Comorbid Generalized Anxiety Disorder Research Articles

Subjective and objective cognitive functioning in untreated late-life depression: An exploration centered on comorbid generalized anxiety disorder

BackgroundLate-Life Depression (LLD) is a prevalent mental health disorder that is often accompanied by cognitive impairments. The objective of this study is to investigate the influence of coexisting Generalized Anxiety Disorder (GAD) on both subjective and objective cognitive abilities in untreated LLD individuals. MethodsA total of 77 participants aged 60 years and above were recruited for this study, comprising 31 individuals with Major Depressive Disorder (LLD group), 46 with MDD and coexisting Generalized Anxiety Disorder (LLDA group), and 54 healthy controls (HC). Prior to the study, all patients had abstained from psychotropic medication for a minimum of two weeks. Comprehensive neuropsychological assessments were administered to all participants. ResultsThe LLDA group exhibited substantial disparities in memory, attention, processing speed,executive function,overall cognitive functioning, and subjective cognitive functioning when compared to the HC group. The LLD group displayed deficits in memory, SCWT-W in attention, SCWT-C in processing speed,overall cognitive functioning, and subjective cognitive functioning in comparison to the healthy controls. Although the LLD group achieved lower average scores in executive function, TMTA in processing speed, and DSST in attention than the HC group, no significant distinctions were identified between these groups in these domains. Linear regression analysis unveiled that anxiety symptoms had a significant impact on subjective cognitive deficits among MDD patients, but exhibited a milder influence on objective cognitive performance. After adjusting for the severity of depression, anxiety symptoms were found to affect TMTA in processing speed and subjective cognitive functioning in LLD patients. ConclusionLate-Life Depression (LLD) exhibits pervasive cognitive impairments, particularly in individuals with generalized anxiety disorder, presenting a crucial target for future therapeutic interventions. Among elderly individuals with depression, anxiety symptoms significantly impact subjective cognitive functioning, suggesting its potential utility in distinguishing between depression-associated cognitive decline and pre-dementia conditions.

Abnormal prefrontal cortical activation during the GO/NOGO and verbal fluency tasks in adult patients with comorbid generalized anxiety disorder and attention-deficit/hyperactivity disorder: An fNIRS study

Generalized anxiety disorder (GAD) and adult attention-deficit/hyperactivity disorder (ADHD) are commonly reported comorbidities. Adult GAD patients with comorbid ADHD are often underdiagnosed and undertreated. To explore the clinical value of functional near-infrared spectroscopy (fNIRS) data for assisting in the accurate diagnosis of ADHD in individuals with GAD, haemoglobin (HbO) concentration changes in the prefrontal cortex (PFC) were detected via fNIRS in 49 patients with both GAD and ADHD, 46 patients with GAD, and 34 healthy controls (HCs) during a verbal fluency task (VFT) and a GO/NOGO task. The correlations between PFC fNIRS data and the severity of inattention and hyperactivity symptoms assessed using the adult ADHD Self-Report Scale (ASRS) were analyzed. Our results showed that, during the GO/NOGO task, channels in the left dorsolateral PFC (channels 28 and 29) were hyperactivated, while channels in the medial PFC (channels 36, 37, and 47) were hypoactivated in participants with ADHD and GAD compared with those with GAD alone. During the VFT, compared with the HC group, both the ADHD + GAD group and the GAD group exhibited significantly decreased HbO activation in the medial PFC (channels 37, 38, and 48) and in the left ventrolateral PFC (channel 39); moreover, no difference was found between the ADHD + GAD group and the GAD group. Activation in the left dorsolateral PFC (channels 28 and 29) during the GO/NOGO task showed a significant positive correlation with ASRS-inattention scores. Our results indicated that fNIRS data collected during the GO/NOGO task may help to distinguish patients with comorbid GAD and ADHD from those with GAD alone.

Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population.

Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms. Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-relatedsymptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms. Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity. Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.

