Management Of Anxiety In Patients Research Articles

Assessment of Dental Anxiety and its Correlation with Denture Satisfaction in Edentulous Patients

The objectives of this study were to measure the level of dental anxiety and its correlation with dental history, denture satisfaction and other variables. A cross-sectional study was conducted on 150 completely edentulous patients reporting to the Department of Prosthodontics, KLES's Institute of Dental Sciences, Belgaum, over a period of 17 months (August 2005 to March 2007). The anxiety level of the patients was assessed with the help of a questionnaire, after obtaining an informed consent. Reliability of the dental anxiety scale was assessed by means of coefficient alpha. The results of this study concluded that dental anxiety scale for edentulous patients was a reliable scale for measuring dental anxiety. The anxiety score was higher for female than male patients. A significant correlation was found between denture satisfaction score and anxiety. Anxiety plays a major role in denture satisfaction. The variables included: Previous denture experience, occupation, medical history, age, gender, dental anxiety scale, period of edentulousness, age of previous dentures, number of complete dentures, denture satisfaction score, and the score on the Hamilton anxiety scale. The study indicated that gender correlates significantly with dental anxiety. Patients with medical history were found to be more anxious than normal patients. Patients with higher anxiety values were less satisfied with the treatment. Lastly, subjects with higher general anxiety showed greater values on the dental anxiety scale. The assessment of dental anxiety will help the prosthodontist in the management of anxious patients and secondly to provide evidence-based research into this psychological construct which has been shown to predict dental avoidance.

Relationship between anxiety and dyspnea on exertion in patients with chronic obstructive pulmonary disease

Dyspnea limits exercise in patients with chronic obstructive pulmonary disease (COPD) and is known to induce anxiety. Little is known whether anxiety contributes to exercise-induced dyspnea, which in turn might influence the outcome of diagnostic tests. The aim of the present study was to examine the relationship between general anxiety and dyspnea on exertion in patients with COPD. Ninety patients with stable COPD participated; 44 men, mean age 61 (standard deviation (SD) 10.4), and mean forced expiratory volume in 1 second (%pred.) 40.5 (SD 16.9). All participants performed pulmonary function tests and an incremental cycle ergometry. The Modified Borg Scale was used to measure the level of dyspnea on exertion. Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale. Data were analyzed using Spearman's correlations and multivariate regression. Dyspnea on exertion was correlated with general anxiety (r=.31), age (r=–.30), and exercise capacity (r=.27). Regression analysis showed that general anxiety was associated with dyspnea on exertion, adjusted for sex, age, baseline dyspnea, and exercise capacity. Consequently, it is reasoned that results of exercise training and activities in daily living may be influenced negatively by anxiety-worsened dyspnea. Attention should be given to anxiety management in patients with COPD to optimize exercise training.

Epidemiology and Management of Anxiety in Patients with Bipolar Disorder

Epidemiological and clinical studies have reported a high prevalence of anxiety symptoms in bipolar disorder, either in manic or depressive episodes, although these symptoms do not always meet criteria for a specific anxiety disorder. In addition to anxiety symptoms, bipolar disorder frequently presents with co-morbid axis I conditions, with anxiety disorders being the most common co-morbidity. Therefore, the objective of this article is to review clinical and epidemiological studies that have investigated the association between bipolar disorder and anxiety. Available data on the efficacy of treatments for bipolar disorder and co-morbid anxiety disorders are also reviewed. Existing guidelines do recognize that co-morbid anxiety has a negative impact on the course and outcome of bipolar disorder; however, there have been very few double-blind, controlled trials examining the treatment response of patients with bipolar disorder and co-occurring anxiety disorders. There is some positive evidence for quetiapine, olanzapine in combination with fluoxetine or lithium, and lamotrigine with lithium, and negative evidence for risperidone. Other therapies used for bipolar disorder, including several mood stabilizers, antidepressants, atypical antipsychotics and benzodiazepines, have been shown to reduce anxiety symptoms, but specific data for their effects in patients with anxiety symptoms co-morbid with bipolar disorder are not available. The co-occurrence of anxiety and bipolar disorder has implications for diagnosis, clinical outcome, treatment and prognosis. Careful screening for co-morbid anxiety symptoms and disorders is warranted when diagnosing and treating patients with bipolar disorder.

State‐of‐the‐art: anxiety management in patients with implantable cardioverter defibrillators

AbstractThrough large‐scale clinical trials, the implantable cardioverter defibrillator (ICD) has been established as the treatment of choice for primary and secondary prevention of sudden cardiac death. Although the ICD offers a confirmed mortality benefit, it may incite psychological adjustment issues within recipients. The most predominant form of psychological morbidity for ICD patients is anxiety. The prevalence of anxiety is well documented within the context of cardiac patients; however, ICD recipients often present with device‐specific concerns, including shock and death anxiety. Therefore, the interventions for these patients must be tailored to their unique concerns. This article will discuss forms and manifestations of anxiety within the ICD patient population, followed by an exploration of the components of psychosocial interventions found to be effective with these patients. Copyright © 2008 John Wiley & Sons, Ltd.

Anxiety and anxiety management in patients with implanted cardioverter-defibrillators

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Anxiety among clients for plastic surgery.

A beautiful face, lithe body, and appealing genitalia are alluring in Western Society. Plastic surgery to repair a defect or improve sexual appeal often elicits the patient's anxiety as well as excitement. The health care professional's empathic and therapeutic support is essential to improving post surgical recovery. The effectiveness of outcome and patient satisfaction often rest on how well the surgery meets the patient's needs. Anxiety is a major factor that influences whether patients have realistic expectations for surgery and whether the patient needs constant reassurance and support from the nurse. The nurse needs to use scientific knowledge and strategies for screening, assessment, and management of anxious patients. Depending on their level of anxiety, patients benefit from diverse nursing interventions to treat anxiety, provide resources, and recommend referrals for those with anxiety disorders.

Exposure and response prevention reduced obsessive compulsive disorder symptoms

Lindsay M, Crino R, Andrews G. Controlled trial of exposure and response prevention in obsessive-compulsive disorder. Br J Psychiatry 1997 ; 171 : 135 –9 [OpenUrl][1][Abstract/FREE Full Text][2] To compare...

Predicting outcome after treatment for generalised anxiety disorder

A previous paper, Butler and Anastasiades ( Behaviour Research and Therapy 26, 531–534, 1988) presented evidence for three reliable predictors of response to Anxiety Management in patients with generalised anxiety disorder. It was argued there that these reflected severity of anxiety, demoralisation and depression. A second study (Butler, Fenneil, Robson & Gelder, Journal of Consulting and Clinical Psychology, 59, 167–175, 1991) has compared two treatments for GAD: Behaviour Therapy and Cognitive Behaviour Therapy. Data from this study is used here to answer two questions: (i) do the same three variables predict outcome in the second study? The answer to this question is ‘no’; and (ii) which variables contribute to prediction of outcome when these two treatments are compared? Information presented here suggests that this depends partly on the nature of the treatment given. Outcome after behaviour therapy is predicted by initial levels of anxiety only, but the gains made are also relatively modest. Outcome after cognitive behaviour therapy is predicted by the degree to which ambiguous (external) information is interpreted as threatening. Thus a cognitive variable contributes reliably to the prediction of outcome after a cognitive treatment, but does not predict in the same way to outcome after a behavioural treatment.

Predicting response to anxiety management in patients with generalised anxiety disorders

This paper describes the analysis of predictive factors in a group of generally anxious patients treated with anxiety management. Evidence for three reliable predictors is presented. It is argued these reflect anxiety, demoralisation and depression. The same three variables contributed to prediction of outcome after treatment and 6 months later, and their pre-treatment values classified 80% of the patients correctly into good or poor responders. Lower initial levels of anxiety and demoralisation together with higher depression rated by the assessor predicted a better outcome. Predictions were more accurate for patients with a mild degree of depression than for those who were not depressed.

Anxiety and epinephrine in multiparous women in labor: Relationship to duration of labor and fetal heart rate pattern

The duration of labor in multigravid subjects in phase 1 labor at term (from 3 to 6 cm of cervical dilatation; mean duration = 2.7 hours) was significantly related to measures of plasma epinephrine and norepinephrine obtained at the onset of the phase (n = 50). Epinephrine was significantly related to observer ratings of subject stress and the scores from the three dimensions of our self-report Labor Anxiety Inventory. The fetal heart rate pattern in phase 2 labor (7 to 10 cm of cervical dilatation; mean duration = 1.2 hours) was significantly related to phase 1 measures of epinephrine, observed stress, and two of the anxiety dimensions (n = 44 to 47). The results provide support for the hypotheses that, under normal clinical conditions, several types of patient anxiety are related to catecholamine levels and that anxiety and epinephrine are related to duration of labor and fetal well-being. The results suggest that medical/nursing evaluation and management of patient anxiety should include a self-report measure of three dimensions of anxiety (coping, safety, and pain), which are relatively independent of observed physical stress and which may relate to maternal labor progress as well as fetal heart rate pattern.

Are all benzodiazepines clinically equivalent?

Since the introduction of chlordiazepoxide in the late 1950's and then diazepam shortly thereafter, the use of benzodiazepines in medicine has proliferated, reaching a peak and then plateauing a few years ago. The number of available benzodiazepines has continued to proliferate for a number of reasons. Thus, the so-called short-acting or short half-life compounds have been promoted commercially as advantageous over the compounds producing a number of metabolites and thus having a longer half-life. 1. 1. Clinical observations are not always consistent with laboratory findings where half-life or pharmacokinetics do not always correlate with pharmacodynamics, ie. clinically effective duration of action. 2. 2. The parent compound, chlordiazepoxide, was observed to have anticonvulsant, anxiolytic, muscle relaxant properties to varying degrees. Subsequently, diazepam seemed to exert a greater potency in these three areas. 3. 3. The final metabolite, oxazepam, has been observed to have a different therapeutic profile. The advent of the triazolo compounds brought a new dimension to benzodiazepine treatment both in primary and side effects. 4. 4. The relationship between blood levels and clinical efficacy is considered in the light of clinical observations as well as in the perspective of clinical management. Problems of tolerance and escalation of dosage must be addressed in the administration of these drugs where the confluence of pharmacokinetic and pharmacodynamic findings may serve as a guide in he management of anxious patients.

Psyche and blood pressure; 100 mental stress tests and 50 personality surveys in patients with essential hypertension.

The psyche may be a participating or a precipitating factor in patients with hypertension for one of the following reasons: 1. The blood pressure varies upward with conscious mental or emotional tension and downward with conscious mental relaxation or calm. 2. Specific emotional abnormalities sometimes are associated with hypertension, and when these abnormalities are relieved the hypertension regresses. 3. Induced mental or emotional stress may be associated with elevation in the blood pressure, perturbation of renal blood flow and alteration in other dynamics of the circulation in normal persons and patients with hypertension. 4. Appropriate management of anxiety in patients with hypertension appears to modify favorably the subjective and possibly the objective condition of the patient while failure to deal successfully with anxiety or disregard of it appears to be associated with unfavorable progress both subjectively and objectively. 5. Certain personality patterns or habitual reactions may be characteristic of patients