Hamilton Anxiety Rating Scale Research Articles

Quality Improvement Programme on Implementing Co-Production in Care Programme Approach in an In-Patient Rehabilitation Psychiatric Unit to Enhance Patient Engagement and Positive Step-Down Discharges

IntroductionThis quality improvement (QI) programme was proposed to integrate co-production principles into rehabilitation psychiatry, focusing on enhancing patient-centred care and promoting positive step-down discharges within the mental health system. The backdrop of the QI programme was the essential role of rehabilitation psychiatry in aiding the recovery and reintegration of individuals with mental health challenges, and sub-optimal audit results about patient’s attendance and positive step-down discharges at an in-patient psychiatric unit.ObjectivesThe QI programme aimed to implement and explore Co-production, a transformative approach involving patients and healthcare professionals as equal partners.-To promote co-production in psychiatric in-patient service-To improve patient experience in the CPA meetings-To reduce anxiety associated with the CPA meetings and discharge planning-To assess staff’s limitations and barriers in promoting co-production. Methods The QI programme was divided into phases, including diagnostic, problem-solving, and evaluation. It employed diagnostic tools such as the fishbone cause and effect diagram and the 5-Why Technique for root cause analysis. The project’s aim was aligned with the Model of Improvement, guided by the three fundamental questions. Change ideas were developed using driver’s diagram and were then evaluated through PDSA cycles. Quantitative analysis utilized paired t-tests to assess the significance of changes, and qualitative analysis focused on patient perspectives gathered through the co-produced CPA questionnaire. Emerging themes from the questionnaire responses were integrated into the project’s trajectory through narrative synthesis. Predictions were formulated to measure project success: 50% patient attendance in the next CPA meetings, 70% positive step-down discharges, and improved Hamilton Anxiety Rating Scale (HAM-A) scores.ResultsThe iterative Plan-Do-Study-Act (PDSA) cycles demonstrated the evolving impact of interventions on patient engagement and discharge outcomes. Implementation of patient information leaflets, staff training, and a CPA agenda template led to increased attendance and positive step-down discharges. Analysis of HAM-A scores revealed a substantial decline in anxiety levels for almost all participants, suggesting the effectiveness of the interventions. Discharge outcomes were influenced by patient engagement and tailored interventions. Patient responses revealed themes such as challenges during transitions to community care, empowerment from shared decision-making, and diverse experiences in communication with healthcare professionals.ConclusionsThe CPA agenda template improved patient experiences by enhancing communication and patient-centeredness.Disclosure of InterestNone Declared

The role of cannabis and salience alterations in determining the severity of psychotic symptoms: a multi-centric, cross-sectional study on adolescent and adult cohorts

IntroductionThe aim of this project is to study to which extent salience alterations influence the severity of psychotic symptoms. However, rather than studying them individually, we decided to focus on their interplay with two additional variables, that is: observing their effect in a vulnerability phase (adolescence) and with another added, well-recognized risk factor (cannabis use).The reason for this study design lies in the fact that, in our opinion, it is fundamental to observe the trajectory of psychotic symptoms over a continuum; however, rather than adopting a longitudinal approach, we decided to structure it as a cross-sectional study confronting patients from two age brackets - adolescence and adulthood.ObjectivesThe primary purpose of this study was to assess a difference between THC-abusing and non-abusing patients in adolescent and adult cohorts, using the Italian version of the psychometric scale “Aberrant Salience Inventory” (ASI), and the possible correlation with more severe psychotic symptoms. The employment of several different psychometric scales and the inclusion of a variegated cohort allowed to pursue multiple secondary objectives.MethodsWe recruited 192 patients, subsequently divided into six subgroups based on age and department of recruitment (whether adolescent or adult psychiatric or neurologic units - the latter serving as controls). Each individual was administered a set of questionnaires and a socio-demographic survey; the set included: Aberrant Salience Inventory (ASI), Community Assessment of Psychic Experiences (CAPE), Positive and Negative Syndrome Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Mania Rating Scale (MRS), Hamilton Anxiety Scale (HAM-A), Association for Methodology and Documentation in Psychiatry (AMDP) and Cannabis Experience Questionnaire (CEQ).ResultsThe data analysis showed statistically significant (p<0.05) differences between adolescents and adults with psychotic symptoms in all of the three scales of PANSS and in MADRS. These two groups were homogenous for both cannabis use and ASI score. The intra-group comparison (either adolescent or adult) showed a hierarchical pattern in the scores of psychometric scales according to the diagnostic subgroup of allocation: patients with psychotic symptoms showed an higher level of psychopathology in all measures when compared to patients from the psychiatric unit without psychotic symptoms, which in turn scored higher than the patients from the neurologic unit.Image:ConclusionsThe results of the present study may suggest that when salience alterations occur in adolescents with cannabis exposure, we might observe worsened positive and negative psychotic symptoms; their influence might be relevant also in other domains, especially regarding the depressive and anxiety spectrums.Disclosure of InterestNone Declared

Association of Retinal Neurovascular Impairment with Disease Severity in Patients with Major Depressive Disorder: An Optical Coherence Tomography Angiography Study.

