Hamilton Anxiety Rating Scale Research Articles

Psychotic Arousal and the Psychopathology of Acute Schizophrenia: An Exploratory Study of the Experiential Emotional State in Acute Psychosis.

Background: Increasing research data suggest that the dysfunction of emotional brain systems may be an important contributor to the pathophysiology of schizophrenia. However, contemporary psychopathology consistently underestimates the role of emotions in the phenomenology of the disease. Psychotic arousal (PA) is a conceptually defined psychopathological construct aiming to portray the experiential emotional state of acute psychosis. The concept provides an explanatory model for the emergence of psychosis, and the formation and maintenance of delusions based on neurobiological models on the formation of core consciousness and subjectivity. This is the first exploratory study of the major assumptions, endorsed in the project summarized as follows: (1) psychotic arousal is a discrete state, eligible for investigation; (2) abnormal experiential feelings are an integral part of this state; and (3) the state is responsive to antipsychotic intervention during the first weeks of treatment. Methods: We developed the Psychotic Arousal Scale (PAS) accordingly, explored its first psychometric properties and tested its relation to other psychopathological measures. Fifty-five acute schizophrenia patients were evaluated with the PAS, the Positive and Negative Syndrome Scale, the Brown Assessment of Beliefs Scale, the Hamilton Anxiety Scale, and the Calgary Depression Scale. Cronbach α coefficients, t-test analysis, correlations and mixed linear regression models were applied for testing the internal reliability of the scale, associations between parameters and sensitivity to change in three time periods during therapeutic intervention. Results: The results of the study support that (PA) is eligible for investigation as a discrete psychopathological state. Abnormal experiential feelings are an integral part of this state, presenting high affinity with other affective measures; their degree of severity relates to the delusions' conviction and are amenable to antipsychotics early in treatment during the acute psychotic episode. Conclusions: The findings of this exploratory study are connotative of the presence of an emotional arousal permeated by abnormal experiential feelings during acute psychosis, largely overlooked by contemporary psychopathology.

Influencing factors of posttraumatic stress disorder in Shidu parents who have lost their only child: a cross-sectional survey

BackgroundIn China, parents who have lost their only child are referred to as Shidu parents (SDPs). This study aimed to investigate the prevalence and risk factors of post-traumatic stress disorder (PTSD) and investigate the influence of depressive and anxiety symptoms on the development of PTSD.MethodFour hundred and thirty-six SDPs completed assessments of PTSD (Structured Clinical Interview for DSM-IV Disorders, SCID-IV; The Clinician-Administered PTSD Scale-IV, CAPS-IV), depression (Hamilton depression scale), and anxiety (Hamilton Anxiety Scale) via in-person interviews. Logistic regression and hierarchical multiple linear regression analyses were used to explore the association of demographic characteristics, depression, and anxiety symptoms with PTSD.ResultsThe prevalence of PTSD in SDPs was 14.45%. The comorbidity of depression and anxiety symptoms was 87.30% in the SDPs with PTSD. The logistic regression model, which included factors of gender, age, education, depression, and anxiety, which contributed to the development of PTSD, was significant [χ² (11) = 122.47, p < 0.001]. The hierarchical multiple linear regression analysis indicated that female gender and the severity of comorbidities (depression and anxiety) were positively associated with the severity of PTSD.ConclusionThis study found that the severity of depression and anxiety was closely related to the severity of PTSD, supporting that SDPs are highly prone to the co-occurrence of PTSD, depression, and anxiety after bereavement. Our findings may provide more insights into the development of individualized interventions for parents who have experienced the loss of their only child.

The impact of temporary residence permit on symptom severity and treatment outcome among refugees with PTSD

Despite an increased focus on the impact of post-migratory factors on the health of trauma-affected refugees, research on the influence of residence permit is limited. This influence may manifest on the outcome of psychiatric treatment. Accordingly, the aim of this study was to examine the role of temporary residence permit on symptom severity and treatment outcome among trauma-affected refugees in PTSD treatment. The sample consisted of 897 patients, who were allocated into three groups based on their residence permit: temporary residence permit, permanent residence permit, and Danish citizenship. The outcome measures were symptoms of PTSD (Harvard Trauma Questionnaire), depression and anxiety (Hopkins Symptom Checklist-25 and Hamilton Depression and Anxiety Rating Scales), quality of life (WHO-5 Well-being Index), and functioning (The Sheehan Disability Scale), evaluated before and after psychiatric treatment. Temporary residents tended to have less severe symptoms prior to treatment. Overall, no significant differences were observed between the three groups on treatment outcome. However, Danish citizens had a poorer treatment outcome on Hamilton Depression Scale compared with temporary residents. This study is one of the first to investigate treatment implications of residence permit in a clinical setting. The interactions between mental health and individual post-migratory factors are complex. Further research is still needed to understand how residence status affects mental health and treatment outcomes for refugees.

