Coping with Parkinson's disease and refractory epilepsy. A comparative study.

Coping strategies and their correlations with demographic and illness related data, depression, locus of control, and psychosocial adaptation were investigated in 45 patients with Parkinson's disease and 40 patients with intractable epilepsy. Three standardized self-report questionnaires were applied: the Freiburg Questionnaire of Coping with Illness (FKV), the von Zerssen Depression Scale (D-S), and the IPC-questionnaire measuring generalized locus of control beliefs. The Social Interview Schedule (SIS), a semi-structured interview, was used to measure psychosocial adaptation. Active, problem-focused and compliance strategies were predominantly used and regarded as most helpful in both groups of patients. Hence, Parkinson and epilepsy patients used similar coping patterns despite the strong dissimilarities of symptoms and illness-associated burdens. The level of depression was not significantly different in both groups and in the range of other chronic somatic diseases. The use of coping patterns, which are regarded as maladaptive, was correlated with distinct depression and a poor psychosocial adaption. In conclusion, no indications for illness-specific coping patterns were found in patients with Parkinson's disease and epilepsy. In both groups, certain coping strategies are associated with good and others with poor psychosocial adjustment. These results indicate the possibility of improving psychosocial adjustment by supporting effective strategies.     

Positive correlation between anxiety severity and plasma levels of dehydroepiandrosterone sulfate in medication-free patients experiencing a major episode of depression

Although numerous studies have identified a correlation between dehydroepiandrosterone sulfate (DHEAS) levels and anxiety or depression, those findings remain controversial. The purpose of the present study was to determine whether a correlation exists between depression severity and anxiety severity and serum DHEAS concentrations in medication-free patients experiencing a major depressive episode. Twenty-eight medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17 [HAM-D 17] score >or=17) were enrolled consecutively. Plasma DHEAS levels of all subjects were measured. Blood from subjects was drawn at 0900-1100 h Depression severity was assessed with the HAM-D 17 and the Hospital Anxiety and Depression Scale (HADS) depression subscale. Anxiety was assessed using the HADS anxiety subscale. Serum concentrations of DHEAS were measured immediately following the HAM-D 17 and HADS assessments. A significant, positive correlation was identified between HADS anxiety subscale total score and morning serum DHEAS concentration (P = 0.013) after controlling for age, gender and body mass index (BMI). No statistically significant correlations were found between depression ratings and morning serum DHEAS concentrations. This preliminary study provides pilot data indicating that morning serum DHEAS concentrations were positively correlated with HADS anxiety subscale score (anxiety severity) after controlling for age, gender and BMI in medication-free outpatients experiencing a major depressive episode. It is not known if morning serum DHEAS levels would show similar or dissimilar changes in non-depressed subjects. The present result needs subsequent replication.     

Psychological state, quality of life, and coping style in patients with digestive cancer

The purpose of this study was to assess the relationships between psychological characteristics such as anxiety and depression, quality of life (QOL) and coping style among patients with digestive cancer. The subjects were 85 in-patients who were scheduled to undergo initial surgery for gastrointestinal cancer. The following psychological tests were administered: Japanese versions of the Hospital Anxiety and Depression Scale, Zung's Self-Rating Depression Scale, the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 and the Coping Inventory for Stressful Situations. The first 3 tests were performed on three occasions: before surgery, before discharge and 6 months after discharge. The results showed that there was no change over the 3 test administration days for the average scores of anxiety and that the scores of depression increased from before surgery to before discharge and did not return to presurgery levels at 6 months after discharge. Changes in each subscale score of the EORTC QLQ C30 across the 3 days displayed two typical trends. Relationships between the abovementioned trends and individual coping styles showed that the higher the score of "emotion-oriented coping style," the greater the deterioration in QOL subscales. It was suggested that focusing on a patient's coping style, particularly emotion-oriented coping style, is important and that patients likely to adopt a more emotion-oriented coping style should receive special consideration.     

Anxiety and depression as risk factors for mortality after coronary artery bypass surgery

OBJECTIVE: This retrospective study examined the association between symptoms of depression, anxiety, and mortality risk following coronary artery bypass graft (CABG) surgery. METHODS: We assessed 440 CABG surgery patients' scores on the Depression Anxiety and Stress Scale (DASS) and followed up mortality status for a median of 5 years, 10 months. RESULTS: There were 67 (15%) deaths overall during the follow-up period. Adjusted survival analysis showed that preoperative depressive symptoms were not associated with a significantly higher risk of mortality. Survival analysis with preoperative anxiety adjusted for covariates showed a significantly increased mortality risk [hazard ratio (HR)=1.88 (95% CI=1.12-3.17), P=.02]. CONCLUSION: Preoperative anxiety symptoms were significantly associated with increased mortality risk after adjustment for known mortality risk factors. Future research should further explore the simultaneous role of anxiety and depression on mortality following CABG.     

Evaluation of brief interventions for managing depression and anxiety symptoms during early discharge period after stroke: a pilot randomized controlled trial

Abstract

Background:

Prevalence estimates for depression and anxiety in individuals post-stroke are approximately 33 and 29%, yet there are few effective preventive interventions. Interventions which commence pre-discharge and continue during the early post-discharge period may support individuals during the critical transition to home adjustment period. This study aimed to evaluate the efficacy of a self-management intervention and a coping skills intervention, compared to usual care, on anxiety and depression post-stroke.

Methods:

A pilot, three-arm randomized trial involving 33 stroke patients (coping skills: n?=?11, self-management: n?=?12, usual care: n?=?10) recruited from an Australian stroke unit. Both interventions were eight 1-hour weekly sessions, with the first two pre-discharge and the remainder at home; targeted both anxiety and depression; and tailored content to individuals. Primary outcome was severity of depressive and anxiety symptoms (measured using Montgomery andÅsberg Depression Rating Scale and Hospital Anxiety and Depression Scale). Secondary measures were: self-efficacy, stroke knowledge, basic and extended activities of daily living, and quality of life. Outcome measures were administered at baseline, one week post-intervention, and at a three month follow-up by a blinded assessor.

Results:

Thirty (91%) participants completed the trial. Immediately post-intervention there was a small improvement in stroke knowledge and a small increase in depression symptoms (on one of the two measures of depression symptoms) in the coping skills group compared to usual care. These differences did not remain significant at the 3-month follow-up, nor were there any other significant differences.

Conclusion:

Neither a coping skills nor self-management intervention reduced anxiety nor depression symptoms early post-stroke more than usual care. Lack of statistical power may have contributed to the non-significant findings in this pilot study.     

Cognition, coping, and outcome in Parkinson's disease

ABSTRACT Background: Cognitive impairment and depression are common and disabling non-motor symptoms of Parkinson's disease (PD). Previous studies have shown associations between them but the nature of the relationship remains unclear. In chronic illness, problem- or task-oriented coping strategies are associated with better outcome but often require higher level cognitive functioning. The present study investigated, in a sample of patients with PD, the relationships between cognitive function, choice of coping strategies, and a broad index of outcome including depression, anxiety, and health-related quality of life (QoL). It was hypothesized that the coping strategy used could mediate the association between cognition and outcome. Methods: 347 participants completed the Coping Inventory for Stressful Situations, the Hospital Anxiety and Depression Scale, the Parkinson's Disease Questionnaire-8, the Unified Parkinson's Disease Rating Scale, and the Addenbrooke's Cognitive Examination-Revised. Structural Equation Modeling was used to test the hypothesized model of cognition, coping, and outcome based on a direct association between cognition and outcome and an indirect association mediated by coping. Results: Overall, poorer cognition predicted less use of task-oriented coping, which predicted worse outcome (a latent variable comprised of higher depression and anxiety and lower QoL). The analyses suggested a small indirect effect of cognition on outcome mediated by coping. Conclusions: The findings suggest that patients who fail to employ task-oriented coping strategies may be at greater risk of depression, anxiety, and poor health-related QoL. Even mild to moderate cognitive impairment may contribute to reduced use of task-oriented coping. Suitably adapted cognitive-behavioral approaches may be useful to enable the use of adaptive coping strategies in such patients.     

Prevalence and effects of depressive and anxiety symptoms in internal medicine inpatients during the first year after hospital discharge

In a prospective follow-up study the German version of the Hospital Anxiety and Depression Scale (HADS) was used to determine the prevalence of anxiety and depressive symptoms in internal medicine inpatients. From a total cohort of 376 admitted study patients questionnaires were completed at admission and after one year follow-up. The data demonstrated that the mean HADS score on the anxiety subscale decreased significantly from 6.7 3.5 at study inclusion to 5.8 3.8 after one year (p < 0.0005) while the mean HADS score on the depression subscale was relatively stable (5.3 3.6 versus 5.4 4.3, p = n.s.). Odds ratios for the prediction of positive HADS results at follow-up were 4.1 (95%-CI 2.0-8.4) for anxiety symptoms and 8.2 (95%-CI 4.6-14.6) for depressive symptoms. Patients with abnormal HADS anxiety scores were significantly more frequently rehospitalized (Odds ratio 1.9; p = 0.028) and also more frequently reported pain symptoms (Odds ratio 2.0; p = 0.019). These results demonstrate the persistence of depressive symptoms and the frequent utilization of health care in internal medicine inpatients with psychiatric disorders in the first year after hospital discharge.     

不育妇女的功能障碍、精神病症状和生活质量：一项来自土耳其横断面研究

背景：不孕不育是一种重大的生活危机,它可以导致精神病症状的发展并且对夫妻的生活质量产生负面影响,但其影响程度可能取决于文化背景。
　　目标：我们比较了土耳其城市中生育妇女和不孕妇女的精神病症状程度、功能障碍水平和生活质量。方法：该横断面研究纳入了100名在里泽教育和研究医院的妇产科门诊治疗不孕不育的已婚女性和100名已婚已育的妇女作为对照组。对所有参与者均采用社会人口信息筛查表、医院焦虑抑郁量表(Hospital Anxiety and Depression Scale, HADS)、简单功能障碍问卷(Brief Disability Quesitonnaire, BDQ)和健康状况问卷(Short Form Health Survey , SF-36)进行评估。
　　结果：不育女性的平均焦虑分量表得分和抑郁分量表得分稍高于对照组,但差异无统计学意义。不孕组妇女中有显著临床焦虑症状的比例（即焦虑分量表得分>11）显著高于育龄妇女(31%v.17%, X2=5.37, p=0.020),但有显著临床抑郁症状的比例（即抑郁分量表评分HADS>8）在两组间没有显著性差异(43%v.33%, X2=2.12, p=0.145)。不育女性自我报告前一个月的功能障碍显著比对照组严重,并且不育女性在SF-36的8个分量表中4个（一般健康、活力、社会功能和心理健康）显著差于对照组。与目前工作的不育女性相比,目前没有工作的女性不育患者报告的抑郁和焦虑程度较轻,且一般健康状况、活力和心理健康状况较好。
　　结论：未发现土耳其城市地区中寻求治疗的不孕不育已婚女性并比已婚已育妇女有更严重的抑郁症状,但他们确实报告有较大的躯体和心理障碍并且生活质量较差。不孕不育的负面影响对在职不孕女性妇女比无业的不孕妇女更严重。西方国家这通常报告不孕患者抑郁和焦虑的患病率更高,我们需要更大规模的随访研究以评估这些结果与西方国家报告的结果不同的原因。     

Anxiety, depression, and comorbid anxiety and depression: risk factors and outcome over two years

ABSTRACT Background: This study aimed to determine: (1) the prevalence of depression, anxiety, and depression associated with anxiety (DA); (2) the risk factor profile of depression, anxiety, and DA; (3) the course of depression, anxiety, and DA over 24 months. Methods: Two-year longitudinal study of 20,036 adults aged 60+ years. We used the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale anxiety subscale to establish the presence of depression and anxiety, and standard procedures to collect demographic, lifestyle, psychosocial, and clinical data. Results: The prevalence of anxiety, depression, and DA was 4.7%, 1.4%, and 1.8%. About 57% of depression cases showed evidence of comorbid anxiety, while only 28% of those with clinically significant anxiety had concurrent depression. There was not only an overlap in the distribution of risk factors in these diagnostic groups but also differences. We found that 31%, 23%, and 35% of older adults with anxiety, depression, and DA showed persistence of symptoms after two years. Repeated anxiety was more common in women and repeated depression in men. Socioeconomic stressors were common in repeated DA. Conclusions: Clinically significant anxiety and depression are distinct conditions that frequently coexist in later life; when they appear together, older adults endure a more chronic course of illness.     

Relationships among depression,anxiety, anxiety sensitivity,and perceived social support in adolescents with conversion disorder

Objective: This study aimed to assess the relationships of depression, anxiety, anxiety sensitivity, and perceived social support with conversion symptoms in adolescents with conversion disorder (CD). Methods: Fifty outpatients, aged 8–18 years, who had been diagnosed with CD and members of a control group were assessed using the psychological questionnaires. Results: Compared with controls, adolescents with CD scored higher on the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI) total, CASI physical and cognitive subscales, and Multidimensional Scale of Perceived Social Support family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the Somatoform Dissociation Questionnaire (SDQ) scores and that CDI and CASI total scores predicted the Children's Somatization Inventory (CSI) scores of subjects. Conclusions: This study suggest that adolescents with CD had poor psychosocial well-being, and depression, global anxiety sensitivity and anxiety sensitivity cognitive concerns are related to conversion symptoms.     

Coping with refractory epilepsy.

We investigated the coping behaviour and its correlation with demographic and illness-related data, depression, locus of control and psychosocial adaptation in 40 patients with intractable epilepsy with primarily or secondarily generalized tonic-clonic seizures. Three standardized self-reporting questionnaires were applied, which are the Freiburg Questionnaire of Coping with Illness (FKV), the von Zerssen Depression Scale (D-S), and the IPC-questionnaire measuring generalized locus of control beliefs; the Social Interview Schedule (SIS), a semi-structured interview, was used to measure the psychosocial adaptation. Active, problem-focused and compliance strategies were predominantly used and regarded as most helpful. Hence, the epileptic patients use similar coping patterns reported in patients with other non life-threatening chronic diseases. The level of depression was moderate and in the range of other chronic somatic diseases. The use of coping patterns, which are regarded as maladaptive, was correlated with distinct depression, a small degree of internal locus of control beliefs and poor psychosocial adaption. These results indicate the possibility to improve psychosocial adjustment by supporting effective strategies.     

The incidence of anxiety and depression among employees—the role of psychosocial work characteristics

Background: Anxiety and depression are prevalent among employees and are associated with functional disability and work impairment. To date, little is known about the incidence and possible risk factors for developing anxiety and depression in the working population. Study aims were to (a) determine the incidence of subclinical anxiety and depression in a general working population and (b) identify the psychosocial work characteristics associated with the onset of subclinical anxiety and depression. Methods: This prospective study is based on 3,707 employees participating in the Maastricht Cohort Study on Fatigue at Work. Psychosocial work characteristics were measured in May 2000; anxiety and depression were measured with the Hospital Anxiety and Depression Scale in April 2002. Results: The cumulative 23‐month incidence for subclinical anxiety and depression was 4.6 and 3.3%, respectively. High psychological job demands increased the risk for both subsequent anxiety and depression. Moreover, low social support was predictive for the onset of anxiety, whereas job insecurity increased the risk for the onset of depression. These prospective associations were independent of potential confounding variables and the other psychosocial work characteristics. Conclusions: Adverse psychosocial work characteristics are significant predictors for the onset of subclinical anxiety and depression in the general working population. These findings encourage intervention studies testing whether modifying the psychosocial work environment reduces both anxiety and depressive symptoms among employees. Depression and Anxiety 26:1040–1048, 2009. © 2009 Wiley‐Liss, Inc.     

Effects of anxiety versus depression on cognition in later life.

OBJECTIVE: The authors investigated the relationship between anxiety and cognition in older persons, taking account of comorbid depression. METHODS: Data were used from the Longitudinal Aging Study Amsterdam (LASA), a large epidemiological study of 3,107 elderly citizens in The Netherlands. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale-Anxiety subscale and the Center for Epidemiologic Studies-Depression Scale. In measuring cognitive performance, general cognitive functioning was measured by means of Mini-Mental State Exam, episodic memory was measured with the Auditory Verbal Learning Test (AVLT), fluid intelligence by using the RAVEN, and information-processing speed by the coding task. Analysis of variance examined the association between anxiety symptoms and cognition in persons with and without depression. RESULTS: Main effects of anxiety symptoms were found for learning and delayed recall of the AVLT. Depression symptoms showed significant main effects on almost all cognitive performance tests. Mild anxiety symptoms were associated with better cognitive performance, whereas severe anxiety symptoms were negatively associated with cognitive functioning. In contrast, depressive symptoms showed a linear association with cognition; more depression was associated with worse cognition. CONCLUSION: This study suggests that anxiety has a curvilinear relationship with cognition. Depressive symptoms, however, were always negatively associated with cognitive performance.     

Coping strategies, anxiety and depression in caregivers of people with Alzheimer's disease

OBJECTIVES: There have been few longitudinal studies investigating the impact of coping on psychological morbidity in caregivers of people with dementia. Findings have been inconsistent and little attention has been paid to anxiety in caregivers. We explored the hypothesis that the relationship between caregiver burden and anxiety and depression is mediated by coping style. METHODS: As part of the LASER-AD study, 93 (73.8%) people with Alzheimer's disease and their family caregivers recruited at baseline were re-interviewed 1 year later. Sampling aimed to ensure that the participants were representative of people living in the UK with Alzheimer's disease in terms of dementia severity, gender and care setting. We used the Hospital Anxiety and Depression Scale, the Zarit Burden scale and the Brief COPE to measure coping strategies. RESULTS: Using fewer emotion-focused strategies and more problem-focused strategies (but not dysfunctional strategies) mediated the relationship between caregiver burden and anxiety a year later, after controlling for potential confounders, in a well-fitting structural equation model (chi(2) = 0.93, df = 3, p = 0.82; NFI = 1.0, RFI = 0.97, IFI = 1.0, TLI = 1.1, RMSEA = 0.0). Using fewer emotion focused strategies also predicted higher psychological morbidity in general. The hypothesised relationship was not proved for depression. CONCLUSIONS: Using emotion-focussed coping strategies in response to caregiver burden seemed to protect caregivers from developing higher anxiety levels a year later; however using problem-focussed strategies did not. Our results suggest that a psychological intervention package to emphasise emotion-focused coping may be a rational approach to reduce anxiety in dementia caregivers. Studies are needed to test such interventions. Copyright (c) 2008 John Wiley & Sons, Ltd.     

Association of subjective anxiety, depression, and sleep disturbance with quality-of-life ratings in adults with epilepsy

Purpose :  To determine the relative contributions of subjective anxiety, depression, sleep disturbance, and seizure-related variables to quality-of-life scores in adults with epilepsy, and the interrelationships among these factors.
Methods :  Consecutive adult patients with epilepsy attending neurology outpatient clinics were recruited. Patients completed the following scales: Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Rating Scale, Medical Outcomes Study (MOS) Sleep Scale, Epworth Sleepiness Scale, and Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Univariate and multivariate linear regression models were used to identify variables associated with QOLIE-31 overall score. Path analysis model was constructed to test for interrelations between the variables.
Results :  Two hundred forty-seven patients completed the questionnaires. By multivariate analysis, in order of degree of contribution, HADS anxiety subscale score, MOS Sleep Scale Sleep Problems Index score, HADS depression subscale score, number of current antiepileptic drugs used, and seizure freedom in the past 4 weeks, significantly correlated with QOLIE-31 overall score, accounting for 65.2% of the variance. Complex interrelationships were present between these factors. A general linear model to predict QOLIE-31 overall score in the presence of these factors was constructed.
Conclusion :  Subjective anxiety, depression, and sleep disturbance exerted greater effect than short-term seizure control on quality of life scores of patients with epilepsy. These factors should be considered simultaneously when evaluating effects of treatment on quality of life.     

Symptoms of Depression and Anxiety in Adolescents with Sickle Cell Disease: The Role of Intrapersonal Characteristics and Stress Processing Variables

Sickle cell disease (SCD) complications place patients at risk for poor psychosocial adaptation, including depression and anxiety symptoms. This study aimed to test a mediator model based on the Risk and Resistance model to explore the role of intrapersonal characteristics and stress processing variables in psychosocial functioning. Participants were 44 adolescents with SCD, 15 healthy siblings, and 43 primary caregivers, recruited from an East Coast comprehensive sickle cell center. The participants completed paper and pencil measures of resilience factors (attributional style, hope, coping) and internalizing symptoms (depression, anxiety). Internalizing symptoms among adolescents␣with SCD and healthy siblings did not differ and were within non-clinical ranges. Self-esteem of adolescents with SCD was correlated with less depression and anxiety and sense of inadequacy was associated with poorer functioning. There were no findings to support the role of coping in psychosocial adjustment. Although the mediation hypothesis was not supported, findings highlighted the resilience of this sample of adolescents with SCD. Determining how these resilience factors protect adolescents with SCD may aid in the development of psychosocial interventions. In particular, interventions should focus on improving intrapersonal skills and coping with stress and investigate ways to tailor these interventions to African-American populations.     

Alexithymia in adolescents with chronic fatigue syndrome

BACKGROUND: Alexithymia is postulated as an important factor in the development of medically unexplained physical symptoms. Chronic fatigue syndrome (CFS) is presently medically unexplained. The aim of this study was to investigate whether the prevalence of alexithymia was higher in adolescents with CFS compared to healthy adolescents. Comorbidity such as anxiety and depression were analyzed as possible confounding factors. Secondly, alexithymia was investigated as a prognostic factor for the recovery of CFS. METHODS: A cross-sectional study was performed among 40 adolescent outpatients diagnosed with CFS and 36 healthy controls. The 20-item Toronto Alexithymia Scale was used to assess all participants for alexithymia. Additionally, all participants completed a number of questionnaires regarding fatigue (Checklist Individual Strength), somatic complaints (Checklist Somatization Inventory), depression (Children's Depression Inventory), and trait anxiety (Spielberger State Trait Anxiety Questionnaire). A follow-up study was performed among the CFS adolescents 1 1/2 years after the initial assessment. RESULTS: CFS adolescents scored higher only on the subscale identifying feelings of the TAS-20 [mean difference after adjustment for depression and anxiety 2.8 (95% CI: 0.6; 4.9]. Twelve CFS adolescents (30%) fulfilled criteria for alexithymia. This subgroup was characterized by higher scores for depression and anxiety and equal scores for fatigue and somatic complaints. At follow-up, no differences in recovery were established between the alexithymic and nonalexithymic CFS adolescents. CONCLUSIONS: Alexithymia neither appears to be a unique correlate of CFS nor to be a prognostic factor for recovery of the CFS illness.     

Fælles psykofarmakologiske undersøgelser

Schaaber Ú, Smári J, Óskarsson H. Comparison of the Hospital Anxiety and Depression Rating Scale (HAD) with other depression and anxiety rating scales.

The ability of the Hospital Anxiety and Depression Rating Scale (HAD) to detect depression and anxiety in a psychiatric, medical, and non-patient setting was compared with that of the Beck Depression Index (BDI), the Hamilton Depression Rating Scale (HDRS), and the Clinical Anxiety Scale (CAS). The correlation coefficient and the coefficient of agreement between the HAD depression subscale and the BDI were satisfactory. Sensitivity and specificity were acceptable. These values were all lower for the HAD anxiety subscale and the CAS. The HAD proved to be a better instrument for screening for depression than for anxiety, although it can be used for both.     

Psychosocial adjustment of epilepsy patients in Cyprus

This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.     

Quetiapine in the treatment of anxiety in patients with bipolar I or II depression: a secondary analysis from a randomized, double-blind, placebo-controlled study

OBJECTIVE: Quetiapine monotherapy shows efficacy in bipolar depression. The analyses in this multicenter, double-blind, randomized, fixed-dose, placebo-controlled study evaluated effects of quetiapine monotherapy on anxiety symptoms in bipolar depression. METHOD: Of 542 outpatients randomly assigned to treatment, 539 with bipolar I (N = 358) or bipolar II (N = 181) disorder experiencing a major depressive episode (DSM-IV) received 8 weeks of quetiapine monotherapy (600 or 300 mg/day) or placebo between September 2002 and October 2003. Anxiety assessments included the Hamilton Rating Scale for Anxiety (HAM-A) and relevant items from the Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Rating Scale for Depression (HAM-D). Analyses evaluated the pooled dose groups versus placebo. RESULTS: At week 8, quetiapine 600 and 300 mg/day each demonstrated significant improvements in HAM-A total score versus placebo (-10.8 and -9.9 vs. -6.7, p < .001). Quetiapine (pooled doses) significantly improved HAM-A total score from week 1. In bipolar I depression, quetiapine showed significant improvement in HAM-A total score versus placebo (-10.4 vs. -5.1, p < .001). In bipolar I depression, quetiapine also showed significant improvements versus placebo on the HAM-A anxious mood and tension items, HAM-A psychic and somatic subscales, MADRS inner tension item, and HAM-D psychic anxiety item (all p < .001), but not the HAM-D somatic anxiety item. In bipolar II depression, quetiapine reduced the HAM-A total score more than placebo, but the difference was not statistically significant (-9.8 vs. -9.0, p = .473). In bipolar II depression, quetiapine showed significant improvement versus placebo on the HAM-A anxious mood, MADRS inner tension, and HAM-D psychic anxiety items (all p < .01). CONCLUSION: Quetiapine monotherapy shows efficacy in treating anxiety symptoms in bipolar I depression; however, the anxiolytic effects in bipolar II disorder require further investigation.