Anxiety in patients with cancer and human immunodeficiency virus.

Physicians who treat patients with cancer or human immunodeficiency virus (HIV) infections frequently encounter the psychological and physical manifestations of anxiety in these populations. This chapter provides a review of the prevalence of anxiety disorders in cancer and HIV patients. The problems in assessment and diagnosis of anxiety in these patients are discussed, and a literature review of the types of anxiety disorders commonly identified in the context of cancer and HIV/AIDS is presented. Finally, the treatment of anxiety in cancer and HIV patients utilizing both pharmacologic and nonpharmacologic modalities is reviewed.     

Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis

Disability status, depression and anxiety are important determinants of quality of life (QoL) in patients with multiple sclerosis (MS). We investigated whether anxiety and depression influence the relation between disability status and QoL in our cohort of recently diagnosed patients. Disability status [Expanded Disability Status Scale (EDSS)], anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], and QoL (SF-36) were prospectively obtained in 101 MS patients. The relation between EDSS and SF-36 scales was examined using regression analyses, without and with adjustment for anxiety and depression. Interaction effects were investigated by comparing the relation between EDSS and QoL in patients with high and low anxiety and depression. In the unadjusted analyses, EDSS was significantly related to all SF-36 physical and mental health scales. After adjustment for anxiety and depression, EDSS was significantly related only to the SF-36 physical functioning, role-physical functioning and bodily pain scales. The relation between EDSS and these SF-36 scales was consistently higher in patients with more symptoms of anxiety or depression, suggesting that anxiety and depression strengthened the association of EDSS in these SF-36 physical health scales. After adjustment for anxiety and depression, EDSS was not significantly related to the SF-36 mental health scales and the general health scale. This finding is compatible with the hypothesis that anxiety and depression are intermediate factors in the association of EDSS with these SF-36 scales. Screening for symptoms of anxiety and depression is recommended in studies that use QoL as an outcome measure of treatment or intervention efficacy.     

A comparison of prazepam, diazepam, lorazepam and placebo in anxious outpatients in non-psychiatric private practices

A double-blind, random design, parallel group, four-week study of prazepam, diazepam, lorazepam, and placebo was conducted in diverse private outpatient practices (surgeon, internist, and obstetrician-gynecologist) using a common protocol, in order to evaluate their comparative efficacy in these settings. In addition, the effects of these anxiolytics on depressive symptoms in patients with anxiety were studied. Results showed that the non-psychiatric practitioners used lower dosages than psychiatrists in previous reports, and perception of anxiety levels of their patients were lower than the psychiatric raters. When patients were divided into two groups (1. predominantly depressed with anxiety, and 2. predominantly anxious with depression), differences between the benzodiazepines were shown. In the high depression-low anxiety group, all four treatment methods were effective in alleviating both anxiety and depression. In the high anxiety-low depression group, only prazepam and placebo were effective in alleviating both anxiety and depression, while diazepam and lorazepam decreased anxiety levels, but not depression.     

Association between nocturia and anxiety in Parkinson's disease

Abstract

Objective:

The objective of the study was to determine whether there exists any relationship between nocturia and anxiety in patients with Parkinson's disease (PD). Although the exact cause of anxiety and nocturia in PD is unknown, we hypothesized that there is a relationship between these two PD symptoms. Anxiety may exacerbate nocturia or an opposite relationship may be present in which nocturia may result in heightened levels of anxiety.

Methods:

Our study consisted of 314 PD patients, selected at random, and divided into groups based on the presence or absence of anxiety and nocturia. The occurrence of anxiety and nocturia was studied individually and collectively within these groups.

Results:

The study found a significant association between anxiety and nocturia primarily driven by all PD patients (P?<?0.0001), with greater significance found for the male patients (P?<?0.0001) than female patients (P?=?0.021).

Discussion:

Based on these findings, we can conclude that anxiety and nocturia are not entirely independent symptoms in all PD patients. Thus, addressing anxiety may improve nocturia in PD or vice versa.     

Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression

High rates of irritable bowel syndrome (IBS) symptoms have been reported in individuals diagnosed with anxiety and depressive disorders. However, most studies have investigated these relations in a single disorder, rather than a heterogeneous group of patients, thereby not allowing for comparisons across anxiety disorders and depression, or for considering the effects of comorbidity. Thus, the present study investigated the symptoms of IBS in a diverse group of patients (N=357) by administering questionnaires and a diagnostic interview. A high frequency of IBS symptoms was found in patients with panic disorder, generalized anxiety disorder, and major depressive disorder. However, the frequency of IBS symptoms in patients with social anxiety disorder, specific phobia, and obsessive-compulsive disorder was comparable to rates found in community samples. In addition, anxiety sensitivity and illness attitudes and intrusiveness were predictive of elevated IBS symptomatology. Together, these findings emphasize the role physiological symptoms of anxiety and worry in the co-occurrence of the anxiety disorders and IBS.     

Anxiety rating scales in Parkinson's disease: Critique and recommendations

Anxiety syndromes are common in patients with Parkinson's disease (PD) with up to 30% suffering from panic disorder, and up to 11% from generalized anxiety disorder (GAD). Anxiety is associated with increased subjective motor symptoms, more severe gait problems, dyskinesias, freezing, and on/off fluctuations. Anxiety has a negative impact on health related quality of life and is strongly associated with depressive syndromes. Since a variety of anxiety scales have been used in PD patients, the Movement Disorder Society commissioned a task force to assess the clinimetric properties of these scales in PD. A systematic review was conducted to identify anxiety scales that have either been validated or used in patients with PD. Six anxiety rating scales were identified. These were the Beck anxiety inventory, the hospital anxiety and depression scale, the Zung self‐rating anxiety scale and anxiety status inventory, the Spielberger state trait anxiety inventory, and the Hamilton anxiety rating scale. In addition, Item 5 (anxiety) of the neuropsychiatric inventory was included in the review. No scales met the criteria to be “recommended,” and all scales were classified as “suggested.” Essential clinimetric information is missing for all scales. Because several scales exist and have been used in PD, the task force recommends further studies of these instruments. If these studies show that the clinimetric properties of existing scales are inadequate, development of a new scale to assess anxiety in PD should be considered. © 2008 Movement Disorder Society     

Social anxiety in patients with Parkinson's disease

Previous research highlights the presence of social anxiety disorder related to disfiguring diseases, although DSM-IV precludes the diagnosis of social anxiety disorder related to a medical condition. The present study investigated the frequency and severity of social anxiety disorder in patients with Parkinson's disease (n=50) and comparison subjects (n=50). Social anxiety was diagnosed in 16% of patients with Parkinson's disease and 2% of the comparison subjects. Regression analysis revealed younger age and depression as predictive factors of social anxiety. This study supported the likelihood of social anxiety disorder as a comorbid condition in Parkinson's disease. Revision of the criteria for social anxiety disorder in future diagnostic systems is necessary for the detection and management of these patients.     

Anxiety Disorders in Persons with Developmental Disabilities: Empirically Informed Diagnosis and Treatment

Anxiety disorders are common in individuals with developmental disabilities (DDs), although they may not be diagnosed and treated as often as they are in patients without DDs. Patients with mental retardation, autism, and other pervasive developmental disorders may exhibit comorbid anxiety disorders, such as generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), phobias, and other anxiety symptoms at much higher rates than in the general population, but identification of these comorbid anxiety disorders may be made more difficult by the presence of the DD and concurrent difficulties with communication, other behavior problems, the lack of standardized assessments specific to diagnosing patients with DDs and psychiatric comorbidities, and the need for greater collateral sources of assessment information. In addition, systematic study of the treatment of anxiety in patients with DD is limited to a relatively small number of empirical studies done specifically in these patients along with case reports and theoretical reviews on the extension and modification of more well-studied treatments used for anxiety in patients without DDs. The present article reviews the literature on the prevalence, features, assessment and diagnosis of anxiety disorders in individuals with DDs, and also reviews empirical studies of pharmacological and psychological treatment of patients with comorbid anxiety and DD and summarizes the findings. Recommendations are made to guide treatment and further research in this area.     

A clinical study of emergent anxiety in neuroleptic-na?ve, first-episode schizophrenia patients following treatment with risperidone]

Risperidone (RIS) alone was administered to patients with neuroleptic-na?ve, first-episode schizophrenia who visited the outpatient clinic of the Department of Psychiatry, Jikei University School of Medicine Hospital between April 1998 and December 2001, and the effectiveness of the drug in alleviating anxiety symptoms was prospectively examined. The study population comprised 42 patients (24 males and 18 females). Their mean age at first visit was 26.0 +/- 6.5 years, DUP (Duration of Untreated Psychosis) was 41.1 +/- 60.0 weeks, and the mean total BPRS (Brief Psychiatric Rating Scale) score at first visit was 60.5 +/- 8.5 points. The rating "effective" (a total BPRS score improvement at week 8 of 50% or more) was given to 32 out of the 42 patients (76.2%). Among these 32 patients, a 25% improvement in the PANSS (Positive and Negative Syndrome Scale) positive scale was achieved at 1. 53 +/- 0.72 weeks and a 50% improvement at 2.93 +/- 2.10 weeks, suggesting early onset of the effects of RIS. The present study focused on the anxiety complained of by some of the patients in whom treatment was rated as effective (increase of 2 points in anxiety BPRS score), dividing these patients into an anxiety group and a non-anxiety group. The anxiety group comprised 17 patients (53.1%). The anxiety observed during the course of treatment with RIS tended to develop early after the disappearance of positive symptoms. A comparison of demographic factors and GAF between the two groups revealed a significant difference in mean age at first visit, DUP and GAF score, the anxiety group tending to be younger, to have shorter DUP and to have social dysfunction compared to the non-anxiety group. Although it cannot be concluded that these anxiety symptoms are characteristic of risperidone, the effect of chemotherapy with other atypical antipsychotic drugs remains as an interesting theme for future investigation.     

意外伤骨科住院患者急性焦虑抑郁影响因素调查

背景:意外伤害事件易致受伤者产生强烈的情绪反应.国内对此类心理状况变化越来越重视,但针对该人群情绪反应的调查不足.综合医院骨科病房存在大量意外伤患者,目前缺少针对该人群情绪反应调查.目的:探讨意外伤骨科住院患者急性焦虑抑郁表现及影响因素.方法:对323例意外伤骨科住院患者进行创伤严重度评分(Injury Severity Score,ISS)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评估.结果:本调查共入组患者323例,其中男性213例,女性110例,平均年龄44.32(13.17)岁;住院时间2-40天,平均住院时间11.09(5.64)天.轻度创伤299人,中度创伤20人,重度创伤4人.ISS评分1-38分,平均8.09(4.86)分.HAMA量表报告人数最多的前3位症状分别为睡眠障碍、胃肠道症状和焦虑心境;HAMD量表报告人数最多的前三位症状为睡眠障碍、抑郁情绪和精神性焦虑.非条件Logistic回归分析显示女性(焦虑:OR=2.738,95%CI=1.511-4.962;抑郁:OR=2.622,95%CI=1.504-4.570)、住院时间长(焦虑:OR=1.091,95%CI=1.040-1.145;抑郁:OR=1.093,95%CI=1.044-1.144)为骨科意外伤患者发生焦虑抑郁的危险因素.结论:意外伤骨科住院患者急性焦虑抑郁症状集中在睡眠紊乱、胃肠道症状和焦虑抑郁情绪,女性患者对于意外伤的情绪反应较男性更强烈,焦虑抑郁症状持续存在与患者住院时间长相关,提示需要对意外伤骨科住院患者进行早期心理评估及干预.     

The construct of generalized anxiety disorder in Alzheimer disease.

OBJECTIVES: The objectives of this study were to examine the criterion validity in Alzheimer disease (AD) of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the International Classification of Diseases, 10th Revision (ICD-10) criteria for generalized anxiety disorder (GAD), to clarify the symptoms associated with excessive anxiety and worry in AD, to examine the co-occurrence of GAD and depression in these patients, and to determine the neuropsychologic and functional impact of GAD in AD. RESULTS: One hundred forty-four of a consecutive series of 552 patients with probable AD (26%) reported excessive anxiety and worry difficult to control for most of the 6 months before the psychiatric evaluation. Excessive anxiety and worry were significantly associated with restlessness, irritability, muscle tension, fears, and respiratory symptoms of anxiety. Using these symptoms as diagnostic criteria, 56 of the 552 patients (10%) met revised diagnostic criteria for GAD as compared with 15% when using DSM-IV criteria and 9% when using the ICD-10 criteria. GAD was present in 38 of the 144 patients (26%) with major depression and in 12 of the 261 patients (5%) without depression. Patients with both GAD and depression showed more severe cognitive deficits than patients with either GAD or depression only. CONCLUSION: The authors validated a set of diagnostic criteria for anxiety in dementia. These criteria include restlessness, irritability, muscle tension, fears, and respiratory symptoms in the context of excessive anxiety and worry. Anxiety in AD is a frequent comorbid condition of major depression.     

Comparing anxiety disorders and anxiety-related traits in bipolar disorder and unipolar depression

The frequent comorbidity of anxiety disorders and mood disorders has been documented in previous studies. However, it remains unclear whether specific anxiety traits or disorders are more closely associated with unipolar major depression (MDD) or bipolar disorder (BPD). We sought to examine whether MDD and BPD can be distinguished by their association with specific types of anxiety comorbidity. Individuals with a primary lifetime diagnosis of either bipolar disorder (N=122) or major depressive disorder (N=114) received diagnostic assessments of anxiety disorder comorbidity, and completed questionnaires assessing anxiety sensitivity and neuroticism. The differential association of these anxiety phenotypes with MDD versus BPD was examined with multivariate modeling. Panic disorder and generalized anxiety disorder (GAD) specifically emerged amongst all the anxiety disorders as significantly more common in patients with BPD than MDD. After controlling for current mood state, anxiety sensitivity and neuroticism did not differ by mood disorder type. This study supports prior research suggesting a specific panic disorder-bipolar disorder connection, and suggests GAD may also be differentially associated with BPD. Further research is needed to clarify the etiologic basis of anxiety disorder/BPD comorbidity and to optimize treatment strategies for patients with these co-occurring disorders.     

Influence of trait anxiety on inhibitory control in alcohol-dependent patients: simultaneous acquisition of ERPs and BOLD responses

Alcohol-dependence is often associated with comorbid psychiatric symptoms. However, the results concerning the influence of these symptoms on cognitive functioning in alcoholism are still inconsistent. The aim of this study was to determine performance monitoring in healthy volunteers and alcohol-dependent patients, and to assess the influence of trait anxiety on these processes. Sixteen healthy volunteers and 16 detoxified alcohol-dependent patients completed an auditory go/nogo paradigm. Functional magnetic resonance imaging, event-related potentials and behavioral data were acquired simultaneously. The patients were classified by median split based on level of self-rated trait anxiety (state-trait anxiety inventory; STAI). The results showed no significant differences regarding inhibition-associated electrophysiological and behavioral responses between alcohol-dependent patients with high-trait anxiety scores and alcohol-addicts with low-STAI scores. However, the functional MRI data revealed elevated activations during the response inhibition task especially in the middle frontal gyrus (BA 6/9), the superior frontal gyrus (BA 6/8/9) and the right inferior frontal gyrus, as well as temporo-parietal brain regions in patients with high-trait anxiety compared to non-anxious alcohol-addicts. Patients and healthy controls showed comparable results with regard to neural and behavioral responses. These results suggest that inhibitory control capacities of alcohol-dependent patients are not consistent: alcohol-addicts with high-trait anxiety ratings showed elevated neural responses compared to patients without any comorbid psychiatric symptoms. This may indicate that comorbid psychiatric symptoms need to be considered when assessing brain responses in alcohol-dependent patients.     

The occurrence of a prodrome of generalized anxiety in panic disorder

Twenty-eight percent of 32 panic disordered patients had a prodrome of generalized anxiety symptoms lasting a median of 5 years before the occurrence of their first panic attack. Patients with a generalized anxiety prodrome were similar to the nonprodrome patients for 55 tested clinical variables, including individual anxiety symptoms, response to treatment, severity of illness, and most aspects of family history. It appears that a prodrome of generalized anxiety symptoms is a variation of the presentation of panic disorder. Initially, these patients may be misdiagnosed as having generalized anxiety disorder (GAD) and contribute to the heterogeneity of GAD.     

Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder

BACKGROUND: Symptoms of depression and anxiety are frequently encountered in the course of schizophrenia and are of considerable clinical importance. They may compromise social and vocational functioning, and they are associated with an increased risk of relapse and suicide. Various treatment approaches have been reported to be successful. METHOD: The sample comprised 177 patients with DSM-III-R or DSM-IV schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials at our academic psychiatric unit over a 7-year period and who were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Analysis was performed on baseline PANSS scores. The depression/anxiety score was compared in the men and women, first-episode and multiple-episode patients, and those with predominantly positive and negative syndromes. Correlations were sought between depression/anxiety scores and age, total PANSS score, positive score, negative score, general psychopathology score, and treatment outcome. Multivariate analysis was applied to determine contributions of individual variables toward depression/anxiety and outcome scores. RESULTS: Depression and anxiety symptoms were more severe in women (p = .007), first-episode patients (p = .02), and those with predominantly positive symptoms (p < .0001). Depression/anxiety scores were significantly correlated to age (r = -0.31, p < .0001), PANSS positive scores (r = 0.39, p < .0001), and treatment outcome (r = 0.25, p = .006). Multivariate analysis bore out these results, with the exception that first episode was not a significant predictor of depression and anxiety scores. CONCLUSION: PANSS depressive/anxiety scores were generally low in our sample, perhaps because patients with schizoaffective disorder were excluded. The finding that these symptoms were more prominent in women and first-episode patients is in keeping with previous literature. The higher scores in first-episode patients are likely due to the higher positive symptom scores in these patients. The association between depressive/anxiety scores and positive symptoms but not with negative symptoms points to a specific relationship between affective symptoms and the positive symptom domain of schizophrenia. The presence of depressive and anxiety symptoms may predict a more favorable outcome to treatment, although this may only apply to the acute exacerbations of the illness.     

Monoamine receptor systems and anxiety disorders

Fear is an adaptive response of the organism to external threat and the physiologic and behavioral responses to stimuli that induce fear involves activation of the sympathetic nervous system. Drugs that alter the function of two of the major brain monoamine neurotransmitter systems involved in sympathetic nervous system regulation (NE and 5-HT) have been shown to alter levels of "fear and anxiety" in laboratory animals, healthy humans, and patients. The relative clinical efficacy in the treatment of anxiety disorders with many of these drugs also emphasizes the importance of these two systems in anxiety. Recent advances in neuropharmacology have led to an improved understanding of how drugs that interact at specific NE and 5-HT receptors alter the function of these two neurotransmitter systems, and a few of the drugs that selectively interact at NE and 5-HT receptors have been used in studies of patients with anxiety disorders. Stimulation of the 5-HT system does not produce marked abnormalities in patients, but stimulation of the NE system does produce abnormal changes in measures of anxiety, somatic symptoms, blood pressure, and a plasma NE metabolite and cortisol levels in patients with panic disorder but not in patients with generalized anxiety disorder, obsessive-compulsive disorder, depression, or schizophrenia. This indicates that some patients with panic disorder have an abnormality in the regulation of the NE system that could explain many of the clinical features of this syndrome. Progress in assessing neurochemistry in the brains of living patients through brain imaging and new advances in the molecular biology of neurotransmitter receptor proteins will offer important new methods to be used in the study of these possible abnormalities.     

Marijuana sensitivity and panic anxiety

The authors explore the relationship between marijuana smoking and panic anxiety by examining the effects of marijuana smoking on patients with panic anxiety compared with marijuana's effects on both patient and nonpatient controls. Patients with panic anxiety were found to be particularly likely to experience increased anxiety while smoking marijuana. The majority of panic anxiety patients spontaneously stopped using marijuana because of increased anxiety; continued marijuana smoking in these individuals was found to be infrequent. The results suggest that current marijuana use is atypical of panic anxiety patients.     

未治疗的未破裂颅内动脉瘤患者的精神心理调查分析

目的 调查并评价未经治疗的未破裂颅内动脉瘤(UIA)患者的精神心理问题.方法 选择上海同济大学附属同济医院神经外科自2008年1月至2011年1月就诊的70例未经治疗的UIA患者和48例健康体检者(对照组)进行调查问卷,应用症状自评量表(SCL-90)、抑郁自评量表(SDS)及焦虑自评量表(SAS)评价未经治疗的UIA患者的精神心理状况.结果 与对照组比较,未经治疗的UIA患者组SCL-90中躯体化、抑郁、焦虑、恐怖四项因子分及总分均较高,未经治疗的UIA组患者更易抑郁、焦虑,差异均有统计学意义(P＜0.05)；内向性格抑郁发生率高于外向和中性性格,外向性格患者焦虑发生率低于中性及内向性格,大学文化程度患者抑郁、焦虑发生率低于高中及初中文化程度患者,差异均有统计学意义(P＜0.05)；多因素Logistic回归分析显示性格、文化程度是影响未经治疗UIA患者抑郁、焦虑的独立危险因素.结论 未治疗的颅内动脉瘤患者容易出现抑郁或焦虑,文化程度低、内向型的患者表现更明显.     

Cognitions in Generalized Anxiety Disorder and Panic Disorder Patients

Forty-three patients with generalized anxiety disorder (GAD) and 44 patients with panic disorder (PD) were given a standardized interview about thoughts and images during times of anxiety. The two groups differed significantly regarding the ideational content of anxiety. GAD patients experienced more thoughts focusing on themes of mental catastrophes and other catastrophes when suffering from anxiety or anxiety attacks, while PD patients mostly described the theme of physical catastrophes. Only 34% (n = 30) of the total sample reported experiencing images when feeling anxious/having panic. For PD patients (70%) onset of anxiety or panic attacks was precipitated by somatic symptoms (a physical feeling). GAD patients reported that onset of anxiety was precipitated by all three alternatives given: a physical feeling (42%), anxious thoughts (37%), or “it all came at once” (21%). The implications of these results are discussed.     

The role of aura in psychopathology and dissociative experiences in epilepsy

Cognitive auras seem to be associated with depression and anxiety, especially in patients with temporal lobe epilepsy (TLE). Dissociative symptoms may occur as an aura or in the context of psychiatric disorders such as depression, anxiety or schizophrenia. This is a cross-sectional study of 62 patients with TLE, using personality and dissociation measures to investigate their relationship with the presence of aura and its different subtypes. Our findings show no difference in psychopathology in patients with different types of aura and reveal that dissociative symptoms correlate with specific measures of anxiety, suggesting a possible link between these experiences and anxiety disorders.