Comorbid Anxiety Symptoms Research Articles

The Effects of Internet-Based Cognitive Behavioral Therapy for Suicidal Ideation or Behaviors on Depression, Anxiety, and Hopelessness in Individuals With Suicidal Ideation: Systematic Review and Meta-Analysis of Individual Participant Data.

Suicide is a global public health problem. Digital interventions are considered a low-threshold treatment option for people with suicidal ideation or behaviors. Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. However, suicidal ideation often is related to additional mental health problems, which should be addressed for optimal care. Yet, the effects of iCBT on related symptoms, such as depression, anxiety, and hopelessness, remain unclear. We aimed to analyze whether digital interventions targeting suicidal ideation had an effect on related mental health symptoms (depression, anxiety, and hopelessness). We systematically searched CENTRAL, PsycInfo, Embase, and PubMed for randomized controlled trials that investigated guided or unguided iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. Individual participant data (IPD) were collected from eligible trials. We conducted a 1-stage IPD meta-analysis on the effects on depression, anxiety, and hopelessness-analyzed as 2 indices: symptom severity and treatment response. We included IPD from 8 out of 9 eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=-0.17; 95% CI -0.25 to -0.09; P<.001) and higher treatment response (ie, 50% reduction of depressive symptoms; b=0.36; 95% CI 0.12-0.60; P=.008) after treatment. We did not find significant effects on anxiety and hopelessness. iCBT for people with suicidal ideation revealed significant effects on depression outcomes but only minor or no effects on anxiety and hopelessness. Therefore, individuals with comorbid symptoms of anxiety or hopelessness may require additional treatment components to optimize care. Studies that monitor symptoms with higher temporal resolution and consider a broader spectrum of factors influencing suicidal ideation are needed to understand the complex interaction of suicidality and related mental health symptoms.

Changes in symptoms of anxiety, depression, and PTSD in an RCT-study of dentist-administered treatment of dental anxiety

BackgroundEducating dentists in treatment methods for dental anxiety would increase the patients’ access to treatments that are important to their oral health. However, to avoid adverse effects on comorbid symptoms, involvement by a psychologist has been considered necessary. The objective of the present paper was to evaluate whether a dentist could implement systematized treatments for dental anxiety without an increase in comorbid symptoms of anxiety, depression or PTSD.MethodsA two-arm parallel randomised controlled trial was set in a general dental practice. Eighty-two patients with self-reported dental anxiety either completed treatment with dentist-administered cognitive behavioural therapy (D-CBT, n = 36), or received dental treatment while sedated with midazolam combined with the systemized communication technique “The Four Habits Model” (Four Habits/midazolam, n = 41). Dental anxiety and comorbid symptoms were measured pre-treatment (n = 96), post-treatment (n = 77) and one-year after treatment (n = 52).ResultsAn Intention-To-Treat analysis indicated reduced dental anxiety scores by the Modified Dental Anxiety Scale (median MDAS: 5.0 (-1,16)). The median scores on the Hospital Index of Anxiety and Depression (HADS-A/D) and the PTSD checklist for DSM-IV (PCL) were reduced as follows: HADS-A: 1 (-11, 11)/HADS-D: 0 (-7, 10)/PCL: 1 (-17,37). No between-group differences were found.ConclusionsThe study findings support that a general dental practitioner may treat dental anxiety with Four Habits/Midazolam or D-CBT without causing adverse effects on symptoms of anxiety, depression or PTSD. Establishing a best practice for treatment of patients with dental anxiety in general dental practice should be a shared ambition for clinicians, researchers, and educators.Trial registrationThe trial was approved by REC (Norwegian regional committee for medical and health research ethics) with ID number 2017/97 in March 2017, and it is registered in clinicaltrials.gov 26/09/2017 with identifier: NCT03293342.

Feasibility of Integrating MEditatioN inTO heaRt Disease (the MENTOR Study): A Phase II Randomized Controlled Trial.

