Treatment Of Generalized Anxiety Disorder Research Articles

Predicting post-treatment symptom severity for adults receiving psychological therapy in routine care for generalised anxiety disorder: a machine learning approach

Approximately half of generalised anxiety disorder (GAD) patients do not recover from first-line treatments, and no validated prediction models exist to inform individuals or clinicians of potential treatment benefits. This study aimed to develop and validate an accurate and explainable prediction model of post-treatment GAD symptom severity. Data from adults receiving treatment for GAD in eight Improving Access to Psychological Therapies (IAPT) services (n=15,859) were separated into training, validation and holdout datasets. Thirteen machine learning algorithms were compared using 10-fold cross-validation, against two simple clinically relevant comparison models. The best-performing model was tested on the holdout dataset and model-specific explainability measures identified the most important predictors. A Bayesian Additive Regression Trees model out-performed all comparison models (MSE=16.54[95%CI=15.58;17.51]; MAE=3.19; R²=0.33, including single predictor linear regression: MSE=20.70[95%CI=19.58;21.82]; MAE=3.94; R²=0.14). The five most important predictors were: PHQ-9 anhedonia, GAD-7 annoyance/irritability, restlessness and fear items, then the referral-assessment waiting time. The best-performing model accurately predicted post-treatment GAD severity using only pre-treatment data, outperforming comparison models that approximated clinical judgement and remaining within the GAD-7 error of measurement and minimal clinically important differences. This model could inform treatment decision-making and provide desired information to clinicians and patients receiving treatment for GAD.

Anxiolytic impact of cognitive behavioural therapy for insomnia in patients with co-morbid insomnia and generalized anxiety disorder.

Cognitive behavioural therapy for insomnia (CBT-I) is an effective treatment for chronic insomnia that also improves non-sleep symptoms, such as mood and anxiety. Identifying sleep-specific variables that predict anxiety change after CBT-I treatment may support alternative strategies when people with generalized anxiety disorder (GAD) do not improve from standard GAD treatment. To investigate CBT-I on changes in anxiety and evaluate whether changes in sleep-specific variables predict anxiety outcomes. Seventy-two participants presenting with insomnia and GAD (GAD-I) completed four sessions of CBT-I. Participants completed daily diaries and self-report measures at baseline and post-treatment. CBT-I in a co-morbid GAD-I sample was associated with medium reductions in anxiety, and large reductions in insomnia severity. Subjective insomnia severity and tendencies to ruminate in response to fatigue predicted post-treatment anxiety change, in addition to younger age and lower baseline anxiety. The findings suggest that younger GAD-I participants with moderate anxiety symptoms may benefit most from the anxiety-relieving impact of CBT-I. Reducing perceived insomnia severity and the tendency to ruminate in response to fatigue may support reductions in anxiety in those with GAD-I.

The effectiveness of using escitalopram in pediatric generalized anxiety disorder and the methods to predict the treatment response: A systematic review and meta-analysis

Background Generalized Anxiety Disorder (GAD) affects approximately 10–15% of children and adolescents. Selective Serotonin Reuptake Inhibitors (SSRIs) are among the main treatment options. Escitalopram, an SSRI for adult anxiety, is being studied for pediatric use. Predicting the treatment response could optimize interventions. This systematic review aimed to understand the safety and efficacy of escitalopram in the treatment of pediatric GAD and to determine potential treatment response indicators. Methods Searches for randomized controlled trials (RCTs) on escitalopram’s effectiveness in pediatric GAD were conducted across six databases. Two reviewers selected the trials, extracted data, and evaluated the trial quality independently. A third reviewer resolved the discrepancies. Outcomes were presented as mean differences (MDs) with 95% confidence intervals (CIs), while the Cochrane risk of bias tool was used to gauge evidence quality. Results Five RCTs including 401 patients were analyzed. Escitalopram showed a greater reduction in The Pediatric Anxiety Rating Scale PARS score than placebo (MD -6.1, 95% CI [-8.75 to -3.44] (P = 0.09, I2 = 65%)). Multiple methods have been used to predict escitalopram treatment responses, such as reaction time changes, executive functions, and Amygdala Functional Connectivity, including the CYP2C19 metabolizer phenotype. The data indicated that neuroimaging was the most effective predictor of the treatment response. Conclusion Escitalopram notably reduced PARS scores in pediatric patients with GAD. Neuroimaging, as a biomarker, is a valuable predictor of treatment response and provides insights into the neurological aspects of anxiety disorders, offering the potential for groundbreaking treatment advancements.

