Generalized Anxiety Disorder Symptoms Research Articles

Prevalence and Predictors of Generalized Anxiety Disorder Symptoms in Residents of Fort McMurray Five Years after the Devastating Wildfires

Background: Natural disasters adversely impact individuals living in places where they occur, resulting in emotional distress. The wildfire that occurred in Fort McMurray (FMM), Alberta in 2016 is no different. Objective: This study aims to identify the prevalence and predictors of Generalized Anxiety Disorder (GAD) symptoms in residents of FMM five years after the devastating wildfires. Methods: Data for the study were collected through a cross-sectional survey conducted online from the 24th of April to the 2nd of June 2021. A validated instrument, the GAD-7 scale, was used to collect information on anxiety. Results: This study involved 186 residents of FMM, of which the majority were females (85.5%), employed (94.1%), working at school boards (50.0%), and were either married, cohabiting, or partnered (71.0%). The prevalence of likely GAD among the study sample was 42.5%. Unemployed respondents were seventeen times more likely to develop GAD symptoms (OR = 16.62; 95% C.I. 1.23–223.67) while respondents who would like to receive mental health counseling were five times more likely to experience GAD symptoms (OR = 5.35; 95% C.I. 2.03–14.15). Respondents who suffered a loss of property because of the wildfire were two times more likely to develop GAD symptoms (OR = 2.36; 95% C.I. 1.01–22.62). Conclusion: Policymakers may mitigate GAD symptoms, particularly after natural disasters, by making long-term mental health counseling available and a key component of post-disaster management, and by investing in the social capital of the people to build resilience and support to deal with the post-disaster mental health effects.

Cumulative trauma from multiple natural disasters increases mental health burden on residents of Fort McMurray

ABSTRACT Background Fort McMurray, a city in northern Alberta, Canada, has experienced multiple traumatic events in the last five years, including the 2016 wildfire, the 2020 floods, and the COVID-19 pandemic. Traumatic events often lead to increased mental health burdens in affected communities. Objective To assess if the number of traumatic events experienced by residents of Fort McMurray correlates with the prevalence and severity of mental health issues experienced. Methodology A cross-sectional study using an online survey questionnaire was used to gather demographic, trauma (wildfire, flooding, and COVID-19), and clinical information from the resident of Fort McMurray between April 24 to June 2 2021. Likely Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD) and low resilience were measured using standardised rating scales. Data were analyzed with SPSS version 26 using Chi-Square tests and multivariate regression analysis. Results Respondents who experienced COVID-19 and either flood or wildfire traumas (N = 101) were eleven times more likely to have GAD symptoms (OR: 11.39; 95% CI: 1.43–91.04), four times more likely to have likely MDD, (OR: 3.85; 95% CI: .995–14.90), ten times more likely to have likely PTSD (OR: 10.47; 95% CI: 1.28–85.67), and low resilience (OR: 10.56; 95% CI: 1.21–92.17). Respondents who experienced COVID-19, flooding, and wildfire traumas (N = 47) were eighteen times more likely to express GAD symptoms (OR: 18.30; 95% CI: 2.20–152.45) and more than eleven times likely to have likely PTSD (OR: 11.41; 95% CI: 1.34–97.37) in comparison to the respondents who experienced COVID-19 only trauma (N = 19). Conclusion Measures to reduce climate change and associated natural disasters could reduce the impact of cumulative trauma and associated mental health burden in vulnerable populations. It is essential that more mental health resources are mobilised to support communities impacted by multiple natural disasters. HIGHLIGHTS The number of traumatic disasters experienced in residents of Fort McMurray five years after the 2016 wildfires, a year after the 2020 flooding, and during the COVID-19 pandemic correlates with the prevalence and severity of the mental health conditions reported in this study.

First-Generation College Students’ Mental Health During the COVID-19 Pandemic

ABSTRACT We analyzed data from 7,269 first-generation college students enrolled at nine large, public research-intensive universities who completed the Student Experience in the Research University (SERU) COVID-19 survey. In our sample, 40.3% of first-generation students experienced clinically significant symptoms of major depressive disorder (MDD) and 44.6% experienced clinically significant symptoms of generalized anxiety disorder (GAD)—figures higher than national averages. We discuss several individual, interpersonal, institutional, health and safety, and academic and financial stressors that were associated with first-generation students’ clinically significant MDD and GAD symptoms.