Hubungan Antara Kelelahan Dengan Tingkat Kecemasan Perawat Rumah Sakit: Sebuah Tinjauan Pustaka

Fatigue can be caused by overwork, prolonged physical and mental activity, lack of rest, high stress or a combination of these factors. Work fatigue is caused by tiring and energy-draining activities, thereby reducing human alertness and response to stress. Anxiety is a common emotional disorder characterized by deep and persistent fear or worry, but without any disturbance in the assessment of reality. A nurse is someone who has graduated from a nursing school, both inside and outside of school, in accordance with the provisions of applicable laws and regulations. This article provides an explanation of work fatigue, anxiety and determines the relationship between anxiety and work fatigue specifically for nurses who work in hospitals. This research uses a qualitative approach research methodology by collecting data using structured interviews with 2 research subjects, namely nurses in the Emergency Department and Inpatient Installation who work in private hospitals in Wonogiri Regency accompanied by a literature review based on the literature. Based on literature sources, it was found that high work fatigue can cause an increased risk of anxiety disorders up to 2.7 times higher compared to subjects with lower work fatigue. From the results of interviews with the 2 research subjects, it was found that the level of work fatigue was positively related to anxiety, meaning that the higher the level of work fatigue based on the scoring of the Job Fatigue Measuring Tool Questionnaire (KAUPK2), the higher the anxiety level score based on the Hamilton Anxiety Rating Scale.

Effects of positive psychology intervention based on the PERMA model on psychological status and quality of life in patients with Parkinson's disease

ObjectiveTo explore the effect of a positive psychology intervention based on the PERMA model on depressive mood and the quality of life of patients with Parkinson's disease (PD). MethodsA total of 60 patients with PD with depression hospitalised between February 2022 and February 2023 were selected using a convenience sampling method. They were divided into a study group (30 cases) and control group (30 cases) using the random number table method. The control group was given routine nursing, whereas the observation group was treated using the PERMA model of positive psychological intervention. The Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Quality-of-Life Questionnaire (PDQ-39), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Positive and Negative Affect Schedule (PANAS), and Connor–Davidson Resilience Scale (CD-RISC) scores were collected and compared before and after the intervention, and patient care satisfaction after the intervention was also recorded and compared. ResultsStatistically significant differences were identified in the UPDRS (t = 4.221, p < 0.001), PDQ-39 (t = 5.331, p < 0.001), HAMD (t = 4.298, p < 0.001), HAMA (t = 3.412, p < 0.001), CD-RISC (t = 3.426, p < 0.001), and PANAS (t = 3.432, t = 4.523, p < 0.001) scores. The UPDRS, PDQ-39, HAMD, HAMA, and negative emotion scores in the study group were lower than those in the control group, whereas the CD-RISC and positive emotion scores in the study group were higher than those in the control group. A significant difference in nursing satisfaction was also determined between the two groups (Z = −2.700, p = 0.012), and this result was higher in the study group (93.33 %) than in the control group (73.33 %). ConclusionA positive psychology intervention using the PERMA model can effectively counter the negative psychological states of depression, anxiety, and negative emotion in patients with PD, thereby significantly improving their quality of life, psychological resilience levels, and patient satisfaction.

