Severity Levels Of Anxiety Research Articles

Prevalence, Distribution and Attributable Risks of Cannabis Use in Young Adults with Generalised Anxiety Disorder at a University in Botswana

Worldwide, cannabis is the most commonly used drug after tobacco and alcohol, especially among young adults. In Africa, cannabis use is often associated with mental health problems. However, few studies have been conducted to assess which mental health problems are linked to cannabis use, particularly among young adults. This study examined the prevalence, distribution and risks of cannabis use attributed to generalised anxiety disorders. Data from 615 young adults (Mean age = 22.15, ±2.55, 18 – 25; 60.2% female) were used to compute the prevalence and distribution of cannabis use and binary logistic regression models fitted to quantify the risk of using cannabis attributed to different levels of anxiety severity. Of the 615 respondents, 13.8%, 20.4% and 31.7% reported using cannabis in the past month, the past year and lifetime, respectively. Similarly, 11.2% were hazardous users and 5.2% had possible cannabis use disorders. The odds of using cannabis varied with the severity of anxiety symptoms. Compared to those with minimal anxiety problems, the risks of using cannabis ranged from 2.61 (95% Confidence Intervals (CI) 1.65-4.93) to 3.72 (95% CI: 2.10-6.61) for mild anxiety and from 3.68 (95% CI: 2.08 – 6.98) to 6.32 (95% CI: 2.40-16.64) for severe anxiety. Interventions to reduce cannabis use and its concomitant long-term negative consequences should target reducing anxiety problems among young adults. Practitioners should prioritise mental health literacy and programmes such as relaxation techniques and guided selfhelp interventions, which are known to be cheap, effective, and efficient in alleviating anxiety problems.

QT interval is correlated with and can predict the comorbidity of depression and anxiety: A cross-sectional study on outpatients with first-episode depression

ObjectPatients with depression are at an increased risk for developing cardiovascular diseases. The associations between electrocardiogram (ECG) abnormalities and the severity of psychiatric disorders, such as depression and anxiety, have not been clearly elucidated. The present study aims to investigate the associations between depression and anxiety symptoms with ECG indices, and to predict the severity of depression and anxiety using ECG indicators.Methods61 outpatients with first-episode depression from the Shanghai Pudong New Area Mental Health Center were selected and met the diagnostic criteria of DSM-IV. All participants provided self-reported scores on the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) and underwent the standard 12-lead ECG assessment.ResultsAmong the 61 included outpatients (mean [standard deviation, SD] age: 37.84 [13.82] years; 41[67.2%] were female), there were 2 (3.3%) outpatients without depression symptoms, 16 (26.2%) with mild depression, 19 (31.1%) with moderate depression, and 24 (39.3%) with severe depression. Ten (16.4%) outpatients did not have anxiety symptoms, 19 (31.1%) exhibited mild anxiety, 20 (32.8%) exhibited moderate anxiety, and 12 (19.7%) exhibited severe anxiety. Only 1 (1.6%) outpatient exhibited neither depression nor anxiety, 9 (14.8%) and 1 (1.6%) outpatients only exhibited depression and anxiety, respectively, and most outpatients (50 [82.0%]) had comorbid depression and anxiety symptoms. In the correlation analysis, depression and anxiety severity levels were significantly positively correlated (r = 0.717, p < 0.01). Moreover, categorical anxiety significantly differs in QT interval (p = 0.022), and continuous SAS scores were significantly correlated with QT interval (r = 0.263, p = 0.04). In addition, the correlations between ECG measurements and both categorical depression and continuous SDS scores were not statistically significant. The comorbidity of anxiety and depression was significantly correlated with heart rate (p = 0.039) and QT interval (p = 0.002). Disorder status significantly differed with different QT intervals (p = 0.021). In the prediction analysis, QT interval was the only significant predictor (p = 0.01, b = 0.058, Odds Ratio = 1.059) for comorbid anxiety and depression symptoms.ConclusionThis study found that comorbid symptoms of depression and anxiety were significantly associated with QT interval and heart rate. Additionally, QT interval could predict the comorbidity of these two psychiatric disorders. Further prospective research in a larger and high-risk population is needed.