Identifying the fundus objective biomarkers for the major depressive disorders (MDD) may help promote mental health. The aim of this study was to evaluate retinal neurovascular changes and further investigate their association with disease severity in MDD. This cross-sectional study conducted in the hospital enrolled patients with MDD and healthy controls.The retinal neurovascular parameters for all subjects, including vessel density (VD), thickness of ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL), and optic nerve head (ONH) eg are automatically calculated by the software in optical coherence tomography angiography (OCTA). The severity of MDD including depressive symptoms, anxiety, cognition, and insomnia was assessed by Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA), Montreal Cognitive Assessment (MoCA), and Insomnia Severity Index (ISI) respectively. This study included 74 MDD patients (n=74 eyes) and 60 healthy controls (HCs) (n=60 eyes). MDD patients showed significantly decreased VD of superficial and deep capillary plexus, thickness of GCC and RNFL, and volume of ONH (all p<0.05) and increased vertical cup-to-disc ratio and global loss volume (GLV) (all p<0.05) compared to HCs. Positive associations were found between HAMD scores and cup area (r=0.30, p=0.035), cup volume (r=0.31, p=0.029), and disc area (r=0.33, p=0.020) as well as ISI scores and RNFL thickness (r=0.34, p=0.047). We found the retinal neurovascular impairment and its association with disease severity in MDD patients. OCTA showed promise as a potential complementary assessment tool for MDD.

Suicide risk, hopelessness, interpersonal needs, and mental health in a sample of migrant psychiatric patients: a case-control study

IntroductionSuicide is a multifactorial phenomenon characterized by many biological, psychological, and social-cultural factors. The study of this phenomenon in migrants is complex, with no theoretical framework that can describe the available heterogeneous data. Although Italy has the fourth largest migrant population of EU, only few studies have assessed suicidal risk in migrants.ObjectivesThe aim of his study is to assess suicide risk factors (hopelessness; interpersonal needs; traumatic experiences) in a sample of migrant patients, and to evaluate the possible application of the Interpersonal Theory of Suicide (ITS). Moreover, suicidal ideation and attempts were compared between migrants and natives. Lastly, a wider psychometric assessment has been conducted (depressive and anxiety symptoms; autistic traits).MethodsIn this case-control study, we included 50 migrants vs. 50 natives. Data were collected during the same period by gender, age, and diagnosis. We collected sociodemographic and clinical characteristics. We administered the following tests: Columbia Suicide Severity Rating Scale, Interpersonal Needs Questionnaire, Beck Hopelessness Scale, Beck Depression Inventory-II, Hamilton Anxiety Scale, Childhood Trauma Questionnaire, and Adult Autism Subthreshold Spectrum.ResultsThere were no differences in sociodemographic characteristics, except for ethnicity. Otherwise, there were significative differences between diagnosis (p:0.013), with native reporting more Mood Disorders, and migrants reporting more Anxiety, Obsessive-Compulsive, Trauma-Related, Eating, and Substance Use Disorders. Migrants were more prone to be on treatment with Mood Stabilizers (p:0.000). There were significative differences for interpersonal needs, trauma, anxiety, and autistic traits. Migrants show more perceived burdensomeness (p:0.05), more physical neglect (p:0.004), physical abuse (p:0.002), and sexual abuse (p:0.016), more anxiety symptoms (p:0.046), and more empathy alterations (p:0.014). No differences were found for suicidal ideation and attempts, hopelessness, and depressive symptoms.ConclusionsDespite there were no differences in suicide risk, migrants showed higher rates of perceived burdensomeness (PB) and childhood traumatic experiences (CTE). Both PB and CTE represent cardinal constructs of the ITS. No differences were found for hopelessness and depressive symptoms. Migrants showed higher rates of anxiety symptoms and empathy alterations. Even if suicide rates between migrants and natives were similar, accurate assessment of suicidal risk in migrants is crucial in improving suicide prevention strategies. Suicide risk evaluation in migrants should consider the application of ITS. For an appropriate clinical evaluation of the migrant patients, anxiety dimensions and autistic traits should be investigated.Disclosure of InterestNone Declared