A Quasi Experimental Study to Assess the Effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on Anxiety and Quality of Sleep Among Covid-19 Patients at Selected Covid Care Centre, Coimbatore

Global prevalence of anxiety and depression increased to 25% during the first year of pandemic. Pandemic is not just a medical phenomenon; it affected individuals, society and caused emotional disruptions, anxiety, stress, stigma and sleep problems. Aim: The present study was undertaken with the aim to assess the effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on anxiety and quality of sleep among COVID-19 patients. Methodology: A quantitative approach with Quasi-Experimental, one group pretest-posttest design was adopted. A purposive sampling technique was used to recruit the study participants, and the sample size was 60. Pretest level of anxiety and quality of sleep were assessed using Hamilton Anxiety Rating Scale and Modified Pittsburgh Sleep Quality Index. Jacobson’s progressive muscle relaxation therapy (JPMR) was administered in individual session for 20 minutes, one session per day for 6 consecutive days. Posttest was conducted by using same questionnaires on the 7th day, after the intervention. Results: ‘z’ test was used to compare the level of anxiety before and after the intervention, the calculated value z=4.85 was greater than the tabulated value 3.29 at 0.001 level of significance. With regard to the quality of sleep before and after intervention, the calculated value z=5.87 was greater than the tabulated value 3.29 at 0.001 level of significance. Conclusion: The study concluded that Jacobson's Progressive Muscle Relaxation Therapy was effective in reducing the anxiety and improving the sleep quality among COVID-19 patients.

Burnout syndrome, anxiety, and depression symptoms among workers in radiation field

BackgroundJob burnout is defined as physical, emotional, and mental exhaustion due to persistent work stress, and it includes emotional exhaustion (EE), cynicism (CY), and reduced personal accomplishment (PA) and usually leads to symptoms of depression, lack of motivation, and decreased enthusiasm. Previous studies from different countries have suggested that job burnout, depression, and anxiety are a common work-related problems. This study aims to assess for job burnout, depression, and anxiety among radiation workers in order to investigate the effects of radiation exposure during work on the mental health. This comparative cross-sectional study was performed on 208 workers in the Egyptian Atomic Energy Authority (EAEA) and the Egyptian Nuclear and Radiological Regulatory Authority (ENRRA) at Cairo Governorate, Egypt. Study participants were divided into 2 groups: 1st group which included 104 workers among radiation field and 2nd group which included 104 workers and employees who do not often work among radiation field. Maslach Burnout Inventory Scale (MBI), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Rating Scale for Anxiety (HAM-A) were used to assess for burnout, depression, and anxiety among study participants.ResultsThe prevalence and severity of depression, anxiety, burnout, and among workers inside radiation field group were statistically significantly higher than those working outside radiation field group. Work type (WIRF) and number of working hours per week (> 40 h) were the significant risk factors for all the burnout, depression, and anxiety, while age (> 40–60 years old) was a significant predictor for depression, female gender was a significant predictor for anxiety, and both age (20–40 years old) and years of experience (≤ 10 years) were significant predictors for burnout among workers inside radiation field.ConclusionsBurnout, depression, and anxiety are common among workers inside radiation field with higher prevalence and severity than those working outside radiation field. Younger age, fewer years of experience, and more working hours per week are significantly associated risk factors for burnout among workers inside radiation field.

Diagnostic value and correlation analysis of serum cytokine levels in patients with multiple system atrophy.

The association between cytokines in peripheral blood and clinical symptoms of multiple system atrophy (MSA) has been explored in only a few studies with small sample size, and the results were obviously controversial. Otherwise, no studies have explored the diagnostic value of serum cytokines in MSA. Serum cytokines, including interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNF-α), were measured in 125 MSA patients and 98 healthy controls (HCs). Correlations of these serum cytokines with clinical variables were analyzed in MSA patients. Diagnostic value of cytokines for MSA was plotted by receiver operating curves. No significant differences were found in sex and age between the MSA group and the HCs. TNF-α in MSA patients were significantly higher than those in HCs (area under the curve (AUC) 0.768), while IL-6 and IL-8 were not. Only Hamilton Anxiety Scale (HAMA) has a positive correlation between with TNF-α in MSA patients with age and age at onset as covariates. Serum IL-6 was associated with HAMA, Hamilton Depression Scale (HAMD), the Unified MSA Rating Scale I (UMSARS I) scores, the UMSARS IV and the Instrumental Activity of Daily Living scores. However, IL-8 was not associated with all clinical variables in MSA patients. Regression analysis showed that HAMA and age at onset were significantly associated with TNF-α, and only HAMA was mild related with IL-6 levels in MSA patients. Serum TNF-α and IL-6 levels in MSA patients may be associated with anxiety symptom; however, only TNF-α was shown to be a useful tool in distinguishing between MSA and HCs.

Efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in anejaculation: A randomized controlled trial.

