Anxious Outpatients Research Articles

Measurement properties of the Swedish clinical outcomes in routine evaluation outcome measures (CORE-OM): Rasch analysis and short version for depressed and anxious out-patients in a multicultural area

IntroductionThe Swedish version of the patient-reported Clinical Outcomes in Routine Evaluation Outcome Measures (CORE-OM) has demonstrated high reliability and acceptable convergent validity in explanatory factor analyses. However, the fundamental scale properties have not yet been validated according to item response theory. The aim of this study was to analyze the measurement properties of the Swedish CORE-OM in a cohort of psychiatric out-patients with depression and anxiety in a multicultural area and to explore combinations of items based on shorter versions of the scale (CORE-10, CORE-6D) to improve measurement properties.MethodsData from CORE-OM assessments of 337 patients were analyzed using Rasch analysis. The patients had a mean age of 30 ± 14 years, the majority were women (72%). Requirements for measurement properties were checked: overall model fit, item fit residuals, targeting, internal consistency, differential item functioning and thresholds. Sensitivity to change was also analyzed.ResultsThe CORE-OM showed high internal consistency (person separation index = 0.947) and adequate targeting, but there was overall model misfit (item trait interaction χ2 = 917.53, p < 0.001), indication of local dependency, and differential item functioning in 9 items. The risk items showed problems with disordered thresholds. The emotional component of the shorter CORE-6D showed the best fit for our sample. Adding 3 items to include depressive and trauma-related content resulted in a unidimensional 8-item set with acceptable reliability, model fit, targeting and sensitivity to change.ConclusionFor out-patients with diagnosed depression or anxiety in a multicultural area, the Swedish CORE-OM showed high internal consistency, but also validity problems. Based on the shorter CORE-6D version, a unidimensional 8-item set could be an alternative brief measure of psychological distress for this population, but further validity studies are required. Qualitative studies exploring the CORE-OM items in non-native speakers are also warranted.

Effectiveness of Text Messaging for the Management of Psychological and Somatic Distress in Depressed and Anxious Outpatients

Background:Cognitive behavioral group therapy has developed several techniques in order to make the treatment of depressive and anxiety disorders more effective. Particularly, the “homework” is a tool in order to practice therapeutic skills in ecological settings. When working with this aim, it is often necessary to support patient compliance.Researches have shown the efficacy of sending a text to the patients in order to support the patient compliance, but only a few data are available on the effectiveness of sending text in the treatment of depression and anxiety.Objective:Verify the effectiveness of sending text in the treatment of depression and anxiety in order to support patient compliance.Methods:Participants were enrolled for cognitive behavioral group therapy. Once completed the treatment, a sub-group of participants (Yes SMS group) was reached by a weekly text message for the whole 3 months time between the end of the intervention and the scheduled follow-up session.All the participants were assessed for the overall psychopathological symptoms, depression, and anxiety before and after the group intervention, and at the 3 months follow up.Results:Both groups improved from pre to post-treatment in all the assessed dimensions; the enhancement endures up to the 3 months follow up.Comparing the two groups regardless of the diagnosis, the Yes SMS group shows significant better outcomes in depression at follow-up and in anxiety both at post-treatment and at follow-up.Conclusion:The weekly SMS as prompt seems to enhance the patient’s compliance.

A test of shame in outpatients with emotional disorder

Background: Shame is an acknowledged part of several psychopathological conditions, but is underrepresented in clinical research. Cook's Internalized Shame Scale (ISS) is the most promising measure, but has mostly been used for testing small clinical samples biased toward depressive pathology and female participants. Aims: To contribute to establishing indicators of pathological shame in outpatients with depression and anxiety disorder, and to contribute to establishing norms for the ISS in Scandinavia. Method: The ISS was administered to n = 200 gender balanced non-patient and outpatient samples. A total of 100 patients each were diagnosed as suffering from a depression or anxiety disorder. The diagnoses were supported by Beck's Depression (BDI) and Anxiety Inventory (BAI). The analyses used were the principal component analysis (PCA) and confirmatory factor analysis (CFA) for item structure and sample equivalence, ANOVAs, t-tests and Mann–Whitney non-parametric statistics for index scores, and the receiver operating curve (ROC) for break-off. Results: Patients' ISS score were similar to the results from previous research, the effect size of patient–non-patient difference was 0.68, correlations indicated a higher level of shame in depression than in anxiety, and the BDI–BAI correlation was 0.56 for both clinical samples. The PCA showed three factors that were identified as: “Inadequacy”, “Emptiness”, and “Vulnerability”. Conclusions: The ISS is a viable instrument, which indicates a widespread shame pathology in both depressive and anxious out-patients. The instrument may not be uni-dimensional, but exploration of factor variation may be a promising goal for further research. Clinical implications: Assessment of shame should be included in diagnosis and treatment of emotional disorder.

Differentiating Cognitive Content between Depressed and Anxious Outpatients

Quantitative research suggests that depressed and anxious patients can be differentiated based on their cognitive content. This study used qualitative research methods to separate the specific components of open‐ended depressive and anxious thought content in 79 psychiatric outpatients. Patients with major depressive disorder (MDD; n = 36), generalized anxiety disorder (GAD; n = 10), and other psychiatric disorders (PC; n = 33) were instructed to (a) describe their most bothersome problem; (b) imagine the worst possible negative outcome followed by the best possible positive outcome; and (c) describe associated thoughts and emotions for each scenario. The content of patients' responses were coded to examine (a) the types and severity of problems; (b) the presence or absence of hopelessness, catastrophizing, hopefulness, and unrealistic positive expectations; and (c) the presence or absence of particular emotions associated with imagined worst and best outcomes. More GAD patients than MDD and PC patients indicated anticipated anxious emotions associated with imagined worst outcomes, and fewer MDD patients than GAD and PC patients indicated anticipated happiness associated with imagined best outcomes. No group differences emerged for the other variables considered. These findings suggest that depressed and anxious patients differ in their cognitive expectancies about future life events in terms of their own anticipated emotional reactions.

P.2.a.024 Social support in anxious and depressive outpatients

P.2.a.024 Social support in anxious and depressive outpatients

Excessive Self-Focused Attention and Defensiveness among Psychiatric Patients: A Vicious Cycle?

The contribution of defensive coping to the phenomenon of excessive self-focused attention was studied in 20 depressed or anxious psychiatric outpatients comprising the negative affect group, 20 patients with psychotic disorders, and a control group of 21 patients of an orthopaedic clinic. Self-focused attention was assessed using the Self-reflectiveness and Internal State Awareness subfactors of the Private Self-consciousness Scale. In accordance with other research on self-focused attention, the negative affect group obtained higher scores on the Self-reflectiveness scale than the control group (t39=2.40, p<.03). To examine the relationship between self-focus and defensiveness, Weinberger, Schwartz, and Davidson's approach was employed, using median splits of short forms of the Taylor Manifest Anxiety Scale and the Marlowe-Crowne scale to differentiate among four groups of subjects. The highest self-reflectiveness was found for those participants who were high in both defensiveness and anxiety. This group scored higher than the nondefensive high anxious group (t30= -2.31, p<.03). The heightened self-focused attention might result from automatically instigated states of self-focused attention and paradoxical effects of defensive efforts to avoid self-focus.

P.2.076 Sleep disorders in anxious and depressive outpatients

P.2.076 Sleep disorders in anxious and depressive outpatients

A psychobiological approach to personality: examination within anxious outpatients

Objective: To examine Cloninger’s psychobiological personality model among different anxiety and depressive outpatients as well as normal healthy comparisons. In addition, the relationship between the underlying temperament dimensions and behavioral coping strategies was also studied using the tri-axial model of coping. Methods: Subjects were 120 outpatients presenting to an anxiety disorders specialty clinic and 17 normal comparisons. They underwent a semi-structured clinical interview and completed a battery of questionnaires, including the Temperament and Character Inventory and the Strategic Approach to Coping Scale. Results: On the temperament dimensions, the patients were elevated on the harm avoidance scale relative to the normal comparisons; the temperament substrate was not differentiated by the anxiety or affective diagnostic types nor was there differences between groups on the other temperament dimensions. Both severity of illness and the presence of a comorbid depressive disorder each contributed independently to harm avoidance scores. Hypotheses regarding the association between underlying temperament and behavioral coping strategies were supported for the dimensions of reward dependence and harm avoidance, but not for novelty seeking. Conclusions: Cloninger’s psychobiological model is supported with the temperament of harm avoidance being the relevant dimension for anxiety and affective disorders. The underlying temperament structure also has clinical relevance for the type of coping strategies that are utilized by an individual.

The efficacy of the Personality Diagnostic Questionnaire-revised as a diagnostic screening instrument in an anxiety disorder group

The efficacy of the Personality Diagnostic Questionnaire - Revised (PDQ-R) as a screening instrument was examined in a sample of 137 anxious outpatients. The SCID-II was used as the criterion. The PDQ-R cut-offs were adjusted until the maximum kappa agreement for each scale was reached. The results showed that increasing the cut-offs decreased the number of false-positive diagnoses and only slightly increased the number of false-negative diagnoses. Inclusion of the PDQ-R as a screening instrument, followed by the SCID-II to verify the false-positive diagnoses appears to be a promising method for the categorical assessment of personality disorders. However, more studies are needed, using DSM-IV instruments to determine the optimal cutoffs. The following aspects should be considered as well: (1) the differences in prevalence rates of PDs, (2) the ability of the PDQ-R to differentiate between state and trait phenomena, (3) the consequences of the false-negative diagnoses and (4) the limited validity of the personality disorder definitions. Copyright (C) 1999 John Wiley Rr Sons, Ltd.

