Presence Of Generalized Anxiety Disorder Research Articles

The natural history of lifetime psychiatric disorders in patients with obsessive-compulsive disorder followed over half a century.

Few long-term studies have examined the life-time prevalence of comorbid psychiatric conditions in patients with obsessive-compulsive disorder (OCD). We therefore studied the frequency of comorbid psychiatric disorders, and their relation to onset and prognosis, in patients with OCD who were followed for almost half a century. During 1947-1953, 285 OCD patients were admitted as inpatients to a university hospital in Gothenburg, Sweden. Among those, 251 (88%) accepted a structured comprehensive psychiatric examination in 1954-1956. In 1989-1993, 176 survivors were eligible and 144 (response rate 82%) were re-examined. The same psychiatrist performed both examinations. OCD was diagnosed according to the Schneider criteria, and other mental disorders according to DSM-IV. Mean follow-up since onset was 47 years. The lifetime frequency of depressive disorders was 84.7% (major depression 43.8%), generalized anxiety disorder (GAD) 71.5%, panic anxiety disorder 47.9%, agoraphobia 52.1%, specific phobias 64.6%, social phobia 47.9%, paranoid conditions 40.3% (29.1% paranoid ideation), psychotic disorders 15.3%, alcohol abuse 13.2% (men 39%, women 3%) and substance abuse 17.4%. Specific phobia most often started before OCD, while depression had a varied onset in relation to OCD. Social phobia, agoraphobia, GAD, alcohol and substance abuse, psychotic disorders and paranoid conditions most often started after OCD. Presence of GAD, psychotic disorder and substance abuse worsened prognosis of OCD. Comorbid psychiatric conditions are common in OCD patients, and have onset throughout the course. OCD signals vulnerability for other psychiatric conditions, which are important to detect in clinical practice as they negatively affect the outcome.

Erectile Dysfunction in Cirrhosis: Its Prevalence and Risk Factors

Erectile dysfunction (ED) is common in men with cirrhosis. The aim of this study was to assess the prevalence of ED and the factors associated with ED in men with cirrhosis. 400 men with cirrhosis [Child-Turcotte-Pugh (CTP) class A, 44.0%; CTP class B, 41.0%; and CTP class C, 15.0%] having high Karnofsky performance score, and living in a stable monogamous relationship with a female partner were included in the study. International Index of Erectile Function (IIEF) questionnaire, and Short-Form (36) Health Survey (SF-36) were used to assess erectile function and the health-related quality of life (HRQOL), respectively. ED was found in 289 (72.3%) patients. Patients with ED reported significantly lower SF-36 scores across all the eight domains of SF-36 (i.e., physical functioning score, role physical score, bodily pain score, general health perception score, vitality score, social functioning score, role emotional score, and mental health score); physical component summary score, and mental physical component summary score, compared with those without ED. On multivariate analysis, factors associated with ED were older age, longer duration of cirrhosis, CTP-C (vs. CTP-A), higher hepatic venous pressure gradient (HVPG), presence of generalized anxiety disorder (GAD), presence of major depression, and lower appendicular skeletal muscle index measured by dual-energy X-ray absorptiometry (DEXA ASMI). ED is common in men with cirrhosis, and men with ED have poor HRQOL compared with those without ED. Older age, longer duration of cirrhosis, CTP-C (vs. CTP-A), higher HVPG, presence of GAD, presence of major depression, and lower DEXA ASMI are associated with ED.