Adaptation of child and adolescent worry scale (caws) in Bangla

The present study aimed to adapt the Child and Adolescent Worry Scale (CAWS) to use in the context of Bangladesh. The original scale developed by Campbell and Rapee in 1994 consisted of 20 items and higher scores on the scale indicate higher anxiety. Standard procedure for adaptation was followed. Item analysis was done on school going 130 mainstream and special need children aged between 6 to 15 years. The Cronbach’s Alpha and test-retest reliability was found to be .799 and .858 respectively for the adapted scale indicating high level of reliability. Criterion-related validity was measured by calculating concurrent and postdictive validity. Concurrent validity was measured by computing correlation (r= .912, p=.001) between the adapted scale and Beck Anxiety Inventory. Similarly, correlation value of postdictive validity was found to be .806, p=.001. Both measures ensured that the adapted scale measures the same construct as the original one. Moreover, the Mann-Whitney U test also indicated that the scale could differentiate between the mainstream and special need children regarding their worry/anxiety. Worry score was greater for the special need children than the other group (U= 608.50 at p =.001). It indicates that the adapted scale has good sensitivity to varying levels of anxiety severity. The psychometric properties of the Bangla CAWS suggest that professionals and the researchers can use the scale to assess children and adolescent’s overall level of anxiety in Bangladeshi context. Dhaka Univ. J. Biol. Sci. 30(3 CSI): 417-427, 2022 (June)

Magnitude and pattern of anxiety levels with gender wise predilection of coping strategies amid resident doctors of emergency department.

Objectives:To screen and assess the severity level of anxiety, its influencing factors along with the gender-wise predilection of coping strategies among resident doctors working in accident and emergency departments.Methods:A transverse study was conducted amongst 260 resident doctors of accident and emergency department of different teaching hospitals of Karachi from October 2020 until March 2021. A demographic sheet containing questions related to factors, GAD-7 (Generalized Anxiety Disorder) and Brief COPE were used to measure the severity level of anxiety and coping strategies. Data was scored according to the standard scoring procedure for each subscale and for further statistical analysis SPSS Version 21 was used.Results:Out of all participants, 68.1% were <30 years of age, 63.1% were females while 54.2% were single. The findings of the study showed the prevalence of anxiety within the range of normal (38.1%), mild (35.0%), moderate (16.9%) and severe (10.0%). Gender (p= 0.001), marital status (p= 0.040) and job satisfaction (p= 0.007) among resident doctors were significantly associated with level of anxiety. Deemed to coping strategies, the most frequently were planning (n=145, 90.0%), acceptance (n=141, 87.6%), and religion (n=137, 85.1 %). All coping strategies were mostly opted by females except substance abuse.Conclusion:More than a half of the resident doctors manifested with mild to severe anxiety disorder, which highlights the need for psychological support programs to minimize anxiety levels and to ensure a healthy environment at workplace for the health practitioners.

POSA51 Economic Burden of Anxiety Severity in a General Population of US Adults Based on National Health and Wellness Survey (NHWS)

Anxiety impacts over 40 million adults in the US, with many people delaying care which can exacerbate symptom severity. Digital Therapeutics (DTx) have been shown to reduce symptoms of anxiety. In order to quantify system-level impact of DTxs, an understanding of how anxiety severity impacts economic burden needs to be established. The study objective was to determine how anxiety severity levels can impact economic burden in adults over one year.