Anejaculation represents significant psychological distress and sexual and reproductive challenges among male individuals and couples. Effective fertility management options are available to address the reproductive challenges associated with anejaculation. However, there is a lack of methods to reverse the condition itself. This study aims to assess the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in patients suffering from anejaculation. A total of 94 patients with anejaculation individuals were randomly assigned to receive high-frequency (HF) stimulation on the left dorsolateral prefrontal cortex (DLPFC), low-frequency (LF) stimulation on the right DLPFC, and sham stimulation for 4 weeks, with daily sessions of stimulation occurring on five consecutive weekdays each week. After 4 weeks of rTMS treatment, the patients in both the HF and LF groups exhibited a similar reduction in their male sexual health questionnaire for ejaculatory dysfunction bother/satisfaction score, Hamilton Anxiety Scale score, Hamilton Depression Scale score, and Pittsburgh Sleep Quality Inventory score, which were statistically significant compared with sham treatment. Additionally, there were no significant differences observed in erectile function and cognitive function across the three groups. However, there were notable disparities in the cure rates between HF- and LF-group patients (16.1% vs. 54.8%, p=0.001). Additionally, it is worth noting that only two HF group patients and one LF group patient experienced spontaneously resolving minor adverse effects during the treatment process. At the 8-week follow-up, among patients who initially responded to the treatment, only one from the HF group experienced a relapse. The findings of this study demonstrate that rTMS represents a secure and efficacious remedy for anejaculation patients.

The evolutionary features and roles of single nucleotide variants and charged amino acid mutations in influenza outbreaks during NPI period

The epidemic and outbreaks of influenza B Victoria lineage (Bv) during 2019–2022 led to an analysis of genetic, epitopes, charged amino acids and Bv outbreaks. Based on the National Influenza Surveillance Network (NISN), the Bv 72 strains isolated during 2019–2022 were selected by spatio-temporal sampling, then were sequenced. Using the Compare Means, Correlate and Cluster, the outbreak data were analyzed, including the single nucleotide variant (SNV), amino acid (AA), epitope, evolutionary rate (ER), Shannon entropy value (SV), charged amino acid and outbreak. With the emergence of COVID-19, the non-pharmaceutical interventions (NPIs) made Less distant transmission and only Bv outbreak. The 2021–2022 strains in the HA genes were located in the same subset, but were distinct from the 2019–2020 strains (P < 0.001). The codon G → A transition in nucleotide was in the highest ratio but the transversion of C → A and T → A made the most significant contribution to the outbreaks, while the increase in amino acid mutations characterized by polar, acidic and basic signatures played a key role in the Bv epidemic in 2021–2022. Both ER and SV were positively correlated in HA genes (R = 0.690) and NA genes (R = 0.711), respectively, however, the number of mutations in the HA genes was 1.59 times higher than that of the NA gene (2.15/1.36) from the beginning of 2020 to 2022. The positively selective sites 174, 199, 214 and 563 in HA genes and the sites 73 and 384 in NA genes were evolutionarily selected in the 2021–2022 influenza outbreaks. Overall, the prevalent factors related to 2021–2022 influenza outbreaks included epidemic timing, Tv, Ts, Tv/Ts, P137 (B → P), P148 (B → P), P199 (P → A), P212 (P → A), P214 (H → P) and P563 (B → P). The preference of amino acid mutations for charge/pH could influence the epidemic/outbreak trends of infectious diseases. Here was a good model of the evolution of infectious disease pathogens. This study, on account of further exploration of virology, genetics, bioinformatics and outbreak information, might facilitate further understanding of their deep interaction mechanisms in the spread of infectious diseases.

Prevalence and Risk Factors of Psychiatric Symptoms among Type 2 Diabetes Mellitus Patients in South India: A Cross-Sectional Study.

