Assessment Of Anxiety Research Articles

Central nervous system active medication use in Medicare enrollees receiving home health care: association with chronic pain and anxiety level.

No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. Three sets of linear regression difference-in-reduction analyses assessed the association of pain or anxiety reduction with number of drugs; drug type; and drug combinations in those with daily pain and daily anxiety. Logistic regression analysis assessed the effect of medication number and class on less-than-daily pain or anxiety at HH discharge. A sensitivity analysis using multinomial regression was conducted with a three-level improvement to further determine clinical significance. Of 85,403 HH patients, 43% received opioids, 27% benzodiazepines, 26% gabapentinoids, 32% selective serotonin reuptake inhibitors, and 8% serotonin and norepinephrine reuptake inhibitors (SNRI). Furthermore, 75% had depression, 40% had substance use disorder diagnoses, and 6.9% had PTSD diagnoses. At HH admission, 83%, 35%, and 30% of patients reported daily pain, daily anxiety, and both, respectively. Central nervous system polypharmacy was associated with worse pain control and had no significant effect on anxiety. For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.

A - 38 Examining Persisting State Anxiety and Concussion Clinical Outcomes across Concussion Recovery

Abstract Purpose Document changes in state anxiety over the course of recovery from concussion and examine the effect of persisting state anxiety on concussion clinical outcomes. Method Patients (ages 15–51 yrs) seeking care for a sport or non-sport-related concussion within 1–7 days post-injury were included in this study. Participants completed a self-report measure of state anxiety (STAI) at each clinical visit. Differences in STAI scores from visit 1 and visit 2 were calculated and used to categorize patients into a PERSIST (scores stayed the same or got worse) and an IMPROVE group (scores improved). Changes in STAI scores across two clinical visits were examined with a paired samples t-test, and a series of independent samples t-tests and chi-square analyses were used to examine between-group differences in clinical outcomes (symptom score, neurocognitive scores, vestibular/ocular motor symptoms and impairment, and recovery time). Results 187 participants (M = 22.37, SD = 10.67 yrs, 65% female) completed study measures at 4.25 (SD = 1.68) (visit 1) and 13.20 (SD = 28.65) (visit 2) post-injury. STAI scores significantly differed between first (M = 20.99, SD = 6.05) and second visit (M = 17.41, SD = 6.21, p < 0.001). The PERSIST group (n = 41, M = 25.90, SD = 20.03) had significantly higher total symptom scores at visit 2 compared to those in the IMPROVE group (n = 122, M = 16.23, SD = 16.17, p = 0.002). There were no significant differences in other clinical outcomes between those with and without persisting state anxiety. Conclusions State anxiety changes throughout concussion recovery and individuals with persisting state anxiety exhibit higher symptom scores at visit 2. Assessment, reassurance and recognition of anxiety is important for overall symptom recovery.

VISCERAL SENSITIVITY INDEX (VSI-IT): Italian Adaptation and Validation.

The Visceral Sensitivity Index (VSI) represents a significant advancement in the assessment of gastrointestinal-specific anxiety among patients with irritable bowel syndrome (IBS) and chronic inflammatory bowel diseases (IBD)-such as ulcerative colitis and Crohn's disease. However, an Italian version of the instrument is not yet available for the Italian-speaking population. This study utilized a national sample of 500 individuals divided into four groups: (a) patients with Crohn's disease, (b) patients with ulcerative colitis, (c) patients with IBS, and (d) healthy controls (individuals without any diagnoses) to test the validity and reliability of the Italian VSI. Using back-translation methodology to ensure translation fidelity, this research applied a questionnaire and the VSI through an online format to 500 participants. Confirmatory Factor Analysis (CFA) revealed that the Italian VSI had excellent psychometric properties, demonstrating high internal consistency (Cronbach's α = 0.949) and construct validity. The scale proved sensitive in detecting significant differences in visceral sensitivity among groups, highlighting its utility as a clinical and research assessment tool. Specifically, the Italian VSI exhibited a unidimensional factorial structure and maintained a strong correlation with interoceptive awareness, type of disease, and gastrointestinal symptom severity, confirming its role in enhancing the understanding and management of IBD and IBS in Italy.

