Major Anxiety Research Articles

Positive beliefs about worry: An evaluation of the Why Worry-II questionnaire in patients with anxiety and mood disorders: Implications for theory and treatment.

Positive beliefs about worry are an important factor that has been shown to be associated with the reduction of worry severity with cognitive behavioural therapy. The present study evaluated the psychometric properties of a measure of positive beliefs about worry, the Why Worry Questionnaire II (WW-II; Hebert et al.,2014, 0.1016/j.paid.2013.08.009) with a clinical sample. The present study also compared mean scores on the WW-II in the present clinical sample with scores found in non-clinical samples. Finally, the study compared mean scores on the WW-II between groups with primary diagnoses of generalized anxiety disorder (GAD), major depressive disorder (MDD) and anxiety disorder not otherwise specified (NOS). The confirmatory factor analysis found the five-factor model an adequate to good fit to the data, and the WW-II demonstrated excellent internal consistency within this clinical sample. Additionally, scores on the WW-II in the present sample were significantly higher than scores found by in their non-clinical sample. Finally, no significant mean differences were found between primary diagnoses of GAD, anxiety disorder NOS or MDD. Important theoretical and clinical implications and suggestions for future research are discussed.

Abstract- Poster

Background: The OCD clinic, NIMHANS has catered to individuals with OCD and related disorders since its inception in 1997. It functions as a specialised clinic with both a walk-in and referral service. Patients are evaluated and offered pharmacological, psychological and somatic therapies on an inpatient and outpatient basis. The initial evaluation includes a detailed clinical history, structured diagnostic questionnaires, and OCD severity rating using the Yale-Brown Obsessive-Compulsive Scale (YBOCS) by trained clinicians.Aim: To describe demographic and clinical characteristics at first visit, of individuals seeking treatment at the OCD clinic between 1997 and 2020.Results: Baseline information was available for a total of 2269 patients. Mean age at presentation was 29.9±10.76 years (range=10-72), 62.1% were male. More than half (52.5%) hailed from states all over India other than Karnataka. The mean duration of illness at presentation was 8.21±7.54 years, and 41.3% had a juvenile-onset. The average YBOCS score at baseline was 23.27±8.26. Most common comorbidities were major depression (19.5%), anxiety disorders (8%), psychosis (6%) and bipolar disorder (3%). 19% of patients were drug-naive at presentation. 27.7% had already received ≥2 adequate SRI trials before presentation, and 10.6% had received CBT.Conclusions: Unlike that of most other OCD specialty centres in the world (e.g., Brazilian OCD Research Consortium), our profile is unique in that it represents both patients with severe or resistant illness, as well as those who are treatment-naive, with mild/moderate illness. It is important to understand the overall profile of the well-characterized cohort from the clinic, in the context of several research studies that have looked at various clinical, social and biological aspects in OCD.

Anxiety-depressive disorders in obese patients

The likelihood of developing major depressive disorder (MDD) and anxiety (T) increases with the number of comorbid metabolic disorders, such as dyslipidemia, insulin resistance, hypertension (AH), and obesity. Research indicates that long-term inflammation caused by reduced physical activity, sedentary behavior, and poor eating habits is necessary for this connection to occur, which in turn can lead to metabolic disorders. The aim of our study was to identify possible anxiety-depressive disorders in obese patients and to investigate the prevalence of such disorders in patients of the Odesa region. According to the research design, 67 obese patients who were treated at the Department of Family Medicine and Polyclinic Therapy of Odesa National Medical University were examined. Patients included in our study were asked to undergo an examination according to a generally accepted algorithm, an anthropometric examination to calculate BMI and determine the content of visceral fat. In addition, patients were asked to complete a series of questionnaires, namely: the physical activity level questionnaire, the HADS Hospital Anxiety and Depression Scale, the Beck Depression Scale, the Generalized Anxiety Disorder Questionnaire (GAD-7), the PHQ-9 questionnaire, and the M.I.N.I. (International Neuropsychiatric Questionnaire). As a result of taking anamnesis, it was established that the vast majority had comorbid diseases in the form of: hypertension - 36 patients (56.72%), type 2 diabetes - 29 patients (43.28%), prediabetes - 15 (22.39%), dyslipidemia was diagnosed in 39 patients (58.21%). Questionnaire M.I.N.I. was used by us to determine the subtype of depressive disorder in our patients. Thus, we found that the most common subtypes were: ADHD (26.87%), depressive disorder with melancholia (16.42%) and dysthymia (17.91%). In our opinion, it is appropriate to use psychological questionnaires in the practice of doctors of various specialties who interact with patients living with obesity. When patients with TDD are identified using diagnostic screening, namely questionnaires, they should be referred for further consultation with a psychotherapist.