Background: Type 2 diabetes mellitus poses a momentous challenge when accompanied by psychiatric symptoms like depression, anxiety, and stress, adding to the complaint's threat. Research on these factors in patients with uncontrolled chronic illnesses in India, particularly in Tamil Nadu, is limited. Hence, this study aims to determine the prevalence and risk factors of these psychiatric symptoms among Type 2 diabetes patients.  Methods: A cross-sectional study was conducted in Alpha Hospital and Research Center in Madurai, South India, from April 2020 to March 2021, enrolling 614 participants (307 with Type 2 diabetes mellitus and 307 general population). Data were collected using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and Perceived Stress Scale. The IBM SPSS version 23 was used for statistical analysis.  Results: Two-thirds of youth women with type 2 diabetes have higher fasting blood sugar levels than men when compared to general population. 82.61% of patients with uncontrolled diabetes developed severe stress, surpassing those with well-controlled and pre-diabetes. Severe depression is most prevalent among patients with neuropathic foot ulcers (54.76%) and nephropathy (61.54%). Predominant mental health risk factors include being single, high school education, poor glycemic control, comorbid hypertension, and family history. Interestingly, lifestyle factors like alcohol use and smoking positively impact mental health outcomes.  Conclusion: This study shows the intricate connection between Type 2 diabetes and mental health problems in Madurai, emphasizing the necessity for a multidisciplinary strategy to enhance outcomes and reduce financial burden. Future research in nursing has to focus on implementing and assessing therapies aimed at reducing patients' stress, anxiety and depression.

Monitoring the psychopathological profile of inflammatory bowel disease patients treated with biological agents: a pilot study.

Biological agents were found to alter the psychopathological profile of a small subgroup of patients treated for a variety of conditions, including inflammatory bowel disease (IBD) and psychiatric disorders. The association between the administration of biological agents and psychopathology needs to be further investigated. In this naturalistic prospective cohort study, patients with IBD were assigned to two treatment groups, i.e., a biological agent (which also included tofacitinib) or conventional therapy. Clinician-administered scales were used to assess psychosomatic symptoms (Hamilton Depression Rating Scale [Ham-D], Hamilton Anxiety Rating Scale [Ham-A], Young Mania Rating Scale [YMRS], and Brief Psychiatric Rating Scale [BPRS]) and disease activity (Mayo Score and Harvey-Bradshaw Index [HBI]) at baseline, after one, three, and six months of treatment. Each group was assessed for the course of their scores during the observation period at each assessment point. Patients on biological drugs who completed three months of treatment (N.=32) and six months of treatment (N.=20) scored significantly lower on the Mayo compared to baseline. Patients on conventional treatment obtained significant drops from baseline on the HBI after one and three months of treatment (N.=30) and also at the six-month endpoint (N.=11). Both groups showed no improvement or worsening on the psychiatric rating scales. In this study, we found no evidence of psychiatric symptom worsening, as some literature would suggest. Our data suggest that the use of biological agents in IBD is safe.

A comparative study on hair cortisol concentration among generalized anxiety disorder patients with and without alcohol dependence syndrome presenting to a tertiary care center: A pilot study.

Generalized anxiety disorder (GAD) affects up to 6% of the population, which if not detected early and adequately treated will continue as a hidden impairment resulting in disability. The primary objective of the study is to assess the hair cortisol levels (HairF) in persons with GAD with and without alcohol dependence syndrome (ADS), and the secondary objective is to assess whether HairF can be used as a biomarker for assessment of GAD. This comparative study was done on 94 subjects (68 persons with GAD with or without ADS and 26 healthy controls) who were divided into three groups. Hamilton Anxiety Rating Scale (HAM-A) and Patient Health Questionnaire-4 (PHQ4) were also used to assess severity of anxiety symptoms. These scores were compared with HairF. Diagnostic accuracy of the HairF analysis test was done. Statistical analysis was done using SPSS version 20. The study found higher levels of HairF in persons with GAD (mean 189.4 ± 33.1) and GAD with ADS (164.2 ± 47.6) compared to healthy controls (mean 45.34 ± 40.7), which were statistically significant. Correlation of HAM-A and PHQ4 scores and HairF also showed positive correlation. The receiver operating characteristic curve suggested the best cutoff point at 88.4 pg/mg with a sensitivity of 98.5% and a specificity of 92.5%, clearly differentiating GAD from healthy controls. HairF were found to be higher in patients with GAD irrespective of ADS as comorbidity. The study supports the possibility of the HairF as a possible biomarker to detect GAD and play a complementary role in a multidimensional approach for management of chronic stress and anxiety.

Glymphatic function assessment with diffusion tensor imaging along the perivascular space in patients with major depressive disorder and its relation to cerebral white-matter alteration.

The link between glymphatic system function in the brain and alterations in white-matter microstructure among individuals with major depressive disorder (MDD) remains unclear. This study aimed to examine the assessment of glymphatic system function in patients with MDD using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index and to evaluate its association with cerebral-white-matter abnormalities and neuropsychological scores. From February 2023 to November 2023, this cross-sectional study recruited 35 patients with MDD from the Psychosomatic Diseases Department of the First Affiliated Hospital of Dalian Medical University. In this time period, 23 healthy controls (HCs) were enlisted from the community and matched with the MDD cohort in terms of years of education, gender, and age. All participants underwent magnetic resonance imaging, depression, anxiety, and cognitive assessments. The tract-based spatial statistics (TBSS) analyzed DTI parameters and identified significant clusters. Automated fiber quantification (AFQ) was used to automatically identify fiber bundles with statistical differences. Mann-Whitney tests or two-sample t-tests were used for comparisons. Interobserver consistency of the DTI-ALPS measurements was evaluated using the interclass correlation coefficient (ICC). Partial correlation analyses and linear regression analyses were used to examine relationships. A comparison of the DTI-ALPS index was made between the two groups. Correlations among diffusion characteristics, neuropsychological scores, and the DTI-ALPS index were analyzed. Compared to HCs, patients with MDD exhibited a lower DTI-ALPS score (P=0.001). According to using linear regression analysis, the ALPS index was found to be an independent predictor of the Hamilton Depression Rating Scale [B=-25.32; P=0.001; 95% confidence interval (CI): -40.35 to -11.55], Hamilton Anxiety Rating Scale (B=-33.48; P=0.003; 95% CI: -55.38 to -11.24), and Montreal Cognitive Assessment total score (B=8.59; P=0.008; 95% CI: 2.38 to 14.79). According to the TBSS analysis, there were clusters of increased axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) in patients with MDD as compared to HCs (all P values <0.05). A lower DTI-ALPS score was correlated with higher AD (r=-0.592; P<0.001), MD (cluster 1: r=-0.567, P=0.001; cluster 2: r=-0.581, P<0.001), and RD (r=-0.491; P=0.004) values. AFQ analysis identified the significantly different diffusion indicators in the left cingulum bundle (CB_L), left inferior longitudinal fasciculus (ILF_L), and left uncinate fasciculus (UF_L) between the two groups (all false discovery rate P values <0.05). DTI-ALPS score was negatively correlated with the AD value of CB_L (r=-0.304; P=0.024), ILF_L (r=-0.35; P=0.008), and UF_L (r=-0.354; P=0.008) in AFQ tract-level analysis. In point-wise analysis, the MD value of CB_L at nodes 33 to 36 was negatively correlated with DTI-ALPS score (r ranging from -0.504 to -0.535; P<0.01). Our results indicated a decrease in DTI-ALPS index score in patients with MDD. DTI-ALPS score was associated with depression, anxiety, declined cognitive ability, and white-matter microstructural abnormalities and may thus be a promising biomarker for the partial evaluation of glymphatic system function in patients with MDD.

The Relationship Between Exercise Frequency and Cognitive Flexibility in Anxiety Disorder Patients Undergoing Combined Exercise and Cognitive Behavioral Therapy

This study investigates the relationship between exercise frequency and cognitive flexibility in patients with anxiety disorders undergoing combined Cognitive Behavioral Therapy (CBT) and exercise interventions. A longitudinal follow-up design was employed, with 80 participants randomized into four groups: low-frequency exercise, moderate-frequency exercise, high-frequency exercise, and a control group receiving CBT without exercise. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST), and anxiety levels were measured by the Hamilton Anxiety Rating Scale (HAM-A) at baseline, post-intervention, and during 3-month and 6-month follow-ups. Results demonstrated a significant dose-response relationship, with higher exercise frequencies leading to greater improvements in cognitive flexibility and reductions in anxiety symptoms. The high-frequency exercise group exhibited the most substantial and sustained cognitive and emotional benefits, suggesting the importance of frequent exercise in enhancing and maintaining therapeutic outcomes in anxiety disorder treatment. These findings have critical implications for optimizing treatment strategies that integrate physical exercise with CBT to improve cognitive and emotional health in anxiety disorder patients.

Executive functions and functioning in women with fibromyalgia.