Comorbid depression and/or anxiety symptoms occur in 25% of patients attending cardiac rehabilitation (CR) programs and are associated with poorer prognosis. There is a need to evaluate psychological interventions, including meditation, that have potential to improve psychological health in CR programs. The aim of this study was to determine the feasibility and acceptability of integrating a meditation intervention into an existing Australian CR program for the reduction of depression and anxiety symptoms. This was a mixed-methods feasibility randomized controlled trial. Thirty-one patients with CVD and, at a minimum, mild depression and/or anxiety symptoms were randomized to meditation and standard CR or to standard CR alone. A 16-minute guided group meditation was delivered face-to-face once a week for 6 weeks, with daily self-guided meditation practice between sessions. Feasibility outcomes included screening, recruitment, and retention. Semistructured interviews of patients' (n = 10) and health professionals' (n = 18) perspectives of intervention participation and delivery were undertaken to assess acceptability. Between-group differences in depression, anxiety, stress, self-efficacy for mindfulness, and health status at 6 and 12 weeks were also assessed. Meditation was considered feasible, with 83% (12/15) of the intervention group completing an average of 3.13 (SD, 2.56) out of 6 group meditation sessions and 5.28 (SD, 8.50) self-guided sessions. Meditation was considered acceptable by patients, clinicians, and health managers. Between-group differences in the number of CR sessions completed favored the intervention group in per-protocol analyses (intervention group vs control group, 12 vs 9 sessions; P = .014), which suggests that meditation may be useful to improve patients' adherence to exercise-based CR program.

Depressive and generalized anxiety symptoms in adults awaiting cataract surgery in India.

Background Systematic data on mental health issues among adults awaiting cataract treatment are not readily available in India. We explored the prevalence and predictors of depressive and generalized anxiety (GA) symptoms in a cohort of adults awaiting cataract surgery. Methods Our study is based on data from baseline assessments which were conducted as part of a multicentre prospective, longitudinal cohort study. Subjects were recruited from four eye hospitals to assess depression and GA and associated risk factors using standardized scales, i.e. Center for Epidemiologic Studies-Depression Scale (CES-D) and Generalised Anxiety Disorder (GAD-7). Variation in the intensity of depression and GA was assessed using multiple classification analysis (MCA). Results A total of 813 adults awaiting cataract surgery participated, of whom 456 (56.1%) were men. The mean (SD) CES-D and GAD-7 scores were 24.6 (7.8) and 6.3 (SD 4.2) for men and 25.8 (8.9) and 6.9 (4.4) for women, respectively. The overall prevalence of depression score of >16 was 87.4% (95% confidence interval [CI] 84.7%- 89.6%), and GA score of >10 was 57.1% (95% CI 53.5%-60.7%). The prevalence of comorbid depressive and anxiety symptoms was 56.6% (95% CI 52.9%- 60.2%). MCA showed that being neglected and mistreated by family/friends because of vision condition and facing difficulty and requiring help with daily tasks had the highest effect on the intensity of both depression (beta=0.254 and 0.238, respectively) and GA (beta=0.219 and 0.211, respectively). Conclusion The majority of adults with untreated cataract had both depressive and GA symptoms. These findings could be used for planning mental health interventions for adults awaiting cataract surgery.

Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study.

Little is still known about the long-term impact of childhood and adolescent persistent depression and anxiety in adulthood. To investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood. This study used data from 8122 participants in the Avon Longitudinal Study of Parents and Children cohort. The Development and Well-Being Assessment (DAWBA) examined child anxiety and depression symptomatology. The DAWBA generalised anxiety and mood subscales at 8, 10 and 13 years were selected, and a measure of comorbid anxiety and depression symptoms was created at each time point. Further, several mental and physical health, substance misuse and education/employment problems were assessed at 24 years. Latent class growth analyses were used to detect trajectories of anxiety, depression and comorbid anxiety and depression; and logistic regression to examine how persistent anxiety, depression or both were associated with adverse outcomes at 24 years. All three classes with persistent anxiety, depression or both were significantly associated with presenting with any mental health problems and any education/employment problem. Persistent high levels of depression and high levels of comorbid anxiety and depression, but not persistent high anxiety, were significantly associated with any physical health problem. High levels of comorbid anxiety and depression was the only DAWBA domain significantly associated with substance misuse; and overall, this was the domain that exerted the greatest negative impact, as it presented the highest odd ratio values. Children and adolescents with comorbid anxiety and depression are at the highest risk for having more adverse outcomes at 24 years.

Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study

BackgroundThe two most prevalent mental health conditions are anxiety and depression and they often coexist (comorbidity) in an individual aggravating the person’s psychological or medical conditions. College students suffered from anxiety and depressive symptoms during the COVID-19 pandemic, according to numerous studies. The lack of information on the comorbidity of anxiety and depression (CAD) among international medical students, however, makes it difficult to develop effective policies or strategies to support these students.ObjectiveThe present research seeks to investigate the incidence of CAD among international medical students in China and to identify the variables that may be useful in predicting CAD.MethodA cross-sectional study was conducted at China Medical University in Shenyang, China, for international medical students during November 2020. A total of 519 international students provided information on their demographics, stress related to the COVID-19 pandemic, generalized anxiety disorder assessment (GAD-7), patient health questionnaire-9 (PHQ-9), simplified coping style questionnaire (SCSQ), perceived stress scale (PSS-10), the multidimensional scale of perceived social support (MSPSS), revised life orientation test (LOT-R), and resilience scale-14 (RS-14). To investigate the potential predictors of CAD, a chi-square test, a nonparametric test, and multinomial logistic regression analyses were carried out as appropriate.ResultsThe incidence of anxiety, depression, and CAD in the current study was 5.8%, 8.9%, and 22.7%, respectively. The predictors for students having symptoms of anxiety were observed to be the negative coping style (β = 0.662, OR = 1.938, CI:1.07–3.694) and perceived stress (β = 0.167, OR = 1.181, CI:1.076–1.297); the predictors for students having symptoms of depression were observed to be the COVID-19 pandemic-related stress (β = 0.323,OR = 1.382,CI:1.211–1.577), negative coping style (β = 0.693,OR = 2.000, CI:1.21–3.568), and perceived stress (β = 0.135,OR = 1.145,CI:1.050–1.248); whereas the predictors for students with CAD were observed to be staying up late (Yes VS No) (β = 1.028,OR = 2.794,CI:1.227–6.364), current place of residence (Other continents VS China) (β = -1.413, OR = 0.243,CI:0.065–0.910), COVID-19 pandemic-related stress (β = 0.371,OR = 1.450,CI:1.284–1.636), negative coping style (β = 1.092,OR = 2.979,CI:1.706–5.203), and perceived stress (β = 0.339,OR = 1.403,CI:1.289–1.527).ConclusionSingle anxiety and depressive symptoms were moderately prevalent among international medical students in China. However, CAD turned out to be the most prevalent mental health issue due to its relatively higher incidence. Negative coping style and perceived stress were the communal predictors of the three categories, whereas stress related to the COVID-19 pandemic was linked to both depression and CAD, and staying up late and in residential places were specific predictors for CAD. Study results suggest that COVID-19 pandemic-related stress was related to students’ CAD and depressive symptoms, and specific intervention measures with stress reduction, proper coping strategy, and a good lifestyle might be useful in improving the international students’ mental health status.

The impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study

IntroductionLittle is still known about the long-term impact of childhood and adolescent persistent depression and anxiety on adulthood.ObjectivesTo investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood.Methods This study used data from 8,122 participants in the ALSPAC cohort, in the UK. The Development and Wellbeing Assessment (DAWBA) was administered to capture child anxiety and depression symptomatology. We focused on the DAWBA generalized anxiety and mood subscales at 8, 10 and 13 years, and created a measure of comorbid anxiety and depression symptoms (i.e., anxiety + depression) at each time point. Further, a range of mental and physical health, and functional problems were assessed at 24 years. Latent Class Growth Analyses was used to detect trajectories of anxiety, depression and comorbid anxiety and depression, separately; and logistic regression to examine how persistent anxiety, depression or both associated with adverse outcomes at 24 years.ResultsAll three classes with persistent anxiety, depression or both associated with presenting any mental health and functional problem at 24 years. However, persistent high anxiety was not associated with any physical health problem at 24 years. Finally, high levels of comorbid anxiety and depression was the domain that exerted the greatest negative impact at 24 years.ConclusionsChildren and adolescents with comorbid anxiety and depressions are at highest risk for suffering from more adverse outcomes at 24 years, compared to those presenting anxiety and depression alone.Disclosure of InterestNone Declared

Treatment of comorbid anxiety symptoms and insomnia in patients with schizophrenia: A review of Pros and Cons.