Effects of adding acupuncture to group psychotherapy for anxiety

IntroductionAcupuncture has long been used in treating anxiety, and a literature exists on its effectiveness. However, acupuncture is rarely covered by government insurance (Medicaid or Medicare) or even by many commercial insurance carriers in the United States, making it inaccessible to those who cannot pay separately.ObjectivesWe asked if adding acupuncture to an anxiety group would improve outcome.Methods We provided acupuncture during group psychotherapy for anxiety as a non-billable service. This was feasible since patients were already being billed for group psychotherapy. A physician and a social work intern led the group. At the start of the group, the physician went around the circle of group members and inserted acupuncture needles, using points in the ears, head, hands, feet, and, in the summer, arms and lower legs). The size of the group ranged from 4 to 12 people. We used Battlefield auricular points, the four gates (Large Intestine 4 and Liver 3, bilaterally), and GV24, GV29, Ht7, and Sp6. Sometimes, other points were added for other symptoms (back pain, neck pain, etc.) People sometimes joined the group without anxiety as a core problem in getting access to acupuncture. A core group of patients formed who came weekly while others came and went. The Hamilton Anxiety Scale measured anxiety after treatments 4, 8, and 12. The group lasted 90 minutes and consisted of mindfulness training, guided imagery, and CBT for anxiety. All patients met the criteria for generalized anxiety disorder. The t-test procedure was used to compare the differences between the means for the two groups.Results Thirty-five patients received acupuncture, while another 55 patients attended the group and did not elect to receive acupuncture. All patients were covered by MaineCare health insurance, Maine’s version of Medicaid. All patients had multiple other medical problems, which was why they were referred to the group. Seventy percent of the patients were women, and 30% were men. The average age was 40.1 years. Anxiety ratings on the Hamilton Anxiety Scale decreased by the last time measured for those not receiving acupuncture by an average of 5.17 points (S.D. 2.9; n = 55). Anxiety ratings for those receiving acupuncture decreased by an average of 7.19 points (S.D. 2.5, n = 35). The difference of the means was -2.02 (S.E. 0.595; 95% CI = -2.203 to -0.837; t = -3.394; p = 0.001). Headaches, shoulder pains, and upper back pain also decreased. Patients reported high levels of benefit from the acupuncture and encouraged other patients to continue to come and try the acupuncture. Usually, the needles could be placed within the first third of the group.ConclusionsAcupuncture improved anxiety ratings for people in group psychotherapy for anxiety over group alone, though the possibility of a placebo effect cannot be eliminated. Patients chose acupuncture, which could also present a potential bias.Disclosure of InterestNone Declared

Alterations of the cerebral microstructure in patients with noise-induced hearing loss: A diffusion tensor imaging study.

To explore the changes in the cerebral microstructure of patients with noise-induced hearing loss (NIHL) using diffusion tensor imaging (DTI). Overall, 122 patients with NIHL (mild [MP, n=79], relatively severe patients [including moderate and severe; RSP, n=32], and undetermined [lost to follow-up, n=11]) and 84 healthy controls (HCs) were enrolled. All clinical data, including age, education level, hearing threshold, occupation type, noise exposure time, and some scale scores (including the Mini-Mental State Examination [MMSE], tinnitus handicap inventory [THI], and Hamilton Anxiety Scale [HAMA]), were collected and analyzed. All participants underwent T1WI3DFSPGR and DTI, and tract-based spatial statistics and region of interest (ROI) analysis were used for assessment. The final sample included 71 MP, 28 RSP, and 75 HCs. The HAMA scores of the three groups were significantly different (p<.05). The noise exposure times, hearing thresholds, and HAMA scores of the MP and RSP were significantly different (p<.05). The noise exposure time was positively correlated with the hearing threshold and negatively correlated with the HAMA scores (p<.05), whereas the THI scores were positively correlated with the hearing threshold (p<.05). DTI analysis showed that all DTI parameters (fractional anisotropy [FA], axial diffusivity [AD], mean diffusivity [MD], and radial diffusivity [RD]) were significantly different in the left inferior longitudinal fasciculus (ILF) and left inferior fronto-occipital fasciculus (IFOF) for the three groups (p<.05). In addition, the FA values were significantly lower in the bilateral corticospinal tract (CST), right fronto-pontine tract (FPT), right forceps major, left superior longitudinal fasciculus (temporal part) (SLF), and left cingulum (hippocampus) (C-H) of the MP and RSP than in those of the HCs (p<.05); the AD values showed diverse changes in the bilateral CST, left IFOF, right anterior thalamic radiation, right external capsule (EC), right SLF, and right superior cerebellar peduncle (SCP) of the MP and RSP relative to those of the HC (p<.05). However, there were no significant differences among the bilateral auditory cortex ROIs of the three groups (p>.05). There was a significant negative correlation between the FA and HAMA scores for the left IFOF/ILF, right FPT, left SLF, and left C-H for the three groups (p<.05). There was a significant positive correlation between the AD and HAMA scores for the left IFOF/ILF and right EC of the three groups (p<.05). There were significantly positive correlations between the RD/MD and HAMA scores in the left IFOF/ILF of the three groups (p<.05). There was a significant negative correlation between the AD in the right SCP and noise exposure time of the MP and RSP groups (p<.05). The AD, MD, and RD in the left ROI were significantly positively correlated with hearing threshold in the MP and RSP groups (p<.05), whereas FA in the right ROI was significantly positively correlated with the HAMA scores for the three groups (p<.05). The changes in the white matter (WM) microstructure may be related to hearing loss caused by noise exposure, and the WM structural abnormalities in patients with NIHL were mainly located in the syndesmotic fibers of the temporooccipital region, which affected the auditory and language pathways. This confirmed that the auditory pathways have abnormal structural connectivity in patients with NIHL.