Decision Level Fusion Using Hybrid Classifier for Mental Disease Classification

Mental health signifies the emotional, social, and psychological well-being of a person. It also affects the way of thinking, feeling, and situation handling of a person. Stable mental health helps in working with full potential in all stages of life from childhood to adulthood therefore it is of significant importance to find out the onset of the mental disease in order to maintain balance in life. Mental health problems are rising globally and constituting a burden on healthcare systems. Early diagnosis can help the professionals in the treatment that may lead to complications if they remain untreated. The machine learning models are highly prevalent for medical data analysis, disease diagnosis, and psychiatric nosology. This research addresses the challenge of detecting six major psychological disorders, namely, Anxiety, Bipolar Disorder, Conversion Disorder, Depression, Mental Retardation and Schizophrenia. These challenges are mined by applying decision level fusion of supervised machine learning algorithms. A dataset was collected from a clinical psychologist consisting of 1771 observations that we used for training and testing the models. Furthermore, to reduce the impact of a conflicting decision, a voting scheme Shrewd Probing Prediction Model (SPPM) is introduced to get output from ensemble model of Random Forest and Gradient Boosting Machine (RF + GBM). This research provides an intuitive solution for mental disorder analysis among different target class labels or groups. A framework is proposed for determining the mental health problem of patients using observations of medical experts. The framework consists of an ensemble model based on RF and GBM with a novel SPPM technique. This proposed decision level fusion approach by combining RF + GBM with SPPM-MIN significantly improves the performance in terms of Accuracy, Precision, Recall, and F1-score with 71\%, 73\%, 71\% and 71\% respectively. This framework seems suitable in the case of huge and more diverse multi-class datasets. Furthermore, three vector spaces based on TF-IDF (unigram, bi-gram, and tri-gram) are also tested on the machine learning models and the proposed model.

Psychological adverse effects of COVID-19 pandemic on health service providers: an online survey

BackgroundIn the current situation of the COVID-19 pandemic, health service providers (HCPs) suffered from mental health consequences such as depression, anxiety, fear, and post-traumatic stress disorder (PTSD). The study aimed to evaluate the adverse psychological impacts of the COVID-19 pandemic on HSPs at the Tabriz University of Medical Science, North West of Iran. An online survey was conducted to assess the psychological adverse effects of COVID-19 during the pandemic of COVID-19 from May 2021 to February 2022. Psychological adverse effects including depression, anxiety, PTSD, and fear were measured using valid instruments. Overall, 298 HSPs responded to the questionnaires. Descriptive and multiple logistic regression analyses with crude and adjusted ORs were used to estimate mental health adverse effects.ResultsThe overall prevalence of depressive symptoms, major depression disorder (MDD), anxiety, and probable PTSD were 58%, 9.1%, 61.7%, and 15%, respectively. The fear of COVID-19 scale (mean) was 17.6± 6.2. We found mental health adverse effects were higher in HSPs who worked in the treatment and health sections than HSPs in the support section. Having a history of mental disorder, HSP type (health and treatment), and female sex had a statistically significant association with MDD and depressive symptoms.ConclusionsMental health problems were high in HSPs. The study highlights the demand for support systems and appropriate interventions for improving HSPs’ mental health and well-being during the COVID-19 pandemic.

Management of psychiatric disorders in patients with cancer.

Management of psychiatric disorders in patients with cancer.

Iron deficiency and internalizing symptom severity in unmedicated adolescents: a pilot study.

Iron plays a key role in a broad set of metabolic processes. Iron deficiency is the most common nutritional deficiency in the world, but its neuropsychiatric implications in adolescents have not been examined. Twelve- to 17-year-old unmedicated females with major depressive or anxiety disorders or with no psychopathology underwent a comprehensive psychiatric assessment for this pilot study. A T1-weighted magnetic resonance imaging scan was obtained, segmented using Freesurfer. Serum ferritin concentration (sF) was measured. Correlational analyses examined the association between body iron stores, psychiatric symptom severity, and basal ganglia volumes, accounting for confounding variables. Forty females were enrolled, 73% having a major depressive and/or anxiety disorder, 35% with sF < 15 ng/mL, and 50% with sF < 20 ng/mL. Serum ferritin was inversely correlated with both anxiety and depressive symptom severity (r = -0.34, p < 0.04 and r = -0.30, p < 0.06, respectively). Participants with sF < 15 ng/mL exhibited more severe depressive and anxiety symptoms as did those with sF < 20 ng/mL. Moreover, after adjusting for age and total intracranial volume, sF was inversely associated with left caudate (Spearman's r = -0.46, p < 0.04), left putamen (r = -0.58, p < 0.005), and right putamen (r = -0.53, p < 0.01) volume. Brain iron may become depleted at a sF concentration higher than the established threshold to diagnose iron deficiency (i.e. 15 ng/mL), potentially disrupting brain maturation and contributing to the emergence of internalizing disorders in adolescents.

