Anxiety Spectrum Research Articles

Correction to: Selective kappa-opioid antagonism ameliorates anhedonic behavior: evidence from the Fast-fail Trial in Mood and Anxiety Spectrum Disorders (FAST-MAS)

Correction to: Selective kappa-opioid antagonism ameliorates anhedonic behavior: evidence from the Fast-fail Trial in Mood and Anxiety Spectrum Disorders (FAST-MAS)

Investigating Principal Working Memory Features in Generalized, Panic, and Social Anxiety Spectrum Disorders.

Anxiety spectrum disorders are characterized by excessive and uncontrollable worrying about potential negative events in the short- and long-term future. Various reports linked anxiety spectrum disorders with working memory (WM) deficits despite conflicting results stemming from different study approaches. It remains unclear, however, how different anxiety spectrum disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD), differ in WM function. In this study, we utilized verbal, numerical, and sequential evaluations of WM to cover most possible facets of the WM data space. We used principal component analysis to extract the uncorrelated/whitened components of WM based on these measures. We evaluated medication-free patients with GAD, SAD, and PD patients as well as matched healthy individuals using a battery that measures WM duration and load. We found that patients with GAD and SAD, but not PD, exhibited poor performance only in the WM principal component that represents maintenance. There were no other significant differences between the four groups. Further, different WM components significantly predicted the severity of anxiety symptoms in the groups. We explored the clinical utility of WM components for differentiating patients with anxiety spectrum disorders from healthy individuals. By only using the WM components that represent maintenance and encoding, we managed to differentiate patients from controls in 84% of cases. For the first time, we present multiple novel approaches to examine cognitive function and design cognitive screening, and potentially diagnostics, for psychiatric disorders.

Side Effect Profiles of Selective Serotonin Reuptake Inhibitors: A Cross-Sectional Study in a Naturalistic Setting.

Background: Side effects of selective serotonin reuptake inhibitors (SSRIs), the most commonly used antidepressants, are usually underreported in clinical trials. Systematic evaluation of side effects associated with SSRIs with structured instruments in a naturalistic setting is an important design to fully understand the side effect profile of various SSRIs. We examined the frequencies of the side effects induced by 3 commonly used SSRIs, sertraline, escitalopram, and fluoxetine, by using a self-rating instrument designed to measure the subjective symptoms of patients in a naturalistic treatment setting.Methods: The subjects were outpatients recruited from the psychiatry department of a tertiary care hospital. The subjects were aged ≥ 18 years; were diagnosed with depression, anxiety spectrum disorders, adjustment disorder, hypochondriasis, or impulse control disorder according to ICD-10 criteria; and were on SSRI monotherapy. The assessment instrument included 42 items and was devised using drug package insert data on the most commonly observed side effects of antidepressants released by the US Food and Drug Administration.Results: A total of 100 patients participated in the study. Among them, 70% were women. The most common diagnosis was depression (49%). Of the patients, 53% were taking sertraline, 38% escitalopram, and 8% fluoxetine. The common side effects reported by patients were flatulence (64%), somnolence (59%), memory impairment (51%), decreased concentration (50%), yawning (47%), fatigue (45%), dry mouth (45%), weight gain (45%), light headedness (43%), and sweating (38%). Patients treated with escitalopram had significantly higher incidence of headache, pruritus, memory impairment, decreased concentration, and dizziness. Patients treated with sertraline had significantly decreased appetite.Conclusions: The study results highlight the prevalence and pattern of side effect profiles of 3 commonly used SSRIs and provide baseline data for comparison with other similar studies.

School Psychologists’ Assessment Practices for Students with Co-Occurring Anxiety and Autism Spectrum Disorder

Anxiety and autism spectrum disorder (ASD) commonly co-occur, but school-based assessment practices surrounding identification of co-occurring presentations are not well understood. This study examined school psychologists’ assessment practices for anxiety in students with ASD, perceptions of their role in the assessment process, and perceived training needs. Participants were a national sample of 177 practicing school psychologists who completed a mail-based questionnaire developed for the study. Most participants agreed that assessment for symptoms of anxiety in students with ASD was part of their role. Assessment practices were similar across school psychologists with varying levels of experience and between doctoral and non-doctoral school psychologists. Common assessment practices were identified, and most participants indicated a need for more training. Implications for future research and practice are discussed.