IntroductionRecent studies report a prevalence of comorbid anxiety disorder of 38% and 80% of sleep disorders in schizophrenia. Insomnia has been associated with worsening of psychopathological symptoms and increased hospitalization rates.ObjectivesThe aim of our work was to review mechanisms of action and the use of benzodiazepines, GABAergic drugs and melatonin for the treatment of anxiety and insomnia in schizophrenia.MethodsWe carried out a narrative review of studies focusing on the treatment of anxiety disorders and insomnia in schizophrenia through PubMed and Google Scholar (2002-September 2022). The use of benzodiazepines, GABAergic drugs and melatonin in schizophrenia are discussed, illustrating them with case reports.ResultsA total of 32 studies were included. (A)Benzodiazepines (BZD) work facilitating the inhibitory actions of gamma-aminobutyric acid (GABA) by binding GABA type A receptors. The beneficial effect of combined use of antipsychotics and BZD is controversial (cognitive complications, sedation, overdosing, substance use, etc). (B)GABAergic drugs: gabapentin (GP) and pregabalin (PG) (structurally related molecules), have no direct GABAergic action and act inhibiting voltage-gated calcium channels. The efficacy of GP and PG in the treatment of anxiety symptoms in schizophrenia is understudied. Positive effects of GP in schizophrenia suffering from restless legs syndrome receiving clozapine. (C )Melatonin, an hormone produced in the pineal gland has been used to treat insomnia. Positive effects on metabolic syndrome and cardiovascular risk factors have been reported. Several works considered it an alternative in schizophrenia.ConclusionsFew evidence is available on the use of BZD, GP, and PG in schizophrenia. Melatonin is a promising compound to treat insomnia.Disclosure of InterestNone Declared

Symptom relationships between internet addiction and anxiety across primary and middle school students during the Omicron lockdown

During the Omicron pandemic, students in Shenzhen took classes at home via the internet, which could lead to internet addiction (IA) symptoms, and anxiety is often considered an important risk factor for IA. There are several different developmental stages within adolescence. However, no studies have explored the interaction between IA and anxiety at the symptom level using a longitudinal design stratified by age. A total of 2744 students completed the questionnaire 50 days after starting the online classes (T1) and 50 days after they returned to school (T2). A cross-lagged panel network model was used to describe the structure of the comorbidity network. With the help of bootstrapping, the Mann-Whitney U test was used to examine the differences between primary school students' and middle school students' networks. The results found that there is a bidirectional interaction between IA and anxiety, and anxiety plays a dominant role. Feeling afraid is the bridge symptom between IA and anxiety. IA did not show developmental stage differences, but anxiety did. These findings extend the model of compensatory internet use and suggest that, when alleviating IA symptoms in adolescents, attention should be given to their possible comorbid anxiety symptoms, especially in middle school students.

Vortioxetine in patients with major depressive disorder and high levels of anxiety symptoms: An updated analysis of efficacy and tolerability

BackgroundPatients with major depressive disorder (MDD) often experience comorbid anxiety symptoms. Vortioxetine has demonstrated efficacy in treating anxiety symptoms in patients with MDD; however, efficacy and tolerability have not been assessed across the entire approved dosage range. MethodsThe efficacy and tolerability of vortioxetine 5–20 mg/day were assessed in patients with MDD and high levels of anxiety symptoms (Hamilton Anxiety Rating Scale [HAM-A] total score ≥ 20) using pooled data from four randomized, fixed-dose, placebo-controlled studies (n = 842). Data from a randomized, double-blind study of vortioxetine 10–20 mg/day versus agomelatine 25–50 mg/day in patients with an inadequate response to prior therapy (n = 299) were analyzed separately. Mean changes from baseline in Montgomery–Åsberg Depression Rating Scale (MADRS), HAM-A, and Sheehan Disability Scale (SDS) total scores were analyzed by vortioxetine dosage. ResultsThe pooled analysis of fixed-dose studies demonstrated a clear dose–response relationship for vortioxetine 5–20 mg/day for improvements in MADRS, HAM-A, and SDS total scores. Vortioxetine 20 mg/day demonstrated significant effects versus placebo from week 4 onwards. In the post-hoc analysis of the active-controlled study in patients with an inadequate response to prior therapy, vortioxetine 10–20 mg/day was superior to agomelatine across all outcome measures from week 4 onwards. Up-titration of vortioxetine to 20 mg/day was not associated with an increase in adverse events. LimitationsShort-term trials. ConclusionsVortioxetine is efficacious and well tolerated in patients with MDD and high levels of anxiety symptoms, including those with an inadequate response to prior therapy. The greatest therapeutic benefits were observed with vortioxetine 20 mg/day. Trial registrationNCT01140906, NCT01153009, NCT01163266, NCT01255787, NCT01488071.