Generalized anxiety disorder symptoms during COVID-19 pandemic in Jazan, Saudi Arabia

The aim of this study was to measure anxiety levels and many co-factors that might influence the levels of anxiety during the COVID-19 outbreak in southern Saudi Arabia (KSA). A cross-sectional self-reporting survey was conducted to determine the level of generalized anxiety disorder (GAD) symptoms related to COVID-19 and quarantining. We selected a convenience sample of eligible participants who had been invited online through social media apps. The survey instrument was distributed, and 981 participants responded. Of the total sample, almost 90% were under the age of 40, 75% were women, and 77% had an educational level beyond high school. Just over half were single, with nearly all participants Saudi nationals. The overall prevalence of anxiety related to COVID-19 was 27%. Factors most strongly related to reporting anxiety included having a diagnosis of COVID-19, spending 1- ≥ 3 h focused on COVID-19, having a previous mental illness history, being a current or former smoker, being female, having a previous diagnosis of chronic or respiratory illness, being below age 40, having a limited standard of living, and being a student. Our study reveals how critical it is to emphasize preventive mental health care during pandemics and what factors may make some individuals most vulnerable to anxiety. Further research is recommended to examine GAD levels pre, during and post pandemic. Additional research to explore the long-term impact of the pandemic on mental health is also needed. being a student, and a limited standard of living.

What is the Relationship between Marijuana Use and Generalized Anxiety Disorder (GAD) Among Young Adults Aged 18–29 in the United States?

Marijuana use is on the rise in the United States, with 18-29-year-old people being the most likely age group to indulge in the illegal drug’s use (Hrynowski, 2019). Similarly, generalized anxiety disorder (GAD) has increased in recent decades for those aged 18 and older (Goodwin et al., 2020). Little research has been conducted to establish a link between these two trends of growth, although researchers have tested THC doses in animals, which proved to elicit anxiety-related responses (Sharpe et al., 2020). Research by de Dios et al. (2010) regarding the correlation indicates that there is a statistically significant relationship between increased marijuana use and symptoms of generalized anxiety disorder in young adults, specifically when there is a third party mediator of tension reduction expectancies. Further systematic review and analysis on marijuana use in Seattle students implies that regular marijuana use throughout teenage years leads to cannabis use disorder by age 33 with stronger symptoms of anxiety than use of other recreational drugs (Guttmannova et al., 2017). The results of this research portray the growing necessity to educate young adults on the long term effects of regular marijuana use, as individuals may believe they are alleviating their GAD symptoms short term, but over time, they are likely facing dangers of worsening their anxiety by increasing dependency on the drug. The following research addresses the question, “What is the relationship between marijuana use and generalized anxiety disorder (GAD) among young adults aged 18–29 in the United States?”

The Interplay Between Expected Psychological Responses to Exercise and Physical Activity in Analogue Generalized Anxiety Disorder: a Cross-sectional Study.

Expectations for psychological responses to exercise are not well characterized, particularly in people at risk for anxiety-related illnesses. Given the substantial evidence for salutary effects of exercise on anxiety symptoms and emerging recognition for expectations as a critical mechanism of placebo/nocebo effects, this study explored the interplay between expectations and physical activity in young adults with and without analogue generalized anxiety disorder. Participants (N=470, 23.2±4.8 years, 63% female) completed a physical activity and mood survey, including a 7-day physical activity recall questionnaire, and a 20-item questionnaire designed to measure positive and negative expectations for psychological and perceptual responses to exercise, particularly expectations for symptoms in the generalized anxiety disorder symptom profile. Analogue generalized anxiety disorder status was determined using the Generalized Anxiety Disorder subscale of the Psychiatric Diagnostic Screening Questionnaire. For select outcomes, expected exercise-induced changes significantly differed according to analogue generalized anxiety disorder (whole-body pain, sleep quality, psychological well-being, stress, relaxation) and active versus inactive (anxious mood, depressed mood, concentration, physical function, psychological well-being, relaxation) status. However, these findings did not survive corrections for multiple comparisons and the magnitude of these differences was small, approximating 0.25 standard deviations. Expectations for anxious (Spearman's ρ=-0.14, p≤0.002) and depressed mood (ρ=-0.15, p≤0.002), and psychological well-being (ρ=0.15, p≤0.001) were significantly associated with higher physical activity levels. Exercise expectations for anxious mood explained a significant, but small (+1.5%, p≤0.03), amount of variance in physical activity. Expectations for exercise-induced improvements did not significantly differ between young adults based on analogue generalized anxiety disorder or physical activity status.

