Somatic Anxiety Symptoms Research Articles

Mexazolam: clinical efficacy and tolerability in the treatment of anxiety.

IntroductionMexazolam is indicated for the management of anxiety with or without psychoneurotic conditions. In adult patients, the recommended daily dosage of mexazolam is 1–3 mg, administered three times daily. The objective of this article is to review the available information on the benzodiazepine (BZD) mexazolam and its clinical utility in treating patients with anxiety.MethodsThe PubMed database was searched using the keyword “mexazolam” with no date or language restrictions applied to the search. As only 11 papers were retrieved, some previously published manuscripts of interest known by the authors (not indexed on PubMed) have been added for completeness. Relevant information was selected for inclusion by the authors.ResultsA number of early studies demonstrated the ability of mexazolam to reduce anxiety symptoms with few side effects in patients with disorders associated with anxiety. Following on from this preliminary evidence, controlled studies directly comparing mexazolam with other BZDs showed that the drug is more effective than bromazepam and oxazolam, and is at least as effective as alprazolam. A larger, multicenter, phase IV study also showed that mexazolam 2 or 3 mg/day rapidly improved Hamilton Anxiety Rating Scale scores and substantially reduced the frequency and severity of numerous somatic anxiety symptoms in patients with anxiety disorders. With regard to safety, the clinical evidence indicates that mexazolam is generally well tolerated, with a low incidence of drowsiness and sedation. Furthermore, the lack of psychomotor or cognitive performance impairment following mexazolam administration may lead to better treatment compliance.ConclusionThe available clinical evidence suggests that mexazolam is an effective therapeutic option for the management of anxiety. However, larger, well-controlled clinical trials are needed to directly compare and contrast mexazolam’s efficacy and safety with other BZDs.Electronic supplementary materialThe online version of this article (doi:10.1007/s40120-014-0016-7) contains supplementary material, which is available to authorized users.

HYPERPHAGIA REACTIONS WITHIN EATING DISORDERS. CLINICAL FEATURES AND THERAPY

Aim. To evaluate clinical features of hyperphagia reactions, their significance in attraction abnormities within eating disorders and treatment options for these conditions with escitalopram. Material and methods. Mental state of 39 women (age 19-50 years) with psychogenic overeating and obesity (body mass index of 30 to 53 kg/m2) was studied. Patients were admitted to the Institute of Nutrition of the Russian Academy of Medical Sciences. Diagnostic criteria for International Classification of Diseases, 10th edition, as well as Eating Disorder Inventory (EDI), Hospital Anxiety and Depression Scale (HADS) and Ferreri Anxiety Rating Diagram (FARD) were used for syndrome qualifications. Patient Global Impression of Change was also studied using a 4-point scale of results (excellent, good, fair, and negative). Results. Clinical features of hyperphagic reactions were found. Escitalopram treatment course was completed with excellent and good results in 80% of patients. 50%-reduction in HADS score for anxiety was found in 74% of patients, for depression – in 63%, and for Ferreri scale – in 68% of patients. Escitalopram promoted more intensive body weight loss: 11% vs 8% of baseline weight in active and control groups, respectively. Adverse events occurred only in 7 (36%) patients; they were transient and did not require therapy discontinuation. Conclusion: Significant differences of premanifest disorders were often observed in patients history. Escitalopram in these patients showed efficacy in improvement of both mental and somatic symptoms of anxiety. It decreased dependence on food as a factor mitigating affect and stress, thus provided better results in body weight reduction.

Symptom dimensions of anxiety following myocardial infarction: Associations with depressive symptoms and prognosis.