Anksiyete Bozukluklarında Kişilik Örgütlenmesi: Yaygın Anksiyete Bozukluğu ve Panik Bozukluğu Karşılaştırılması

The objective of this study was to explore the level of personality organization in patients diagnosed with generalized anxiety disorder (GAD) and panic disorder (PD). The study comprised 86 patients undergoing treatment for GAD (n=46) and PD (n=40). Various tools were utilized for data collection including a Sociodemographic Data Collection Form, Personality Organization Diagnostic Form (PODF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A significant difference was observed between the GAD and PD groups regarding the PODF scores for mature defense, anxiety, and depression. However, no significant difference was observed in relation to the PODF identity total score and primitive defense scores. Furthermore, the quality of object relations and the overall level of personality organization according to the PODF did not display any significant differences between the groups. According to the BDI, comorbid depressive symptoms were detected in 67.4% (n=58) of the participants with GAD and PD. There was no significant difference in the PODF scores, quality of object relations, and the overall level of personality organization between the group with comorbid depressive symptoms and the group without it.These findings suggest that while the primary focus of therapeutic interventions should be on targeting the specific type of anxiety disorder, assessing the level of personality organization in patients with GAD and PD could add valuable insights to individual case understanding, selection of psychotherapy approaches, and the treatment process..

Contrast Avoidance and General Anxiety Disorder: Theory and Assessment

This review delves into the intricate relationship between General Anxiety Disorder (GAD) and emotion regulation (ER), with the Contrast Avoidance Model (CAM) serving as a core theoretical framework. This research investigates emotional inflexibility, distress tolerance, and avoidance of emotional contrast through continuous worrying as features of ER difficulties in GAD. CAM argues that individuals diagnosed with GAD sustain a negative emotional state relying on worry, avoiding rapid shifts to negative feelings. Relevant diagnostic indices are potential instruments for detecting contrast avoidance tendencies in people with GAD. At the same time, this review emphasizes the necessity of addressing emotion regulation in the context of GAD, as well as the promise of complementary and alternative medicine as a theoretical framework and diagnostic tool in furthering our understanding of the illness. Although there are limitations, including the need for further validation of diagnostic indices and the recognition that GAD is a complex, multifaceted disorder, this comprehensive study contributes to the ongoing enhancement of the assessment, diagnosis, and treatment of GAD, and ultimately improves the well-being of those affected by this debilitating disorder.

Evaluating the Effectiveness of Cognitive Behaviour Therapy for General Anxiety Disorder

Generalized Anxiety Disorder (GAD) is a common and challenging anxiety disorder with origins in DSM-III and later DSM-III-R. It involves persistent, uncontrollable worry and various symptoms affecting people of various ages. While GAD has received less research attention compared to other anxiety disorders, this essay examines Cognitive Behavioral Therapy (CBT) as an effective GAD treatment. It introduces two theoretical models, compares CBT to control groups, and highlights its partial effectiveness and potential long-term benefits. CBT is applicable across age groups, with limitations in older adults. It may also impact cognitive function. In conclusion, evidence supports CBT as a useful GAD treatment, acknowledging potential bias and the need for research into cultural influences.

Neuroimaging Insights: Kava's (Piper methysticum) Effect on Dorsal Anterior Cingulate Cortex GABA in Generalized Anxiety Disorder.