Response to ketamine treatment for major depressive disorder not associated with number of psychiatric comorbidities

BackgroundKetamine has demonstrated efficacy in treating depression unresponsive to traditional interventions and is increasingly utilized in psychiatric practice. However, limited information is available regarding effectiveness in patients with psychiatric comorbidity. The aim of this study is to compare the response of ketamine treatment for depression in patients in a community sample with and without one or more coexisting psychiatric diagnoses. MethodsA retrospective review of medical records from a community ketamine clinic was done. Statistical analyses compared response to intravenous ketamine treatment, as defined by a 50% reduction in Patient Health Questionnaire (PHQ-9) score or final score of <10, in patients with an isolated diagnosis of major depressive disorder (MDD) to those with comorbid generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and/or attention-deficit/hyperactivity disorder (ADHD). ResultsData from 129 patient were analyzed (55.8 % female). It was found that the number of psychiatric comorbidities was not associated with ketamine treatment response rate nor mean change in PHQ-9 scores. LimitationsLevel of previous treatment resistance was not assessed systematically, and psychiatric interview and some elements of the patients’ care were not standardized, such as treatment schedule and dosing. ConclusionsThese findings suggest ketamine may be an effective treatment for depression in appropriate patients with psychiatric comorbidities including GAD, OCD, PTSD and/or ADHD. Additional investigation is warranted to evaluate various patient-level and other factors that may impact ketamine's ability to attenuate depressive symptoms.

Outcomes of Acute Pancreatitis in Hospitalized Patients With Generalized Anxiety Disorder.

Introduction Acute pancreatitis (AP) is a common cause of hospitalization in the United States. There is evidence that chronic stress increases the risk for more severe AP episodes. One common form of chronic stress is generalized anxiety disorder (GAD). The purpose of this research was to investigate the impact of GAD on the outcomes of adult patients admitted to the hospital with AP. Methods Utilizing the 2014 National Inpatient Sample database and International Classification of Diseases, Ninth Edition Revision (ICD) codes, AP patients were selected. Common inpatient outcomes of AP patients with and without GAD were examined. The outcomes studied were acute renal failure, acute respiratory failure, sepsis, acute deep vein thrombosis, myocardial infarction, intestinal perforation, and inpatient mortality. A multivariate logistic regression analysis was conducted to assess if GAD was an independent predictor for these outcomes. Results Among 82,156 adult patients hospitalized for AP during the 2014 year, 10,611 of them had coexisting GAD. AP patients with comorbid GAD were found to have an increased likelihood of acute renal failure (aOR = 1.19, 95% confidence interval (CI) = 1.11-1.28, p < 0.001), sepsis (aOR = 1.09, 95% CI = 1.01 -1.19, p = 0.037), acute deep vein thrombosis (aOR = 1.63, 95% CI = 1.06-2.50, p = 0.025), and inpatient mortality (aOR = 1.62, 95% C = I 1.27-2.08, p < 0.001). There was no statistically significant difference found between the two cohorts for the outcomes of myocardial infarction and intestinal perforation. Conclusion In patients hospitalized with AP, those with coexisting GAD were found to have an increased risk of developing acute renal failure, sepsis, acute deep vein thrombosis, and inpatient mortality. There may be benefits to identifying AP patients with comorbid GAD at the time of admission and monitoring them more carefully during their hospitalization to help identify early signs of complications or prevent the negative outcomes seen in this study.

The differences of event-related potential components in patients with comorbid depression and anxiety, depression, or anxiety alone

BackgroundThere was a high comorbidity rate of major depressive disorder (MDD) and generalized anxiety disorder (GAD), showing a poor prognosis and significant detrimental impact on functioning. The study aimed to find whether patients with comorbid GAD and MDD had some differences in cognitive functions from patients with MDD or GAD alone. Methods360 adult patients were enrolled from inpatient department of psychiatry from 2020 to 2022. They were divided into three groups with 120 patients for each group: MDD, GAD, and MDD + GAD. All the patients completed psychological evaluation scales including patient health questionnaire-9 (PHQ-9) and 7-item generalized anxiety disorder (GAD-7). All the patients underwent examinations of auditory brainstem response and event-related potentials (ERPs). ResultsIn MDD + GAD group, P3b latency was significantly longer than patients with MDD alone, and P300 reaction time was positively correlated with total score of GAD-7 and PHQ-9, and PHQ-9 total score was also significantly positively correlated with P2-P3b amplitude (all p < 0.05). In addition, MDD patients had significantly longer P300 reaction time and lower P2-P3b amplitude than the GAD group (p < 0.05). LimitationsIt was a single-center and cross-sectional study, and we used self-report scales as assessment tools. ConclusionsPatients with MDD and GAD comorbidity might have a worse cognitive function than MDD patients, and the severity of cognitive impairments was positively correlated with the severity of anxiety and depression symptoms.

Symptomatic and Therapeutic Significance of Generalized Anxiety Disorder Comorbidity in Patients with Obsessive-Compulsive Disorder

Background: Psychiatric disorders frequently accompany comorbid conditions, which can have negative prognostic effects. The etiological and phenomenological distinctions between these conditions may have significant implications for their therapeutic approach and clinical course. Objectives: Our study aimed to investigate the symptomatic and therapeutic significance of comorbid generalized anxiety disorder (GAD) on obsessive-compulsive disorder (OCD). Methods: This cross-sectional study included OCD patients referred to private and institutional psychiatric clinics in Rasht, Guilan, in 2021. All participants were divided into two groups: those with OCD and those with both OCD and GAD (OCD-GAD). The diagnoses were determined using structured clinical interviews that followed the DSM-5-research version (DSM-5-RV) criteria and included psychiatric histories. Patients were assessed using the Hamilton anxiety rating (HAM) scale, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and Global Assessment of Functioning (GAF). The data were analyzed using SPSS version 20. Results: Out of the 146 participants, 80 had only OCD, while 66 had both OCD and GAD. Both groups demonstrated significant improvements in GAF scores throughout the treatment period (P &lt; 0.0001); however, there was no significant difference between the groups in terms of these improvements. The Y-BOCS score was significantly higher in the OCD group at baseline (P &lt; 0.0001), and it decreased more during the first 3 months in the OCD-GAD group (P = 0.006). The severity of obsessive-compulsive symptoms related to symmetry (P = 0.014), hoarding (P = 0.034), taboo thoughts (P = 0.023), and aggression (P = 0.002) was significantly higher in the group with OCD. Both HAM-A and Y-BOCS scores decreased over time, but HAM-A showed a greater decline at the first follow-up, while Y-BOCS showed a greater decline at the second follow-up. Conclusions: Considering our findings, OCD-GAD diagnosis is not a unique subcategory of current psychiatric disorders, and it is not necessarily beneficial to regard it as such. However, we found that the comorbidity of GAD did not harm the prognosis of patients with OCD. Further investigations are recommended to evaluate the clinical significance of OCD-GAD comorbidity.

Outcomes of Patients Hospitalized for Acute Diverticulitis With Comorbid Generalized Anxiety Disorder.

Introduction Diverticular disease and anxiety disorders are common in the general population. Prior research on diverticular disease showed that these patients have an increased frequency of anxiety and depression. The objective of this study was to explore the impact of generalized anxiety disorder (GAD) on the outcomes of adult patients admitted with acute diverticulitis. Methods Using the National Inpatient Sample database from the year 2014 and International Classification of Diseases, Ninth Edition Revision, Clinical Modification (ICD-9 CM) codes, acute diverticulitis patients were selected. The outcomes of diverticulitis patients with and without GAD were explored. The outcomes of interest included inpatient mortality, hypotension/shock, acute respiratory failure, acute hepatic failure, sepsis, intestinal abscess, intestinal obstruction, myocardial infarction, acute renal failure, and colectomy. A multivariate logistic regression analysis was performed to determine if GAD is an independent predictor for the outcomes. Results Among 77,520 diverticulitis patients in the study, 8,484 had comorbid GAD. GAD was identified as a risk factor for intestinal obstruction (adjusted odds ratio (aOR) 1.22, 95% CI: 1.05-1.43, p<0.05), and intestinal abscess (aOR 1.19, 95% CI: 1.10-1.29, p<0.05). GAD was found to be a protective factor for hypotension/shock (aOR 0.83, 95% CI: 0.76-0.91, p<0.05) and acute respiratory failure (aOR 0.76, 95% CI: 0.62-0.93, p<0.05). The aORs of sepsis, inpatient mortality, myocardial infarction, acute renal failure, and colectomy were not statistically significant. Conclusions Patients with acute diverticulitis who are also diagnosed with GAD are at increased risk for intestinal obstruction and intestinal abscess, which may be due to the influence GAD has on the gut microbiota as well as the impact of GAD pharmacotherapy on gut motility. There was also a decreased risk for acute respiratory failure and hypotension/shock appreciated in the GAD cohort which may be attributable to the elevated healthcare resource utilization seen generally in GAD patients, which may allow for presentation to the emergency department, hospitalization, and treatment earlier in the diverticulitis disease course.

S1017 Outcomes of Patients Hospitalized for Inflammatory Bowel Disease With Comorbid Generalized Anxiety Disorder

Introduction: The development of inflammatory bowel disease (IBD) is multifactorial. A risk factor for IBD is stress from anxiety. Generalized anxiety disorder (GAD), a prevalent form of anxiety, is twice as common in IBD patients. This study explores the outcomes of adults hospitalized for IBD with comorbid GAD. Methods: Adults hospitalized for IBD were selected from the 2014 National Inpatient Sample database. ICD-9 codes were used to select diagnoses. Demographic data and outcomes of IBD were compared between a subgroup with GAD and a subgroup without GAD. The outcomes of interest were hypotension/shock, sepsis, acute hepatic failure, acute respiratory failure, acute renal failure (AKI), myocardial infarction (MI), acute deep vein thrombosis (DVT), ileus, inpatient mortality, colectomy, intestinal abscess, obstruction, and perforation. Chi-squared tests and independent t-tests were used to compare proportions and means respectively. A multivariate logistic regression analysis was used to establish if GAD is an independent predictor for the outcomes, after adjusting for age, sex, race, and Charlson Comorbidity Index (CCI). Results: Among 24,773 IBD patients, 3,400 also had GAD. Patients with comorbid GAD were more likely to be younger (54.8 vs. 55.9 years old, p< 0.001), to be female (68.6% vs. 46.3%, p< 0.001), to be white (86.1% vs. 76.7%, p< 0.001), to have a lower hospitalization cost ($56,313 vs. $68,784, p< 0.001) and a lower CCI (2.45 vs. 2.65, p< 0.001). There was no significant difference in length of stay (6.6 vs. 6.8 days, p=0.264). After adjusting for age, sex, race, and CCI, GAD was found to be a risk factor for sepsis (adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.17-1.50, p< 0.001), acute hepatic failure (aOR 1.80, 95% CI 1.18-2.73, p=0.006), acute respiratory failure (aOR 1.24, 95% CI 1.04-1.49, p=0.018), inpatient mortality (aOR 1.87, 95% CI 1.50-2.31, p< 0.001), intestinal abscess (aOR 2.35, 95% CI 1.20-4.61, p=0.013) and perforation (aOR 1.44, 95% CI 1.06-1.95, p=0.019). The aORs were not statistically significant for hypotension/shock (p=0.306), AKI (p=0.083), MI (p=0.278), DVT (p=0.972), ileus (p=0.613), colectomy (p=0.760), and obstruction (p=0.129). (Table) Conclusion: In IBD patients, GAD is a risk factor for sepsis, acute hepatic failure, acute respiratory failure, intestinal abscess, perforation, and inpatient mortality. The worse outcomes may be attribuTable to the microbiome disruption as well as poor medication compliance associated with GAD. Table 1. - Title: Multivariate logistic regression analysis of clinical outcomes among inflammatory bowel disease patients Outcomes Adjusted odds ratio* 95% confidence interval p-value Acute deep vein thrombosis 0.99 0.73-1.35 0.972 Acute hepatic failure 1.80 1.18-2.73 0.006 Acute renal fail 1.11 0.99-1.24 0.083 Acute respiratory failure 1.24 1.04-1.49 0.018 Colectomy 1.06 0.69-1.63 0.760 Hypotension/shock 0.94 0.84-1.06 0.306 Ileus 1.05 0.88-1.24 0.613 Inpatient mortality 1.87 1.50-2.31 < 0.001 Intestinal abscess 2.35 1.20-4.61 0.013 Intestinal obstruction 1.20 0.95-1.53 0.129 Intestinal perforation 1.44 1.06-1.95 0.019 Myocardial infarction 1.18 0.87-1.62 0.278 Sepsis 1.33 1.17-1.50 < 0.001 Footnote: *Adjusted for age, sex, race, and Charlson comorbidity index

S1330 Outcomes of Patients Hospitalized for Acute Alcoholic Hepatitis With Comorbid Generalized Anxiety Disorder

S1330 Outcomes of Patients Hospitalized for Acute Alcoholic Hepatitis With Comorbid Generalized Anxiety Disorder

S240 Outcomes of Patients Hospitalized for Acute Diverticulitis With Comorbid Generalized Anxiety Disorder

Introduction: The prevalence of diverticulosis is as high as 50% in adults greater than 60 years old. Prior research on diverticular disease showed that these patients have an increased frequency of anxiety. Generalized anxiety disorder (GAD) is a common form of anxiety. This study explored the impact of GAD on the outcomes of patients admitted with acute diverticulitis. Methods: Adults hospitalized for diverticulitis were selected from the 2014 National Inpatient Sample database. ICD-9 codes were used to select diagnoses. Demographic data and outcomes of diverticulitis were compared between a subgroup with GAD and a subgroup without GAD. The outcomes of interest were sepsis, acute renal failure (AKI), myocardial infarction (MI), acute respiratory failure, obstruction, colectomy, hypotension/shock, gastrointestinal perforation and inpatient mortality. Chi-squared tests and independent t-tests were used to compare proportions and means respectively. A multivariate logistic regression analysis was used to establish if GAD is an independent predictor for the outcomes after adjusting for age, sex, race, and Charlson Comorbidity Index (CCI). Results: Among 77,520 diverticulitis patients in the study, 8,434 had GAD. Patients with GAD were younger (62.7 vs. 63.2 years old, p< 0.05), more likely to be female (72.6% vs. 43.5%, p< 0.05), more likely to be caucasian (83.9% vs. 75.5%, p< 0.05), and had a longer hospital stay (4.86 vs. 4.53 days, p< 0.05). There were no significant differences in total hospital charge ($40,003 vs. $39,660, p=0.54) and CCI (2.89 vs. 2.85, p=0.15). After adjusting for age, sex, race, and CCI, GAD was found to be a risk factor for obstruction (adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI) 1.05-1.43, p< 0.05) and intestinal abscess (aOR 1.19, 95% CI 1.10-1.29, p< 0.05). GAD was also found to be a protective factor for acute respiratory failure (aOR 0.76, 95% CI 0.62-0.93, p< 0.05) and hypotension/shock (aOR 0.83, 95% CI 0.76-0.91, p< 0.05). The p-values for the aORs of sepsis (p=0.19), inpatient mortality (p=0.11), MI (p=0.77), AKI (p=0.76), and colectomy (p=0.07) were not statistically significant. (Table) Conclusion: In acute diverticulitis patients, GAD is a risk factor for intestinal obstruction and intestinal abscess, which may be due to GAD’s impact on motility. GAD is also a protective factor against acute respiratory failure and hypotension/shock possibly due to its association with higher healthcare utilization which may lead patients to seek out care earlier. Table 1. - Multivariate logistic regression analysis of clinical outcomes among diverticulitis patients Outcomes *Adjusted Odds Ratio 95% Confidence Interval p-Value Acute renal failure 1.02 0.93-1.11 0.76 Acute respiratory failure 0.76 0.62-.93 < 0.05 Colectomy 0.75 0.55-1.02 0.07 Hypotension/shock 0.83 0.76-.91 < 0.05 Inpatient mortality 1.34 0.93-1.92 0.11 Intestinal abscess 1.19 1.10-1.29 < 0.05 Intestinal obstruction 1.22 1.05-1.43 < 0.05 Myocardial infarction 1.05 0.78-1.40 0.77 Sepsis 1.07 0.97-1.19 0.19 *Adjusted for age, sex, race, and the Charlson comorbidity index.

