Comorbid Generalized Anxiety Disorder Research Articles

Fat distribution and major depressive disorder in late adolescence.

Substantial evidence exists to indicate bidirectional relationships between obesity and depressive disorders and the importance of fat distribution to this relationship. This analysis used a well-characterized sample of individuals in late adolescence to determine the association between depressive illness and fat distribution. Medically healthy 15- to 20-year-olds, one-half of whom had recently begun treatment with a selective serotonin reuptake inhibitor, underwent a comprehensive psychiatric evaluation that resulted in diagnostic classification and weekly psychiatric disorder ratings over the prior 4 months using the Longitudinal Interval Follow-Up Evaluation. A whole-body scan, using dual-energy x-ray absorptiometry, allowed estimations of total body less head (TBLH), total mass, fat mass, and visceral adipose tissue (VAT) mass. Assessments occurred between September 2010 and April 2014. Multivariable linear regression analyses, adjusted for relevant covariates, examined the association between DSM-IV-TR-diagnosed major depressive disorder (MDD) and VAT, the primary outcome of interest. These procedures also determined whether significant associations were confined to overweight/obese participants. The analysis included data from 200 participants (71% female; mean age = 19.0 ± 1.6 years), of whom 128 had current MDD. The presence of MDD was associated with increased fat mass among overweight/obese participants (Cohen d = 0.79, P < .02), but not normal weight participants. This was true of both visceral and nonvisceral fat mass measures. Accounting for the presence of generalized anxiety disorder (GAD) did not alter the findings. In adolescents, relationships between central adiposity and MDD may be confined to those who are overweight/obese. Despite the high comorbidity of GAD and depressive disorders, only the latter appeared to be significantly associated with central adiposity.

A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population

BackgroundBipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. AimsTo determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta-analysis. MethodRandom effects meta-analyses were used to calculate the lifetime prevalence of comorbid generalised anxiety disorder, panic disorder, social anxiety disorder, specific phobia, agoraphobia, obsessive compulsive disorder and posttraumatic stress disorder in bipolar affective disorder. Results52 studies were included in the meta-analysis. The rate of lifetime comorbidity was as follows: panic disorder 16.8% (95% CI 13.7–20.1), generalised anxiety disorder 14.4% (95% CI 10.8–18.3), social anxiety disorder13.3% (95% CI 10.1–16.9), post-traumatic stress disorder 10.8% (95% CI 7.3–14.9), specific phobia 10.8% (95% CI 8.2–13.7), obsessive compulsive disorder 10.7% (95% CI 8.7–13.0) and agoraphobia 7.8% (95% CI 5.2–11.0). The lifetime prevalence of any anxiety disorders in bipolar disorder was 42.7%. ConclusionsOur results suggest a high rate of lifetime concurrent anxiety disorders in bipolar disorder. The diagnostic issues at the interface are particularly difficult because of the substantial symptom overlap. The treatment of co-existing conditions has clinically remained challenging.

Generalized Anxiety Disorder and Major Depressive Disorder in Pregnant and Postpartum Women: Maternal Quality of Life and Treatment Outcomes

Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) in perinatal women is often under-diagnosed, resulting in suboptimal treatment and leading to significant maternal dysfunction. We describe a prospective, longitudinal study of the course, treatment outcomes, and quality of life (QoL) in pregnant and postpartum women with MDD and anxiety disorders. Two separate cohorts of women were recruited through the Reproductive Mental Health Program, Women's and Children's Hospital, Vancouver, British Columbia, for pharmacotherapy of depressed mood. One cohort was recruited during pregnancy and followed to one month postpartum; the other cohort was recruited postpartum and followed for 12 weeks. All women met the DSM-5 criteria for MDD and anxiety disorders. This non-lactating perinatal population completed measures of depression, anxiety, worry symptoms, and QoL at multiple study visits. Depressed women with GAD or excessive worry were compared to those without GAD in each cohort. Analysis revealed that despite the majority of women with MDD having remission of symptoms with treatment, those with postpartum GAD displayed a poorer quality of life, with persistent worry symptoms, and their illness was slower to remit. Pregnant depressed women with uncontrollable worry (a GAD indicator) showed a lower probability of achieving remission of symptoms with treatment than those without uncontrollable worry. All pregnant and postpartum women with GAD and MDD responded to pharmacotherapy, and the majority attained complete remission of MDD. However, their GAD symptoms persisted, and their QoL was compromised. Given the chronic debilitating course of concomitant MDD and GAD in the perinatal population, it is essential to focus on adjunctive therapies to aim for full recovery.

Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: A randomized controlled trial

Disorder-specific cognitive behavior therapy (DS-CBT) is effective at treating major depressive disorder (MDD) while transdiagnostic CBT (TD-CBT) addresses both principal and comorbid disorders by targeting underlying and common symptoms. The relative benefits of these two models of therapy have not been determined. Participants with MDD (n=290) were randomly allocated to receive an internet delivered TD-CBT or DS-CBT intervention delivered in either clinician-guided (CG-CBT) or self-guided (SG-CBT) formats. Large reductions in symptoms of MDD (Cohen’s d≥1.44; avg. reduction≥45%) and moderate-to-large reductions in symptoms of comorbid generalised anxiety disorder (Cohen’s d≥1.08; avg. reduction≥43%), social anxiety disorder (Cohen’s d≥0.65; avg. reduction≥29%) and panic disorder (Cohen’s d≥0.45; avg. reduction≥31%) were found. No marked or consistent differences were observed across the four conditions, highlighting the efficacy of different forms of CBT at treating MDD and comorbid disorders.

Persistent benefits of slow titration of paroxetine in a six-month follow-up.

Paroxetine titration may be difficult in older individuals as they are more sensitive to side effects. The current study extends to 6 months our previously published report in which paroxetine was started at 2.5 mg/day and slowly increased by 2.5 mg on alternate days (slow titration) or rapidly titrated to target dose from 10 mg/day (standard titration) in a naturalistic setting. Here, the follow-up period was extended to 26 weeks. We performed an intent-to-treat analysis of 47 subjects from the original sample (major depressive disorder and/or generalized anxiety disorder (GAD); >60 years of age). Missing evaluations were replaced by last observations carried forward. GAD was included as a stratification factor. Patients in whom paroxetine was slowly up-titrated were more likely to remit (84.0% vs 54.5%; p = 0.028) and had lower core depression (p = 0.0015) and psychic anxiety levels (p = 0.006) after 26 weeks. Dropout rate was 20% in the slow titration group compared with 77.3% in the standard titration arm (p < 0.001). Patients with GAD accounted for all significant associations. No substantial differences were reported between slow and standard titration groups in the subsample without GAD. Despite some limitations, these findings suggest that paroxetine treatment should be started at lower doses in older depressed patients and slowly up-titrated. This strategy would allow to increase antidepressant response and the likelihood of completing treatment cycle in patients with high anxiety levels and GAD comorbidity.

Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity (I10-2C)

Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity (I10-2C)

Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity (P6.190)

Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity (P6.190)

Brain structural abnormalities in patients with major depression with or without generalized anxiety disorder comorbidity.

An overlap frequently occurs between major depression disorder (MDD) and generalized anxiety disorder (GAD). Aim of this study was to assess cortical and white matter (WM) alterations in MDD patients with or without GAD comorbidity. Seventy-one MDD patients and 71 controls were recruited. All subjects underwent T1-weighted and diffusion tensor (DT)/MRI. MRI metrics of cortical thickness and WM integrity were obtained from atlas-based cortical regions and the interhemispheric and major long association WM tracts. Between-group MRI comparisons and multiple regressions with clinical scale scores were performed. Compared to controls, both MDD and MDD-GAD patients showed a cortical thinning of the middle frontal cortex bilaterally, left medial frontal gyrus and frontal pole. Compared to controls and MDD patients, MDD-GAD cases also showed a thinning of the right medial orbitofrontal and fusiform gyri, and left temporal pole and lateral occipital cortices. Compared to controls, MDD patients showed DT MRI abnormalities of the right parahippocampal tract and superior longitudinal fasciculus bilaterally, while no WM alterations were found in MDD-GAD. In all patients, brain abnormalities were related with symptom severity. MDD and MDD-GAD share a common pattern of cortical alterations located in the frontal regions. However, while both the cortex and WM integrity are affected in MDD, only the former is affected in MDD-GAD. These findings support the notion of MDD-GAD as a distinct clinical entity, providing insights into patient vulnerability for specific networks as well as into patient resilience factors reflected by the integrity of other cerebral circuits.

