Mixed Anxiety Disorder Research Articles

Bipolar disorders in the new DSM-5 and ICD-11 classifications.

The DSM-5 and ICD-11 classifications, the latter still under development, are aimed at harmonizing the diagnoses of mental disorders. A critical review is presented in the issues that can converge or separate both classifications regarding bipolar disorders, and those conditions–included in depressive disorders–with special relevance for bipolar (e.g. major depressive episode). The main novelties include the incorporation of dimensional parameters to assess the symptoms, as well as the sub-threshold states in the bipolar spectrum, the consideration of new course specifiers such as the mixed symptoms, the elimination of mixed episodes, and a more restrictive threshold for the diagnosis of hypo/mania. The most noticeable points of convergence are the inclusion of bipolar II disorder in ICD-11 and the additional requirement of an increase in activity, besides mood elation or irritability, for the diagnosis of hypo/mania in both classifications. The main differences are, most likely keeping the mixed depression and anxiety disorder diagnostic category, maintaining bereavement as exclusion criterion for the depressive episode, and maintaining the mixed episode diagnosis in bipolar disorder in the forthcoming ICD-11. Since DSM-5 has already been published, changes in the draft of ICD-11, or ongoing changes in DSM-5.1 will be necessary to improve the harmonization of psychiatric diagnoses.

Bipolar disorders in the new DSM-5 and ICD-11 classifications

The DSM-5 and ICD-11 classifications, the latter still under development, are aimed at harmonizing the diagnoses of mental disorders. A critical review is presented in the issues that can converge or separate both classifications regarding bipolar disorders, and those conditions –included in depressive disorders–with special relevance for bipolar (e.g. major depressive episode). The main novelties include the incorporation of dimensional parameters to assess the symptoms, as well as the sub-threshold states in the bipolar spectrum, the consideration of new course specifiers such as the mixed symptoms, the elimination of mixed episodes, and a more restrictive threshold for the diagnosis of hypo/mania.The most noticeable points of convergence are the inclusion of bipolar II disorder in ICD-11 and the additional requirement of an increase in activity, besides mood elation or irritability, for the diagnosis of hypo/mania in both classifications. The main differences are, most likely keeping the mixed depression and anxiety disorder diagnostic category, maintaining bereavement as exclusion criterion for the depressive episode, and maintaining the mixed episode diagnosis in bipolar disorder in the forthcoming ICD-11. ConclusionSince DSM-5 has already been published, changes in the draft of ICD-11, or ongoing changes in DSM-5.1 will be necessary to improve the harmonization of psychiatric diagnoses.

Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.

BackgroundCollaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication).Methods and FindingsSystematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient −0.11, 95% CI −0.20 to −0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication.ConclusionTrials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.

Low baseline pCO2 predicts poorer outcome from behavioral treatment: Evidence from a mixed anxiety disorders sample

Low levels of end-tidal partial pressure of carbon dioxide (pCO2)—the amount of carbon dioxide measured from expired air—are commonly found in individuals with anxiety disorders but have not been examined as predictors of outcome from anxiety treatment. The current study examined pre-treatment baseline pCO2 as a predictor of outcome from cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. Sixty-one individuals with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defined principal anxiety disorder diagnosis completed 12 sessions of either CBT or ACT. Baseline pCO2 was measured prior to entering treatment. Self-reported anxiety symptoms and quality of life were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Low baseline pCO2 was associated with higher anxiety symptoms and lower quality of life across follow-up timepoints, above and beyond baseline symptom severity. These results suggest that low baseline pCO2 predicts poorer outcome from CBT and ACT for anxiety and may warrant treatment that directly addresses respiratory dysregulation.

Migraine headaches and mood/anxiety disorders in the ELSA Brazil.