How Is Self-Stigma Associated with Generalized Anxiety Disorder Symptoms in Men Who Have Sex with Men? Roles of Perceived Stress and Negative Affect in a Longitudinal Study

How Is Self-Stigma Associated with Generalized Anxiety Disorder Symptoms in Men Who Have Sex with Men? Roles of Perceived Stress and Negative Affect in a Longitudinal Study

The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status

BackgroundThe COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health.MethodsThis cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis.ResultsA total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations.ConclusionEmployees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

Accelerated Resting-State fMRI-Guided Theta Burst Stimulation to the Right DLPFC for Late-Life Depression: A Pilot Study

<h3>Introduction</h3> Repetitive transcranial magnetic stimulation (rTMS) is FDA-approved for treatment of major depressive disorder; however, its efficacy in late-life depression (LLD) may be reduced due to age-related changes (see Figure 1). rTMS of the dorsolateral prefrontal cortex (DLPFC) has been shown to affect mood control via modulation of the subgenual cingulate cortex (SgCC). The area within the DLPFC having maximum anticorrelated activity to the SgCC is currently believed the most efficacious target for rTMS for depression. While trials of accelerated neuronavigated rTMS to the left DLPFC for depression have shown large effects for depression,¹ there has not yet been a validation of this technique specifically for LLD. Additionally, no studies have tested accelerated intermittent theta burst stimulation (iTBS) to the right DLPFC for depression, although it may have benefit for both depression and anxiety.² We proposed a pilot study of accelerated resting-state functional MRI (rsfMRI)-guided iTBS for LLD and hypothesized that this intervention would result in a significant improvement in depressive and generalized anxiety disorder symptoms. <h3>Methods</h3> A total of 18 elderly patients (ages 50-79 years) with a clinical diagnosis of moderate to severe major depressive disorder of at least 6 months' duration were recruited from local clinics. Each patient underwent rsfMRI and behavioral assessment prior to treatment. Change in depressive symptoms was measured by the Inventory of Depressive Symptoms (IDS-30-C). Change in anxiety symptoms was measured by the Generalized Anxiety Disorder-7 (GAD-7). Each participant's unique stimulation target was found by preprocessing resting-state data within Analysis of Functional NeuroImages (AFNI). A connectivity map of the bilateral SgCC as defined by the Brainnetome atlas was computed and smoothed to 12mm. The maximally anti-correlated voxel within the DLPFC search region (Brodmann areas 9 and 46) was located. A 3mm sphere around the target voxel was warped to subject space and exported to a neuronavigation system. Each participant received 45 sessions of iTBS to their fMRI target with a Magventure MagPro X100 stimulator with Cool-B70 coil (see Figure 2). Stimulation parameters were: 5Hz burst frequency, 50Hz intraburst frequency, 2 second train duration, 8 second intertrain interval, 60 trains/session, 5 sessions/day, 50 minute intersession interval, for 9 days totaling 81,000 pulses. After the 15th and 45th treatments, participants repeated clinical and imaging assessments (see Figure 3). Depression scores were elicited by phone interview at one and three months after treatment. Means and standard deviations of depressive and anxious symptoms were calculated for each visit. Repeated measures analysis of variances (ANOVA) was used to assess change in symptoms over time. Changes in connectivity between nodes in the default mode network (DMN), salience network (SN), and frontoparietal network (FPN) were analyzed with independent components analysis (ICA) in Statistical Parametric Mapping (SPM). <h3>Results</h3> Mean age of the 18 patients (2M, 16F) was 63 ± 7.4 years. Mean duration of depression was 166 ± 154.4 months. Nine patients had comorbid GAD and five patients had comorbid posttraumatic stress disorder. Four of the 18 patients had previously undergone ECT. Mean depression (IDS-30-C) scores decreased throughout the study protocol (Visit 1: 39.31 ± 9.24; Visit 2: 30.74 ± 10.44; Visit 3: 20.79 ± 8.13) and remained below pre-treatment values at one month (19.84 ± 15.63) and three months (20.34 ± 14.15) (F(4,28) = 7.15, p = .0004, ??_p² = 0.5) (see Figure 4). Mean GAD-7 scores (N=18) also decreased with treatment (Visit 1: 9.95 ± 5.89; Visit 2: 9.58 ± 5.28; Visit 3: 6.53 ± 5.00) (F(2,36) = 7, p < .006, ??_p² = 0.28) (see Figure 5). Preliminary analysis of changes in connectivity from Visit 1 to Visit 3 indicate significantly increased within-network connectivity in the DMN (p = .003), and decreased between-network connectivity between the DMN and FPC (p = .011). <h3>Conclusions</h3> In this single-arm, uncontrolled pilot study, accelerated rsfMRI-guided iTBS to the right DLPFC in patients with LLD was effective in reducing both symptoms of depression and generalized anxiety. Connectivity changes in DMN and FPN network components were also observed. Future work should confirm these effects in a larger sample size and controlled study design. <h3>Secondary Rationale</h3> Reason for Late-Breaking Status: Data collection was continued beyond the regular submission deadline to attain greater statistical power to inform study conclusions. <h3>This research was funded by</h3> UNM Successful Aging Pilot Grant, Mind Research Network Center of Biomedical Research Excellence (COBRE) Pilot Grant (NIH/NIGMS 5P30GM122734-03)