Anxiety and Social Skills Deficit levels among Children with Autism Spectrum Disorder in Nairobi, Kenya

This paper examines the severity level of anxiety and social skills deficits among children living with Autism among two schools in Nairobi County. Parents and teachers of 40 children and adolescents aged between 5-21 years old were used to conducting the assessment. Social skills deficits (SRS-2) and anxiety (CASI) questionnaires were used in data collection. The quasi-experimental study then involved a follow-up six months after data collection before conducting a statistical analysis. The results depict a significant decline in social skills represented by p=0.006 (95% C.I 4.97, 27.8). However, anxiety treatment was found to be not substantial even though the p-value = 0.002 was less than the significant level. The study concluded that the effect of ASD is real and can be treated. It requires being addressed as early as possible in the affected persons to allow them to achieve their full potential in life. The results provide essential insights into ASD and mental health. This paper adds to knowledge on ASD and anxiety and social skills and common comorbid disorders. The study recommended that the effect of ASD is real and can be treated. It requires being addressed as early as possible in the affected persons to allow them to achieve their full potential in life. The results provide essential insights into ASD and mental health.

The Role of Sleep Disturbance, Depression and Anxiety in Frail Patients with AF-Gender Differences.

The aim of the study was to assess the link between anxiety and depression and frailty syndrome (FS) in patients with atrial fibrillation (AF) with regard to gender differences. Material and methods. The study was conducted on 158 patients with AF (mean age 70.4 ± 7.6). The study used the hospital anxiety and depression scale (HADS-M), the Athens insomnia scale (AIS) and the Edmonton frailty scale to assess and compare anxiety, depression, and sleep disturbance between frail and non-frail patients with AF. Results. FS was diagnosed in 53.2% of patients. A comparative analysis showed a statistically significantly higher severity level of anxiety (12.0 ± 2.6 vs. 8.4 ± 2.5, p < 0.001) and depression (12.5 ± 2.5 vs. 7.2 ± 3.3, p < 0.001) in frail patients compared to non-frail patients. The analysis of the level of anxiety, depression and FS did not show any significant differences between the studied women and men. However, statistically, significant differences were observed when FS occurred, regardless of gender. Anxiety disorders were observed in 75.5% of patients with FS and in 16.7% without frailty, whereas depressive disorders were observed in 73.6% of frail patients and in 4.2% without frailty. In an analysis of the impact of cumulative variables on the level of frailty, the risk of FS in patients with anxiety/depression and sleep disturbance is almost 500 times higher compared to patients without anxiety/depression and sleep disturbance. The risk of frailty in patients with sleep disturbance only is thirteen times higher than in the reference group, i.e., in patients without depression/anxiety and sleep disturbances. Conclusions: Patients with AF and FS show deeper anxiety, depression and sleep disturbances. Gender does not influence the risk of frailty in AF patients. Frailty in patients with AF is associated with a higher risk of depression, sleep disturbances and anxiety.

Stress, anxiety, depression and insomnia in adults outside Hubei province during the COVID-19 pandemic

Objective: To investigate the severity of stress, anxiety, depression and insomnia during the novel coronavirus disease (COVID-19) pandemic in adults outside Hubei Province, China. Methods: An online survey of psychological and sleep by using Questionnaire Star program from 5th to 19th February 2020 was conducted. The Impact of Event Scale-Revised was used to assess COVID-19 outbreak-related stress symptoms. Meanwhile, Questionnaires of Generalized Anxiety Disorder-7, Patient Health Questionnaire-9 and the Insomnia Severity Index were respectively used to assess the severity of anxiety, depression and insomnia symptoms prior to and during the COVID-19 pandemic. Results: A total of 3 134 subjects were included. Among the included subjects, 15.5% (487), 24.9% (779), 28.7% (899) and 30.9% (968) of the subjects had COVID-19-related stress symptoms, anxiety, depression and insomnia after the COVID-19 outbreak, respectively. The severity levels of anxiety, depression and insomnia were significantly increased during the COVID-19 pandemic compared to prior to the outbreak (all P<0.01). Furthermore, the subjects' stress response to the COVID-19 outbreak was an independent risk factor for increased anxiety, depression and insomnia after the outbreak. Conclusion: The COVID-19 outbreak resulted in related stress response and widespread increase in anxiety, depression, and insomnia outside Hubei Province, China in the general population. The aggravation of anxiety, depression and insomnia is associated with stress levels. Our data demonstrate that the widespread psychological and insomnia problems in the general population need to be addressed at the early phase of the pandemic.

