Anxiety In Primary Care Patients Research Articles

Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trial

BackgroundThere is a need for high-quality research regarding exercise interventions for persons with anxiety disorders. We investigate whether a 12-week exercise intervention, with different intensities, could reduce anxiety symptoms in patients with anxiety disorders. Methods286 patients were recruited from primary care in Sweden. Severity of symptoms was self-assessed using the Beck Anxiety Inventory (BAI) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Participants were randomly assigned to one of two group exercise programs with cardiorespiratory and resistance training and one control/standard treatment non-exercise group, with 1:1:1 allocation. ResultsPatients in both exercise groups showed larger improvements in both anxiety and depressive symptoms compared to the control group. No differences in effect sizes were found between the two groups. To study a clinically relevant improvement, BAI and MADRS-S were dichotomized with the mean change in the control group as reference. In adjusted models the odds ratio for improved symptoms of anxiety after low-intensity training was 3.62 (CI 1.34–9.76) and after moderate/high intensity 4.88 (CI 1.66–14.39), for depressive symptoms 4.96 (CI 1.81–13.6) and 4.36 (CI 1.57–12.08) respectively. There was a significant intensity trend for improvement in anxiety symptoms. LimitationsThe use of self-rating measures which bears the risk of an under- or overestimation of symptoms. ConclusionsA 12-week group exercise program proved effective for patients with anxiety syndromes in primary care. These findings strengthen the view of physical exercise as an effective treatment and could be more frequently made available in clinical practice for persons with anxiety issues.

Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial.

BackgroundIn the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant.AimTo determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety.Design and settingSecondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012.MethodIn each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months.ResultsA total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = −2.7% [95% CI = −5.1% to −0.3%]; P = 0.029).ConclusionA personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety.

Effectiveness of Rational Emotive Behaviour Therapy in Clinical Social Work: Impact on Frequency of Visits and Use of Psychopharmacological Treatment

Introduction : Over 70% of mental health problems are exclusively managed in Primary Care. The yearly prevalence of depression and anxiety in Primary Care patients in Catalonia is 30% in women and 14% in men. The prevalence of major depressive disorder and of dysthymia is 1.3/1000 and 1.9/1000. As a consequence of their emotional distress, patients with dysthymia are typically frequent users of social and medical services and they are often prescribed psychopharmacological agents, which results in an increased risk of chronification and high pharmacy costs. Objective : The objective of this study is to evaluate the effectiveness of Rational Emotive Behavior Therapy (REBT) administered by a social worker in patients with dysthymia (Intervention Group) in reducing social and primary care (S&PC) attendance and prescription of psychopharmacological agents when compared with standard care (Control Group). Methods : Nonrandomized clinical trial with a 12month followup period from October 2009 to May 2013. Participants were patients with a diagnosis of dysthymia according to the Diagnostic and Statistical Manual of Mental Disorders–IV (DSMIV), recruited from two Primary Care Centers with similar sociodemographic characteristics in the Barcelona metropolitan area. Exclusion criteria were: cognitive impairment, illiteracy, refusal of treatment, severe psychiatric disorder and participation in psychoeducational groups and similar therapies. The Social Worker carried out the individual psychosocial intervention, with a maximum of 8 fortnightly sessions of 30 minutes in the Intervention Group while Control Group was treated as usual only by the general practitioner. Each session is aimed at identifying and analyzing the dysfunctional thoughts of the patients in order to suggest healthier alternatives. The treatment is active, directive, dynamic, and oriented towards psychosocial issues with the goal of empowering the person, group or community. Outcome variables were the frequency of use of primary care services related to the diagnosis of dysthymia and the prescription of psychopharmacological agents as registered in the electronic medical records during the previous 12 months. Other were sociodemographic variables, living arrangements, Beck Depression Inventory and comorbidities at baseline, mesured at baseline, 4 and 12 months. Baseline data from participants in the Intervention Group and Control Group were compared using a chi-square test and the t test. Two logistic regression analyses with adjustment for the propensity scores were carried out to evaluate the effect of the intervention in the improvement of attendance and of prescription of psychopharmacological agents. Ethical Aspects : This study was approved by the Ethics Committee of the Institute of Primary Care Research (IDIAP) Jordi Gol (Protocol: 13/035) and is registered in Clinical Trial Registries with the number IDNCT02112708. Results : The reduction in attendance was 47.9% in the Control Group (n=39) and 77.5% in the Intervention Group (n=51) (OR=3.75, p=0.021). The proportion of patients with a reduced prescription of psychopharmacological agents was 11.4% in the Control Group and 47.8% in the Intervention Group (OR=7.14, p=0.006). Discussion : The results of this study indicate that REBT carried out by clinical Social Worker at S&PC is effective in the treatment of dysthymia, as reflected in the decreased use of psychopharmacological agents and in the reduction of attendance to primary care. Based on the adjusted results, standard medical care and standard prescription of psychopharmacological agents decrease number of visits in 47.9% of patients. This study shows a significant decrease in the number of visits and in the prescription of psychopharmacological agents after a year of the REBT intervention. The results of this study show that these indicators are adequate to evaluate the efficacy of REBT in patients with dysthymia. This study shows that the Social Worker can assume the implementation of REBT in S&PC. This one translates into a great improvement in the healthcare of the patient with dysthymia, which is usually on chronic medication, because other comorbidities, and never prioritized by mental health specialists. We suggest for Rational Emotive Behavior Therapy to be included in the training program of Social Worker so that they are prepared to deliver REBT when required by their colleagues in S&PC, and included in integrated care. Taking into account a broader, biopsychosocial perspective on health, further studies on the effectiveness of REBT to improve quality of life and mood states are needed. Despite that patient perception of REBT has been excellent during the study, it should be evaluated and the qualitative and quantitative results compared by means of methodological triangulation. Finally, cost-effectiveness of REBT in the medium and long term in Primary Care must be studied. Conclusions : Rational Emotive Behavior Therapy decreases the proportion of patients that need prescription of psychopharmacological agents and frequent attendance to S&PC.

Validation of the Generalized Anxiety Disorder-7 in people with epilepsy: A MEPSY study

The Generalized Anxiety Disorder-7 (GAD-7) is a valuable instrument to screen for anxiety in primary care patients. However, it has not been validated in people with epilepsy (PWE). Therefore, we validated the GAD-7 and examined its differential effect from adverse effects of antiepileptic drugs (AEDs) on the detection of anxiety in Korean PWE. Eligible patients who visited outpatient clinics in 4 tertiary care hospitals and 1 secondary care hospital underwent several instruments including the Mini International Neuropsychiatric Interview—Plus Version 5.0.0 (MINI-Plus 5.0.0), the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Korean version of the Liverpool Adverse Event Profile (K-LAEP), and the Quality of Life in Epilepsy-10 (QOLIE-10). Two hundred forty-three patients were enrolled in the study, and 51 (21.0%) patients had GAD by the MINI-Plus 5.0.0. Cronbach's α coefficient for the GAD-7 was 0.924. At a cutoff score of 6, the GAD-7 had a sensitivity of 92.2%, a specificity of 89.1%, a positive predictive value of 69.1%, and a negative predictive value of 97.7%. The GAD-7 score was well correlated with the K-NDDI-E score, the K-LAEP score, and the QOLIE-10 overall and subscale scores. The impact of adverse effects of AEDs on the GAD-7 was less than that on the K-NDDI-E. In conclusion, the GAD-7 is a reliable and valid screening tool for detecting GAD in PWE.

Managing co-morbid depression and anxiety in primary care patients with asthma and/or chronic obstructive pulmonary disease: study protocol for a randomized controlled trial.