Management of emotionally unstable personality disorder in an urban Irish setting

AimsTo determine the prevalence of emotionally unstable personality disorder (EUPD) attending a community mental health team (CMHT) in a major Irish cityTo describe the current psychiatric care afforded to this cohort of service userMethodClinical chart review of all 328 patients attending a CMHT outpatient in an urban setting was carried out. Patients diagnosed with EUPD or displayed features of EUPD were identified. Data on the various interventions offered to this cohort of service users were collected and compared against current guidelines.ResultOut of the 328 patients actively attending the service, almost 17% (n = 55) were diagnosed with EUPD and further 6% (n = 19) were found to display features of EUPD such as emotional dysregulation, self-harming behaviour and cognitive distortions. Comorbid psychiatric disorder such as mood or anxiety spectrum disorder was diagnosed in 23% (n = 17) of this cohort. Meanwhile, 8% (n = 6) was diagnosed with addiction disorders and 5% (n = 4) was diagnosed with a comorbid personality disorder. A significant proportion of 77% (n = 57) were prescribed psychotropic medication with 51% (n = 29) being on more than one psychotropic medication. Antidepressants, antipsychotics and hypnotics were the three most common medications prescribed at the rate of 89% (n = 51), 30% (n = 17) and 28% (n = 16) respectively. A majority of 66% (n = 49) were offered intervention from a multi-disciplinary team (MDT) member with 47% (n = 23) being offered more than one type of intervention. Referrals to community mental health nurses and psychology service were the two most common interventions offered with a referral rate of 59% (n = 29) and 55% (n = 27) respectively. 28% (n = 21) of service users with EUPD or EUPD traits has had at least one hospital admission while attending the CMHT and 46% (n = 34) have been admitted to the day hospital at least once.ConclusionThe prevalence of EUPD in our outpatient sample corresponds with findings in previous studies. Standard psychiatric care is the most common option available to the majority of general adult patients with EUPD in Ireland due to the lack of any national treatment programme and scarce availability of specialised therapeutic approaches such as dialectical behavioural therapy within community mental health teams. Our CMHT will attempt to integrate mentalization-based treatment into our outpatient management of EUPD patients taking into account current clinical guidelines for management of EUPD and resources needed for training and delivering the intervention.

Network structure of depression and anxiety symptoms in Chinese female nursing students

BackgroundComorbidity between depressive and anxiety disorders is common. From network perspective, mental disorders arise from direct interactions between symptoms and comorbidity is due to direct interactions between depression and anxiety symptoms. The current study investigates the network structure of depression and anxiety symptoms in Chinese female nursing students and identifies the central and bridge symptoms as well as how other symptoms in present network are related to depression symptom “thoughts of death”.MethodsTo understand the full spectrum of depression and anxiety, we recruited 776 Chinese female nursing students with symptoms of depression and anxiety that span the full range of normal to abnormal. Depression symptoms were measured by Patient Health Questionnaire-9 while anxiety symptoms were measured by Generalized Anxiety Disorder 7-Item Questionnaire. Network analysis was used to construct networks. Specifically, we computed the predictability, expected influence and bridge expected influence for each symptom and showed a flow network of “thoughts of death”.ResultsNine strongest edges existed in network were from the same disorder. Four were between depression symptoms, like “sleep difficulties” and “fatigue”, and “anhedonia” and “fatigue”. Five were between anxiety symptoms, like “nervousness or anxiety” and “worry too much”, and “restlessness” and “afraid something will happen”. The symptom “fatigue”, “feeling of worthlessness” and “irritable” had the highest expected influence centrality. Results also revealed two bridge symptoms: “depressed or sad mood” and “irritable”. As to “thoughts of death”, the direct relations between it and “psychomotor agitation/retardation” and “feeling of worthlessness” were the strongest direct relations.ConclusionsThe current study highlighted critical central symptoms “fatigue”, “feeling of worthlessness” and “irritable” and critical bridge symptoms “depressed or sad mood” and “irritable”. Particularly, “psychomotor agitation/retardation” and “feeling of worthlessness” were identified as key priorities due to their strongest associations with suicide ideation. Implications for clinical prevention and intervention based on these symptoms are discussed.