The association among insomnia symptom severity, comorbid symptoms, and suicidal ideation in two veteran cohorts meeting diagnostic criteria for insomnia disorder.

Examine the association between insomnia symptom severity and suicidal ideation (SI), after adjusting for clinical comorbidity in veterans meeting diagnostic criteria for insomnia disorder. Secondary data analyses of psychometrically validated baseline assessments of depression, posttraumatic stress disorder(PTSD), and anxiety symptoms from two online insomnia intervention randomized clinical trials (n = 232; n = 80) were conducted. Multiple linear regression was used to determine the association between insomnia symptom severity and SI, after controlling for clinical comorbidity and demographics. Insomnia symptom severity was significantly correlated with comorbid depression, PTSD, and anxiety symptoms in both cohorts and significantly correlated with SI in one. After controlling for demographics and clinical comorbidity, insomnia symptom severity was not significantly associated with SI in linear regression models. Findings extend insomnia-suicide research by providing evidence that insomnia symptom severity may not confer a unique risk for SI above comorbid mental health symptoms in veterans meeting diagnostic criteria for insomnia disorder.

A Single-Case Study of Experience of Disordered Eating Influenced by a Track and Field Talent Development Environment

The study provides an interpretation of a young woman’s experience of being in a track and field environment in relation to the early stages of disordered eating and anxiety symptoms. The study shows the process of an intake interview with a potential client and the subsequent interpretation of the stories told. We designed the study as a single-case study and conducted one narrative interview with an 18-year-old woman. The findings were analyzed using narrative analysis and communicated using creative nonfiction. Anna’s story shows how she experiences being labeled as a “talent” in her sport and how she struggles with living up to the values and goals of others in the sports environment. Based on the narrative, we chose to interpret Anna’s experience using existential psychology; focusing on authenticity and loneliness, which seemed to exacerbate comorbid anxiety symptoms. The implication of our findings is that support in dealing with body issues and performance should involve guidance on how young athletes make choices and consciously consider their personal development. And sport psychologist can use the current study to guide how they interpret an intake interview.

Acid-sensing ion channel 1a in the central nucleus of the amygdala regulates anxiety-like behaviors in a mouse model of acute pain.

Pain is commonly comorbid with anxiety; however, the neural and molecular mechanisms underlying the comorbid anxiety symptoms in pain (CASP) have not been fully elucidated. In this study, we explored the role of acid-sensing ion channel 1a (ASIC1a), located in GABAergic neurons from the central nucleus of the amygdala (GABACeA), in the regulation of CASP in an acute pain mouse model. We found that the mice displayed significant mechanical pain sensitization and anxiety-like behaviors one day post injection of complete Freud's adjuvant (CFA1D). Electrophysiological recordings from acute brain slices showed that the activity of GABACeA neurons increased in the CFA1D mice compared with that in the saline mice. In addition, chemogenetic inhibition of GABACeA neurons relieved mechanical pain sensitization and anxiety-like behaviors in the CFA1D mice. Interestingly, through pharmacological inhibition and genetic knockdown of ASIC1a in the central nucleus amygdala, we found that downregulation of ASIC1a relieved the hypersensitization of mechanical stimuli and alleviated anxiety-related behaviors, accompanied with reversing the hyperactivity of GABACeA neurons in the CFA 1D mice. In conclusion, our results provide novel insights that ASIC1a in GABACeA neurons regulates anxiety-like behaviors in a mouse model of acute pain.

ПАТОГЕНЕТИЧНІ МЕХАНІЗМИ КОМОРБІДНИХ ТРИВОЖНИХ ПОРУШЕНЬ В ОСІБ ІЗСОЦІАЛЬНИМ ТРИВОЖНИМ РОЗЛАДОМ: РОЛЬ ДИСФУНКЦІЙНИХ КОГНІТИВНИХ СХЕМ

Background. Anxiety disorders are one of the common categories of mental health problems characterized by a persistent debilitating feeling of anxiety, which is due mainly to unproductive expectations about potential challenges or threats. For example, for people with social anxiety disorder, the fear of social situations can feel so intense that it seems out of their control, leading to a tendency toward social isolation and complicating the recovery process. Methods. An empirical study was conducted between 2018 and 2022 among individuals (aged 18-40) with social anxiety disorder and with clinically significant symptoms of co-occurring anxiety disorders (including generalized anxiety disorder and symptoms of panic attacks) according to DSM-5 criteria - the main the group consisted of 651 people. All study participants participated voluntarily and provided informed consent. Results. Individuals with social anxiety disorder exhibit higher levels of clinical anxiety and general distress compared to controls. Significant differences in the intensity of early dysfunctional schemes were also found compared to the control group. Correlations between manifestations of dysfunctional schemas, levels of social anxiety and manifestations of comorbid psychopathology have been demonstrated. It has been suggested that the contribution of cognitive, emotional, and behavioral responses related to schemas such as social isolation/alienation, incompetence/failure anticipation, and catastrophe anticipation may explain the distribution of variability in social anxiety symptoms and comorbid anxiety symptoms. Conclusions. The analysis of the results of the empirical study confirms the close relationship between dysfunctional beliefs and the severity of anxiety psychopathology in individuals with social anxiety disorder. Considering the features of the functioning of deep beliefs about oneself and social interaction, structured into cognitive schemes, can contribute to a practical approach to therapy and improve the quality of life of persons with the specified symptoms. Further research can be directed at expanding the role of early dysfunctional schemes in the pathogenesis of comorbid conditions and the role of avoidance mechanisms in adapting to life circumstances.

Comorbid Depressive and Anxiety Symptomatology in Older Adults: The Role of Aging Self-Stereotypes, Loneliness, and Feelings of Guilt Associated with Self-Perception as a Burden.

The main objective of this study was to analyze the differences between older adults' symptom profiles (subclinical, anxiety, depressive, and comorbid) in negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden. Participants were 310 community-dwelling people aged 60 years and over. The sample was grouped into four symptom profiles of older adults: anxiety, depressive, comorbid anxiety-depression, and subclinical symptoms. We carried out multinomial logistic regression analyses to analyze the role of assessed variables in the explanation of the four symptom profiles. Older adults who reported a comorbid symptomatology presented higher negative aging self-stereotypes and feelings of loneliness than the other three profiles. Compared with the subclinical profile, older adults who reported clinical symptomatology (anxiety, depressive, and comorbid profile) presented higher feelings of guilt associated with self-perception as a burden. The findings of this study suggest potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults.

Efficacy of Olanzapine in Anxiety Dimension of Schizophrenia: A Systematic Review of Randomized Controlled Trials.

Anxiety symptoms and anxiety disorders are frequent in patients with schizophrenia and are associated with greater severity of both positive and negative symptoms, cognitive impairment, poorer functioning and quality of life. Accumulating evidence suggests that atypical antipsychotics may have a role in treating comorbid anxiety symptoms. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting randomized control trials (RCTs) that evaluated efficacy of olanzapine on anxiety symptoms in patients diagnosed with schizophrenia and included anxiety evaluation scales. We searched PubMed and Web of Science databases for articles in English language available until September 2021. We selected 7 studies (3 with primary data analysis, 4 with secondary data analysis) regarding the use of olanzapine in patients with schizophrenia. In fours studies olanzapine was superior to haloperidol in improving anxiety symptoms. Four studies compared olanzapine versus risperidone: in two of them risperidone was superior to olanzapine, although one study was limited by a relatively small sample size. In the other two there were no significant differences between olanzapine and risperidone-treated patients. One study found that olanzapine and clozapine were comparable in terms of efficacy. Although olanzapine was superior to haloperidol in treating anxiety, this symptom was a secondary outcome measure in most of the considered studies. Future RCTs comparing different antipsychotics and larger sample sizes may allow to develop more solid treatment strategies.