The role of childhood traumas, interpersonal problems, and contrast avoidance model in development of the generalized anxiety disorder: A structural equation modeling.

The present study was conducted to investigate the mediating role of interpersonal problems, contrast avoidance of worry, and emotional contrast avoidance in the relationship between childhood trauma and symptoms of generalized anxiety disorder (GAD). In this cross-sectional study, 457 individuals (with mean age of 31.5 ± 5.49 years old) with symptoms of GAD who had been referred to psychotherapy centers in Khorramabad City, Lorestan Province, Iran were included. The tools used for data collection were the Childhood Trauma Questionnaire (CTQ), the Brief Inventory of Interpersonal Problems-Circumplex (IIP-C), the Contrast Avoidance Questionnaire-Worry (CAQ-W), the Contrast Avoidance Questionnaire-General Emotion (CAQ-GE), and the GAD Questionnaire-7 (GAD-7). The results showed that contrast avoidance of worry and interpersonal problems had a direct and significant effect on symptoms of GAD (p < .001), but childhood trauma and emotional contrast avoidance had no direct and significant effect on symptoms of GAD (p < .05), and also contrast avoidance of worry and interpersonal problems significantly mediated the relationship between childhood traumas and symptoms of GAD (CI [.01,.30]). Generally, our results showed that the people who have had trauma experiences in childhood may face difficulties in interpersonal relationships later in life. While faced with unpleasant events triggering their negative emotions, these individuals tend to have worry in order to prolong and maintain a negative emotional state-thereby avoiding an unexpected negative emotional shift or contrast experience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychiatric Outcomes after Mild Traumatic Brain Injury in Adults