A Survey in the Treatment of Generalised Anxiety Disorder and Comorbid Major Depression by Venezuelan Psychiatrists

Introduction Anxiety disorders and depression are major world-wide health problems. In the US National Comorbidity Survey, lifetime prevalence of anxiety and mood disorders were 28.8% and 20.8%, respectively 1. High levels of comorbidity are seen between anxiety disorders and major depression (MD) 2 It is well reported that indi-viduals with comorbid generalised anxiety disorder (GAD) and MD are significantly more likely to remain symptomatic than individuals with depression or generalised anxiety disorder alone 3 Objectives To investigate the use of different pharmacological strategies in the management of GAD and MD. Aims To gain insight into the local current management of GAD and comorbid MD by Venezuelan psychiatrists, as well as comparing the correlation with international recommendations. Methods This survey was conducted recently at a National Psychiatric meeting in Caracas. A 27-item questionnaire, developed to investigate the different treatment strategies, was completed by 100 psychiatrists during a presentation of clinical cases, with the model of key-pad. Results 80% prescribed selective serotonin reuptake inhibitors (SSRIs). 70% prescribed an SSRI plus benzodiazepines (BZD); in addition, 80% favoured a combined approach, pharmacotherapy and psychotherapy. Cognitive Behavioural Therapy was the psychological treatment most commonly used (60%). Conclusions The survey shows that the majority of participants prefer a combination of pharmacotherapy and psychotherapy as first-line treatment strategy. Reported practice in this sample for the pharmacological approach, appears consistent with recent evidence-based treatment guidelines. The main drawback of the study is the small number of participants.

Associations between diabetes, major depressive disorder and generalized anxiety disorder comorbidity, and disability: Findings from the 2012 Canadian Community Health Survey — Mental Health (CCHS-MH)

ObjectiveTo examine the associations between diabetes, disability, and the likelihood of comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD). MethodsData were obtained from the 2012 Canadian Community Health Survey — Mental Health (N=17 623). Diabetes assessment consisted of a self-reported diagnosis of diabetes made by a health care professional. Disability was assessed via self-report. 12-Month and lifetime MDD and GAD were assessed with the Composite International Diagnostic Interview 3.0. ResultsIn multinomial logistic regression models adjusted for sociodemographic and health-related factors, having diabetes was associated with a greater likelihood of 12-month comorbid MDD and GAD (OR=1.99, 95% CI [1.22, 3.25], p=.006), compared with those with neither MDD nor GAD. No significant associations were found for MDD without GAD or GAD without MDD. This pattern of effects held when lifetime diagnoses of MDD and GAD were considered. For individuals with diabetes (n=1730), adjusted binary logistic regression models demonstrated that with 12-month diagnoses, MDD without GAD (OR=2.79, 95% CI [1.39–5.62], p=.004), GAD without MDD (OR=3.69, 95% CI [1.34–10.11], p=.01), and comorbid MDD and GAD (OR=4.17, 95% CI [1.66–10.51], p=.002) were associated with greater disability than the control group. Only comorbid MDD and GAD were associated with disability when lifetime diagnoses of MDD and GAD were considered. ConclusionsIndividuals with diabetes may be particularly vulnerable to comorbid MDD and GAD, and MDD-GAD comorbidity may exacerbate disability in persons with diabetes.

Prevalence and disability of comorbid social phobia and obsessive–compulsive disorder in patients with panic disorder and generalized anxiety disorder

Objective. Generalized anxiety disorder (GAD) and panic disorder (PD) are disabling conditions, often comorbid with other anxiety disorders. The present study was aimed to assess prevalence and related disability of comorbid social phobia (SP) and obsessive–compulsive disorder (OCD) in 115 patients with GAD (57) or PD (58). Methods. Patients were classified as having threshold, subthreshold, or no comorbidity, and related prevalence rates, as well as disability (Sheehan Disability Scale, SDS), were compared across diagnostic subgroups. Results. SP and OCD comorbidities were present in 30.4% of the sample, with subthreshold comorbidities present at twice the rate of threshold ones (22.6% vs. 11.3%). Compared with GAD patients, PD patients showed significantly higher subthreshold and threshold comorbidity rates (27.6% and 13.8% vs. 17.5% and 8.8%, respectively). Comorbid PD patients had higher SDS scores than the comorbid and non-comorbid GAD subjects. The presence of threshold SP comorbidity was associated with the highest SDS scores. Conclusions. SP and OCD comorbidities were found to be prevalent and disabling among GAD and PD patients, with higher subthreshold than threshold rates, and a negative impact on quality of life. Present findings stress the importance of a dimensional approach to anxiety disorders, the presence of threshold and subthreshold comorbidity being the rule rather than the exception.

P.2.a.003 Anxiety and depression symptoms among patients with type 2 diabetes mellitus and poor glycaemia control

To examine the associations between diabetes, disability, and the likelihood of comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD).Data were obtained from the 2012 Canadian Community Health Survey — Mental Health (N = 17 623). Diabetes assessment consisted of a self-reported diagnosis of diabetes made by a health care professional. Disability was assessed via self-report. 12-Month and lifetime MDD and GAD were assessed with the Composite International Diagnostic Interview 3.0.In multinomial logistic regression models adjusted for sociodemographic and health-related factors, having diabetes was associated with a greater likelihood of 12-month comorbid MDD and GAD (OR = 1.99, 95% CI [1.22, 3.25], p = .006), compared with those with neither MDD nor GAD. No significant associations were found for MDD without GAD or GAD without MDD. This pattern of effects held when lifetime diagnoses of MDD and GAD were considered. For individuals with diabetes (n = 1730), adjusted binary logistic regression models demonstrated that with 12-month diagnoses, MDD without GAD (OR = 2.79, 95% CI [1.39–5.62], p = .004), GAD without MDD (OR = 3.69, 95% CI [1.34–10.11], p = .01), and comorbid MDD and GAD (OR = 4.17, 95% CI [1.66–10.51], p = .002) were associated with greater disability than the control group. Only comorbid MDD and GAD were associated with disability when lifetime diagnoses of MDD and GAD were considered.Individuals with diabetes may be particularly vulnerable to comorbid MDD and GAD, and MDD-GAD comorbidity may exacerbate disability in persons with diabetes.

Efficacy and Safety of Quetiapine-XR as Monotherapy or Adjunctive Therapy to a Mood Stabilizer in Acute Bipolar Depression With Generalized Anxiety Disorder and Other Comorbidities

To study the efficacy and safety of quetiapine-XR as monotherapy or adjunctive therapy to a mood stabilizer in acute bipolar I or II depression with comorbid generalized anxiety disorder (GAD) and other comorbidities. The study was conducted from January 2007 to November 2011. The Mini-International Neuropsychiatric Interview was used to ascertain the diagnosis of DSM-IV bipolar disorder, GAD, and other Axis I disorders. Eligible patients were randomly assigned to quetiapine-XR or placebo for up to 8 weeks. The Hamilton Depression Rating Scale-17 items (HDRS-17) was used as a primary outcome to evaluate the difference between the 2 groups using the change from baseline to end of study. Last observation carried forward and mixed-effects modeling for repeated measures were used to analyze the primary and secondary outcome measures. Of the 120 patients screened, 100 patients were randomized to receive quetiapine-XR (n = 50) or placebo (n = 50). Twenty-six patients in the quetiapine-XR and 18 in the placebo group completed the study. The mean quetiapine-XR dose was 276 ± 50 mg/d (50-300 mg/d). There was no significant difference between the 2 groups in the change from baseline to end of study in HDRS-17 total score with an effect size of 0.19 favoring quetiapine-XR. There were also no significant differences between the 2 groups in secondary efficacy and safety outcome measures. Quetiapine-XR was not significantly superior to placebo in bipolar I or II depression with GAD and other comorbidities, suggesting that data from relatively "pure" bipolar patients may not be generalizable to a highly comorbid population. ClinicalTrials.gov identifier: NCT00671853.

Intensive Treatments for Generalized Anxiety Disorder in Children and Adolescents

Worry is a normal part of child development. However, a significant proportion of young people experience excessive worry that causes distress and interference with daily functioning. Although worry is a common feature of all anxiety disorders, it is a defining feature of Generalized Anxiety Disorder (GAD). Cognitive-behavioural therapy is an efficacious treatment for GAD and other anxiety disorders that in recent years has been successfully adapted into short, time-limited formats for other childhood anxiety disorders including Specific Phobia, Social Phobia, Panic, Separation Anxiety and Obsessive Compulsive Disorder. However, intensive treatments for GAD specifically have not been examined to date. This paper provides a brief overview of the characteristics of youth with GAD, followed by a review of current intensive treatments for other anxiety disorders and evidence suggesting these approaches are effective in treating comorbid GAD. Potential benefits of an intensive treatment for GAD are outlined, and directions for future research on intensive treatments for GAD are discussed.

EPIDEMIOLOGY AND COURSE OF UNIPOLAR MANIA: RESULTS FROM THE NATIONAL EPIDEMIOLOGIC SURVEY ON ALCOHOL AND RELATED CONDITIONS (NESARC)

Unipolar mania (UM), in which only manic episodes occur during the course of illness, may be an important clinical manifestation of bipolar disorder that is under-recognized and understudied. The aim of this study is, for the first time, to examine the prevalence of UM and its clinical characteristics in the community. Among a total of 1,411 subjects with bipolar I disorder, we evaluated the prevalence of UM using three different criteria proposed in previous studies. We compared the clinical characteristics of subjects with UM to those with a more classic bipolar presentation with mania and lifetime major depressive episode (MDE). We additionally explored the proportion of subjects with UM who later experience at least one MDE during a 3-year follow-up period and determined risk factors for converting from UM to classic bipolar disorder. The prevalence rate of UM among those with bipolar disorder ranged from 5.0 to 7.2% depending on the criteria. UM was more common in male and nonwhite subjects. About half of individuals with UM experienced subthreshold depression. Individuals with UM had lower rates of comorbid anxiety disorders or attention deficit hyperactivity disorder (ADHD). During the follow-up, about 18% of subjects with UM experienced MDEs. Male, nonwhite, comorbid generalized anxiety disorder and ADHD predicted an increased transition from UM to classic bipolar disorder. Subthreshold depression was not associated with the risk of the transition. UM is an infrequent but clinically distinct subtype of bipolar I disorder. Further research delineating the characteristics of UM is warranted.

Gender Difference in Major Depression and Generalized Anxiety Disorder Comorbidity in Patients of Obsessive Compulsive Disorder

Context : Obsessive Compulsive Disorder is a disease with controversies regarding co-morbidities. Studies have noted there are some doubts due to the disease's heterogeneity and cultural influence. Some studies have reflected that women are more likely to have Major depressive disorder(MDD) as co-morbidity while the impact of gender on co-morbid generalized anxiety disorder(GAD) was inconclusive. There are few Indian studies in this regard and hence this cross-sectional study was performed in a tertiary referral centre in Eastern India. Material and method : 100 consecutive eligible patients with OCD(Male=41,Female=59) were interviewed. The data were recorded for socio-demographic profile, depression and anxiety comorbidities. Results : The mean age of the study sample was 32.73 yrs, mostly from rural background(82%) and nuclear families (62%).The subjects were found to be suffering mostly from co-morbid MDD(85%) and GAD(83%).93% of our female subjects had co-morbid MDD while 90% of them had co-morbid GAD. The corresponding percentages for 41 males was 73%(for both MDD and GAD). Gender had an impact on both these co-morbid diagnoses(P-value<0.05)though the association with depression was more. Conclusion : Our study showed both MDD and GAD were highly comorbid with OCD and gender(i.e female sex) having influence on diagnosis. This may be due to long-term suppression&underreporting of our patients due to the taboo of suchi-bai,distress caused by this suppression and denial in family life and the female majority. Recommendations : 1)Early diagnosis and prompt management of MDD and GAD in female OCD subjects to reduce morbidity. 2) Further longitudinal community-based studies.

Depression, anxiety, and heart rate variability: A case-control study in Taiwan

Objective: Decreased heart rate variability (HRV) has been reported in persons with major depressive disorder (MDD), but the results obtained are inconsistent. Little is known about the impact of comorbid anxiety disorders on HRV in MDD patients. Both issues necessitate further investigation. Materials and Methods: Forty-nine unmedicated, physically healthy, MDD patients without comorbidity, 21 MDD patients with comorbid generalized anxiety disorder (GAD), 24 MDD patients with comorbid panic disorder (PD), and 81 matched controls were recruited. The Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale are employed to assess the severity of depression and anxiety, respectively. The cardiac autonomic function was evaluated by measuring the HRV parameters. The frequency-domain indices of HRV were obtained. Results: MDD patients without comorbidity had lower high-frequency (HF)-HRV (which reflected vagal control of HRV) than controls. Any comorbid anxiety disorder (GAD or PD) was associated with significantly faster heart rates, relative to the controls, and caused greater reductions in HF-HRV among MDD patients. MDD participants with comorbid GAD displayed the greatest reductions in HF-HRV, relative to controls. Correlation analyses revealed that the severity of both depression and anxiety were significantly associated with the mean R wave to R wave (R-R) intervals, variance, low-frequency (LF)-HRV, and HF-HRV. Conclusion: The present results show decreased HRV in MDD patients, suggesting that reduction in HRV is a psychophysiological marker of MDD. MDD patients with comorbid GAD had the greatest reductions in HRV. Further investigation of the links between MDD and comorbid GAD, HRV, and cardiovascular disease is warranted.

