Generalized Anxiety Disorder Patients Research Articles

Visual responses of patients with generalized anxiety disorder who cycling in the virtual sportscapes with different tree cover densities.

The tree density of virtual sportscape is the main factor that determines the benefits that generalized anxiety disorder (GAD) patients can obtain when they exercise with virtual environment. By using pupil size, fixation count and time as metrics, this research aimed to clarify the relationship between tree cover density and stress in the virtual environment. Ninety GAD patients were randomly grouped into the 36–60% tree density (high tree density, HTDS), 20–35% tree density (medium tree density, MTDS), or control groups (n = 30). Researchers used eye-tracking technology to analyze fixation time, fixation count and changes in pupil size to evaluate the stress changes of participants after 20 min of aerobic exercise in a virtual environment. The results showed that pupil size expanded in GAD patients after exercising in the virtual environment. Furthermore, GAD patient cycling in the MTDS group can show smaller pupil size than those in HTDS. Those results suggest that GAD patient cycling 20 min in the MTDS group can perceived lower stress. The results of eye tracking analysis showed that GAD patients spend more time and counts observing tree elements in HTDS and MTDS sportscapes. Specifically, they spent more 48% and 27% time on tree and green plants in the HTDS condition and MTDS condition, respectively, than in non-natural sportsscapes. Although 36–60% tree density of virtual natural sportscape can get more visual attention from GAD patients, 20–35% tree density of virtual natural sportscape is more capable of reducing their stress.

Effects of group mindfulness-based cognitive therapy and group cognitive behavioural therapy on symptomatic generalized anxiety disorder: a randomized controlled noninferiority trial

BackgroundMindfulness-based cognitive therapy (MBCT) is a promising alternative treatment for generalized anxiety disorder (GAD). The objective of this study was to examine whether the efficacy of group MBCT adapted for treating GAD (MBCT-A) was noninferior to group cognitive behavioural therapy (CBT) designed to treat GAD (CBT-A), which was considered one of first-line treatments for GAD patients. We also explored the efficacy of MBCT-A in symptomatic GAD patients compared with CBT-A for a variety of outcomes of anxiety symptoms, as well as depressive symptoms, overall illness severity, quality of life and mindfulness.MethodsThis was a randomized, controlled, noninferiority trial with two arms involving symptomatic GAD patients. Adult patients with GAD (n = 138) were randomized to MBCT-A or CBT-A in addition to treatment as usual (TAU). The primary outcome was the anxiety response rate assessed at 8 weeks after treatment as measured using the Hamilton Anxiety Scale (HAMA). Secondary outcomes included anxiety remission rates, scores on the HAMA, the state-trait anxiety inventory (STAI), the Hamilton Depression Scale (HAMD), the Severity Subscale of the Clinical Global Impression Scale (CGI-S), and the 12-item Short-Form Health Survey (SF-12), as well as mindfulness, which was measured by the Five Facet Mindfulness Questionnaire (FFMQ). Assessments were performed at baseline, 8 weeks after treatment, and 3 months after treatment. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed for primary analyses. The χ2 test and separate two-way mixed ANOVAs were used for the secondary analyses.ResultsITT and PP analyses showed noninferiority of MBCT-A compared with CBT-A for response rate [ITT rate difference = 7.25% (95% CI: -8.16, 22.65); PP rate difference = 5.85% (95% CI: − 7.83, 19.53)]. The anxiety remission rate, overall illness severity and mindfulness were significantly different between the two groups at 8 weeks. There were no significant differences between the two groups at the 3-month follow-up. No severe adverse events were identified.ConclusionsOur data indicate that MBCT-A was noninferior to CBT-A in reducing anxiety symptoms in GAD patients. Both interventions appeared to be effective for long-term benefits.Trial registrationRegistered at chictr.org.cn (registration number: ChiCTR1800019150, registration date: 27/10/2018).