Generalised Anxiety Disorder (GAD) is a prevalent, chronic mental health disorder. The measurement of regional brain gamma-aminobutyric acid (GABA) offers insight into its role in anxiety and is a potential biomarker for treatment response. Research literature suggests Piper methysticum (Kava) is efficacious as an anxiety treatment, but no study has assessed its effects on central GABA levels. This study investigated dorsal anterior cingulate (dACC) GABA levels in 37 adult participants with GAD. GABA was measured using proton magnetic resonance spectroscopy (1H-MRS) at baseline and following an eight-week administration of Kava (standardised to 120 mg kavalactones twice daily) (n = 20) or placebo (n = 17). This study was part of the Kava for the Treatment of GAD (KGAD; ClinicalTrials.gov: NCT02219880), a 16-week intervention study. Compared with the placebo group, the Kava group had a significant reduction in dACC GABA (p = 0.049) at eight weeks. Baseline anxiety scores on the HAM-A were positively correlated with GABA levels but were not significantly related to treatment. Central GABA reductions following Kava treatment may signal an inhibitory effect, which, if considered efficacious, suggests that GABA levels are modulated by Kava, independent of reported anxiety symptoms. dACC GABA patterns suggest a functional role of higher levels in clinical anxiety but warrants further research for symptom benefit. Findings suggest that dACC GABA levels previously un-examined in GAD could serve as a biomarker for diagnosis and treatment response.

Psychotherapies for Generalized Anxiety Disorder in Adults

Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified. To use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD. MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD. RCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion. This study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results. Eight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated. Data from 65 RCTs were included. Effect size estimates on data from 5048 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, -0.76 [95% CI, -1.15 to -0.36]; certainty, moderate), CBT (SMD, -0.74 [95% CI, -1.09 to -0.38]; certainty, moderate), and relaxation therapy (SMD, -0.59 [95% CI, -1.07 to -0.11]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.04 [95% CI, 0.64-1.67] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, -0.47; 95% CI, -1.18 to 0.23). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, -0.60; 95% CI, -0.99 to -0.21). Given the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.

Investigation of Cognitive Distortions in Panic Disorder, Generalized Anxiety Disorder and Social Anxiety Disorder.

The aim of this study was to determine the main cognitive distortions observed in panic disorder (PD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD) and to investigate the impact of cognitive distortions on diagnoses, depression levels, disorder type and severity of anxiety. This study consisted of 150 clinical (50 PD, 50 GAD, 50 SAD) and 91 healthy control participants. A sociodemographic data form, the Beck Depression Inventory (BDI), the Dysfunctional Attitudes Scale (DAS), the Cognitive Distortions Scale (CDS) and the State-Trait Anxiety Inventory (STAI) scales were administered to all participants. It was found that cognitive distortions were higher in individuals with PD, GAD and SAD. The PD, SAD and GAD groups were similar for "catastrophizing", "mindreading", "all or nothing thinking", "overgeneralization", "should statements" and "emotional reasoning". "Personalization", "labeling" and "minimizing or disqualifying the positive" were observed at a higher severity in the SAD group compared to the PD group, and "mental filter" was observed at a higher severity in the GAD group compared to the PD group. Our findings emphasize the need to address cognitive distortions in PD, GAD and SAD treatment. The evaluation of cognitive distortions specific to anxiety disorders is significant in guiding therapy goals and pioneering new research.

Efficacy of manual acupuncture vs. placebo acupuncture for generalized anxiety disorder (GAD) in perimenopausal women: a randomized, single-blinded controlled trial.

Generalized 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 the adrenocorticotropic hormone (ACTH). The objective of this study is to evaluate the efficacy of manual acupuncture (MA) vs. placebo acupuncture (PA) for perimenopausal women with GAD. This study is a single-center, randomized, single-blind clinical trial conducted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 112 eligible patients with GAD were randomly assigned (1:1) to receive MA (n = 56) or PA (n = 56) three times per week for 4 weeks. The primary outcome measure was the HAMA score. The secondary outcome measures were the GAD-7 and PSQI scores and the levels of CORT and ACTH. The evaluation will be executed at the baseline, 2 weeks, the end of the treatment, and a follow-up 3-month period. Significant improvements in HAMA (p < 0.001, η2p = 0.465), GAD-7 (p < 0.001, η2p = 0.359) and ACTH (p = 0.050) values were found between T0 and T2 in the MA group compared to the PA group. No difference in PSQI (p = 0.613, η2p = 0.011) and CORT (p = 0.903) was found between T0 and T2 in the MA group compared to the PA group. Long-term improvements in HAMA (p < 0.001, p < 0.001) were found in the MA group and PA group. This study was the first completed study to evaluate the efficacy of acupuncture and placebo acupuncture for GAD in perimenopausal patients. Results suggested that placebo acupuncture has a therapeutic effect, however, acupuncture had a greater therapeutic effect than placebo acupuncture. This study supports the effectiveness of acupuncture and thereby contributes to extended treatment options for GAD.Clinical trial registration:http://www.chictr.org.cn, Chinese Clinical Trial Registry, ID: ChiCTR2100046604. Registered on 22 May 2021.