Association of Comorbid Generalized Anxiety Disorder and Alcohol Use Disorder Symptoms with Health-Related Quality of Life

Although prior studies have documented the co-occurrence of generalized anxiety disorder (GAD) and alcohol use disorder (AUD) disorder, there is a paucity of research assessing the patterns of alcohol involvement among individuals with GAD symptoms. This study investigated subtypes, or classes, of comorbid AUD and GAD symptoms, and assessed the association of class membership with health-related quality of life. Using data from the Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, a latent class analysis was performed on the subset of individuals who were current drinkers and had reported ever experiencing a 6-month episode of feeling tense, nervous, or worried most of the time. We examined the association of these latent classes with physical and mental health-related quality of life measured by the Short Form-12, version 2. Latent class analysis identified a 5-class model of AUD and GAD symptoms. A significant graded relationship was observed between the ordered classes and severity of impairment on the mental health scale of the Short Form-12, version 2, but no significant relationship was found with the physical health scale. Mental, but not physical, health-related quality of life in this population is associated with both the number and pattern of comorbid GAD and AUD symptoms.

An open-label trial of duloxetine in patients with irritable bowel syndrome and comorbid generalized anxiety disorder

Objective. Irritable bowel syndrome (IBS) is commonly comorbid with generalized anxiety disorder (GAD). We evaluated whether duloxetine would lead to improvement in symptoms and quality of life in patients with both conditions. Method. A 12-week, open-label trial of duloxetine was conducted in 13 subjects with IBS and GAD. The primary outcome measure was the Clinical Global Impression (CGI) Scale. Secondary measures included the Hamilton Anxiety Rating Scale, IBS Quality of Life (IBS-QOL) Scale, and IBS Symptom Severity Scale (IBS-SSS). Results. Repeated measures ANOVA was used to examine the effect of treatment with duloxetine on ratings of anxiety and IBS. Significant improvement was observed on the CGI-Improvement (F = 14.19, df = 1,12, p < 0.001) and Severity scales (F = 16.16, df = 1,12, p < 0.001). Secondary measures revealed significant reduction in symptoms of anxiety (F = 11.66, df = 1,12, p < 0.01), ηp2 = 0.56, and IBS-SSS (F = 6.05, df = 1,12, p < 0.001), ηp2 = 0.34, in addition to IBS-QOL improvements (F = 11.66, df = 1,12, p < 0.01), ηp2 = 0.56. Conclusion. Results of this pilot study support the efficacious use of duloxetine in comorbid IBS and GAD. Participants reported significant reductions in IBS components, as well as improvement in GAD.

An examination of generalized anxiety disorder and dysthymic disorder by latent class analysis

The nosological status of generalized anxiety disorder (GAD) versus dysthymic disorder (DD) has been questioned. The aim of this study was to examine qualitative differences within (co-morbid) GAD and DD symptomatology. Latent class analysis was applied to anxious and depressive symptomatology of respondents from three population-based studies (2007 Australian National Survey of Mental Health and Wellbeing; National Comorbidity Survey Replication; and Netherlands Mental Health Survey and Incidence Study-2; together known as the Triple study) and respondents from a multi-site naturalistic cohort [Netherlands Study of Depression and Anxiety (NESDA)]. Sociodemographics and clinical characteristics of each class were examined. A three-class (Triple study) and two-class (NESDA) model best fitted the data, reflecting mainly different levels of severity of symptoms. In the Triple study, no division into a predominantly GAD or DD co-morbidity subtype emerged. Likewise, in spite of the presence of pure GAD and DD cases in the NESDA sample, latent class analysis did not identify specific anxiety or depressive profiles in the NESDA study. Next, sociodemographics and clinical characteristics of each class were examined. Classes only differed in levels of severity. The absence of qualitative differences in anxious or depressive symptomatology in empirically derived classes questions the differentiation between GAD and DD.