Anxiety in adolescent epilepsy. A clinimetric analysis

Background Anxiety and depression have been considered to be neglected disorders in epilepsy. Because panic disorder is one of the most important anxiety disorders, it has been problematic to use very comprehensive anxiety questionnaires in epilepsy patients, as panic attacks and epileptic seizures, although two distinct clinical entities from a diagnostic point of view, show a significant overlap of symptoms.

Aims We have focused on single items for anxiety and depression as screening candidates in adolescent epilepsy.

Methods The individual panic attack item in the Screen for Children Anxiety Related Emotional Disorders Scale (SCARED) and the single depression item in the Kellner Symptom Questionnaire were tested. Our samples consisted of adolescent patients with epilepsy and a matched control group with healthy participants, as well as two numerical groups acting as controls.

Results The single panic attack item identified panic anxiety in 24.1% in the group of patients with epilepsy and 0.0% in the matched control group (p?=?0.01). The single depression item identified 52.2% with depression in the epilepsy group and 6.2% in the matched control group (p?=?0.001).

Conclusion As screening instruments, single items of panic attack and depression are sufficient to screen for these affective states in adolescent epilepsy. The clinical implications are that it is important to be quite specific when screening for depression and panic attacks in adolescent patients with epilepsy.     

The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients

Abstract

Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n?=?31) and without childhood and adulthood separation anxiety disorder (SeAD) (n?=?50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables.

Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation.

Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD.

Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.     

Anxiety disorders and CRP in a population cohort study with 54,326 participants: The LifeLines study

Objectives: Growing evidence indicates that inflammatory processes may play a role in the pathogenesis of anxiety disorders. Nevertheless, much remains to be learned about the involvement of inflammation, including C-reactive protein (CRP), in specific anxiety disorders. This study examines the relation between anxiety disorders and CRP.

Methods: Associations of serum CRP with anxiety disorders were determined in a large population study (n?=?54,326 participants, mean age?=?47 years; 59% female), the LifeLines cohort. Depressive and anxiety disorders (generalized anxiety disorder, social anxiety phobia, panic disorder with or without agoraphobia and agoraphobia without panic disorder) were assessed using the Mini-International Neuropsychiatric Interview.

Results: Anxiety disorders, with the exception of social anxiety disorder, were significantly associated with increased CRP. After adjusting for demographics, life style factors, health factors, medication use, depression, and psychological stressors, CRP remained significantly associated with panic disorder with agoraphobia (β?=?0.01, P?=?.013). Moreover, CRP levels were significantly higher in people with panic disorder with agoraphobia compared to other anxiety disorders, independent of all covariates (F?=?3.00, df?=?4, P?=?.021).

Conclusions: Panic disorder with agoraphobia is associated with increased CRP, although the effect size of this association is small. This indicates that neuroinflammatory mechanisms may play a potential role in its pathophysiology.     

Self-esteem in carers of frail older people: resentment predicts anxiety and depression

Objectives: Anxiety and depression are major health problems for carers of frail older people. Positive reactions to caregiving have been shown to protect people against anxiety and depression. The aims of this study are to explore specific aspects of self-esteem, termed positive caregiving reactions, and examine its relationship with caregiving anxiety and depressive symptoms.

Method: A cross-sectional study of a cohort of carers (n?=?119) of community-living people (≥70 years) identified empirically as frail completed postal questionnaires. Positive caregiver reactions were evaluated using the self-esteem subscale (seven items) of the Caregiver Reaction Assessment (CRA). Anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale.

Results: Anxiety and depressive symptoms were related significantly (p?r ²?=?0.093, p?=?0.044 for anxiety, and r ²?=?0.121, p?=?0.041 for depression).

Conclusion: The results of this study indicate that those carers who resent having to care for their frail older relative are susceptible to anxiety and depressive symptoms. This study supports the notion that there is a need for assessment of caregiving reactions in carers of frail older people.     

Neurocognitive markers of suicidal ideation in patients with anxiety and mood disorders

Abstract

Objective: This study aims at identifying associations between cognitive function and suicidal ideation in the sample of patients with anxiety and mood disorders (AMD).

Methods: In sum, 186 (age = 39?±?12.3 years; 142 [76.3%] females) patients with AMD were enrolled in the study. Assessment included evaluation of socio-demographic information, medication use, anxiety and depression symptoms. Cognitive tests included measures of psychomotor performance and incidental learning using the Digit Symbol Test. Trail Making Tests respectively measured perceptual speed, task-switching and executive control. Additionally, 21 patients completed tests from the Cambridge Automated Neuropsychological Test Battery measuring set shifting (Interdimensional/extradimensional set-shift), executive planning (Stockings of Cambridge), and decision making (Cambridge Gamble Task [CGT]).

Results: Almost half (45.0%, n?=?86) of the study sample patients had experienced suicidal ideations. In multivariable regression analysis, suicidal ideation was associated with a greater overall proportion of bet and risk taking on the CGT task (β?=?0.726, p?=?.010 and β?=?0.634, p?=?.019), when controlling for socio-demographic characteristics, medication use, anxiety and depression symptoms.

