GAD Patients Research Articles

Attenuated responses to emotional expressions in women with generalized anxiety disorder

Generalized anxiety disorder (GAD) is under-researched despite its high prevalence and large impact on the healthcare system. There is a paucity of functional magnetic resonance imaging (fMRI) studies that explore the neural correlates of emotional processing in GAD. The present study investigated the blood oxygen level dependent (BOLD) response to processing positive and negative facial emotions in patients with GAD. A total of 15 female GAD patients and 16 female controls undertook an implicit face emotion task during fMRI scanning. They also performed a face emotion recognition task outside the scanner. The only behavioural difference observed in GAD patients was less accurate detection of sad facial expressions compared with control participants. However, GAD patients showed an attenuated BOLD signal in the prefrontal cortex to fearful, sad, angry and happy facial expressions and an attenuated signal in the anterior cingulate cortex to happy and fearful facial expressions. No differences were found in amygdala response. In contrast with previous research, this study found BOLD signal attenuation in the ventrolateral and medial prefrontal cortex and the anterior cingulate cortex during face emotion processing, consistent with a hypothesis of hypo-responsivity to external emotional stimuli in GAD. These decreases were in areas that have been implicated in emotion and cognition and may reflect an altered balance between internally and externally directed attentional processes.

P03-350 Pharmacotherapy of generalized anxiety disorders under conditions of routine treatment

BackgroundGeneralized anxiety disorders (GAD) are characterized by persistent excessive worrying about minor hassles. GAD patients are high utilizers of medical services and medication.According to an analysis of 21 double-blind placebo-controlled trials by of Hidalgo et al. (2007) highest effect sizes are reproted for pregabalin (0.50), hydroxyzine (0.45), venlafaxine XR (0.42), benzodiazepines (0.38), SSRIs (0.36), buspirone (0.17) and herbal medicines (-0.31). The question is how GAD is treated under conditions of routine treatment. This was studied in patients were admitted to inpatient treatment.MethodPsychotropic premedication and changes in medication during the inpatient treatment were analyzed in 107 patients.ResultBefore admission, 27,1% of GAD patients got tricyclic antidepressants, 25,2% SSRI, 8,4% benzodiazepines, 7,4% atypical antidepressants, 1,9% anticonvulsants/pregabaline, 1,9% herbal drugs. Furthermore, 20,6% got betablocker, preferably because of hypertension.During the inpatient stay changes in medication were made according to the clinical discretion of the therapist. At discharge 41,1% of GAD patients received SSRI, 23,4% tricyclic antidepressants, 22,4% pregabaline, 9,4% atypical antidepressants.ConclusionSSRI and tricyclic antidepressants play the major role in the drug treatment of GAD. Under clinical conditions there has been an optimization of treatment by increasing preferably the rate of SSRI treatments and of pregabaline treatment, while reducing benzodiazepine treatment and to some degree tricyclic antidepressants.LiteratureHidalgo RB, Tupler LA, Davidson JRT (2007): An effect-size analysis of pharmacologic treatments for generalized anxiety disorder. J Psychopharmacol 21(8):864-872.

Meta-cognitive profiles in anxiety disorders

This study had two distinct objectives. First, to examine the relationships between meta-cognitions and anxiety disorders. Second, to identify specific meta-cognitions as unique predictors of generalized anxiety (GAD), depression (DD) and obsessive–compulsive (OCD) disorders. A total of 180 cases were analyzed using the Meta-cognitions Questionnaire (MCQ), Anxious Thoughts Inventory (AnTI), and the Thought Control Questionnaire (TCQ). The results suggest that all the five types of negative metacognitive beliefs measured by the MCQ are significantly correlated with one another and with AnTI and TCQ scores except for cognitive self-consciousness, which failed to correlate with TCQ scores. Multivariate analysis revealed that the clinical cases differed from normal subjects in their beliefs about uncontrollability and danger, beliefs about cognitive competence, and general negative beliefs. Only OCD patients differed from both normal subjects and GAD patients in their cognitive self-consciousness. Health worry was elevated in GAD patients, while meta-worry was elevated in OCD patients. Furthermore, depressives tended to use worry while OCD patients tended to use distraction as meta-cognitive strategies to control intrusive and distressing thoughts. Discriminant analysis was performed with GAD, DD and OCD as dependent variables and the MCQ, AnTI and TCQ subscales as predictor variables. Overall the discriminant functions successfully predicted outcome for over 70% of cases. Findings provide support for the Self-Regulatory Executive Function model.