BackgroundChronic Obstructive Pulmonary Disease (COPD) and asthma are common chronic diseases that are frequently accompanied by depression and/or anxiety. However, symptoms of depression and anxiety are often not recognized and therefore not treated. Currently, only a few studies have tested new clinical approaches that could improve the treatment of co-morbid depression and anxiety in these groups of patients.Methods/designThe present randomized controlled study will be conducted within the framework of PoZoB (Praktijk Ondersteuning Zuid-Oost Brabant), a large primary care organization in the Netherlands. Patients with asthma/COPD and co-morbid anxiety/depression will be included in order to test the effectiveness of a disease management approach to treat these co-morbid disorders. Important elements of this approach are: 1) systematic screening to improve detection of anxiety and depression 2) treatment in case of positive screening 3) monitoring of anxiety and depression 4) intensified treatment in case of non-remission (stepped care).DiscussionThe present study is a large primary care study on the treatment of co-morbid depression and anxiety in patients with asthma and COPD. Strengths of this study are its randomized design, the focus on implementation in primary care and the fact that it applies the latest findings on the treatment of depression and anxiety. First results are expected in 2012/2013.Trial registrationNetherlands Trial Register (NTR): NTR2626

Disease management for co-morbid depression and anxiety in diabetes mellitus: design of a randomised controlled trial in primary care

BackgroundDepression and anxiety are common co-morbid health problems in patients with type 2 diabetes. Both depression and anxiety are associated with poor glycaemic control and increased risk of poor vascular outcomes and higher mortality rates. Results of previous studies have shown that in clinical practice, treatment of depression and anxiety is far from optimal as these symptoms are frequently overlooked and undertreated.Methods/DesignThis randomised controlled trial will examine the effectiveness of a disease management programme treating symptoms of depression and anxiety in primary care patients with Type 2 diabetes. Patients will be randomized on patient level in 1:1 ratio. Random block sizes of 2 and 4 are used. The disease management programme consists of screening, stepped treatment and monitoring of symptoms (n = 80). This will be compared to care as usual (n = 80).DiscussionThe disease management model for co-morbid depression and anxiety in primary care patients with diabetes is expected to result in reduced symptoms of depression and anxiety, improved quality of life, reduced diabetes specific distress and improved glyceamic control, compared to care as usual.Trial RegistrationDutch Trial Register NTR2626

Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA)

BackgroundAppropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety. This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (social phobia, panic disorder with or without agoraphobia, agoraphobia or generalized anxiety disorder), depressive disorders or no disorder (controls).MethodsParticipants were 1601 primary care patients participating in the Netherlands Study of Depression and Anxiety (NESDA). Regression analyses were used to compare the mean BAI scores of the different diagnostic groups and to correct for age and gender.ResultsPatients with any anxiety disorder had a significantly higher mean score than the controls. A significantly higher score was found for patients with panic disorder and agoraphobia compared to patients with agoraphobia only or social phobia only. BAI scores in patients with an anxiety disorder with a co-morbid anxiety disorder and in patients with an anxiety disorder with a co-morbid depressive disorder were significantly higher than BAI scores in patients with an anxiety disorder alone or patients with a depressive disorder alone. Depressed and anxious patients did not differ significantly in their mean scores.ConclusionsThe results suggest that the BAI may be used as a severity indicator of anxiety in primary care patients with different anxiety disorders. However, because the instrument seems to reflect the severity of depression as well, it is not a suitable instrument to discriminate between anxiety and depression in a primary care population.

Brief Intervention for Anxiety in Primary Care Patients

To address the difficulty of assessing and managing multiple anxiety disorders in the primary care setting, this article provides a simple, easy-to-learn, unified approach to the diagnosis, care management, and pharmacotherapy of the 4 most common anxiety disorders found in primary care: panic, generalized anxiety disorders, social anxiety disorders, and posttraumatic stress disorder. This evidence-based approach was developed for an ongoing National Institute of Mental Health-funded study designed to improve the delivery of evidence-based medication and psychotherapy treatment to primary care patients with these anxiety disorders. We present a simple, validated method to screen for the 4 major disorders that emphasizes identifying other medical or psychiatric comorbidities that can complicate treatment; an approach for initial education of the patient and discussion about treatment, including provision of some simple cognitive behavioral therapy skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders; a validated method for monitoring treatment outcome; and an algorithmic approach for the selection of initial medication treatment, the selection of alternative or adjunctive treatments when the initial approach has not produced optimal results, and indications for mental health referral.