Conclusions: Outpatients with AMD and suicidal ideation could be distinguished by the presence of cognitive deficits in the executive function domain, particularly in impulse-control and risk taking.     

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.     

Challenging predictions between affective temperaments,depression and anxiety in a Kosovo student community sample

Abstract

Objective: The relationship between temperament and mental health problems is seen very important as we hope to explain the trajectory of this interaction. The aim of this study was to test the validity of affective temperaments for predicting psychiatric morbidity, by explaining the relationships between temperament, anxiety and depression in a community sample.

Methods: This was a cross-sectional study. The present sample consisted of 960 participants (347 male, 622 female) with a mean age of M?=?28.4 (SD?=?10) randomly recruited. Affective temperaments were measured by the brief version of TEMPS-A, depression and anxiety measured with Beck Depression Inventory and Beck Anxiety Inventory.

Results: The Cronbach alpha reliability coefficients for affective temperaments were between .72 and .81, for BDI and BAI, were .88 and .90. The study found significant gender differences on depressive [t(959)?=?–4.2, p<.001], cyclothymic [t(957)?=?–4.6, p?<?.001] and anxious temperament [t(957)?=?–8.2, p?<?.001], females having higher scores than males, and reverse results on hyperthermic temperament [t(958)?=?2.1, p?<?.045], males having higher scores than females. No gender difference is found in irritable temperament [t(955)?=?–.581, p?<?.561]. Affective temperaments were found significant predictors for depression and anxiety. The combination of the depressive temperament and cyclothymic temperament explained the 32% variance of depression and the 25% variance of anxiety.

Conclusions: Study findings are consistent with some other studies and stress the importance of screening for effective temperament in order to early identify depression and anxiety. Further investigation is needed to understand what are other factors that influence the relationship between affective temperaments with depression and anxiety.     

Childhood and adult attention deficit hyperactivity disorder symptoms in fibromyalgia: associations with depression,anxiety and disease impact

Abstract

Objective: The first aim of this study was to determine the prevalence of childhood and current attention deficit hyperactivity disorder (ADHD) symptoms in patients with fibromyalgia. The second aim is to assess the role of depression and anxiety on the relationship between childhood and adult ADHD symptoms with disease impact in this population.

Methods: Sixty-four patients with fibromyalgia were compared to matched 58 healthy controls. All participants completed the Wender Utah Rating Scale (WURS), Adult ADHD Self-Report Scale (ASRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Fibromyalgia Impact Questionnaire (FIQ).

Results: Patients with fibromyalgia had significantly higher mean scores of depression (BDI), anxiety (BAI), childhood ADHD symptoms (WURS) and adult ADHD symptoms (ASRS total, ASRS hyperactivity/impulsivity subscale and ASRS attention deficit subscale) than the control group. Fibromyalgia impact (FIQ) was significantly correlated with depression (BDI; r?=?0.57, p < .001), anxiety (BAI; r?=?0.56, p < .001) and childhood ADHD symptoms (WURS; r?=?0.41, p < .001) in fibromyalgia group. There was no significant correlation between fibromyalgia impact (FIQ) and adult ADHD symptoms (ASRS total or sub-scale scores). Hierarchical multiple regression indicated that childhood ADHD symptoms (WURS), anxiety (BAI) and depression (BDI) predicted fibromyalgia impact. Both anxiety (BAI) and depression (BDI) mediated the relationship between childhood ADHD symptoms (WURS) and fibromyalgia impact (FIQ).

Conclusion: Childhood ADHD symptoms may be a contributory factor to poorer functioning in the patients with fibromyalgia. The relationship was more pronounced in the presence of depression and anxiety symptoms. Evaluation of childhood and adult ADHD symptoms in patients with fibromyalgia is important for recognition and treatment of ADHD comorbidity and also for attenuating the severity of the disease.     

Longitudinal covariance of resting-state cardiac function and borderline personality disorder symptoms in adolescent non-suicidal self-injury

Objectives: Cardiac function is altered in borderline personality disorder (BPD). In adolescents with non-suicidal self-injury (NSSI) resting heart rate (HR) and vagally mediated heart rate variability (vmHRV) are associated with BPD symptoms. The study aimed to investigate longitudinal covariance of BPD symptoms and cardiac function in adolescent NSSI.

Methods: HR and vmHRV were recorded in female adolescents with NSSI (n?=?17) completing a baseline and 1-year follow-up assessment. Physiological data, structured clinical interviews and self-reports were obtained at both time points. Predictors of change in clinical outcomes and cardiac function were assessed.

Results: Patients showed a reduction of NSSI (z_(34;17)?=?–3.79, P?z_(34;17)?=?–3.74, P?z_(34;17)?=?2.87, P?=?0.004). Symptoms of BPD and frequency of BPD diagnosis did not significantly change. No significant differences on HR or vmHRV were observed. Changes in BPD symptoms were associated with changes in HR (r₍₁₇₎= 0.532, P?=?0.028) and vmHRV (r₍₁₇₎?=?–0.516, P?=?0.033).

Conclusions: Longitudinal changes in BPD symptomatology in adolescents engaging in NSSI are associated with changes in resting cardiac function. Clinical studies are needed to investigate the utility of cardiac markers to track treatment outcome in adolescents with BPD.     

Age-related characteristics of outpatients with anxiety disorders: the Leiden routine outcome monitoring study

Objective: It has been hypothesised that clinically important age-related differences between adults with anxiety disorders exist; this study aims to elucidate these differences.

Methods: We analysed data from 1950 outpatients diagnosed with DSM-IV-TR anxiety disorders treated at a Dutch hospital or affiliated mental healthcare centres. Three age-groups (young- (18–25; n?=?435), mid- (26–40; n?=?788) and older adult (41–65; n?=?727)) were compared with regard to social demographic characteristics, diagnostic characteristics, anxiety symptom profile, general psychiatric symptom profile and generic health status, in addition, linear analyses were carried out with age as a continuous variable.

Results: Average age was 36.48 years (SD 11.71), 62.8% were female. Significant associations with age emerged for gender, employment, education level, living situation, observed depression, agoraphobia (AP), social phobia, aches and pains, inner tension, sleep, interpersonal sensitivity, observed hostility, physical functioning, role limitations due to physical problems, vitality and bodily pain in categorical and continuous analyses. Self reported hostility was only significant in group-wise comparisons; role limitations due to emotional problems were only significant in linear analyses (all at p?Conclusions: This study identified clinically relevant differences between younger and older adult outpatients with anxiety disorders. Clinicians should take these findings into account, as they may support treatment.     

Portuguese version of the Geriatric Anxiety Inventory: transcultural adaptation and psychometric validation

Objectives: The Geriatric Anxiety Inventory (GAI) is a recently developed anxiety instrument designed to assess the severity of anxiety symptoms across a range of presentations in older adults. In this study, the authors examined the validity of the Portuguese version of the GAI and assessed its psychometric properties.

Method: A cross-sectional study was designed using a sample of 152 community-dwelling older adults, and a geriatric psychiatric sample of outpatients with clinical diagnoses of depression (n?=?32), anxiety disorders (n?=?23), and early Alzheimer's disease (n?=?10).

Results: The Portuguese version of the GAI required linguistic and transcultural adaptations, particularly on the somatic expressions of anxiety. It exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberg State-Trait Anxiety Inventory, the Geriatric Depression Scale (GDS-30), and the General Health Questionnaire (GHQ-12). The optimal cut-off point to detect severe anxiety symptoms was 8/9, but no optimal cut-off point for Generalized Anxiety Disorder could be estimated.

Conclusion: These findings provide initial evidence that the Portuguese version of the GAI is a valid and reliable measure for assessing late-life anxiety and highlights the need for possible modifications of the instrument before being used in other languages and cultural groups.     

Usefulness of repetitive transcranial magnetic stimulation as a maintenance treatment in patients with major depression

Objectives: To investigate the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS), venlafaxine or a combination of both treatments as a maintenance treatment in patients with treatment-resistant depression (TRD).

Methods: In a three-arm open-label study, 66 patients, including 45 remitters, who responded to rTMS (n?=?25), venlafaxine (n?=?22), or a combination of both treatments (n?=?19) continued to receive the treatment that led to a response as a maintenance treatment over 12 months. Maintenance rTMS was administered twice per week for 1 month, once per week for 2 months, and once every 2 weeks for 9 months. Venlafaxine was maintained at the dose that induced a clinical response (150 or 225?mg/day).

Results: After the 12-month follow-up, the rates of remitters (HDRS?2?=^?1.25; P?=?.3). The rates of patients who not relapsed (HDRS?2?=^?0.33; P?=?.8): 40.0% in the rTMS group, 45.1% in the venlafaxine group and 36.9% in the combination group.

Conclusions: The three maintenance approaches exhibited similar efficacies in relapse prevention and the maintenance of remission in patients with TRD.     

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.     

Predicting individual responses to lithium with oxidative stress markers in drug-free bipolar disorder

Abstract

Objectives: This is the first study to investigate the oxidative stress (OxS) levels in drug-free bipolar disorder (BD) patients and their association with lithium response.

Methods: A total of 61 drug-free BD patients and 49 controls were included. Patients treated with lithium were followed-up for 6 weeks. The levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and malondialdehyde (MDA) were measured at baseline and at the end of the sixth week.

Results: Compared to controls, the SOD levels were lower, whereas the MDA were higher in the BD-depression (BD-D) group (both P?<?0.001). GSH-Px levels were higher in both the BD-D and the BD-mania (BD-M) group (both P?<?0.001). Both GSH-Px and MDA levels in the BD (P?=?0.009, P?<?0.001) and the BD-D subgroup (P?=?0.006, P?=?0.001) decreased significantly after the 6-week treatment with lithium. Interestingly, both GSH-Px and MDA levels decreased in responders (P?=?0.03, P?=?0.002) but not in the non-responders of BD-D (both p?>?0.05). Moreover, the reduction in the MDA levels were associated with lithium response (B?=?1.47, