderating role of extraversion in explaining the relation between shyness and anxiety in a non-clinical early adolescent sample (N = 119, nfemale = 75; Mage = 12.93 years, SDage = 2.23 years) and a clinical adult sample from an outpatient anxiety disorders clinic (N = 100, nfemale = 77; Mage = 34.97 years, SDage = 12.66 years). We found evidence for the protective role of relatively high levels of extraversion in both samples, such that shyness was positively associated with anxiety in the context of relatively low levels of extraversion. Our results provide support for the protective role of extraversion in the presence of high levels of shyness.

Poor insight in obsessive-compulsive disorder: Examining the role of cognitive and metacognitive variables

The purpose of the current study was to examine the cognitive and metacognitive constructs that conceptually relate to poor insight in obsessive-compulsive disorder (OCD). Associations between various dimensions of insight in OCD (e.g., clinical insight, conviction in one's beliefs) and cognitive and metacognitive variables (e.g., cognitive insight, decentering) were examined. Participants with OCD (N = 80) referred for treatment at an outpatient anxiety disorders clinic completed a clinical interview and a computer-administered questionnaire package assessing the variables of interest. Cognitive insight, a type of metacognitive process, was significantly negatively associated with delusional thinking, and cognitive self-consciousness was significantly negatively correlated with delusional thinking regarding a psychiatric source for one's symptoms. Finally, insight decreased during recall of times when OCD symptoms were activated for both the good and poor insight groups, and did not significantly vary as a function of insight group status. Implications, limitations, and directions for future research are discussed.

Protocole de relaxation intégrative et transdiagnostique pour patients anxieux. Résultats d’une étude pilote

The literature data show that relaxation practice is effective in reducing anxiety symptoms. Different techniques such as progressive muscular relaxation, autogenic training, applied relaxation and meditation have been evaluated independently for anxiety disorders. The question is to know whether the combination of various techniques may be of interest in the transdiagnostic treatment of anxiety disorders. The present study assessed the short-term efficacy of a 10-week integrative and transdiagnostic relaxation program for anxiety disorders in outpatients of an anxiety disorders unit. The diagnoses were made according to the Mini-International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) and completed with an assessment of anxiety and depressive symptoms using: the State Trait Anxiety Inventory (STAI-Y, -S and -T), the Penn State Worry Questionnaire (PSWQ) and the Beck Depression Inventory (BDI-II). Four techniques were integrated into the structured 10-week protocol: breathing control, muscular relaxation, meditation and mental visualization. Twenty-eight patients (12 men and 16 women), mean age (S.D.)=38.82 years (11.57), were included in the study. All the included patients fulfilled the DSM-IV criteria for a current diagnosis of Generalized Anxiety Disorder (n=13) or Panic Disorder (n=15) with or without agoraphobia. At the end of the 10 sessions, we found a significant reduction in mean scores (S.D.) on the STAI-T from 53.179 (6.037) to 49.821 (8.028) (P<0.02), the BDI-II 20.964 (13.167) to 15.429 (11.341) (d=0.6543) and the QIPS 55.071 (10.677) to 49.679 (11.7) (d=0.5938). The observed reduction in the STAI-S (d=0.2776) was not significant. The results of this open study showed that this program significantly decreases the level of trait anxiety, depression and worry. The integrative and transdiagnostic relaxation program could represent an accessible and effective treatment to reduce anxious and depressive symptoms in various anxiety disorders. Future research should address the development of controlled trials assessing the impact of the different dimensions of anxiety and the long-term effects of this protocol.

Peer victimization among children and adolescents with anxiety disorders.

This study examined peer victimization among a sample of youth who were seeking treatment at an outpatient anxiety disorders clinic. The study examined the association between peer victimization and internalizing symptoms and looked at whether frequent victimization was more common among youth with Social Phobia (SoP) as compared to youth with other anxiety disorders The study also examined the relation between SoP and peer victimization dimensionally. Participants were 90 youth (47 boys; M age = 11.06 years) and their parents. Results showed that peer victimization was associated with social anxiety symptoms, and relational victimization, in particular, was associated with internalizing problems among youth with anxiety disorders. Negative beliefs about the peer group accounted for some of this relation. Victimization was associated with symptomatology rather than diagnosis. Peer victimization is important to assess and consider in the treatment of anxiety disorders in youth.

Perceived Control is a Transdiagnostic Predictor of Cognitive-Behavior Therapy Outcome for Anxiety Disorders.

Perceived control has been proposed to be a general psychological vulnerability factor that confers an elevated risk for developing anxiety disorders, but there is limited research examining perceived control during cognitive-behavioral therapies (CBT). The present study examined whether treatment resulted in improvements in perceived control, and the indirect effects of CBT on changes in symptoms of obsessive-compulsive disorder, social phobia, generalized anxiety disorder, and panic disorder via changes in perceived control. Participants (n = 606) were a large clinical sample presenting for treatment at an outpatient anxiety disorders clinic. Participants completed a series of self-report questionnaires and a structured clinical interview at an intake evaluation and at two follow-up assessments 12 and 24 months later, with the majority of participants initiating CBT between the first two assessments. Results of latent growth curve models indicated that individuals initiating CBT subsequently reported large increases in perceived control and significant indirect effects of treatment on intraindividual changes in each of the four anxiety disorders examined via intraindividual changes in perceived control. These results suggest that the promotion of more adaptive perceptions of control is associated with recovery from anxiety disorders. Furthermore, the consistent finding of indirect effects across the four anxiety disorders examined underscores the transdiagnostic importance of perceived control in predicting CBT outcomes.

Changes in Beliefs about the Social Competence of Self and Others Following Group Cognitive-Behavioral Treatment

The current study examined changes in social anxiety thoughts and beliefs following cognitive-behavioral treatment (CBT). Participants (N = 77) were adults with a principal diagnosis of SAD who received 12, 2-h sessions of group CBT at a hospital-based outpatient anxiety disorders clinic. There were significant decreases from pretreatment to posttreatment in social anxiety symptoms and in symptoms of depression, nonspecific anxiety and tension, as well as significant improvements in social anxiety beliefs, as assessed via the Social Thoughts and Beliefs Scale (STABS; Turner et al., Psychol Assess 15:384–391, 2003). Change in social anxiety beliefs made a significant contribution to the prediction of social anxiety symptoms at posttreatment over and above pretreatment social anxiety symptoms and changes in depression, nonspecific anxiety and tension. A positive change in the belief that others are more socially-competent emerged as a significant unique predictor of social anxiety symptoms at posttreatment. The findings demonstrate that the STABS is sensitive to cognitive-behavioral treatment. The findings also suggest that social comparison processes in particular are a key aspect of improvement in social anxiety symptoms. This is an important direction for future research.

Can levels of a general anxiety-prone cognitive style distinguish between various anxiety disorders?

BackgroundThe question of whether certain anxiety disorders are especially related to a cognitive style characterized by an exaggerated perception of threat and appraisal of the future as excessively unpredictable (general anxiety-prone cognitive style) remains open. ObjectivesThis study aimed to compare patients with generalized social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with agoraphobia (PDA), and panic disorder without agoraphobia (PD) in terms of the levels of general anxiety-prone cognitive style when the severity of general distress and psychopathology is controlled for and to ascertain whether a co-occurring depressive disorder contributes substantially to the levels of this cognitive style. MethodsThe Anxious Thoughts and Tendencies Scale, a measure of a general anxiety-prone cognitive style, and Symptom Checklist 90—Revised were administered to 204 patients with various anxiety disorders who attended an outpatient anxiety disorders clinic and were diagnosed based on a semistructured diagnostic interview. ResultsPatients with principal diagnoses of SAD and GAD had a more prominent general anxiety-prone cognitive style than patients with principal diagnoses of PD and PDA when the severity of general distress and psychopathology was controlled for. The presence or absence of a co-occurring depressive disorder had no bearing on this finding. ConclusionsThe general cognitive component characterizes SAD and GAD more than it does PD and PDA, and a co-occurring depressive disorder does not affect this finding. These results have implications for distinguishing between various anxiety disorders.

Successful Treatment of Olfactory Reference Syndrome With Cognitive Behavioral Therapy: A Case Study

Olfactory reference syndrome (ORS) is characterized by a preoccupation with the belief that one's body emits a foul odor. Cognitive behavioral therapy (CBT) was used to treat a woman in her 50s who presented in our outpatient anxiety disorders specialty clinic with ORS, accompanied by embarrassment, shame, distress, avoidance behavior, and social isolation. Monitoring and systematic reduction of safety behaviors, combined with exposure to anxiety-provoking situations, resulted in elimination of the perceived body odor over the course of ten treatment sessions. Scores on the Overvalued Ideas Scale indicated improvements in the client's insight over the course of treatment, and there was an 82.6% reduction in her preoccupation and compulsive behaviors as measured by the Body Dysmorphic Disorder Yale-Brown Obsessive Compulsive Scale. Indices of depression, anxiety, and stress as measured by the 21-item version of the Depression Anxiety Stress Scales were also reduced from the extremely severe to normal range. These findings suggest further investigation of CBT in the treatment of ORS is warranted.

Hoarding among patients seeking treatment for anxiety disorders

The aim of the present study was to examine the prevalence of hoarding symptoms among individuals presenting for treatment of anxiety symptoms. Participants included 130 adults who were seeking treatment at an outpatient anxiety disorders clinic between January 2004 and February 2006. During their initial assessment, participants (31 with panic disorder, 15 specific phobia, 27 social phobia, 36 obsessive-compulsive disorder, 21 generalized anxiety disorder, mean age 37 years, 57% female, 88% White) completed the Saving Inventory-Revised, a self-report measure of hoarding symptoms, and several measures of anxiety symptoms, depressive symptoms, and functional impairment. Approximately 12–25% of anxious patients reported significant hoarding symptoms. Patients diagnosed with generalized anxiety disorder and obsessive-compulsive disorder were more likely to report significant hoarding symptoms than were those with panic disorder or specific phobia. Hoarding symptoms were positively correlated with trait anxiety, depressive symptoms, and functional impairment. These findings suggest that hoarding symptoms may be associated with anxiety disorders other than obsessive-compulsive disorder. The findings further suggest that hoarding symptoms may be underreported by anxious populations since typical intake assessments do not include specific questions about hoarding and individuals with hoarding symptoms may be unlikely to spontaneously report them.

Do Symptom Interpretations Mediate the Relationship Between Panic Attack Symptoms and Agoraphobic Avoidance?

There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

The prevalence of comorbid anxiety disorders in outpatients with schizophrenia

Objective. The purpose of this study was to determine the prevalence of lifetime anxiety disorders in patients with schizophrenia in Sanliurfa, Turkey, and to assess the association between comorbidity and several demographic and clinical variables. Methods. Eighty-two outpatients diagnosed with schizophrenia were recruited for the study. They were assessed by means of the Structured Clinical Interview for DSM-IV axis I Disorders-Clinician Version (SCID-I-CV), Anxiety Disorder Module, the Positive and Negative Syndrome Scale (PANSS), the Hamilton Anxiety Rating Scale (HARS), and the Global Assessment of Functioning Scale (GAF). Results. Fifty-five (67.1%) were diagnosed with at least one lifetime comorbid anxiety disorder. The most common anxiety disorder was obsessive-compulsive disorder (39.0%), followed by social phobia (13.4%). We found patients with a diagnosis of schizophrenia with comorbid anxiety disorders had shorter duration of illness than those without such comorbid conditions. Atypical antipsychotics were more commonly prescribed to treat these patients. Conclusion. As comorbidity of anxiety disorders is relatively prevalent among patients with a diagnosis of schizophrenia, special attention to this issue should be paid when interviewing these patients.

The prevalence of comorbid anxiety disorders in outpatients with schizophrenia

The prevalence of comorbid anxiety disorders in outpatients with schizophrenia

Epidemiological study on neurosis of internal medicine outpatient department in general hospital

Objective To investigate the prevalence status of neurosis among outpatients in internal medicine department of general hospital, and to find some characteristics of the neurosis. Methods 600 outpatients visiting the internal medicine department were investigated ,and they are from 3 general hospital in Dalian:seeond I-Iospital,Jinzhou hospital and second teaching hospital affiliated to Dalian medical university. 309 neurosis were selected with neurosis screening scale, and met the DSM-IV. Results Higher prevalence (57.43%) was found in neurosis of general hospital. The results showed that the prevalence rate of anxiety disorder is 68% within the neurosis, which included general anxiety (37.00%) and panic disorder (21.7%);and depression concomitant with panic disorder (9.6%), depression concomitant with general anxiety (14.2%), somatoform disorder (0.30%) ,other neurosis (26.8%) and serious depression (3.00%). No significantly differences were seen in age, education years, marital status among the groups of 309 neurosis. There were significant different suggested in sleeping time, times visited to doctors, cost to self disease, time length to treatment (P<0.01). Different results were also suggested in satisfaction to medicine (P=0.000). Other's different showed at taking in special exami-nation and pain-killer among the differ groups(P=0.000). Conclusion Neurosis is the serious problem in out-patient department of general hospital, and anxiety disorder is the most common one. Physicians should pay more attention on the anxiety disorder in outpatients and also need notice the other neurosis existing. Key words: General Hospital; Outpatients; Neurosis; Prevalence; Satisfaction

Konsiliar-Liaisondienst und Ambulanz einer Psychosomatischen Universitätsklinik: Patientenzuweisung, Anlass der Vorstellung, Empfehlungen

While psychosomatic clinics in German hospitals in general provide consultation-liaison and outpatient services, up to now no direct comparisons of the two systems of care have been made. Based on a comparison of 750 CL patients and 617 outpatients from a university hospital during the course of one year, differences between the two patient populations were recorded for referral, reasons for presentation, and psychotherapeutic recommendations. Compared to outpatients (43 years), the average age of CL-patients was higher (50 years); the proportion of men was higher, and level of education was lower. Adjustment disorders and psychological factors in somatic disorders were more frequently diagnosed (versus more somatoform, affective and anxiety disorders in outpatients). CL patients had fewer experiences with psychotherapy and were overall less distressed than outpatients. More frequently they were recommended basic psychosomatic care or psychiatric outpatient treatment and less outpatient psychotherapy. Implications for concepts of care are discussed. A uniform basic documentation for the two fields of care seem to make sense.

Quality of life and anxiety and depressive disorder comorbidity

The present investigation evaluated the relations among anxiety and depressive disorder comorbidity and quality of life (QOL) by utilizing self-report measures of life satisfaction and functional disability. Participants were 94 individuals who were presented for treatment at an outpatient anxiety disorders clinic and 26 nonclinical participants. Results indicated that participants diagnosed with anxiety disorders reported lower QOL than did nonclinical participants. Anxiety disorder comorbidity did not additionally impact QOL; however, presence of a depressive disorder comorbid with an anxiety disorder did negatively impact QOL as these individuals reported significantly more functional disability and less life satisfaction than did individuals with anxiety disorders alone or those without a psychiatric diagnosis. These results highlight the negative nature of anxiety disorders and improve clarification on the role of diagnostic comorbidity on QOL among those with an anxiety disorder.