Neural mechanisms of aberrant self-referential processing in patients with generalized anxiety disorder

Massive theoretical studies in clinical psychology have implicated the self in understanding internalizing disorders (i.e., anxiety and mood disorders), in which self-related tasks were frequently used to investigate internalizing psychopathology. As one of the most frequently seen internalizing disorder in primary care, patients with generalized anxiety disorder (GAD) are characterized by inappropriate self-related processing such as negative self-referential thinking. However, relevant neural mechanisms remain unknown. In this study, participants underwent a self-related task which they were presented with several positive and negative trait words and were required to judge the extent to which these traits matched themselves when compared to their average peers. Aberrant brain activation and functional connectivity of GAD were detected during processing positive and negative traits. Compared to healthy controls (HCs), patients with GAD exhibited abnormal self-processing which manifested as lower biased self-rating scores particularly for negative traits and weaker brain activity in the left dorsomedial prefrontal cortex, inferior frontal gyrus, superior temporal sulcus (STS), and bilateral lingual gyrus when processing trait words. Abnormal functional connections between these hypoactive regions and regions associated with reward, emotion, and theory of mind were observed in subsequent psychophysiological interaction analysis. An attenuation of connectivity between the left insula and left STS was associated with greater severity of anxiety symptom in GAD patients. These findings provide insight into the abnormal neurocognitive mechanisms of biased self-related processing in GAD patients, which involves distorted self-schema accompanied by abnormal activation and functional connections of regions implicated in self-related and social cognition processing.

Primary clinical testing of the questionnaire “Brief questionary of quality of anxiety” in patients with generalized anxiety disorder

IntroductionThe clinical differentiation of anxiety can play an important role, particularly in response to treatment. Patients with generalized anxiety disorders (GAD) reflect anxiety, therefore questionnaires are effective. Previous attempts to create a questionnaire assessing the quality of anxiety assessed only one aspect – tolerance to uncertainty (3). The new questionnaire covers such aspects of anxiety as behavioral manifestation, hypochondria, relation to cognition, personal trait and expectation from treatment.ObjectivesClinical testing of the questionnaire.Methods38 GAD patients (total score of Hamilton depression rating scale 27±4.7), aged 42.5±13, 75% females and 38 healthy volunteers aged 36.5±11, 74% females. The questionnaire included 8 statements, (two of them have subparagraphs). The testing version does not include statement about expectations from treatment. It takes 10 minutes to fill it out.ResultsThe difference between groups were found in following statements:“I am often told that a am worried about small things” (χ2 22 p=0.00001)–behavioral presentation of anxiety.“When I am anxious, I find it difficult to concentrate” (χ23,6 p=0.059)–cognitive aspect.“My anxiety is getting worse, when I can’t complete the task strictly according to the instruction” (χ2 13.6 p=0.0002) -obsessive aspect.“My anxiety is getting worse, when something goes wrong” (χ2=9 p=0.002)-obsessive aspect.“My anxiety is getting worse, when I need to make my own decision” (χ29 p=0.003)- narcissism“My anxiety is getting worse when I have to hold back irritation or discontent” (χ24.2 p=0.04)-narcissism.ConclusionsOnly part of statements differs GAD patients from healthy volunteers, but they cover different fields of mental functioning.DisclosureNo significant relationships.

Prevalence and clinical features of anxiety disorders: Tunisian study about 436 subjects

IntroductionAnxiety disorders represent one of the most common mental disorders following a chronic course.ObjectivesThe aim of our study is to determine the prevalence, incidence and clinical characteristics of these disorders.MethodsWe conducted a retrospective and descriptive study about 436 outpatients fulfilling the DSM-V diagnostic criteria for anxiety disorder and followed in the department of psychiatry of Monastir (Tunisia) between 1998 and 2017. Selective mutism and separation anxiety were excluded for lack of cases.ResultsThe overall prevalence was 5.51%. Panic Disorder was the most prevalent anxiety disorder subtype (3.2%). The incidence of anxiety disorders in the last years has increased from 3.31% in 1998 to 7.5% in 2017. The mean age at diagnosis was 37.76±12.87 years [16-77]. Female gender was the most prevalent in overall anxiety disorders with a sex ratio of 0.78, however, a significant male predominance was recorded in Social Anxiety Disorder (SAD) with a sex ratio of 1.85. Generalized Anxiety Disorder patients were more likely to have low educational level (OR= 1.879), to be laborers (OR=2.55), to be married (OR=2.418) and to have children (OR=2.564) whereas SAD patients were more likely to have higher education (OR=9.118), to be students (OR=5.565), to be single (OR=11.325) and have no children (OR=7.464).ConclusionsThis study highlignts the frequency of anxiety disorders and the fact that being a middle-age married woman with kids make oneself more prone to have an anxiety disorder. Specific attention should be paid to these anxiety disorders with early preventive programs.DisclosureNo significant relationships.

Clinical effects of central antagonist of cholecystokinin-1 receptors GB-115 in patients with Generalized Anxiety Disorder

Introduction The pilot clinical study of GB-115, a new peptide antagonist of central cholecystokinin-1 receptors, revealed that drug was clinically effective in patients with generalized anxiety disorder (GAD) at dose 6 mg daily. Here, we provide results of post-hoc analysis of changes of anxiety and fatigue symptoms to give characterization of its clinical effects in clinically relevant doses.ObjectivesTo research the changes of anxiety- and fatigue-related symptoms during GB-115 treatment in patients with generalized anxiety disorder (GAD).Methods Patients with GAD without somatic diseases aged 18-55 years were eligible in the study. Patients were prescribed with GB-115 6 mg daily for 21 days. Anxiety and fatigue symptoms were assessed with Hamilton Anxiety Rating Scale (HARS) and Multidimensional Fatigue Inventory (MFI-20). Variables are described as medians and interquartile range (IQR). Pre-post comparisons were performed using the Friedman ANOVA at 2-side p-value <0.05.Results25 patients diagnosed with GAD (8 males, 17 females; median [IQR] age: 34 [29.75, 43.0]) included in the analysis. Median [IQR] HARS total score decreased from 22 [20, 24.5] to 19 [16, 20], 13 [10.5, 15.5], 9 [5.5, 11] and 5 [3.5, 8] on the Day 3,7,14 and 21, respectively (χ2=95.07, df=4, p<0.001). Median [IQR] MFI-20 score decreased from 70 [46, 75.5] to 59 [41, 74.5], 52 [37.5, 64.5], 37 [26.5, 63] and 28 [24, 48.5] on the Day 3, 7, 14 and 21, respectively (χ2= 55.41, df=4, p<0.001). None of patients had stimulation-related side effects.ConclusionsGB-115 action in the treatment of GAD patients is characterized with anxiolytic action with mild psychostimulant properties.DisclosureNo significant relationships.

Threat reversal learning and avoidance habits in generalised anxiety disorder

Avoidance and heightened responses to perceived threats are key features of anxiety disorders. These disorders are characterised by inflexibility in dynamically updating behavioural and physiological responses to aversively conditioned cues or environmental contexts which are no longer objectively threatening, often manifesting in perseverative avoidance. However, less is known about how anxiety disorders might differ in adjusting to threat and safety shifts in the environment or how idiosyncratic avoidance responses are learned and persist. Twenty-eight patients with generalised anxiety disorder (GAD), without DSM co-morbidities, and 27 matched healthy controls were administered two previously established paradigms: Pavlovian threat reversal and shock avoidance habits through overtraining (assessed following devaluation with measures of perseverative responding). For both tasks we used subjective report scales and skin conductance responses (SCR). In the Pavlovian threat reversal task, patients with GAD showed a significantly overall higher SCR as well as a reduced differential SCR response compared to controls in the early but not late reversal phase. During the test of habitual avoidance responding, GAD patients did not differ from controls in task performance, habitual active avoidance responses during devaluation, or corresponding SCR during trials, but showed a trend toward more abstract confirmatory subjective justifications for continued avoidance following the task. GAD patients exhibited significantly greater skin conductance responses to signals of threat than controls, but did not exhibit the major deficits in reversal and safety signal learning shown previously by patients with OCD. Moreover, this patient group, again unlike OCD patients, did not show evidence of altered active avoidance learning or enhanced instrumental avoidance habits. Overall, these findings indicate no deficits in instrumental active avoidance or persistent avoidance habits, despite enhanced responses to Pavlovian threat cues in GAD. They suggest that GAD is characterised by passive, and not excessively rigid, avoidance styles.

An fMRI study of cognitive regulation of reward processing in generalized anxiety disorder (GAD)

BackgroundCognitive regulation can affect the process of decision making. Generalized anxiety disorder (GAD) patients seem to have an impairment in cognitive regulation of reward processing concerning food stimuli. This study aims to explore the impact of GAD in cognitive regulation of food-related rewards. MethodsGAD patients (n=11) and healthy controls (n=15) performed a cognitive regulation craving task with food images while undergoing a functional magnetic resonance imaging (fMRI) acquisition. Between-group differences in functional connectivity were measured using dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) seeds during cognitive regulation. ResultsDuring cognitive regulation, there was a significant interaction for functional connectivity between the right dlPFC and bilateral vmPFC with the thalamus. GAD patients had lower functional connectivity for cognitive regulation conditions (distance and indulge) than for the non-regulated condition in these clusters, while control participants presented the opposite pattern. GAD group presented fixed food valuation scores after cognitive regulation. ConclusionsGAD participants showed inflexibility while valuating food images, that could be produced by cognitive regulation deficits underpinned by functional connectivity alterations between prefrontal regions and the thalamus. These results show cognitive inflexibility and difficulty in the modulation of cognitive responses during decision making in GAD patients.

Reliability and validity of the traditional Chinese version of the GAD-7 in Taiwanese patients with epilepsy

Generalized anxiety disorder (GAD) is the second most common psychiatric comorbidity of epilepsy. GAD has a negative impact on seizure control, and it is underrecognized. The Generalized Anxiety Disorder 7-item (GAD-7) questionnaire is useful for screening GAD in patients with epilepsy (PWE). This study aimed to validate the traditional Chinese version of the GAD-7 for Taiwanese patients by obtaining data on adult PWE from our hospital. PWE were recruited from the Taipei Veterans General Hospital from April 2017 to January 2020. The mood disorder module of the Mini International Neuropsychiatric Interview (MINI) was used for the psychiatric assessment. The traditional Chinese version of the GAD-7 and the Beck Anxiety Inventory were included as self-rated psychiatric evaluation. To investigate the psychometric properties, internal consistency, external validation, and receiver operator characteristic (ROC) curve analysis were conducted to assess the utility of the Taiwanese version of the GAD-7. We recruited 109 patients in the present study. Seventeen patients (15.9%) had GAD according to the MINI. The mean GAD-7 score was 10.28±10.68. All the GAD-7 items were significantly and positively associated with the corrected overall GAD-7 score (Cronbach's alpha=0.928, p<0.0001). The cut-off point for the GAD-7 in ROC curve analysis was 7. The patients with GAD were more likely to be female and single. The traditional Chinese version of the GAD-7 is a reliable and valid self-report questionnaire for detecting GAD in Taiwanese PWE.

Hypogyrification in Generalized Anxiety Disorder and Associated with Insomnia Symptoms.

PurposeInsomnia is a recognized feature of generalized anxiety disorder (GAD). The underlying neural substrate of insomnia in GAD is still unclear. Cortical folding is a reliable index and possibly an endophenotype of psychiatric disease. The aim of this study was to explore whether the aberrant cortical morphology was associated with insomnia in GAD.Patients and MethodsWe enrolled 73 patients with GAD and 74 matched healthy controls (HCs) to undergo neuropsychiatric assessment and 3.0 T magnetic resonance imaging scanning. Neuropsychiatric batteries included the 14-item Hamilton Anxiety Rating Scale (HAMA) and the Insomnia Severity Index (ISI). Using FreeSurfer7.1.1, we calculated local gyrification index, cortical thickness and surface area and identified group differences in these parameters. Then, we calculated the functional connectivity of these identified regions and determined functional alterations. The relationship between these neuroimaging indicators and clinical measurement was explored.ResultsCompared with HCs, the LGI in the bilateral orbitofrontal cortex (OFC), bilateral insula, left middle frontal gyrus, left temporal pole, and left fusiform area was significantly decreased in GAD. GAD patients had concurrent decreased surface area in the left OFC and thicker right OFC. GAD patients also exhibited increased functional connectivity between the left insula and frontoparietal control network. In addition, a negative relationship was observed between decreased LGI in these limbic regions and ISI score.ConclusionGAD patients presented aberrant cortical folding in limbic network. Cortical morphology is a potential endophenotype in GAD, corresponding to an insomnia phenotype.

Effects of Jie Yu Wan on Generalized Anxiety Disorder: A Randomized Clinical Trial.

Objective To systematically assess the clinical efficacy of the Jie Yu Wan (JYW) formula in treating generalized anxiety disorder (GAD). Methods A multicenter, prospective, double-blind, double-dummy, randomized controlled trial (RCT) was conducted at four hospitals in China. A total of one hundred thirty-three patients with GAD were enrolled from 2017 to 2019. This study aimed to evaluate the effects of a Traditional Chinese Medicine (TCM) JYW formula on GAD at eight weeks, with the use of Buspirone as the comparator. A stepwise dosing protocol was used (JYW: high dose 24 g/day, low dose 12 g/day; Buspirone: high dose 30 mg/day, low dose 15 mg/day) and the dose was adjusted depending on whether the treatment response of Hamilton Anxiety Scale (HAMA) score was less than or equal to 25% after one week. The primary outcome was a change in total score on the HAMA. The secondary outcomes included the Hamilton Depression Scale (HAMD), Clinical Global Impression (CGI) scale, and TCM Syndrome Scale. Adverse events were recorded using the Treatment Emergent Symptom Scale (TESS). Assessments were conducted at the baseline and 1, 2, 4, and 8 weeks. Results A total of one hundred thirty-three participants were randomly assigned to the JYW group (n = 66) and the Buspirone group (n = 67). One hundred twenty-one patients (91%) completed at least one follow-up session. There were no significant differences between the two groups in terms of gender, age, disease course, HAMA, HAMD, CGI, and TCM Syndrome Scale scores at baseline (all P > 0.05). Repeated-measures analysis of variance revealed statistically significant time effects for the HAMA (P=0.002), HAMD (P = 0.018), and CGI (P=0.001) in both groups. Sensitivity analyses supported the credibility of the main results (P > 0.05). The group effect was not significant for the HAMA (P=0.43), HAMD (P=0.27), CGI (P=0.37), and TCM Syndrome Scale (P=0.86). Furthermore, there were no significant interaction effects between time and group in terms of the HAMA (P=0.47), HAMD (P=0.79), CGI (P=0.67), and TCM Syndrome Scale (P=0.69). After one week, 53 patients (80%) of the JYW group and 52 patients (78%) of the Buspirone group were adjusted to high doses. The interaction effect between time, group, and the dose was determined by repeated measures ANOVA test, and the HAMA score served as the outcome measure. The interaction effect between time and dose was statistically significant (P=0.04), which shows that high-dose JYW (24 g/day) was more effective in decreasing patients' HAMA scores than low-dose JYW (12 g/day), and Buspirone had the same effect, which means that high-dose Buspirone (30 mg/day) was more effective than low dose. (15 mg/day). Conclusions The conclusion of this study supports that JYW and Buspirone can effectively alleviate the anxiety symptoms of GAD patients, which are both effective and safe for treatment of mild to moderate GAD. Besides, high-dose JYW or Buspirone are more effective than low-dose, which is of great importance in assisting clinical medication choice.

Increased Intra-Individual Variability as a Marker of Executive Dysfunction in Generalized Anxiety Disorder

Recent studies suggest that individual difference in intra-individual variability (IIV) of reaction times is an important indicator of attentional executive control. However, there are few existing studies on the executive control of high trait-anxious individuals assessed by using reaction time variability. This study assessed whether executive functions are impaired among clinical and non-clinical trait-anxious individuals indicated by IIV. The cross-reliability and discriminative power of three IIV parameters (raw intra-individual standard deviation, SD; reaction time coefficient of variation, RTCV; and mean absolute deviation, MAD) were compared. Twenty-five non-clinical individuals with low trait anxiety (LTA), 31 non-clinical individuals with high trait anxiety (HTA), and 19 clinical patients diagnosed with generalized anxiety disorder (GAD) finished self-reported measures, an emotional spatial-cuing task, and a non-emotional arrow flanker task. In the emotional task, GAD patients had significantly slower response speed, lower accuracy, and greater IIV parameters than the LTA and HTA groups. In the non-emotional task, the GAD group exhibited poorer processing efficiency, greater SD and RTCV, and intact performance effectiveness. RTCV is suggested to be a better marker of executive dysfunction than SD and MAD due to its good discriminative power and reliability as well as less affected by reaction times.

Measurement of Post-Treatment Changes in Brain Metabolites in Patients with Generalized Anxiety Disorder using Magnetic Resonance Spectroscopy.

Background: From previous studies, we know the correlations of some brain metabolites with a generalized anxiety disorder (GAD) and its symptoms. The response of GAD patients to various treatments is not the same and finding the best treatment option for each patient takes a long period of time.Objective: In this study, we try to examine if there is any relationship between a special treatment option and GAD patients’ response and brain metabolite correlation with anxiety level change.Material and Methods: This study is a clinical trial type of studies. We have used proton MRS (1H-MRS) with field strength of 3 Tesla to assess whether a different treatment option makes different responses based on metabolite changes. We chose 16 patients based on Hamilton’s anxiety rate and a psychiatrist diagnosis. Patients were divided into two groups randomly. Each group took different treatments. Before treatment started, patients underwent MRS imaging and 8 weeks after treatment as well. Our study lacked a control group, and the results were analyzed by comparing the measured values of metabolites and clinical scores before and after treatment. Results: The NAA and Cho concentration increased after treatments and Cr concentration remained constant in both groups. Both groups showed improvements in their symptoms of anxiety and also in their clinical score rates. Sertraline group showed a more increase in NAA concentration than CBT and also a more decrease in HAMA and HAMD-17 scores.Conclusion: A simultaneously increase in NAA and Cho in both groups and a decrease in clinical anxiety levels demonstrate that NAA and Cho concentration are associated negatively with anxiety levels. In addition, both CBT and sertraline are effective in the improvement of anxiety symptoms.

Evaluation of Coronavirus Anxiety Levels and Coping Strategies of Major Depressive Disorder, Generalized Anxiety Disorder, and Panic Disorder Patients During the Covid-19 Pandemic.

This study aims to compare patients with major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD), whom we have frequently seen in our hospital practice during the pandemic, with healthy controls (HC) in terms of coronavirus anxiety levels and coping strategies. In this study, the Sociodemographic Data Form, Coronavirus Anxiety Scale (CAS), Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Coping Orientation to Problems Experienced (COPE) scale were applied to the participants. 30 MDD patients, 32 GAD patients, 31 PD patients and 38 HCs, totaling 131 participants, constituted the sample of the study. Evaluation of the CAS scores of the participants revealed that HC scored 3.306 (p=0.002) points lower than GAD patients and 3.014 (p=0.005) points lower than PD patients, while HC and major depression patients were not statistically different in terms of CAS scores (p=0.880). In the comparison of coping strategies, HC scored 3.151 (p<0.001) points higher than MDD patients and 2.059 (p=0.004) points higher than GAD patients in terms of "active coping." In terms of "planning," HC scored 2.726 (p<0.001) points higher than MDD patients, 2.589 (p=0.001) points higher than GAD patients, and 2.171 (p=0.006) points higher than PD patients. This study found higher coronavirus anxiety levels in GAD and PD patients but no difference in MDD patients compared to HC during the COVID-19 pandemic, which may indicate that MDD patients can COPE better with coronavirus anxiety. Determining the coping strategies that individuals use to COPE with coronavirus anxiety during the COVID-19 pandemic may help mental health professionals to control disease-related stressors and contribute to the treatment process.

Inflammatory markers changes following acceptance-based behavioural psychotherapy in Generalised Anxiety Disorder patients – evidence from a randomised controlled trial

Inflammatory markers changes following acceptance-based behavioural psychotherapy in Generalised Anxiety Disorder patients – evidence from a randomised controlled trial

Prevalence of Generalised Anxiety Disorder among Urban Omani Patients Attending Primary Care Centres: A Cross-Sectional Study

Background: Anxiety disorders are common mental health illnesses in primary care. Undiagnosed and thus untreated mental disorders can interfere with the patient’s quality of life, ultimately resulting in poor daily functioning, a greater number of doctor consultations, and increased disability. Objective: The objective of this study was to establish the prevalence of generalised anxiety disorder (GAD) among an urban adult Omani population as well as associated sociodemographic and clinical variables. Methodology: This study utilised a cross-sectional design and was performed between December 2019 and January 2020. A total of 250 Omani patients were recruited from eight randomised government-funded primary care centres in Muscat, Oman. The prevalence of GAD among the participants was determined by utilising an Arabic version of the validated 7-item General Anxiety Disorder tool delivered during face-to-face interviews. Results: Overall, a total of 33 patients had GAD (13.2%). According to the univariate analysis, a personal history of anxiety (P = 0.001), chronic medical illnesses (P = 0.025), low monthly income (P = 0.018), divorced individuals (P = 0.015), and housewives with extra part-time employment (P = 0.032) were significantly associated with GAD. However, only the absence of a personal history of anxiety (P = 0.001), and high monthly income (P = 0.002) remained a statistically significant protector against GAD in the multivariate analysis. Conclusion: We found a high prevalence of GAD among an adult urban Omani population. Moreover, certain clinical and sociodemographic variables were found to be significantly associated with the disorder, including a personal history of anxiety and low monthly income. The quality of life of Omani GAD patients may be improved via rapid screening of the general population.

Study of the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder.

The effects of dialectical behavior therapy on generalized anxiety disorder have not been examined to date, whereas cognitive behavioral therapy is a well-known psychotherapy for generalized anxiety disorder. This study investigated the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder. In the present study, 72 generalized anxiety disorder patients were randomly assigned to one of two groups: dialectical behavior therapy or cognitive behavioral therapy. Evaluations were performed at baseline, post-test, and three months after interventions as a follow-up. Measures included the Structured Clinical Interview for DSM-IV Axis I disorders, the Generalized Anxiety Disorder scale, the Beck Anxiety Inventory, the Beck Depression Inventory, the Tower of London Task, and the Wisconsin Card Sorting Task.Results: The results of the present study showed that both groups had reduced scores for depression and anxiety and increased scores for executive function after the psychotherapies. These changes were maintained at follow-up. Although depression and anxiety symptoms were significantly reduced by cognitive behavioral therapy, dialectical behavior therapy was more effective for improving executive function.

Effect of breathing exercises on respiratory indices and anxiety level in individuals with generalized anxiety disorder: a randomized double-blind clinical trial.

[Purpose] The purpose of this study was to assess the efficacy of breathing exercises alongside traditional therapy on respiratory indexes and the level of anxiety of generalized anxiety disorder patients. [Participants and Methods] Forty-one patients were assigned a study group undergoing medication and routine counselling plus breathing exercises (EXS), and a control group received medication and routine counselling only (Non-EXS). Every two weeks, patients are called (weeks 2, 4, 6, and 8) to monitor their schedule adherence. [Results] This study’s results showed FEV1/FVC ratio significantly increased in the EXS group in the second study follow-up period after two months. Anxiety, FVC, FEV1, Etco2, respiration, and pulse rate over time have tended towards desirable results in the exercise group than control groups, especially after two months, but significant differences not seen. [Conclusion] This study’s findings indicated that breathing exercises could improve generalized anxiety disorder’s pharmacotherapy and psychotherapy. Our data bring up this hypothesis that longer follow up, increasing breathing period, and more exercising is associated with higher outcome.

Efficacy of manual acupuncture versus placebo acupuncture for generalized anxiety disorder (GAD) in perimenopause women: study protocol for a randomized controlled trial

BackgroundGeneralized anxiety disorder (GAD) is common among perimenopausal women. Acupuncture may be an effective treatment for GAD, but evidence is limited. The pathogenesis of GAD is not yet clear, but it is related to the hypothalamic-pituitary-adrenal axis and its excretion, cortisol (CORT), and adrenocorticotropic hormone (ACTH). The object of this study is to evaluate the efficacy of manual acupuncture (MA) versus placebo acupuncture (PA) for perimenopausal women with GAD.MethodsThis study is a single-center, randomized, single-blind clinical trial that will be conducted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 112 eligible GAD patients will be randomly assigned (1:1) to receive MA (n=56) or PA (n=56) three times per week for 4 weeks. The primary outcome measure will be the HAMA score. The secondary outcome measures will be the GAD-7 and PSQI scores and the levels of CORT and ACTH. The evaluation will be executed at baseline, 2 weeks, the end of the treatment, and a follow-up 3-month period. All main analyses will be carried out based on the intention-to-treat (ITT) principle.DiscussionThis study intends to compare the efficacy between MA and PA in the treatment of perimenopausal women with GAD and to further study the mechanisms underlying the effect.Trial registrationChinese Clinical Trial Registry ChiCTR2100046604. Registered on 22 May 2021.

The evaluation of urinary vanillylmandelic acid level in patients with generalized anxiety disorder

Background and objectives: The prevalence of anxiety disorders is increasing in the world. Studies revealed that generalized anxiety disorder may lead to change in circulating catecholamine levels. Thus, the changes of catecholamine metabolite like urinary vanillylmandelic acid may increase the future risk of thrombotic diseases in patients with generalized anxiety disorder (GAD). The aim of this present study is to evaluate urinary vanillylmandelic acid (VMA) levels in patients with generalized anxiety disorder. Materials and methods: A cross-sectional study was performed in the Department of Physiology, Dhaka Medical College, Dhaka from July 2019 to June 2020.After obtaining ethical clearance, a total 144 individuals were selected based on inclusion and exclusion criteria with age ranging from 18-50 years. Group A was study group selected from Out Patient Department of Psychiatry of Dhaka Medical College Hospital, Dhaka diagnosed by the experienced psychiatrist. Group B was control group who were apparently healthy adults selected from different area of Dhaka city. The subjects were interviewed and detailed history regarding personal, family, medical and drug history were taken. Prior to sample collection, informed written consent was taken from the participants. Urinary vanillylmandelic acid levels were measured in the Department of Endocrinology, BIRDEM General Hospital, Dhaka. Statistical analysis: For statistical analysis, Unpaired Student’s ‘t’ test was considered using SPSS 25.0 version. Results: Urinary vanillylmandelic acid of generalized anxiety disorder patients was significantly higher (p&lt; 0.001) than control group. Conclusion: It can be concluded that generalized anxiety disorder patients may have more chance of thrombotic diseases due to significantly higher urinary vanillylmandelic acid (VMA) levels than healthy adults.