Anxiety In Chronic Obstructive Pulmonary Disease Patients Research Articles

Diagnosis of Anxiety in COPD Patients: Usefulness of the HADS Test in Primary Care and Pulmonology Services.

Anxiety disorders, characterized by excessive fear and anxiety, are increasingly recognized as significant comorbidities in chronic diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the prevalence of anxiety in COPD patients referred from primary care centers to pulmonology services and to identify predictive factors for anxiety. This was a multicentric, observational, and prospective study in which 293 COPD patients were recruited, and they underwent comprehensive respiratory and smoking histories, spirometry, and anxiety assessments using the Hospital Anxiety and Depression Scale (HADS). The results showed a diagnosis of suspected anxiety in 85 patients (29.0%): 17 possible and 68 with a strong suspicion. The study found significant associations between anxiety and factors such as gender (women had a risk that was 3.5 times higher than men), weight, and body mass index (BMI). Disease severity, smoking status, and clinical manifestations did not significantly influence anxiety prevalence. These findings underscore the need for systematic psychological evaluations in COPD management and support the use of simple diagnostic tools like the HADS to facilitate referrals to mental health services. Addressing anxiety in COPD patients could potentially improve their quality of life and disease outcomes. This study highlights the importance of a multidisciplinary approach involving family medicine, pulmonology, and psychiatry to optimize COPD patient care and suggests that future research should focus on the impact of anxiety treatment on COPD progression. These insights call for integrating psychological assessments into routine clinical practice for comprehensive COPD management. The registration number is 10.14201/gredos.148549.

Reliability, Validity, Modification and Expansion of the Chinese Version of the Disease-Specific Anxiety Questionnaire for Chronic Obstructive Pulmonary Disease.

To translate a disease-specific anxiety questionnaire on chronic obstructive pulmonary disease (COPD) and test its reliability and validity in China. The German version of the revised COPD Anxiety Questionnaire (CAF-R) was initially validated using step-by-step translation, back-translation, and cross-cultural adaptation. The reliability and validity of the Chinese version of the CAF-R (CAF-R-CN) were tested among 448 patients with COPD (mean age =71.42±9.33 years, 17.2% female) from four medical institutions in Suzhou, Jiangsu Province, using convenience sampling, from April 2022 to June 2023. The CAF-R-CN included six dimensions with a total of 25 items. The item-level content validity index was 0.860-1.000; the scale-level content validity index was 0.920. The structural validity χ2/df was 2.326, the root mean square error of approximation was 0.077, the comparative fit index was 0.924, and the Tucker-Lewis index was 0.912. The six-dimensional internal consistency index Cronbach's α coefficient was 0.696-0.910, and the test-retest reliability was 0.949. An optimal cut-off score of 50.5 was selected with a sensitivity of 0.786 and specificity of 0.870. The CAF-R-CN had satisfactory reliability and validity and can be used to identify and assess anxiety in COPD patients with a Chinese cultural background.

Psychometric Validity of the Anxiety Inventory for Respiratory Disease (AIR) Scale in an Indian Sample of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.

Introduction Researchers have found that chronic obstructive pulmonary disease (COPD)patients suffer from anxiety more than the general population.The Anxiety Inventory for Respiratory Disease (AIR) scale has been primarily used to assess non-somatic anxiety in COPD patients. The validity of AIR among COPD patients has not been evaluated in Indian settings. Therefore, this study was undertaken to determine the validity of AIR in these patients. The study aimed to evaluate concurrent criterion and discriminative validity of the AIR screening scale among patients with COPD using Mini International Neuropsychiatric Interview (MINI) 7.0.2 as the gold standard measure for diagnosing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) anxiety disorders. Materials and methods A cross-sectional study was conducted in the Outpatients Department (OPD) of the Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, from August 2018 to July 2019. A total of 100 patients diagnosed with COPD and aged 30 or above were recruited. All participants were further assessed in person by a psychiatry resident doctor using semi-structured proforma, MINI7.0.2, and AIRDisease (Hindi). Mann-Whitney U and receiver operating characteristic (ROC) curves were conducted. The two-sided p-value of less than 0.05 was considered to be statistically significant. Results To assess the concurrent criterion validity of the AIR scale for screening clinical anxiety disorders, the ROCcurve was constructed using MINI diagnoses of anxiety disorder as the gold standard measure. A cut-off score of 5.5 was found to maximize both the specificity and sensitivity of the AIR scale for screening anxiety disorders among COPD patients with COPD. The AIR scale showed a high sensitivity (95%) and specificity (89%) at this cut-point. Conclusion The findings of this studyrecommend a cut-off score of 5.5 on the AIR scale instead of 8 in previous studies, as maintaining the previously recommended cut-offs in Indian settings may lead to an increase in false negatives. This could have negative consequences for patients seeking treatment. Further studies may be planned to explore the psychometric properties of the current tool in a larger population.