Fibromyalgia (FM) is a chronic condition characterized by widespread pain that is associated with sleep, emotional, and cognitive disturbances, including in executive functions (EFs). To investigate the relationship between EFs and functionality in women with FM. The study included 17 women with FM, aged between 30 and 59 years, with no history of neurological disease. The EFs were assessed using the Digit Span Subtest (DS), Five Digit Test, Trail Making Test (TMT), Corsi Block-Tapping Task, Hayling Test (HT), and Verbal Fluency Task. Functionality was evaluated through the Fibromyalgia Impact Questionnaire. The Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Brief Pain Inventory were used to measure depression, anxiety, and pain, which were controlled in the statistical analyses. The FM patients showed longer response latency on the HT and TMT. They made fewer errors on part B of the HT, and they performed worse on the DS backward and on the Corsi Block-Tapping Task forward and backward. There were moderate correlations in the expected direction between performance on the Corsi Block-Tapping Task backward and interference at work, as well as between the time to complete part B of the Trail Making Test - B (TMT-B) and fatigue. An unexpected relationship was found between errors on part B of the HT and interference at work. The results suggest lower efficiency in processes such as inhibitory control and cognitive flexibility, difficulties in working memory and non-executive processes such as processing speed. Even with pain, anxiety, and depression controlled, some relationships between EFs and functionality were observed, indicating that these symptoms do not fully explain this relationship. We suggest that cognition, particularly EFs, and broader measures of functionality be considered in the evaluation of FM.

Demographic Differences in Insomnia and Anxiety and the Association with Cardiovascular Risk Factors among Jordanian Healthy Adult.

Prior studies showed that anxiety and insomnia are both associated with Cardiovascular Disease (CVD). There is a lack of literature related to the prevalence of insomnia and anxiety among healthy adult populations in developing countries as in Jordan, Therefore, this study aimed to examine the association between the CVD risk factors and both insomnia and anxiety among healthy adults had one or more modifiable CVD risk factors. A cross-sectional method was used to examine the prevalence of anxiety, insomnia, and demographical and clinical association with anxiety and insomnia among 1000 Jordanian adult participants using the Hamilton Anxiety Rating Scale and the insomnia severity index. Pearson's correlation was used to examine the correlation between anxiety and insomnia scores. Linear regression was used to examine predictors to anxiety and insomnia based on demographical and clinical details. The result of the current study showed that (30.20%) of participants had higher anxiety scores, (29.70%) had moderate to severe insomnia. Moreover, there was a significant positive correlation between anxiety and insomnia scores, p = 0.01. Based on the current study findings only marital status and anxiety were unique predictors of insomnia F(14,45) = 989, p = 0.001. Moreover, Predictors of anxiety were gender, hypertension, Diabetes mellitus, dyslipidemia, and insomnia F(19,89) = 989, p = 0.001. Sleep and psychological well-being are important components of an adult's health and well-being. The study showed that marital status and anxiety are predictors of insomnia. Whereas, gender, hypertension, diabetes mellitus, dyslipidemia, and insomnia were predictors of anxiety. This study highlights the importance of the implementation of a primary prevention strategy for individuals with modifiable CVD risk factors to reduce anxiety and insomnia levels among adults.

A predictive model for functionality improvement after stroke rehabilitation

ObjectiveThis study develops a simple predictive model for identifying stroke patients who have a better chance of showing improved activities of daily living (ADL) outcomes following a stroke. MethodsThe cohort of 489 stroke patients was divided into testing and training groups. Multivariate logistic regression analysis was conducted for each model. Four models were compared using the C statistic (AUC), Akaike's information criterion (AIC), and other metrics. The best model was assessed using a nomogram. ResultsUnivariate analysis revealed that several variables measured significantly higher at discharge than at admission, including manual muscle testing, standing, and so on. Multivariate logistic regression analysis revealed that activities-specific balance confidence, Brunnstrom recovery stage for lower extremities, standing, the mini-balance evaluation systems test, and the Hamilton anxiety scale were independent predictors of ADL. Model 1 was found to be more accurate for the prediction of ADL (AUC: training, 0.916 [0.889−0.943] and test, 0.887 [0.806−0.968]; AIC: training, 257.42 and test, 76.79) than model 2 (AUC: training, 0.850 [0.894−0.806] and test, 0.819 [0.715−0.923]; AIC: training, 314.44 and test, 83.78), model 3 (AUC: training, 0.862 [0.901−0.823] and test, 0.830 [0.731−0.929]; AIC: training, 307.76 and test, 86.55), and model 4 (AUC: training, 0.862 [0.901−0.823] and test, 0.833 [0.733−0.932]; AIC: training, 305.8 and test, 86.28). ConclusionA multivariate model can be used to predict functionality improvement, as measured by ADL, following hospitalization with a stroke.