Suicide attempts and correlates among in-school adolescents in Benin City, Nigeria

We aim to add to the literature on suicidality in Africa by estimating the prevalence and exploring the behavioural correlates of suicide attempts among in-school adolescents in Benin City, Nigeria. Utilising a cross-sectional design, participants were a random, stratified sample of students who filled out questionnaires to identify various determinants of suicidal attempts among adolescents between the ages of 10 and 19. We used bivariate and multivariate analyses to determine associations between suicide attempts and other variables. A total of 725 adolescents completed the instruments. Over 13.5% reported suicidal ideation, and approximately 10.5% reported that they had attempted suicide in the last year. At the multivariate level, adolescents who attempted suicide had significantly greater odds of being anxious, lonely, or victims of bullying behaviour. Individuals experiencing persistently sad moods, suicidal thoughts and plans were significantly associated with suicide attempts. Suicidal ideation and attempts are prevalent among adolescents. Assessment of anxiety, loneliness, and persistently sad moods as risk factors for suicide attempts among adolescents is vital. Indicators of bullying appear to be particularly relevant to the risk of suicide attempts among adolescents and should be given attention as part of risk assessments. We suggest that bullying prevention programs and early identification of the risk factors be a vital part of strategies for initiating and maintaining public health interventions pitched toward suicide prevention in Nigeria and Africa. This study will, in addition, provide a baseline for future studies on suicidal behaviour.

Assessment of Anxiety, Stress, and Depression Among COVID-19 Survivors After 40 Months in the Kurdistan Region of Iraq: An Online Cross-Sectional Study.

COVID-19 survivors often experience significant and pervasive psychological distress. This study aimed to investigate the prevalence and demographic factors affecting anxiety, stress, and depression levels among COVID-19 survivors in the Kurdistan region of Iraq. This online cross-sectional study was conducted from August 1, 2023to December 17, 2023, in the Kurdistan region of Iraq, including Erbil, Sulaymaniyah, and Duhok. Purposive sampling was used to collect data using an online survey. The survey included demographic information and the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Statistical analysis was performed using Stata version 12(StataCorp LLC, College Station, TX), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess associations between demographic factors and mental health outcomes. A p-value of less than 0.05 was considered statistically significant. A total of 783 participants were enrolled in the study. The mean score for anxiety was 11.62 ± 4.71, indicating moderate levels. For depression, the mean score was 11.54 ± 5.21, indicating mild levels, and for stress, the mean score was 14.0 ± 5.78, indicating normal levels. Younger individuals (15-27) showed higher stress (Estimate: 18.96, P=0.001) and anxiety (Estimate: 2.79, P=0.001) levels compared to older age groups. Males reported significantly lower stress (Estimate: -1.01, P=0.001), anxiety (Estimate: -1.29, P=0.001), and depression (Estimate: -0.72, P=0.001) than females. Participants with a diploma had lower anxiety (Estimate: 0.65, P=0.004) and stress (Estimate: 0.77, P=0.002) levels compared to those with only elementary education. The study found moderate levels of anxiety among COVID-19 survivors, with mild depression and normal stress levels. To address these issues, it is recommended that policymakers develop targeted mental health interventions. Healthcare providers should focus on early identification and treatment, providing personalized counseling and support to enhance coping mechanisms and overall psychological well-being. By implementing these measures, mental health outcomes for COVID-19 survivors in Iraq can be significantly improved.

Women's experiences and views of routine assessment for anxiety in pregnancy and after birth: A qualitative study.

Anxiety in pregnancy and postnatally is highly prevalent but under-recognized. To identify perinatal anxiety, assessment tools must be acceptable to women who are pregnant or postnatal. A qualitative study of women's experiences of anxiety and mental health assessment during pregnancy and after birth and views on the acceptability of perinatal anxiety assessment. Semi-structured interviews were conducted with 41 pregnant or postnatal women. Results were analysed using Sekhon etal.'s acceptability framework, as well as inductive coding of new or emergent themes. Women's perceptions of routine assessment for perinatal anxiety were generally favourable. Most participants thought assessment was needed and that the benefits outweighed potential negative impacts, such as unnecessary referrals to specialist services. Six themes were identified of: (1) Raising awareness; (2) Improving support; (3) Surveillance and stigma; (4) Gatekeeping; (5) Personalized care and (6) Trust. Assessment was seen as a tool for raising awareness about mental health during the perinatal period and a mechanism for normalizing discussions about mental health more generally. However, views on questionnaire assessments themselves were mixed, with some participants feeling they could become an administrative 'tick box' exercise that depersonalizes care and does not provide a space to discuss mental health problems. Routine assessment of perinatal anxiety was generally viewed as positive and acceptable; however, this was qualified by the extent to which it was informed and personalized as a process. Approaches to assessment should ideally be flexible, tailored across the perinatal period and embedded in continuity of care.

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.

Assessment of Depression and Anxiety Among Public Health Students: A Cross-Sectional Study in University of Hail, Saudi Arabia

Objective: The study aims to identify the socio-demographic and lifestyle factors associated with depression, and anxiety among public health students at the University of Hail in Saudi Arabia. Methods: The researchers collected responses from 446 participants using a convenience sampling approach through a cross-sectional quantitative research design. The collected data underwent analysis through descriptive statistics, focusing on socio-demographic and lifestyle factors. Additionally, the measure of association is used to verify the associations of these factors with depression and anxiety among public health students of the University of Hail in Saudi Arabia. Finally, the binary logistic regression is used to identify the impacts of various socio-demographic, and lifestyle factors on mild to severe anxiety and depression of these students. Results: The research proves that lower family income and bad relationships with classmates are significant demographic factors, while unsatisfied sleep, smoking habits, and symptoms ranging from mild to severe depression are lifestyle factors that contribute to heightened anxiety among public health students at the University of Hail in Saudi Arabia. Additionally, it was also found that transitional age (21-25 years) from socio-demographic factors, unsatisfied sleep level, smoking habit, and mild to severe symptoms of anxiety also cause significant increased depression among these students. Conclusion: The study concludes that students who are not satisfied with their sleep, and have a smoking status are more exposed to anxiety as well as depression as compared to non-smokers, and the students with satisfied sleep. Additionally, those students who are not good in relationships with their classmates, and have mild to severe symptoms of depression are exposed to anxiety significantly. Finally, those students having a transitional age of 21-25 years along with mild to severe symptoms of anxiety are significantly exposed to depression.

Impact of Mind-Body Interventions on Psychosocial and Bio Physiological Markers among Elderly

ABSTRACT Background: The global demographic shift toward an older population is witnessing an increase in age-related psychological disorders and chronic illnesses, particularly among those residing in old age homes. Mind-body interventions (MBIs) have shown promise in enhancing mental and physical health without the adverse effects associated with pharmaceuticals. Materials and Methods: This quasi-experimental study involved 42 elderly participants from two old age homes in South India. Participants were divided into an experimental group, which received interventions including Benson’s Relaxation Technique, Guided Imagery, and various mindfulness exercises, and a control group, which received routine care. Assessments of stress, anxiety, depression, and quality of life were conducted at baseline and post-intervention using standardized scales. Results: The experimental group exhibited significant improvements, with reductions in stress scores from an average of 23.71 to 10.86, anxiety scores from 27.62 to 12.71, and depression scores from 10.05 to 5.24. The quality of life scores improved from an average of 37.81 to 54.24. In contrast, the control group showed minimal changes in these psychological parameters, with only slight modifications in quality of life scores from 37.24 to 38.38. Physiological and biochemical markers remained largely unchanged across both groups. Conclusion: The study highlights the critical role of nurses in implementing MBIs to enhance the psychological health and overall well-being of the elderly. Integrating these interventions into regular nursing care can significantly improve the quality of life for elderly individuals, suggesting the adaptation of MBIs as primary non-pharmacological interventions in elderly care practices.

Post-traumatic, Depression, Anxiety, and Stress Symptoms among Malaysian Firefighters

INTRODUCTION: Emergency responders, including firefighters are frequently exposed to life-threatening situations in their daily lives causing an increased risk for occupational stress, anxiety, depression and post-traumatic stress symptoms (PTSS). Hence, this study aimed to determine the prevalence, and correlation of PTSS with stress, anxiety, and depression among Malaysian firefighters. MATERIALS AND METHODS: A cross-sectional study was conducted among firefighters stationed in 20 fire and rescue stations in Penang, Malaysia using self-administered online survey through a purposive sampling. Information collected were sociodemographic data, measurement of severity of PTSS via Post-Traumatic Checklist-5 (PCL-5), and assessment of depression, anxiety, and stress via Depression, Anxiety, and Stress Scale (DASS-21). A descriptive analysis and Pearson's correlation coefficient analyses were employed in study analysis. RESULTS: Out of 562 firefighters participated in the study, the prevalence of PTSS, stress, anxiety, and depression was 5.0%, 2.1%, 13.0%, and 8.5%, respectively. Among those with PTSS, 28.6%, 78.6%, and 67.9% suffered from stress, anxiety, and depression, respectively. Hence, anxiety was highly coexisted with PTSS. There was significant positive correlation between PTSS score and the score of stress (r=0.656, P< 0.001), anxiety (r=0.699, P< 0.001), and depression (r=0.700, P< 0.001). CONCLUSION: Our study findings suggested that stress, anxiety, and depression can co-occur with PTSS. Hence, firefighters should have regular mental health assessments as the concurrent effect of multiple medical conditions may require comprehensive treatment to address the various aspects of each condition.

Elevated Specific Pro-Inflammatory Cytokines in Peripheral Circulation Indicate an Increased Risk of Anxiety and Depression in Rosacea.

Pro-inflammatory cytokines mediate the course of rosacea, anxiety, and depression through various means such as immunity and inflammation. This study aims to further explore the relationship between rosacea, anxiety, and depression through changes in the levels of pro-inflammatory cytokines. 280 rosacea patients were included in the rosacea group, divided into: rosacea without mental disorders, rosacea with anxiety, rosacea with depression, and rosacea with combined anxiety and depression. The mental control group included 210 anxiety and depression patients, divided into: anxiety, depression, and combined anxiety and depression. The healthy control group consisted of 70 healthy individuals. Serum specimens were collected and ELISA was used to detect major pro-inflammatory cytokines. CEA, IGA, GFSS, RosaQoL, HAMA, and HAMD-24 were used for the diagnosis and severity assessment of rosacea and anxiety and depression. This study primarily used the Chi-Square test, Kruskal-Wallis H-test, generalized linear model, and binary logistic regression to evaluate the data. IL-1β, IL-17, and IL-8 levels in rosacea patients and anxiety/depression patients were higher than those in the healthy population (P<0.001), and TNF-α levels in rosacea patients were higher than those in the healthy population (P<0.001). There was an interaction between rosacea, anxiety, and depression in terms of IL-1β, IL-17, and IL-8 levels (P<0.001). Elevated levels of IL-1β, IL-17, and IL-8 are positively correlated with anxiety and depression in rosacea (all P<=0.05). It was confirmed that the elevated levels of IL-1β, IL-17, and IL-8 are positively correlated with the onset of anxiety and depression in rosacea. The interaction of the above inflammatory factors suggests a possible common inflammatory mechanism in the coexistence of rosacea and mental disorders. TNF-α only increased in patients with rosacea, combined with the skin-to-mental irreversible phenomenon, indicating that this cytokine may be a key and potential therapeutic target for the onset of rosacea.

Assessment of anxiety, depression, stress and vitamin d levels in women in warfare

Objective of the study: to assess the levels of vitamin D (25(OH)D) in the blood serum of military women and women involved in a military conflict, as well as to identify the relationship of its indicators with the level of anxiety, depression and stress.Materials and methods. 52 women serving in the Armed Forces of Ukraine and other categories of women involved in the military conflict were surveyed. They entered the main group. The comparison group includes 50 women who are not related to military conflict.The concentration of vitamin D (25(OH)D) in blood serum was determined by enzyme immunoassay In all women. The level of stress was studied using the Depression Anxiety and Stress Scale (DASS-21).Results. The vast majority of women in the main group (76.5%) were diagnosed with vitamin D hypovitaminosis conditions, which significantly exceeded the specific gravity of such patients in the comparison group – 46.0% (р &lt; 0.05). Only 12 (23.08%) women of the main group had a normal level of this vitamin, which was half as much as the specific gravity of such patients in the comparison group – 54% (р &lt; 0.05).The values of the DASS-21 test on the depression scale were 5.74 ± 0.26 points In the main group, while in the comparison group – 4.57 ± 0.31 points (p &lt; 0.05), on the stress scale – 8.22 ± 0.24 points and 6.67 ± 0.28 points, respectively (p &lt; 0.05). Anxiety levels, on the contrary, were more pronounced in civilian women – 5.81 ± 0.24 points compared to the main group (р &lt; 0.001). Signs of anxiety were found in 84.0% of civilian women and in 61.54% of women involved in the military conflict (p &lt; 0.05). However, the specific weight of patients with different levels of this disorder almost did not differ between groups.Conclusions. Today, vitamin D deficiency is a widespread problem among women, regardless of profession. But a more pronounced decrease in its levels was found in female military personnel and other categories of women involved in the military conflict, which is related to the type of chosen profession, service conditions and psycho-emotional stress.It has been established that women who serve in the Armed Forces of Ukraine are more prone to depression and stress. Civilian women, on the other hand, show more signs of anxiety. The revealed relationship between the levels of vitamin D in the blood and elevated scores of the DASS-21 questionnaire in both groups indicates the importance of this vitamin in psycho-emotional stability. The pronounced decrease in the concentration of vitamin D, found in military women against the background of high stress load, substantiates the feasibility of a rational approach to the examination before military service and periodic determination of the vitamin D level, as well as the regular use of its adequate preventive doses.

CATATYMNO-IMAGINATIVE PSYCHOTHERAPY IN THE TREATMENT OF PATIENTS WITH ANXIETY-PHOBIC DISORDERS

Modern conditions are not sufficient for a psychotherapist to study and apply only one modality in practice. Requires a level of professional competence that allows to use the psychotherapeutic potential of various psychotherapeutic modalities, in combining them in their work. In this case, the multimodal (integrative) approach of using the method of catatymno-imaginative symbolic drama allows fully implementing the principle of an individual approach to each patient, providing the opportunity to take into account not only the nature of his mental disorders, but also personal characteristics such as the level of intelligence, emotional state, and also behavior. This research aims to reveal the peculiarities of organizing and implementing psychotherapy using the catatym-imaginative drama symbol method involving 14 outpatients in various departments of the State Budget Agency who have been diagnosed with anxiety based on ICD-10. The testing method used in this research was the Sheehan Anxiety Scale and anxiety assessment techniques based on the Spielberger-Khanin theory. The measurements were carried out at the initial session of the meeting and the final session (8th meeting). The method used is combined with body-oriented psychotherapy. The results of this study showed that respondents with anxiety-phobic disorders had a positive correlation, and this relationship was more pronounced before training. Pearson correlation coefficient (r) was 0.87 (before training) and 0.79 (after training). It can be concluded that in the treatment of patients with anxiety-phobic disorders, the method of catatim-imaginative therapy significantly reduces the negative symptoms.

Body image and social appearance anxiety in patients with cancer undergoing radiotherapy: a cross-sectional study