Brief Spanish Zung Self-Rating Anxiety Scale: Dimensionality, Internal Consistency, Nomological Validity, and Differential Item Functioning Among Chronic Obstructive Pulmonary Disease Patients in Colombia.

Background and purposes: The brief Spanish Zung Self-Rating Anxiety Scale is a ten-item tool available; however, there is little information about its psychometric performance. The study aimed to test the dimensionality, internal consistency, nomological validity, and gender differential item functioning of the scale in patients with chronic obstructive pulmonary disease (COPD) in Colombia. Methods: A psychometric study was designed. It participated in 408 COPD patients aged between 40 and 102 years. Results: The confirmatory factor analysis showed both one- and two-dimension structures with acceptable goodness-of-fit indicators. The brief Spanish Zung Self-Rating Anxiety Scale presented high internal consistency, acceptable nomological validity, and non-gender differential functioning. Conclusions: The brief Spanish Zung Self-Rating Anxiety Scale presents some good indicators of validity and reliability, and it can be used in the measurement of anxiety in COPD patients.

A Literature Review of Depression and Anxiety in Chronic Obstructive Pulmonary Disease (COPD) Patients

Chronic obstructive pulmonary disease (COPD) is a disease that causes disability problems in the world. The high incidence exacerbation of COPD causes an increase in hospitalization rates. Depression and anxiety are conditions that are often associated with COPD, this is due to the burden of disease borne on patients such as shortness of breath, intensity of recurrence, chest pain, chronic cough with productive sputum that interferes with the quality of daily life patients. To assess the scale of depression and anxiety in COPD patients, the Hamilton Depression Rating Scale (HAMA) is used to determine the anxiety scale and the Hamilton Depression Rating Scale (HAMD) is used to assess the depression scale in COPD patients. Both of these scales are tools that are often used in the world because they have good consistency and validity. This literature review also discusses the effective therapies for depression and anxiety patients in COPD such as pulmonary rehabilitation, oxygen therapy, and also includes psychological pharmaceutical therapy.

Other options usually better than benzodiazepines in alleviating dyspnoea, sleeping problems and anxiety in COPD patients

Chronic obstructive pulmonary disease (COPD) is common, especially in older people, and causes progressive dyspnoea that is often accompanied by anxiety and depression. Benzodiazepines (BZDs) are regularly prescribed to COPD patients but can cause significant respiratory adverse events. There are usually better treatment alternatives, such as pulmonary rehabilitation and treatment with antidepressants. The increasing prescription of BZDs with age is concerning, particularly as COPD becomes more prevalent.

Does Liuzijue Qigong affect anxiety in patients with chronic obstructive pulmonary disease, even during the COVID-19 outbreak? a randomized, controlled trial

Background: Anxiety is a common comorbidity associated with chronic obstructive pulmonary disease (COPD), but no well-recognized method can provide effective relief. Liuzijue Qigong (LQG) is a traditional Chinese fitness method, based on breath pronunciation. This study aimed to examine the efficacy of LQG to relieve anxiety in COPD patients and to explore the factors that influence anxiety, including whether LQG is effective during the coronavirus disease 2019 (COVID-19) outbreak. Methods: We conducted an open-label, randomized, controlled, clinical trial. A total of 60 patients with stable COPD were randomly assigned to two groups. Both groups were given routine medical treatment, and the patients in the pulmonary rehabilitation (PR) group were given an extra intervention in the form of LQG, performed for 30 minutes each day for 12 weeks. Data collection was performed at baseline and 12 weeks (during the COVID-19 epidemic). The primary outcomes were the self-rating anxiety scale (SAS) scores, and the secondary outcomes were relevant information during the epidemic and analyses of the related factors that influenced SAS scores during the COVID-19 outbreak. Results: Compared with baseline, patients in both groups demonstrated varying degrees of improvements in their SAS scores (all P < 0.01). An analysis of covariance, adjusted for baseline scores, indicated that the SAS scores improved more dramatically in the PR group than in the control group (F = 9.539, P = 0.004). During the outbreak, the SAS scores for sleep disorder were higher than all other factors, reaching 1.38 ± 0.67, and the scores for “I can breathe in and out easily” for the PR group were lower than the scores for the control group (Z = −2.108, P = 0.035). Significant differences were identified between the two groups for the categories “How much has the outbreak affected your life”, “Do you practice LQG during the epidemic” and “Do you practice other exercises during the epidemic” (all P < 0.05). Compared with current reports, LQG had a relatively high adherence rate (80.95%). A multiple linear regression analysis revealed multiple predictors for SAS scores during the outbreak: group (b = −3.907, t = −3.824, P < 0.001), COPD assessment test score (b = 0.309, t = 2.876, P = 0.006), SAS score at baseline (b = 0.189, t = 3.074, P = 0.004), and living in a village (b = 4.886, t = 2.085, P = 0.043). Conclusion: LQG could effectively reduce the risks of anxiety among COPD patients, even during the COVID-19 outbreak. For those COPD patients with high COPD assessment test and high baseline SAS scores or who live in villages, we should reinforce the management and intervention of psychological factors during the epidemic.