Millon multiaxial personality patterns differentiate depressed and anxious outpatients

Millon multiaxial personality patterns differentiate depressed and anxious outpatients

Millon multiaxial personality patterns differentiate depressed and anxious outpatients

Ninety-three patients, including 47 patients with Generalized Anxiety Disorder (GAD) and 46 patients with Major Depression (MD), were entered into recent clinical trials. Clinicians acknowledge that during the initial screening process, clear separation between depressed and anxious patients may be difficult. By using the DSM-IV criteria, the Hamilton Depression and Anxiety Scales, and a variety of other structured evaluations, patients were divided into the two diagnostic groups. The Millon Multiaxial Inventory (MCMI-III) was administered to all 93 patients as part of their initial assessment, but was not used in the diagnostic decision making process or in assignment to a particular clinical study. Upon completion of these studies, the Millon data were analyzed utilizing a cutoff score of 75, conforming to previous studies. Statistically significant differences in Millon personality patterns between MD and GAD patients included dependent, obsessive-compulsive, self-defeating, and borderline traits. Patients exhibiting dependent, self-defeating, and borderline patterns were statistically more likely to be included in clinical trials of MD rather than GAD. Also, patients with MD were more likely to disclose clinical information and exhibit self-critical behavior when compared to those with GAD. These results suggest that the MCMI-III may detect personality differences between anxious and depressed outpatients presenting for clinical trials.

Millon multiaxial personality patterns differentiate depressed and anxious outpatients

Millon multiaxial personality patterns differentiate depressed and anxious outpatients

The Structured Clinical Interview for DSM-III-R, Axis II and the Millon Clinical Multiaxial Inventory: A Concurrent Validity Study of Personality Disorders Among Anxious Outpatients

The purpose of this study was to examine the concurrent validity of personality disorder diagnoses and the interrater reliability of a relatively new instrument for assessment of personality disorders, the Structured Clinical Interview for DSM-III-R, Axis II (SCID-II). Diagnoses of agoraphobic outpatients yielded by a standardized interview (SCID-II) and by a self-report questionnaire (Millon Clinical Multiaxial Inventory, MCMI-II) were compared

Therapeutic Effects and Effects on Actual Driving Performance of Chronically Administered Buspirone and Diazepam in Anxious Outpatients

Two groups of 12 outpatients each (six men and six women) with generalized anxiety disorder, participated in this study. Each patient was treated single-blind with placebo during the first 7 days (baseline), followed by a double-blind drug treatment period of 4 consecutive weeks (active) and ending again with 7 days single-blind placebo treatment (washout). One group received buspirone 5 mg three times a day in the first week and continued with 10 mg in the morning, 5 mg in the afternoon, and 5 mg in the evening during the second, third, and fourth weeks. The other group received diazepam 5 mg three times a day in all 4 weeks. On the evening of the seventh day of each treatment week the Hamilton Rating Scale for Anxiety and the Symptom Check List (90 items) were applied to assess the therapeutic effects, followed by an on-the-road driving test that started 1.5 hours after the last drug or placebo intake. The test consisted of operating an instrumented vehicle over a 100 kilometer highway circuit while attempting to maintain a constant speed and a steady lateral position within the right traffic lane. Two patients in the diazepam group were unable to complete their test after the first and second treatment week, respectively, because of serious sedative reactions. Both buspirone and diazepam were equally effective in reducing overall anxiety symptoms. The specific profiles showed that buspirone also reduced concomitant depressive symptoms and symptoms of interpersonal sensitivity and anger-hostility. In contrast, diazepam was found to be slightly more effective in reducing somatic symptoms and to positively affect sleep disturbances. Moreover, abrupt discontinuation of diazepam resulted in a relapse of psychic anxiety symptoms comparable with the placebo-baseline level and a partial relapse of somatic anxiety symptoms. Chronic treatment with buspirone had no significant effects on lateral position and speed control. In contrast, diazepam significantly impaired control of lateral position in the first 3 weeks of treatment. There was no significant impairment in the fourth treatment week and the placebo-washout week. Speed control was significantly impaired only in the first week. The relevance of the trend toward decreasing performance impairment during chronic treatment remains to be established.