Differential associations of symptom dimensions with prognosis in myocardial infarction (MI) patients have been shown for depression, but no studies have focused on anxiety dimensions. The aim of this study was to assess the association between somatic and psychological symptoms of anxiety following acute MI with adverse prognosis and to assess the overlap between anxiety and depression dimensions. Patients (n = 418) were assessed on demographic and clinical variables. The Hamilton Anxiety and Depression Rating Scales were used to measure anxiety and depression 2 months post-MI. Mean follow-up period was 3.8 years and the endpoint consisted of all-cause mortality and recurrent MI. After adjustment for demographic and clinical variables, somatic anxiety was significantly associated with recurrent MI and mortality (HR: 1.32; 95% CI [1.03, 1.69]; p = .03), and a trend was shown for an association between psychological anxiety and outcome (HR: 1.29; 95% CI [0.99, 1.67]; p = .06). The total anxiety score of the HARS was the strongest predictor of recurrent MI and mortality (HR: 1.38; 95% CI [1.07, 1.78]; p = .02). The HARS and the HDRS were highly correlated (r = .86; p < .01). Dimensions consisting of psychological distress (HR: 1.29; 95% CI [1.02, 1.63]; p = .03) and cardiopulmonary/autonomic symptoms (HR: 1.36; 95% CI [1.06, 1.75]; p = .02) also predicted outcome in adjusted analyses. Anxiety was associated with adverse prognosis in MI patients with significant associations for somatic anxiety and total anxiety. When combining anxiety and depression items, psychological distress and cardiopulmonary/autonomic symptoms predicted recurrent MI and mortality. Future research might better focus on dimensions of anxiety and depression simultaneously in MI patients.

Osteoporosis and Somatization of Anxiety

Chronic stress can now be physiologically traced as a significant player in the creation of osteoporotic bones. The present pilot study involved 100 women ( N = 42 have been diagnosed with osteopenia, N = 21 have been diagnosed with osteoporosis, N = 37 had a non-osteoporotic condition) who participated in the Hellenic Society of Osteoporosis Association Support. Correlations between somatic symptoms of anxiety and osteoporosis, and among medications and somatization in women were explored. Assessments were based on a self-report demographic questionnaire and on the Short Anxiety Screening Test (SAST) administered for detection of anxiety disorder and somatization. Statistical analysis detected non-significant differences regarding the correlation between anxiety symptomatology or somatization due to osteoporosis and osteopenia diagnosis. The same pattern is observed among women’s age group, the occupational and marital status. Hypothesis that the osteoporosis and osteopenia group would manifest significant relationships with the age group and medicines was confirmed, as well as between somatization and medicines that women with osteoporosis and osteopenia undertake. The results suggest that women are not prone to manifest anxiety or somatization in relation to the osteoporosis condition. However, the majority of women with osteoporosis and osteopenia consume more than two medicines other than those for osteoporosis. This quantity and combination they undertake appear to contribute and deteriorate their anxiety/somatization symptomatology. Further research based on a larger sample would give more definite results.

Evaluating the impact of depression, anxiety &amp; autonomic function on health related quality of life, vocational functioning and health care utilisation in acute coronary syndrome patients: the ADVENT study protocol

BackgroundDepression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients. Somatic and cognitive subtypes of depression and anxiety in acute coronary syndrome have been shown to be associated with mortality although their association with patient outcomes is unknown, as are the mechanisms that underpin these associations. We are conducting a prospective cohort study which aims to examine in acute coronary syndrome patients: (1) the role of somatic subtypes of depression and anxiety as predictors of health related quality of life outcomes; (2) how somatic subtypes of depression and anxiety relate to long term vocational functioning and healthcare utilisation; and (3) the role of the autonomic nervous system assessed by heart rate variability as a moderator of these associations.MethodsPatients are being screened after index admission for acute coronary syndrome at a single, high volume centre, MonashHeart, Monash Health, Victoria, Australia. The inclusion criterion is all patients aged > 21 years old and fluent in English admitted to MonashHeart, Monash Health with a diagnosis of acute coronary syndrome. The primary outcome is mean health related quality of life (Short Form-36) Physical and Mental Health Summary scores at 12 and 24 months in subtypes with somatic symptoms of depression and anxiety. Depressive domains are assessed by the Beck Depression Inventory II and the Cardiac Depression Scale. Anxiety is measured using the Speilberger State-Trait Anxiety Inventory and the Crown Crisp Phobic Anxiety questionnaire. Secondary outcomes include clinical variables, healthcare service utilisation and vocational functioning.DiscussionThis manuscript presents the protocol for a prospective cohort study which will investigate the role of somatic subtypes of depression and anxiety as predictors of health related quality of life, long-term vocational functioning and health service use, and the role of the autonomic nervous system in moderating these associations. Findings from the study have the potential to inform more effective pharmacological, psychological and behavioural interventions and better guide health policy on the use of health care resources.