<h3>Research Objectives</h3> To enhance the knowledge regarding psychiatric outcomes after mild traumatic brain injury (mTBI) in adults, specifically considering premorbid psychiatric history. <h3>Design</h3> A retrospective observational study using a clinical dataset from the initial evaluation in clinic. Self-reported premorbid psychiatric history was determined by clinician interviews. <h3>Setting</h3> An ambulatory mTBI clinic. <h3>Participants</h3> Participants were 85 adults with mTBI confirmed by clinicians. Participants were 14 to 365 days post injury with valid psychiatric history and outcomes data. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The Psychiatric Diagnostic Screening Questionnaire (PDSQ) was part of the clinical assessment process. The PDSQ is a brief screening measure for common psychiatric diagnoses based upon the diagnostic and statistical manual of mental disorders, 4th edition. Major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) scales represented psychiatric outcomes. Raw scores were used as well as binary categories with scores above and below cut-off scores indicating caseness. <h3>Results</h3> There were no significant differences (p > .05) in demographic and injury characteristics (age, gender, race, loss of consciousness, and days since injury) by psychiatric history status (yes/no) with exception of year of education (p= .025). On average, participants were 36.6 years old with 13.8 years of education. Men (47.6%) and women (52.4%) were fairly even in representation. Most participants were Caucasian (89.4%). Individuals with premorbid psychiatric histories had greater symptoms of GAD (F(1, 76)= 11.90, p=.001, partial eta squared=0.14), MDD (F(1, 76)= 4.62, p=.035, partial eta squared=0.06), and PTSD (F(1, 76)= 6.54, p=.013, partial eta squared=0.08). When considering scores above respective cut-offs for each outcome, similar findings were revealed. Of note, the Odds Ratio for positive screens on depression was 7.08 (p < .001), and it was 5.45 (p= .002) for anxiety, among those with a premorbid psychiatric history. There was no association with PTSD screening and premorbid psychiatric history (p= .083). <h3>Conclusions</h3> Premorbid psychiatric history is demonstrably associated with worse psychiatric outcomes after mTBI in adults, particularly for anxiety and depression outcomes. <h3>Author(s) Disclosures</h3> None.

Climate change anxiety and mental health: Environmental activism as buffer.

A growing body of research has documented the phenomenon of climate change anxiety (CCA), defined broadly as negative cognitive, emotional, and behavioral responses associated with concerns about climate change. A recently validated scale of CCA indicated two subscales: cognitive emotional impairment and functional impairment (Clayton & Karazsia, 2020). However, there are few empirical studies on CCA to date and little evidence regarding whether CCA is associated with psychiatric symptoms, including symptoms of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), and whether engaging in individual and collective action to address climate change could buffer such relationships. This mixed methods study draws on data collected from a sample of emerging adult students (ages 18–35) in the United States (N = 284) to address these gaps. Results indicated that both CCA subscales were significantly associated with GAD symptoms, while only the Functional Impairment subscale was associated with higher MDD symptoms. Moreover, engaging in collective action, but not individual action, significantly attenuated the association between CCA cognitive emotional impairment and MDD symptoms. Responses to open-ended questions asking about participants’ worries and actions related to climate change indicated the severity of their worries and, for some, a perception of the insignificance of their actions relative to the enormity of climate change. These results further the field’s understanding of CCA, both in general and specifically among emerging adults, and suggest the importance of creating opportunities for collective action to build sense of agency in addressing climate change.

Heightened false alarms of conditioned threat predict longitudinal increases in GAD and SAD symptoms over the first year of college

Lab-based fear-conditioning studies have repeatedly implicated exaggerated threat reactivity to benign (unreinforced) stimuli as concurrent markers of clinical anxiety, but little work has examined the strength of false alarms as a longitudinal predictor of anxiety problems. As such, we tested whether heightened false alarms of conditioned threat assessed in participants’ first semester of college predicted second-semester symptoms of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) – two anxiety conditions that are common in college students, have been associated with excessive false alarms, and have yet to be assessed with longitudinal conditioning designs. Here, we focused on the predictive effects of behavioral threat responses (threat expectancy, subjective anxiety, avoidance) given their greater potential for translation to the clinic. Results implicate conditioning-related increases in anxiety to safe stimuli resembling the danger-cue as prospective predictors of GAD. In contrast, SAD was predicted by non-specific elevations in anxiety to a broad set of safe stimuli, as well as by increased threat expectancy toward cues least resembling the conditioned danger cue. These findings suggest that risk for GAD and SAD are captured by distinct, behavioral indicators of false-alarms that may be more feasibly collected in clinical settings compared to alternative experimental anxiety measures like psychophysiological responses.

Screening for generalized anxiety disorder (GAD) and associated factors in adolescents and young adults with type 1 diabetes: Cross-sectional results of a Germany-wide population-based study

AimsThe aims of this study were to screen 14- to 30-year-olds with early-onset type 1 diabetes for generalized anxiety disorder (GAD) and to compare the characteristics of the study participants who had a positive result for GAD with those who had a negative result. MethodsThis study used data from a questionnaire survey conducted from 2018 to 2019. The GAD-7 questionnaire was used to screen for GAD (positive: GAD-7 score ≥ 10). All regression analyses were adjusted for age, sex, depression diagnosis and considered multiple testing. ResultsThe 713 participants had a mean GAD-7 score of 4.32 (SD 4.18). A total of 12% of the study population (10% of adolescents, 13% of adults) was screened positive for GAD. Positive screening results were associated with impairments in various domains, such as self-assessed physical performance (RR poor versus good 3.03 [95% CI 1.85–4.96]), difficulty falling asleep (RR ≥3 times/week versus not during the last 4 weeks 5.36 [2.86–10.07]), glycemic control (RR HbA1c per 1% 1.16 [1.03–1.31]), and diabetes treatment satisfaction (RR poor versus good 2.67 [1.43–5.00]). ConclusionsDiabetologists should be aware that adolescents and young adults with GAD symptoms might experience extensive impairments in their daily lives.

Psicopatología como red causal compleja de síntomas interactivos

Over the past years, psychopathology has frequently been represented as a complex system, where psychiatric symptoms are causally interconnected in a network architecture. The network theory of psychopathology has led to more than 300 novel publications, academic courses, methodology for estimating novel models, and freely available software. However, despite the success of this novel research avenue, all relevant information has mostly been published in English. This paper translates the network theory of psychopathology and its model, together with its relevance for research and clinical practice of psychology and psychiatry, to the Spanish language. To serve the dissemination of this theory, this paper serves as an introductory paper for Spanish scholars, for example, as a starting point to learn more about the approach or for academic courses. The main idea of the network theory of psychopathology is that the activation of one clinical symptom in the network leads to the activation of a neighboring symptom. If symptoms are strongly connected with each other, for example, excessive worry and insomnia, they are more likely to be in the same state, meaning that if a person faces a stressful life event such as losing one’s job, the activation of the symptom excessive worry will increase the probability they will also suffer from insomnia. In this way, a whole symptom activation pattern develops from which mental disorders emerge. Mental disorders are conceived as stable states of strongly connected symptom networks, allowing for a common explanatory model for multiple mental disorders, thereby providing a comprehensive model of psychopathology. Traditional representations of mental disorders conceptualize symptoms as merely passive indicators of latent, underlying mental disorders which act as common causes for patients’ symptomatology. The network theory of psychopathology flips the explanatory and statistical model: instead of focusing on one underlying cause or underlying causes, it proposes to study the direct interactions between these symptoms. This imposes two important implications for the conceptualization of mental disorders. First, symptoms are no longer statistically exchangeable since every symptom can have a different role in the onset and development of psychopathology. Some symptoms can be more important than others in keeping the whole system “stuck” in a disordered state. Second, comorbidity is conceptualized as clustering symptoms which are connected to each other via certain “bridge symptoms”. Bridge symptoms are symptoms which are attributed to two (or more) mental disorders, such as Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). If a person suffers from symptoms of MDD, such as loss of motivation and depressed mood, this can lead to the activation of bridge symptoms such as fatigue and concentration problems, which by themselves lead to the activation of GAD symptoms such as irritability and excessive worry. https://doi.org/10.16888/interd.2022.39.2.11

Repetitive Transcranial Magnetic Stimulation Modulates Frontal and Temporal Time-Varying EEG Network in Generalized Anxiety Disorder: A Pilot Study.

Generalized Anxiety Disorder (GAD) is a highly prevalent yet poorly understood chronic mental disorder. Previous studies have associated GAD with excessive activation of the right dorsolateral prefrontal cortex (DLPFC). This study aimed to investigate the effect of low-frequency repetitive transcranial magnetic stimulation (repetitive TMS, rTMS) targeting the right DLPFC on clinical symptoms and TMS-evoked time-varying brain network connectivity in patients with GAD. Eleven patients with GAD received 1 Hz rTMS treatment targeting the right DLPFC for 10 days. The severity of the clinical symptoms was evaluated using the Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD) at baseline, right after treatment, and at the one-month follow-up. Co-registration of single-pulse TMS (targeting the right DLPFC) and electroencephalography (TMS-EEG) was performed pre- and post-treatment in these patients and 11 healthy controls. Time-varying brain network connectivity was analyzed using the adaptive directed transfer function. The scores of HAMA and HAMD significantly decreased after low-frequency rTMS treatment, and these improvements in ratings remained at the one-month follow-up. Analyses of the time-varying EEG network in the healthy controls showed a continuous weakened connection information outflow in the left frontal and mid-temporal regions. Compared with the healthy controls, the patients with GAD showed weakened connection information outflow in the left frontal pole and the posterior temporal pole at baseline. After 10-day rTMS treatment, the network patterns showed weakened connection information outflow in the left frontal and temporal regions. The time-varying EEG network changes induced by TMS perturbation targeting right DLPFC in patients with GAD were characterized by insufficient information outflow in the left frontal and temporal regions. Low-frequency rTMS targeting the right DLPFC reversed these abnormalities and improved the clinical symptoms of GAD.

Differential Predictors of Suicidal Ideation and Suicide Attempts: Internalizing Disorders and Substance Use in a Clinical Sample of Adolescents

Objective: Dually diagnosed adolescents are a high-risk population for experiencing suicidal thoughts and behavior. Given that research suggests risk factors for suicidal ideation and suicide attempts may be different, this study examined whether internalizing disorder severity, frequency of substance use, and the interaction between them differentiated adolescents who attempted suicide from those who ideated. Methods: Baseline data from 287 adolescents who received formal substance use disorder (SUD) treatment were used in this analysis. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity as well as past-3 month use of alcohol, cannabis, and other illicit drugs were considered. The outcome of interest was a three-category measure of suicide risk: no reported suicidal ideation or attempts, suicidal ideation only, and suicide attempts. Results: Over half of the sample disclosed prior suicidal ideation (30.0%) or attempts (27.9%). Multinomial logistic regression models indicated more severe MDD and GAD symptomology differentiated ideators from non-suicidal adolescents, but internalizing disorder severity did not differ between ideators and attempters. Substance use frequency did not differ between suicide risk groups. MDD severity and frequency of alcohol use interacted to increase the risk of attempts, yet the effects were minimal. Instead, prior weapon violence victimization and sexual abuse were the largest differentiators between attempters and ideators. Conclusions: Findings suggest that internalizing disorder severity and prior traumatic experiences put adolescents with SUD histories at higher risk of suicidal thoughts and behaviors. Thus, integrating evidence-based suicide prevention and intervention efforts into SUD treatment is critical, particularly for dually diagnosed adolescents who meet these risk profiles. Psychotherapy and medication may help curtail the development of ideation by reducing symptoms of MDD and GAD, whereas adolescents with prior traumatic experiences may benefit from additional treatments shown to lower risk of suicide attempts.

Features of psychoemotional status in patients with chronic thromboembolic pulmonary hypertension after cardiac surgery during the COVID-19 pandemic

To study the features of the psychoemotional status in patients with chronic thromboembolic pulmonary hypertension in the long term after pulmonary thromboendarterectomy (PTE) during the COVID-19 pandemic and to identify factors affecting the development of clinically pronounced anxiety and depressive disorders. Psychoemotional status was analyzed in 151 patients in the long term after PTE using the Generalized Anxiety Disorder (GAD) Assessment (GAD-7) and the Beck Depression Inventory. The number of patients who underwent COVID-19 was recorded and the functional status scale of the patient who underwent COVID-19 (PCFS) was evaluated. Logistic regression analysis was used to identify predictors of clinically pronounced depression and GAD in the long-term period after surgery during the COVID-19 pandemic. Clinically significant GAD and depression in the long-term period after PTE during the COVID-19 pandemic were observed in 11 and 17.8% of patients, respectively. Clinically pronounced depression is associated with older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status according to PCFS. The development of GAD symptoms is influenced by cardiopulmonary insufficiency in the hospital period after PTE. The combination of anxiety and depression symptoms is correlated with older age. In patients in the long term after PTE during the COVID-19 pandemic, the symptoms of GAD and depression were detected in 11 and 17.8% of cases, respectively. The complicated course of cardiac surgery has shown a negative impact on the development of GAD in the long term after surgery. The factors influencing the development of clinically pronounced depression were older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status.