P01-128 Sensitivity of the generalised anxiety disorder inventory (GADI) to detect changes in two experimental models of human anxiety

We developed and validated a new questionnaire for the assessment of the symptom profile and severity of generalised anxiety, the Generalised Anxiety Disorder Inventory (GADI). The 18-item scale (Argyropoulos et al, 2007, J Psychopharmacology, 21: 145-152) showed good reliability, convergent and divergent validity. The scale comprises three factors, relating to cognitive, somatic and sleep symptoms. It distinguishes accurately GAD patients from non-patient controls. The cognitive factor also distinguishes GAD from other anxiety disorders and depression. The sensitivity of the GADI to detect changes in symptom levels was tested in two experimental models of anxiety induction; the inhalation of 7.5% CO2 over a period of 20 minutes, which models generalised anxiety, and a single vital capacity inhalation of 35% CO2, which models panic anxiety (Bailey et al, 2005, Depression & Anxiety, 21: 18-25; Bailey et al, 2007, J Psychopharmacology, 21: 42-49). We found that the GADI was able to detect the differential drug effect of a benzodiazepine (alprazolam) and placebo in the anxiety induced by these tests in healthy volunteers.

Impact of Pregabalin on gastrointestinal symptoms in generalized anxiety disorder: Results of a 6-study combined analysis

Background and Aims:To evaluate the clinical characteristics of GAD patients with prominent GI symptoms (GI-high) and their response to pregabalin (PGB) treatment.Methods:Data were pooled from 6 double-blind, placebo-controlled, 4-6 week trials of outpatients who met DSM-IV criteria for GAD with a minimum HAM-A total score ≥18. Treatment response was evaluated for 3 PGB fixed-dosage groups: 150 mg/d, 300-450 mg/d, and 600 mg/d. A GI-high subgroup (high GI symptomatology) was defined by a baseline HAM-A item-11 (GI) score ≥3 (severe/very severe).Results:At baseline, 261 patients (17%) met criteria for the GI-high subgroup, while 1294 patients (83%) were in the GI-low subgroup. Baseline characteristics were similar for the 4 study treatments in the GI-high subgroup. For the GI-high subgroup, LOCF-endpoint reduction in HAM-A was significantly higher on PGB-150, -13.8±1.7; PGB-300/450 -13.5±1.2; PGB-600, -14.8±1.1; vs PBO, -10.6±1.0 (P<0.0001 for all comparisons). In the GI-high subgroup, the proportion of patients showing a response in GI symptoms (HAM-A item 11 improving from severe/very severe to mild-to-none) was significantly higher on PGB-150 (62%), PGB-300/450 (73%), PGB-600 (68%) vs PBO (56%; P<0.0001 for all comparisons). The incidence of adverse events referable to the GI system was the same on PGB-150 and PBO, 8% higher on PGB-200/450 vs PBO, and 5% higher on PGB-600 vs PBO.Conclusion:PGB was effective and well-tolerated in the subgroup of GAD patients presenting with severe GI symptoms. Treatment with PGB improved both overall levels of anxiety, as well as specifically improving GI symptoms.Funded by Pfizer Inc

Differentiating Cognitive Content between Depressed and Anxious Outpatients

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

How does thought suppression impact upon beliefs about uncontrollability of worry?

According to Wells’ metacognitive model of generalised anxiety disorder (GAD; [Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalised anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320]), GAD patients attempt to suppress intrusions that trigger worry. Wells postulates that these attempts are rarely effective and may increase the frequency of worry triggers. These apparent failures are interpreted as evidence for loss of mental control, thereby exacerbating beliefs about worry uncontrollability. The current study tested these predictions. Sixty-two high worriers completed a naturalistic experiment comprising two sessions separated by 1 week. In Session 1, participants recorded their beliefs about worry in general, including its uncontrollability. They then selected a current worry and recorded how often it came to mind over the following week. The Suppression group (N=32) suppressed their chosen worry during the week. The Mention group (N=30) simply monitored its occurrence. In Session 2, Session 1 measures were repeated. Contrary to prediction, the Suppression group reported a significant increase in worry controllability in general. No shift was demonstrated by the Mention group. In addition, relative to the Mention group, the Suppression group reported more success at suppressing their chosen worries, spent less time thinking about them, and found them more controllable and less distressing. Findings are discussed within the context of Wells’ model.