Anxiety Severity Levels and Coping Strategies during the COVID-19 Pandemic among People Aged 15 Years and Above in Gonabad, Iran.

The coronavirus disease 2019 (COVID-19) outbreak is a global health problem. It is necessary to provide evidence on its unprecedented psychological effects to develop effective psychological interventions. The current study aims to determine the anxiety severity level, coping strategies, and influencing factors in response to the COVID-19 pandemic among people aged 15 years and above in Gonabad, Iran. We conducted a cross-sectional survey via online questionnaires between February and March 2020. We evaluated the anxiety severity levels and coping strategies using the Corona Disease Anxiety Scale (CDAS) and Coping Inventory for Stressful Situations-Short Form (CISS-SF), respectively. Multinomial and ordinal logistic regression models were used to identify the predictors of coping strategies and anxiety. Totally, 500 people completed the questionnaires (response rate: 73%). Of them, 53.4% (95% confidence interval [CI]: 48.9%- 57.8%) suffered moderate to severe levels of anxiety. More than half of the respondents (52.0%; 95% CI: 47.5%-56.4%) utilized emotional-based or avoidant coping strategies. People with no academic education (odds ratio [OR]: 2.16; 95% CI: 1.41- 3.31) and without physical exercise (OR: 2.04; 95% CI: 1.22-3.33) preferred emotional-based coping instead of problem-based coping strategy. Female gender (OR: 1.60, 95%, CI: 1.13-2.28), underlying medical conditions (OR: 2.52, 95% CI: 1.65-3.87), and emotional-based coping (OR: 4.06, 95% CI: 2.76-5.99) were associated with higher severity levels of anxiety. The severity of anxiety during the COVID-19 pandemic was significant among participants. Further attention is needed to enhance the mental health of the vulnerable population during the COVID-19 pandemic. Our findings also identified some factors related to the severity level of anxiety related to COVID-19 that could help formulate better psychological interventions.

A-089 The Role of Anxiety Severity and Neurocognitive Functions in Parkinson’s Disease

Abstract Objective Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms. While much of the extant literature on neuropsychiatric symptoms and cognitive deficits have focused on depression, comparatively less have examined the role of anxiety among patients with PD. Here, we examined levels of anxiety severity (i.e., minimal, mild, moderate–severe) and cognition in this population. Method Fifty-six PD patients (M age = 60.8 ± 9.3; 69.6% male) being considered for surgical intervention were evaluated at an outpatient clinic. Inclusion criteria included no history of neurosurgical procedure and no other diagnosis of a neurodegenerative disorder. Participants completed a battery of neuropsychological tests and reported mood symptoms (Geriatric Depression Scale-15, Beck Anxiety Inventory). Those who scored above clinical cutoffs for depressive symptoms were excluded due to high comorbidity with anxiety. Motor symptom severity was rated by neurologists using the Unified Parkinson’s Disease Rating Scale. Results Analysis of covariance revealed significant group differences on tests of working memory (p = .03), set-shifting (p = .04), problem-solving (p = .05), and phonemic fluency (p = .03) when controlling for motor symptom severity. PD patients with moderate–severe levels of anxiety performed significantly lower than those with minimal or mild anxiety (p’s &amp;lt; .05). There were no other significant group differences in neuropsychological test performance. Conclusions These findings suggest measurable differences in neurocognitive functions associated with frontostriatal circuits among PD patients with varying levels of overall anxiety. Future work should consider the potential overlap between anxiety and PD symptoms as they relate to cognition.