Chronic oxytocin-driven alternative splicing of Crfr2α induces anxiety

The neuropeptide oxytocin (OXT) has generated considerable interest as potential treatment for psychiatric disorders, including anxiety and autism spectrum disorders. However, the behavioral and molecular consequences associated with chronic OXT treatment and chronic receptor (OXTR) activation have scarcely been studied, despite the potential therapeutic long-term use of intranasal OXT. Here, we reveal that chronic OXT treatment over two weeks increased anxiety-like behavior in rats, with higher sensitivity in females, contrasting the well-known anxiolytic effect of acute OXT. The increase in anxiety was transient and waned 5 days after the infusion has ended. The behavioral effects of chronic OXT were paralleled by activation of an intracellular signaling pathway, which ultimately led to alternative splicing of hypothalamic corticotropin-releasing factor receptor 2α (Crfr2α), an important modulator of anxiety. In detail, chronic OXT shifted the splicing ratio from the anxiolytic membrane-bound (mCRFR2α) form of CRFR2α towards the soluble CRFR2α (sCRFR2α) form. Experimental induction of alternative splicing mimicked the anxiogenic effects of chronic OXT, while sCRFR2α-knock down reduced anxiety-related behavior of male rats. Furthermore, chronic OXT treatment triggered the release of sCRFR2α into the cerebrospinal fluid with sCRFR2α levels positively correlating with anxiety-like behavior. In summary, we revealed that the shifted splicing ratio towards expression of the anxiogenic sCRFR2α underlies the adverse effects of chronic OXT treatment on anxiety.

Pediatric home confinement due to COVID-19: Somatic and anxiety spectrum consequences.

Aims and ObjectivesWe aimed to determine the impact of COVID‐19 related home confinement on the paediatric population by focusing on anxiety, behavioural disturbances and somatic symptoms.BackgroundTo limit the spread of the COVID‐19 outbreak, governments have imposed nationwide lockdowns to prevent direct contact; this has affected everyday lives and activities such as attending school classes. Such isolation may have impacted children’s anxiety levels.Design and MethodsWe conducted a cross‐sectional observational study using a web‐based anonymous questionnaire from 22–26 April, 2020, among children (N = 2,292) in Spain. For children below 7 years of age, parents reported the children’s behavioural, emotional and somatic symptoms and family environment data on a questionnaire designed by the researchers. Children over 7 years answered the Revised Children’s Manifest Anxiety Scale either independently or with their parents’ assistance.ResultsChildren over 7 years, boys in particular, scored high on the anxiety spectrum. Moreover, participants who knew someone who had suffered from COVID‐19 at home or whose parent was directly involved in the pandemic, obtained higher Total Anxiety scores. Significantly high values were found in all aspects of anxiety among those who feared infection or whose parents been unemployed. Of the children below 7 years, 56.3% had four or more anxiety‐related symptoms, the most frequent of which were tantrums, emotional changes, restlessness and fear of being alone. The number of symptoms reported was significant when someone in the family home had been infected with COVID‐19.ConclusionsThe COVID‐19 home confinement had a significant impact on children, causing anxiety, behavioural problems and somatic manifestations.Relevance to clinical practiceNurses play a key role in screening children who have experience confinement owing to the COVID‐19 pandemic in order to detect early anxiety symptoms using tele‐health. Suitable direct interventions can then be implemented or interdisciplinary manage could be started.

Gaze behavior is associated with the cortisol response to acute psychosocial stress in the virtual TSST.

The Trier Social Stress Test (TSST) is a reliable tool for psychobiological stress induction. Because of its socio-evaluative nature, it has been useful for investigating gaze behavior. It has been shown that healthy people avoid looking toward faces when under stress, a finding that corroborates studies demonstrating avoidance of eye contact in social anxiety disorder. Yet, little is known about the relationship between gaze behavior and the biological stress response. In a final sample of 74 healthy males, a virtual reality version of the Trier Social Stress Test (TSST-VR) with an integrated eye tracker was implemented to investigate gaze behavior during acute stress induction. Stress response measures were collected via saliva samples and subjective stress ratings. Additional questionnaires were administered for examining the influence of social anxiety traits. The TSST-VR elicited a significant psychobiological stress response. Overall, higher gaze times on judges compared to surroundings were found in the speech task while this pattern was reversed in the arithmetic task. Critically, there was a significant negative association between gaze time on judges and cortisol output in cortisol responders. In a non-clinical sample, avoidance of gaze is associated with a stronger cortisol response to acute stress. This study demonstrates the potential of eye tracking to disentangle the effects of acute stress on social interaction, warranting further investigation in clinical populations characterized by high levels of anxiety in social situations, such as social anxiety and autism spectrum disorder.

Determinants of Mental Health Care Access in a Tribal District of Central India: Findings from a Health Camp.

Objective Mental health care needs of urban, rural, and tribal regions of India are varied and challenging, which require region-specific approaches. A significant treatment gap calls out for a state-wise introspection of existing service delivery models to cater to the specific mental health needs. In Madhya Pradesh, key findings were noted from a camp conducted in one of the tribal districts. To establish patient-centered services, it is important to understand their mental health care needs. Materials and Methods A cross-sectional study within a mental health camp was conducted in the east-central tribal district of Madhya Pradesh by using a semi-structured interview. Statistical Analysis Treatment deficit, pathways to care, and treatment barriers were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20. Results Among 113 patients who sought help, treatment deficit was 85% with patient factors contributing 76% predominantly affecting the unmarried group of patients. Common mental illnesses (CMIs) outnumbered severe mental illnesses (SMIs) of which anxiety spectrum disorder contributed the most. SMIs still appear to remain undiagnosed till late in the course of illness. Nicotine dependence was higher in males ( p < 0.001), and an increase in the dependence pattern was observed with increasing age ( p = 0.001). Conclusion Rising awareness and recognition of CMIs as a common mental health concern while under-recognition of SMIs among tribal communities needs further research. Considering attribution of symptoms to unknown factors, treatment barriers revolving around patient factors, and higher nicotine dependence in males, a timely evaluation of a multitargeted intervention to establish the balance in access to mental health care among the tribal population of Madhya Pradesh is warranted.

Comparative study of psychoactive substance use pattern in romania and hungary

IntroductionEurope’s drug situation is facing an increasing trend.ObjectivesTo compare the psychoactive substance use pattern in Romania and Hungary.MethodsData was collected from the electronical databases of the 3rd Psychiatry Clinic of Cluj County Emergency Hospital, Cluj-Napoca, Romania and from the Psychiatry Department of Kenezy Gyula Hospital Debrecen, Hungary. We included adult patients who had at least one hospital admission for mental and behavioral disorders due to psychoactive substance use between 01/01/2013 and 31/12/2016.Results96 patients from Romania (80.2% males, mean age 27.8 years (18, 82)) and 816 from Hungary (71.93% males, mean age 47 years (18, 90)) were included. Romanian patients consumed more opioids (31.52% vs 4.34%, p&lt;0.05 Chi-square Test), cannabinoids (66.3% Ro vs 13.04%, p&lt;0.001 Chi-square Test), and synthetic drugs (declared 73.91% vs 8.21%, p&lt;0.001 Chi-square Test), an underlying personality disorder (52.08% vs 34.06% p=0.001 Chi-square test) was more often diagnosed. Hungarian patients consumed more alcohol (89.46% vs 30.43%, p&lt;0.001 Chi-square Test), a comorbid bipolar disorder (18.75% vs 5.2%, p=0.001 Chi-square Test), a major depressive disorder (40.8% vs 16.6% p&lt;0.001, Chi-square Test) or an anxiety spectrum disorder (55.26% vs 7.29%, p&lt;0.001 Chi-square test) were more often diagnosed. Overall, more than 85% had a dependence use pattern, more than 65% having multiple admissions.ConclusionsRomanian drug users are younger, prefer opioids, cannabinoids and synthetic drugs and have more often a comorbid personality disorder than Hungarian patients, who consume more alcohol and have a comorbid affective disorder.

Post-COVID-19 Panic Disorder in Older Adults: Two Case Reports

IntroductionPatients who recover from infection with SARS-CoV-2 (COVID-19) are at risk for a range of neuropsychiatric conditions, among which anxiety spectrum disorders have been frequently observed.MethodsIn this report we present two cases of older adults with no past psychiatric history who developed panic disorder after recovering from COVID-19.ResultsPatient A is a 51-year-old Haitian American woman who was admitted to inpatient psychiatry with symptoms of anxiety, insomnia, disorganized behavior, and suicidal ideation, as well as intermittent hypertensive episodes. After discharge, the hypertensive episodes persisted and were associated with feelings of impending doom, palpitations, and shortness of breath. While undergoing blood pressure management from her cardiologist, she was admitted to outpatient psychiatry, diagnosed with panic disorder, and tried on multiple medications (Mirtazapine, Trazodone, Hydroxyzine, Escitalopram, Sertraline). None of these medications relieved her symptoms, which gradually evolved from panic/anxiety/depression to derealization/depersonalization. Eventually, all her symptoms abated without medication. Patient B is a 61-year-old African American woman who was admitted to outpatient psychiatry with episodes of chest tightness, palpitations, and trembling, as well as insomnia and depressed mood; she too was diagnosed with panic disorder. She had previously been treated by her primary care doctor and in the emergency room with various benzodiazepines (Diazepam, Alprazolam, Lorazepam), but she was eventually stabilized on a regimen of Sertraline, Trazodone, and Gabapentin.ConclusionsHere we examine the rationale and effectiveness of various medication trials for COVID-19-induced panic disorder, as well as how psychosocial risk factors may predict the course of illness. We also discuss some hypothesized mechanisms by which SARS-CoV-2 could produce neuropsychiatric sequelae (e.g. direct viral injury, cytokine storm, molecular mimicry). These mechanisms could affect both peripheral and central nervous systems, resulting in the combination of autonomic instability and mood disturbance classically associated with panic disorder.FundingNew York State Department of Health, Center of Excellence Grant

The Roles of Serotonin in Neuropsychiatric Disorders.

The serotonergic system extends throughout the central nervous system (CNS) and the gastrointestinal (GI) tract. In the CNS, serotonin (5-HT, 5-hydroxytryptamine) modulates a broad spectrum of functions, including mood, cognition, anxiety, learning, memory, reward processing, and sleep. These processes are mediated through 5-HT binding to 5-HT receptors (5-HTRs), are classified into seven distinct groups. Deficits in the serotonergic system can result in various pathological conditions, particularly depression, schizophrenia, mood disorders, and autism. In this review, we outlined the complexity of serotonergic modulation of physiologic and pathologic processes. Moreover, we provided experimental and clinical evidence of 5-HT's involvement in neuropsychiatric disorders and discussed the molecular mechanisms that underlie these illnesses and contribute to the new therapies.

Attention Bias and Prodromal Anxiety Symptoms in Toddlers With Fragile X Syndrome and Down Syndrome.

Early identification of behavioral risk markers for anxiety is essential to optimize long-term outcomes in children with neurodevelopmental disorders. This study analyzed attentional avoidance and its relation to anxiety and autism spectrum disorder (ASD) symptomatology during social and nonsocial fear conditions in toddlers with fragile X syndrome (FXS) and Down syndrome (DS). Toddlers with FXS and DS exhibited increased nonsocial attentional avoidance relative to typically developing (TD) toddlers. Attentional avoidance was not related to anxiety symptom severity in any group; however, higher ASD symptom severity was related to more social attentional avoidance in the FXS and TD groups. Findings suggest that there may be different underlying mechanisms driving attentional avoidance across neurodevelopmental disorders.

Regulating digital therapeutics for mental health: Opportunities, challenges, and the essential role of psychologists.

With so many promising digital therapeutics for anxiety and obsessive-compulsive (OC) spectrum problems, there is an urgent need to consider how evolving regulatory oversight of digital therapeutics is poised to shift how these tools are developed, evaluated, reimbursed, and delivered. In this commentary, we discuss both opportunities and potential pitfalls associated with emerging government regulations of digital therapeutics for mental health, and we consider how applying the traditional 'prescription-based' medical approval paradigm to digital therapeutics for mental health could ultimately undermine and limit the broad accessibility of these software-based innovations that have been explicitly designed to expand the accessibility of care. For example, the vast majority of behavioural and mental health providers do not have 'prescription privileges' (a term originally rooted in pharmacologic practices), and as a result, under current regulations in the U.S. would not be authorized to make FDA-cleared digital therapeutics available to their patients. This is particularly concerning given that most digital therapeutics for mental health are directly rooted in psychological and behavioural science, yet psychologists would not be authorized to incorporate these innovations into their practice. We consider how synchronizing regulatory standards across countries may prove useful, and we conclude by arguing that multidisciplinary teams making regulatory decisions concerning digital therapeutics for mental health must include representation from the discipline and practice of psychology. PRACTITIONER POINTS: Emerging government regulations of digital therapeutics for mental health present both opportunities and potential pitfalls Applying the traditional 'prescription-based' medical approval paradigm to digital therapeutics for mental health could ultimately undermine the broad accessibility of these software-based innovations. Synchronizing regulatory standards across countries may prove useful. Multidisciplinary teams making regulatory decisions concerning digital therapeutics for mental health must include representation from the field of psychology.

How technology can enhance treatment: A scoping review of clinical interventions for anxiety and obsessive-compulsive spectrum disorders.

Researchers are increasingly investigating how technology could be used to improve the efficacy of treatment for anxiety and obsessive-compulsive (OC) spectrum disorders. A broad range of technologies, disorders and therapeutic processes have been examined in the literature. This review summarizes the evidence for using technology in clinical interventions for anxiety and OC-spectrum disorders and highlights research gaps that should be addressed to improve the evidence base. A scoping review was conducted based on systematic searches of three databases. Broadly, the criteria included interventions that had integrated technology into clinical contexts to enhance treatment for anxiety and OC-spectrum disorders. All records were double-screened by two reviewers, and data were extracted on the characteristics of interventions, symptom outcomes, and implementation factors. Searches returned 2,475 studies, of which 117 were eligible for inclusion in this review. Although almost all studies reported pre-post-symptom reductions, only one quarter of the controlled studies demonstrated additive effect of technology-based interventions in between-group analyses. We noted a trend in underreporting implementation factors. Technology-based interventions can improve the efficacy of treatment for anxiety and OC-spectrum disorders, but there are challenges to achieving this goal. Based on a review of the included studies, we provide four specific recommendations to improve the quality and likelihood of success of future research projects. Technology-based adjuvants are unlikely to improve the efficacy of treatment for anxiety or OC-spectrum disorders based on their novelty or convenience alone. A subset of studies gives hope that specific innovations can improve treatment when targeting a therapeutic process that has been problematic. Clinicians seeking to improve the efficacy of their treatment should first define client-specific therapeutic factors (e.g., homework compliance) that could be leveraged, then apply a specific innovation to address this factor.

Profiles of Autonomic Activity in Autism Spectrum Disorder with and without Anxiety.

Both anxiety and autism spectrum disorder (ASD) are associated with atypical physiological activity. Few studies have systematically assessed the resting physiological activity in ASD with co-occurring anxiety disorders. We tested 75 participants divided in four groups: youth with ASD, with (ASD + Anxiety = 22, 6F, 12.29±2.83years old) and without co-occurring anxiety (ASD Alone = 15, 6F, 11.59±2.85years old) and compared their physiological profile with that of matched typically developing controls (TDC) with (Anxiety Alone = 16, 6F, 11.24±3.36years old) and without co-occurring anxiety disorders (TDC = 22, 8F, 11.88±2.88years old). Results indicated reduced sympathetic and parasympathetic activity at rest in ASD as compared to TDC youth. ASD + Anxiety and Anxiety Alone groups showed different sympathetic, but similar parasympathetic activity. These findings suggest that autonomic profile-based approaches may advance research, diagnosis, and treatment of ASD and anxiety.

Systematic review and meta-analysis of randomized controlled trials of ketamine in the treatment of refractory anxiety spectrum disorders.

Background:Anxiety disorders are common, associated with significant burden of disease, and have high levels of treatment resistance. Low-dose ketamine has been extensively studied in treatment-resistant depression, with fewer reports in treatment-resistant anxiety disorders.Aims:This systematic review and meta-analysis collected efficacy, safety, and tolerability data for ketamine as a treatment for anxiety spectrum disorders.Methods:We conducted a systematic search for randomized controlled trials (RCTs) of acute ketamine treatment for patients with anxiety disorders. Open-label trials of ketamine maintenance therapy were also considered. Qualitative and, where possible, quantitative syntheses of findings were performed using Review Manager software (RevMan). Acute dose-response and maintenance treatment data were also collected.Results:There were six eligible acute RCTs – two in social anxiety disorder (SAD), three in post-traumatic stress disorder (PTSD), and one in obsessive-compulsive disorder (OCD). Four of the six showed significant improvement in anxiety rating scores in ketamine compared with control groups. Pooled analysis showed ketamine was associated with an increased likelihood of treatment response for SAD (odds ratio (OR): 28.94; 95% confidence interval [CI]: 3.45–242.57; p = 0.002) but not for PTSD (OR: 2.03; 95% CI: 0.67–6.15; p = 0.21). A dose-response profile was observed for ketamine and changes in SAD symptoms, with doses ⩾0.5 mg/kg associated with greater reduction in anxiety rating scores than lower doses. Ketamine maintenance therapy was associated with sustained anxiolytic effects and improved social and/or work functioning.Conclusion:These preliminary analyses suggest that acute ketamine may be broadly effective across treatment-resistant anxiety spectrum disorders. These effects can be prolonged with maintenance treatment. Future studies will be needed to provide critical knowledge gaps around off-label use, side effects, and potential risks for abuse in clinical settings.

A Cross-sectional Study to Assess Psychiatric Co-morbidity among Patients of Migraine and Other Headaches

Introduction: Migraine is the most common cause of vascular headache with a one-year prevalence as high as 6-14.3%. Having various pathophysiological theories, it occurs in much co-morbidity with several medical as well as psychiatric disorders like mood disorders, phobia, anxiety spectrum, etc. Migraine, especially when co-morbid with psychiatric illness stands markedly burdensome economically, diagnostically, therapeutically and prognostically. Hence, needs even further research. Aim: To study patients with migraine versus other types of headache and to study psychiatric co-morbidity among patients with migraine. Materials and Methods: This cross-sectional study was conducted on total 100 patients presenting with headache, meeting the criteria were taken up for the study and divided into two groups. Patients meeting International Headache Society (IHS) criteria for migraine were enrolled under group A and patients suffering from headache other than migraine under group B. Having subjected to detailed history and evaluation, patients were subjected to Symptom checklist-80, Hamilton’s Anxiety Rating Scale (HARS) and Montgomery Asberg Depression Rating Scale (MADRS), International Classification of Diseases (ICD)-10 criteria. The data so collected was subjected to statistical analysis and association of psychiatric morbidity with migraine patients was assessed. Results: Patients with migraine (group A) and among those too, patients having psychiatric morbidity had significantly (p&lt;0.01) longer duration of illness (≥8 years), more frequent attacks ≥5 attacks per month and had longer duration of each attack &gt;24 hours compared to the other groups. Patients having migraine had significantly (p&lt;0.01) higher psychiatric morbidity, more SCL-80 symptoms (mean score 83.05); more depressive symptoms (mean MADRS score was 31.9±9.2) and more anxiety with the mean Hamilton Anxiety score was 23.3 than in patients without psychiatric morbidity. Conclusion: A thorough evaluation of psychiatric disorders in migraine is important so as to propose a non segregated model of care to direct the burden and deterioration associated with psychiatric co-morbidity in migraine.

Anxiety Disorder in Homemakers of Kumaon Region of Uttarakhand, India.

Background:Anxiety is graded as the sixth major contributor to nonfatal health loss worldwide and is included in the top ten causes of years lived with disability. National Mental Health Survey 2015–2016 too reported the prevalence of anxiety spectrum disorders as 3.5%, and way higher among females than males. The present study was undertaken to find the prevalence of anxiety disorders in homemakers aged 15–59 years and identify factors causing anxiety disorders in this population.Methods:In the present cross-sectional study, a total of 324 ever-married, apparently healthy women aged less than 60 years were included using systematic random sampling from the four selected urban areas after applying proportional sampling. A generalized anxiety disorder-7 (Hindi version) questionnaire was used for screening the anxiety disorders. Additional information was collected using a pretested questionnaire for assessing determinants. The data so collected were coded and compiled in MS Excel and analyzed using IBM®SPSS® Statistics (version 17.0).Results:Forty-four (13.6%) out of 324 women were screened positive for anxiety disorder. Moderate anxiety was present in 10.2% and severe anxiety in 3.4% of study subjects. Anxiety symptoms were significantly higher among women with perceived economic instability 4.3 (95% CI 1.5–12.2) and non-cordial relation with family members (11.5 [95% CI 2.4–55.5] with in-laws and 20.2 [95% CI 4.3–94.2] with husband) Health of the children was also seen to be major reason of anxiety (31.1 [95% CI 3.8–256.6]).Conclusion:Anxiety disorder is a significant mental health problem affecting over 13% homemaker women in the Kumaon region of Uttarakhand, India.