Pengaruh Cognitive Behavior Therapy terhadap Penurunan Kecemasan pada Pasien Penyakit Paru Obstruktif Kronis (PPOK) Rawat Inap di Rumah Sakit Paru dr. H. A. Rotinsulu Bandung

This study was conducted to obtain an overview of the influence of Cognitive Behavior Therapy (CBT) to reduce anxiety by changing negative automatic thoughts (NATs) in patients with chronic obstructive pulmonary disease (COPD) hospitalization in Lung Hospital Dr. H. A. Rotinsulu Bandung became a positive thoughts. Krauskopf et al (2015) revealed that illness beliefs and medication beliefs can affect NATs of COPD patients. The samples in this research were two patients with COPD inpatient at Lung Hospital Dr. H. A. Rotinsulu Bandung who has high degree of anxiety. The main measuring tool used in this research is Beck Anxiety Inventory (BAI) which has been translated into Indonesian. The therapy sessions were conducted over five sessions. From the results of the study, it can be concluded that Cognitive Behavior Therapy can reduce the degree of anxiety in COPD patients hospitalized by changing the NATs related to illness beliefs and medication beliefs.&#x0D; &#x0D; Keywords: anxiety, cognitive behavior therapy, chronic obstructive pulmonary disease, inpatient

A Review of Cognitive Behavioral Therapy for Panic Disorder in Patients with Chronic Obstructive Pulmonary Disease: The Rationale for Interoceptive Exposure

Panic disorder commonly co-occurs in patients with chronic obstructive pulmonary disease (COPD), and translational interventions are needed to address the fear of physiological arousal in this population. This paper examines the utility of interoceptive exposures (IE), a key component of cognitive behavioral therapy (CBT) for panic disorder, in patients with comorbid panic and COPD. Our translational review of the literature suggests that IE is supported by both cognitive- and learning-theory perspectives of panic, and that the breathing exercises associated with IE are safe and highly compatible with existing pulmonary rehabilitation exercises for COPD. Unfortunately, few research studies have examined the use of CBT to treat anxiety in COPD patients, and none have included IE. Given the strong theoretical and empirical support for the use of IE, we suggest that mental health providers should consider incorporating IE into CBT interventions for patients with comorbid panic and COPD.