Prevalence of and Factors Associated with Sleep-Wake Abnormalities in Patients with Cirrhosis

Sleep-wake abnormalities [poor nighttime sleep and excessive daytime sleepiness (EDS)] are common in patients with cirrhosis. The aim of this study was to assess the prevalence of sleep-wake abnormalities and clinical factors associated with these abnormalities in a group of patients with cirrhosis. 1098 patients with cirrhosis [Child Turcotte Pugh (CTP) class A, 22.2%; CTP class B, 29.2% and CTP class C, 48.6%], with either no ascites or mild ascites controlled on diuretics, and no history of or current overt hepatic encephalopathy were included in the study. Poor nighttime sleep and EDS were found in 569 (51.8%) and 489 (44.5%) patients respectively. On multivariate analysis, factors associated with poor nighttime sleep were CTP class C (vs. class A), presence of minimal hepatic encephalopathy (MHE), intermediate or evening type of diurnal preference category (vs. morning type), high risk for obstructive sleep apnea (OSA), diuretic use, presence of major depression, and presence of generalized anxiety disorder (GAD). Factors associated with EDS on multivariate analysis were CTP class B and C (vs. class A), intermediate or evening type of diurnal preference category (vs. morning type), high risk for OSA, presence of major depression, and presence of GAD. Sleep-wake abnormalities are common in patients with cirrhosis. CTP status, diurnal preference chronotype, risk of OSA, major depression and GAD are associated with both poor nighttime sleep and EDS. MHE and diuretic use are associated with poor nighttime sleep, but not with EDS.

Predictors of depressive symptom trajectories in a prospective follow-up of late adolescents.

Group-based trajectory modeling holds promise for the study of prognostic indicators in the mood disorders because the courses that the individuals with these disorders follow are so highly variable. However, trajectory analyses of major depressive disorder have so far not included some of the more robust predictors of mood disorder outcome, nor have they described interactions between these predictors. A group of 186 individuals aged 15-20 years with past or current depressive symptoms, who had recently begun taking a serotonin reuptake inhibitors antidepressant, underwent extensive baseline evaluations and were then followed for up to 2 years. Trajectory analyses used weekly ratings of depressive symptoms and the resulting groups were compared by the risk factors of sex, psychiatric comorbidity, negative emotionality, and childhood adversity. A three-group solution provided the best statistical fit to the 2-year symptom trajectory. Negative emotionality and childhood adversity, though correlated, independently predicted membership in higher-morbidity groups. Female sex and comorbidity with generalized anxiety disorder (GAD) were also significantly more likely in the trajectory groups with higher symptom levels. However, the presence of GAD, rather than female sex, was the most important determinant of group membership. Negative emotionality was predictive of group membership only among women. Trajectory analyses indicated that week-to-week variations in depressive symptoms across individuals could best be condensed into low, remitting and persistent symptom patterns. Female sex, anxiety symptoms, negative emotionality and childhood adversity were each independently associated with trajectories of higher morbidity but negative emotionality may be prognostically important only among women.

Screening of Generalized Anxiety Disorder in Patients with Epilepsy: Using a Valid and Reliable Indonesian Version of Generalized Anxiety Disorder-7 (GAD-7).

Introduction Generalized anxiety disorder (GAD) is one of the most common types of anxiety disorder in epilepsy population, comprising 21.9%, that would further impair patients' quality of life. Generalized Anxiety Disorder-7 (GAD-7) is the only screening tool for GAD that has been validated in patients with epilepsy (PWE). It is a self-reporting instrument that can be completed in less than three minutes; hence, its usage is appropriate in primary healthcare and neurology outpatient clinic. This study aimed to obtain a valid and reliable Indonesian version of GAD-7, assess its accuracy, and finally evaluate the prevalence of GAD in Indonesian PWE along with its contributing factors. Methods A cross-sectional study was conducted in Cipto Mangunkusumo General Hospital, Jakarta. The GAD-7 was translated and adapted using World Health Organization (WHO) steps. Validity, reliability, test-retest reliability, and diagnostic accuracy were evaluated. Then, epilepsy outpatients were screened for GAD using the Indonesian version of GAD-7. Results Internal validity and reliability for Indonesian version of GAD-7 were satisfactory with validity coefficient of 0.648 to 0.800 (p<0.01) and Cronbach's alpha value of 0.867. The best cutoff value to detect GAD in Indonesian PWE was >6 with the sensitivity, specificity, negative predictive value, and positive predictive value of 100%, 84.4%, 100%, and 55.8%, respectively. ROC analysis showed the area under the curve of 0.98 (95% CI: 0.96–0.99). The total subjects screened with the validated Indonesian version of GAD-7 were 146, and 49% were screened as having GAD. Sociodemographic and clinical characteristics had no statistically significant association with the presence of GAD. Conclusion The Indonesian version of GAD-7 was a valuable screening tool to detect GAD in PWE. GAD was screened in a quite high proportion of PWE. Sociodemographic and clinical characteristics were not proven to play role in its development.

