Generalized Anxiety Disorder Patients Research Articles

Traitement du trouble d’anxiété généralisée chez des individus présentant un trouble bipolaire : un protocole à cas unique

Resume Objectif Le taux de comorbidite est eleve chez les patients bipolaires, en particulier avec les troubles anxieux (TA). Les TA comorbides sont associes a un pronostic plus sombre, a un moins bon fonctionnement et a un risque suicidaire plus eleve. Parmi les TA, la comorbidite entre le trouble bipolaire (TB) et le trouble d’anxiete generalisee (TAG) est frequente. L’objectif principal de la presente etude est d’explorer l’efficacite de la therapie cognitive comportementale (TCC) pour le traitement du TAG chez des patients presentant un TB stabilise. Methode Quatre participants ont ete recrutes dans un protocole a cas unique experimental ABA a niveaux de base multiples. Ils ont suivi une TCC de 12 semaines et ont ete evalues en ce qui a trait aux symptomes anxieux et aux symptomes du trouble de l’humeur. Resultats Pour trois participants sur quatre, la TCC a produit des changements cliniquement significatifs au niveau des symptomes du TAG. Une baisse des symptomes depressifs a ete observee chez tous les participants a l’evaluation post-traitement. Conclusion Ces resultats preliminaires indiquent qu’un traitement specifique pour le TAG peut etre efficace chez des patients bipolaires. Le traitement devrait, en revanche, etre adapte aux clienteles plus severes.

Emotion dysregulation and sleep difficulties in generalized anxiety disorder

Diagnostic criteria for generalized anxiety disorder (GAD) include sleep problems, which often persist even after successful treatment of the disorder. The purpose of this study was to examine emotion dysregulation as a potential contributor to sleep problems in GAD patients. Participants comprised two groups: 59 individuals diagnosed with GAD and 66 healthy controls. They were assessed for the presence of mood and anxiety disorders and then completed self-report questionnaires assessing problems with sleep and emotion regulation. Participants in the GAD group scored significantly higher on a number of sleep outcomes than did the control group. Importantly, difficulties with emotion regulation statistically mediated the relationship between GAD and a wide range of outcomes of sleep dysfunction independently of the effects of depression and secondary anxiety diagnoses. Emotion regulation difficulties that characterize GAD mediate the relationship between symptoms of this disorder and a wide range of sleep problems. Implications for treatment and future research directions are discussed.

White matter integrity alterations in first episode, treatment-naive generalized anxiety disorder

BackgroundSeveral neurobiological models of anxiety disorder posit a primary role for dysfunction of the amygdala and anterior cingulate cortex (ACC). This study tests the hypothesis that patients with generalized anxiety disorder (GAD) have abnormal white matter microstructure in the amygdala and ACC, as inferred from diffusion tensor imaging, compared with healthy controls. MethodsSubjects were 16 right-handed, first-episode, treatment-naive GAD patients without comorbid disorders and 26 matched, healthy comparison controls. All subjects underwent diffusion tensor imaging and structural magnetic resonance imaging brain scanning. Fractional anisotropy (FA), a robust intravoxel measure of water self-diffusion, was compared between groups on a voxel-by-voxel basis. Associations between clinical ratings of symptom severity (i.e., the Hamilton Anxiety Scale and the Penn State Worry Questionnaire) and FA were assessed. ResultsCompared with healthy volunteers, patients demonstrated significantly higher FA in the right amygdala white matter and lower FA in the caudal ACC/mid-cingulate cortex white matter. Higher right amygdala FA correlated significantly with higher Hamilton Anxiety Scale scores and higher Penn State Worry Questionnaire scores. LimitationsThe sample size was modest and may contribute to false positive effects. ConclusionsThese findings provide the first evidence of an abnormality in white matter microstructure that involves the amygdala and the cingulate cortex in the pathogenesis of GAD, and are consistent with neurobiological models that posit a defect in emotion-related brain regions.

Generalized Anxiety Disorder, Comorbid Major Depression and Heart Rate Variability: A Case-Control Study in Taiwan

ObjectiveDecreased heart rate variability (HRV) has been reported in generalized anxiety disorder (GAD), but the results are mixed. Little is known about the impact of comorbid major depression (MD) on HRV in GAD patients. Both issues necessitate further investigation.MethodsTwenty unmedicated, physically healthy GAD patients, 20 GAD patients with a secondary diagnosis of MD, 40 MD patients and 60 matched controls were recruited. We used the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale to assess anxiety and depression severity, respectively. Cardiac autonomic function was evaluated by measuring HRV parameters. Frequency-domain indices of HRV were obtained.ResultsThree patient groups had more anxiety and depression symptoms than control subjects, but heart rates (HRs) were significantly elevated only in GAD patients with comorbid depression. Relative to controls, GAD patients had reduced HRV while GAD patients with comorbid depression displayed the greatest reductions in HRV among three patients groups. Correlation analyses revealed anxiety/depression severity significantly associated with HRs, variance, LF-HRV and HF-HRV. However, separately analyzing among individual groups and adjusting for HRV-associated covariables rendered the correlations non-significant.ConclusionOur results suggest that reduction in HRV is a psychophysiological marker of GAD and individuals with comorbid GAD and MD may be distinguished based on psychophysiological correlates (for example, HF-HRV) from non-comorbid GAD patients. Taken into account that comorbid depression may confer increased risks for cardiovascular events in GAD patients, this subgroup of GAD patients may benefit better from cardiovascular risk reduction strategies.

Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training

Mindfulness training aims to impact emotion regulation. Generalized anxiety disorder (GAD) symptoms can be successfully addressed through mindfulness-based interventions. This preliminary study is the first to investigate neural mechanisms of symptom improvements in GAD following mindfulness training. Furthermore, we compared brain activation between GAD patients and healthy participants at baseline. 26 patients with a current DSM-IV GAD diagnosis were randomized to an 8-week Mindfulness Based Stress Reduction (MBSR, N = 15) or a stress management education (SME, N = 11) active control program. 26 healthy participants were included for baseline comparisons. BOLD response was assessed with fMRI during affect labeling of angry and neutral facial expressions. At baseline, GAD patients showed higher amygdala activation than healthy participants in response to neutral, but not angry faces, suggesting that ambiguous stimuli reveal stronger reactivity in GAD patients. In patients, amygdala activation in response to neutral faces decreased following both interventions. BOLD response in ventrolateral prefrontal regions (VLPFC) showed greater increase in MBSR than SME participants. Functional connectivity between amygdala and PFC regions increased significantly pre- to post-intervention within the MBSR, but not SME group. Both, change in VLPFC activation and amygdala–prefrontal connectivity were correlated with change in Beck Anxiety Inventory (BAI) scores, suggesting clinical relevance of these changes. Amygdala–prefrontal connectivity turned from negative coupling (typically seen in down-regulation of emotions), to positive coupling; potentially suggesting a unique mechanism of mindfulness. Findings suggest that in GAD, mindfulness training leads to changes in fronto-limbic areas crucial for the regulation of emotion; these changes correspond with reported symptom improvements.

Mindfulness and Self-Compassion in Generalized Anxiety Disorder: Examining Predictors of Disability

Generalized anxiety disorder (GAD) is a condition characterized by worry and physiological arousal symptoms that causes significant disabilities in patients' lives. In order to improve psychotherapeutic interventions, a careful characterization of the deficiencies of this population as well as factors that ameliorate disability is crucial. Variables that have not traditionally been the focus of research should be considered, such as trait mindfulness and self-compassion. We investigated whether GAD patients would report lower mindfulness and self-compassion levels than healthy stressed individuals. Eighty-seven GAD patients and 49 healthy controls completed the Five Facet Mindfulness Questionnaire, the Self-Compassion Scale, and measures of anxiety. Patients with GAD also completed the Sheehan Disability Scale. Results showed that GAD patients had lower mindfulness and self-compassion than healthy stressed controls, and both were negatively correlated with levels of anxiety, worry, and anxiety sensitivity. In patients, mindfulness was a better predictor of disability than actual anxiety symptom scores. These findings highlight that in the presence of anxiety symptoms, mindfulness can be a factor that helps protect against feeling disabled by the disorder. The findings thereby add an important variable to the characterization of this disorder and should be taken into consideration for future treatment development.

Decreased Serum Sulphydryl Levels as a Sign of Increased Oxidative Stress in Generalized Anxiety Disorder

ObjectiveIn recent years, many published studies have focused on the relationship between oxidative stress and psychiatric disorders. However, studies in generalized anxiety disorder (GAD) are few despite relatively high prevalence rates. In an attempt to fill this gap in the literature we aimed to measure serum levels of free sulphydryl, an important member of antioxidant defense mechanisms, of the patients with GAD.MethodsA total of 35 (23 female, 12 male) GAD patients without any other co-morbid medical or psychiatric disorder and 35 (23 female, 12 male) healthy controls have been included in the study. Disease severity of the patients were quantified by using the Hamilton Anxiety Rating Scale (HAM-A). Serum free sulphydryl group levels of patients and healthy controls were measured in an appropriate way.ResultsMean level of serum sulphydryl groups was significantly lower in the patient group. There was a negative correlation between their level and the disease duration. However, they did not show any significant correlation with the disease severity.ConclusionDecreased serum sulphydryl level observed in pure GAD patients suggests an increased oxidative stress in these patients. Well designed future researches are needed to replicate our findings and to test the implications of the present study.

964 – Cost-consequences of adjunctive therapy with pregabalin in generalized anxiety disorder patients with partial response to ssri treatment in clinical practice

To analyze the effect of adjunctive therapy with pregabalin versus usual care (UC) on healthcare costs and clinical consequences in generalized anxiety disorder (GAD) patients with partial response (PR) to previous SSRI. Post-hoc analysis of patients enrolled in a prospective 6-month observational study. Patients with a PR [CGI score >3 and insufficient response with persistence of anxiety symptoms (HAM-A score ≥16)] to SSRI monotherapy were considered eligible for inclusion. Two groups (based on psychiatrist judgment) were analyzed 1) adding pregabalin (150-600 mg/day) to existing therapy; or 2) UC (switching to a different SSRI or adding another anxiolytic. Costs estimation used year-2009 prices for GAD related healthcare resources utilization. Measures of clinical consequences were, changes in total scores of anxiety in HAM-A (primary outcome) and GAD co-morbid depressive symptoms in MADRS (secondary outcome) scales. Four-hundred-eighty-six newly prescribed pregabalin and 239 UC GAD patients [mean (SD) HAM-A 26.7 (6.9) and CGI 4.1 (0.5)] were analyzed. Adding pregabalin was associated with significantly higher adjusted mean changes (95% CI) vs. UC in HAM-A [-11.2 (-12.2;-10.2) vs. -14.9 (-15.6;-14.2), respectively; p< 0.001] and MADRS [-7.8 (-8.7;-6.8) vs. -11.6 (- 12.2;-10.9), respectively; p< 0.001]. Adjusted mean baseline healthcare costs were significantly reduced in both cohorts; -€487 (-652;-317) and -€531 (-648;-413), respectively (both p< 0.001), yielding to similar 6-month costs; €1543 (1375;1711) UC and €1497 (1380;1614) pregabalin, p=0.661. In this post-hoc analysis, GAD patients with PR to SSRI experienced greater symptom improvement with adjunctive therapy with pregabalin versus UC without increasing healthcare cost.

2741 – Clinical investigation of serum trace elements, antioxidants and immunoglobulins in generalized anxiety disorder patients in bangladesh

The purpose of the study was to determine the serum concentration of trace elements, antioxidants and immunoglobulins in generalized anxiety disorder (GAD) patients and compare those values of healthy volunteers matched by age, sex and socioeconomic conditions. 50 GAD patients and 51 healthy volunteers were recruited. Socio-economic data revealed that most of the patients are middle aged and literate. Patients were recruited from Bangabandhu Sheikh Mujib Medical University by random sampling diagnosed by trained psychiatrist. 4 ml of venous blood was aspirated from the subjects and controls. Serum trace elements (Zn, Cu, Mn, Fe, Ca, Mg) were determined by flame atomic absorption spectroscopy. Serum retinol and α- tocopherol were determined using RP-HPLC method, whereas serum vitamin-C was estimated by UV spectrophotometry. Immunoglobulins were determined by turbidimetric method using immunoglobulin kit. Data were analyzed by independent ttest using SPSS. The concentration of Zn decreased significantly (p 0.05). There was significant(p 0.05). From the study it is found that serum concentrations of Cu, Fe, Mn, ascorbic acid and IgM were increased significantly and those of Zn and α- tocopherol decreased significantly in compare to control. Moreover this study may provide prognostic tool for the diagnosis and treatment of this disease.

1673 – Evaluation of sleep and pain in newly diagnosed patients with generalised anxiety disorder (GAD): the espiga study

Introduction In the general population the 12-month prevalence of GAD is estimated to be about 2%. Higher prevalences have been found in primary care settings, with estimates of well over 6%. The role of sleep problems and pain in GAD remains understudied. Objectives To evaluate the frequency of sleep problems and pain in newly diagnosed GAD patients in 5 European countries. Methods Non-interventional, cross-sectional survey of 1650 adult patients newly diagnosed with GAD in primary care settings. Assessment included clinical interview rating and self report data. Results Mean age of the sample was 49.2 years (SD; 14.5). Mean GAD-7 score was 14.8 (SD; 3.1) and the median duration of symptoms was 12.0 months. The proportion with sleep disturbance and pain were 85.9% and 75.9%, respectively. Disturbed sleep had persisted for a median of 9.0 months and was mainly classified as “difficulty in falling asleep” (76.1%) or “nocturnal awakening” (58.8%). The median duration of pain was 6.0 months, and located mainly in the cervical region (47.0%) and upper back/limbs (40.1%). The mean number of days that patients were unable to work because of GAD-related health problems during the preceding 3 month period was 10.8 (95%CI; 9.6-12.0). The proportion of patients that visited the primary care physician and specialist during the preceding 3 months was 93.8% and 40.3%, respectively. Conclusions Sleep problems and pain are extremely frequent characteristics of GAD, contributing to the disability and work productivity profile associated with GAD as well as the patients’ use of health care resources.

Executive skills in older adults with GAD: Relations with clinical variables and CBT outcome

Although cognitive behavior therapy (CBT) is an effective intervention for treating generalized anxiety disorder (GAD) in older adults, researchers are now considering augmenting the therapy to enhance outcome. We are also long overdue in identifying moderators of CBT response (e.g., cognitive abilities) in late life anxiety. The goals of the current investigation were to examine performance on verbal versus nonverbal tests of executive skills (ES) and to test the relation between ES and clinical indices in older GAD patients. Hierarchical and logistic regression models identified baseline ES predictors of premature termination, homework compliance and quality, and indices of cognitive restructuring, an essential component of CBT. Although the analyses of response on symptom measures did not reveal any significant baseline predictors, an alternative ES grouping scheme showed that those whose ES improved during CBT also responded best in terms of worry reduction. These findings can be applied to the optimization of treatment for older anxiety patients, who are an underserved demographic group.

Cognitive-behavior therapy resolves implicit fear associations in generalized anxiety disorder

BackgroundCognitive schema theories postulate that anxiety disorders are associated with excessive fear associations in memory. For generalized anxiety disorder (GAD), it has been shown that patients not only exhibit negative implicit evaluations of clearly negative worry words (e.g., cancer), but also a generalization of this effect to neutral words (e.g., diagnosis). This study assessed the sensitivity of this bias, which has been interpreted as an indicator of a pathologically broadened fear structure, to cognitive-behavioral therapy (CBT). MethodsAn Extrinsic Affective Simon task was used to measure implicit associations with idiosyncratic neutral and negative worry words in 23 GAD patients and 25 healthy controls (HC). Patients were tested before and after CBT, and half of them were additionally tested while waiting for treatment. Clinical symptoms were measured before and after treatment, and at 6-months follow-up. ResultsCBT normalized bias for neutral words, and the extent of bias reduction during treatment predicted the extent of additional symptom improvement during the 6 months following intervention. Furthermore, the amplitude of pre-treatment bias predicted the onset of CBT response, with lower bias predicting immediate symptom improvement at the end of treatment, and higher bias predicting delayed treatment effects during the 6 months follow-up. ConclusionsBiased implicit evaluation of neutral worry targets does not represent an enduring vulnerability factor for the development of GAD but is related to heightened levels of state worry. Furthermore, the normalization of this bias might be a crucial factor in the therapeutic action of CBT.

Decreased hypothalamus volumes in generalized anxiety disorder but not in panic disorder

BackgroundThe hypothalamus is a brain structure involved in the neuroendocrine aspect of stress and anxiety. Evidence suggests that generalized anxiety disorder (GAD) and panic disorder (PD) might be accompanied by dysfunction of the hypothalamus-pituitary-adrenal axis (HPA), but so far structural alterations were not studied. We investigated hypothalamic volumes in patients with either GAD or PD and in healthy controls. MethodsTwelve GAD patients, 11 PD patients and 21 healthy controls underwent a 1.5T MRI scan. Hypothalamus volumes were manually traced by a rater blind to subjects' identity. General linear model for repeated measures (GLM-RM) was used to compare groups on hypothalamic volumes, controlling for total intracranial volume, age and sex. ResultsThe hypothalamus volume was significantly reduced (p=0.04) in GAD patients, with significant reductions in both the left (p=0.02) and right side (p=0.04). Patients with PD did not differ significantly (p=0.73). Anxiety scores were inversely correlated with hypothalamic volumes. LimitationsThe small sample size could reduce the generalizability of the results while the lack of stress hormone measurements renders functional assessment of the hypothalamus-pituitary-adrenal axis not feasible. ConclusionsThe present study showed decreased hypothalamic volumes in GAD patients but not in those with PD. Future longitudinal studies should combine volumetric data with measurements of stress hormones to better elucidate the role of the HPA axis in GAD.

Efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy in the treatment of generalized anxiety disorders

ObjectiveTo observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders. MethodsA total of 202 generalized anxiety disorders patients were randomly allocated to a control condition (Paroxetine combined with cognitive therapy) or a treatment condition (Yiqiyangxin Chinese medicine compound combined with cognitive therapy). Subsequently, scores of Hamilton Anxiety Scale (HAMA), Zung Self-rating Anxiety Scale (SAS) and blood routine, urine routine, liver function, renal function, electrocardiogram were detected before treatment, 3 months, 6 months after treatment and 6 months after medicine withdrawal, respectively. ResultsHAMA and SAS scores were significantly reduced in two groups (P<0.001) after treatment, but the differences in HAMA and SAS scores, apparent effect and effectiveness were not significant (P>0.05). HAMA and SAS scores were significantly increased in two groups (P<0.05) after medicine withdrawal, and there were significant differences in HAMA and SAS scores, recurrent disease and adverse reaction (P<0.001). The incidence of recurrent disease and adverse reaction in treatment group was low. Both two groups showed no apparent abnormality in blood routine, urine routine, liver and renal function, and electrocardiogram. ConclusionsYiqiyangxin Chinese medicine compound combined with cognitive therapy can significantly reduce the recurrence after medicine withdrawal and is effective on generalized anxiety disorders. Furthermore, the incidence of adverse reactions is low. The treatment program is worthy clinic application in the further.

Cognitive-behavioural therapy reduces unwanted thought intrusions in generalized anxiety disorder

Background and objectivesVoluntary attempts to suppress certain thoughts can paradoxically increase their intrusive return. Particular impairments in thought suppression are thought to be key mechanisms in the pathogenesis of mental disorders. To assess the role of this processing bias in the maintenance of generalized anxiety disorder (GAD), we investigated whether it is susceptible to cognitive-behavioural treatment (CBT). Methods22 GAD patients and 22 healthy controls (HC) were tested twice within 15 weeks, with patients receiving CBT in between. A subset of patients was additionally tested while waiting for treatment to control for retest effects. Using a mental control paradigm, we measured intrusion frequency during the voluntary suppression of thoughts related to (a) the individual main worry topic, (b) a negative non-worry topic, and (c) a neutral topic. Self-reported worry was measured before and after treatment, and at 6-months follow-up. ResultsCompared to HC, GAD showed specifically more worry-related intrusions. CBT reduced this bias to a healthy level, over and above mere test-retest effects. LimitationsThis study could not clarify whether the demonstrated effect mediates other changes, or how it relates to other cognitive biases in GAD. ConclusionsThe results indicate that thought suppression processes are not only impaired in GAD, but that the impairment is specific to the patients' worries, and that it can be successfully targeted by CBT. This highlights the importance of thought suppression processes in the maintenance of GAD.

A pilot study of hippocampal volume and N-acetylaspartate (NAA) as response biomarkers in riluzole-treated patients with GAD

Anxiolytic benefit following chronic treatment with the glutamate modulating agent riluzole in patients with generalized anxiety disorder (GAD) was previously associated with differential changes in hippocampal NAA concentrations. Here, we investigated the association between hippocampal volume and hippocampal NAA in the context of riluzole response in GAD. Eighteen medication-free adult patients with GAD received 8-week of open-label riluzole. Ten healthy subjects served as a comparison group. Participants underwent magnetic resonance imaging and spectroscopy at baseline and at the end of Week 8. GAD patients who completed all interventions were classified as remitters (n=7) or non-remitters (n=6), based on final Hamilton Anxiety Rating Scale (HAM-A) scores ≤7. At baseline, GAD patients had a significant reduction in total hippocampal volume compared to healthy subjects (F(1,21)=6.55, p=0.02). This reduction was most pronounced in the remitters, compared to non-remitters and healthy subjects. Delta (final−baseline) hippocampal volume was positively correlated with delta NAA in GAD. This positive association was highly significant in the right hippocampus in GAD [r=0.81, p=0.002], with no significant association in healthy subjects [Fisher r-to-z p=0.017]. Across all GAD patients, delta hippocampal volume was positively associated with improvement in HAM-A (rspearman=0.62, p=0.03). These preliminary findings support hippocampal NAA and volume as neural biomarkers substantially associated with therapeutic response to a glutamatergic drug.

Functional MRI of the amygdala and bed nucleus of the stria terminalis during conditions of uncertainty in generalized anxiety disorder

Generalized anxiety disorder (GAD) is a common psychiatric disorder characterized by constant worry or anxiety over every day life activities and events. The neurobiology of the disorder is thought to involve a wide cortical and subcortical network that includes but is not limited to the amygdala and the bed nucleus of the stria terminalis (BNST). These two regions have been hypothesized to play different roles in stress and anxiety; the amygdala is thought to regulate responses to brief emotional stimuli while the BNST is thought to be involved in more chronic regulation of sustained anxiety. In this study, we exposed medication-free GAD patients as well as non-anxious controls to a gambling game where one of the conditions involved non-contingent monetary loss. This condition of high uncertainty was intended to elicit a stressful response and sustained anxiety. Functional MRI scans were collected simultaneously to investigate BOLD activity in the amygdala and BNST during performance of this task. Compared to controls, we found that GAD patients demonstrated decreased activity in the amygdala and increased activity in the BNST. Skin conductance measures showed a consistent early versus late effect within block where GAD patients demonstrated higher arousal than controls late in the task blocks. Based on these results, we hypothesize that GAD patients disengage the amygdala and its response to acute stress earlier than non-anxious controls making way for the BNST to maintain a more sustained response. Future studies are needed to investigate the temporal dynamics of activation and deactivation in these regions.

Adjunctive therapy with pregabalin in generalized anxiety disorder patients with partial response to SSRI or SNRI treatment

This study evaluated the efficacy of adjunctive pregabalin versus placebo for treatment of patients with generalized anxiety disorder (GAD) who had not optimally responded to previous or prospective monotherapies. This was a phase 3, randomized, double-blind, placebo-controlled study. Patients diagnosed with GAD who had a historical and current lack of response to pharmacotherapy [Hamilton Anxiety Rating Scale (HAM-A) of ≥ 22 at screening] were randomized to adjunctive treatment with either pregabalin (150-600 mg/day) or placebo. The primary outcome measure was the change in HAM-A total scores after 8 weeks of combination treatment. Adverse events were regularly monitored. Randomized patients (N=356) were treated with pregabalin (n=180) or placebo (n=176). Mean baseline HAM-A scores were 20.7 and 21.4, respectively. After treatment, the mean change in HAM-A was significantly greater for pregabalin compared with placebo (-7.6 vs. -6.4, respectively; P<0.05). HAM-A responder rates (≥ 50% reduction) were significantly higher for pregabalin (47.5%) versus placebo (35.2%; P=0.0145). The time-to-sustained response favored pregabalin over placebo (P=0.014). Adverse events were consistent with previous studies and discontinuations were infrequent for pregabalin (4.4%) and placebo (2.3%). The study was discontinued early after an interim analysis. The results indicate that adjunctive pregabalin is an efficacious therapy for patients with GAD who experience an inadequate response to established treatments.

The therapeutic effects of oxygen inhalation combined with relaxation training on generalized anxiety disorder

Objective To observe the therapeutic effects of oxygen inhalation combined with relaxation training on patients ,with generalized anxiety disorder （GAD）. Methods A total of 188 GAD patients were divided into the study group and the control group randomly. The two groups were treated with conventional antianxiety drugs （paroxetine） , in addition to conventional medical therapy. The study group was aided with oxygen inhalation and relaxation training, the control group was given henzodiazepine. The scores of Hamilton anxiety rating scale （HAMA） , global improvement（GI） [ a part of clinical global impression （CGI）], and treatment emergent symptom scale （TESS） were used to evaluate clinical effects and adverse reactions before and after 4-week treatment. The indexes of breathing, heart rate and blood pressure were evaluated before and after treatment. Results The scores of HAMA scale and GI in the two groups were significantly different after treatment（ P 〈 0.05 ） , and the study group changed significantly（ P 〈 0.05 or P 〈 0.01 ）. The adverse reactions of the two groups were slight, there was no significant difference of TESS before and after treatment （ P 〉 0. 05 ）. There was no significant difference in terms of breathing, heart rate and blood pressure between the two groups before treatment（ P 〉 0.05 ） , but were all lower after treatment the study group changed more apparently and significantly（ P 〈 0.01 ）. Conclusions Based on conventional drugs treatment oxygen inhalation combined with relaxation training could improve anxiety and somatization rapidly, there was no obvious adverse reaction and the patients compliance was good, so the treatment was worth to use in clinic. Key words: Oxygen inhalation; Relaxation training; Generalized anxiety disorder

Psychometric properties of the GAD-Q-IV and DERS in older, community-dwelling GAD patients and controls

Thirty-seven community-dwelling, older generalized anxiety disorder (GAD) patients and 37 nonanxious controls completed the Generalized Anxiety Disorder Questionnaire for DSM-IV (GAD-Q-IV; Newman et al., 2002), the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and other measures of anxiety and depression. The GAD-Q-IV and DERS were assessed for internal consistency reliability, construct validity, and test–retest reliability, with results indicating good psychometric performance. Receiver operating characteristic (ROC) analysis conducted on the full sample suggested that the optimal GAD-Q-IV cutoff for classifying GAD cases was 3.71, with .97 sensitivity and .92 specificity. The cutoff score for classifying those participants with GAD and comorbid conditions was higher, however. ROC analysis with the full sample revealed an optimal DERS cutoff score of 62.5, with .76 sensitivity and .86 specificity. Findings support the use of the GAD-Q-IV and DERS as screening instruments for GAD in older, community-dwelling adults in a research setting.