Gut microbiome characteristics of comorbid generalized anxiety disorder and functional gastrointestinal disease: Correlation with alexithymia and personality traits

ObjectiveThe aim of this study was to investigate the characteristics of intestinal flora in patients with functional gastroenteropathy and generalized anxiety disorder (GAD) and the relationship between intestinal flora and psychological factors.Materials and methodsFrom March 2020 to December 2020, a total of 35 patients with functional gastroenteropathy and generalized anxiety disorder, 30 healthy controls, 16 patients with functional gastroenteropathy, and 44 patients with generalized anxiety disorder were selected from the Affiliated Hospital of Guizhou Medical University. Fecal samples were collected from each group, and the related psychophysiological factors scales (Hamilton Anxiety Scale, Hamilton Depression Scale, Neurotic Personality Questionnaire, concept of illness questionnaire, Toronto Alexithymia Scale, Severity of Physical Symptoms Scale, and Cognitive Emotion Regulation Questionnaire) were improved. 16S rRNA high-pass sequencing was used to determine the correlation between intestinal flora changes and functional gastroenteropathy with generalized anxiety disorder. Then, the scale and gut microbiota results were analyzed for correlation to determine the correlation between personality traits and gut microbiota.ResultsWe found similar intestinal microbiota in patients with functional gastroenterology, generalized anxiety disorder, and functional gastroenteropathy with generalized anxiety disorder. But the relative abundance of Clostridium was significantly increased in patients with functional gastrointestinal disease (FGID) and generalized anxiety. The relative abundance of Haemophilus influenzae was significantly increased in patients with functional gastrointestinal disease without a generalized anxiety disorder. The intestinal microecological composition was significantly correlated with personality traits.ConclusionFunctional gastrointestinal disease comorbidity GAD may be related to an increase in the relative abundance of Fusobacterium. FGID non-comorbidity GAD may be related to the increased relative abundance of Hemophilus. The increased relative abundance of Fusobacterium and Megamonas is associated with personality traits such as difficulty describing feelings and difficulty identifying feelings, neuroticism, and negative cognition of disease.

Robbery Victimization in Early Adulthood, and Depression and Anxiety at Age 30 Years: Results From the 1982 Pelotas (Brazil) Birth Cohort Study.

Robbery is one of the most common urban crimes, but little is known about its relationship with mental disorders in young adults. This study aimed to assess the relationship between robbery victimization and Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD) and comorbidity between MDD and GAD at 30 years of age. A birth cohort study has followed all children born in the city of Pelotas, southern Brazil, since 1982. At ages 23 and 30 years, participants were interviewed and asked about lifetime and recent experiences of robbery. Covariates were measured in interviews between birth and age 30 years. MDD and GAD were measured using the MINI-International Neuropsychiatric Interview. Adjusted prevalence ratio (aPR) and corresponding 95% confidence interval (CI) for associations between robbery and mental disorders were calculated using Poisson regression with robust standard error. Of 3,701 cohort members interviewed at age 30 years, 42% reported robbery victimization during their lifetime. Victimization across three periods (lifetime, past 10 years, past 12 months) was associated with increased occurrence of MDD, GAD, as well as the MDD and GAD comorbidity. The strongest associations were found to robbery occurring in the previous 12 months with the MDD and GAD comorbidity, both for burglary at home (aPR 2.52; 95% CI 1.52–4.22) or community family victimization (aPR 2.10; 95% CI 1.34–3.27). These findings highlight the importance of community violence for mental health in young adulthood, and the need for public policies to prevent violence as well as support services for victims to mitigate its adverse health consequences.

Response rate underreports improvement in patients with major depressive disorder and comorbidities treated with repetitive transcranial magnetic stimulation (rTMS)

To study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depressive Disorder (MDD) including comorbidities of Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), and Borderline Personality Disorder (BPD). We compared response and remission rates to a single question patient-reported outcome (PRO). A retrospective review of patients completing rTMS from 1/2009-2/2021. Standard response (≥50% reduction in Patient Health Questionnaire-9 [PHQ-9]) and remission (PHQ-9 ​< ​5) definitions were used. The PRO was a single yes/no question “Did you feel rTMS was helpful?” rTMS parameters were 10 ​Hz, 3000 pulses/session, 120% of motor threshold over the left dorsolateral prefrontal cortex (DLPFC). Student’s t-test was used to compare PHQ-9 baseline, endpoint, and change scores with and without comorbidities. Response, remission, and PRO were analyzed using chi-square or Fisher’s Exact tests. Logistic regression examined gender and age predictors. 84 patients were analyzed, with comorbidities of GAD (52.4%), PTSD (13.1%), and BPD (15.5%). Response and remission rates were 42.9% and 16.7%, respectively. The PRO was 61.9%. There were no significant differences in these rates with versus without comorbidities. In post-hoc analysis, gender was not a predictor for better outcomes, and older patients were more likely to experience remission than younger patients. Retrospective study, small sample size of PTSD and BPD. Comorbidities did not influence response and remission rates. The standard response rate underreported the patient’s perceived improvement. The patient’s point of view should be taken into account when discussing the clinical use of rTMS for MDD. • In our sample, rTMS for depression had response and remission rates of 42.9% and 16.7%. • Comorbidity of GAD in about half the patients did not reduce these rates. • Comorbidity of PTSD and BPD did not reduce the rates either but the limitation was a small sample. • Single question patient-reported outcome of response was 61.9%, higher than formal response rate.

Outcomes of Upper Gastrointestinal Bleeding in Hospitalized Patients With Generalized Anxiety Disorder.

BackgroundUpper gastrointestinal bleeding (UGIB) has a high morbidity and mortality. Social deprivation is a risk factor for UGIB and is associated with anxiety. The primary pharmaceutical therapeutic agents for anxiety are selective serotonin reuptake inhibitors. Anxiety is prevalent in the general population and generalized anxiety disorder (GAD) is a common form of anxiety. This study explores the impact of GAD on the outcomes of adult patients hospitalized with UGIB.MethodsAdult UGIB patients were selected utilizing the National (Nationwide) Inpatient Sample database from year 2014 and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The outcomes of UGIB patients with and without GAD were investigated. The outcomes explored include inpatient mortality, hypotension/shock, acute renal failure, acute hepatic failure, acute respiratory failure and acute myocardial infarction. A multivariate logistic regression analysis was used to determine if GAD is an independent predictor of the outcomes.ResultsAmong 19,850 UGIB patients studied, 2357 had comorbid GAD. GAD was identified as a risk factor for acute renal failure (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 1.30-1.57, p < 0.05) and inpatient mortality (aOR 1.50, 95% CI 1.01-2.06, p < 0.05). The aORs of hypotension/shock, acute hepatic failure, acute respiratory failure and acute myocardial infarction were not statistically significant.ConclusionUGIB patients with comorbid GAD are at elevated risk of inpatient mortality and acute renal failure. These results may gain increasing relevance as GAD prevalence has increased since the start of the coronavirus disease 2019 (COVID-19) pandemic.

Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016.

Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.

Major depressive disorder comorbid with general anxiety disorder: Associations among neuroticism, adult stress, and the inflammatory index

Accumulating evidence shows that higher neuroticism and adult stress may be potential risk factors for major depressive disorder (MDD) comorbid with generalized anxiety disorder (GAD). Studies have shown that anxious and depressed patients have significantly more neurobiological abnormalities than non-anxious depressed patients. However, the biological mechanism of comorbidity remains unknown. A study of serum markers allows a better understanding of the mechanism. This was a multi-centre, cross-sectional study. A total of 169 MDD patients (42 MDD patients with comorbid GAD and 127 MDD patients without comorbid GAD) were studied to analyse the risk factors for MDD with comorbid GAD. Twenty-four peripheral serum markers were measured. Path analysis was applied to test the association among neuroticism, adult stress, inflammatory markers, and psychopathology. After Bonferroni correction, MDD patients with comorbid GAD had lower levels of CCL2 (P = 0.001) and higher levels of α2M (P < 0.001) and TLR-1 (P = 0.001) than MDD patients without comorbid GAD (adjusted P < 0.002). In the path analyses of the association among adult stress, the inflammatory index, and psychopathology, neuroticism had a direct effect (β = 0.238, P = 0.003) and an indirect effect (β = 0.068, P = 0.004) on MDD and GAD comorbidity through adult stress and the inflammatory index. Our results suggest that MDD with comorbid GAD is associated with higher levels of inflammatory markers, stress factors and personality traits, which may provide some cues for early identification or more tailored and comprehensive treatment for MDD with comorbid GAD.

Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity

BackgroundPatients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life.MethodsA total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points.ResultsAverage NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up.ConclusionsComorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.

Revisiting Treatment Options for Depressed Patients with Generalised Anxiety Disorder.

Symptoms of anxiety and depression often coexist, and evidence suggests that this has a genetic basis, among other possible causes. However, the current classification of comorbid generalised anxiety disorder (GAD) and depression (anxious depression) in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-5) does not fully reflect the high prevalence of anxiety symptoms in people with depression and the International Classification of Diseases (10th and 11th revisions) has tended to identify anxious depression with minor disorders seen in primary care. As a result, few dedicated therapeutic trials have been conducted in patients with anxious depression, and specific treatment guidelines and recommendations are lacking. Fortunately, there is considerable therapeutic overlap between anxiety and depression, such that many agents with antidepressant efficacy are also effective for symptoms of GAD. The initial treatment of a patient with depression and symptoms of anxiety should be with an agent that is approved for both major depressive disorder and GAD, such as a selective serotonin reuptake inhibitor. There is an obvious need for greater recognition of anxious depression in order to boost the volume of high-quality clinical data, which should translate over time into better, more specific treatment recommendations and improved outcomes.

Buspirone for the Treatment of Generalized Anxiety Disorder in Down Syndrome: 3 Cases.

Reports on the pharmacologic treatment of anxiety, including generalized anxiety disorder (GAD), in individuals with Down syndrome (DS) are lacking. We present the case histories of 1 adolescent and 2 young adults with DS and the treatment course of comorbid GAD with buspirone. Treatment with buspirone was safe and well-tolerated and resulted in sustained improvement in symptoms of anxiety for a minimum of 2 years in all 3 cases. Buspirone's generally benign adverse effect profile makes it well suited for treating anxiety in individuals with DS in light of their common medical comorbidities.