Evaluation of Anxiety and Depression Among Orphan and Non-Orphan Adolescents in a Rural Residential School of Maharashtra

Abstract Background: Adolescence marks a critical stage of development characterized by profound physical, emotional, and social changes. This study explores the prevalence of anxiety and depression among orphan and non-orphan adolescents in a rural residential school setting, aiming to identify associated factors. Method: A community-based cross-sectional descriptive study was conducted among 100 adolescents (50 orphans and 50 non-orphans) aged 10-19 years in Warudi, Jalna from August 10 to October 10, 2022. Institutional ethical approval and written informed consent were obtained. Data collection included DSM-5 criteria for anxiety and depression assessment, using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS). Additional parameters assessed were sleep disturbances, academic performance, social interactions, duration of stay in the residential school, and type of orphanhood. Statistical analysis was performed using SPSS version 21, with qualitative parameters presented as percentages and the chi-square test used for comparisons (p&lt;0.05 considered significant). Result: The study revealed notable disparities in mental health outcomes between orphan and non-orphan adolescents. Orphans, predominantly categorized as double orphans (54%), exhibited higher prevalence rates of anxiety (46%) and depression (30%) compared to non-orphans (anxiety 14%, depression 12%). Factors such as prolonged stays in residential schools and the duration of orphanhood were significantly associated with heightened levels of anxiety and depression among orphans. Conclusion: Orphan adolescents residing in rural residential school face significantly elevated risks of anxiety and depression compared to their non-orphan peers. The findings highlight the urgent need for targeted psychological support and interventions tailored to the unique challenges of orphanhood, including the prolonged institutional care and the emotional impact of parental loss. Future research should focus on longitudinal studies to assess the effectiveness of interventions and track mental health trajectories over time.

Shoden promotes Relief from stress and anxiety: A randomized, double-blind, placebo-controlled study on healthy subjects with high stress levels

BackgroundThis randomized placebo-controlled study examined the effect of ashwagandha root and leaf extract 60 mg (AE60) and 120 mg (AE120) (35 % withanolide glycosides, Shoden) in physically healthy subjects with higher stress and anxiety. It is hypothesized that a low dose extract with higher withanolide glycosides would decrease cortisol and increase testosterone thereby reducing stress and anxiety. MethodsThis parallel arm study recruited 60 subjects with an allocation ratio of 1:1:1 (AE60:AE120: placebo) for 60 days. Subjects who fulfilled the DSM –IV Criteria for generalized anxiety disorder (GAD) with a Hamilton Anxiety Rating Scale, HAMA score >20, and morning serum cortisol >25 mcg/dl were included in the study. The participants did not have depression symptoms and were screened using Montgomery-Asberg Depression Rating Scale. The primary outcome measure was HAMA and the secondary measures were morning serum cortisol, testosterone, perceived stress scale (PSS), clinical global impressions scale (CGI), and patient's global impression of change scale (PGIC). ResultsAfter 60 days, significant differences were observed between the treatment groups and placebo. HAMA scores decreased by 59 % in both AE60 and AE120 groups compared to a negligible increase of 0.83 % in the placebo group (p < 0.0001). Morning serum cortisol levels decreased by 66 % in AE60 and 67 % in AE120, compared to a 2.22 % change in the placebo group (p < 0.0001). Testosterone levels increased by 22 % in AE60 and 33 % in AE120, compared to a 4 % increase in males in the placebo group (p < 0.0001). PSS scores decreased by 53 % in AE60 and 62 % in AE120, CGI-severity scores decreased by 72 % in AE60 and 68 % in AE120, and PGIC scores improved by 60 % in both AE60 and AE120 groups, all showing significant differences compared to the placebo group. ConclusionAshwagandha extract with 35 % withanolide glycosides (Shoden) at 60 mg and 120 mg was significantly effective in reduced morning serum cortisol and increasing total testosterone. Therefore, it can be recommended for reducing high stress and anxiety. Clinical trial registrationThe study was prospectively registered in Clinical Trial Registry, India with registration number CTRI/2022/04/042133 [Registered on: April 25, 2022].