Long-term Follow-up of Psychiatric Disorders in Children and Adolescents Conceived by Assisted Reproductive Techniques in Sweden

Individuals conceived with assisted reproductive techniques (ARTs) could be at elevated risk of psychiatric disorders owing to potential adverse effects of the procedures themselves, or because such traits or their risk factors may be more common in couples with infertility. To investigate the risk of psychiatric disorders in adolescents and young adults conceived with ARTs and to evaluate the role of treatment-related parental characteristics. This prospective follow-up of a nationwide birth cohort used linkage of Swedish population registers with coverage through 2018. All children born in Sweden from January 1, 1994, to December 31, 2006, were included in the analysis. Follow-up was completed on December 31, 2018, when participants were 12 to 25 years of age, and data was analyzed from March 17, 2020, to September 10, 2021. In vitro fertilization with or without intracytoplasmic sperm injection and transfer of fresh or frozen-thawed embryos. Clinical diagnoses of mood disorder, including major depression, anxiety, obsessive-compulsive disorder (OCD), or suicidal behavior, were identified from hospital records and outpatient specialist care. Suicide was additionally identified from death certificates. Antidepressant use was identified from dispensations of prescribed medications. A total of 1 221 812 children (48.6% female, 51.4% male) born between 1994 and 2006 were followed up to a median age of 18 (IQR, 15-21) years. Among these participants, 31 565 (2.6%) were conceived with ART. Compared with all others, adolescents conceived with ART had an elevated risk of OCD (hazard ratio [HR], 1.35 [95% CI, 1.20-1.51]), but the association was attenuated and no longer statistically significant after adjustment for parental characteristics (adjusted HR [aHR], 1.10 [95% CI, 0.98-1.24]) and was no longer present when restricted to individuals born to couples with known infertility (aHR, 1.02 [95% CI, 0.89-1.17]). Adolescents conceived with ARTs were not at elevated risk of depression or suicidal behavior compared with other adolescents (irrespective of parental infertility). Type of fertilization (standard in vitro fertilization or intracytoplasmic sperm injection) had no association with outcomes. Compared with non-ART-conceived children of couples with infertility, fresh, but not frozen, embryo transfer was associated with a lower risk of mood disorders (aHR, 0.90 [95% CI, 0.83-0.97]), making frozen embryo transfer appear less advantageous when directly contrasted with fresh embryo transfer. These findings suggest that adolescents conceived with ARTs around the millennium are not at risk of poor psychiatric health compared with the general population, except for an elevated risk of OCD that may be explained by differences in parental characteristics.

Update on Statin Treatment in Patients with Neuropsychiatric Disorders.

Statins are widely accepted as first-choice agents for the prevention of lipid-related cardiovascular diseases. These drugs have both anti-inflammatory and anti-oxidant properties, which may also make them effective as potential treatment marked by perturbations in these pathways, such as some neuropsychiatric disorders. In this narrative review, we have investigated the effects of statin therapy in individuals suffering from major depressive disorder (MDD), schizophrenia, anxiety, obsessive-compulsive disorder (OCD), bipolar disorder (BD), delirium, and autism spectrum disorders using a broad online search of electronic databases. We also explored the adverse effects of these drugs to obtain insights into the benefits and risks associated with their use in the treatment of these disorders. Lipophilic statins (including simvastatin) because of better brain penetrance may have greater protective effects against MDD and schizophrenia. The significant positive effects of statins in the treatment of anxiety disorders without any serious adverse side effects were shown in numerous studies. In OCD, BD, and delirium, limitations, and contradictions in the available data make it difficult to draw conclusions on any positive effect of statins. The positive effects of simvastatin in autism disorders have been evaluated in only a small number of clinical trials. Although some studies showed positive effect of statins in some neuropsychiatric disorders, further prospective studies are needed to confirm this and define the most effective doses and treatment durations.