To describe the relationship between mood/anxiety disorders and migraine headaches emphasizing the frequency of episodes based in a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health. It has been suggested that frequency of migraine headaches can be directly associated with the presence of psychiatric disorders. Migraine headaches (International Headache Society criteria) was classified as <1×/month, 1×/month-1×/week, 2-6×/week, and daily. Psychiatric disorders using the Clinical Interview Schedule - Revised were classified in 6 categories: common mental (CMD), major depressive (MDD), generalized anxiety (GAD), panic, obsessive-compulsive (OCD), and mixed anxiety and depressive (MADD) disorders. We performed multivariate logistic models adjusted for age, race, education, marital status, income, and use of selective serotonin reuptake inhibitors. In our sample, 1261 presented definite migraine and 10,531 without migraine headaches (reference). Our main result was an increase in the strength of association between migraine and MDD as frequency of migraine increased for all sample: odds ratio of 2.14 (95% confidence interval [CI] 1.33-3.43) for <1 episode of migraine/month to 6.94 (95% CI 4.20-11.49) for daily headaches for all sample. Significant associations with migraine were also found for GAD, OCD, MADD, and CMD for total sample: MDD, GAD, OCD, MADD, and CMD for women, and MADD and CMD for men. Among men with daily migraine complaint, we found a significant association between migraine and OCD after correction for multiple comparisons (odds ratio 29.86 [95% CI 4.66-191.43]). Analyzing probable and definite migraine cases together, we replicated the findings in a lower magnitude. The increase in migraine frequency was associated with progressively higher frequencies of having mood/anxiety disorders in all samples suggesting for some psychiatric disorders a likely dose-response effect especially for women.

The association of postpartum maternal mental health with breastfeeding status of mothers: a case-control study.

Background:Maternal health status might have an important effect on breastfeeding, growth, and general health of the infants.Objectives:This study was conducted to assess the association between maternal mental health and breastfeeding status of mothers in Kashan province.Patients and Methods:This case-control study was conducted on 458 mothers in two groups of unsuccessful breastfeeding (case) and successful breastfeeding (control) attending Kashan province health clinics. In this study, the GHQ questionnaire and clinical interview were employed to collect data. The data were statistically analyzed using Chi-square and Fisher’s exact tests.Results:It was found that mothers of the case group had a greater susceptibility to depression than those of the control group, that is, breastfeeding status was directly associated with susceptibility to depression (P = 0.001, OR = 5.48). Furthermore, there was a significant association between basic characteristics such as maternal occupational status (P = 0.04) or their educations (P = 0.006) with breastfeeding. Besides, clinical interview revealed that mixed depression and anxiety disorder was the most prevalent type of psychological disorder in the case group.Conclusions:Screening depression during pregnancy and postpartum period appeared to be necessary and it should be incorporated into prenatal and postnatal care due to its influence on mothers’ successful breastfeeding.

Quality of life impact of mental health conditions in England: results from the adult psychiatric morbidity surveys

BackgroundThe main objective is to present health state utility estimates for a broad range of mental health conditions including anxiety, depression, long-term depression, obsessive compulsive disorder, phobia, panic disorder, psychosis, alcohol and drug dependency that can be used in economic models.MethodsThis study uses pooled data from the Adult Psychiatric Morbidity Surveys carried out in 2000 and 2007 of a representative sample of the general population in England. Health state utility values measured by the SF-6D and EQ-5D indices are the dependent variables. Independent variables include background characteristics, mental health and physical health conditions. Regression models were estimated using OLS for the SF-6D and tobit for EQ-5D. Further regressions were carried out to consider the impact of mental health and physical health morbidities and the impact of severity of conditions on utility values.ResultsMental health conditions tend to have a larger impact on health state utility values than physical health conditions. The mental health conditions associated with the highest decrements in utility are: depression, mixed anxiety and depressive disorders and long-term depression. Interaction terms used to model the effect of co-morbidities are generally found to be positive implying that simply adding the utility decrements for two mental health conditions overestimates the burden of the disease.ConclusionsThis paper presents reliable and representative community based mean SF-6D and EQ-5D estimates with standard errors for health state utility values across a broad range of mental health conditions that can be used in cost effectiveness modelling.

Impulsiveness in chronic hepatitis C patients

ObjectiveThe objective was to investigate impulsiveness among chronic hepatitis C (CHC) patients and its association with sociodemographic, clinical and psychopathological factors. MethodNinety-one CHC individuals were enrolled in a cross-sectional study at a Brazilian public university-based outpatient’s service for infectious diseases. They were assessed using the Barrat Impulsiveness Scale, Brief Fatigue Inventory, Beck Depression Inventory and Hamilton Anxiety Scale. Structured psychiatric interview was performed according to the Mini International Neuropsychiatric Interview. Multivariate analysis was performed according to linear stepwise forward regression. ResultsThe total score of impulsiveness according to BIS in studied population was 64.6±9.8. The scores for the nonplanning, cognitive–attentional and motor domains were 23.8±5, 19.4±2.9 and 21.4±5, respectively. Impulsiveness was associated with lower educational level, current interferon-α (IFN) use, attention-deficit/hyperactivity disorder, alcohol use disorder, mixed anxiety and depressive disorder, specific phobia, bipolar spectrum disorders and anxiety symptoms. During IFN treatment, impulsiveness was also associated with suicide risk. ConclusionImpulsiveness was frequent in CHC patients and was associated with several psychopathological alterations. Impulsiveness management should be considered when attending CHC patients.

Bereavement and common mental disorders in middle-aged adults: Results from the Brazilian longitudinal study of adult health (ELSA-Brasil)

BackgroundAlthough bereavement is accompanied with depression and anxiety symptoms, it is usually not associated with increased rates of mental disorders in North American and European samples. Data from low- and middle-income countries are, however, scarce. We therefore explored the prevalence of mental disorders after bereavement in Brazil. MethodsThe Clinical Interview Schedule-Revised (CIS-R) was used for psychiatric assessment of 15,105 participants from the Brazilian Health Longitudinal Study (ELSA-Brasil). We asked whether the participant suffered loss of a first-degree relative/spouse within 6 and 12 months prior to the interview. ResultsThe prevalence within 6 and 12 months after bereavement for major depressive disorder (MDD, 4.3% for 6 and 12 months) and anxiety disorders (17.4% and 15.9%, respectively) did not differ compared to non-bereaved participants, except for panic disorder. Sociodemographic and clinical data were also similar. Conversely, we found increased 12-month prevalence of bereaved-related (vs. non-related) mixed anxiety and depressive disorder (15.7% vs. 12.5%, respectively) and common mental disorder (30.7% vs. 26.2%); diagnoses that are solely based on the number and severity of depression and anxiety symptoms. LimitationsAlthough this was a cross-sectional study, the sample size was large. ConclusionsBereavement was associated with greater psychopathological burden but not with increased prevalence of MDD and anxiety disorder diagnoses, therefore highlighting the need of carefully monitoring subjects whom recently experienced bereavement. Our findings also support and provide a “cultural validator” for excluding bereavement as an exclusionary criterion for MDD diagnosis.

Psychiatric morbidity among inmates of leprosy homes.

Context:Leprosy affected people are having high psychological distress and it in turn leads to psychiatric disorders. There is a paucity of literature from our country in this significant health problem.Aims:The aim of this study was to find the prevalence of psychiatric morbidity and its association with sociodemographic and clinical factors among the inmates of leprosy homes.Settings and Design:Study sample was obtained from individuals residing in two leprosy homes of malwa belt of Punjab.Materials and Methods:In screening stage, the study subjects were administered sociodemographic proforma and general health questionnaire (GHQ-12). In the confirmation stage, the study subjects were interviewed in detail and disability assessment was done using World Health Organization disability scale. Final psychiatric diagnosis was made as per ICD-10 criteria's.Statistical Analysis:Statistical analysis was performed using the descriptive statistics, Chi-square test, analysis of variance, and correlation analysis.Results:Majority of the subjects was in the age group 41-50 years, female, married, illiterate, Hindu and were from nuclear families. Nearly, 50.38% of subjects were having GHQ-12 score more than twelve. Nearly, 55.6% subjects were having psychiatric disorders out of which a large number of patients was diagnosed as having dysthymia. The other psychiatric disorders found in the study population were moderate depressive episode, generalized anxiety disorder, mixed anxiety and depressive disorder and schizophrenia unspecified. Psychiatric morbidity was found to be significantly related to age, family status, and duration of leprosy illness and presence of deformities among inmates.Conclusions:This study highlighted that psychiatric disorders were found in a large number among inmates of leprosy homes. Leprosy eradication program must place specific emphasis on psychiatric care of these patients.

Using the Internet to Provide Psychodynamic Psychotherapy

Over the last 15 years, there has been a substantial increase in research and clinical implementations of Internet-delivered, cognitive behavioral therapy (ICBT). Several studies on ICBT have been in the format of guided self-help where a therapist guides the patient throughout the whole treatment. ICBT is typically in the form of self-help material (e.g., text or video) which is provided to a client over the Internet with additional therapist contact by e-mail. ICBT has been shown to be effective for various conditions and, in some studies, has shown to be as effective as face-to-face cognitive behavioral therapy for mild to moderate depression, anxiety disorders, and somatic problems. Recently, the field has expanded to include other orientations including psychodynamic psychotherapy. Currently, there are three randomized controlled trials that have tested the efficacy of psychodynamic psychotherapy delivered in this format. The latest published trial focused on an affect-focused, psychodynamic psychotherapy delivered to a sample of participants with mixed depression and anxiety disorders. This article aims to provide a deeper understanding of the process of providing psychodynamic psychotherapy via the Internet. We will give a detailed description of our latest manual and show how psychotherapeutic work is conducted utilizing this text. Furthermore, we provide examples of dialogue between therapist and client from the online environment. Similarities and differences between psychodynamic psychotherapy delivered over the Internet and in face-to-face formats are discussed.

Juvenile bipolar disorder and suicidality: a review of the last 10 years of literature

Although children and adolescents with bipolar disorder (BD) are at elevated risk for suicide, little research to date has been conducted on suicidality in this population. The purpose of this descriptive review of the past 10years of scientific literature on suicidality in youths with BD was to identify the risk and protective factors associated with this phenomenon, and to discuss the implications for research and clinical practice. Searches on Medline and PsycINFO databases for the period from early 2002 to mid-2012 yielded 16 relevant articles, which were subsequently explored using an analysis grid. Note that the authors employed a consensus analysis approach at all stages of the review. Four primary categories of risk factors for suicidality in youths with BD were identified: demographic (age and gender), clinical (depression, mixed state or mixed features specifier, mania, anxiety disorders, psychotic symptoms, and substance abuse), psychological (cyclothymic temperament, hopelessness, poor anger management, low self-esteem, external locus of control, impulsivity and aggressiveness, previous suicide attempts, and history of suicide ideation, non-suicidal self-injurious behaviors and past psychiatric hospitalization), and family/social (family history of attempted suicide, family history of depression, low quality of life, poor family functioning, stressful life events, physical/sexual abuse, and social withdrawal). Youths with BD who experienced more complex symptomatic profiles were at greater risk of suicidality. Few protective factors associated with suicidality have been studied among youths with BD. One protective factor was found in this descriptive literature review: the positive effects of dialectical behavior therapy. This article allows a better appreciation of the risk and protective factors associated with suicidality among youth with BD. Greater awareness of risk factors is the first step in suicide prevention.

Cognitive and Affective Dimensions of Difficulties in Emotional Functioning in Somatoform Disorders and Borderline Personality Disorder

Background: To study difficulties in emotional functioning in two mental disorders that have been associated with difficulties in identifying and modulating emotions: borderline personality disorder (BPD) and somatoform disorder (SoD). Sampling and Methods: In 472 psychiatric inpatients, difficulties in emotional functioning were measured using the Bermond-Vorst Alexithymia Questionnaire. Results: Profiles of difficulties in emotional functioning were identified, suggesting that patients diagnosed with BPD with or without SoD were more likely to report difficulty identifying emotions and less likely to report reduced ability to fantasize or ‘pensée opératoire' (externally oriented thinking) than patients diagnosed with SoD only and patients with mixed anxiety and affective disorders. SoD patients were more likely to report reduced ability to phantasize or pensée opératoire than difficulty identifying emotions. Patients with mixed anxiety and affective disorders were more likely to report reduced ability to experience emotions than patients diagnosed with BPD and/or SoD. Conclusions: By using a finer-grained perspective on difficulties in emotional functioning some evidence was found for the existence of cognitive-emotional profiles that may provide more clinically relevant information than alexithymia as just a unitary construct. Further research on cognitive-emotional profiles of difficulties in emotional functioning is needed to advance the understanding, diagnosis and treatment of mental disorders.

Chronic fatigue and affective disorders in older adults: Evidence from the 2007 British National Psychiatric Morbidity Survey

BackgroundAlthough chronic fatigue is common in old age, the association between chronic fatigue and common affective disorders is largely unknown. AimsTo fill this research gap, the present study aims to determine the relationship between chronic fatigue and common psychiatric disorders among older adults aged 65 and older. MethodA national representative sample of 1793 England community-dwelling respondents aged 65 and above was assessed in the 2007 Adult Psychiatric Morbidity Survey (APMS) using the Revised Clinical Interview Schedule to measure chronic fatigue and common psychiatric disorders. Demographic characteristics, medical conditions, and four health-related variables based on the Short Form 12 were also measured. ResultsThe prevalence of chronic fatigue was 18.6%. Bivariate analyses revealed that chronic fatigue was more common among women and non-white ethnicities. In addition, chronic fatigue was significantly related to depression, mixed anxiety and depressive disorder, and generalized anxiety disorder after adjusting for demographic variables, medical conditions, and four other health-related variables. ConclusionThe prevalence rate of chronic fatigue in our sample is higher than a previous study. The psychiatric comorbidity of chronic fatigue supports the notion that chronic fatigue has a strong impact on quality of life in old age.

Will DSM-5 change the way we practise psychiatry?

The DSM-5 is expected to be released in May 2013. Much new knowledge about psychiatric disorders has emerged since then and it was thought that most of this would be incorporated into the new classification. The descriptive approach of the DSM IV has been retained in the DSM-5 and it still remains primarily a syndromal classification system. The DSM-5 includes several new categories such as attenuated psychosis and mixed anxiety disorder in Section III as disorders which need further study. The personality disorder category has undergone major changes including the provision for identification of personality traits. Diagnostic criteria of some older categories have been changed with the removal of the bereavement exclusion criteria for diagnosing depression leading to much discussion. DOI: http://dx.doi.org/10.4038/sljpsyc.v3i1.4451 SL J Psychiatry 2012; 3 (1):1-2

Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders

ObjectiveTo assess the relationship between session-by-session putative mediators and treatment outcomes in traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for mixed anxiety disorders. MethodSession-by-session changes in anxiety sensitivity and cognitive defusion were assessed in 67 adult outpatients randomized to CBT (n = 35) or ACT (n = 32) for a DSM-IV anxiety disorder. ResultsMultilevel mediation analyses revealed significant changes in the proposed mediators during both treatments (p < .001, d = .90–1.93), with ACT showing borderline greater improvements than CBT in cognitive defusion (p = .05, d = .82). Anxiety sensitivity and cognitive defusion both significantly mediated post-treatment worry; cognitive defusion more strongly predicted worry reductions in CBT than in ACT. In addition, cognitive defusion significantly mediated quality of life, behavioral avoidance, and (secondary) depression outcomes across both CBT and ACT (p < .05, R2 change = .06–.13), whereas anxiety sensitivity did not significantly mediate other outcomes. ConclusionsCognitive defusion represents an important source of therapeutic change across both CBT and ACT. The data offered little evidence for substantially distinct treatment-related mediation pathways.

Uma causa rara de hipertensão arterial secundária

A RARE CAUSE OF SECONDARY ARTERIAL HYPERTENSION Introduction: Familial amyloid polyneuropathy (FAP) type 1, better known in Portugal as "Doença dos Pezinhos", is a heredita- ry form of amyloidosis caused by the accumulation of a mutant protein (transthyretin). It is a rare disease which may be diffi- cult to diagnose when there is no previous family history of the condition. Case description: This report describes the case of a 60-year-old Caucasian woman with a history of hypothyroidism, dyslipi- demia, hyperuricemia, mixed anxiety and depressive disorder, chronic venous disease of the legs and hypertension. In June 2009, she was seen for the first time by her new family doctor, with laboratory results that showed proteinuria. A 24-hour urine col- lection for microalbuminuria and a renal scan were obtained. A diagnosis of chronic renal failure was made. The patient was re- ferred for a nephrology consultation in a central hospital where additional tests were done to determine the cause of her ill- ness. In August 2010, she was hospitalised in the nephrology unit with rapidly progressive renal failure with nephrotic protei- nuria. A renal biopsy showed familial amyloidosis, Portuguese type (ATTR). She was then referred to the familial amyloid poly- neuropathy clinic in another hospital. Comment: This case report shows the importance of adequate investigation in a patient with arterial hypertension. It also shows how rare causes may be considered in common clinical syndromes.

Migraine: Clinical pattern and psychiatric comorbidity.

Background:Migraine is a common disorder which has psychiatric sequelae.Objective:The objective of this study was to determine the clinical pattern and psychiatric comorbidity of migraine.Materials and Methods:100 cases of migraine seen over a period of one year were analysed to know the sociodemographic characteristics, clinical pattern and psychiatric morbidity.Results:Maximum patients were between 31-40 years of age group (40%), females (78.0%), married (76%) and housewives (56.0%). Family history of migraine was present in 12% cases. Average age of onset was 22 years. Unilateral and throbbing type of headache was most common. The commonest frequency was one to two per week. Migraine without aura was commonest sub-type (80%). Generalized anxiety disorder (F41.1) was the most common psychiatric disorder (34%), followed by mixed anxiety and depressive disorder (F41.2) (18%) and depressive episode (F32) (14%). In 22% cases, no psychiatric disorder could be elicited.Conclusion:The present study confirms that majority patients with migraine had psychiatric disorders. This needs timely detection and appropriate intervention to treat and control the migraine effectively.

P-954 - Does C3435T Genetic polymorphism of MDR1 gene influence therapeutic effectiveness of paroxetine? (preliminary results)

Clinical efficacy of antidepressants is unsatisfactory, full remission occurs in one-third of the patients after monotherapy with antidepressant. Personalized medicine is promising aspect of modern medicine. P-glycoprotein (P-gp) encoded by the multidrug resistance 1 (MDR1) gene, acts as a cellular efflux pump. It is expressed in blood-brain barrier. In depressed patients prescribed with paroxetine, which is substrate of P-gp, the higher activation of P-gp would result in a lower level of paroxetine in brain and, thus, in resistance to clinical response. C3435T polymorphism has been found to be associated with altered expression of P-gp, the results are contradictory. We identified the C3435T polymorphism of MDR1 gene in 33 patients with major depression, panic disorder and mixed anxiety and depression disorder, who were treated with paroxetine in monotherapy. PCR-restriction fragment length polymorphism was used for genotyping. Therapeutic response was evaluated at baseline and after 6 weeks of therapy using the Hamilton Rating Scale for Depression and Anxiety (HAM-D, HAMA). Comparison of allele frequencies between responders and non-responders showed no significant difference (CC vs CT: p = 0.673; CC vs TT: p = 1.000; C vs T: p = 0.805; Fisher exact test or χ2-test). We also evaluated a quantitative changes in HAM-D and HAMA score in relation to particular genotypes. No significant difference was found (p = 0.622; Kruskall-Wallis test). According to our preliminary results, MDR1 polymorphism C3435T is not associated with therapeutic response to paroxetine in Slovak population. Further studies are needed to elucidate the implication of other polymorphisms of MDR1 gene.

Supplemental Material for Randomized Clinical Trial of Cognitive Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for Mixed Anxiety Disorders

Supplemental Material for Randomized Clinical Trial of Cognitive Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for Mixed Anxiety Disorders