Managing mood disorders in patients attending pulmonary rehabilitation clinics

BackgroundThere is good evidence for the positive benefits of pulmonary rehabilitation (PR) in the prevention of hospital admissions, lower mortality, and improved health-related quality of life. There is also increasing evidence about the impact of PR on mental health and, in particular, mood disorders. We aimed to identify how depression in chronic obstructive pulmonary disease (COPD) patients in Victoria, Australia, is being managed in PR, to identify the prevalence of depressive symptoms among COPD patients who attend PR, and to determine whether patients with depressive symptoms or anxiety symptoms dropped out of PR early.MethodOf 61 PR clinics, 44 were invited and 22 agreed to participate. Telephone interviews were conducted to see how depression and anxiety in COPD patients were being recognized and managed in these clinics. A total of 294 questionnaires were distributed to patients by clinic coordinators to determine the prevalence of anxiety/depression, as measured by the Hospital Anxiety and Depression Scale. Coordinators were contacted to provide information on whether respondents dropped out of rehabilitation early or continued with their treatment at 2–4 months post program.ResultsSeven clinics were not aware of local guidelines on assessment/treatment/management of mood. Four clinics did not use any screening tools or other aids in the recognition and management of depression and/or anxiety. Overall, eight clinics participating in this study requested advice on suitable screening tools. The patient survey indicated that the mean depression score on the Hospital Anxiety and Depression Scale was 5.0 (standard deviation 3.0, range 1–13). The mean anxiety score was 5.5 (standard deviation 3.4, range 0–18). There was no evidence of a link between failure to complete rehabilitation and depression or anxiety scores, as only three of 105 patients failed to complete their rehabilitation.Discussion: Awareness of management guidelines for depression and anxiety in COPD patients was variable across the clinics recruited into our study. We found no link between compliance with rehabilitation and depression, but our sample had limitations.ConclusionFuture research needs to investigate how best to encourage more use of available guidelines regarding integrating psychological and psychosocial support to supplement the exercise and education that are currently offered routinely by all PR clinics studied in Victoria, Australia.

The role of social support in anxiety for persons with COPD

ObjectiveThis study examined the contribution of perceived social support to the presence of anxiety in persons with chronic obstructive pulmonary disease (COPD). MethodsA cross-sectional survey sample of 452 persons with COPD (61.3% female; 53.5% older than 65; 70.8% without a college degree or higher educational achievement, and 54.8% with household income of $40,000 or less) completed a telephone survey. Measures included the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), 5 social support subscales from the Positive and Negative Social Exchanges (PANSE) Scale, a COPD Severity Score (CSS; a weighted algorithmic combination of symptoms and the need for various COPD medical interventions), and the Geriatric Depression Scale, Short Form (GDS-SF). Zero order correlations and a series of multiple regression analyses were calculated. ResultsMultiple regression analysis revealed that the receipt of instrumental support, feeling let down by the failure of others to provide needed help, and unsympathetic or insensitive behavior from others each positively predicted a higher level of patient anxiety in COPD patients, after controlling for demographic variables, smoking status, comorbid depression (GDS) and severity of illness (CSS). Additionally, the control variable of depression was the strongest predictor of anxiety, suggesting a high degree of co-morbidity in this sample. ConclusionAnxiety and depression are serious co-morbid mental health concerns for persons with COPD. It is important to examine both positive and negative aspects of perceived social support for COPD patients and how they may impact or interact with these mental health concerns.

Mental disorders in chronic obstructive pulmonary disease (COPD)

Recent research using questionnaire measures has demonstrated high prevalence rates of mental disorders in chronic obstructive pulmonary disease (COPD). However, clinical interviews and clinical rather than healthy control groups have rarely been employed. The aim of the present study was to assess mental disorders in patients with COPD with advanced methodology, to identify moderating factors explaining mental co-morbidities and to compare results with a clinical control group without COPD. A standardized clinical interview (F-DIPS) and a range of questionnaires were used to assess mental disorders, perceived physical symptoms and cognitions in 20 hospitalized patients with mild-to-moderate COPD (mean FEV(1)/VC (%)=61.3). Results were compared with a hospitalized clinical control group without pulmonary dysfunction (CCG; N=20). Results showed that 55% of patients with COPD received a diagnosis of a mental disorder compared to 30% of CCG patients. All principal mental diagnoses in the COPD group were anxiety disorders (especially Panic Disorder with Agoraphobia), while CCG patients received a wider range of diagnoses (anxiety, pain, alcohol abuse). There was no systematic association between anxiety levels and respiratory function in the whole COPD group, but a positive correlation between anxiety levels and perceived physical symptoms (p<0.001) as well as negative cognitions (p<0.001 and p<0.05, respectively) for COPD patients with anxiety disorder (N=11). The present results confirm the high prevalence rate of anxiety in patients with COPD and suggest further that anxiety in COPD patients may be mediated by cognitive processes. These findings are discussed in terms of their implications for treatment.