A Comprehensive Review of the Generalized Anxiety Disorder.

Excessive, uncontrollable, and usually unjustified worry about certain things is a sign of the mental and behavioral disease known as generalized anxiety disorder (GAD). Genetic research suggests that numerous genes are likely implicated in the development of GAD, even if much is yet unclear about this. As a result, if someone in a family has GAD, there is a high likelihood that someone else will also suffer from the illness, as well as another anxiety disorder. Individuals with GAD are frequently overly bothered about workaday affairs like health, assets, demise, family, accord issues, or effort challenges. Worry frequently interferes with daily functioning. Excessive concern, restlessness, difficulty sleeping, tiredness, irritability, sweating, and trembling are a few symptoms that may be present. For a formal diagnosis of GAD, symptoms must be persistent for at least six months and consistent. Conversion in the amygdala's utilitarian congruence and how it processes fear and anxiety have been linked to generalized anxiety disorder. Neurotransmitters, and particularly the gamma-aminobutyricacid (GABA) variant, have long been known to cause GAD through dysregulating amygdala activity in the brain. Anxiety, concern, or physical symptoms must significantly hinder social, academic, or occupational functioning in order to qualify for a GAD diagnosis. The Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) provides explicit ethos to aid doctors in identifying this disorder. Psychological therapy based on cognitive behavioral therapy (CBT) principles is effective in reducing anxiety symptoms for short-term treatment of GAD. In this, the patient's thinking ability and methods are focused. The main principle behind CBT is that your thought patterns affect your feelings, which in turn can affect your behavior. Drugs like antidepressants, buspirone, benzodiazepines, and can all be worn to goody GAD. Outside of therapy, patients with anxiety can learn to manage it by practicing relaxation methods, reframing unfavorable ideas, and adopting stress-relieving adjustments. Being socially active and setting aside time for proper self-care are crucial components of managing generalized anxiety disorder.

Evaluation of a Web-Based Self-Help Intervention for Patients With Generalized Anxiety Disorder: Protocol for a Randomized Controlled Trial.

Generalized anxiety disorder (GAD) is a highly prevalent and severely distressing condition that can lead to functional impairments and is considered one of the most difficult anxiety disorders to treat. Following new technological developments, a highly structured cognitive behavioral therapy (CBT) approach that has already shown success in face-to-face psychotherapy can be implemented: internet-delivered CBT (iCBT). There is now evidence for the efficacy of both guided and unguided iCBT interventions for GAD regarding symptom reduction. To establish the usefulness of such interventions, we plan to evaluate the efficacy of a web-based self-help program (Selfapy) for GAD in a relatively large sample. We aim to assess effects beyond symptom reduction, including effects on well-being, functioning, and mental health literacy, as well as the effect on health care burden, while testing the intervention in conditions comparable to routine care. Patients (n=156) who have been diagnosed with GAD, are aged between 18 and 65 years, have internet access, and have sufficient German language skills will be recruited for this study. The intervention group (n=78) will receive access to the 12-week self-help web-based program Selfapy. The waitlist control group (n=78) will receive no intervention in the context of the study. However, both groups will be allowed to access further health care services (eg, psychotherapy, medication), reflecting current routine care in Germany. Outcome measures will be assessed at baseline (T1) and 6 weeks (T2) and 12 weeks (T3) after the start of the intervention. The primary outcome will be generalized anxiety symptoms and quality of life at T3. Additional outcomes include depression, work capacity, therapy-related expenses and burdens, health literacy, and negative effects. By May 2023, all participants had finished the trial and the report was being prepared for publication. Web-based interventions may be an important addition to the German health care system to reduce barriers to treatment access. Further, they may prove cost-effective for the treatment of GAD. Deutsches Register Klinischer Studien DRKS00023799; https://tinyurl.com/22bds38x. DERR1-10.2196/41440.