Connecting the Dots Between Mental and Menstrual Health: An Exploratory Review

Context: Mental and menstrual health, two emerging aspects of health critical to the female population, are bidirectionally linked. But there is limited empirical evidence that establishes the association between these entities. This essay aims to draw the attention of researchers to this healthcare niche. Evidence Acquisition: An exploratory review was carried out on literatures sourced from medical databases (e.g. PubMed, Google Scholar, Scopus, Science Direct, and Web of Science), and gray sources (popular and reputable institutional and journalistic websites that publishes mental or menstrual health research). The key words used for the search are “menstruation, menstrual hygiene, menstrual disorders, premenstrual syndrome, period poverty, menarche, menopause, mental health, mental disorder, mental illness, depression, anxiety, phobia, mania, mood, and affect”. The initial search generated 368 results. But after the duplicates were removed, the exclusion criteria (publication before 2000, and in languages other than English) was applied, and manual review of abstract (for relevance) was done, 21 publications from the databases and 5 from gray sources were included in this review. Results: Associations were found between menstrual cycle irregularities and disorders and mental disorders such as premenstrual syndrome, premenstrual dysphoric disorder, major depressive disorder, major anxiety disorder, psychotic disorder, bipolar disorder, borderline personality disorder, sleep disorder, substance use and abuse, and suicidal ideation and attempts. Few positive associations between mental and menstrual health were recorded, and several research and treatment gaps were identified. Conclusions: Research into the links between mental and menstrual health should not remain a fringe area of scientific curiosity, as it shows tremendous promise in improving healthcare offered to women/girls globally.

Off-Label Use of Ketamine: A Challenging Drug Treatment Delivery Model With an Inherently Unfavorable Risk-Benefit Profile.

Off-Label Use of Ketamine: A Challenging Drug Treatment Delivery Model With an Inherently Unfavorable Risk-Benefit Profile.

Oxidative stress and soluble receptor for advanced glycation end-products play a role in the pathophysiology of delirium after cardiac surgery

Coronary-artery bypass graft (CABG) surgery is known to improve cardiac function and decrease mortality, albeit, this method of treatment is also associated with a neuropsychiatric complications including postoperative delirium. The pathophysiology of delirium after cardiac surgery remains poorly understood. Thus, the purpose of this study was to investigate whether oxidative stress reflected by decreased preoperative and postoperative plasma antioxidant activity is independently associated with delirium after cardiac surgery. The second aim was to assess whether decreased antioxidant activity is stress-related or mediated by other pathologies such as major depressive disorder (MDD), anxiety disorders, and cognitive impairment. Furthermore, the putative relationship between pre- and postoperative soluble receptor for advanced glycation end-products (sRAGE) overexpression and plasma antioxidant capacity was evaluated. The patients cognitive status was assessed 1 day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of MDD and anxiety disorders was established on the basis of DSM-5 criteria. Blood samples for antioxidant capacity and sRAGE levels were collected both preoperatively and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used within the first 5 days postoperatively to screen for a diagnosis of delirium. Postoperative delirium was diagnosed in 34% (61 of 177) of individuals. Multivariate logistic regression analysis revealed that low baseline antioxidant capacity was independently associated with postoperative delirium development. Moreover, increased risk of delirium was observed among patients with a preoperative diagnosis of MDD associated with antioxidant capacity decreased postoperatively. According to receiver operating characteristic analysis, the most optimal cutoff values of the preoperative and postoperative antioxidant capacity that predict the development of delirium were 1.72 mM and 1.89 mM, respectively. Pre- and postoperative antioxidant capacity levels were negatively correlated with postoperative sRAGE concentration (Spearman's Rank Correlation − 0.198 and − 0.158, p < 0.05, respectively). Patients with decreased preoperative antioxidant activity and those with depressive episodes complicated with lower postoperative antioxidant activity are at significantly higher risk of delirium after cardiac surgery development. sRAGE overexpression may be considered as protective mechanism against increased oxidative stress and subsequent cell damage.