Assessment of Anxiety and Depression among Heart Failure Patients at King Faisal Cardiac Center, King Khalid Hospital, Jeddah

Background: Cardiovascular diseases are extremely common in Saudi Arabia. Depression and anxiety is highly prevalent in patients with heart failure disease and heralds adverse cardiovascular outcomes and increased health care costs. The aim is to assess the occurrence and severity level of anxiety and depression among heart failure patients. Methods: A Cross sectional correlational survey design was used to recruit 60 heart failure patients from King Faiesal cardiac center at King Khalid hospital Jeddah. The Arabic version of Beck Anxiety Inventory (BAI) and Zung self-rating depression scale were adopted and used to collect data. The results revealed that only (15%) of the study population have mild degree of depression while the majority 78.9% have moderate level of anxiety compared by 10.0% have severe level of anxiety. The study results showed a 23.52% of severe anxiety among patients who were diagnosed with heart failure 6-20 years ago and female, who had higher educational level and history of heart failure are at risk for depression and anxiety more than male patients. Conclusion: Anxiety and depression comorbid with heart failure patients with different degree starting from mild to severe level of anxiety and only mild level of depression was reported among study population. Female gender, duration of illness and pervious history of heart failure and psychiatric illness have an association with the severity of depression and anxiety with apparent significant difference among study population. Therefore, awareness training program targeting patients to help them detect depression and anxiety manifestations that may affect them either because of their long life chronic disease or dependency feeling on their families. Moreover, providing heart failure patients with psychosocial and Liaison psychiatric services to support patients’ mental health problems through referral or follow up.

Assessment of Anxiety, Depression and Stress using Machine Learning Models

Abstract Over the last few decades, psychological health issues have become very common in people worldwide. In this paper, prediction of the occurrence of psychological problems such as anxiety, depression and stress has been made by applying eight machine learning algorithms to data taken from the online DASS42 tool. Five different severity levels of anxiety, depression and stress have been predicted using eight algorithms. The algorithms are grouped into four categories: probabilistic, nearest neighbor, neural network and tree based. A hybrid classification algorithm was also applied for prediction of different severity level anxiety, depression and stress. The same methods were also applied to another dataset, DASS21 collected by authors. The prediction accuracy found by using the hybrid algorithm was greater than by using single algorithms, but the highest accuracy was found by use of the radial basis function network, which comes under the category of neural network.

Assessing treatment efficacy by examining relationships between age groups of children with autism spectrum disorder and clinical anxiety symptoms: Prediction by correspondence analysis

IntroductionAutism spectrum disorders (ASD) are neurodevelopmental in nature and are frequently accompanied by anxiety. To fully assess treatment efficacy, we examined rates of anxiety symptom change by age groups following either cognitive behavioral therapy (CBT) or treatment as usual (TAU). MethodsOne hundred sixty-three children with ASD and ASD-related anxiety symptoms were randomly assigned to either CBT or TAU. Utilizing prediction by correspondence analysis (CA), we evaluated the age effect (defined in three groups; ages 6–9, 10–12, and 13–16) and the changes in correlations between age and anxiety severity levels over the course of treatment. ResultsSignificantly greater anxiety symptom reduction was associated with CBT compared with TAU across the three age groups. Of particular note, the children ages 10–12 who received CBT showed the greatest improvement compared to all other groups. Late childhood, prior to adolescence, showed the best response to CBT for anxiety in ASD. DiscussionThese findings suggest that treatment programs need to more closely address developmental factors within narrower bands of age groups. The present results are limited in their generalization to the CBT efficacy for a specific age band (ages 10–12). Longitudinal investigations are recommended to confirm whether the similar age group children who receive CBT experience the greatest benefit in reducing their ASD-related anxiety symptoms.

Comparison of Laughter Yoga and Anti-Anxiety Medication on Anxiety and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome.

BACKGROUND Irritable bowel syndrome (IBS) is the most common chronic gastrointestinal (GI) disorder. Patients with IBS usually suffer from anxiety and depression. A combination of psychological approaches and pharmacological treatments can be a significantly effective treatment for IBS. The main objective of the present study was to provide a therapeutic plan based on laughter yoga and anti-anxiety medication, employed for the very first time, and to determine the effectiveness of these treatments on the anxiety and GI symptoms of patients with IBS. METHODS In this randomized, controlled, clinical trial, the participants were 60 patients selected from those who referred to the GI clinic of Vali-asr Hospital (Birjand, Iran) during the study period (April 2017 to March 2017) and were diagnosed as having IBS based on ROME III criteria. The participants were randomly assigned to either the laughter yoga group, the anti-anxiety medication group, or the symptomatic treatment (control) group. Severity levels of anxiety and GI symptoms before and after intervention were determined and compared among these three groups according to approved protocols. RESULTS The severity of IBS symptoms after the interventions was more greatly reduced in the laughter yoga group than in the anti-anxiety medication and control groups (p = 0.006). The severity of anxiety after interventions decreased in all three groups, especially in the yoga treatment group, but the difference was not statistically significant (p = 0.1). CONCLUSION Laughter yoga is more effective than anti-anxiety medication in reducing the GI symptoms of patients with IBS. Therefore, applying laughter yoga along with common pharmacological therapies for patients with IBS might be strongly advised.

Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review.

Anxiety Disorders often show a chronic course, even when treated with one of the various effective treatments available. Lack of treatment effect could be due to Treatment Resistance (TR). Consensus on a definition for TR Anxiety Disorders (TR‐AD) is highly needed as currently many different operationalizations are in use. Therefore, generalizability in current TR‐AD research is suboptimal, hampering improvement of clinical care. The objective of this review is to evaluate the currently used definitions of TR‐AD by performing a systematic review of available literature. Out of a total of n = 13 042, 62 studies that operationalized TR‐AD were included. The current review confirms a lack of consensus on TR‐AD criteria. In 62.9% of the definitions, TR was deemed present after the first treatment failure. Most studies (93.0%) required pharmacological treatment failures, whereas few (29.0%) required psychological treatment failures. However, criteria for what constitutes “treatment failure” were not provided in the majority of studies (58.1%). Definitions for minimal treatment duration ranged from at least 4 weeks to at least 6 months. Almost half of the TR‐AD definitions (46.8%) required elevated anxiety severity levels in TR‐AD. After synthesis of the results, the consensus definition considers TR‐AD present after both at least one first‐line pharmacological and one psychological treatment failure, provided for an adequate duration (at least 8 weeks) with anxiety severity remaining above a specified threshold. This definition could contribute to improving course prediction and identifying more targeted treatment options for the highly burdened subgroup of TR‐AD patients.

The relationship of anxious and depressive symptoms in Parkinson's disease with voxel-based neuroanatomical and functional connectivity measures

BackgroundAnxiety and depression are two frequent comorbidities of Parkinson's disease (PD). However, the underlying neural mechanism is still unclear and the studies on their neural correlates were insufficient. MethodsUsing voxel-based neuroanatomical and functional connectivity (FC) measures, i.e. grey matter volume, fractional anisotropy, and weighted degree centrality (WD), we examined their correlations with the severity levels of anxious and depressive symptoms in 36 PD patients. ResultsPositive correlations were shown between anxiety and the WDs in the left amygdala, and between depression and short-ranged WDs in the left parahippocampal gyrus. Using these two regions as the seeds, we found that the severity levels of anxiety and depression were positively correlated with the FCs between the two seeds and the areas in the default mode network (DMN), while negatively correlated with the FCs between the two seeds and the prefrontal and superior temporal cortices. Anxiety was also positively correlated with the FC between the amygdala and the superior parietal lobule. LimitationsThe severity levels of anxious and depressive symptoms of our participants is relatively mild than some previous studies. The cross-sectional design of this study cannot clarify the etiological relationship between PD and two comorbidities. ConclusionsOur results were in line with the key roles of the amygdala and parahippocampal gyrus in anxiety and depression, and reflected the distinct effects of the DMN, prefrontal and superior temporal cortices, and sensory-motor regions on emotional regulation. The identification of these neural substrates might assist clinical monitoring mood disturbances in PD.