BackgroundThe body image of patients with cancer can be negatively affected due to treatment toxicities. Changes in body image may cause patients to experience social appearance anxiety. This study aimed to evaluate the body image and social appearance anxiety of patients with cancer undergoing radiotherapy.MethodsThe cross-sectional study was conducted with 153 patients with cancer undergoing radiotherapy in a university hospital. The data were collected with a Patient Information Form, the Body Image Scale, and the Social Appearance Anxiety Scale and the Radiation Therapy Oncology Group Skin Toxicity Criteria.ResultsPatients’ mean body image score was 15.18 ± 8.26 (min = 0, max = 30), mean social appearance anxiety score was 45.29 ± 14.50 (min = 16, max = 80). Patients with low education levels and low-income levels had higher body image and social appearance anxiety scores (p < 0.01). Body image and social appearance anxiety scores were found to be higher in patients with advanced cancer, grade III-IV skin toxicity, pain, fatigue, and constipation (p < 0.05).ConclusionsRadiotherapy may negatively affect body image and social appearance anxiety. Assessments of body image and social appearance anxiety regularly before, during, and after treatment are essential. Psychosocial support should be provided to patients to reduce body image and social appearance anxiety and increase their well-being. Patients with cancer especially those who have low income and education levels, advanced cancer stage and skin toxicity, and suffer from pain, fatigue, constipation, etc. should be supported by methods such as counseling and social support groups.

Dietary supplementation with a wild green oat extract (Avena sativa L.) to improve wellness and wellbeing during smoking reduction or cessation: a randomized double-blind controlled study.

Smoking reduction or cessation are critical public health goals, given the well-documented risks of tobacco use to health. Reducing smoking frequency and cessation entirely are challenging due to nicotine addiction and withdrawal symptoms, which can significantly affect mental wellness and overall wellbeing. Previous research has suggested that certain dietary supplements may support smoking cessation and reduction efforts by mitigating these adverse effects. The objective of this study was to assess the effect of supplementation with 900 mg/day of Neuravena®, a green oat extract (GOE) of Avena sativa L., in enhancing wellness and wellbeing during a smoking reduction or cessation experience. This was an 8-week randomized, double-blind, placebo-controlled study, ClinicalTrials Identifier: NCT04749017 (https://classic.clinicaltrials.gov/ct2/show/NCT04749017). Participants were assigned to one of the study groups, 72 participants were assigned to GOE and 73 to placebo. The subjects were followed for 8-weeks intervention period as well as an additional 4-week follow-up period. At subsequent visits, they underwent clinical assessments including assessments of quality of life, perceived stress, depression, nicotine dependence, anxiety, cognitive performance, and specific assessments of craving intensity. GOE was associated with greater improvements in elements of the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire as compared with placebo. Similar results were obtained from the SF-36 questionnaire and a visual QoL analogue scale (VAS). Perceived stress levels showed greater decline from baseline among the GOE supplemented participants as compared to placebo. Sleep quality parameters improved with GOE supplementation and worsened in the placebo group. At the end of the intervention period, the percentage of successful reducers (defined as >20% reduction in daily cigarettes) was higher in the GOE group as compared to placebo (66.7% vs. 49.3%, p = 0.034). The improvements from baseline in QoL measures in the GOE group persisted at 4 weeks after termination of the intervention. GOE supplementation demonstrated greater improvements in quality of life measures, stress and sleep related parameters during a smoking reduction or cessation experience and the product was shown to be safe and well tolerated.

Valine and Inflammation Drive Epilepsy in a Mouse Model of ECHS1 Deficiency.

ECHS1 Deficiency (ECHS1D) is a rare and devastating pediatric disease that currently has no defined treatments. This disorder results from missense loss-of-function mutations in the ECHS1 gene that result in severe developmental delays, encephalopathy, hypotonia, and early death. ECHS1 enzymatic activity is necessary for the beta-oxidation of fatty acids and the oxidation of branched-chain amino acids within the inner mitochondrial matrix. The pathogenesis of disease remains unknown, however it is hypothesized that disease is driven by an accumulation of toxic metabolites from impaired valine oxidation. To expand our knowledge on disease mechanisms, a novel mouse model of ECHS1D was generated that possesses a disease-associated knock-in (KI) allele and a knock-out (KO) allele. To investigate the behavioral phenotype, a battery of testing was performed at multiple time points, which included assessments of learning, motor function, endurance, sensory responses, and anxiety. Neurological abnormalities were assessed using wireless telemetry EEG recordings, pentylenetetrazol (PTZ) seizure induction, and immunohistochemistry. Metabolic perturbations were measured within the liver, serum, and brain using mass spectrometry and magnetic resonance spectroscopy. To test disease mechanisms, mice were subjected to disease pathway stressors and then survival, body weight gain, and epilepsy were assessed. Mice containing KI/KI or KI/KO alleles were viable with normal development and survival, and the presence of KI and KO alleles resulted in a significant reduction in ECHS1 protein. ECHS1D mice displayed reduced exercise capacity and pain sensation. EEG analysis revealed increased slow wave power that was associated with perturbations in sleep. ECHS1D mice had significantly increased epileptiform EEG discharges, and were sensitive to seizure induction, which resulted in death of 60% of ECHS1D mice. Under basal conditions, brain structure was grossly normal, although histological analysis revealed increased microglial activation in aged ECHS1D mice. Increased dietary valine only affected ECHS1D mice, which significantly exacerbated seizure susceptibility and resulted in death. Lastly, acute inflammatory challenge drove regression and early lethality in ECHS1D mice. In conclusion, we developed a novel model of ECHS1D that may be used to further knowledge on disease mechanisms and to develop therapeutics. Our data suggests altered metabolic signaling and inflammation may contribute to epilepsy in ECHS1D, and these alterations may be attributed to impaired valine metabolism.

Photobiomodulation in the aging brain: a systematic review from animal models to humans.

Aging is a multifactorial biological process that may be associated with cognitive decline. Photobiomodulation (PBM) is a non-pharmacological therapy that shows promising results in the treatment or prevention of age-related cognitive impairments. The aim of this review is to compile the preclinical and clinical evidence of the effect of PBM during aging in healthy and pathological conditions, including behavioral analysis and neuropsychological assessment, as well as brain-related modifications. 37 studies were identified by searching in PubMed, Scopus, and PsycInfo databases. Most studies use wavelengths of 800, 810, or 1064nm but intensity and days of application were highly variable. In animal studies, it has been shown improvements in spatial memory, episodic-like memory, social memory, while different results have been found in recognition memory. Locomotor activity improved in Parkinson disease models. In healthy aged humans, it has been outlined improvements in working memory, cognitive inhibition, and lexical/semantic access, while general cognition was mainly enhanced on Alzheimer disease or mild cognitive impairment. Anxiety assessment is scarce and shows mixed results. As for brain activity, results outline promising effects of PBM in reversing metabolic alterations and enhancing mitochondrial function, as evidenced by restored CCO activity and ATP levels. Additionally, PBM demonstrated neuroprotective, anti-inflammatory, immunomodulatory and hemodynamic effects. The findings suggest that PBM holds promise as a non-invasive intervention for enhancing cognitive function, and in the modulation of brain functional reorganization. It is necessary to develop standardized protocols for the correct, beneficial, and homogeneous use of PBM.

Correlation of DAS 28 Score and Treatment Compliance with Depression and Anxiety in Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder characterized by synovial inflammation, joint destruction, and significant disability. Psychological factors, particularly depression and anxiety, are prevalent among RA patients and can impact disease management and treatment adherence. Understanding the relationship between disease activity, treatment compliance, and mental health is essential for comprehensive RA management. Objective: To investigate the correlation between Disease Activity Score 28 (DAS28) and treatment compliance with levels of depression and anxiety in patients with rheumatoid arthritis. Methods: This cross-sectional study was conducted at the Department of Rheumatology and Immunology, Sheikh Zayed Hospital, Lahore, over six months. A total of 130 RA patients were enrolled using non-probability convenience sampling. Inclusion criteria were adults aged 18 years and above, diagnosed with RA based on ACR/EULAR criteria, and compliant with medication for at least three months prior to the study. Exclusion criteria included other autoimmune diseases, significant concurrent medical conditions, history of substance abuse, and recent initiation of biologic treatments. Data collection involved demographic details, RA onset and duration, and assessments of depression and anxiety using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. RA disease activity was measured using DAS28, and systemic inflammation markers (ESR and CRP) were recorded. Data analysis was performed using SPSS version 25.0, employing descriptive statistics, correlation analysis, and regression analysis to determine the relationships between variables. Results: The study included 59 males (45.4%) and 71 females (54.6%), with a mean age of 49.69 years (SD = 18.82). The mean duration of RA diagnosis was 14.07 years (SD = 8.69). Higher PHQ-9 scores were associated with lower treatment adherence (B = -1.264, p &lt; 0.001), and higher GAD-7 scores also negatively impacted adherence (B = 0.870, p &lt; 0.01). The regression model explained 40.3% of the variance in treatment adherence (R² = 0.403, F(7, 122) = 11.779, p &lt; 0.001). Weak negative correlations were observed between DAS28 ESR and treatment adherence (r = -0.150), indicating that higher disease activity slightly reduced adherence. Conclusion: The study highlighted the significant role of mental health in the management of RA. Depression and anxiety were found to be major barriers to treatment adherence, underscoring the need for integrating psychological care into RA management. Addressing mental health issues could enhance treatment adherence and improve overall disease outcomes. Keywords: Rheumatoid Arthritis, DAS28, Treatment Adherence, Depression, Anxiety, Psychological Factors, Systemic Inflammation, PHQ-9, GAD-7, Chronic Disease Management, SPSS 25.0, Cross-Sectional Study, ACR/EULAR Criteria

Re-assessing the assessment of fears of positive and negative evaluation: Scale development and psychometric evaluation of the Bivalent Fear of Evaluation Scale (BFOES)

The bivalent fear of evaluation (BFOE) model of social anxiety divides fear of evaluation into two distinct valences: fear of positive evaluation (FPE) and fear of negative evaluation (FNE). However, there is evidence that the two most widely utilized and psychometrically supported measures of FNE and FPE contain items which are ambiguous with regard to valence of evaluative fear. To formally address this, the BFOE Scale (BFOES) was developed, by merging items from measures of FNE and FPE into a single scale with an integrated response format. The present studies examined the psychometric profile of the BFOES across a large pooled archival dataset (N = 2216), which included approximately 10 % (n = 224) patients with social anxiety disorder (SAD). The factorial validity, internal consistency, and construct validity of the BFOES were examined. Additionally, item response theory analyses were employed for the purpose of merging items from self-report scales which utilized different Likert-type response formats. Results from both studies provided support for the psychometric profile of the BFOES. The implications of the BFOES for the assessment of social anxiety, and theoretical models of fear of evaluation and SAD, are discussed.

Predictors of short-term anxiety outcome in subthalamic stimulation for Parkinson’s disease

The effects of subthalamic nucleus deep brain stimulation (STN-DBS) on anxiety in Parkinson’s disease (PD) are understudied. We identified clinical predictors of STN-DBS effects on anxiety in this study. In this prospective, open-label, multicentre study, we assessed patients with anxiety undergoing STN-DBS for PD preoperatively and at 6-month follow-up postoperatively. We assessed the Hospital Anxiety and Depression Scale (HADS-anxiety and depression subscales), Unified PD Rating Scale-motor examination, Scales for Outcomes in PD-motor (SCOPA-M)-activities of daily living (ADL) and -motor complications, Non-Motor Symptom Scale (NMSS), PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose. We tested changes at follow-up with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We identified patients with a clinically relevant anxiety improvement of anxiety based on a designated threshold of ½ standard deviation of baseline HADS-anxiety. Moreover, we investigated predictors of HADS-anxiety changes with correlations and linear regressions. We included 50 patients with clinically relevant baseline anxiety (i.e., HADS-anxiety ≥ 8) aged 63.1 years ± 8.3 with 10.4 years ± 4.5 PD duration. HADS-anxiety improved significantly at 6-month follow-up as 80% of our cohort experienced clinically relevant anxiety improvement. In predictor analyses, worse baseline SCOPA-ADL and NMSS-urinary domain were associated with greater HADS-anxiety improvements. HADS-anxiety and PDQ-8 changes correlated moderately. Worse preoperative ADL and urinary symptoms predicted favourable postoperative anxiety outcome, which in turn was directly proportionate to greater QoL improvement. This study highlights the importance of detailed anxiety assessments alongside other non-motor and motor symptoms when advising and monitoring patients undergoing STN-DBS for PD.