Sedative Effects of Low-Dose Risperidone in GAD Patients and Risk of Drug Interactions

Sedative Effects of Low-Dose Risperidone in GAD Patients and Risk of Drug Interactions

Dr. Brawman-Mintzer and Colleagues Reply

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: We appreciate the comments of Drs. Kopecek, Mohr, and Novak in response to our report suggesting that risperidone at low doses may represent a useful tool in the management of symptomatic GAD patients.1 Two issues are brought to our attention that were only marginally addressed in the original report.First, the possibility is raised that risperidone could have contributed to the somnolence experienced by some patients.†‹

Persecutory delusions and catastrophic worry in psychosis: Developing the understanding of delusion distress and persistence

In a recent theoretical account of persecutory delusions, it is suggested that anxiety and worry are important factors in paranoid experience [Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41(4), 331–347]. In emotional disorders worry has been understood in terms of catastrophising. In the current study, the concept of catastrophising is applied for the first time with persecutory delusions. Thirty individuals with current persecutory delusions and 30 non-clinical controls participated in a cross-sectional study. The group with persecutory delusions was also followed up at 3 months to assess predictors of delusion persistence. At its most severe, 21% of individuals with persecutory delusions had clinical worry, 68% had levels of worry comparable with treatment seeking GAD patients. Further, high levels of anxiety, worry and catastrophising were associated with high levels of persecutory delusion distress and with the persistence of delusions over 3 months. If future research replicates these findings, worry reduction interventions for individuals with persecutory delusions may be warranted.

The epidemiology of generalized anxiety disorder in Europe

The objective of this paper is to provide a review on available data to date on the epidemiology of GAD in Europe, and to highlight areas for future research. MEDLINE searches were performed and supplemented by consultations with experts across Europe to identify non-published reports. Despite variations in the design of studies, available data suggest that (a) about 2% of the adult population in the community is affected (12-month prevalence), (b) GAD is one of the most frequent (up to 10%) of all mental disorders seen in primary care, (c) GAD is a highly impairing condition often comorbid with other mental disorders, (d) GAD patients are high utilizers of healthcare resources, and (e) despite the high prevalence of GAD in primary care, its recognition in general practice is relatively low. Marked data deficits are: lack of data from eastern European countries, lack of information about the natural course of GAD in unselected samples, the vulnerability and risk factors involved in the aetiology of GAD and lack of data about adequate and inappropriate treatments in GAD patients as well as the associated and societal costs of GAD.

CBT Effective in Pilot Study of GAD Patients

CBT Effective in Pilot Study of GAD Patients

Stability of worry content in GAD patients: a descriptive study

The stability of worry content was investigated in a sample of 27 individuals diagnosed with Generalized Anxiety Disorder. During an initial evaluation, participants were asked to describe the content of their current worries, and the examining psychiatrist rated the frequency and intensity of these topics. During the following year, the investigators interviewed the participants on a monthly basis assessing the intensity and frequency of original worries, intensity and frequency of new worries, overall worry level, and general anxiety level. Analysis of this longitudinal data indicated level of overall worry and anxiety remained fairly stable over a 12-month period. Although the intensity and frequency of original worries decreased over time, few original worry topics completely remitted. In fact, at the end of the 12-month monitoring period, worry content identified at baseline continued to account for over 65% of the overall worry variance. Most participants did identify new worry topics during the course of the 12-month period, and the frequency and intensity of the new worries were comparable to the decrease in frequency and intensity of the original worries.

P01.62 Efficacy of venlafaxine er in gad patients with predominantly somatic symptomatology

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Anxiolytic effect of hydroxyzine: a double‐blind trial versus placebo and buspirone

Benzodiazepines have major drawbacks including lessening of anxiolytic effect in long-term use, impairment of psychological functioning, problems on discontinuation, and addiction potential. Alternatives have been sought including the antihistamines such as hydroxyzine. Two studies are described, one comparing hydroxyzine 50 mg/day with placebo in GAD patients. Significant advantages were found for the active drug. The second GAD evaluation compared hydroxyzine 50 mg/day, buspirone 20 mg/day, and placebo. Hydroxyzine was significantly superior to placebo with buspirone intermediate. Adverse effects were minor and transient. It is concluded that hydroxyzine may prove a useful and safer alternative to the benzodiazepines. Copyright © 1999 John Wiley & Sons, Ltd.

Don’t Worry and Beware of White Bears: Thought Suppression in Anxiety Patients

The ability to suppress unwanted thoughts was investigated in patients with Generalized Anxiety Disorder (GAD; n = 29), Speech Phobics ( n = 25), and nonanxious controls ( n = 28). All participants spent 5 minutes thinking aloud about anything that came to mind while trying not to think of white bears. In another task, they thought aloud for 5 minutes while trying not to think of their main worry. Intrusions of unwanted thoughts were signaled by button presses and recorded on tape. In accordance with the disorder’s definition and complaints of the GAD patients, they showed more intrusions of their main worry than of white bears. The opposite was true for other participants. Compared to a baseline measure, all participant groups were unable to reduce duration of main worry thoughts when trying to suppress them.