Dysfunctional Beliefs and Attitudes about Sleep and Its Relation with Insomnia in Three Groups of Psychiatric Patients

Background and Objective: Reports have shown a link between dysfunctional beliefs about sleep and sleep disorders. We investigated the frequency of dysfunctional beliefs about sleep in three groups of patients suffering from psychiatric disorders (patients with major depression, bipolar disorder, and anxiety). Materials and Methods: In this cross-sectional study, 150 patients with psychiatric disorders referred to psychiatry clinic affiliated to Qazvin University of Medical Sciences, Qazvin, Iran. Fifty patients were selected in each group (anxiety, depression, and bipolar disorder). Two questionnaires of Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Insomnia Severity Index (ISI) were completed for all patients. Data were analyzed with Student’s t, chi-square, analysis of variance (ANOVA), and Pearson correlation tests. Results: A significant difference was observed between the three groups in the latency to fall asleep at night (P = 0.002) and Pittsburgh Sleep Quality Index (PSQI) ≤ 5 (P = 0.002). Patients with anxiety and bipolar disorder more than other groups believed that insomnia caused loss of life joy (P = 0.010) and the only solution for sleeplessness was medication (P = 0.003), respectively. There was a significant relationship between sleep quality and anxiety (P = 0.030), total sleep time (P = 0.040), sleep latency (P = 0.020), and ISI (P &lt; 0.010) with depression, awakening time during night, and bipolar disorder (P = 0.030). Conclusion: Patients with psychiatric disorders have high frequency of dysfunctional beliefs about sleep. Regarding the relationship between dysfunctional beliefs about sleep and insomnia, future work is needed for better treatment.

Prevalence of depression, anxiety and Quality of life among North Indian Polycystic ovary syndrome Women: Evidence from a prospective observational study

Background: Polycystic ovary syndrome (PCOS) is a common heterogeneous gynaecological endocrine disorder characterized by clinical features including oligo-amenorrhea/ovulatory dysfunction, hyperandrogenism and polycystic ovarian morphology. PCOS increases the risk of depression and anxiety which leads to poor quality of life. Aim of the study were to determine the prevalence of anxiety and depression among women suffering from PCOS and to determine the quality of life (QOL) in PCOS women.Methods: The study was prospective, observational, non-interventional and questionnaire-based. 192 women with PCOS voluntarily helped in filling the questionnaires consisting of questions using PHQ-9 for depression, GAD-7 for anxiety, SF-12 for general health and PCOSQ-50 for disease-specific domains. All data were recorded in pre-designed case record forms and analysis of data was done using different statistical methods.Results: Majority of PCOS women were either overweight or obese. Based on PHQ-9 20% of women was suffering with major depression and based on GAD-7, 25% with major anxiety. It is found that psychosocial and emotional domain and coping domain of PCOSQ-50 is significant in patients with major depression and major anxiety. Significant effects were seen on their general health as per SF-12 domain. Lack of physical exercise was found in 83% of women.Conclusions: PCOS is a complex disease which decreases the overall quality of life. Therefore, treatment of PCOS women should include psychological counselling along-with with medication, especially in obese PCOS women. Women should be educated with the benefits of lifestyle modification in PCOS.

Exploring Art Therapy as a Treatment for Children with Autism Spectrum Disorder

The purpose of this study is to understand the various therapies for children with autism spectrum disorder (ASD) and to discover a more effective method in connection with the research results in other fields. Art therapy was initially used at British mental hospitals to help frequently inhibited patients release creative and positive energy. As art therapy gained more attention, its usage expanded t­­­o help cure patients not only with mental disorders, but also developmental disorders like ASD. Actively used in social facilities and psychiatric treatment, art therapy is one of the most used methods to interact and understand individuals with ASD. Substantial number of papers have been published based on these various practical case studies, which proves the effectiveness of art therapy. Art therapy for children with ASD includes the following: clay, corrugated cardboard work and color mix work, drawing with crayon, paint, and pastel. These materials are frequently used to draw or create body parts, emotions, motions, and specific objects given by the instructor. From the data from research papers, clay and other tactile materials are one of the most effective materials to use to improve the condition of individuals with ASD, major depressive disorder, anxiety, and other mental disorders. Clay-based methods use the sense of touch and vision to create an abstraction process. As the usage of art therapy continues to increase in various fields, integrating effective methods among other disorders is necessary and further investigation is needed for a more effective therapy method for individuals with ASD.