Effect of Wearing Noise-Canceling Headphones on Delivery Process in Natural Childbirth Puerperae: A Single-Center Study.

To investigate the effect of incorporating noise-canceling headphones into the delivery process for natural childbirth puerperae. We conducted a retrospective analysis of clinical data encompassing natural childbirth puerperae in the People's Hospital of Suzhou New District from January 2021 to February 2023. The implementation of routine noise reduction management was done from January 2021 to January 2022. During this interval, 69 natural childbirth puerperae were selected as subjects, with 7 excluded, resulting in 62 participants constituting the reference group. Subsequently, noise-canceling headphones were distributed to natural childbirth puerperae from February 2022 to February 2023. In this phase, 66 subjects were selected, and 6 were excluded, resulting in 60 participants forming the observation group. Following admission, both groups underwent corresponding nursing management. Emotional states, pain levels, and various indicators were systematically collected and meticulously compared. The observation group exhibited significantly lower Hamilton Anxiety Rating Scale scores than the reference group before delivery and during the first stage of labor (P < 0.05). The observation group demonstrated significantly lower visual analog scale scores and substance P, nitric oxide, and prostaglandin E2 levels than the reference group during the first stage of labor (P < 0.001). During the second stage of labor, the visual analog) scale scores were significantly lower in the observation group than in the reference group (P < 0.05). The durations of first and second labor stages were significantly shorter in the observation group than in the reference group (P < 0.05). No significant difference existed in Apgar scores between the two groups (P > 0.05). The utilization of noise-canceling headphones emerges as an effective intervention, alleviating anxiety, reducing pain during T1, and abbreviating total labor time in natural childbirth puerperae, suggesting its substantial clinical application value and potential as a beneficial addition to maternity care practices.

Effectiveness of Combined Treatment of Transcranial Direct Current Stimulation and Treatment as Usual on Depression, Anxiety and Anger in Adolescents with Bipolar Disorder

Objectives: Bipolar disorder (BD) is a prevalent psychological disorder associated with depressive symptoms. Transcranial direct current stimulation (tDCS) is a portable and non-invasive technique for brain stimulation. The present study was conducted to determine the effectiveness of the combined treatment of tDCS and routine medication on the symptoms of depression, anxiety, and anger in BD adolescents. Methods: In this double-blind randomized clinical trial study, forty adolescents with BD referred to the outpatient clinic of child and psychiatry of Golestan Ahvaz Teaching Hospital were included. Eligible patients aged 12 - 18 years were randomly divided into 2 groups receiving routine medications plus active tDCS (intervention group) or routine medications plus sham tDCS (control group). Transcranial direct current stimulation intervention with an intensity of 2 mA was applied to the dorsolateral prefrontal cortex in two sessions for 20 minutes each day, for 5 consecutive days. Data were collected at baseline, one week, and one month after the start of the intervention using the Hamilton Depression Rating Scale (HDRS-21), Hamilton Anxiety Rating Scale (HDRS), and State-Trait Anger Expression Inventory. Results: Based on our findings, age and gender were not considerably different between the two groups (P = 0.592, P = 0.1, respectively). In both groups, scores of depression (control: 12.25 ± 3.97, intervention: 0.75 ± 1.44, mean [SD]), anxiety (13.55 ± 2.58, 25.0 ± 0.55), and anger (52.65 ± 8.27, 47.25 ± 4.86) improved significantly one month after treatment (P &lt; 0.0001). After one month of treatment, the severity of bipolar symptoms in the intervention group (slightly: 10%, moderately: 50%, and markedly: 40%) improved significantly compared to the control group (slightly: 15%, moderately: 10%, and markedly: 0%) (P &lt; 0.0001). The improvement rate of HDRS in the intervention group was 81.29% and 95.24% at one week and one month after treatment, while these values were 8.41% and 23.04% in the control group, respectively (P &lt; 0.0001). All patients tolerated the treatment well without serious side effects. There was no significant difference between the side effects observed in both groups (P = 0.185). Conclusions: The combination of tDCS with routine medications can reduce depressive symptoms and improve bipolar symptoms. Therefore, tDCS add-on could be an effective, safe, and tolerable intervention for bipolar depression.

Peculiarities of the affective sphere in patients with different forms of diffuse alopecia