An experimental investigation of intolerance of uncertainty and its impact on sub-clinical psychopathology

BackgroundIntolerance of Uncertainty (IU) is a transdiagnostic construct that is implicated in psychological difficulties, including Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and eating disorders (ED). However, most studies exploring IU have been correlational in nature. This study examined (1) whether a linguistic manipulation of the Intolerance of Uncertainty Scale (IUS) would successfully manipulate IU in an undergraduate sample, (2) whether experimentally increased or decreased levels of IU affect symptoms of MDD, GAD, OCD and ED, and (3) whether increased baseline symptom severity influences the magnitude of change in symptom severity post-manipulation. MethodsA linguistic manipulation of the IUS was used to manipulate participants’ beliefs about their ability to tolerate uncertainty. N = 106 undergraduate participants were randomised to one of two conditions: high IU (HIU; n = 54) or low IU (LIU; n = 52), and completed measures on symptom severity at baseline and one-week follow-up. ResultsThe manipulation successfully reduced IU in LIU. Participants in this group did not experience significant changes in symptom severity post-manipulation. However, individuals with higher baseline OCD in LIU demonstrated greater decreases in post-manipulation OCD symptoms, compared with individuals in HIU. LimitationsOnly the LIU manipulation was effective, limiting the findings from the HIU. The one-week follow-up and relatively small sample size of predominantly female undergraduate students may dilute and limit the generalisability of results. Conclusion: Findings support the utility of this manipulation in reducing IU, and the significance of different levels of IU in OCD.

GAD: Over-reactive and unstable mood

• Generalized Anxiety Disorder (GAD) consists of an over-reactive and/or unstable mood that could be mistaken with mood swings and affective instability of bipolar disorder and borderline personality disorder. • Recognition of the over-reactive and/or unstable mood in GAD has significant clinical implication not to be misdiagnosed as bipolar disorder or borderline personality disorder that occurred in our research sample. • Inclusion of over-reactive and/or unstable mood in the next DSM edition as cardinal diagnostic criteria symptoms is a step towards a more comprehensive understanding of this very common psychiatric condition. We sought to clarify if over-reactive mood in Generalized Anxiety Disorder (GAD) could be misdiagnosed as mood swings of Bipolar Disorder, or with affective instability in Borderline Personality Disorder. We re-assessed 32 subjects who were referred to our clinic in 2020 and had been previously diagnosed with Bipolar and Borderline Personality Disorders, as they seem to fit more the diagnostic criteria of Generalized Anxiety Disorder (GAD), based on the structured clinical interview for DSM5 (SCID-DSM5) and our previously published general definition of this disorder. All the subjects met the DSM5 criteria of GAD and presented with excessive anxiety and worry lasting more than 6 months in different situations or spontaneous with no triggers, leading to dysfunctions in social, occupational, or any other important areas of the individual's life. The subjects also met our general definition of GAD and met the DSM5 diagnostic criteria for Social Anxiety Disorder, Panic Disorder and Major Depressive Disorder. Moreover some of these subjects had an over-reactive mood that was subjectively labeled by themselves as “mood swings”, but without any discreet hypomanic or manic episodes. Some of the subjects also described their mood as "unstable" that had led their previous clinicians with mislableing them with "affective instability" leading to the misdiagnosis of Borderline Personality Disorder. The result of the study showed that the over-reactive mood in GAD could simply by the patients be interpreted as mood swings and when reported to the physicians, diagnosed as Bipolar Disorder. In the same token the unstable mood in GAD could be taken as affective instability by the patients and the physicians, leading to the misdiagnosis of Borderline Personality Disorder. Other than mood over-reactivity and unstable mood in this sample that led their previous misdiagnoses with Bipolar and Borderline Personality Disorders, they were all presented with the symptoms of GAD like others without over-reactive and unstable mood. The findings of our present adds a new symptom of over-reactive mood in GAD that could be easily misinterpreted as mood swings and affective instability and misdiagnosed as Bipolar and Borderline Personality Disorders.