The prevalence and associated factors of prenatal depression and anxiety in twin pregnancy: a cross-sectional study in Chongqing, China

BackgroundPregnant women expecting twins are more likely to experience stress, which can lead to anxiety and depression. Our aim was to investigate the prevalence of prenatal anxiety and depressive symptoms in women with twin pregnancies and the associated factors.MethodsIn a cross-sectional survey, 210 women with twin pregnancies who satisfied the inclusion and exclusion criteria in two tertiary centers in Southwestern China were asked to complete a basic information form, the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). To compare statistics with normal distribution in distinct characteristic groups, a paired t-test, and one-way ANOVA were utilized. Binary logistic step regression was used to analyze the associated factors of antenatal anxiety and depressive symptoms.ResultsThe 210 women with twin pregnancies (age = 30.8 ± 4.2 years) were between 7 and 37 gestational weeks (29.2 ± 1.2 weeks), were typically well-educated (72.4% had a post-high-school degree), and reasonably affluent (88.1% were above the low-income cutoff). Among them, 34.8% had symptoms associated with clinical levels of anxiety, and 37.1% had symptoms indicating possible depression. The prevalence of co-morbid anxiety and depressive symptoms was 24.3%. Binary stepwise logistic regression analysis showed that previous health status and sleep disturbance during pregnancy were the associated factors of anxiety symptoms in women with twin pregnancies (P < 0.05), whereas age, previous health status, negative life events, and physical activity during pregnancy were the associated factors of depressive symptoms in women with twin pregnancies (P < 0.05).ConclusionAbout one-third of women with twin pregnancies had symptoms of anxiety or depression; these were most strongly predicted by some modifiable factors, suggesting that early preventive mind-body interventions may be a promising strategy to protect against mental health issues for women with twin pregnancies.

Depression and anxiety among people with hypertension on follow-up in Eastern Ethiopia: A multi-center cross-sectional study.

People with hypertension have a high risk of developing mental disorders, such as depression and/or anxiety. However, there is a paucity of data regarding comorbid depression and anxiety symptoms among people with hypertension in study settings. The study determined the prevalence and associated factors of depression, and anxiety symptoms among people with hypertension on follow-up at public hospitals, in Eastern Ethiopia. A cross-sectional study was carried out among 471 people with hypertension who were randomly chosen from four public hospitals in Harar town and the Dire Dawa Administration. The data were collected by interviewer-administered structured questionnaires. A validated nine-item Patient Health Questionnaire and Generalized Anxiety Disorder scales were used to assess depression and anxiety symptoms, respectively. A logistic regression model was used to identify the association among depression, anxiety, and their predictors. An adjusted odds ratio and a 95% confidence interval were used to report the association. The statistical significance was set at a p-value of < 0.05. Depression and anxiety symptoms were present in 27.2 and 32.7% of people with hypertension, respectively. Being women (AOR = 1.74, 1.09-2.78), having no formal education (AOR = 2.19, 1.19-4.81), presence of other medical illnesses (AOR = 2.23, 1.39-3.56), having a family history of depression (AOR = 2.01, 1.25-3.19), and poor social support (AOR = 2.80, 1.60-5.22) were statistically associated with depressive symptoms, whereas being women (AOR = 1.54, 1.01-2.35), widowed and divorced (AOR = 2.22, 1.41-3.52), presence of other medical illnesses (AOR = 1.64, 1.06-2.53), and poor social support (AOR = 3.54, 2.09-6.01) were statistically associated with anxiety symptoms. More than a quarter of people with hypertension reported symptoms of depression and anxiety. Findings demonstrated that being a woman, having an additional medical illness and having poor social support were statistically associated with depressive and anxiety symptoms. Regular screening, early detection, and offering the proper intervention should be on top priorities for healthcare professionals.