Clinical effectiveness and safety of prolonged release form of alimemazine in patients with generalized anxiety disorder

The prolonged release tablets form of alimemazine is seen as a promising agent for the long-term treatment of generalized anxiety disorder (GAD).Objective: to investigate the efficacy and safety of therapy with alimemazine (Teraligen® retard, prolonged release film-coated tablets) in patients with GAD.Material and methods. The study design was a multicentre, open-label, non-comparative clinical trial (CT) with two doses of alimemazine 20 and 40 mg (Teraligen® retard, prolonged-release film-coated tablets). 129 patients diagnosed with GAD (criteria according to the ICD-10 classification), 86 women and 43 men were included, mean age 38.0±11.1 years. The level of anxiety, assessed by the Hamilton HARS scale, at Week 0 (Visit 1) was 24.8±7.3 points.Results. By Week 6, the level of anxiety statistically significantly decreased to a mean score of 10.8±6.6, while the dynamics of the mean score relative to baseline was -14.0±6.27 (p&lt;0.0001). The proportion of patients with a decrease in the total score on the HARS scale by 50% or more compared with the initial value was: after 1 week of therapy – 10.3% (n=13); after 3 weeks of therapy – 60.5% (n=75; compared to baseline, p&lt;0.0001); after 6 weeks of therapy – 69.4% (n=86; compared to baseline, p&lt;0.0001). The therapy was well tolerated, among the adverse events (AEs) patients noted: morning sleepiness (7.8%; n=10); dry mouth (7.8%; n=10); general weakness (4.7%; n=6). Other AEs (dizziness, headache, impaired concentration, muscle weakness, memory impairment, tinnitus, tachycardia) were much less common. From the side of the liver, no AEs were detected, including changes in the activity of liver enzymes.Conclusion. Prolonged release alimemazine tablets 20 mg and 40 mg for six weeks resulted in a statistically significant reduction in anxiety levels, with at least two-thirds of patients experiencing more than half their anxiety. The effect increases with each week as you continue to take the drug. The prolonged release form of alimemazine is well tolerated, the treatment of GAD with the drug is effective and safe and may represent a rational alternative to antidepressant therapy.

The prevalence of undiagnosed anxiety: A national survey

Generalized anxiety disorder (GAD) is a chronic condition characterized by excessive, unrealistic worry and anxiety about multiple events or activities and leads to significant impairment in daily functioning and quality of life. Effective treatments for GAD exist, but the first step is identification of the disorder. The current study aims to document the frequency of GAD symptoms amongst the general US population. A web-based survey was conducted to assess the frequency of daily anxiety symptoms amongst adults residing in the United States. Questions from the GAD-7 were used to be able to quantify the burden of diagnosed and undiagnosed generalized anxiety disorder. JMP 16.0 for Mac OS was used to perform statistical analyses. Institutional Board Review gave the study an exempt determination (#2022–569). The median GAD-7 score was 16 (IQR 12–19) with a range from to 7 to 28. GAD-7 scores stratified by diagnosed (median=14) vs. undiagnosed (median =18) demonstrated a significant difference (P<0.0001) with a robust goodness-of-fit coefficient (R2= 14.3%).Persons who were retired (p = 0.0262) or older (p = 0.0356) were significantly less likely to experience GAD symptoms. Conversely, sex, age, income and the use of depressants, stimulants or benzodiazepines were not significantly correlated with a GAD score of ≥15. The present findings are based on cross-sectional survey data. This study suggests that more than 50% experience symptoms concerning for GAD, without a formal diagnosis. The relevance of this research is it underscores the importance of mental health outreach, and removal of stigma surrounding mental health.

