Treatment Of Anxiety In Patients Research Articles

Sex differences and determinants of anxiety symptoms in patients with COPD initiating pulmonary rehabilitation

BackgroundAnxiety is common in patients with chronic obstructive pulmonary disease (COPD). However, there is little evidence available regarding gender differences, and severity of dyspnea in relation to anxiety in patients with COPD. AimsWe examined gender differences and the association of dyspnea with anxiety in a cohort of patients with COPD prior to entering a pulmonary rehabilitation (PR) program. MethodWe analyzed data from a prospective cohort of COPD patients who attended PR from 2013 to 2019 in Lytham, Lancashire, UK. Patients were aged 40 years or older with a post-bronchodilation forced expiratory volume in 1 s (FEV1) less than 80 % of the predicted normal value and FEV1/FVC (forced vital capacity) ratio less than 0.7. We assessed quality of life (QoL) using the Saint George's Respiratory Questionnaire (SGRQ), anxiety using the Anxiety Inventory for Respiratory disease (AIR), dyspnea using the modified Medical Research Council (mMRC) scale, and exercise capacity using the Incremental Shuttle Walk Test (ISWT). ResultsNine hundred ninety-three patients with COPD (mean age = 71 years, FEV1/FVC = 58 % predicted, 51 % male) entered the PR program. Of these, 348 (35 %) had anxiety symptoms (AIR ≥8); of these 165 (47 %) were male and 183 (53 %) female, (χ2 = 3.33, p = 0.06). On logistic multivariate analysis, the following variables were independently associated with elevated anxiety: younger age (p < 0.001), female sex (p = 0.03), higher SGRQ-total score (p < 0.001) and high FEV1/FVC (p < 0.002). Dyspnea was associated with anxiety r = 0.25, p < 0.001. ConclusionOver a third of COPD patients had clinically relevant anxiety symptoms with a higher prevalence in women than men. Anxiety was associated with younger age, female gender, and impaired QoL. Early recognition and treatment of anxiety in patients with COPD is worthy of consideration for those attending PR, especially women.

Virtual reality-based cognitive–behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction: a randomised clinical trial

BackgroundThe presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction (AMI), significantly disrupting their recovery. Providing timely and easily accessible psychological interventions using virtual reality-based...

Vitamin D in the treatment of anxiety in patients with autoimmune thyroiditis and hypothyroidism in the West-Ukrainian population

Objective — to study the effects of cholecalciferol on the level of anxiety in patients with autoimmune thyroiditis and hypothyroidism in the Western Ukrainian population.&#x0D; Materials and methods. The study included 56 patients with hypothyroidism caused by autoimmune thyroiditis. Hypothyroidism was diagnosed under the guidance of recommendations of the American Association of Clinical Endocrinologists 2012. To verify autoimmune thyroiditis, the following was taken into account: related clinical signs, sonograms of the thyroid gland (reduced echogenicity) and reveal of the circulating antibodies to thyroid peroxidase and thyroglobulin. The patients were divided into two groups. Patients of the first group (n = 28) received cholecalciferol in a dose of 4000 IU/24 hours (28 000 IU/week) and L‑thyroxine ((88.39 ± 12.70) mkg/24 hours). Patients of the second group (n = 28) were administered L‑thyroxine only ((87.50 ± 12.73) mkg/24 hours). Presence of anxiety was assessed using the Hamilton rating scale for anxiety (HAMA). Examinations were performed at the baseline and after 12 weeks of treatment.&#x0D; Results. Assessment of the anxiety level by Hamilton scale after the treatment of patients of the first group demonstrated the significant reduction of anxiety level by 48.27 %, whereas in the second group by 18.25 % (p &lt; 0.001). In the patients of the first group after treatment, anxiety disappeared in 42.9 % of subjects, and mild anxiety according to the Hamilton scale remained in 57.1 %. At the same time, in the second group 21.4 % of patients had moderate anxiety, 78.6 % had mild anxiety. Thus, there was a significant decrease in the anxiety level according to the Hamilton scale after the treatment of patients of the first group compared to the subjects of the second group..&#x0D; Conclusions. Patients suffering from autoimmune thyroiditis and hypothyroidism should be administered vitamin D supplementation with the purpose of attenuation of anxiety disorders.

Exercise and Escitalopram in the Treatment of Anxiety in Patients with Coronary Heart Disease: One Year Follow-Up of the UNWIND Randomized Clinical Trial.

Anxiety is common among patients with coronary heart disease (CHD) and is associated with a worse prognosis. UNWIND was a 12-week randomized clinical trial comparing exercise and escitalopram to placebo on measures of anxiety, depression, and CHD biomarkers. Primary results of the trial reported that treatment with escitalopram, but not exercise, was associated with significant reductions in anxiety and depression. At 1-year follow-up, participants completed the Hospital Anxiety-Depression Scale-Anxiety (HADS-A) along with the HADS-Depression (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Godin Leisure Time Exercise survey to assess physical activity. Results showed that those patients randomized to escitalopram had lower scores on the HADS-A compared to those randomized to exercise (P = 0.006) and had less depression compared to exercise on the HADS-D (P = 0.004) and BDI-II (P = 0.004). Participants randomized to exercise reported higher levels of physical activity at 1-year compared to those randomized to Placebo (P = 0.039). However, despite reporting being more physically active, those randomized to exercise did not have less anxiety or depression compared to placebo controls. Escitalopram appears to be a safe and effective treatment for anxiety; exercise has many health benefits, but does not appear to be effective in treating anxiety.

Effectiveness of Acupuncture for Anxiety Among Patients With Parkinson Disease

One of the ordinary manifestations of Parkinson disease (PD) is anxiety, which remains untreated. Anxiety is closely associated with the accelerated progression of PD. Efficacy of acupuncture for anxiety has been reported. However, to date, there are no data on acupuncture's effectiveness on anxiety for patients with PD. To investigate the effect of acupuncture vs sham acupuncture for treating anxiety in patients with PD. This is randomized, double-blinded, clinical trial enrolled patients between June 20, 2021, and February 26, 2022. Final follow-up was April 15, 2022. Patients with Parkinson disease and anxiety were allocated randomly (1:1) to receive acupuncture or sham acupuncture for 8 weeks. Acupuncture operators, outcome measures evaluators, and statistical analysts were blinded to the grouping of patients. Patients were blinded to their own grouping during the study. This study took place in the Parkinson clinic of a hospital in China. Real acupuncture or sham acupuncture for 8 weeks. Primary outcome was Hamilton Anxiety Scale (HAM-A) score. Secondary outcomes were scores on the Unified Parkinson Disease Rating Scale (UPDRS), 39-item Parkinson Disease Questionnaire (PDQ-39), and serum levels of the adrenocorticotropic hormone (ACTH) and cortisol (CORT). Seventy eligible patients were enrolled, including 34 women (48.5%) and 36 men (51.4%). Sixty-four patients (91%) completed the intervention and the 8-week follow-up, including 30 women (46.9%) and 34 men (53.1%) with a mean (SD) age of 61.84 (8.47) years. At the end of treatment, the variation of HAM-A score was 0.22 (95% CI, -0.63 to 1.07; P = .62) between the real acupuncture and sham acupuncture groups. At the end of follow-up, the real acupuncture group had a significant 7.03-point greater (95% CI, 6.18 to 7.88; P < .001) reduction in HAM-A score compared with the sham acupuncture group. Four mild adverse reactions occurred during the study. This study found acupuncture to be an effective treatment for anxiety in patients with PD. These findings suggest that acupuncture may enhance the wellbeing of patients who have Parkinson disease and anxiety. Chinese Clinical Trial Registry: ChiCTR2100047253.

Longer term benefits of exercise and escitalopram in the treatment of anxiety in patients with coronary heart disease: Six month follow-up of the UNWIND randomized clinical trial

Anxiety is a common comorbidity in patients with coronary heart disease (CHD) and is associated with worse prognosis. However, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial showed that 12-week treatment of escitalopram was better than exercise training or placebo in reducing anxiety in anxious CHD patients. The longer-term benefits of treatment for anxiety are not known. Patients were randomized to 12 weeks of Escitalopram (up to 20 mg), Exercise (3 times/wk), or placebo pill. At the conclusion of treatment, participants were followed for 6-months to determine the persistence of benefit on the primary anxiety endpoint assessed by the Hospital Anxiety and Depression Scale-Anxiety scale (HADS-A) and to assess the effects of treatment on major adverse cardiac events over a follow-up period of up to 6 years. Of the 128 participants initially randomized, 120 (94%) were available for follow-up. Participants randomized to the Escitalopram condition exhibited lower HADS-A scores (3.9 [3.1, 4.7]) compared to those randomized to Exercise (5.5 [4.6, 6.3]) (P = .007) and Placebo (5.3 [4.1, 6.5]) (P = .053). Over a median follow-up of 3.2 years (IQR: 2.3, 4.5), there were 29 adverse events but no significant between-group differences. In the UNWIND trial, 12 weeks of escitalopram treatment was effective in reducing anxiety. These beneficial effects were sustained for 6 months posttreatment. Although moderate or vigorous physical activity has a number of health benefits, exercise was not an effective treatment for anxiety in patients with CHD.

Treatment of COVID-19 anxiety by auricular points

Background:In December 2019, a series of acute, atypical respiratory diseases was identified in Wuhan, China. The source of the illnesses was attributed to a novel coronavirus, named the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the subsequent disease it causes was named the coronavirus disease 2019 (COVID-19). Evidence from previous coronavirus outbreaks has shown that infected patients are at risk for developing psychiatric and mental health disorders, such as depression, anxiety, and sleep disturbances.Methods:According to the retrieval strategies, randomized controlled trials on auricular points for anxiety in patients with coronavirus 2019 will be obtained from the China National Knowledge Infrastructure, WanFang Data, Chinese Scientific Journals Database, PubMed, Embase, and Cochrane Library, regardless of publication date or language. Studies will be screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed with the Markov chain Monte Carlo method and carried out with Stata 14.2 and WinBUGS 1.4.3 software. Ultimately, the quality of the evidence obtained from the results will be evaluated.Results:This study will evaluate whether auricular points can effectively treat anxiety in patients with COVID-19.Conclusion:This study will provide evidence for whether auricular points is beneficial to the treatment of anxiety in patients with COVID-19.INPLASY registration number:CRD42022302649.

Exercise and Escitalopram in the Treatment of Anxiety in Patients with Coronary Heart Disease: One Year Follow-Up of the UNWIND Randomized Clinical Trial

Exercise and Escitalopram in the Treatment of Anxiety in Patients with Coronary Heart Disease: One Year Follow-Up of the UNWIND Randomized Clinical Trial

Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease

Anxiety is common among patients with coronary heart disease (CHD) and is associated with worse health outcomes; however, effective treatment for anxiety in patients with CHD is uncertain. To determine whether exercise and escitalopram are better than placebo in reducing symptoms of anxiety as measured by the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) and in improving CHD risk biomarkers. This randomized clinical trial was conducted between January 2016 and May 2020 in a tertiary care teaching hospital in the US and included 128 outpatients with stable CHD and a diagnosed anxiety disorder or a HADS-A score of 8 or higher who were older than 40 years, sedentary, and not currently receiving mental health treatment. Twelve weeks of aerobic exercise 3 times per week at an intensity of 70% to 85% heart rate reserve, escitalopram (up to 20 mg per day), or placebo pill equivalent. The primary outcome was HADS-A score. CHD biomarkers included heart rate variability, baroreflex sensitivity, and flow-mediated dilation, along with 24-hour urinary catecholamines. The study included 128 participants. The mean (SD) age was 64.6 (9.6) years, and 37 participants (29%) were women. Participants randomized to the exercise group and escitalopram group reported greater reductions in HADS-A (exercise, -4.0; 95% CI, -4.7 to -3.2; escitalopram, -5.7; 95% CI, -6.4 to -5.0) compared with those randomized to placebo (-3.5; 95% CI, -4.5 to -2.4; P = .03); participants randomized to escitalopram reported less anxiety compared with those randomized to exercise (-1.67; 95% CI, -2.68 to -0.66; P = .002). Significant postintervention group differences in 24-hour urinary catecholamines were found (exercise z score = 0.05; 95% CI, -0.2 to 0.3; escitalopram z score = -0.24; 95% CI, -0.4 to 0; placebo z score = 0.36; 95% CI, 0 to 0.7), with greater reductions in the exercise group and escitalopram group compared with the placebo group (F1,127 = 4.93; P = .01) and greater reductions in the escitalopram group compared with the exercise group (F1,127 = 4.37; P = .04). All groups achieved comparable but small changes in CHD biomarkers, with no differences between treatment groups. Treatment of anxiety with escitalopram was safe and effective for reducing anxiety in patients with CHD. However, the beneficial effects of exercise on anxiety symptoms were less consistent. Exercise and escitalopram did not improve CHD biomarkers of risk, which should prompt further investigation of these interventions on clinical outcomes in patients with anxiety and CHD. ClinicalTrials.gov Identifier: NCT02516332.

Manipulations of the gut microbiome alter chemotherapy-induced inflammation and behavioral side effects in female mice

Chemotherapy treatment is associated with acute behavioral side effects (fatigue, anorexia) that significantly reduce patient quality of life and are dose-limiting, thereby increasing mortality (Kidwell et al., 2014). Disruptions to gut homeostasis (diarrhea, constipation, microbial dysbiosis) are also observed in patients receiving chemotherapy. In non-oncological patients, facets of mental health (fatigue, anxiety, depression) correlate with alterations in the gut microbiome, suggestive of a contribution of the gut in CNS disease etiology. The potential gut-to-brain pathway is poorly understood in patients receiving chemotherapy. Our prior studies have demonstrated a correlation between chemotherapy treatment, gut changes, peripheral and central inflammation, and behavioral symptoms in mice. Here we aimed to determine the extent to which chemotherapy-associated gut manipulations modulate the behavioral and biological consequences of chemotherapy. We measured sickness behaviors, peripheral and central inflammatory mediators, and anxiety in conventional or germ-free female mice: 1) cohabitating with mice of the opposite treatment group, 2) pre-treated with broad-spectrum antibiotics, or 3) given an intra-gastric gavage of gut content from chemotherapy-treated mice. In cohabitation studies, presumed coprophagia promoted body mass recovery, however strong associations with inflammation and behavior were not observed. Reduction of gut microbial alpha diversity via antibiotics did not prevent chemotherapy-associated side effects, however the relative abundances of the genera Tyzzerella, Romboutsia, and Turicibacter correlated with circulating inflammatory (IL-1β) and behavioral outcomes (lethargy, anxiety-like behavior). A gut microbiota transplant from chemotherapy-treated mice decreased central locomotion in open field testing, increased circulating CXCL1, and increased hippocampal Il6 and Tnfa in germ-free mice compared to germ-free mice that received a transplant from vehicle-treated mice. Taken together, these data provide further evidence that the gut microbiota likely contributes to the development of chemotherapy-associated side effects. This work has significant implications in the future treatment of anxiety in patients, and warrants future studies using microbe-based treatment options.

Cognitive Behavioral Therapy for Anxiety in Parkinson's Disease: A Randomized Controlled Trial.

ABSTRACTBackgroundAnxiety disorders are among the most prevalent and disabling neuropsychiatric syndromes in patients with Parkinsonʼs disease (PD), but no randomized controlled treatment trials of anxiety have been published to date.ObjectiveThe aim of this study was to assess the effectiveness of cognitive behavioral therapy (CBT) in the treatment of anxiety in patients with PD.MethodsForty‐eight patients with PD with anxiety were randomized 1:1 between CBT and clinical monitoring only (CMO). The CBT program was developed to specifically address anxiety symptoms in PD and consisted of 10 weekly sessions. Assessments were conducted by blinded assessors at baseline, at the end of the intervention, after 3 months, and after 6 months (CBT group only). Main outcome measures were the Hamilton Anxiety Rating Scale (HARS) and the Parkinson Anxiety Scale (PAS).ResultsBoth the CBT and CMO groups showed clinically relevant improvement. Although there was no between‐group difference in outcome on the Hamilton Anxiety Rating Scale (6.7‐point reduction in the CBT group versus 3.9‐point reduction in the CMO group; P = 0.15), there was both a statistically significant and a clinically relevant between‐group difference on the total PAS in favor of CBT (9.9‐point reduction in the CBT group versus 5.2‐point reduction in the CMO group; P = 0.012), which was due to improvement on the PAS subscales for episodic (situational) anxiety and avoidance behavior. This greater improvement was maintained at 3‐ and 6‐month follow‐ups.ConclusionCBT is an effective treatment for anxiety in patients with PD and reduces situational and social anxiety, as well as avoidance behavior. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Pregabalin as a Treatment for Anxiety in Patients With Dementia With Lewy Bodies: A Case Series.

Anxiety is a common and invalidating symptom of dementia with Lewy bodies (DLB). To evaluate the efficacy of pregabalin as a treatment for anxiety in DLB, we screened all medical files of our patients with DLB for the use of pregabalin in this context. Overall, pregabalin was well tolerated. Ten (62.5%) of 16 patients showed an improvement of anxiety, whereas in 3 of them, anxiety disappeared completely, at respectively 3, 11, and 22 months of follow-up, with total daily doses ranging from 75 to 150 mg. Positive response to pregabalin was associated with a significant reduction in benzodiazepine use. Pregabalin seems a useful and safe tool for treating anxiety in patients with DLB.

Effect of music therapy on anxiety levels on patient undergoing dental extractions.

Background and Aims:Dental anxiety has been found to be a significant problem faced by patients undergoing extractions. Anxious patients tend to avoid dental care ultimately leading to complications. Treatment of anxious patients can be very challenging to the dentists, prolonging the treatment duration. There has been various methods to reduce anxiety of which non pharmacological ways include music and aroma therapy. Music has been known to reduce fear, stress and is a form of meditation and relaxation. Hence effect of music on the reduction of anxiety levels for patients undergoing extractions were assessed. The aim of this study is to assess the effect of music therapy on dental anxiety levels of patients undergoing extractions.Methods:50 patients visiting the outpatient department of Saveetha Dental College for dental extractions were randomly selected and allocated to Test group and Control group. The test group (N = 25) were subjected to music during extractions and Control (N = 25) were not exposed. Dental anxiety levels and hemodynamic changes namely systolic pressure, diastolic pressure and heart rate were assessed before and after extraction. The data was collected and analyzed using SPSS software with Paired t Test.Results:The study showed that the control population had elevated hemodynamic changes with regard to systolic, diastolic blood pressure and heart rate, of which the diastolic pressure rise was significant. In the test population, there was fall in the hemodynamic changes with respect to systolic diastolic blood pressure and heart rate, all of which were statistically significant. This was evident in the modified dental anxiety scale as well.Conclusion:Music seems to be a psychological and spiritual way to calm oneself down. Hence music therapy can be used as an anxiolytic agent for stressful dental procedures.

Randomised controlled trial of cognitive behavioural therapy in COPD.

Anxiety is an important comorbidity in chronic obstructive pulmonary disease (COPD). We investigated if cognitive behavioural therapy (CBT), delivered by respiratory nurses, reduced symptoms of anxiety and was cost-effective.Patients with COPD and anxiety were randomised to CBT or self-help leaflets. Anxiety, depression and quality of life were measured at baseline, 3, 6 and 12 months. A cost-effectiveness analysis was conducted from a National Health Service hospital perspective and quality-adjusted life-years estimated using the EuroQol-5D questionnaire.In total, 279 patients were recruited. Group mean change from baseline to 3 months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% CI 2.62–4.17, p<0.001) for the CBT group and 1.88 (95% CI 1.19–2.55, p<0.001) in the leaflet group. The CBT group was superior to leaflets at 3 months (mean difference in the Hospital Anxiety and Depression Anxiety Subscale was 1.52, 95% CI 0.49–2.54, p=0.003). Importantly, the CBT intervention was more cost-effective than leaflets at 12 months, significantly lowering hospital admissions and attendance at emergency departments.CBT delivered by respiratory nurses is a clinically and cost-effective treatment for anxiety in patients with COPD relative to self-help leaflets.

Exercise in the treatment of clinical anxiety in general practice \u2013 a systematic review and meta-analysis

BackgroundAnxiety disorders are common, yet treatment options in general practice are often limited to medication or CBT. There is a lack of evidence for the effectiveness of exercise in the treatment of anxiety in patients who present to general practice and also about the intensity of exercise required to lead to improvement. The aim of this systematic review was to assess the use of exercise versus waiting list control groups in the treatment of anxiety and also to assess the benefit of high intensity exercise vs low intensity exercise. Long term follow up scores were also analysed. We included patients who met diagnostic criteria for anxiety disorders or had clinically raised anxiety levels on a validated rating scale and performed a subgroup analysis of the outcomes between the two groups. The intervention was any aerobic exercise programme carried out for at least two weeks, or exercise carried out at high intensity for at least two weeks. The comparison groups were either a waiting list control group or low intensity exercise.MethodSystematic review of randomised controlled trials. Three databases were searched; CENTRAL, Medline and Embase. Outcome assessment was based on validated anxiety rating scales. The quality of the studies was appraised according to the Cochrane Risk of Bias tool. Effect sizes were calculated using the standardised mean difference.ResultsFifteen studies were identified with a total of 675 patients. Nine trials had participants with diagnosed anxiety disorders and six trials had participants with raised anxiety on a validated rating scale. Aerobic exercise was effective in the treatment of raised anxiety compared to waiting list control groups (effect size − 0.41, 95% CI = − 0.70 to − 0.12). High intensity exercise programmes showed greater effects than low intensity programmes. There was no significant difference in outcomes between groups of patients with diagnosed anxiety disorders and patients who had raised anxiety on a rating scale. Conclusions were limited by the small number of studies and wide variation in the delivery of exercise interventions.ConclusionExercise programmes are a viable treatment option for the treatment of anxiety. High intensity exercise regimens were found to be more effective than low intensity regimens. The results have implications for the use of exercise schemes in General Practice.

Systematic meta-analysis of pharmacological and psychological interventions for the treatment of anxiety in patients with chronic obstructive pulmonary disease

Rates of anxiety symptoms in patients with COPD range from 13% to 51%, which is higher than rates for patients with other chronic diseases, yet evidence underpinning the effectiveness of the various treatment options is lacking. The aim of this review was to assess the efficacy and safety of both pharmacological and psychological interventions for the management of anxiety in COPD. We searched two Cochrane Specialised Registers of Cochrane Airways group and Cochrane Col-laboration of Depression, Anxiety and Neurosis with complementary screening of Medline, PsycINFO and CENTRAL. Reference lists of included studies and online clinical trial registries were also explored. Randomised controlled trials (RCTs) and cross-over studies of pharmacological or psychological interventions for patients (age >40 years) with diagnosed COPD and co-existing anxi-ety (confirmed by recognised diagnostic criteria or validated measurement scale) were identified for inclusion. Data was extracted by two independent review authors with meta-analyses of outcomes performed using the random-effect model using Review Manager Version 5.3. A total of 1,792 citations resulted in nine included studies (five pharmacological and four psycho-logical). Meta-analysis of these studies revealed significant reductions in anxiety symptoms, both with and without adjusting for heterogeneity, in the treatment arm (mean difference -2.84; 95%CI - 4.42 to -1.26; p=0.0004, standardised mean difference -0.44; 95% CI -0.74 to -0.14; p=0.004) with the psychological studies producing greater treatment efficacy (p=0.005 for MD and p=0.02 for SMD) over pharmacological (p=0.10 for MD and p=0.20 for SMD) within sub-group analysis. Sig-nificant improvement in depression scores was noted (p=0.03), mainly driven by psychological in-terventions. A trend in favour of the intervention was found for the physical composite of quality of life measured by St George’s Respiratory Questionnaire (standardised mean difference -0.36; 95%CI -0.74 to 0.02; p=0.06; 3 studies), but not for other measures of quality of life. No evidence of any effect was found for exercise capacity or FEV1. Psychological therapies appear to be more effective than pharmacological interventions, which have little or no effect to reduce anxiety in COPD pa-tients. However, poor methodological quality and small sample size of studies investigating pharma-cotherapy may be contributing to this discrepancy.

Pregabalin for anxiety in patients with schizophrenia — A randomized, double-blind placebo-controlled study

IntroductionAnxiety is frequent in patients with schizophrenia and poses a major impact on patients perceived quality of life, daily functioning and risk of suicide. Pregabalin has shown effective in the treatment of generalized anxiety disorder and has been suggested for the treatment of anxiety in patients with schizophrenia. As evidence is sparse regarding treatment of anxiety in this patient group, we aimed to investigate the use of pregabalin for anxiety in patients with schizophrenia. MethodsA randomized, double-blind placebo controlled study was used. Patients were randomized to either placebo or pregabalin (≤600mg/d) as add-on treatment. Primary analyses were intention-to-treat based with change in Hamilton Anxiety Scale after 4 and 8weeks of treatment as primary outcome. Secondary outcomes were change in psychopathology, quality-of-life, cognitive functioning and sleep. The study used centralized raters to increase accuracy and minimize baseline inflation. ResultsA total of 54 patients were included with 46 completing the study. Pregabalin reduced the HAM-A6 score significantly compared to placebo and with a medium effect size 0.72 (p=0.01). No significant between-group difference was found for the overall HAM-A14. Most common side-effects were weight gain, dizziness, sedation and increased duration of sleep. ConclusionsAlthough no effect was found on overall HAM-A14, pregabalin might be effective in the treatment of psychic anxiety symptoms in patients with schizophrenia with a medium effect size.

Efficacy of a freeze-dried aqueous extract of Nepeta menthoides Boiss. & Buhse in the treatment of anxiety in patients with depression: A double-blind, randomized, controlled trial

ObjectiveTo assess the efficacy and safety of a freeze dried, aqueous extract of Nepeta menthoides Boiss. & Buhse (N. menthoides) in reducing anxiety in patients suffering from depression. MethodA two–armed, double-blind, randomized, controlled trial was conducted with 70 patients suffering from anxiety and depression. Participants were randomly assigned to two groups, receiving capsules of either N. menthoides or sertraline for four weeks. The Beck anxiety inventory (BAI) score together with side effects of the intervention were evaluated at baseline and then every two weeks up to the sixth week (i.e. two weeks after cessation of the intervention). In addition, Folin-Ciocalteu and Dowd methods were utilized to determine total phenolic and flavonoid contents of the N. menthoides extract. ResultsThe N. menthoides group demonstrated: (a) a greater reduction of BAI scores as compared to the sertraline group in the 2nd (16.52±8.07 vs. 21.38±10.98, P=0.04) and 4th (11.55±6.74 vs. 20.47±11.53, P<0.0001) weeks, (b) a lower recurrence rate, with BAI scores of 11.06±7.36 in the N. menthoides vs. 24.73±12.93 in the sertraline group, two weeks after finishing the intervention (P<0.0001), and (c) fewer side effects when compared to those of the sertraline group. Twelve patients reported severe side effects from the intervention, with only one of these belonging to the N. menthoides group. The total phenolic and flavonoid contents of the N. menthoides extract were 127.09±0.43mg Gallic acid equivalent/g and 16.93±0.09mg Quercetin/g of the extract, respectively. ConclusionThe anxiolytic effects of N. menthoides, its lower symptom recurrence rate and its lesser side effects make this herb a potential alternative treatment for anxiety in patients with depression. The presence of polyphenols and flavonoids in the extract might be at least partially responsible for these clinical effects.

The Complexity of Assessment and Treatment for Anxiety in Patients With a Terminal Illness

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Treatment of anxiety in patients with coronary heart disease: Rationale and design of the UNderstanding the benefits of exercise and escitalopram in anxious patients WIth coroNary heart Disease (UNWIND) randomized clinical trial

Anxiety is highly prevalent among patients with coronary heart disease (CHD), and there is growing evidence that high levels of anxiety are associated with worse prognosis. However, few studies have evaluated the efficacy of treating anxiety in CHD patients for reducing symptoms and improving clinical outcomes. Exercise and selective serotonin reuptake inhibitors have been shown to be effective in treating patients with depression, but have not been studied in cardiac patients with high anxiety. The UNWIND trial is a randomized clinical trial of patients with CHD who are at increased risk for adverse events because of comorbid anxiety. One hundred fifty participants with CHD and elevated anxiety symptoms and/or with a diagnosed anxiety disorder will be randomly assigned to 12 weeks of aerobic exercise (3×/wk, 35 min, 70%-85% VO2peak), escitalopram (5-20 mg qd), or placebo. Before and after 12 weeks of treatment, participants will undergo assessments of anxiety symptoms and CHD biomarkers of risk, including measures of inflammation, lipids, hemoglobin A1c, heart rate variability, and vascular endothelial function. Primary outcomes include post-intervention effects on symptoms of anxiety and CHD biomarkers. Secondary outcomes include clinical outcomes (cardiovascular hospitalizations and all-cause death) and measures of quality of life. The UNWIND trial (ClinicalTrials.gov NCT02516332) will evaluate the efficacy of aerobic exercise and escitalopram for improving anxiety symptoms and reducing risk for adverse clinical events in anxious CHD patients.