Pharmacological Management of Mood and Anxiety Disorders in Headache Patients

There is emerging evidence that treatment of comorbid mood and anxiety disorders can improve headache treatment outcome when implemented within a comprehensive program. Effective treatment for comorbid mood and anxiety disorders requires screening headache patients and accurately diagnosing specific psychiatric disorders when present. Specific dual-action antidepressant, anticonvulsant, and atypical antipsychotic medications can serve as dual agents that simultaneously treat both headaches and a mood or anxiety disorder. Serotonin reuptake inhibitors and most other antidepressant, anxiolytic, and mood-stabilizing medications are generally ineffective for headache prophylaxis. However, they can be safely added to a headache regimen for treatment of a comorbid psychiatric disorder. Treatment of comorbid psychiatric disorders in headache patients requires patient education about the psychiatric disorder, its treatment, possible side-effects, and expected benefits. Clinicians need to be sensitive to possible stigma that some patients fear from a psychiatric diagnosis or its treatment.     

Substance Use and Alcohol Abuse in Emergency Medicine Training Programs, by Resident Report

ABSTRACT
Objective : To determine the prevalence of substance use and alcohol abuse among emergency medicine residents.
Method : The study instrument was an anonymous, self-report survey that assessed the use of 13 substances and included the CAGE questions for measuring alcohol abuse. The survey was administered to emergency medicine residents at the time of the American Board of Emergency Medicine's annual In-Service Examination.
Results : Alcohol was the substance most commonly used by emergency medicine residents for nonmedical reasons. Using the CAGE score, 4.9% of residents were classified as alcoholic and another 7.6% as suspect for alcoholism, rates similar to those for housestaff of all specialties as reported in earlier studies. Instruction related to physician impairment during training in their emergency medicine residency was reported by only 36% of the respondents.
Conclusions : Emergency medicine residents report a low rate of illicit substance use and do not appear to misuse alcohol differently than other housestaff. Interpretation of these results must be tempered with the potential for underreporting that may occur with a voluntary self-report survey of a sensitive nature.
Acad. Emerg. Med. 1994; 1:47–53.     

Anxiety Sensitivity and Health Anxiety in a Nonclinical Sample: Specificity and Prospective Relations with Clinical Stress

The present study examines the association between anxiety sensitivity (AS) and symptoms of hypochondriasis (a pattern of intense health anxiety) in a nonclinical sample. Findings from study 1 (n = 498) revealed a significant association between AS and health anxiety even after controlling for symptoms of depression and negative affect. However, the association between AS and health anxiety was not moderated by stress levels. Subsequent analysis did reveal a specific association between AS for physical concerns and health anxiety when controlling for other AS dimensions. Contrary to predictions, AS did not significantly predict residual change in symptoms of health anxiety over a 12-week period (n = 195) in Study 2. However, exploratory analyses suggest that some AS dimensions (e.g., physical concerns) may be more predictive of some facets of health anxiety (e.g., body vigilance) than others (e.g., illness severity). Findings from this study are discussed in the context of future research on the role of AS in the development of hypochondriasis.

An audit of clinical outcomes and client and referrer satisfaction with a Mood and Anxiety Disorders Unit

OBJECTIVE: To evaluate outcome and client and referrer satisfaction with the service provided by a Mood and Anxiety Disorders Unit (MADU). METHOD: MADU was a specialized clinical service for the assessment and management of individuals suffering with affective and anxiety disorders. Clients were referred to MADU from a variety of health service providers. A telephone survey of 30 clients and 20 referrers who have used the services of MADU was conducted, investigating outcome satisfaction with the service provided by MADU. RESULTS: Clients and referrers reported a high level of satisfaction with the service provided by MADU. There was a high degree of adherence to treatment recommendations. The mean Patient Global Impression of Improvement (PGI) rating by the clients before the MADU assessment was 2.74 (SD=1.27). In comparison the mean PGI rat-ing at the time of follow-up was 6.64 (SD=1.91). CONCLUSIONS: Specialist mood disorders units are a useful and potentially cost-effective additional service included as a part of a mental health service.     

Impact of Substance Use on Older Patients With Human Immunodeficiency Virus

As a result of effective antiretroviral treatment, patients with human immunodeficiency virus are living nearly normal life spans and are presenting to primary care nurse practitioners for management of comorbidities. Substance use disorders are common but often unexpected in aging patients due to the misconception that older patients do not abuse drugs. When symptoms of substance use are attributed to the normal aging process and overlooked, the diagnosis can be missed, which leads to high morbidity and mortality rates, especially in patients with human immunodeficiency virus. Through early recognition, nurse practitioners can facilitate timely diagnosis and comprehensive treatment that can improve patient outcomes.     

急性脑血管病患者血清内源性类洋地黄物质与低钠血症的临床观察

为探讨急性脑血管病患者血清内源性类洋地黄物质与并发低钠血症的关系，对１００例急性脑血管病患者进行血钠及ＥＤＬＳ测定，结果，血清钠与ＥＤＬＳ含量呈负相关（ｒ＝３．８５８，Ｐ＜０．０５）；有意识障碍者血清ＥＤＬＳ明显高于无意识障碍者（Ｐ＜０．０５）。提示有意识障碍的急性脑血管病患者易并发低钠血症，尤其是脑出血患者，且病情越重，并发低钠血症的可能性越大。     

Cognitive Errors in Youth with Anxiety Disorders: The Linkages Between Negative Cognitive Errors and Anxious Symptoms

This study examined the linkages between negative cognitive errors and anxiety in a sample of children and adolescents referred for anxiety problems (N = 251). The Children's Negative Cognitive Error Questionnaire was used to assess cognitive errors and several self-report measures of anxiety were used to examine the specific linkages between cognitive errors and different aspects of children's anxiety phenomenology. Results indicated that each of the measures of anxiety (i.e., trait anxiety, manifest anxiety, and anxiety sensitivity) were significantly related to each of the cognitive errors examined (i.e., catastrophizing, overgeneralization, personalizing, and selective abstraction). The cognitive errors of catastrophizing, overgeneralization, and personalizing were still correlated with trait anxiety, anxiety sensitivity, and manifest anxiety while controlling for children's level of depression. In addition, the correlation between selective abstraction and anxiety sensitivity was still evident while controlling for children's level of depression. Stepwise regression analyses indicated that overgeneralization was the strongest predictor of trait anxiety, catastrophizing and personalizing were the strongest predictors of anxiety sensitivity and manifest anxiety, and overgeneralization and selective abstraction were the strongest predictors of depression. Results also indicated that age moderated the relation between some types of cognitive errors and anxiety. The results are discussed with respect to the development of cognitive models of anxiety in youth, future research directions, and potential treatment implications.     

Attributions of Control,Anxiety Sensitivity,and Panic Symptoms Among Adolescents

The present study examined the concurrent and prospective relation between attributions of control, anxiety sensitivity (AS) and panic symptoms among a community sample of African-American adolescents (N=109; mean age 15.75 years; 57 girls). On two occasions, 6 months apart, participants completed self-report measures of AS and panic symptoms. Two measures of control, one for general situations and another for anxiety-specific situations, were completed at time 1. At time 2, adolescents also completed the Panic Attack Questionnaire and were classified as panickers (i.e., those reporting a spontaneous attack) or nonpanickers. Overall, results indicated that external attributions of control for general and anxiety-specific situations were positively associated with AS and panic symptoms at time 1 but only external attributions of control in anxiety-specific situations were associated with AS and panic symptoms at time 2. Internal attributions of control over anxiety-specific situations for failure, but not success, were associated with higher levels of AS and panic symptoms. Control attributions for anxiety, but not general situations, predicted panic symptoms after levels of AS were controlled. Findings support and extend cognitive theories of panic and suggest further study is needed on anxiety-specific control attributions among youth.     

Differentiating social phobia and panic disorder: A test of core beliefs

Fears of anxiety symptoms, panic attacks, and negative evaluation as well as assertiveness were examined in 102 patients with a diagnosis of panic disorder alone, social phobia alone, comorbid social phobia and panic disorder, or comorbid social phobia and depressive disorder. The results indicated that social phobia and panic disorder can be differentiated by fears of negative evaluation and by assertiveness, but a substantial overlap between these disorders exists with regard to anxiety sensitivity and catastrophic beliefs about panic attacks. The boundaries between social phobia and panic disorder were especially blurred by the presence of comorbid depression within social phobia. Mood-specific biases in catastrophic thoughts and pessimistic attitudes may account for the findings for depression. Treatment implications are discussed.     

Expecting That Alcohol Use Will Reduce Social Anxiety Moderates the Relation Between Social Anxiety and Alcohol Consumption

We examined the hypothesis that social anxiety and alcohol outcome expectancies interact in relating to the quantity and frequency of alcohol consumption. Two hundred twenty-nine undergraduates completed self-report questionnaires. The results showed situational specificity of alcohol expectancies. Expecting that alcohol would reduce anxiety in social situations moderated the relation between social anxiety and alcohol consumption; no such moderating effect was found for expectancy of general tension reduction. Among those who did not expect alcohol to reduce their anxiety in social situations, high-social-anxiety participants reported lower frequency and quantity of alcohol consumption than did low-social-anxiety individuals. High- and low-social-anxiety participants who expected alcohol to reduce their social anxiety did not differ in their alcohol consumption.     

Anxiety Sensitivity Dimensions in the Prediction of Body Vigilance and Emotional Avoidance

The present study evaluated 2 interrelated hypotheses concerning the relation between specific anxiety sensitivity dimensions and how one responds to bodily sensations in a population with no known history of psychopathology (N = 214). Specifically, the Physical Concerns subscale of the Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. Gursky, & R. J. McNally, 1986) was found to be uniquely and statistically predictive of bodily vigilance, whereas the Mental Incapacitation ASI subscale was predictive of emotional avoidance. These effects were above and beyond the variance accounted for by demographic variables, treatment history for common interoceptive medical conditions, subclinical panic attack history, and trait anxiety. We discuss these findings in relation to differential predictive validity conceptualizations of anxiety sensitivity, with implications for understanding models of health functioning and panic disorder.     

630例功能性胃肠病患者焦虑抑郁筛查分析

目的了解功能性胃肠病患者焦虑、抑郁状况,以供临床护士参考。方法采用Zung’s焦虑自评量表和抑郁自评量表,调查功能性消化不良患者446例、胃食管反流病患者115例、功能性便秘患者69例,分析其阳性检出率和不同人口学特征患者得分水平的差异。结果 446例功能性消化不良患者中,33.2%有焦虑症状,45.3%有抑郁症状,25.6%合并焦虑和抑郁症状。115例胃食管反流病患者中,27.8%有焦虑症状,44.3%有抑郁症状,21.7%合并焦虑和抑郁症状。69例功能性便秘患者中,36.2%有焦虑症状,66.7%有抑郁症状,30.4%合并焦虑和抑郁。3种功能性胃肠病不同性别、年龄患者的焦虑抑郁情况差异均无统计学意义(P0.05);不同学历分组组内差异显著,小学及以下学历者的焦虑、抑郁阳性率最高(P0.01或P0.05)。结论 1/3功能性胃肠病患者存在焦虑症状,近1/2有抑郁症状,焦虑合并抑郁者占1/4,学历低患者的焦虑、抑郁阳性率最高。提示对于常规治疗无效的和学历低的功能性胃肠病患者,更应重视心理检测;对于伴有心理障碍的功能性胃肠病患者,除了对症治疗护理外,应给予抗焦虑、抗抑郁和心理辅助治疗及心理护理干预。     

Anxiety Sensitivity and Anxious Responding to Bodily Sensations: A Test among Adolescents Using a Voluntary Hyperventilation Challenge

This study examined the general factor and lower-order facets of the Childhood Anxiety Sensitivity Index (CASI; W. K. Silverman, W. Flesig, B. Rabian, & R. A. Peterson, 1991) in relation to anxious and fearful responding to a 3-min voluntary hyperventilation procedure. Participants were 151 psychologically healthy adolescents (66 females), as indexed by a screening using the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual—Fourth Edition (DSM-IV): Child Version (ADIS-C; W. K. Silverman & A. M. Albano, 1996), between the ages of 12 and 17 (M = 14.93). Results indicated, relative to negative affectivity and prechallenge ratings of anxiety, both the global factor and the Disease Concerns facet of the CASI significantly predicted postchallenge anxiety and intensity of panic symptoms. CASI total and subfactor scores were unrelated to psychophysiological responding to the challenge. Results are discussed in relation to panic-relevant emotional vulnerability among adolescents.     

Anxiety, Depression, and Their Comorbidity: An Experience Sampling Test of the Helplessness-Hopelessness Theory

This prospective study applied the experience sampling method to test the helplessness-hopelessness theory of anxiety and depression (Alloy, Kelly, Mineka, & Clements, 1990). Forty-four subjects with attributional styles at high or low risk for depression were signaled five times daily by electronic pagers to provide reports of negative events, attributions, and anxious and depressed moods. Consistent with the theory, causal attributions of stability and globality explained increases in depressed mood immediately after negative events. Attributional style predicted these causal attributions but did not directly explain changes in postevent depressed mood. Despite support for more established components of the theory, no support was found for newer aspects concerning the relationship of control attributions to anxious mood. The implications for understanding the helplessness-hopelessness theory and anxiety and depression comorbidity are discussed.