3 Patient perspectives on COPD

Recent research using questionnaire measures has demonstrated high prevalence rates of mental disorders in chronic obstructive pulmonary disease (COPD). However, clinical interviews and clinical rather than healthy control groups have rarely been employed. The aim of the present study was to assess mental disorders in patients with COPD with advanced methodology, to identify moderating factors explaining mental co-morbidities and to compare results with a clinical control group without COPD.A standardized clinical interview (F-DIPS) and a range of questionnaires were used to assess mental disorders, perceived physical symptoms and cognitions in 20 hospitalized patients with mild-to-moderate COPD (mean FEV1/VC (%)=61.3). Results were compared with a hospitalized clinical control group without pulmonary dysfunction (CCG; N=20).Results showed that 55% of patients with COPD received a diagnosis of a mental disorder compared to 30% of CCG patients. All principal mental diagnoses in the COPD group were anxiety disorders (especially Panic Disorder with Agoraphobia), while CCG patients received a wider range of diagnoses (anxiety, pain, alcohol abuse). There was no systematic association between anxiety levels and respiratory function in the whole COPD group, but a positive correlation between anxiety levels and perceived physical symptoms (p<0.001) as well as negative cognitions (p<0.001 and p<0.05, respectively) for COPD patients with anxiety disorder (N=11).The present results confirm the high prevalence rate of anxiety in patients with COPD and suggest further that anxiety in COPD patients may be mediated by cognitive processes. These findings are discussed in terms of their implications for treatment.

Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review

A review of the literature revealed high comorbidity of chronic obstructive pulmonary disease (COPD) and states of anxiety and depression, indicative of excess, psychiatric morbidity in COPD. The existing studies point to a prevalence of clinical significant symptoms of depression and anxiety amounting to around 50%. The prevalence of panic disorder and major depression in COPD patients is correspondingly markedly increased compared to the general population. Pathogenetic mechanisms remain unclear but both psychological and organic factors seem to play a role. The clinical and social implications are severe and the concurrent psychiatric disorders may lead to increased morbidity and impaired quality of life. Furthermore, the risk of missing the proper diagnosis and treatment of a concurrent psychiatric complication is evident when COPD patients are treated in medical clinics. Until now only few intervention studies have been conducted, but results suggest that treatment of concurrent psychiatric disorder leads to improvement in the physical as well as the psychological state of the patient. Panic anxiety as well as generalized anxiety in COPD patients is most safely treated with newer antidepressants. Depression is treated with antidepressants according to usual clinical guidelines. There is a need for further intervention studies to determine the overall effect of antidepressants in the treatment of anxiety and depression in this group of patients.

Anxiety and chronic obstructive pulmonary disease: prevalence, impact, and treatment.

This article reviews the prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease (COPD) as well as the impact of comorbid anxiety on quality of life in patients with COPD. Published studies on three types of treatments for anxiety are then reviewed: psychopharmacology, psychotherapy, and pulmonary rehabilitation programs. A PubMed search was conducted of the literature from 1966 through 2002 using the keywords anxiety, chronic obstructive pulmonary disease, respiratory diseases, obstructive lung diseases, and pulmonary rehabilitation. Any articles that discussed the prevalence of anxiety symptoms or anxiety disorders among patients with COPD, the impact of anxiety on patients with COPD, or the treatment of anxiety in COPD patients were included in this review. Anxiety disorders, especially generalized anxiety disorder (GAD) and panic disorder, occur at a higher rate in patients with COPD compared with the general population. Not surprisingly, anxiety has a significant and negative impact on quality of life of COPD patients. Nonetheless, few studies have examined pharmacological, psychotherapeutic, or pulmonary rehabilitation treatments for anxiety disorders in the context of COPD. Trials of nortriptyline, buspirone, and sertraline have been found to reduce symptoms of anxiety. Similarly, cognitive-behavioral programs that focus on relaxation and changes in thinking also produced declines in anxious symptoms. Finally, multicomponent pulmonary rehabilitation programs can also result in reductions in anxious symptoms. Studies examining the treatment of anxiety disorders in patients with COPD are promising, yet their efficacy needs to be established. The long-term effects of treatment of anxiety disorders on quality of life of COPD patients have yet to be explored.

Relaxation to Reduce Dyspnea and Anxiety in COPD Patients

The purpose of this study was to test the effectiveness of a taped relaxation message in reducing dyspnea and anxiety in chronic obstructive pulmonary disease (COPD) patients. Twenty-six adult COPD patients with dyspnea were randomly assigned to two groups. The treatment group was taught relaxation using a prerecorded tape while the control group was instructed to sit quietly. Skin temperature, heart rate, and respiratory rate were recorded for all subjects during a total of four weekly sessions. Anxiety, dyspnea, and airway obstruction were measured at the beginning and end of the study. The relaxation group achieved the preset relaxation criteria. Dyspnea, anxiety, and airway obstruction were reduced in the relaxation group while the control group remained the same or became worse.