Untreated Anxiety Research Articles

Psychotherapeutic Treatment Approaches of Anxiety Disorders in the Elderly

Anxiety disorders among older adults are fairly common but often go undiagnosed and under treated. Unfortunately, untreated anxiety leads to hastened aging, including increased risk for cardiac morbidity and cognitive impairments. First-line treatments for anxiety disorders are typically pharmacological measures, primarily selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines. However, many patients may not accept medications or may experience debilitating side effects. Additionally, anxiety symptoms may not be entirely addressed by medications alone. All of this points to the need for non-pharmacological treatments. When treating anxiety, cognitive behavioral therapy (CBT) has become the gold standard psychotherapeutic intervention. However, sometimes CBT alone is insufficient in treating anxiety. New innovative approaches, such as mindfulness therapy (MT) and acceptance and commitment therapy (ACT), have been developed to augment CBT and have proven to be beneficial in small studies. Additionally, the skills learned in these novel treatment modalities can continue to be used by older adults in managing anxiety long after the treatment sessions have ended.

A rock and a hard place: The selective serotonin reuptake inhibitor dilemmas in addressing perinatal mood and anxiety disorders

Untreated perinatal depression and anxiety increase the risk of pregnancy complications, introducing significant maternal and neonatal complications. Unfortunately, antidepressant treatment with selective serotonin reuptake inhibitors (SSRIs) is similarly associated with adverse perinatal outcomes. Providers should consider all maternal and fetal outcomes when addressing this dilemma.

Transdiagnostic cognitive behavioural treatment and the impact of co-morbidity: An open trial in a cohort of primary care patients

Background: The development of initiatives to improve access to psychological therapies has been driven by the realization that untreated anxiety and depression are both very common and costly to individuals as well as society. Effective and efficient treatments, mostly in the form of cognitive behavioural therapies (CBT), can be used in ways which enhance their acceptability and accessibility. To date, numbers of group therapies have been developed to improve cost efficiency, but in spite of growing interest in transdiagnostic approaches, group therapies have so far mostly been diagnosis specific. Aims: This study is aimed at evaluating a brief transdiagnostic cognitive behavioural group therapy (TCBGT) designed to treat both anxiety and depression among patients in primary care. Method: The participants were 287 adult patients in primary care with diagnoses of depression and/or anxiety disorders. They underwent a 5-week TCBGT. A mixed design ANOVA was used to evaluate differential effects of treatment according to diagnostic groups (anxiety versus depression) and number of diagnoses (co-morbidity). Results: Pre–post differences were significant and the treatment was equally effective for both anxiety disorders and depression. Number of diagnoses did not affect the outcome. Conclusions: The study indicates feasibility of the brief transdiagnostic group therapy for a wide range of mood and anxiety disorders in primary care. The results indicate that low intensity, brief transdiagnostic group therapies may be a feasible way to improve access to psychological therapies for a large number of patients.

Treating perioperative anxiety and pain in children: a tailored and innovative approach.

Millions of children undergo outpatient surgery in the United States each year; the overwhelming majority will experience significant perioperative anxiety and pain. Behavioral preparation programs focused on skills acquisition and modeling, considered essential for effective preparation, are no longer offered to most children and families in the outpatient surgery setting. Moreover, what little preparation does occur is typically generic in nature, rather than tailored to unique characteristics of the child and family. Untreated anxiety and pain have significant implications for children's short- and long-term recovery and future interactions in the medical environment. The rapid growth of the World Wide Web and increasing access to Internet by families across the country provide an opportunity to develop tailored, Web-based behavioral preparation programs that can be accessed repeatedly at times convenient to the child and family, that include coping skills training and modeling, and that can provide unique output based upon child and parent characteristics known to impact perioperative pain and anxiety. In this review article, we present a conceptual framework for a computer-based intervention that may transform the way we manage children and parents before and after surgery.

A closer look at the nature of anxiety in weight loss surgery candidates.

Depression among weight loss surgery (WLS) candidates is common. Anxiety in this population is less studied. Untreated anxiety persists post-surgery and is associated with poor surgical outcomes. The current study sought to explore the nature of anxiety in WLS candidates. Given shared symptoms of anxiety and obesity, we hypothesized that physiological symptoms of anxiety would be most common. In this retrospective study, the medical records of 174 pre-WLS candidates at a large medical center were reviewed. Each completed a comprehensive medical, surgical, and psychological evaluation as part of standard of care. Data from these evaluations were abstracted. One hundred forty-three candidates completed the Beck Anxiety Inventory (BAI). A Principal Components Analysis (PCA) with varimax rotation was used to identify the factor structure of the BAI. The sample consisted of primarily middle-aged (46.0 ± 13.24 years), married (60.8%), Caucasian (65.7%), females (79%) with Class III obesity (Body Mass Index = 50.1 ± 10.68) and mild anxiety (8.86 ± 8.70). Forty-four percent of the sample endorsed clinically significant anxiety. PCA revealed a four-factor structure that explained 56.28% of the variance in the BAI. The four factors were: 1) cognitive-emotional distress, 2) autonomic hyperarousal, 3) neurophysiologic concerns, and 4) body temperature. Clinically significant anxiety is common among WLS candidates. Cognitive-emotional clustering of anxiety symptoms was more common than hypothesized. This is notable given the overlap of physiological symptoms of anxiety and obesity. Findings lend support for the utility of psychotherapeutic approaches tailored to address maladaptive thoughts to address anxiety and potentially improve WLS outcomes.

Untreated psychiatric disorder in pregnancy: Weighing the risks

Though approximately 15 to 29% of pregnant patients have a psychiatric disorder during pregnancy, only about 5 to 14% seek treatment. Untreated mental illness during pregnancy has been associated with poor nutrition, failure to follow prenatal and medical guidelines, and alcohol or other substance misuse. The risks of untreated mental illness during pregnancy must be carefully evaluated along with the risks posed by medications. This review will evaluate consequences of untreated depression, anxiety, schizophrenia, and bipolar disorder in the pregnant patient.

Depression and Anxiety in University Music Students

Performance anxiety among musicians and music students has been widely addressed, but far less attention has been given to examining the rates and characteristics of broader mental distress in this population. This study examined depression and anxiety in music students at one university. A considerable number of students reported symptoms indicative of anxiety or depression. Even though prevalence rates were not markedly different than those described in the literature for other university students irrespective of major, the high rate of untreated anxiety and depression among the music students is concerning. Music educators can help prepare their junior high and high school–aged students for the stressors of university music study by helping them develop coping strategies, fostering awareness of anxiety and depression as common and treatable conditions, and promoting acceptability of seeking treatment when necessary.

Differences in latency to first pharmacological treatment (duration of untreated illness) in anxiety disorders: a study on patients with panic disorder, generalized anxiety disorder and obsessive–compulsive disorder

The latency to first pharmacological treatment (duration of untreated illness or 'DUI') is supposed to play a major role in terms of outcome in psychotic conditions. Interest in the field of affective disorders and, in particular, of duration of untreated anxiety, has been recently registered as well. However, a preliminary epidemiologic investigation of the phenomenon is necessary. The present study was aimed to investigate and compare age at onset, age at first pharmacological treatment and DUI in a sample of patients affected by different anxiety disorders. DUI was defined as the interval between the onset of the specific anxiety disorder and the administration of the first adequate pharmacological treatment in compliant subjects. Study sample included 350 patients, of both sexes, with a DSM-IV-TR diagnosis of panic disorder (n = 138), generalized anxiety disorder (n = 127) and obsessive-compulsive disorder (n = 85). Panic disorder was associated with the shortest DUI (39.5 months), whereas obsessive-compulsive disorder was associated with the longest latency to treatment (94.5 months) (F = 13.333; P < 0.0001). Patients with generalized anxiety disorder showed a mean DUI of 81.6 months. Present results indicate that patients with different anxiety disorders may wait for years (from 3 up to 8) before receiving a first adequate pharmacological treatment. Differences in terms of age at onset, age at the first pharmacological treatment and, ultimately, in DUI in specific anxiety disorders may depend on multiple clinical and environmental factors. Latency to non-pharmacological interventions (e.g. psychoeducation and different forms of psychotherapy) needs to be addressed and correlated with DUI in future studies.

Anxiety, Health Risk Factors, and Chronic Disease

Anxiety disorders are the most common mental health condition and frequently co-occur with a variety of health risk factors, such as physical inactivity, cigarette smoking, and alcohol consumption. As such, untreated anxiety and increased risk for engagement in these health risk habits can further increase risk for later-onset chronic disease and complications in disease management. Contemporary studies have identified unique temporal relationships between the onset of specific anxiety disorders with smoking and alcohol use disorders. Incorporating exercise with evidence-based treatments for anxiety is emerging and promising in enhancing treatments for anxiety-related conditions. Likewise, substance use treatment programs may benefit from the detection and management of anxiety. Collaborative care models for anxiety may provide the needed systems-based approach for treating anxiety more effectively in primary and specialty care medical settings. Based on a qualitative review of the literature, this article summarizes the current research on the associations between anxiety, health risk factors, and the risk for chronic diseases. The authors also offer suggestions for future research that would help in better understanding the complex relationships between the role anxiety plays in the vulnerability for and management of physical inactivity and substance use.

The course of untreated anxiety and depression, and determinants of poor one-year outcome: a one-year cohort study

BackgroundLittle is known about the course and outcome of untreated anxiety and depression in patients with and without a self-perceived need for care. The aim of the present study was to examine the one-year course of untreated anxiety and depression, and to determine predictors of a poor outcome.MethodBaseline and one-year follow-up data were used of 594 primary care patients with current anxiety or depressive disorders at baseline (established by the Composite Interview Diagnostic Instrument (CIDI)), from the Netherlands Study of Depression and Anxiety (NESDA). Receipt of and need for care were assessed by the Perceived Need for Care Questionnaire (PNCQ).ResultsIn depression, treated and untreated patients with a perceived treatment need showed more rapid symptom decline but greater symptom severity at follow-up than untreated patients without a self-perceived mental problem or treatment need. A lower education level, lower income, unemployment, loneliness, less social support, perceived need for care, number of somatic disorders, a comorbid anxiety and depressive disorder and symptom severity at baseline predicted a poorer outcome in both anxiety and depression. When all variables were considered at the same time, only baseline symptom severity appeared to predict a poorer outcome in anxiety. In depression, a poorer outcome was also predicted by more loneliness and a comorbid anxiety and depressive disorder.ConclusionIn clinical practice, special attention should be paid to exploring the need for care among possible risk groups (e.g. low social economic status, low social support), and support them in making an informed decision on whether or not to seek treatment.

A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD

Previous research indicates a high prevalence of untreated anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). The current study examined the effect of cognitive behavioral therapy (CBT) in groups for co-morbid, clinically significant anxiety and depression in COPD outpatients of both sexes. In a randomized, controlled trial, CBT (n = 25) was compared with enhanced standard care (n = 26). Participants in both conditions were followed up at 2 and 8 months from baseline. Main outcome measures comprised the Beck Anxiety Inventory and the Beck Depression Inventory-II. Measures of health status and sleep were included as secondary outcomes. The effects of sex and age were also investigated. CBT resulted in improvement in symptoms of anxiety and depression, with effect sizes of 1.1 and 0.9 at post-treatment, respectively. The improvement was maintained at the 8-month follow-up, with effect sizes of 1.4 and 0.9. In the control group, there was no significant change. Compared to men, women had higher symptom levels throughout the whole study period. Younger patients had more anxiety and depression, age had also differential effects in the two groups on change in depressive symptoms. Changes in sleep and health status were small in both groups. The findings indicate that CBT may provide rapid symptom relief for COPD patients with clinically significant anxiety and depression, and underline the need for integrating mental health care into the overall medical regimen for COPD.

Addressing Co-Occurring Disorders and Other Clinical Issues in a DUI Population

Clients of driving under the influence (DUI) programs with co-occurring mental health disorders are more likely to relapse or repeat their offense. DUI programs often do not address mental health problems, as they may not be required to do so by state regulations. This article presents a case study of one program that is intervening using a clinical team composed of clinical supervisors and counselors. Over the course of 3 years, the DUI program had 835 clients referred to this clinical team for assessment and intervention. About 50% of the clients were drinking while taking medication and 17% had untreated anxiety or depression. A case vignette is presented to demonstrate the assessment and intervention process.

P01-105 - Characteristics and one-year outcome of untreated anxiety and depression

ObjectiveTo study reasons for not receiving treatment, and examine characteristics and one-year outcome of untreated anxiety and depression.MethodsData were used of 743 primary care patients with a six-month anxiety or depressive disorder in the Netherlands Study of Anxiety and Depression (NESDA). Diagnoses were confirmed by the Composite Interview Diagnostic Instrument (CIDI). Patients’ perceived need for care, service utilisation, and reasons for no treatment were assessed by the Perceived Need for Care Questionnaire (PNCQ).Results43% of the respondents received no treatment. Of these untreated patients, 25% did not perceive a mental problem; 26% perceived no need for care; and 49% expressed a need for care which was not met. Untreated patients with a treatment need showed the same symptom severity and disability as treated patients, and reported even more loneliness. Compared to other untreated patients, they were more handicapped regarding clinical and psychosocial functioning.After one year, treated and untreated patients with a treatment need showed a poorer outcome than untreated patients without a self-perceived mental problem or need for care.ConclusionsMany patients with anxiety or depression do not seek treatment. Half of them are probably right: they do not perceive a mental problem or treatment need, suffer from relatively mild symptoms, and show a favourable one-year course. Untreated patients with a perceived treatment need, however, suffer from severer symptoms, and show a poorer outcome than other untreated patients. Therefore, care providers should pay considerable attention to this worrisome group.

Screening and Assessing Adolescent Asthmatics for Anxiety Disorders

The purpose of this study was to evaluate a strategy designed to permit early detection of anxiety disorders in adolescent asthmatics. Adolescents with asthma (N = 53) were screened for anxiety disorders using the Trait subscale of the State-Trait Anxiety Inventory for Children [STAI-C (Trait)] and the Multidimensional Anxiety Scale for Children (MASC). Adolescents and their parents were individually evaluated by a nurse trained in the administration of the Anxiety Disorders Interview Schedule-IV: Parent and Child Versions (ADIS-IV: P&C). Of the participants, 21 (40%) met the diagnostic criteria for one or more anxiety disorders. The STAI-C (Trait) was more effective than the MASC in screening adolescents for risk of coexisting anxiety disorders. Nurses trained to administer the ADIS-IV: P&C diagnosed anxiety disorders with a high degree of accuracy. These results have important implications for resolving the problem of unrecognized and untreated anxiety disorders in the adolescent asthmatic population.

Untreated Insomnia May Precipitate Anxiety Disorders

Untreated Insomnia May Precipitate Anxiety Disorders

Anxiety disorders: under-diagnosed and insufficiently treated

Anxiety disorders have a high prevalence, particularly specific phobia, social anxiety disorder (SAD), post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). The lifetime prevalence for any anxiety disorder is almost 30%. Also, many anxiety disorders have a high rate of comorbid depression, which is generally secondary to the anxiety. Despite high prevalence, anxiety disorders are under-diagnosed, misdiagnosed and inappropriately treated. There is a hierarchy in the lifetime probability of treatment contact, with panic and GAD being diagnosed and treated earlier – possibly as a result of these disorders being the most “visible”, unlike SAD, which is characteristically discreet. Under-diagnosis is linked with under-treatment: less than one in five patients with an anxiety disorder receive appropriate medication, which improves to almost one in three for subjects with comorbid depression. For the majority of people with undiagnosed or untreated anxiety disorder, there are many negative consequences, for both the individual and society. These include disability, reduced ability to work leading to loss of productivity, and a high risk of suicide. All of these factors contribute to a reduced quality of life. The economic costs associated with anxiety disorders are large – €48 billion over 28 European countries – and similar to those for dementia. Almost half of the costs are indirect, due to loss of productivity and earnings; the remainder being direct medical and non-medical costs. Current first-line therapies are the antidepressive selective serotonin reuptake inhibitors (SSRIs), with cognitive behavioural therapy a first- or second-line treatment. However, benzodiazepines continue to be prescribed more often than antidepressants. Recent studies have shown that a new type of SSRI, escitalopram (the S-enantiomer of the racemic citalopram), with a unique mode of action, is effective and offers potential as a new treatment for anxiety disorders.

Treating Alcoholics with a Co-Occurring Anxiety Disorder

Objectives: Psychiatric comorbidity likely complicates the treatment of alcoholism. Studies of alcoholics with and without co-occurring anxiety disorders suggest that the presence of an anxiety disorder can significantly impact alcoholism treatment efficacy and can increase subsequent alcohol relapse rates. The objective of this study was to estimate the long-term relapse rates and costs associated with treating an alcoholic with an anxiety disorder. Methods: We have used a Markov model to create a virtual clinical trial to predict and compare long-term outcomes in alcoholics with and without a co-occurring anxiety disorder. We have also incorporated the subsequent associated costs of the two subject groups. Results: In our model, at the end of five years, 34% of our hypothetical group of 100 alcoholics with an ameliorated anxiety disorder remained abstinent compared to only 8% of the 100 alcoholics with an untreated anxiety disorder. Furthermore, the costs associated with these relapses are greater for the untreated group, after factoring in the costs of anxiety treatment in the treated group, even if only 50% of the anxiety treated group gets amelioration of their anxiety disorder. Conclusion: Our results suggest that addressing co-occurring anxiety disorders in an alcohol treatment setting may have a dramatic impact on alcohol relapse and its associated costs.

Challenges in Using SSRIs in Young Anxious Children

Free AccessChallenges in Using SSRIs in Young Anxious ChildrenKatharina ManassisKatharina ManassisSearch for more papers by this authorPublished Online::June 2005https://doi.org/10.1521/capn.8.5.5.22903PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsBirmaher , B, Yelovich, A. K., & Renaud, J. (1999). Pharmacologic treatment for children and adolescents with anxiety disorders. Pediatric Clinics of North America, 45(5), 1187–1204. Crossref, Google ScholarKastelic , E. A., Labellarte, M. J., & Riddle, M. A. ( 2001). Selective serotonin reuptake inhibitors for children and adolescents. Current Psychiatry Report, 2(2): 117–123. Crossref, Google ScholarRappaport , N., & Chubinsky, P. ( 2000). The Meaning of Psychotropic Medications For Children, Adolescents, and Their Families. Journal of the American Academy of Child and Adolescent Psychiatry, 39(9), 1198–1200. Crossref, Google ScholarResearch Units on Pediatric Psychopharmacology (RUPP) Anxiety Study Group (2001). Fluvoxamine Treatment of Anxiety Disorders in Children and Adolescents. New England Journal of Medicine, 344, 1279–1285. Crossref, Google ScholarManassis , K., & Owens, M. ( 1999). Timing of discontinuing SSRIs in OCD. Journal of the American Academy of Child and Adolescent Psychiatry, 38(5), 499–500. Crossref, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 8Issue 5Aug 2003 Information© The Guilford PressPDF download

Anxiety, somatic complaints, and depressive symptoms in rural adolescents.

Undiagnosed and untreated anxiety in adolescents is often associated with greater rates of mood and behavior problems, somatic complaints, and risk for future psychiatric disorders. METHODS. A self-report anxiety instrument was administered as part of a community survey of 466 rural adolescents. Anxiety symptoms were strongly correlated with both physical complaints and depression. Females had higher scores for total anxiety and the anxiety subtypes of generalized anxiety disorder, separation anxiety disorder, panic disorder, social phobia, and school phobia. Implications for nursing practice are provided.

Functional Status and Somatization as Predictors of Medical Offset in Anxious and Depressed Patients

Objective Certain anxious/depressed primary care patients decrease medical utilization after mental health treatment. Previous research has established demo-graphic and medical comorbidities as distinguishing these patients. We asked whether characteristics such as symptom severity, somatization, or health-related quality of life (HRQoL) could also distinguish patients who reduce or increase primary care utilization after mental health care. Methods Primary care patients in a mixed-model HMO were screened for untreated anxiety with and without depression, using the Symptom Checklist (SCL-90-R) and medical records abstractions, and also for HRQoL (SF-36). We identified 165 symptomatic patients who subsequently received mental health treatment and then defined two subgroups: 1) offset patients (reduced medical utilization the year after initiation of mental health treatment) (N=97); and 2) no-offset patients (increased utilization) (N =68). Results Three HRQoL domains (general health perceptions, physical functioning, and role functioning– physical) predicted increased offset savings in the year after initiation of mental health treatment. Each point of improved functioning in these domains was associated with $4 to $10 of additional offset savings. Somatization-related comorbidities were predictive of greater additional costs ($230). Conclusion Using models to predict individual patient costs, we found that HRQoL and somatic comorbidities did not predict by anxiety/depression symptom severity or medical comorbidities, but by increasing or decreasing utilization after mental health care. Patients with higher functioning levels and no somatic comorbidities were most likely to reduce utilization. These findings support growing evidence for the need of inclusion of reliable indicators of somatization and patients' functioning in offset research and inpatient care.