Anti-GAD65 autoantibody in Taiwanese patients with insulin-dependent diabetes mellitus: effect of HLA on anti-GAD65 positivity and clinical characteristics.

Anti-GAD65 antibody has been studied widely in patients with insulin-dependent diabetes mellitus (IDDM) in many different populations. However, the prevalence of GAD65 autoantibody has not been assessed in Taiwanese patients with IDDM. We therefore characterized GAD65 antibody and investigated the effect of HLA-DR phenotypes on GAD65 autoimmunity and other clinical characteristics in Taiwanese subjects with IDDM. Two hundred and twenty-five patients (male 102, female 123) with IDDM were recruited. The diagnostic criteria for IDDM were age of onset before 30 years, presence of diabetic ketoacidosis, and insulin-dependency within 3 years of onset. We employed a radioligand method to detect GAD65 antibody. HLA-DR typing was performed by the PCR-SSO techniques. Plasma C-peptide and anti-thyroid microsomal antibody were also measured. The prevalence of GAD65 antibody according to duration of disease were 50/91 (54.9%), 37/95 (38.9%), 8/24 (33%), and 3/15 (20%) among the groups of duration < or = 5, 6-10, 11-15, and > 15 years, respectively (p = 0.0011). There were no significant differences between GAD(+) and GAD(-) patients in age of onset (11.5 +/- 6.5 and 11.6 +/- 13.4 years, respectively), gender distribution (male:female 39:59 and 58:69, respectively) and percentage with residual beta cell function (38.8% and 29.1%, respectively). Multiple regression analysis revealed that duration of IDDM correlated inversely with residual beta cell function. Earlier onset of IDDM correlated with a loss of beta cell function and a HLA-DR phenotype containing DR3/4, DR3/3 or DR3/9. Prevalence of GAD65 autoantibody among Taiwanese subjects with IDDM was negatively correlated with duration of disease. Different determinants in the HLA-DR locus contributed to the clinical onset of IDDM but not to GAD autoimmunity.

14-14 - Comparative EEG-mapping and psychometry in insomniac GAD patients with diphenhydramine/lorazepam (Somnium R)

14-14 - Comparative EEG-mapping and psychometry in insomniac GAD patients with diphenhydramine/lorazepam (Somnium R)

Does muscle tension reflect arousal? Relationship between electromyographic and electroencephalographic recordings

Increased muscle tension and heightened arousal are the most consistent finding in patients with anxiety disorders. This study examined the relationship between frontalis and gastrocnemius electromyographic (EMG) and electroencephalographic activity on 14 female generalized anxiety disorder patients and 14 female control subjects. In GAD patients, gastrocnemius but not frontalis EMG was correlated with right but not left hemisphere activity. For the non-anxious subjects, there was a pattern for both β 1 and β 2 waves to be positively associated with both frontalis and gastrocnemius muscle tension levels. The results, while preliminary, suggest that EMG activity may reflect central nervous system arousal. © 1997 Elsevier Science Ireland Ltd.

Psychometric properties of four anxiety measures in older adults

Despite relatively high prevalence rates of anxiety disorders in older adults, little attention has been paid to the establishment of psychometrically sound measures for this population. The current study addresses this issue by examining the psychometric properties of four self-report anxiety measures: the Spielberger State-Trait Anxiety Inventory (STAI), Worry Scale (WS), Fear Questionnaire (FQ), and Padua Inventory (PI). Two older adult community subsamples were assessed, one with Generalized Anxiety Disorder (GAD; n = 50) and the other with no anxiety complaints (Normal Controls: NC; n = 94). Descriptive data revealed that mean scores in the GAD sample were similar to those reported in studies of younger GAD patients. Mean scores in the NC sample, however, were lower than those reported in studies of younger control samples. Internal consistency for all measures generally was adequate in both the GAD and NC subsamples, although alpha coefficients for two of the FQ subscales were marginal. Test-retest reliability over a 2–4 week interval (assessed in a subgroup of NC subjects) was mixed, with some measures apparently assessing stable, trait-like dimensions of fear and anxiety, and others estimating more state-like clinical features. Intercorrelations among subscales for all four measures in both the GAD and NC groups generally were high and consistent with findings from prior research. Finally, some support for the convergent validity of the four anxiety measures was obtained, particularly in the NC sample. Results are discussed in terms of the utility of these instruments for future investigations of the psychopathology and treatment of anxiety disorders in the elderly.