QT interval is correlated with and can predict the comorbidity of depression and anxiety: A cross-sectional study on outpatients with first-episode depression

ObjectPatients with depression are at an increased risk for developing cardiovascular diseases. The associations between electrocardiogram (ECG) abnormalities and the severity of psychiatric disorders, such as depression and anxiety, have not been clearly elucidated. The present study aims to investigate the associations between depression and anxiety symptoms with ECG indices, and to predict the severity of depression and anxiety using ECG indicators.Methods61 outpatients with first-episode depression from the Shanghai Pudong New Area Mental Health Center were selected and met the diagnostic criteria of DSM-IV. All participants provided self-reported scores on the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) and underwent the standard 12-lead ECG assessment.ResultsAmong the 61 included outpatients (mean [standard deviation, SD] age: 37.84 [13.82] years; 41[67.2%] were female), there were 2 (3.3%) outpatients without depression symptoms, 16 (26.2%) with mild depression, 19 (31.1%) with moderate depression, and 24 (39.3%) with severe depression. Ten (16.4%) outpatients did not have anxiety symptoms, 19 (31.1%) exhibited mild anxiety, 20 (32.8%) exhibited moderate anxiety, and 12 (19.7%) exhibited severe anxiety. Only 1 (1.6%) outpatient exhibited neither depression nor anxiety, 9 (14.8%) and 1 (1.6%) outpatients only exhibited depression and anxiety, respectively, and most outpatients (50 [82.0%]) had comorbid depression and anxiety symptoms. In the correlation analysis, depression and anxiety severity levels were significantly positively correlated (r = 0.717, p < 0.01). Moreover, categorical anxiety significantly differs in QT interval (p = 0.022), and continuous SAS scores were significantly correlated with QT interval (r = 0.263, p = 0.04). In addition, the correlations between ECG measurements and both categorical depression and continuous SDS scores were not statistically significant. The comorbidity of anxiety and depression was significantly correlated with heart rate (p = 0.039) and QT interval (p = 0.002). Disorder status significantly differed with different QT intervals (p = 0.021). In the prediction analysis, QT interval was the only significant predictor (p = 0.01, b = 0.058, Odds Ratio = 1.059) for comorbid anxiety and depression symptoms.ConclusionThis study found that comorbid symptoms of depression and anxiety were significantly associated with QT interval and heart rate. Additionally, QT interval could predict the comorbidity of these two psychiatric disorders. Further prospective research in a larger and high-risk population is needed.

Efficacy of Repetitive Transcranial Magnetic Stimulation on Comorbid Anxiety and Depression Symptoms in Obsessive-Compulsive Disorder: A Meta-Analysis of Randomized Sham-Controlled Trials.

To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing comorbid anxiety and depressive symptoms in patients with obsessive-compulsive disorder (OCD). Three electronic databases were searched for randomized, sham-controlled clinical trials evaluating rTMS for the treatment of OCD. Hedge's g was calculated as the effect size for anxiety/depression symptom severity (primary outcome) and OCD severity (secondary outcome). Subgroup analyses and meta-regression analyses were carried out to evaluate the most promising target and whether a reduction in OCD severity moderates the change in anxiety or depression scores. Twenty studies (n = 688) were included in the meta-analysis. rTMS had small-medium effect size on OCD (Hedge's g = 0.43; 95% confidence interval [CI]: [0.20, 0.65]; P < 0.001), anxiety (Hedge's g = 0.3; 95% CI: [0.11, 0.48]; P = 0.001) and depression (Hedge's g = 0.24; 95% CI: [0.07, 0.40]; P = 0.003) symptoms. Subgroup analysis showed that protocols targeting dorsolateral prefrontal cortex (DLPFC) were effective for 3 outcome measures. The change in anxiety, but not depression severity, was moderated by a change in OCD symptom scores. However, the findings are uncertain as a majority of the studies had some concerns or a high risk of bias. Active rTMS protocol targeting DLPFC is effective in reducing the comorbid anxiety/depression symptoms along with OCD severity. The antidepressant effect is not moderated by the anti-obsessive effect of rTMS.