Background. To determine the peculiarities of the affective sphere in patients with different forms of diffuse alopecia, in order to develop personalized approaches to treatment and rehabilitation for this contingent of patients in the future. Purpose. To determine the features of the affective sphere in patients with different forms of diffuse alopecia, for the development, subsequently, personalized approaches to treatment and rehabilitation for this contingent of patients. Materials and Methods. Our examination involved 153 women aged 25 to 45 with diffuse alopecia. By means of a structured interview according to the criteria of International Classification of Diseases, 10th Revision (ICD-10) and the psychodiagnostic method, three groups were distinguished among female patients at the first stage of the work: without signs of mental maladjustment (MM) numbering 45 people (group 1 – G1); with separate signs of maladjustment, numbering 73 people (group 2 – G2); and with the adjustment disorders according to the ICD-10 criteria, numbering 35 people (group 3 – G3). Taking into account the genesis of alopecia within each of these groups the following two subgroups were distinguished: metabolic (45 patients) or mixed (108 patients). Further study of the affective sphere of the examinees, which was conducted at the second stage of the work, was carried out by clinical-psychopathological and psychometric methods (using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) and The Beck Depression Inventory). Results. The mental state of patients with diffuse alopecia of both metabolic and mixed genesis is characterized by diversity and clinical-psychopathological heterogeneity along the axis «mental health – adjustment disorders F43.2». Among this contingent there are mentally healthy individuals (a total of 29.4%, 66.7% of them with metabolic alopecia, 13.9% with mixed alopecia), patients with mosaic signs of mental maladjustment (MM), the variability and intensity of which do not reach the nosologically defined level (only 47.7%, 20.0% of them with metabolic alopecia and 59.3% with mixed alopecia), and patients with adjustment disorders of cluster F43.2 (total 22.9%, 13.3% of them with metabolic form of alopecia and 26.8% with a mixed form of alopecia). Thus, the majority of female patients with diffuse alopecia are in a state of mental maladjustment (47.7%), having individual symptoms of different, but not very significant severity, while the quantitative difference of both mentally healthy people and persons with stress-associated adjustment disorders (29.4% and 22.9%, accordingly), is not statistically significant. In the structure of mental pathology in patients with diffuse alopecia, there are relevant differences depending on the genesis of the dermatological disease: mentally healthy people predominate (66.7%) among patients with metabolic alopecia, while among people with a mixed form of alopecia, the majority have signs of mental maladjustment (MM) (59.3%), and a little less than a third (26.8%) – clinically formed adjustment disorders. Clinical variability and intensity of psychopathological affective anxiety-depressive symptoms also varies depending on the genesis of alopecia, having significant differences in expressiveness in patients with a mixed form, in contrast to the metabolic one. This applies to both the leading depressive and anxiety clinical-psychopathological phenomena. Conclusion. The revealed regularities should be taken into account when developing a strategy of personalized treatment of patients with diffuse alopecia.

Traditional Chinese exercises on depression: A network meta-analysis.

Exercise is an important factor for the treatment and rehabilitation of depression. Traditional Chinese exercise is considered as an effective treatment for depression. In recent years, many studies have shown that Chinese exercise therapy may be safe in the treatment of depression. To evaluate the therapeutic effect of traditional Chinese exercise on depression using network meta-analysis. PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP shop Database, China Biomedical Literature Database, and Wan Fang Data Knowledge Service Platform were included in randomized controlled studies on traditional Chinese exercises for the treatment of depression from the establishment of the library to July 2023. The literature was extracted and assessed for risk of bias using the Cochrane Risk of Bias Assessment and statistically analyzed using Review Manager 5.4 and Stata 14.2. A total of 25 studies involving 3 exercises with a total of 1605 cases were included. The results of the network meta-analysis showed that each exercise significantly reduced the 24-item Hamilton Depression Scale (HAMD-24), Hamilton Anxiety Scale, Beck Depression Inventory, and Self-rating Depression Scale scores. However, conventional treatments have the advantage of improving the sleep quality of patients with depression. The 3 exercises included in this study were effective for depression. Baduanjin and Tai Chi were better at improving the outcomes related to depression and anxiety. The effect of sleep quality intervention was slightly worse. Larger, high-quality randomized controlled trials are needed to compare interventions across exercises in a more granular manner.

Whole-process case management effects on mental state and self-care ability in patients with liver cancer.

Regarding the incidence of malignant tumors in China, the incidence of liver cancer ranks fourth, second only to lung, gastric, and esophageal cancers. The case fatality rate ranks third after lung and cervical cancer. In a previous study, the whole-process management model was applied to patients with breast cancer, which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction. To explore Mental state and self-care ability in patients with liver cancer: effects of whole-process case management. In this single-center, randomized, controlled study, 60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group (n = 30), who received whole-process case management on the basis of routine nursing measures, and a control group (n = 30), who were given routine nursing measures. We compared differences between the two groups in terms of anxiety, depression, the level of hope, self-care ability, symptom distress, sleep quality, and quality of life. Post-intervention, Hamilton anxiety scale, Hamilton depression scale, memory symptom assessment scale, and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention, and the observation group had lower scores than the control group (P < 0.05). Herth hope index, self-care ability assessment scale-revision in Chinese, and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention, with higher scores in the observation group compared with the control group (P < 0.05). Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer, alleviate symptoms and problems, and improve the level of hope, self-care ability, sleep quality, and quality of life, as well as provide feasible nursing alternatives for patients with liver cancer.

Analysis of gait characteristics and related factors in patients with Parkinson's disease based on wearable devices.

Postural instability and gait disorder dominant (PIGD) is one of the most common disabling symptoms of Parkinson's disease (PD), which seriously affects patients' quality of life. Therefore, it is essential to identify PIGD and develop targeted interventions to reduce the risk of PIGD in PD patients. This study aimed to investigate the gait characteristics of PD patients based on wearable devices and to establish a predictive model for their related influencing factors. The retrospective medical records of patients from January 2020 to September 2023 were collected, including 159 patients with PD (divided into PIGD [n=73] and non-PIGD [n=86] groups) and 200 healthy patients (as the healthy control group). Information from social demographic data, a blood test, scale scores, gait analysis based on wearable devices, white matter lesions, and the Fazekas scale was extracted and analyzed. Compared with the healthy control group, the mean step length, mean rate, mean angular velocity, and step length were lower in the PD group, while the mean steps were higher in the turning test. The incidence of PIGD was 46% in PD patients, and PD patients with the non-tremor onset mode were more likely to develop PIGD than those with the tremor onset mode. Compared to the non-PIGD group, the PIGD group showed more serious gait problems in different experimental tasks and had a higher Hoehn and Yahr (H-Y) stage, Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Scale score, periventricular white matter (PVWM) score, deep white matter score, and Fazekas scale score, but they had lower hemoglobin levels, D-dimer levels, Tinetti Balance scores, Tinetti Gait scores, Berg Balance Scale scores, and Mini-Mental State Examination (MMSE) scores. Logistic regression analysis showed that the MMSE score was negatively correlated with the occurrence of PIGD, while the HAMA score, H-Y stage, PVWM score, and non-tremor form of onset were positively correlated with the occurrence of PIGD CONCLUSION: The incidence of gait disorder in PD patients is higher than that in the normal population. Moreover, cognitive dysfunction, anxiety state, H-Y stage, PVWM score, and the non-tremor mode of onset can be considered independent risk factors for PIGD.

Prevalence of anxiety among patients with a total knee replacement

Introduction and Aim: Knee pain mainly attributed to osteoarthritis in the elderly, significantly impacts daily life. Non-surgical options include analgesics and physical therapy, but Total Knee Replacement (TKR) is most effective for severe cases. While complications are generally minimal, infections and psychological distress may arise. Studies indicate improved mental well-being post-TKR due to pain relief. The aim is to determine the prevalence of anxiety among patients with Total Knee Replacement.&#x0D; &#x0D; Methods and Materials: 100 participants, aged 45-84, comprising both genders, were selected through convenient sampling. Informed consent was obtained, and assessments were conducted using the Hamilton Anxiety Rating Scale (HAM-A) over 8 weeks at SMCH. The researcher collected sociodemographic details, including name, age, height, weight, and comorbidities. The HAM-A, consisting of 14 items graded from 0 to 4, measured anxiety levels. Total scores ranged from 0-56, indicating mild to severe anxiety. The study aimed to understand anxiety prevalence among TKR patients, employing a comprehensive approach to gather and analyze data within a specified time.&#x0D; &#x0D; Results: The statistical analysis revealed among 100 patients with a total knee replacement, between the age of 45-84 years, the prevalence of anxiety is widespread.&#x0D; &#x0D; Conclusion: Post total knee replacement, widespread anxiety necessitates coordinated intervention from surgeons, physical therapists, and psychotherapists within hospital management to effectively address associated complications.

Yoga as an Add-on Therapy in Parkinson's Disease: A Single Group Open-label Trial.

We aimed to evaluate the effect of yoga on motor and non-motor symptoms and cortical excitability in patients with Parkinson's disease (PD). We prospectively evaluated 17 patients with PD at baseline, after one month of conventional care, and after one month of supervised yoga sessions. The motor and non-motor symptoms were evaluated using the Unified Parkinson's disease Rating Scale (motor part III), Hoehn and Yahr stage, Montreal Cognitive Assessment, Hamilton depression rating scale, Hamilton anxiety rating scale, non-motor symptoms questionnaire and World Health Organization quality of life questionnaire. Transcranial magnetic stimulation was used to record resting motor threshold, central motor conduction time, ipsilateral silent period (iSP), contralateral silent period (cSP), short interval intracortical inhibition (SICI), and intracortical facilitation. The mean age of the patients was 55.5 ± 10.8 years, with a mean duration of illness of 4.0 ± 2.5 years. The postural stability of the patients significantly improved following yoga (0.59 ± 0.5 to 0.18 ± 0.4, p = 0.039). There was a significant reduction in the cSP from baseline (138.07 ± 27.5 ms) to 4 weeks of yoga therapy (116.94 ± 18.2 ms, p = 0.004). In addition, a significant reduction in SICI was observed after four weeks of yoga therapy (0.22 ± 0.10) to (0.46 ± 0.23), p = 0.004). Yoga intervention can significantly improve postural stability in patients with PD. A significant reduction of cSP and SICI suggests a reduction in GABAergic neurotransmission following yoga therapy that may underlie the improvement observed in postural stability. CTRI/2019/02/017564.

Low 25-Hydroxyvitamin D Increases the Risk of Cognitive and Emotional Disorders Among Chinese Patients with Cerebral Small Vessel Disease

The association between 25-hydroxyvitamin D and cognitive impairment and emotional disorder in patients with cerebral small vessel disease is unknown. This retrospective study included, 504 Chinese patients with cerebral small vessel disease admitted to the Department of Neurology of the First Hospital of Hebei Medical University between June 2019 and October 2021. The Montreal Cognitive Assessment and Hamilton Anxiety Scale (14 items) scores were utilized to divide the patients into four groups. The multivariate Cox regression analysis revealed that low 25-hydroxyvitamin D, high homo-cysteine, hyperuricemia, severity of white matter lesions, and a history of hypertension were independent risk factors for cognitive impairment among patients with cerebral small vessel disease. However, a high level of education is a protective factor. Furthermore, the level of 25-hydroxyvitamin D was significantly associated with the changes in brain functional regions. Serum 25-hydroxyvitamin D is a promising biomarker for predicting cognitive and emotional disorders in patients with cerebral small vessel disease and is highly associated with alterations in brain functional regions.

Association of Tension Headache with Anxiety among Medical Students of Lahore, A Cross-Sectional Study

Background: The prevalence of anxiety and tension-type headaches among medical students has become a topic of growing concern, given the rigorous demands of medical education. Anxiety, characterized by feelings of worry, nervousness, or unease, has been closely linked with the occurrence of tension-type headaches, a common condition manifesting as bilateral, pressing pain in the head. The intersection of these conditions within the medical student population necessitates a deeper investigation to elucidate potential associations and contributing factors. Objective: This study aimed to explore the association between chronic tension-type headaches and anxiety among medical students in Lahore, focusing on the prevalence of these conditions and identifying any significant correlations between them. Methods: A descriptive, cross-sectional study was conducted among 370 medical students in Lahore using convenient sampling. Data collection spanned from May 2020 to October 2020. Participants' anxiety levels were assessed using the Hamilton Anxiety Rating Scale, and tension-type headaches were evaluated based on criteria from the International Classification of Headache Disorders-3. Statistical analysis was performed using SPSS version 25, with a significance level set at p &lt; 0.05. Results: The mean age of participants was 20.98 ± 1.8911 years, with 54.05% being female. The prevalence of chronic tension-type headaches was 72.97%, while anxiety levels were classified as mild (30.27%), moderate (32.97%), and severe (36.76%). A significant positive correlation (r = .348, p &lt; .000) was observed between chronic tension-type headaches and anxiety levels among the medical students. Conclusion: The findings indicate a high prevalence of both chronic tension-type headaches and anxiety among medical students, with a significant association between these conditions. This underscores the need for medical educational institutions to implement comprehensive mental health and wellness programs to address these issues effectively.

Application of Benson Relaxation Therapy Combined with Spiritual Therapy to Reduce Anxiety in Chronic Kidney Disease Patients Undergoing Hemodialysis

Background: Chronic Kidney Disease (CKD) is a failure of kidney function to maintain metabolism and fluid and electronic balance due to progressive kidney structural damage. Hemodialysis is a replacement therapy for damaged kidney performance, if hemodialysis is carried out for a long time it can cause disturbances in the biological aspects and psychological aspects for hemodialysis patients. One of the effects that is often experienced in hemodialysis patients is anxiety. The research objective was to determine the application of spiritual-based benson relaxation therapy to anxiety levels in CKD patients undergoing hemodialysis. Method:Quasy-Experimental research design with one group pre post test design. Population of all CKD patients undergoing hemodialysis. The large number of samples of 20 intervention respondents. The sampling technique was purposive sampling by taking samples according to the inclusion criteria. The research intervention that was carried out was benson relaxation therapy which was carried out in CKD patients who routinely had hemodialysis for more than 6 months with a frequency of 2 times a week for 10-15 minutes with guidance from a clergyman and repeated until the patient could be independent. The research instrument for measuring anxiety used HARS (Hamilton Anxiety Rating Scale) and the respondent's intervention used Benson relaxation SOP and spiritual healing SOP (spiritual guidance). Test analysis in this study was paired t test. Results: the results of the research based on the intervention carried out obtained the anxiety score before the intervention from 20 respondents, the majority on the score of severe anxiety (28-41) which is as much as 70% then followed by moderate anxiety (21-27) which is as much as 30%. Anxiety scores after the intervention of 20 respondents, the majority on mild anxiety scores (14-20) which is as much as 70% then followed by moderate anxiety (21-27) which is as many as 20% and the minority in non-anxious conditions (&lt;14) which is as many as 10% . From the results of the analysis using the paired t test, the results obtained were a p value of 0.001, with α = 0.05 so that the p value &lt;α (0.001 &lt;0.05). meaning that there is a difference between the pre and post tests on the level of anxiety with the spiritual-based benson relaxation therapy intervention in CKD patients undergoing hemodialysis. Conclusion: Based on the discussion that we have conveyed, it can be concluded that benson relaxation and spiritual healing can reduce anxiety in CKD patients undergoing hemodialysis.

Neuropsychiatric symptoms profile and markers of Alzheimer disease–type pathology in patients with Lewy body dementias

BackgroundTo determine whether Lewy body dementia (LBD) patients with likely copathology of Alzheimer’s disease (AD) exhibit greater neuropsychiatric symptom (NPS) compared to those without likely AD-type copathology. MethodsWe enrolled 69 individuals diagnosed with Lewy body dementia (LBD), comprising both dementia with Lewy bodies (DLB) (n = 36) and Parkinson's disease dementia (PDD) (n = 33). These participants had accessible cerebrospinal fluid (CSF) markers related to Alzheimer's disease (AD) and cognitive data. We assessed CSF levels of β-amyloid 42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau). Employing autopsy-validated CSF thresholds (t-tau/Aβ42 ratio > 0.3, n = 69), we categorized individuals into LBD with AD pathology (LBD + AD, n = 31) and LBD without apparent AD co-pathology (LBD - AD, n = 38). Moreover, the Hamilton Depression Scale (HAMD24), Hamilton Anxiety Scale (HAMA14), and Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to assess the NPS. Spearman correlations were utilized to explore links between NPS and CSF marker profiles. ResultsIn terms of neuropsychiatric symptoms, LBD + AD patients demonstrated notably elevated levels of depressive symptoms (HAMD24) in comparison to LBD - AD patients (P < 0.001). However, based on PDD and DLB groups, no significant variations were noted in the neuropsychiatric symptoms(P＞0.05). Moreover, CSF-derived biomarkers of Aβ42, and t-tau/Aβ42 were also associated with HAMD24 total scores in the LBD + AD subsample (P < 0.05). ConclusionThere is an association between AD pathological markers and the NPS of LBD. The biologically based classification of LBD may be more advantageous in elucidating clinical heterogeneity than clinically defined syndromes.

Amelioration of Anxiety Associated with Opioid Withdrawal by Activation of Spinal Mechanoreceptors Via Novel Heterodyned Whole Body Vibration.

Opioid use disorder (OUD)-associated overdose deaths have reached epidemic proportions worldwide. An important driving force for relapse is anxiety associated with opioid withdrawal. We hypothesized that our new technology, termed heterodyned whole-body vibration (HWBV) would ameliorate anxiety associated with OUD. Using a randomized, placebo (sham)-controlled, double-blind study design in an NIH-sponsored Phase 1 trial, we evaluated 60 male and 26 female participants diagnosed with OUD and undergoing treatment at pain and rehabilitation clinics. We utilized the Hamilton Anxiety Scale (HAM-A) and a daily visual analog scale anxiety rating (1-10) to evaluate anxiety. Subjects were treated for 10 min 5X/week for 4 weeks with either sham vibration (no interferential beat or harmonics) or HWBV (beats and harmonics). The participants also completed a neuropsychological test battery at intake and discharge. In OUD subjects with moderate anxiety, there was a significant improvement in daily anxiety scores in the HWBV group compared to the sham treatment group (p=3.41 × 10-7). HAM-A scores in OUD participants at intake showed moderate levels of anxiety in OUD participants (HWBV group: 15.9 ± 1.6; Sham group: 17.8 ± 1.6) and progressively improved in both groups at discharge, but improvement was greater in the HWBV group (p=1.37 × 10-3). Furthermore, three indices of neuropsychological testing (mental rotations, spatial planning, and response inhibition) were significantly improved by HWBV treatment. These findings support HWBV as a novel, non-invasive, non-pharmacological treatment for anxiety associated with OUD.

Pengaruh Hypnobreastfeeding Terhadap Tingkat Kecemasan Ibu Menyusui Pada Ibu Post Partum Sectio Caesarrea Dalam Meningkatkan Produksi ASI Di RS. Simpangan Depok

Introduction: This study highlights the level of anxiety of breastfeeding mothers in post partum caesarean section mothers. The cause that can influence the success of breastfeeding is the mother's psychological changes, mothers who give birth using the Sectio Caesarea method have a higher level of anxiety than mothers who give birth spontaneously. The importance of breast milk for babies contains the most optimal nutritional content to provide immune protection for the baby, for this reason hypnobreastfeeding intervention is given which is expected to reduce the level of maternal packaging. Objective: The aim of this research is to determine the effect of Hypnobreastfeeding on the level of anxiety of breastfeeding mothers in post partum sectio caessarea mothers in increasing breast milk production in hospitals. Depok intersection. Method: This research uses a quasi-experimental design with a one group pretest-posttest design without control group. The data collection method involved using the Hamilton Rating Scale For Anxiety (HARS) questionnaire to measure students' anxiety levels before and after the hypnobreastfeeding intervention. This study aims to assess the effect of hypnobreastfeeding on the anxiety level of breastfeeding mothers in post partum mothers. Results: The results of the research obtained a P-valeu value of 0.000 p &lt; 0.05 which states that the Ha hypothesis was accepted and H0 was rejected, thus there was a significant change between before and after the hypnobreastfeeding intervention on changes in anxiety levels.&#x0D;