Anxiety Ratings Research Articles

Alleviating Pregastroscopy Anxiety Using Mobile Social Media Application.

AimThe research aimed to study the effect of using WeChat (a mobile social media application) on pregastroscopy anxiety and the cooperation of patients with different coping styles.MethodsIn order to decrease patients' pregastroscopy anxiety and improve the tolerance of unsedated gastroscopy, WeChat, a widely used mobile social media application, was applied to provide information prior to their endoscopic procedure. Two hundred and thirty patients who underwent initial unsedated gastroscopy in a large teaching hospital in China were classified into two groups based on their coping style: information seekers or information avoiders, using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). Each of the two groups was prospectively randomly assigned to either receiving the brochure information or conjunctive interactive WeChat-delivered information of gastroscopy. To measure the level of state anxiety, the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory questionnaire was used. State anxiety, blood pressure and heart rate were measured at enrollment, upon arrival, and before gastroscopy.ResultsInformation seekers and avoiders who received information from the brochure and the WeChat platform experienced significantly less state anxiety upon arrival and before gastroscopy. Furthermore, information seekers who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of nausea and bloating, and better tolerance. Information avoiders who received information from the conjunctive WeChat platform had lower frequency of retching, lower scores of discomfort while swallowing the scope and nausea, and better tolerance. However, we found the percentage of information seekers who preferred no WeChat-delivered pregastroscopy information is greater than WeChat-delivered information at the initial questionnaire. No significant difference was found in blood pressure or heart rate upon arrival and before gastroscopy.ConclusionsAlthough people preferred no WeChat-delivered pregastroscopy information, the provision of gastroscopy information through a mobile social media application, such as WeChat, could significantly reduce patients' pregastroscopy anxiety, lower the frequency of retching, reduce the scores of nausea and bloating, and improve tolerance for information seekers. In addition, it could lower the frequency of retching, reduce the scores of discomfort while swallowing the scope and its concurrent nausea, and improve tolerance for information avoiders.

The influence of a manipulation of threat on experimentally-induced secondary hyperalgesia.

Pain is thought to be influenced by the threat value of the particular context in which it occurs. However, the mechanisms by which a threat achieves this influence on pain are unclear. Here, we explore how threat influences experimentally-induced secondary hyperalgesia, which is thought to be a manifestation of central sensitization. We developed an experimental study to investigate the effect of a manipulation of threat on experimentally-induced secondary hyperalgesia in 26 healthy human adults (16 identifying as female; 10 as male). We induced secondary hyperalgesia at both forearms using high-frequency electrical stimulation. Prior to the induction, we used a previously successful method to manipulate threat of tissue damage at one forearm (threat site). The effect of the threat manipulation was determined by comparing participant-rated anxiety, perceived threat, and pain during the experimental induction of secondary hyperalgesia, between the threat and control sites. We hypothesized that the threat site would show greater secondary hyperalgesia (primary outcome) and greater surface area (secondary outcome) of induced secondary hyperalgesia than the control site. Despite a thorough piloting procedure to test the threat manipulation, our data showed no main effect of site on pain, anxiety, or threat ratings during high-frequency electrical stimulation. In the light of no difference in threat between sites, the primary and secondary hypotheses cannot be tested. We discuss reasons why we were unable to replicate the efficacy of this established threat manipulation in our sample, including: (1) competition between threats, (2) generalization of learned threat value, (3) safety cues, (4) trust, and requirements for participant safety, (5) sampling bias, (6) sample-specific habituation to threat, and (7) implausibility of (sham) skin examination and report. Better strategies to manipulate threat are required for further research on the mechanisms by which threat influences pain.

The impact of the COVID pandemic on the attitude and mental health of healthcare professionals working in COVID departments

IntroductionThe COVID pandemic brought an overwhelming impact on hospital systems and personnel in the world.ObjectivesOur study aimed to examine the impact of the COVID pandemic on the attitude and mental health of healthcare professionals working in COVID departments.MethodsWe included 23 healthcare professionals working in the COVID departments of the Hospitals of Sfax. Sociodemographic data, medical history and COVID related details were collected from the participants. Their mental health was assessed by the Hospital anxiety and depression scale (HADS).ResultsIn our sample, 26.1% were men and 73.9% were women, they were aged from 26 to 52. They worked for 57 hours per week, including 27.38 hours of direct contact with COVID positive patients and 5.43 nightshifts per month. A rate of 52.2% of the participants claimed having enough protection tools and 13% confirmed having enough equipment for patient management. 30.4% feared the lack of equipment and 39.1% considered themselves trained enough to manage COVID patients. As for the protective measures, 95.7% reduced contact with family members, 30.4% stopped visiting their parents, 8.7% left the family house and 4.3% didn’t take any particular measure. The mean HADS depression score was 9.61, and 60.86% had a Depression score equal or greater than 8, indicating depression. As for the HADS Anxiety score, its mean was 10.61 and 69.56% had a score equal or greater than 8, indicating anxiety.ConclusionsThe pandemic had a big impact on healthcare professionals working in COVID departments, as shows the relatively high depression and anxiety rate.DisclosureNo significant relationships.

Mental Health Impact among Survivors from COVID 19 Pneumonia, Almoosa Hospital Experience

IntroductionCOVID-19 is associated with mental manifestations, Anxiety and depression appear to be common amongst people hospitalized for COVID-19.Objectivesevaluate the emotional stress resulting from infection and assess its impact on the mental health of patients who recovered from COVID-19 pneumonia.MethodsIt is a cross-sectional study, The mental health assessment tool DASS2 (Arabic version) was applied in collecting the data for the study. Demographic characteristics, chronic disease status, COVID 19 pneumonia, oxygen saturation level were recorded at the follow-up visit, soon after the psychiatric evaluation. Psychological distress was assessed An Arabic version of the Depression, Anxiety, and Stress Scale-21 (DASS-21) was used to assess the mental health status. Statistical analysis by (SPSS, version 25).Results466 patients were consented prior to enrollment in the study, out of the total respondents; (53.2%) were females, anxiety rate was found in (18%), stress in (17%), and depression in (14%) of the patients, significantly elevated blood levels of the inflammatory marker in patients with depression and anxiety, increase in the rates of depression with male gender, increasing age and longer duration of ICU stay respectively, with non-significant p-values. There was also a small increase in the period stayed in ICU among those who developed depression and anxiety. Reduced oxygen saturation in COVID-19 patients with depression was 4 times those with no depression.Conclusionsprolonged ICU stays and reduced oxygen saturation was associated with a high rate of depression in patients with COVID-19, as well as elevated levels of the inflammatory marker D-dimer with depression and anxiety.DisclosureNo significant relationships.

Does a Dog Improve the Mental Well-being of Patients and Staff in a CAMHS Hospital?

AimsThe aim was to create and deliver support sessions with the psychiatry consultant's dog, Rupert, to improve the emotional health of both patients and staff. It was hypothesised that having time with a calm and affectionate dog would reduce both young person and adult anxiety, improve their mood, and help them communicate. Since the start of the COVID-19 outbreak, there has been a gradual increase in demand from children and adolescent mental health services (CAMHS), and consequent pressure on NHS staff. On June 2021, Rupert was registered as an emotional support dog with the Trust and began weekly visits to the Darwin Hospital, Stoke-On-Trent. This is a 12 bedded CAMHS hospital, which has seen an increase in patient illness and increasing staff absence due to COVID-19. Informal reports from staff and patients suggested multiple mental health benefits from spending time with Rupert. To quantify the impact of an emotional support dog on the unit, it was agreed to perform a service evaluation on mood, communication and anxiety of both patients and staff.MethodsA questionnaire, using a Likert-type rating scale, was given to staff and patients before and after spending time with Rupert. Questions asked for ratings of mood, anxiety, and comfort in communicating on a scale from ‘very low’ to ‘very high’. The data collection took place in the last 3 months of 2021. In all, 19 people completed the questionnaire. Because of the small sample size, non-parametric bootstrap resampling methods were used to test before-and-after paired differences for individual participants.ResultsBecause the rating scale is ordinal, care needs to be exercised in interpreting differences, but in broad terms a unit increase is equivalent to an improvement, for example, from ‘low’ to ‘neutral’. On average, patients reported statistically significant improvements in mood (mean diff: 1.14, 95% CI: [0.43, 1.71]), anxiety (mean diff: 2.00, 95% CI: [1.43, 2.57]), and communication (mean diff: 1.00, 95% CI: [0.43, 1.86]). Results for staff were similar with improvements in mood (mean diff: 1.08, 95% CI: [0.83, 1.58]) and anxiety (mean diff: 0.83, 95% CI: [0.50, 1.25]) but smaller in communication (mean diff: 0.33, 95% CI: [0.08, 0.67]).ConclusionTaking an emotional support dog into a CAMHS Hospital produced clear benefits, with consistently positive feedback from sessions and no negative effects. Such was the improvement in both patient and staff well-being, staff have since been encouraged to register their dogs too.

The relation of common inflammatory cytokines with anxiety and depression and their values in estimating cardiovascular outcomes in coronary heart disease patients.

BackgroundInflammatory cytokines are associated with the occurrence and severity of psychological disorders in cerebro‐cardiovascular disease patients. This study aimed to investigate the correlation of inflammatory cytokines with anxiety and depression in coronary heart disease (CHD) patients and their values for estimating cardiovascular outcomes.MethodsTotally, 150 CHD patients and 50 healthy subjects were enrolled. Then, tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6, IL‐10, and IL‐17 in their serum samples were detected using ELISA assay; anxiety and depression were assessed by the HADS score. For CHD patients, major adverse cardiac events (MACE) were recorded and evaluated.ResultsCHD patients presented with increased TNF‐α (median: 50.0 vs. 37.0 pg/ml, p < 0.001), IL‐1β (median: 2.7 vs. 2.0 pg/ml, p < 0.001), IL‐6 (median: 24.7 vs. 24.3 pg/ml, p = 0.032), IL‐17A (median: 58.6 vs. 43.6 pg/ml, p < 0.001), HADS‐A score (p < 0.001), HADS‐D score (p < 0.001), anxiety rate (p < 0.001), and depression rate (p < 0.001) compared to healthy subjects. Then, TNF‐α (p = 0.003), IL‐1β (p = 0.023), and IL‐17A (p < 0.001) were related to elevated HADS‐A score. Also, TNF‐α (p = 0.014) and IL‐17A (p = 0.020) positively, while IL‐10 (p = 0.047) negatively related to the HADS‐D score in CHD patients. Interestingly, elevated TNF‐α and IL‐17A were associated with anxiety and depression occurrence in CHD patients (all p < 0.05). Inspiringly, only TNF‐α high, but not other cytokines, was related to elevated accumulating MACE (p = 0.041), while no correlation of anxiety (p = 0.173) or depression (p = 0.068) with accumulating MACE was observed.ConclusionTNF‐α and IL‐17A correlate with anxiety and depression, while only TNF‐α high is related to elevated accumulating MACE in CHD patients.

The Relationship between Psychological Profiles and Longitudinal Pain Trajectories in People with Chronic Knee Pain

Considerable evidence demonstrates that radiographic findings (e.g., osteophytes) are only modestly associated with the severity of knee pain, suggesting that other biopsychosocial factors likely influence symptom severity. Multiple psychological factors have been linked to worse health outcomes in people with chronic knee pain; however, it remains unclear whether psychological profiles might help explain variability in knee pain severity. The primary goal of this study was to identify unique psychological differences among people with and without chronic knee pain, and then examine whether psychological profiles longitudinally predicted knee pain trajectories over two years. Individuals with (n = 180) and without (n = 64) knee pain were enrolled via community and clinic-based recruitment at two study sites in the Southeastern US. All participants provided sociodemographic information and self-reported psychological measures. Baseline psychological measures included assessments of perceived stress, passive/active coping, somatic symptoms, positive/negative affect, optimism, depression, and anxiety. Individuals with knee pain completed X-rays to determine radiographic disease severity via the Kellgren-Lawrence (KL) scale prior to provision of self-reported pain severity and pain interference every 3 months for two years. Individuals with knee pain had higher ratings of depression, anxiety, positive/negative affect, passive/active coping, perceived stress, and somatic symptoms when compared to individuals without knee pain (all p's < .05). Individuals with knee pain were clustered into four separate psychological profiles (Low-risk, low-moderate risk, high-moderate risk, and high risk). Controlling for baseline KL scores, age, education, and income, linear mixed models revealed the group with the high-risk psychological profile demonstrated the greatest severity of pain and interference over two years when compared to the other groups. Results indicate that psychological profiles, in addition to other pieces of evidence such as radiographic disease severity, may be useful for longitudinally predicting severity of knee pain and related interference over time. Grant support from 5R37AG033906-12.

Deep brain stimulation in the bed nucleus of the stria terminalis: A symptom provocation study in patients with obsessive-compulsive disorder

Deep brain stimulation (DBS) is an emerging therapy for treatment-resistant obsessive-compulsive disorder (OCD), and several targets for electrode implantation and contact selection have been proposed, including the bed nucleus of the stria terminalis (BST). Selecting the active electrode contacts (patients typically have four to choose from in each hemisphere), and thus the main locus of stimulation, can be a taxing process. Here, we investigated whether contact selection based purely on their neuroanatomical position in the BST is a worthwhile approach. For the first time, we also compared the effects of uni- versus bilateral BST stimulation. Nine OCD patients currently receiving DBS participated in a double-blind, randomized symptom provocation study to compare no versus BST stimulation. Primary outcomes were anxiety and mood ratings in response to disorder-relevant trigger images, as well as ratings of obsessions, compulsions, tendency to avoid and overall wellbeing. Furthermore, we asked whether patients preferred the electrode contacts in the BST over their regular stimulation contacts as a new treatment setting after the end of the task. We found no statistically significant group differences between the four conditions (no, left, right and bilateral BST stimulation). Exploratory analyses, as well as follow-up data, did indicate that (bilateral) bipolar stimulation in the BST was beneficial for some patients, particularly for those who had achieved unsatisfactory effects through the typical contact selection procedure. Despite its limitations, this study suggests that selection of stimulation contacts in the BST is a viable option for DBS in treatment-resistant OCD patients.

Grouping of mood symptoms by time series dynamics

BackgroundUnderstanding how symptoms of mood disorders vary over time in relation to each other is potentially valuable for diagnosis and predicting episodes of illness. In this paper, we characterize the degree of similarity of time series of different mood disorder symptoms. MethodsWe collected 32,215 mood disorder symptom questionnaires, administered twice-daily over 18 months to (n = 19) subjects with rapidly cycling bipolar disorder and (n = 20) healthy control subjects, using visual analog scales to rate 11 sets of symptom severity ratings plus a control item. We used Dynamic Time Warping to calculate similarity ratings between all within-subject pairs of severity ratings followed by Exploratory Factor Analysis (EFA) to identify latent factors of symptom time series across all subjects. ResultsTwo latent factors were identified: one with depression and anxiety; and a second, with concentration, energy, irritability, fatigue, appetite, euphoria/elation and overall mood. Restlessness, racing thoughts, and the control item (daily hours of daylight) did not cluster with any of the others. LimitationsLimited sample size dictated that we pool bipolar and healthy patients and use an iterative EFA procedure. ConclusionThis analysis suggests that, in a pooled sample of individuals with bipolar disorder and in healthy controls, severity ratings of overall depression and overall anxiety vary jointly as one dynamic factor, while some but not all other DSM mood symptoms vary jointly along with overall mood rating as a second dynamic factor. Further investigation may determine if these findings can simplify subjective symptom reporting in mood-monitoring studies.

Mood and Behaviors of Adolescents With Depression in a Longitudinal Study Before and During the COVID-19 Pandemic.

ObjectiveTo investigate whether, compared to pre-pandemic levels, depressive and anxiety symptoms in adolescents with depression increased during the pandemic.MethodWe used data from National Institute of Mental Health Characterization and Treatment of Depression (NIMH CAT-D) cohort, a longitudinal case-control study that started pre-pandemic. Most of the participants are from the states of Maryland and Virginia in the United States. We compared depressive symptoms (1,820 measurements; 519 measurements pre-pandemic and 1,302 during the pandemic) and anxiety symptoms (1,800 measurements; 508 measurements pre-pandemic and 1,292 ratings during the pandemic) of 166 adolescents (109 girls, 96 adolescents with depression) before and during the pandemic. Data were collected during yearly clinical visits, interim 4-month follow-up visits, inpatient stays, and weekly outpatient sessions, with additional data collection during the pandemic. Pre-pandemic, healthy volunteers (HVs) had a median of 1 depressive and anxiety rating (range, 1-3), and adolescents with depression had a median of 2 ratings (anxiety rating range, 1-25; depressive rating range, 1-26). During the pandemic, HVs had a median of 8 anxiety ratings and 9 depressive ratings (range, 1-13), and adolescents with depression had a median of 7 anxiety and depressive ratings (range, 1-29). We also analyzed adolescent- and parent-reported behaviors in the CoRonavIruS Health Impact Survey (CRISIS), totaling 920 self-reported measures for 164 adolescents (112 girls, 92 adolescents with depression). HVs had a median of 7 surveys (range, 1-8), and adolescents with depression had a median of 5 surveys (range, 1-8).ResultsPre-pandemic, adolescents with depression had a mean depressive score of 11.16 (95% CI = 10.10, 12.22) and HVs had a mean depressive score of 1.76 (95% CI = 0.40, 3.13), a difference of 9.40 points (95% CI = 7.78, 11.01). During the pandemic, this difference decreased by 22.6% (2.05 points, 95% CI = 0.71, 3.40, p = .003) due to 0.89 points decrease in severity of scores in adolescents with depression (95% CI = 0.08, 1.70, p = .032) and 1.16 points increase in HVs’ depressive symptoms (95% CI = 0.10, 2.23, p = .032). Compared to their pre-pandemic levels, adolescents with depression reported overall lower anxiety symptoms during the pandemic. Parent-on-child reports also were consistent with these results.ConclusionContrary to our hypothesis, we found that both depressive and anxiety symptoms were lower for adolescents with depression during the pandemic compared to before. In contrast, the depression scores for the HVs were higher during the pandemic relative to their pre-pandemic ratings; these scores remained much lower than those of adolescents with depression.Clinical trial registration informationCharacterization and Treatment of Adolescent Depression; https://clinicaltrials.gov/; NCT03388606.

Predictors of Mental Health Help-Seeking During COVID-19: Social Support, Emotion Regulation, and Mental Health Symptoms.

Little is known about factors that contribute to mental health help-seeking during disasters beyond attitudes toward counseling. The COVID-19 (SARS-CoV-2) global pandemic dramatically impacted individuals, families, and communities worldwide. The pandemic led to significant disruptions to family routines, and evidence suggests an increase in instances of mental health symptoms, like depression and anxiety, and poor utilization of mental health services. To better understand psychological factors associated with help-seeking during the COVID-19 pandemic, researchers surveyed respondents (n = 1,533 at time 1) about their mental health and help-seeking using Amazon’s MTurk platform. The results indicated that individuals with higher levels of anxiety rate their likelihood of help-seeking as higher and those who do seek psychological help report higher levels of depression. Further, those who began new treatment for behavioral health difficulties during the COVID-19 pandemic reported lower social support and less clarity about how they felt (specifically, emotional clarity when upset). Implications for clinical researchers and public health are discussed.

An intervention to address math anxiety in the geosciences

Math anxiety involves moderate to extreme fear, anxiety, and occasionally physical pain associated with anticipating or performing mathematical tasks. High levels of math anxiety have been tied to students taking lower levels of math and choosing less quantitatively challenging courses and careers. In a small geoscience program in a primarily undergraduate university, math anxiety has been assessed using a standardized math anxiety rating survey embedded into a more general anxiety survey. An intervention that involves re-phrasing geoscience-focused quantitative word problems was used on both low- and high-stakes assessments. In courses with no intervention at both the major and general education levels, students were found to have similar math anxiety ratings and no significant change over the semester. In contrast, students in the intervention major courses were statistically more likely to have a drop in their math anxiety when compared to the large control and also when compared to a smaller control of similar-level courses. In a geoscience classroom, rephrasing quantitative questions to focus more on geoscience knowledge versus the quantitative task appears to be a viable way to lower math anxiety while giving students’ experience to build their quantitative skills.

Self‐Reported Anxiety Ratings in Children With and Without Food Allergies and Teacher Knowledge of Food Allergies

Researchers have found a relationship between having food allergies and anxiety in children. Anxiety may relate to others' lack of food allergy knowledge. This study investigated the relationship between having a food allergy and self-reported anxiety among children. Furthermore, knowledge of food allergies among children without food allergies and teachers was explored. Children with food allergies and their parents each completed a perceived food allergy severity questionnaire. Children without food allergies completed a food allergy knowledge measure. All children completed a self-reported anxiety measure. Teachers completed a questionnaire investigating knowledge, attitudes, and beliefs about food allergies. Correlational analyses and analyses of variance were conducted. Overall anxiety was significantly higher in children with food allergies than in children without food allergies. When controlling for the effects of sex and age, children with food allergies had significantly higher social phobia and school phobia. Teachers correctly answered 69.7% of knowledge-based questions about food allergies; children without food allergies correctly answered 62.7%. Findings highlight the need for an integrated approach in which families, school personnel, psychologists and other mental health professionals, and medical professionals work together to increase awareness about the multifaceted needs of children with food allergies.

The Impact of the COVID-19 Pandemic on the Psychological Well-being of Healthcare Workers in Obstetrics and Gynaecology: An Observational Study at an Apex Institute.

Background and objectiveThe coronavirus disease 2019 (COVID-19) pandemic has affected the health, social, and economic sectors all over the world. With a view to assessing the impact of COVID-19 on the mental health of healthcare workers (HCWs), we conducted a study to find out the incidence and severity of depression, anxiety, and post-traumatic stress disorder (PTSD) among HCWs.Material and methodsThis was an observational cross-sectional study conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of Psychiatry at AIIMS, New Delhi from March 2021 to June 2021. One hundred HCWs working in the Department of Obstetrics and Gynaecology were surveyed using a set of semi-structured interview schedules and structured questionnaires distributed via email or manually. The structured questionnaire included the demographic profile; other baseline information; the 42-item Depression, Anxiety, and Stress Scale (DASS-42); and the Impact of Event Scale-Revised (IES-R) instrument. Data analysis was carried out using the statistical package STATA version 14.0 (StataCorp LLC, College Station, TX).ResultsA total of 100 HCWs participated in the study, out of which 39 (39%), 45 (45%), and 16 (16%) were doctors, nursing staff, and supporting staff, respectively. Overall, 92 (92%) of the participants were women, and the mean age of the participants was 29.87 ±4.85 years. Out of the 100 participants, 17 (17%), 25 (25%), 13 (13%), and two (2%) participants had depression, anxiety, stress, and PTSD, respectively. Occupation-wise, among the nursing staff, doctors, and supporting staff, the incidence of depression was 24.4%, 15.4%, 0.0%, respectively; the anxiety rate was 33.3%, 25.6%, and 0.0%, respectively; and the rate of stress was 17.8%, 12.8%, and 0.0%, respectively. The IES-R score was significantly higher among unmarried as compared to married participants (2.70 ±7.935 vs. 1.60 ±3.583, p=0.000). Participants living in joint families had a higher DASS-42 score (DASS-D: 4.00 ±5.299 vs. 3.77 ±7.727, p=0.889; DASS-A: 4.31 ±4.398 vs. 4.12 ±7.496, p=0.905; DASS-S: 4.08 ±4.816 vs. 3.88 ±7.567, p=0.016) and lower IES-R score (1.31 ±4.922 vs. 2.66 ±9.947, p=0.752) as compared to those living in nuclear families. Depression (4.86 ±8.165 vs. 2.00 ±4.388, p=0.054), anxiety (5.31 ±7.538 vs. 2.14 ±4.704, p=0.024), stress (5.20 ±7.651 vs. 1.67 ±4.733, p=0.014) and PTSD (3.61 ±10.900 vs. 1.44 ±2.634, p=0.245) were all higher among HCWs having exposure to COVID-19 more than 10 hours per week compared to participants with an exposure of less than 10 hours per week. The participants having psychiatric illness in the family showed significantly higher mean values for DASS-42 (DASS-D: 20.00 ±26.870 vs. 3.50 ±6.264, p=0.001; DASS-A: 18.50 ±20.506 vs. 3.88 ±6.215, p=0.002; DASS-S: 18.00 ±21.213 vs. 3.64 ±6.346, p=0.003) as compared to those without any psychiatric illness in the family.ConclusionBased on our findings, occupational and environmental factors at the workplace play a key role in mental health outcomes, and COVID-19 has had a significant impact on the mental health of HCWs. Furthermore, we have also observed that effective planning can significantly reduce mental stress.

Determination of Death Anxiety and Death-Related Depression Levels in the Elderly During the COVID-19 Pandemic.

The aim of the study is to determine the levels of death anxiety and death-related depression in the elderly during the COVID-19 pandemic. The sample of the descriptive-relational study includes 344 elderly people registered in a family health center. It was determined that the most dreaded fear reported by the elderly who got COVID-19 infection was death, and there was a highly significant positive correlation between death anxiety and death-related depression ratings of the elderly and that as the average death anxiety score of the elderly rises, so does the degree of death-related depression.

Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives.

Standard opioid tapers tend to be associated with increased patient anxiety and higher pain ratings. Pre-authorized concealed opioid reductions may minimize expectations such as fear of increased pain due to the reduction of opioids and, prolong analgesic benefits in experimental settings. We recently observed that patients and clinicians are open to concealed opioid tapering. However, little is known about the “why” behind their attitudes. Based on this lack of data, we analyzed qualitative responses to survey questions on patients' and clinicians' acceptance of a concealed opioid reduction for chronic pain. Seventy-four patients with a history of high dose opioid therapy and 49 clinicians completed a web-based questionnaire with open-ended questions examining responses to two hypothetical clinical trials comparing a concealed opioid reduction pre-authorized by patients vs. standard tapering. We used content analysis based on qualitative descriptive methodology to analyze comments from the patients and clinicians. Five themes were identified: informed consent; anxiety; safety; support; and ignorance is bliss, or not. These themes highlight the overall positive attitudes toward concealed opioid tapers. Our findings reinforce the importance of patient-centered care and are expected to inform the design of clinical trials from both the patient and clinician perspective. This qualitative study presents patients' and clinicians' attitudes toward hypothetical scenarios for a trial of pre-authorized reduction of opioids. The findings indicate positive attitudes and the relevance of engaging patients with effective decision-making processes.

Impact of Emotional Expression of Parents on their Children who have Specific Learning Disorders and the Role of Parental Educational Counseling Program

&#x0D; Background: Children are the world’s real treasures; they should be cherished, well raised and given the chance to develop properly. Some of them in different countries all over the world are suffering from different forms of specific learning disorders, which can be extremely frustrating the school child especially if associated with parental high emotional expression.&#x0D; Objectives: The purpose of the study is to identify the relation between emotional expressions (EE) of parents and anxiety rate in their children with specific learning disorders (SLDs), and its correlation with serum cortisol level of the children. The effect of parental educational counseling program (PECP) on anxiety rate of children and parental emotional expression was studied.&#x0D; Methods: The study was carried out on 140 children with SLD to evaluate their anxiety rate by using Taylor anxiety scale of children, and measuring serum cortisol level. Data were collected from parents by emotional expression scale (EES). Taylor anxiety scale and EES were repeated for children and parents after conducting sessions of PECP.&#x0D; Results: Results of Taylor anxiety scale showed that 60% of studied children were suffering from morbid anxiety. Results of EES showed that 80% of parents were practicing high emotional expression. Scores of children on Taylor anxiety scale demonstrated significant drop from 33.06±10.4 to 25.85±10.4 after applying the intervention (P &lt; 0.001). More than two thirds of parents became practicing low EE after receiving sessions of the interventional program PECP. Scores of parents on EES showed significant drop from 61.31±16.84 to 36.51±13.89 after PECP (P &lt; 0.001). A statistically significant positive correlation between scores of Taylor anxiety scale and EES before PECP was found (R = 0.533), and also after PECP (R = 0.309).&#x0D; Average level of serum cortisol of children with SLD was 8.973+1.784 mcg/dl, and it was significantly higher in boys than girls (P &lt; 0.05). Serum cortisol level of studied children was higher in children with morbid and severe anxiety (P &lt; 0.001). Cortisol levels of children were significantly higher in those whose parents were practicing high EE. Serum cortisol level of children revealed positive correlation with each of their scores on Taylor anxiety scale (R = 0.771) and scores of parents on EES (R = 0.468).&#x0D; Conclusion: Results of this study proved presence of direct relation between anxiety in school children with specific learning disorders and high emotional expressions of their parents. Results concluded effectiveness of PECP in management of children’s anxiety and parental emotional expression.&#x0D; Key words: Specific learning disorders, Emotional expression, Anxiety disorder, Serum cortisol level.

Cued fear conditioning in humans using immersive Virtual Reality

Virtual Reality (VR) is a promising tool for the study of cued fear conditioning in humans because it allows the use of complex and realistic experimental situations. The present study aims to validate a task for the acquisition and extinction of cued fear learning through VR with ecologically relevant Unconditional Stimuli (USs). In a first experiment (n = 69), we evaluated the effectiveness of six USs specially created to be presented in a virtual environment and to provoke physiological and affective reactions of fear. The two stimuli that evoked significantly higher than baseline electromyographic responses during three trials were then selected to be used as the USs in a second experiment. Experiment 2 (n = 51) aimed to determine if the previously selected US could generate a conditioned response (CR) when associated with another visual stimulus (Conditioned Stimulus; CS) in a differential conditioning paradigm, and subsequently go through extinction. We measured physiological, subjective and behavioral responses of fear, and evaluated their relationship to trait anxiety. This study showed that visual CSs in a VR environment can potentiate a startle reflex during acquisition, but we observed no discrimination between stimuli that signaled the US (fear cues CS+) and stimuli that signaled the absence of the US (safety cue CS-). Nevertheless, differential learning was observed in subjective measures (US expectancy and retrospective anxiety ratings) during acquisition, where participants responded differently to fear and safety cues. Subjective CRs, but not physiological, were reduced during extinction. No changes were observed in response suppression presented with CS, and no relationship was found between trait anxiety and fear responses. We conclude that VR is an appropriate model to elicit valid unconditioned fear responses (URs). The results of the present experiments are particularly important given that subjective CRs (observed in Experiment 2) account for an important part of the clinical experience of anxiety-related disorders, which may help to translate the use of VR to exposure therapy. Future research could improve the task to effectively generate differential physiological and behavioral responses with greater sensitivity to individual differences. • Cued fear conditioning is a widely accepted model for specific phobias. • Virtual reality allows the development of more ecological experimental situations with humans. • We created two contextually integrated stimuli (US) in a virtual reality environment. • US were effective in evoking unconditioned responses which were resistant to habituation. • Differential learning and extinction were found in subjective measures.

Anxiety induction and sexual arousal in men and women

Anxiety can sometimes inhibit and sometimes potentiate sexual arousal. We examined whether an anxiety manipulation in a classical fear-conditioning paradigm impacts self-reported sexual arousal in men and women. University students (62 men, 61 women) underwent differential fear conditioning to erotic images; half the images were sometimes (60%) paired with a shock (CS+) and half were never paired with a shock (CS–). For each trial, participants rated their sexual arousal and anxiety in response to the image; skin conductance response (SCR) and zygomatic and corrugator activity were recorded. During acquisition, self-reported sexual arousal was lower to CS+ than CS− (inhibiting effect), but in men only. During extinction, self-reported sexual arousal was lower to CS+ than CS− for both genders. Some differences produced by CS+ and CS− were observed for SCR and zygomatic and corrugator activation at different points during acquisition and extinction, but the effects were unrelated to ratings of anxiety or sexual arousal. The negative impact of anxiety on sexual arousal appears to be resistant to extinction, and small gender differences were observed. Future studies should include direct measures of physiological sexual arousal. The relationship between sexual arousal and anxiety appears to be complex and should be further investigated.

The Impact of Emotional Expressions of Parents on their Children with Specific Learning Disorders: The Role of Parental Educational Counseling Program

BACKGROUND: Children are the world’s real treasures; they should be cherished, well raised, and given the chance to develop properly. Some of them in different countries worldwide are suffering from various forms of specific learning disorders (SLDs), which can be extremely frustrating the school child, especially if associated with parental high emotional expression (EE). OBJECTIVES: The purpose of the study is to identify the relation between parents’ EEs and anxiety rate in their children with SLDs and its correlation with serum cortisol level of the children. The effect of parental educational counseling program (PECP) on the anxiety rate of children and parental EE was studied. METHODS: The study was carried out on 140 children with SLD to evaluate their anxiety rate using Taylor anxiety scale of children, and measuring serum cortisol level. Data were collected from parents by EE scale (EES). Taylor anxiety scale and EES were repeated for children and parents after conducting sessions of PECP. RESULTS: Results of Taylor anxiety scale showed that 60% of studied children were suffering from morbid anxiety. Results of EES showed that 80% of parents were practicing high EE. Scores of children on Taylor anxiety scale demonstrated a significant drop from 33.06 ± 10.4 to 25.85 ± 10.4 after applying the intervention (p &lt; 0.001). More than two-thirds of parents became practicing low EE after receiving sessions of the interventional program PECP. Scores of parents on EES showed a significant drop from 61.31 ± 16.84 to 36.51 ± 13.89 after PECP (p &lt; 0.001). A statistically significant positive correlation between scores of Taylor anxiety scale and EES before PECP was found (r = 0.533) and after PECP (r = 0.309). Average level of serum cortisol of children with SLD was 8.973 ± 1.784 mcg/dl, and it was significantly higher in boys than girls (p &lt; 0.05). Serum cortisol level of studied children was higher in children with morbid and severe anxiety (p &lt; 0.001). Cortisol levels of children were significantly higher in those whose parents were practicing high EE. Serum cortisol level of children revealed a positive correlation with each of their scores on Taylor anxiety scale (r = 0.771) and scores of parents on EES (r = 0.468). CONCLUSION: Results of this study proved the presence of direct relation between anxiety in school children with SLDs and high EEs of their parents. Results concluded the effectiveness of PECP in the management of children’s anxiety and parental EE.