Effect of Wuling capsule on patients with generalized anxiety disorder

Purpose: To investigate the effectiveness of Wuling capsule for the treatment of patients diagnosed with generalized anxiety disorder (GAD).&#x0D; Methods: Patients with generalized anxiety disorder (GAD) admitted in Affiliated Hospital of Huanghe Science and Technology College, Zhengzhou, China were treated with the Chinese traditional patent medicine, Wuling capsule. A self-control study was conducted before and after treatment. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Global Rating Scale (CGI-SI) were used to evaluate the symptoms of anxiety and depression suffered by GAD patients before and after treatment. Inflammatory factors (IL-6, IL-8, and IFN-γ), superoxide dismutase (SOD), γ-aminobutyric acid (GABA), and glutamic acid (Glu) levels were assessed in the peripheral blood of patients using ELISA before and after treatment.&#x0D; Results: A total of 58 patients with GAD completed 8 weeks of fixed-dose Wuling capsule treatment. After treatment, total scores on the HAMA scale, HAMD scale, and CGI scale significantly improved compared with baseline, and the differences before and after treatment were statistically significant (p &lt; 0.01). The levels of inflammatory factors (IL-6, IL-8, and IFN-γ) in the peripheral blood of patients decreased significantly (p &lt; 0.05). SOD and GABA/Glu increased after treatment (p &lt; 0.05). Nine patients (15.5 %) had mild reactions, but no patients withdrew from the study as result of adverse reactions. &#x0D; Conclusion: The Chinese traditional patent medicine, Wuling capsule, is effective in the treatment of GAD patients with high safety. Future studies will need to explore the specific biological pathways and physiological processes that are involved in the treatment of GAD using Wuling capsule.

Erythropoietin and Erythropoietin Receptor Levels and Their Diagnostic Values in Drug-naïve Patients with Generalized Anxiety Disorder.

Generalized anxiety disorder (GAD) is a prevalent psychiatric disorder. Diagnosis of GAD depends on subjective complaints of patients, thus the need for biological markers is constantly emerging. In this study, we aimed to the investigate diagnostic values of Erythropoietin (Epo) and its receptor (EpoR) levels in drug-naïve patients with GAD. This study included 45 newly diagnosed drug-naive patients with GAD, aged and sex-matched 30 healthy controls. Medical histories were obtained, and physical examinations and laboratory tests were conducted. Also, the Hamilton Anxiety Rating Scale (HAM-A) was used for all participants. Serum Epo and EpoR levels were measured by ELISA. HAM-A score was significantly higher in GAD patients versus the controls (p < 0.05). While the levels of Epo in patients with GAD were lower than the control patients, EpoR levels were increased in these patients (p < 0.05). Epo/EpoR ratios were significantly lower in the patients with GAD than in the control subjects (p < 0.05). A positive significant correlation was observed between the EpoR level and the HAM-A score (r = 0.755, p < 0.001). However, there was a negative significant correlation between Epo levels and HAM-A score (r = -0.749, p < 0.001). Receiver operator characteristic curve analysis showed high diagnostic performance for Epo and EpoR, areas under curves were 0.901 and 0.912, respectively. This is the first report to investigate the association between serum Epo and EpoR levels in GAD patients. Our results reveal possible diagnostic value of Epo and EpoR. Moreover, Epo therapy may be a good choice for GAD treatment.

Understanding Generalized Anxiety Disorder: Etiology, Mechanisms and Treatment Implications

This paper focuses on exploring treatment implications that target better for generalized anxiety disorder (GAD) with enhanced efficacy by (1) discovering attributes that better differentiate GAD from normal high-level worries or other mental disorders with similarities in symptoms and features, (2) grasping GADs mechanism more soundly through gaining and combining insights from extant research and four classical conceptualizing models. A literature review of past and current theories about conceptual framework and treatments of GAD has found leading roles, attributes, and risk factors sharing commonality and connection among different theories. Then, treatment implications for GAD have been illustrated and divided into two primary aspects. In the end, there are recommendations for future research, empirical evidence, and clinical consideration of both the current theoretical models and established improvement in treatments for GAD, which ends with a conclusion of promising new research and treatment direction worth clinical attention and future studies in the field.