Factors Related to Non-recovery from Whiplash. The Nord-Trøndelag Health Study (HUNT)

Whiplash injuries show a variable prognosis which is difficult to predict. Most individuals experiencing whiplash injuries rapidly recover but a significant proportion develop chronic symptoms and ongoing disability. By employing longitudinal data, we investigated how psychological and physical symptoms, self-rated health, use of health services and medications, health behavior and demographic factors predict recovery from whiplash. Data from two waves of a large, Norwegian, population-based study (The Nord-Trøndelag Health Study: HUNT2 and HUNT3) were used. Individuals reporting whiplash in HUNT2 (baseline) were identified in HUNT3 11 years later. The characteristics of individuals still suffering from whiplash in HUNT3 were compared with the characteristics of individuals who had recovered using Pearson's chi-squared test, independent sample t-tests and logistic regression. At follow-up, 31.6 % of those reporting whiplash at baseline had not recovered. These individuals (n = 199) reported worse health at baseline than recovered individuals (n = 431); they reported poorer self-rated health (odds ratio [OR] = 3.12; 95 % confidence interval [CI], 2.20-4.43), more symptoms of anxiety (OR = 1.70; 95 % CI, 1.15-2.50), more diffuse somatic symptoms (OR = 2.38; 95 % CI, 1.61-3.51) and more musculoskeletal symptoms (OR = 1.21; 95 % CI, 1.13-1.29). Individuals still suffering from whiplash also visited more health practitioners at baseline (OR = 1.18; 95 % CI, 1.06-1.32) and used more medications (OR = 1.24; 95 % CI, 1.09-1.40). Poor self-rated health seems to be a strong risk factor for whiplash injuries becoming chronic. Diffuse somatic symptoms, musculoskeletal symptoms and symptoms of anxiety at baseline are important prognostic risk factors. Knowledge of these maintaining risk factors enables identification of individuals at risk of non-recovery, facilitating adequate treatment for this vulnerable group.

Anxiety and Disordered Eating

Anxiety and Disordered Eating

The Prospective Role of Depression, Anxiety, and Worry in Stress Generation

Generalized Anxiety Disorder is characterized by worry and somatic anxiety symptoms which may generate dependent negative events and convey risk for depression. The current study prospectively examined the role of anxiety, worry, and depression in stress generation among an unselected undergraduate sample using a cross-lagged panel design with data collected at three time points. Results partially supported the role of depressive symptoms and anxiety symptoms as risk factors for dependent events. However, the role of worry in stress generation was not supported. The current study also suggested that anxiety symptoms serve as a risk factor for the development of depressive symptoms and that depressive symptoms mediate the association between anxiety symptoms and negative life events over time. These findings partially support the role of anxiety in the stress generation process and are consistent with a model of sequential comorbidity in which anxiety symptoms convey risk for depression. The importance of the current findings for the broad stress generation literature and the nature of comorbidity between GAD and MDD are discussed.

Traitement du trouble d’anxiété généralisée chez des individus présentant un trouble bipolaire : un protocole à cas unique

Resume Objectif Le taux de comorbidite est eleve chez les patients bipolaires, en particulier avec les troubles anxieux (TA). Les TA comorbides sont associes a un pronostic plus sombre, a un moins bon fonctionnement et a un risque suicidaire plus eleve. Parmi les TA, la comorbidite entre le trouble bipolaire (TB) et le trouble d’anxiete generalisee (TAG) est frequente. L’objectif principal de la presente etude est d’explorer l’efficacite de la therapie cognitive comportementale (TCC) pour le traitement du TAG chez des patients presentant un TB stabilise. Methode Quatre participants ont ete recrutes dans un protocole a cas unique experimental ABA a niveaux de base multiples. Ils ont suivi une TCC de 12 semaines et ont ete evalues en ce qui a trait aux symptomes anxieux et aux symptomes du trouble de l’humeur. Resultats Pour trois participants sur quatre, la TCC a produit des changements cliniquement significatifs au niveau des symptomes du TAG. Une baisse des symptomes depressifs a ete observee chez tous les participants a l’evaluation post-traitement. Conclusion Ces resultats preliminaires indiquent qu’un traitement specifique pour le TAG peut etre efficace chez des patients bipolaires. Le traitement devrait, en revanche, etre adapte aux clienteles plus severes.

Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: Findings from the Netherlands Study of Depression and Anxiety (NESDA)

Depression and anxiety have been suggested to be associated with systemic inflammation upregulation. However, results are not always consistent, which may be due to symptom heterogeneity of depression and anxiety. There are some indications that associations with inflammation are mainly driven by somatic symptoms of depression and anxiety. We therefore set out to evaluate the differential association of somatic and cognitive symptoms of depression and anxiety with inflammation, while adjusting for demographic, health related, and lifestyle related variables. We evaluated baseline data from 2861 participants from the Netherlands Study of Depression and Anxiety (NESDA). The Inventory of Depressive Symptomatology and the Beck Anxiety Inventory were used to assess depressive symptoms and anxiety symptoms. For both scales somatic and cognitive symptoms scales were calculated. Baseline blood samples were collected to determine high sensitivity C-Reactive Protein (CRP), interleukin (IL)-6, and Tumor Necrosis Factor (TNF)-α. We used linear regression to analyze the associations adjusting for demographics and health indicators and markers for an unhealthy lifestyle. After adjustment for sociodemographic and health indicators, depressive symptoms were associated with higher levels of CRP, IL-6 and TNF-α. This association was mainly driven by somatic symptoms. For anxiety, somatic symptoms were associated with higher levels of CRP, IL-6 and TNF-α, whereas cognitive anxiety symptoms were associated with CRP (men only). Markers of an unhealthy lifestyle explained the significant associations. Especially somatic symptoms of depression and anxiety are associated with inflammation. However, this association was mostly mediated through unhealthy lifestyles among depressed and anxious individuals.

Anti - Anxiety Drugs An Overview

Everyone experiences anxiety at one time or another butterflies in the before giving a speech or sweaty palms during a job interview are common symptoms. Other symptoms of anxiety include irritability, uneasiness, jumpiness, feelings of apprehension, rapid or irregular heartbeat, stomach ache, nausea, faintness and breathing problems. An anxiolytic or antipanic or antianxiety agent is a drug used for the treatment of anxiety, and its related psychological and physical symptoms. Anxiolytics have been shown to be useful in the treatment of anxiety disorders. Beta-receptor blockers such as propranolol and oxprenolol, although not anxiolytics, can be used to combat the somatic symptoms of anxiety. Anxiolytics are also known as minor tranquilizers. The term is less common in modern texts, and was originally derived from a dichotomy with major tranquilizers, also known as neuroleptics or antipsychotics.

Acute anxiolytic effects of quetiapine during virtual reality exposure—A double-blind placebo-controlled trial in patients with specific phobia

Anxiety disorders are among the most frequent psychiatric disorders. With regard to pharmacological treatment, antidepressants, the calcium modulator pregabalin and benzodiazepines are recommended according to current treatment guidelines. With regard to acute states of anxiety, so far practically only benzodiazepines provide an immediate anxiolytic effect. However, the risk of tolerance and dependency limits the use of this class of medication. Therefore, there is still a need for alternative pharmacologic strategies. Increasing evidence points towards anxiety-reducing properties of atypical antipsychotics, particularly quetiapine. Therefore, we aimed to evaluate the putative acute anxiolytic effects of this compound, choosing the induction of acute anxiety in patients with specific phobia as a model for the evaluation of ad-hoc anxiolytic properties in a proof-of-concept approach. In a randomized, double-blind, placebo-controlled study, 58 patients with arachnophobia were treated with a single dose of quetiapine XR or placebo prior to a virtual reality spider challenge procedure. Treatment effects were monitored using rating scales for acute anxiety as well as measurements of heart rate and skin conductance. Overall, quetiapine showed significant anxiolytic effects compared to placebo. However, effects were not seen on the primary outcome measure (VAS Anxiety), but were limited to somatic anxiety symptoms. Additionally, a significant reduction of skin conductance was observed. Further exploratory analyses hint towards a mediating role of the (COMT) val158met genotype on treatment response. The present results thus suggest a possible suitability of quetiapine in the acute treatment of anxiety, particularly with regard to somatic symptoms.

Treatment with Adjunctive N-Acetylcysteine in an Adolescent with Selective Serotonin Reuptake Inhibitor-Resistant Anxiety

elective serotonin reuptake inhibitors (SSRIs) are amainstay of psychopharmacologic treatment for pediatricanxiety disorders (Strawn et al. 2012); however, 20–35% of SSRI-treated youth with anxiety disorders do not achieve significantbenefit from these treatments (Walkup et al, 2008). Nonetheless,there is currently limited evidence for adjunctive pharmacologicinterventions in children and adolescents with who have notresponded to initial SSRI medications. Recently, however, severalstudies of anxiety-spectrum disorders in adults have noted increasedcentral glutamate concentrations, and glutamatergic hyperactivity isimplicated in the pathophysiology of anxiety disorders (Phan et al.2005). Among available glutamate modulators is the over-the-counter antioxidant, N-acetylcysteine (NAC), which is convertedinto cysteine and—through its action at the glial cysteine–glutamateantiporter—increases extrasynaptic glutamate and, in doing so,stimulates inhibitory metabotropic glutamate receptors and de-creases synaptic glutamate (Lafleur et al., 2006). This decrease insynaptic glutamate has been hypothesized to confer benefit in anx-iety treatment. Herein, we report a case of a 17-year-old adolescentboywithfunctionally-impairinggeneralizedanxietydisorder(GAD)and social phobia (SoP),who partially responded to high-dose ser-traline, but whose response was accentuated by adjunctive NAC.A. is a 17-year-old white boy with a history of GAD andgeneralized SoP. At initial outpatient presentation, A. describedpersistent fear of social situations, was preoccupied by perceivedevaluation by peers and social situations, and he avoided mostsocial situations, including school. He had demonstrated limitedimprovement in school avoidance and withdrawal from socialsituations, despite ongoing cognitive-behavioral psychotherapyand fluoxetine, which had been titrated to 20mg daily and report-edly worsened his anxiety. A. also described intense anxiety relatedto the future, a constant sense of inner tension and restlessness, andanxious ruminations that were associated with initial and middleinsomnia. Moreover, he described recurrent headaches in times ofanxiety, and secondary to his significant anxiety, A. had recentlyterminated his part-time employment at a local restaurant.Fluoxetine was discontinued and, over the next 8 weeks,sertraline monotherapy was initiated and titrated to 150mg daily,yielding a decrease in his anxiety. However, although there wassome improvement in his subjective anxiety, A. reported persistentsocial anxiety andhisClinicalGlobalImpressions-Severity(CGI-S)score remained a 5. At that time, adjunctive NAC was initiated(600mg capsules by mouth twice daily) and, over the next 4 weeks,A.experiencedadecreaseinhisanxietyandhisCGI-Sdecreasedtoa4. To target A.’s significant anxiety symptoms, NAC was increasedto 1200mg twice daily and, over the subsequent 4 weeks, he noted adecreaseinanxietyandbecameabletoattendseveralsocialactivitieswith friends at a local coffee shop, was less concerned about others’perceptionsofhim,andwasableto attendchurchandbeginapplyingfor a part-time job. A. also reported improvement in his anxiety-related insomnia, a decrease in his sense of inner tension and rest-lessness, and diminished somatic symptoms. At that time, his CGI-Shad decreased to 2, he reported that adjunctive NAC was welltolerated, and he denied any side effects.This case highlights the potential efficacy of adjunctive NAC(1200mg twice daily) in adolescents with anxiety disorders whohave experienced partial responses to SSRI pharmacotherapy. Theonset of action was rapid, with reduction of psychic and somaticanxiety symptoms; onset of efficacy occurred within 1 week of thetarget dose (1200mg twice daily), and the effect was sustained overthe treatment period. Importantly, NAC was well tolerated, as hasbeen the case in children with autism (Hardan et al. 2012), in ad-olescents with cannabis dependence (Gray et al. 2012), in adultswith trichotillomania (Grant et al. 2009), and when used adjunc-tively with SSRIs, in adults with SSRI-resistant anxiety disorders(Lafleur et al. 2006). Additional, prospective trials are urgentlyneeded to assess the potential role of glutamate modulators, such asNAC, in youth with anxiety disorders, including those who havehad partial responses to ‘‘first-line’’ psychopharmacologic andpsychotherapeutic interventions.DisclosuresDrs. Strawn and Saldan˜a disclosed no competing financial in-terests. Dr. Strawn has received research support from Eli Lilly,Shire, and the American Academy of Child & Adolescent Psy-chiatry; these are noted in the spirit of full disclosure and are notdirectly related to the work or results presented herein.References

Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis.

This study was designed to determine whether pseudoexacerbations and confirmed MS exacerbations are preceded by or concurrent with increased anxiety or depressive symptoms. This was a secondary analysis of 121 patients with MS who were observed for 48 weeks during a randomized controlled trial. Participants completed monthly self-reports on depressive and anxiety symptoms. Patient-reported exacerbations were assessed through a telephone-administered symptom checklist and neurologic examination. Both pseudoexacerbations and confirmed exacerbations were associated with concurrent somatic depressive (β = .16 and β = .33, respectively; p values < .05), affective depressive (β = .17 [p = .02] and β = .12 [p = .06]), and anxiety symptoms (β = .24 and β = .20, p values < .01), controlling for baseline symptoms. Preexisting somatic and affective depressive symptoms predicted amplified relationships between concurrent confirmed exacerbations and these symptoms (β = .19 and β = .20, respectively; p values < .01). A standard deviation increase in anxiety symptoms relative to baseline predicted subsequent onset of pseudoexacerbations (odds ratio = 1.54, p = .02), whereas increased somatic depressive symptoms predicted confirmed exacerbations (odds ratio = 1.59, p = .01). Patients with MS experiencing pseudoexacerbations or confirmed exacerbations should be assessed and monitored for depressive and anxiety symptoms, and confirmed exacerbations are particularly concerning in patients with a history of depression. The psychological or psychiatric antecedents of MS exacerbations generate new hypotheses on etiologies of confirmed exacerbations and pseudoexacerbations. clinicaltrials.gov Identifier: NCT00147446.

Trauma Exposure in Anxious Primary Care Patients

The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N = 1263) treated as part of the CALM program (Roy-Byrne et al., 2010) were assessed for presence of trauma exposure. Those with and without trauma exposure were compared on baseline demographic and diagnostic information, symptom severity, and responder status six months after beginning treatment. Trauma-exposed individuals (N = 662, 53%) were more likely to meet diagnostic criteria for Obsessive Compulsive Disorder and had higher levels of somatic symptoms at baseline. Individuals with and without trauma exposure did not differ significantly on severity of anxiety, depression, or mental health functioning at baseline. Trauma exposure did not significantly impact treatment response. Findings suggest that adverse effects of trauma exposure in those without PTSD may include OCD and somatic anxiety symptoms. Treatment did not appear to be adversely impacted by trauma exposure. Thus, although trauma exposure is prevalent in primary care samples, results suggest that treatment of the presenting anxiety disorder is effective irrespective of trauma history.

Nonmedical Use of Prescription Opioids Among Adolescents: Subtypes Based on Motivation for Use

The purpose of this study was to advance our understanding of nonmedical use of prescription medications by identifying the distinguishing characteristics of 2 subtypes of adolescent nonmedical users of prescription opioids that have been previously described. A Web-based, self-administered survey was completed by 2,597 7th–12th grade students. Sensation-seeking nonmedical users were best characterized by rule breaking and aggressive behaviors and possible substance dependence. Medical users and nonmedical self-treating users were best characterized by somatic complaints, anxiety and depressive symptoms, and history of sexual victimization.

Increased soluble interleukin-2 receptor levels are related to somatic but not to cognitive-affective features in major depression

Cell-mediated immune activation may play a role in the pathogenesis of depression as indicated by findings of increased soluble tumor necrosis factor receptor (sTNF-R) levels and meta-analytic evidence for elevated soluble interleukin-2 receptor (sIL-2R) concentrations. However, little research has been done on how these soluble cytokine receptors are differently related to specific features in patients with depression. We measured levels of the soluble cytokine receptors sIL-2R, sTNF-R1 and sTNF-R2 in 25 non-medicated patients with major depression (DSM-IV) and 22 healthy controls. Psychometric measures included cognitive-affective depressive symptoms, somatoform symptoms, somatic and cognitive dimensions of anxiety and current mood states. While patients with depression showed increased levels of sIL-2R (p<0.01), differences in sTNF-R1 (p=0.09) and sTNF-R2 (p=0.08) marginally failed to reach significance. Increased concentrations of sIL-2R were related to somatic measures such as the severity of somatoform symptoms and somatic anxiety symptoms but not to cognitive-affective measures or current mood states. Our findings may suggest some specificity in the relationship between sIL-2R and symptom dimensions and highlight potential pathways by which T cell mediated immune activation may underpin somatic symptoms in depression.

Pain symptoms in Malay patients with major depression

ObjectivesThere is a strong association between depression and pain, which is influenced by various biological and psychological mechanisms. The objectives of this study were to assess the prevalence and severity of pain symptoms among patients with major depression; and to determine the correlation between pain with clinical variables, neurotic pathology and severity of depression. MethodsFifty-one Malay patients with major depressive disorder without psychotic feature enrolled for the study. They were assessed with the Hamilton Rating Scale for Depression (HAM-D), Brief Pain Inventory (BPI) and Crown Crisp Experiential Index (CCEI). ResultsThe majority (80.4%) of the subjects had experienced pain, but overall severity of the pain was mild (33.3%). There were no statistically significant differences in socio-demographic variables with the status of pain. The prevalence of pain was significantly higher in patients who were still depressed (p<0.05), had anxious depression (p<0.05) and those with prominent somatic symptoms of anxiety (SOM) (p<0.05). The severity of pain was significantly correlated with neuroticism, the severity of depression (HAM-D total score) and high scores on SOM, DEP and FFA subscales of the CCEI. Among the three, the DEP subscale had the highest correlation with severity of pain. ConclusionsThe somatising patients were heterogeneous group. The pain symptoms were common in severe mixed anxiety–depression, predisposed by the underlying neurotic pathology. Neuroticism and high scores on SOM, DEP and FFA subscales of the CCEI contributed significantly to the pathogenesis of depressed Malay patients with pain symptoms.

Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation.

Generalized anxiety disorder (GAD) is characterized by excessive worry and somatic symptoms of anxiety (e.g., restlessness, muscle tension). Several psychological treatments lead to significant reductions in GAD symptoms by posttreatment. However, little is known about how GAD symptoms change over time. Our main goal was to examine how GAD symptoms changed in relation to one another during 2 distinct but efficacious psychological treatments: cognitive-behavioral therapy (CBT) and applied relaxation (AR). Specifically, we asked whether change in worry accounted for change over time in somatic anxiety (or the reverse) to the same degree in CBT and AR. We examined data from 57 individuals with GAD enrolled in a randomized controlled trial. Self-report measures of worry and somatic anxiety were obtained daily during treatment. Although the direction of influence between changes in worry and somatic anxiety was bidirectional to some extent in both treatments, a significant difference was also observed: Change in worry accounted for subsequent change in somatic anxiety to a greater extent in CBT than in AR. These findings allowed us to identify differences in a mechanism of change in GAD symptoms during 2 treatments and to provide some support for the idea that similarly efficacious treatments may produce symptom change via different mechanisms in a manner that is consistent with the theoretical rationales on which the treatments are based.

AS29-02 - The factor structure of treatment resistant depression

A significantly number of depressed patients does not have a complete response to an adequate monotherapy with a first line antidepressant. We have too few controlled trials to evaluate when to switch to a different class of antidepressants or adding another treatment modality to the current treatment to which the patient is resistant. The symptom profile of these patients developing only partial response has been insufficiently analysed, because the summed total scores of the outcome depression scales have been considered sufficient. To make a psychometric analysis at baseline to discriminate at the level of the individual symptoms between complete responders and non-responders in patients who have not responded to a first line monotherapy and who hereafter have to be augmented. Baseline scores on the Hamilton Depression Scale (HAM-D) and the Montgomery-Åsberg Depression Scale (MADRS) were analysed by Principal Component Analysis (PCA) without rotation procedure. Within both scales the symptoms are more or less positively correlated and it was therefore the non-general principal component we looked for to classify the treatment resistant patients. Two principal components were identified. The first component was a general factor while the second was a bi-directorial factor separating pure depression symptoms and arousal-related symptoms (including sleep problems, concentrations problems, and somatic anxiety symptoms). It is very important to monitor both the pure depression symptoms and the arousal-related symptoms to prevent the development of treatment resistant depression. In this respect the total scores on HAM-D 17 and MADRS are not in itself sufficient.