Assess the Stress Level among Spouses of Alcoholics and Spouses of Non- Alcoholics in a Hospital at Avadi, Chennai

The addiction leads to the usage of unconscious purposive abused substances like alcohol and these harms to the self, family and society also. Most of the abuse substances result in mental instability such as depression, major personality disorder, anxiety disorders and dysthymia. The alcoholism is the predominant abused compound and makes very harder life in India and throughout worldwide. Among them, their spouses are most affected beings than any others and they face severe negative impacts on mental and physical health. The present study aimed to analyses the stress created and the successive management in alcoholic spouses compared to the wives of non- alcoholics. The non-experimental, comparative study was includes totally, 70 women (alcoholic and non- alcoholic spouse, 35 each) using non-possibility convenient sampling method at a government hospital, Chennai, Tamil Nadu.The analysis was done using geographical, demographical variations and stress was assessed based on the Sheldon Cohen parameters. The data was collected and statistically evaluated. The study was framed based on Betty Newman system theory. The study also showed that the spouses of alcoholics faced severe stress level due to domestic violence. This study also showed that .they need adequate medical and psychological care from society.

Depression and Anxiety in Persons with Von Willebrand Disease

Depression and Anxiety in Persons with Von Willebrand Disease

Pyrazolotriazines: Biological activities, synthetic strategies and recent developments.

Heterocyclic compounds create an important class of molecules that demonstrates various chemical spaces for the definition of effective medicines. Many N-heterocycles display numerous biological activities. Among condensed heterocycles, pyrazolotriazine derivatives have received the attention of researchers owing to the extensive spectrum of biological activities. The reactivity of identified compounds was similar to the free azoles and triazines. The pyrazolotriazine scaffold exhibited antiasthma, antiinflammatory, anticancer, antithrombogenic activity and showed activity for major depression and pathological anxiety. Pyrazolotriazine derivatives also exhibited antibacterial, anticancer, antimetabolites, antidiabetic, antiamoebic, anticonvulsant, antiproliferative activity, human carbonic anhydrase inhibition, cyclin-dependent kinase 2 inhibition, tyrosinase and urease inhibition, MAO-B inhibition, TTK inhibition, thymidine phosphorylase inhibition, tubulin polymerization inhibition, protoporphyrinogen oxidase inhibition, GABAA agonistic activity, hCRF1 receptor antagonistic activity, and CGRP receptor antagonistic activity. This paper structurally categorized various pyrazolotriazines to isomeric classes into six groups that containing pyrazolo [1,5-d] [1,2,4] triazine, pyrazolo [5,1-c] [1,2,4] triazine, pyrazolo [3,4-e] [1,2,4] triazine, pyrazolo [4,3-e] [1,2,4] triazines, pyrazolo [1,5-a] [1,3,5] triazine, and pyrazolo [3,4-d] [1,2,3] triazine and expressed biological activity, the synthetic procedures for each class of pyrazolotriazines, structure-activity relationship and their mechanism of action. Generally, this review summarily indicated the past and present studies about the discovery of new lead compounds with good biological activity.

Combining selective serotonin reuptake inhibitors and cognitive behavioral therapy in youth with depression and anxiety

BackgroundTreatment studies of children and adolescents with internalizing disorders suggest that the combination of a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy (CBT) consistently produces greater improvement than either treatment alone. We sought to determine how response to combined treatment varies across disorders (anxiety versus depression), and by specific patient characteristics. MethodsThree large National Institutes of Health-funded trials of children and adolescents with major depression (n = 2) and anxiety disorders (n = 1) were evaluated, each comparing CBT + SSRI to SSRI only, Bayesian Hierarchical Models (BHMs) were used, for endpoint response, time course of response and predictors of response in participants who received SSRI or SSRI+CBT. ResultsSSRI+CBT significantly decreased symptoms by week 4 (p<0.001) across disorders. This improvement continued at week 8 and 12 (p<0.001); however, the additive benefit of CBT over SSRI monotherapy was not statistically significant until week 12 (p<0.001). The fastest response to SSRI+CBT was for patients who were younger, with milder baseline anxiety/depression symptoms and depressive disorders. The slowest response for SSRI+CBT was for boys, adolescents, minoritized children, those with severe symptoms and externalizing disorders. LimitationsLimitations included inconsistent moderators, variation in the number of observations over time and a lack of genetic or pharmacokinetic variables related to SSRI exposure across studies. ConclusionsThe superiority of SSRI+CBT for youth with depression and anxiety is further supported. For purposes of rapid and greater relief, combination treatment is the superior approach across anxiety and depression and is robust to a range of participant characteristics. However, the added value of CBT (with an SSRI) occurs late in treatment. These findings represent a step towards understanding heterogeneity of treatment response and raise the possibility that interventions could be better tailored or adapted based on patient characteristics.

The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls

BackgroundAnorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity).MethodsThe present study systematically assesses cognitive biases in 12–18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group.DiscussionThis is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder.