Mild Anxiety Symptoms Research Articles

Gender differences in the relationship between anxiety symptoms and physical inactivity in a community-based sample of adults with type 2 diabetes.

To examine the association between physical inactivity and anxiety symptoms in a community-based sample of men and women with type 2 diabetes mellitus. Eligibility criteria included residents of Quebec, Canada aged between 40 and 75 years, having a diagnosis of type 2 diabetes (≤10 years), being insulin-naive and having participated in a previous telephone-based survey of diabetes treatments. Of the 2028 eligible respondents, 1953 (96.3%) provided information on anxiety symptoms and were included in this analysis. Participants were interviewed and provided information on diabetes-related clinical and sociodemographic factors. A total of 27.3% of participants reported being physically inactive. The prevalence of mild to severe anxiety symptoms was 22.9%. Persons with mild anxiety symptoms and moderate to severe anxiety symptoms were 1.4 times and 1.7 times more likely to report being inactive than persons without anxiety symptoms, respectively. Subgroup analyses according to gender revealed that women who had mild anxiety symptoms were 1.5 times more likely to report being inactive compared with women who did not have anxiety symptoms, whereas men who had moderate to severe anxiety symptoms were 2.5times more likely to be inactive than men who did not have anxiety symptoms. Anxiety symptoms in the mild and moderate to severe range are a relevant clinical comorbidity in persons with type 2 diabetes, and men may represent a particularly vulnerable subgroup. Future research is recommended to further assess the relationship between anxiety symptoms and diabetes-related health behaviours.

Depression and Anxiety Trajectories among Women Who Undergo an Elective Cesarean Section

BackgroundDepression and anxiety are important mood changes in childbearing women. However, changes in depression and anxiety over time in women who undergo an elective cesarean section (CS) have not yet been elucidated. We aimed to characterize the trajectories of depressive and anxiety symptoms, and patterns of co-occurrence, and examined the associated predictors of depression and anxiety courses.MethodsA prospective longitudinal study of childbearing women (N = 139) who underwent a CS was conducted. Depressive and anxiety symptoms were respectively assessed using the Edinburgh Postnatal Depression Scale and State Anxiety Inventory, in the third trimester and at 1 day, 1 week, and 1 and 6 months postpartum.ResultsGroup-based modeling identified three distinct trajectories of depressive symptoms: group 1 (low, 30.9%), group 2 (mild, 41.7%), and group 3 (high, 27.3%). Four group trajectories of anxiety symptoms were identified: group 1 (low, 19.4%), group 2 (mild, 44.6%), group 3 (high, 28.8%), and group 4 (very high, 7.2%). Mild symptoms of both depression and anxiety were the most common joint trajectory. Depression trajectories were significantly related to anxiety trajectories (p<0.001). Predictors of the joint trajectory included the pre-pregnant body mass index (odds ratio (OR): 2.42, 95% confidence interval (CI): 1.1∼6.3) and a poor sleep score (OR: 3.2, 95% CI: 1.4∼7.3) in the third trimester.ConclusionsDistinctive trajectories and co-occurrence patterns of depressive and anxiety symptoms were identified. Our findings suggest a need for greater attention to continuous assessment of psychological well-being among women who undergo an elective CS.

Maternal Stress and Psychological Status and Sleep in Minority Preschool Children

Minority women living in inner city environments may be at more risk for psychological distress. Maternal stress, anxiety, depression, and psychological trauma can influence the preschool child's behavior and may have a negative impact on the preschool child's sleep patterns. The purpose of the study was to: (a) examine objective and subjective preschool children sleep patterns and (b) explore the relationship between objective and subjective sleep patterns in preschool children and maternal psychological status. A cross-sectional observational design was used. Descriptive analyses and correlations were conducted to examine the data. Twenty-one minority women were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children Program. Preschool children wore wrist actigraphs, and their sleep efficiency, time in bed, and sleep periods were analyzed. Mothers completed measures on depression, anxiety, stress, and psychological trauma. Mothers' self-report of their children's sleep habits indicated at risk scores for sleep problems. Life stress in the mothers was statistically significant and negatively related to preschool child's sleep duration. Mild to severe symptoms of depression and mild anxiety were reported and criteria for Post Traumatic Stress Disorder were found in 12 of the 21 mothers. The results of the study indicate that parent education on sleep and the minority preschool child should be part of community interventions and screening preschool parents for psychological distress should be considered with referrals for support services.

A feasibility open trial of internet-delivered cognitive-behavioural therapy (iCBT) among consumers of a non-governmental mental health organisation with anxiety

Background. To date the efficacy and acceptability of internet-delivered cognitive behavioural treatments (iCBT) has been examined in clinical trials and specialist facilities. The present study reports the acceptability, feasibility and preliminary efficacy of an established iCBT treatment course (the Wellbeing Course) administered by a not-for-profit non-governmental organisation, the Mental Health Association (MHA) of New South Wales, to consumers with symptoms of anxiety.Methods. Ten individuals who contacted the MHA’s telephone support line or visited the MHA’s website and reported at least mild symptoms of anxiety (GAD-7 total scores ≥5) were admitted to the study. Participants were provided access to the Wellbeing Course, which comprises five online lessons and homework assignments, and brief weekly support from an MHA staff member via telephone and email. The MHA staff member was an experienced mental health professional and received minimal training in administering the intervention.Results. All 10 participants completed the course within the 8 weeks. Post-treatment and two month follow-up questionnaires were completed by all participants. Mean within-group effect sizes (Cohen’s d) for the Generalized Anxiety Disorder 7 Item (GAD-7) and Patient Health Questionnaire 9 Item (PHQ-9) were large (i.e., > .80) and consistent with previous controlled research. The Course was also rated as highly acceptable with all 10 participants reporting it was worth their time and they would recommend it to a friend.Conclusions. These results provide support for the potential clinical utility of iCBT interventions and the acceptability and feasibility of employing non-governmental mental health organisations to deliver these treatments. However, further research is needed to examine the clinical efficacy and cost-effectiveness of delivering iCBT via such organisations.

Assessing the Metabolic Effects of Aromatherapy in Human Volunteers

Aromatherapy, a form of complementary and alternative medicine (CAM) that uses essential oils through inhalation, is believed to enhance physical and spiritual conditions. Although clinical studies suggest that the use of essential oils may have therapeutic potential, evidence for the efficacy of aromatherapy in treating medical conditions remains poor, with a particular lack of studies employing rigorous analytical methods that capture its identifiable impact on human biology. Here, we report a comprehensive metabolomics study that reveals metabolic changes in people after exposed to aroma inhalation for 10 continuous days. In this study, the metabolic alterations in urine of 31 females with mild anxiety symptoms exposed to aerial diffusion of aromas were measured by GC-TOF-MS and UPLC-Q-TOF-MS analyses. A significant alteration of metabolic profile in subjects responsive to essential oil was found, which is characterized by the increased levels of arginine, homocysteine, and betaine, as well as decreased levels of alcohols, carbohydrates, and organic acids in urine. Notably, the metabolites from tricarboxylic acid (TCA) cycle and gut microbial metabolism were significantly altered. This study demonstrates that the metabolomics approach can capture the subtle metabolic changes resulting from exposure to essential oils, which may lead to an improved mechanistic understanding of aromatherapy.

Migraine and psychiatric comorbidities among sub-saharan african adults.

Despite being a highly prevalent disorder and substantial cause of disability, migraine is understudied in Africa. Moreover, no previous study has investigated the effects of stress and unipolar psychiatric comorbidities on migraine in a sub-Saharan African cohort. To evaluate the prevalence of migraine and its association with stress and unipolar psychiatric comorbidities among a cohort of African adults. This was a cross-sectional epidemiologic study evaluating 2151 employed adults in sub-Saharan Africa. A standardized questionnaire was used to identify sociodemographic, headache, and lifestyle characteristics of participants. Migraine classification was based on the International Classification of Headache Disorders-2 diagnostic criteria. Depressive, anxiety, and stress symptoms were ascertained with the Patient Health Questionnaire and the Depression Anxiety Stress Scale, respectively. Multivariable logistic regression models were used to estimate adjusted odds ratio (OR) and 95% confidence intervals (CIs). A total of 9.8% (n=212) of study participants fulfilled criteria for migraine (9.8%, 95% CI 8.6-11.1) with a higher frequency among women (14.3%, 95% CI 11.9-16.6) than men (6.9%, 95% CI 5.5-8.3). Similar to predominantly Caucasian migraine cohorts, sub-Saharan African migraineurs were more likely to be younger, have a lower education, and more likely to report a poor health status than non-migraineurs. However, in contrast with historical reports in predominantly Caucasian migraine cohorts, sub-Saharan African migraineurs were less likely to report smoking than non-migraineurs. Participants with moderately severe depressive symptoms had over a 3-fold increased odds of migraine (OR=3.36, 95% CI 1.30-8.70) compared with those classified as having minimal or no depressive symptoms, and the odds of migraine increased with increasing severity of depressive symptoms (P trend<0.001). Similarly, those with mild, moderate, and severe anxiety symptoms had increased odds of migraine (OR=2.28, 95% CI 1.24-4.21; OR=1.77, 95% CI 0.93-3.35; and OR=5.39, 95% CI 2.19-13.24, respectively). Finally, those with severe stress had a 3.57-fold increased odds of migraine (OR=3.57, 95% CI 1.35-9.46). Although historically it has been reported that migraine prevalence is greater in Caucasians than African Americans, our study demonstrates a high migraine prevalence among urban-dwelling Ethiopian adults (9.9%) that is comparable with what is typically reported in predominantly Caucasian cohorts. Further, among employed sub-Saharan African adults and similar to predominantly Caucasian populations, migraine is strongly associated with stress and unipolar psychiatric symptoms. The high burden of migraine and its association with stress and unipolar psychiatric symptoms in our study of well-educated and urban-dwelling African adults has important clinical and public health implications pending confirmation in other African populations.

Symptoms of depression and anxiety and adherence to antihypertensive medication.

Nonadherence to drug treatment is a major contributor to antihypertensive treatment failure. Mood disorders could impair the patient's desire and ability to follow physician's recommendations. We evaluated the role of symptoms of depression and anxiety on adherence to antihypertensive drug treatment. We conducted a longitudinal cohort study in 20-70 years old patients starting antihypertensive drug treatment, without other chronic conditions, and not taking mood-modifying drugs. Severity of symptoms of depression and anxiety were evaluated at enrollment and 3, 6, 9, and 12 months of follow-up, using the Beck depression inventory-II (BDI-II) and the psychological general well-being index (PGWB), respectively. Treatment adherence was measured by pill count. Nonadherence was defined as taking <80% of the prescribed number of pills. Poisson regression was used to model the association of the exposures with adherence. We enrolled 178 patients (58% male; mean age: 50 years; 508 follow-up visits). The risk of nonadherence was 52.6% in 12 months (95% confidence interval (CI): 46.1, 59.1). After adjusting for other risk factors, individuals with at least mild depression (BDI-II ≥14) and those with at least mild anxiety (PGWB anxiety score <22) were 2.48 (95% CI: 1.47, 4.18) and 1.59 (95% CI: 0.99, 2.56) times more likely to become nonadherent in the following 3 months, respectively. Patients with at least mild anxiety and depression symptoms are at increased risk of becoming nonadherent to antihypertensive medication. Screening for depression and anxiety symptoms could be used to identify high-risk patients. Further evidence is needed to elucidate whether interventions targeting these conditions improve adherence.

P-914 - Can mood instability replace neurosis as an explanatory concept: a replication

Introduction We recently reported (EPA 2011) that one factor of the Eysenck Neuroticism Scale (EPI-N) represents Mood Instability (MI) that was a significant predictor of suicidal thoughts. Aims To increase our understanding of MI in psychological distress we examined a national sample with longitudinal follow-up: Objectives 1. To determine whether factor analysis of the EPI-N scale yields a MI factor. 2. To determine whether the MI factor predicts psychological well-being at follow-up. Methods British Health and Lifestyle survey (1984) (N = 6,124) individuals that completed both of the following questionnaires. 3,232 individuals were followed in 1991–92. Eysenck Personality Inventory consists of 57 items that includes the EPI-N with 24 items. The General Health Questionnaire (GHQ) is a 30-item scale used to measure psychological distress in the community. The EPI-N was factor analyzed and the extracted factors were entered as predictors of GHQ (1991) in a linear regression model, while controlling for baseline (1984) GHQ score and important physical health and socio-demographic variables. Results We replicated the 3 factors of the EPI-N, the second factor represented MI. The other two factors represented mild symptoms of anxiety and depression. The 3 EPI-N factors (Including the MI factor), GHQ, hypertension and forced expiratory volume (1984) predicted GHQ (1991). Age, sex, marital status, occupational class, and household income were not predictors. Conclusions MI is the salient and distinct feature of neuroticism. MI may be a more clinically and empirically useful concept than “neuroticism” and is a fertile subject for clinical and basic research.

Hypomania as a Genuine Side Effect of Fluoxetine

Hypomania as a Genuine Side Effect of Fluoxetine

Do we have an alternative for the Rome III gastroduodenal symptom-based subgroups in functional gastroduodenal disorders? A cluster analysis approach

Functional dyspepsia (FD) is a heterogeneous biopsychosocial disorder. The Rome III consensus proposed a subdivision into epigastric pain syndrome and postprandial distress syndrome, based on gastroduodenal symptom pattern only; nausea/vomiting- and belching disorders were classified as separate functional gastroduodenal disorders (FGD). We aimed to investigate an alternative subdivision of FGD, taking into account gastric sensorimotor function, anxiety & depression and 'somatization', besides gastroduodenal symptoms. Gastroduodenal symptom data were available for 857 consecutive FGD patients (Rome II criteria). In a subsample (n=259), additional data were obtained on gastric sensitivity, anxiety, depression and 'somatization'. Two separate cluster analyses were performed. In analysis 1, clustering was based on individual gastroduodenal symptom scores. In analysis 2, gastric sensitivity, anxiety & depression and 'somatization', besides total gastroduodenal symptoms score, were used for clustering. Analysis 1 identified four clusters, largely supporting the Rome III classification, with early satiation, pain and nausea/vomiting clusters, besides a limited severity cluster (R(2) = 0.32). Analysis 2 suggested a five-cluster solution (R(2) = 0.48). Anxiety, depression and 'somatization' were the most important variables separating the clusters. 'Primary somatization' (with low psychiatric symptom levels) as well as 'secondary somatization' (with high anxiety & depression scores) subgroups were identified, besides three other subgroups characterized by psychiatric/gastroduodenal symptoms, mild anxiety symptoms and limited overall severity, respectively. We propose an alternative to the current subgrouping in FGD that is exclusively based on gastroduodenal symptoms. This may have consequences for future classification of FGD, as well as broader relevance towards the debate on subgrouping 'functional somatic syndromes'.

P02-415 - The relationship of mood instability to neuroticism and suicidal thoughts

IntroductionMany patients with depression mention sudden short “mood swings” (MI) when asked. MI is distressing but little is known about its relationship to personality disorders, depression and suicidal thoughts.ObjectivesTo determine the relationship between mood instability (MI), neuroticism, and suicidal thoughts.AimsTo deconstruct the concept of neuroticism to determine whether MI is an important component. To determine whether MI predicts suicidal thoughts.Methods129 patients with Major Depression were interviewed with the MINI diagnostic interview. They also completed the Eysenck Neuroticism Scale (ENS), Beck Depression Inventory (BDI), Mood Disorders Questionnaire (MDQ), Perceived Stress Scale (PSS), Affective Lability Scale (ALS), Beck Suicide Scale (BSS) and 5 questions describing mood swings and its effects on behaviour.ResultsIn a regression analysis with the BSS as the dependent variable, with age and sex controlled, and all of the other variables entered, only the BDI (p &lt; 0.001) and the ALS (p &lt; 0.01) were significant predictors. In an exploratory factor analysis of the ENS, 3 main factors (53% of variance) emerged. 2 of the factors consisted of mild anxiety and depression symptoms. The third factor (16% variance) was a mood instability factor. The ALS and the ENS both correlated with the 5 questions describing mood swings, but the correlations with the ALS were stronger.ConclusionsMood Instability is the unique component of neuroticism. MI (ALS) predicts suicidal thoughts along with the broad concept of depression (BDI). In this model, neuroticism (ENS) is not a predictor.

P52 Is a pulmonary rehabilitation (PR) programme effective in reducing severe symptoms of anxiety and depression in patients with COPD?

IntroductionPatients with COPD have a high prevalence of anxiety and depression which has been associated with poorer health outcomes. PR has been found to be successful in reducing anxiety and...

Reasons and Determinants for Not Receiving Treatment for Common Mental Disorders

Reasons and Determinants for Not Receiving Treatment for Common Mental Disorders

Reasons and Determinants for Not Receiving Treatment for Common Mental Disorders

This study focused on patients in the general population whose anxiety or depressive disorder is untreated. It explored reasons for not receiving treatment and compared four groups of patients-three that did not receive treatment for different reasons (no problem perceived, no perceived need for care, and unmet need for care) and one that received treatment-regarding their predisposing, enabling, and need factors. Cross-sectional data were used for 743 primary care patients with current anxiety or depressive disorder from the Netherlands Study of Depression and Anxiety (NESDA). Diagnoses were confirmed with the Composite International Diagnostic Interview. Patients' perception of the presence of a mental problem, perceived need for care, service utilization, and reasons for not receiving treatment were assessed with the Perceived Need for Care Questionnaire. Forty-three percent of the respondents with a six-month anxiety or depression diagnosis did not receive treatment. Twenty-one percent of all respondents with depression or anxiety expressed a need for care but did not receive any. Preferring to manage the problem themselves was the most common reason for respondents to avoid seeking treatment. There were no significant differences in clinical need factors between treated patients and untreated patients with a perceived need for care. Compared with patients in the other two untreated groups, untreated patients with a perceived need for care were more hindered in regard to symptom severity, functional disability, and psychosocial functioning. General practitioners should pay considerable attention to patients whose need for care is unmet. Furthermore, findings support the implementation of patient empowerment in mental health care in order to contribute to easily accessible and patient-centered care.

Correlates of symptoms of depression and anxiety in chronic hemodialysis patients

Objective Little is known about the demographic, clinical and laboratory variables which may be correlated with symptoms of depression and anxiety in hemodialysis (HD) patients. The present study aimed at evaluating such correlation in HD patients treated at a single HD center in a Mediterranean country. Methods Eighty HD patients were assessed for depression and anxiety with the Beck Depression Inventory (BDI) and the Hamilton Anxiety Rating Scale (HARS). The scores of BDI and HARS were correlated with demographic, clinical and laboratory variables. Results Based on the Beck Depression Inventory, 38 patients had no symptoms of depression and 42 had symptoms of depression. Based on the HARS, three patients had no symptoms of anxiety and 38 had mild symptoms of anxiety, whereas moderate or severe symptoms of anxiety were present in 39 patients. In univariate analysis, BDI score correlated significantly with age, the Charlson Comorbidity Index, SF-36 Vitality Subscale, Mini-Mental Status Examination, creatinine, albumin, plasma 25-hydroxy vitamin D and interleukin-6 (IL-6) levels. HARS score correlated significantly with age, Charlson Comorbidity Index, SF-36 Vitality Subscale and parathyroid hormone (PTH) levels. In the multivariate analysis, a direct and an inverse correlation between BDI and IL-6 [ P=.042, OR=1.31 (95% CI=1.01–1.71)] and creatinine [ P=.050, OR=0.73 (95% CI=0.54–1.00)] was observed. With regard to HARS, only a direct correlation with Charlson Comorbidity Index [ P<.001, OR=1.55 (95% CI=1.22–1.96)] was found. Conclusion Although numerous demographic, clinical and laboratory variables correlated with BDI and HARS in univariate analysis, the multivariate regression analysis showed only a direct correlation between BDI and IL-6 [ P=.042, OR=1.31 (95% CI=1.01–1.71)] and an inverse correlation between BDI and creatinine [ P=.050, OR=0.73 (95% CI=0.54–1.00)] and a direct correlation between HARS and the Charlson Comorbidity Index [ P<.001, OR=1.55 (95% CI=1.22–1.96)].

Symptoms of Anxiety and Depression Among Teens and Adults in the Thalassemia Longitudinal Cohort Study.

Abstract 555 Background and Significance:Individuals with chronic medical conditions are vulnerable to symptoms of anxiety and depression. Promoting healthy emotional functioning is important not only to psychological well-being, but also to physical health as it has been shown to impact adherence to medical regimens. Thalassemia is an inherited blood disorder which requires lifelong intervention and may be associated with treatment and disease-related complications that impact both the length and quality of life for most who are affected.While several studies have examined the prevalence of anxiety and depressive symptoms in patients with thalassemia, most have been conducted with small, homogeneous samples of children. In addition, the one study which examined psychological adjustment in adults included patients from only one medical center (Messina et al.; Intern Emerg Med, 3:339, 2008). Further, few studies have examined demographic, medical, and psychosocial variables possibly correlated with the occurrence of these symptoms. Understanding the factors that are related to the experience of depressive and anxiety symptoms may help us to identity individuals at risk and help in developing targeted interventions.The current study aimed to (1) determine the prevalence of depressive and anxiety symptoms in adolescent and adult patients with thalassemia; and (2) explore possible demographic, medical, and psychosocial correlates of these symptoms. Specifically, we hypothesized that (1) anxiety and depressive symptoms in this sample would be similar to the rates of these symptoms in individuals diagnosed with other chronic medical conditions and higher than in individuals without chronic medical conditions; (2) symptoms of depression and anxiety would be inversely correlated with measures of adherence (i.e., subjective report, ferritin); and (3) symptoms of depression and anxiety would be inversely correlated with functional health and well-being. Method:Data on quality of life and mental health self assessments were collected as part of the Thalassemia Longitudinal Cohort (TLC), a multi-center multinational study conducted by the NHLBI-sponsored Thalassemia Clinical Research Network. The current analysis included 281 participants (14-58 years old, M age=27.83; 52% female) who completed the Hospital Anxiety and Depression Scale (HADS), a 14-item questionnaire examining presence of anxiety and depression symptoms. Participants also completed a measure of functional health and well-being (SF-36), as well as questions related to adherence to their medical regimen. In addition, as part of the larger TLC study, medical data such as ferritin and method of chelation was collected. Results:32% of participants indicated experiencing at least mild symptoms of anxiety and 11% at least mild symptoms of depression. While these rates are higher than rates of symptoms of depression and anxiety found in the general population, they are similar to rates found in other groups with chronic illness (e.g., diabetes). Older age, female gender, and chelation with deferoxamine (as compared to deferasirox) were factors that were significantly associated with anxiety and/or depression and were statistically controlled for in subsequent analyses. Symptoms of depression, but not anxiety, were inversely correlated with subjective reports of adherence (p<.05), although not with ferritin levels. However, a significant correlation in the expected direction between subjective report of adherence and ferritin was found (p<.01). Finally, as hypothesized, both symptoms of depression and anxiety were significantly and negatively correlated with functional health and well-being (p<.0001). Conclusion:While the majority of patients with thalassemia do not report significant symptoms of anxiety and depression, the rates are higher than in the general population. Given that symptoms of anxiety and depression were associated with poor adherence and lower functional health and well-being, regular screening for anxiety and depression symptoms could help to identify at risk individuals in order to provide them with appropriate psychological support with the goal of improving both emotional and physical health. Disclosures:Porter:Novartis: Research Funding. Thompson:Novartis: Research Funding. Neufeld:Novartis: Research Funding.

Violent sleepwalking in a general hospital ward: a case report

th night of bad sleep, A. stood up, started to vigorously batter another accompanying mother (Mrs. B.) with a blanket and tried to strangle her. The nurses found A. with a blank stare and tried to wake her up. A. was confused for about three minutes and started crying. Before the event, A. and B. had had a good relationship. Two days after this episode, A. was sleeping during the afternoon when she suddenly stood up and vigorously shook her daughter’s bassinet being witnessed by other person in the ward. After wakening up the confused mother, the psychiatric consultationliaison was called. A. vaguely remembered fragmentary dream images of a fight for her life at the first event and an assault attempt at the second. She denied previous major psychiatric disorders or treatment, seizures, use of medication, alcohol or drugs abuse but affirmed SW through her eleven to thirteen years of age. Since ten months after her husband’s death, A. had had repeated screaming night arousals. She presented with mild anxiety symptoms and normal EEG. Clonazepam 1mg per night was prescribed, with good improvement of sleep and no recurrence of confusional arousals. Her 16-channel polysomnographic study revealed only fragmented sleep with excessive movements on the bed, but inconclusive for parasomnias.

Improvements in patient-reported outcomes in moderate-to-severe psoriasis patients receiving continuous or paused etanercept treatment over 54 weeks: the CRYSTEL study

To assess patient-reported outcomes (PRO) in patients with moderate-to-severe plaque psoriasis receiving continuous or paused etanercept treatment. In a multicentre European open-label study, one group (n = 352) received continuous therapy: 25 mg subcutaneously (SC) twice weekly (BIW) throughout 54-weeks. The other group (n = 359) received paused therapy: 50 mg SC BIW (<or= 12 weeks) until response was adequate by Physician Global Assessment; after psoriasis returned, retreatment (25 mg BIW) was begun. PRO included the Dermatology Life Quality Index (DLQI), EuroQoL-5D (EQ-5D), Hospital Anxiety and Depression Scale (HADS), and the SF-36 Vitality subscale. At baseline, mean DLQI for patients in the continuous (12.8) and paused group (13.8), indicated significant quality-of-life impairment; mean EQ-5D utility scores were 0.65 and 0.66 for continuous and paused patients, respectively; 30.0% of continuous and 37.0% of paused patients had at least mild symptoms of depression; 40.2% and 48.6%, respectively, had at least mild symptoms of anxiety. At week 54, both groups showed statistically significant (P < 0.05) and meaningful improvement in DLQI and EQ-5D scores; improvements in HADS-D, HADS-A, and SF-36 vitality were also significant. Improvements in DLQI and EQ-5D were significantly greater in the continuous arm than the paused arm, but the differences were not meaningful. Differences between arms in HADS and SF-36 Vitality at week 54 were not significant. At baseline, patients exhibited significant quality-of-life impairment. Both continuous and paused etanercept treatment provided improvements in PRO measures. Either regimen could be considered and care should be individualized.

Psychopathology and Clinical Features in an Italian Sample of Patients with Myofascial and Temporomandibular Joint Pain: Preliminary Data

Aim of this study was to provide data on the relationships between psychopathological variables and temporomandibular disorders (TMD). Sixty-three TMD patients were investigated using clinical and anamnestical psychiatric informations and psychopathological measures. Three groups of TMD patients were recruited according to the Research Diagnostic Criteria for TMD guidelines: a group of patients presenting myofascial pain alone (RDC/TMD axis I group I), a group with temporomandibular joint (TMJ) pain alone (RDC/TMD axis I group IIIa, IIIb), and a group presenting both myofascial and TMJ pain. Two secondary groups were identified on the basis of the presence/absence of myofascial pain. The study design provided a psychiatric interview and psychometric assessment including the Symptom Check List-90-Revised (SCL-90-R), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS). --Psychiatric evaluation: Myofascial pain patients had higher scores for personal psychiatric history and a history of more frequent psychotropic drug use. --HDRS and HARS: The sample presented scores indicating mild depressive symptoms and moderate anxiety symptoms. --SCL-90-R: The global sample showed acute levels of psychological distress as measured by the GSI score (Global Severity Index). Myofascial pain patients scored higher than TMJ pain patients in the GSI (p = .028), PAR (paranoia; p = .015), PSY (psychoticism; p = .032), and HOS (hostility; p = .034) subscales. TMD patients showed elevated levels of depression, somatization, and anxiety. These characteristics did not differ significantly between patients with myofascial or TMJ pain. Other specific psychopathological dimensions, detected with SCL-90-R, appeared to be closely associated to the myofascial component.

Sleep-Related Hypomanic Symptoms as a Predictor of Bipolar Spectrum Disorders

Sir: Deciding whether to prescribe antidepressants for the depressed patients with bipolar spectrum disorders remains a challenge for clinicians. Two most-feared potential consequences of using antidepressants in patients with bipolar spectrum disorders are triggering a manic switch and/or generating a rapid cycling course of the disease.1 Experts have long tried to recognize the depressed patients who are at a greater risk for switching to mania; thus, several symptoms have been suggested as “soft signs” of bipolarity, including hypersomnia, psychomotor retardation, young age at onset of depression, family history of bipolar disorder, drug-induced hypomania, seasonality of the episodes, and diurnal variation of the symptoms.2 However, the list is not yet complete, and many cases still cannot be correctly predicted. As a result, clinical findings that could be used as new predictors of bipolar spectrum disorders could be helpful for future interventions. Case report. Ms. A was a 27-year-old married woman who experienced an aggravation of depressive and anxiety symptoms for 6 months beginning in August 2005. Symptoms included depressed mood, loss of interest, repeated crying spells, loss of concentration, insomnia, decreased appetite, irritability, worry, and preoccupation with death. Past history revealed no significant finding other than mild depressive and anxiety symptoms in the previous 4 years and no episodes of mania or hypomania. She had no suggestive symptoms for a bipolar spectrum disorder except for very brief periods (about 30 seconds) of euphoria and inflated self-esteem, which occurred just before falling asleep, in a semiconscious state between wakefulness and sleep. During these periods, she experienced an exuberant sense of power, and she believed that she was able to “move mountains.” Family history for bipolar disorder was negative. The patient met the criteria for major depressive disorder based on DSM-IV-TR and received 5 mg/day of citalopram (February 2006), and after 5 days, the dose was increased to 10 mg/day, in addition to 1.25 mg/day of alprazolam, in 3 divided doses. One week later, the patient showed significant improvement. In addition, alprazolam had reduced the sleep latency, and the patient did not experience or remember any sleep-related hypomanic symptoms. Instead, she reported having distinct periods of euphoria and talkativeness 15 to 20 minutes after taking each dose of alprazolam. These periods would happen after all doses of alprazolam and would completely resolve after about 10 minutes, and the patient would return to her depressed baseline. The patient did not experience any other side effects other than a mild sedation during the day. The alprazolam dose was reduced to 0.75 mg/day to decrease sedation and then tapered to complete cessation in the next 3 weeks, and citalopram was continued. Sleep-related hypomanic symptoms did not recur after reducing or discontinuing alprazolam. The patient was followed for 6 more months and remained euthymic (August 2006). Recent studies suggest that the lifetime prevalence of bipolar spectrum disorders in the general population is more than 6%,3 that is, much higher than what was previously speculated.2 It is also reported that about 12.5% of the patients initially diagnosed as having depression will be reclassified as having a bipolar spectrum disorder in their course of illness.4 This patient reported experiencing distinct brief periods of euphoria and inflated self-esteem before sleep onset, which could potentially be related to bipolar spectrum disorders. Even though we did not have enough evidence to accept it as a new soft sign of bipolar spectrum disorders before starting the medications, transient hypomanic symptoms induced by taking al-prazolam suggested that “sleep-related periods of euphoria” could be assumed as one of the predictors of bipolar spectrum disorders. We are aware that had the patient been followed without decreasing the dose of alprazolam, she might not have developed a bipolar disorder. Obviously, this could not be performed because of ethical considerations. Future studies could tell more about the diagnostic value and effect of each of the soft signs on the long-term course of the disease.