Psychometric properties of the Generalized Anxiety Disorder Questionnaire - IV (GAD-Q-IV) in postpartum mothers.

Generalized anxiety disorder (GAD) is a mental disorder of which the main feature is persistent and impairing worry. GAD symptoms are common for women during the postpartum period and GAD prevalence rates have been reported as higher in postpartum mothers than in the general population. Currently, little psychometric evidence exists for a screening measure to detect the possible presence of diagnosable GAD for postpartum women. The purpose of this investigation was to gather psychometric information for the Generalized Anxiety Disorder Questionnaire–IV (GAD-Q-IV; Newman et al., 2002) with a sample of postpartum mothers. Factor analyses were conducted to determine the factor structure of the GAD-Q-IV in postpartum women. Receiver-operating characteristic (ROC) analysis was used to determine a range of potential GAD-Q-IV cut-off scores for detecting the likely presence of GAD in postpartum women. Results from this study provided evidence to justify a 1-factor structure for the GAD-Q-IV responses from postpartum women, which demonstrated structural, metric, and scalar invariance over time. Findings from these analyses provided evidence of incremental validity, as there was a significant increase in predicting GAD diagnoses when GAD-Q-IV responses were used compared with another measure of postpartum depression. Last, using ROC analysis, a range of GAD-Q-IV cut-off scores was determined, which can be applied to screening for the likely presence or absence of GAD in postpartum women. The evidence presented in this study suggests that the GAD-Q-IV could be a viable screening measure used to identify the likely presence of GAD in postpartum women so that further evaluations and treatments can be recommended.

An investigation of the coupling of temperament traits with anxiety

Temperament traits and anxiety have been linked to varying degrees of neurotransmitter imbalances in neurophysiological systems of regulating behaviour. The diversity of neurotransmitters implicated in anxiety symptoms raises questions as to whether the multiple neurotransmitter systems secondarily express dysfunction in a higher-level system, which modulates their activity. This study analyzed the predictions of the neurochemical functional ensemble of temperament (FET) model that proposes that a dysregulation of the opioid receptors acting on monoaminergic and GABA systems gives rise to the symptoms of GAD. The study investigated the coupling of sex, age and temperament traits with generalized anxiety disorder (GAD) across three age groups (17–24, 25–45, 46–65 years). The records of patients aged 65–85 years old were also examined but showed significantly less presence of GAD in comparison to other age groups. Temperament was assessed using the activity specific 12-trait structure of temperament questionnaire. Consistent with the hypotheses of the FET, patients with GAD reported lower mean scores on the traits of social-verbal endurance, mental endurance, plasticity and sensation seeking and higher mean scores in the trait of impulsivity, than healthy individuals. GAD was associated with significantly lower self-confidence in women than in men. The results suggest that new versions of the DSM should consider an increase of impulsivity and a decrease in plasticity of behavior as criteria symptoms of anxiety. Moreover, the results suggest that the current criterion of fatigue should be specified as more related to social-verbal and mental aspects and less to physical aspects of endurance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The ages of anxiety—differences across the lifespan in the default mode network functional connectivity in generalized anxiety disorder

Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders, but its neural basis is relatively understudied. This study aims to characterize the functional connectivity in the default mode network (DMN) in GAD across the lifespan. Functional and structural magnetic resonance imaging data were collected with subjects at rest. We analyzed the resting state functional connectivity patterns in the DMN for 27 GAD participants and 39 non-anxious comparison participants. Using a two-way analysis of variance, we explored the interaction between age and GAD status on functional connectivity. In GAD participants, we analyzed the correlation of functional connectivity indices with the duration of illness and worry severity. The age-by-anxiety interaction showed a greater anxiety effect on the functional connectivity between the posterior cingulate seed and the medial prefrontal cortex for the older group relative to the younger participants. Longer duration of illness was positively correlated with greater functional connectivity between the posterior cingulate cortex and the insula. Worry severity was inversely correlated with the functional connectivity between the posterior cingulate cortex seed and the medial prefrontal cortex. The presence of GAD, longer duration of illness, and more severe worry exacerbate the effects of age on the functional connectivity in the DMN. These results support the need for tailored research and interventions in late-life anxiety.

Generalized anxiety disorder within the course of major depressive disorder: examining the utility of the DSM‐IV hierarchy rule

The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) specifies that generalized anxiety disorder (GAD) should not be diagnosed if it occurs exclusively during an episode of a major depressive disorder (MDD) or another mood disorder. This hierarchy rule was intended to promote diagnostic parsimony, but may result in the loss of important clinical information. The goal of this study was to compare individuals with MDD, comorbid MDD and GAD, and GAD within the course of MDD at intake and 12-month follow-up on self-report measures, clinician ratings, and rates of comorbidity. Participants were divided into three diagnostic groups: MDD without GAD (n=124), comorbid MDD and GAD (n=59), and GAD within the course of MDD (n=166). All the participants completed a semi-structured clinical interview and self-report measures assessing psychopathology, temperament, and functional impairment. A subset of the total sample completed a follow-up assessment of 12 months postintake. Individuals with comorbid MDD and GAD and GAD within the course of MDD reported more psychopathology, negative affect, and functional impairment at intake than individuals with MDD only. The presence of GAD at intake, however, did not differentially predict symptom severity, functional impairment, or the presence of comorbidity at 12-month follow-up. Cross-sectional findings indicate that individuals with GAD within the course of MDD experience levels of psychopathology, functional impairment, and comorbidity similar to those found in individuals with comorbid GAD and MDD. Preliminary longitudinal findings, however, suggest that the presence of GAD in patients with MDD does not have prognostic significance.

Generalized anxiety disorder and the circadian rhythm of blood pressure in patients with hypertension

Objective. To investigate the impact of generalized anxiety disorder (GAD) on the circadian rhythm of blood pressure in patients with hypertension. Methods. The 24-h ambulatory blood pressure was compared between patients with hypertension and GAD, and patients with hypertension only. Results. The mean day- and night-time systolic (SBP, 156.6±11.0 and 149.6±12.4 mmHg, respectively) blood pressure in patients with GAD was greater than in the no-GAD group (143.2±15.0 and 126.0±10.8 mmHg, respectively, P<0.01). The mean day- and night-time diastolic blood pressure (DBP, 101.5±10.1 and 96.9±17.6 mmHg, respectively) in the GAD group was also greater than in the no-GAD group (94.1±10.9 and 77.4±10.2 mmHg, respectively, P<0.01). SBP and DBP dipping was found in 87.5 and 80.1% of the hypertension only patients, as compared with 16.6 and 21.4% respectively, of the hypertension and GAD patients (P<0.01). Conclusions. The presence of GAD is associated with a higher level of blood pressure in hypertensive patients. GAD is also associated with a diminished circadian rhythm of blood pressure. The clinical significance of the reduced blood pressure dipping at night requires further investigation.

Factors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder

Background We aimed to investigate the correlates of major depressive disorder (MDD) occurring after the onset of obsessive-compulsive disorder (OCD). Methods Forty-three OCD patients who developed MDD after the onset of OCD (OCD-MDD group) and 67 OCD patients without MDD (non-MDD, NMDD group) were compared with regard to sociodemographic characteristics, clinical history, symptom severity, types of obsessions and compulsions, insight degree, comorbid axis I and axis II diagnosis and quality-of-life level. Results The OCD-MDD group scored significantly higher on measures of obsessions, compulsions and depression severity than did the NMDD. Significantly more aggressive obsessions were identified in the OCD-MDD group than in the NMDD group. The OCD-MDD group was also significantly more likely than the NMDD group to have generalized anxiety disorder (GAD). There was no significant difference in the rate of personality disorders between the groups. The OCD-MDD group reported significantly lower levels of quality of life (QOL) in the domains of physical health, psychological health and social relationships. Depression severity was associated with obsession but not with compulsion severity. In a logistic regression model, obsession severity, presence of GAD and aggressive obsessions emerged as the factors associated with the occurrence of MDD. Limitations To exclude ineligible patients, we gathered the information about past mood episodes cross-sectionally. Conclusions These results suggest that psychopathological processes mediated by specific obsessions as well as excessive anxiety and worries may render the neurocircuities more vulnerable to the development of MDD. The occurrence of MDD in OCD cannot sufficiently be explained as a secondary complication to the disability of OCD.

Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32

The close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize them in future diagnostic systems. We tested whether risk factors for MDD and GAD are similar or different. The representative 1972-73 Dunedin birth cohort of 1037 males and females was followed to age 32 with 96% retention. Adult GAD and MDD were diagnosed at ages 18, 21, 26, and 32 years, and juvenile anxiety/depression were also taken into account. Thirteen prospective risk measures indexed domains of family history, adverse family environment, childhood behavior, and adolescent self-esteem and personality traits. Co-morbid MDD+GAD was antedated by highly elevated risk factors broadly across all domains. MDD+GAD was further characterized by the earliest onset, most recurrence, and greatest use of mental health services and medication. Pure GAD had levels of risk factors similar to the elevated levels for co-morbid MDD+GAD; generally, pure MDD did not. Pure GAD had risks during childhood not shared by pure MDD, in domains of adverse family environment (low SES, somewhat more maltreatment) and childhood behavior (internalizing problems, conduct problems, somewhat more inhibited temperament). Pure MDD had risks not shared by pure GAD, in domains of family history (of depression) and personality (low positive emotionality). Specific antecedent risk factors for pure adult MDD versus GAD may suggest partly different etiological pathways. That GAD and co-morbid MDD+GAD share many risk markers suggests that the presence of GAD may signal a pathway toward relatively more severe internalizing disorder.

Quality of life in geriatric generalized anxiety disorder:a preliminary investigation

Objective: To examine the impact of late-life generalized anxiety disorder (GAD) on health-related quality of life. Method: We compared quality of life in 75 treatment-seeking older adults with GAD, 39 of whom had psychiatric comorbidity, with 32 older adults without psychiatric illness. We examined predictors of quality of life in these samples. We also compared data from the GAD patients to published norms from a large national sample of older adults with chronic medical conditions or major depression. Results: Older GAD patients reported worse health-related quality of life across most domains than asymptomatic older individuals. There were no differences in quality of life between GAD patients with and without psychiatric comorbidity, and comorbidity did not predict quality of life in multivariate regression analyses. Presence of GAD or symptoms of anxiety or depression were significantly related to impairment in every domain of quality of life. Comparisons with national norms suggest that older GAD patients report overall worse quality of life than individuals with recent acute myocardial infarction or type II diabetes, and are comparable in quality of life to individuals with major depression. Conclusion: Results suggest that late-life GAD is associated with substantial impairment in quality of life, and these findings cannot be explained by psychiatric comorbidity.

Worries and obsessions in individuals with obsessive–compulsive disorder with and without comorbid generalized anxiety disorder

Participants from the DSM-IV field trial for OCD ( N=381) were divided into two groups based on the SCID interview: those who met current criteria for obsessive–compulsive disorder (OCD) but not generalized anxiety disorder (GAD) and those who met current diagnostic criteria for both. The groups were compared on their severity of obsessive and compulsive symptoms, as well as on the percent of individuals who reported excessive worry concerning everyday issues (e.g. health, finances). The comorbidity rate was 20%. While the presence of GAD did not elevate OCD symptoms per se, it was associated with more pathological responsibility and indecisiveness. Excessive worries were significantly more common in those with comorbid OCD and GAD. The relationship between obsessions and worries is discussed.