A Korean validation study of the Clinically Useful Anxiety Outcome Scale: Comorbidity and differentiation of anxiety and depressive disorders.

BackgroundThis study aimed to evaluate the psychometric properties of the Korean version of the Clinically Useful Anxiety Outcome Scale (CUXOS) and to examine the current diagnostic comorbidity and differential severity of anxiety symptoms between major depressive disorder (MDD) and anxiety disorders.MethodologyIn total, 838 psychiatric outpatients were analyzed at their intake appointment. Diagnostic characteristics were examined using the structured clinical interview from the DSM-IV because the DSM5 was not available at the start of the study. The CUXOS score was measured and compared with that of 3 clinician rating scales and 4 self-report scales.Principal findingsThe CUXOS showed excellent results for internal consistency (Cronbach’s α = 0.90), test–retest reliability (r = 0.74), and discriminant and convergent validity. The CUXOS significantly discriminated between different levels of anxiety severity, and the measure was sensitive to change after treatment. Approximately 45% of patients with MDD were additionally diagnosed with anxiety disorders while 55% of patients with anxiety disorders additionally reported an MDD. There was a significant difference in CUXOS scores between diagnostic categories (MDD only, anxiety only, both disorders, and no MDD or anxiety disorder). The CUXOS scores differed significantly between all categories of depression (major, minor, and non-depression) except for the comparison between minor depression and non-depression groups.ConclusionsThe Korean version of the CUXOS is a reliable and valid measure of the severity of anxiety symptoms. The use of the CUXOS could broaden the understanding of coexisting and differentiating characteristics of anxiety and depression.

Shifts in the care for patients presenting in primary care with anxiety; stepped collaborative care parameters from more than a decade

BackgroundThe mental health burden on primary care is substantial and increasing. Anxiety is a major contributor. Stepped collaborative care (SCC) is implemented worldwide to improve patient outcomes, but long term real-world evaluations of SCC do not exist. Using routinely used electronic medical records from more than a decade, we investigated changes in anxiety prevalences, whether physicians made distinction between non-severe and severe anxiety, and whether these groups were referred and treated differently, both non-pharmacologically and pharmacologically. MethodsRetrospective assessment of anxiety care parameters recorded by 54 general practitioners between 2003 and 2014, in the electronic medical records of a dynamic population of 49,841–69,413 primary care patients. ResultsSubstantial shifts in anxiety care parameters have occurred. The prevalence of anxiety symptoms doubled to 0.9% and of anxiety disorders almost tripled to 1.1%. Use of ICPC codes seemed comprehensive and use of instruments to support in anxiety level differentiation increased to 13% of anxiety symptom and 7% of anxiety disorder patients in 2014. Minimal interventions were used more frequently, especially for anxiety symptoms (OR 21 [95% CI 5.1–85]). The antidepressant prescription rates decreased significantly for anxiety symptoms (OR 0.5 [95% CI 0.4–0.8]) and anxiety disorders (OR 0.6 [95% CI 0.4–0.8]). More patients were referred to psychologists and psychiatrists. ConclusionsWe found shifts in anxiety care parameters that follow the principles of SCC. Future primary care research should comprehensively assess the use of the SCC range of therapeutic options, tailored to patients with all different anxiety severity levels.

Evaluation of 99mTc-ECD SPECT/CT brain imaging with scenium analysis in patients with generalized anxiety disorder

To assess the perfusion changes in brains of patients with varying levels of generalized anxiety disorder (GAD). A total of 38 GAD outpatients of Department of Psychiatry at our hospital from February to August, 2014 and 10 healthy controls received a 99mTC-ECD SPECT/CT scan with scenium analysis. Differences between brain perfusion and anxiety levels were analyzed by SPSS 16. 0 with one-way ANOVA, Pearson's Chi-square, t test and Spearman's correlation. They were grouped according to the levels of anxiety severity, i. e. mild (n = 11) , moderate (n = 16) and severe (n = 11). They had significantly lower blood flow in right superior frontal medial gyrus, right precuneus, right putamen, bilateral paracentral lobule and bilateral supplementary motor area (t = -2.19, -2.14, -2.22, -2.34, -2.08, -3.26, -2.72, P < 0.05). Individuals had significantly greater blood flow in mild group than those of control group in right olfactory (t = 2.09 P = 0.05). Individuals of moderate group had significantly lower blood flow than those of control group in left superior frontal gyrus medial orbital, right superior frontal gyrus medial orbital and left supplementary motor area, but greater in right olfactory (t = -2.16, -2.24, -2.49, 2.17, P = 0.04, 0.04, 0.02, 0.04). Individuals had lower blood flow in severe group than those of control group in left frontal lobe, right putamen, left paracentral lobule, right paracentral lobule, left precuneus, right precuneus, left parietal lobe, left precentral, right precentral, right postcentral, left rolandic operculum, left supplementary motor area, right supplementary motor area and left central region (t = -2.32, -2.11, -3.16, -2.61, -2.39, -2.18, -2.32, -2.67, -2.14, -2.11, -2.25, -4.38, -3.54, -2.38, P = 0.03, 0.05, 0.01, 0.02, 0.03, 0.04, 0.03, 0.02, 0.05, 0.05, 0.04, 0.00, 0.00, 0.03). Statistical differences existed in right middle frontal gyms orbital part (mild: 0.96 ± 0.07, moderate: 1.03 ± 0.06, severe: 0.98 ± 0.08, P = 0.04) and left paracentral (mild: 0.91 ± 0.07, moderate: 093 ± 004 severe: 0.87 ± 0.07, P = 0.02). There was a tendency of negative correlation between perfusion in right middle cingulate and paracingulate gyri, left precuneus, right precuneus and left thalamus and anxiety scores by Spearman's correlation analysis (r = -0.28, -0.28, -0.27, -0.29, P = 0.09, 0.09, 0.10, 0.07). Scenium software provides quantitative measurements for diagnosis of GAD in different anxiety levels. Also larger samples are required for confirming the results in further studies.

EPA-1259 – Stressful life events history and mental disorders in behcet's disease

Introduction Behcet's disease (BD) is a heterogeneous, multisystemic, recurrent, inflammatory disorder with a chronic course and an unknown cause. Mental disorders (MD) occur quite often with BD. The influence of childhood experience, relations traumatic events with BD and MD, specificity of MD still have not investigated carefully. Methods 55 BD patients (44 male and 11 female mean age 33,1±10,1) were included. ICD-10 criteria were used for MD diagnostic. Severity levels of stress, anxiety, depression found by PSS, HAM-A, MADRS. Results Early traumatic childhood experiences observed in 29(52,7%) patients. Among this patients BD started before 18 years in 13(44,8%) cases whereas in patients without early traumatic childhood experiences in 7(26,3%). The severe stress factors were preceded first BD symptoms in 12(21,8%) cases, prolonged low-intensity stressors in 24(43,6%). Most patients 45(81,8%) self-reported connection between stressful life events and exacerbation of BD. MD were diagnosed in 47(86%) BD patients: dysthymia 19(34,5%), recurrent depressive disorder − 14 (25,4%), depressive episode (mild, moderate) − 8 (14,5%), generalized anxiety disorder − 4 (7,3%), adjustment disorder − 2 (3,6%). MD preceded BD in 20% cases. Depression scores showed a clinically normal level in 13 BD patients (23,6%), mild level in 34 (61,8%), and moderate level in 8 (14,5%). Mean severity levels of anxiety, stress were 14,3±5,4 and 16,1±5,9 accordingly. Conclusions The received data show, that individual history of stressful life events is important for the beginning of the rheumatic disease and MD in BD patients. Depression and anxiety spectrum disorders are the most common MD in BD patients.