Alprazolam and Oxazepam in the Treatment of Anxious Out-Patients with Depressive Symptoms: A Double-Blind Multicenter Study

In a four-week double-blind study comparing alprazolam with oxazepam, 62 outpatients suffering from anxiety with depressive symptoms were evaluated. The average daily doses of alprazolam and oxazepam were 1.48 mg and 44.4 mg, respectively. According to all rating scales applied, both alprazolam and oxazepam were effective in relieving anxiety associated with mild depression (p less than 0.01). Alprazolam proved somewhat more effective than oxazepam especially with regard to overall performance (p less than 0.05). Treatment-emergent adverse effects were few and mild for both compounds tested.

Relationship between the beck anxiety inventory and the Hamilton anxiety rating scale with anxious outpatients

The Beck Anxiety Inventory (BAI) and Hamilton Anxiety Rating Scale (HARS) were administered to 367 outpatients with DSM-III/DSM-III-R anxiety disorders. Principal components analyses of the 21-item BAI and 14-item HARS found four BAI components reflecting neurophysiological, subjective, panic, and autonomic self-reported symptoms of anxiety and two HARS components indicating psychic and somatic clinical-ratings of anxiety. Subscales derived by summing the ratings for the items with the highest loadings for each instrument's components had coefficient alphas ….70. The positive correlations of the BAI subscales with the HARS subscales supported the concurrent validities of the BAI subscales. Evidence for the BAI subscales' discriminant validities was also found: The mean BAI subjective, neurophysiological, and panic subscale scores of the patients diagnosed with panic disorders were significantly higher than those for the patients diagnosed with generalized anxiety disorder.

Explorative single‐blind study on the sedative and hypnotic effects of buspirone in anxiety patients

In this single-blind study the sedative and hypnotic properties of buspirone, a nonbenzodiazepine anxiolytic, were investigated in 8 anxious outpatients. Polysomnographic recordings were gathered during baseline, at the start of active medication, after 3 weeks of treatment and one night after discontinuing treatment. Daytime alertness was measured using the Multiple Sleep Latency Test and performance tests. The effects of buspirone on sleep structure were minimal and of no clinical consequence. Subjectively, the patients reported improved sleep quality. There were no effects on daytime alertness at the beginning, after 3 weeks or at sudden discontinuation of the medication. It is concluded that buspirone does not have a sedative or hypnotic effect in anxiety patients.

The Kinetic and Dynamic Characteristics of Benzodiazepines in the Treatment of Anxiety

SummaryBenzodiazepines are assumed to cause drowsiness and sedation. Rating scales such as the Massachusetts General Hospital Sedation Scale and the Morning Evaluation of Drug Induced Sedation Scale allow testing of this hypothesis and assessment of the effects of benzodiazepines. We performed a five-week study of prazepam in 63 anxious outpatients. Plasma levels of desmethyldiazepam were assessed weekly. Placebo was given the first week, followed by active drug for three weeks, and placebo the final week. One group received prazepam 30 mg/h, the other received prazepam 10 mg three times per day. Drowsiness-sedation and anxiolytic efficacy were assessed at baseline and weekly. Plasma desmethyldiazepam levels were similar in both treatment groups. Efficacy was profound in both groups. Drowsiness-sedation measured high at baseline and decreased significantly (P=0.05) over the 3 weeks when active drug was administered. Sedation decreased by as much as 40%. Sleep was improved with prazepam, and this may have resulted in decreased drowsiness. We conclude that anxious outpatients have significant levels of drowsiness-sedation and that treatment with benzodiazepines reduces the occurrence of this symptom.

A study of buspirone coprescribed with histamine H2-receptor antagonists in anxious outpatients.

In a study of a large cohort of patients suffering from anxiety symptoms and treated with the new anxiolytic, buspirone, 0.5% were found to be receiving concomitant histamine H2-receptor antagonist therapy. A study of this subgroup showed that no drug interaction occurred.

Double-blind comparison of buspirone and clorazepate in anxious outpatients

Buspirone, a new nonbenzodiazepine anxiolytic agent, was compared with clorazepate in a double-blind, multicenter trial conducted with 336 outpatients who had moderate to severe anxiety. The two treatments were equally effective for relief of symptoms, including anxiety with associated depression. Although both agents were generally well tolerated, the profile of side effects was dissimilar. Drowsiness and depression occurred significantly (p <0.055) more frequently with clorazepate, whereas nausea and headache occurred significantly (p <0.055) more frequently with buspirone. Clorazepate-treated patients were significantly (p <0.055) more likely to have had an adverse experience that was considered drug related or that interfered with the therapeutic effect. In this study, buspirone was shown to be an effective antianxiety agent, causing significantly less sedation than clorazepate.