A longitudinal investigation of marital dissolution, marital quality, and generalized anxiety disorder in a national probability sample

Generalized anxiety disorder (GAD) is a common psychiatric disorder that is associated with high levels of distress and impairment. The present study was conducted to examine the 10-year longitudinal associations between marital dissolution, three measures of marital quality, and GAD among married participants from the Midlife in the United States (MIDUS) survey, a probability sample of American adults aged 24–74 years. Results indicated that GAD at baseline was significantly and positively associated with incidence of marital dissolution during the 10-year follow-up and marital strain (i.e., negative partner interaction) at baseline was significantly and positively associated with incidence of GAD at the 10-year follow-up. These associations remained statistically significant after adjusting for demographic characteristics and neuroticism. In comparison, marital satisfaction and marital support (i.e., positive partner interaction) at baseline were not significantly associated with incidence of GAD, GAD at baseline was not significantly associated with any of the three measures of marital quality at follow-up, and marital dissolution during follow-up was not significantly associated with incidence of GAD. These findings suggest that negative interactions with one’s partner may be a risk factor for GAD and that improving marital functioning may be important for the prevention and treatment of GAD.

Homoeopathy: A promising treatment for generalized anxiety disorder

An anxiety disorder characterized by excessive worry about a wide range of events is broadly termed as Generalized Anxiety Disorder (GAD). This excessive worry hinders physiology, and these individuals are unduly preoccupied in issues of health, financial, family, intimate relations, social connection problems, death, or work challenges. Amygdala of brain is responsible for carrying out the events of GAD. These events are manifested at psychic and somatic level and is differently manifested in various individuals. DSM – V is helpful in the diagnosis and management of GAD. In the treatment of GAD, homoeopathy provides an integrated approach. Dr. Hahnemann recommends a full understanding of an individual by history taking, followed by a thorough investigation and selection of the appropriate remedy for significant cure. Also Psychotherapy and the use of an anti-psoric medicine to complete the healing are required. Various Reportorial rubrics are mentioned from Repertory along with the Homoeopathic Remedies showing their therapeutic cleavage in the cases of GAD.

Early outcomes, associated factors and predictive values of clinical outcomes of tandospirone in generalized anxiety disorder: a post-hoc analysis of a randomized, controlled, multicenter clinical trial

Objective To examine the early outcomes, associated factors and predictive values of clinical outcomes of different tandospirone doses in patients with a generalized anxiety disorder (GAD). Methods This was a posthoc analysis of “a randomized, controlled multicenter clinical trial of the efficacy and safety of different doses of tandospirone on GAD”. A total of 274 patients with GAD were included and randomized into the high-dose (tandospirone 60 mg/d) and low-dose (tandospirone 30 mg/d) groups for a 6-week treatment. The Hamilton Anxiety (HAMA), Clinical Global Impression-Severity (CGI-S), Short-Form-12 (SF-12) scales were used for assessment. The trial was registered at clinical trail.gov (NCT01614041). Results (1) In the first week of treatment, 35.8% of patients in the high-dose group fulfilled the early onset criteria, which was significantly higher than 19.0% found in the low-dose group (p = 0.002). In the second week of treatment, 22.6% of patients in the high-dose group achieved an early response, versus 12.4% in the low-dose group, indicating a significant difference (p = .026). (2) Factors associated with early onset at week 1 included baseline HAMA total score (OR = 0.916, 95%CI 0.882–0.952), age (OR = 0.974, 95%CI 0.950–0.998), drug dose (30 mg vs. 60 mg; OR = 0.298, 95%CI 0.156–0.568) and SF-12 physiological total score (OR = 1.030, 95%CI 1.010–1.050). (3) Early onset was significantly associated with response rate (OR = 18.34, 95%CI 12.10–27.81), remarkable response rate (OR = 27.56, 95%CI 11.65–65.17) and recovery rate (OR = 11.85, 95%CI 4.98–28.18). Group (high dose group vs. low dose group) (χ 2 = 8.535, p = .003) and baseline HAMA total score (χ 2 = 70.840, p < .001) were independent predictors of onset time. Conclusions The early outcomes of high-dose tandospirone in the treatment of GAD are better than those of the low-dose group. Patients with younger age at onset, milder anxiety symptoms and better physiological functions administered high-dose tandospirone showed rapid onset, great early outcomes, high recovery rate and good prognosis. Drug onset time had a good predictive effect on treatment outcome.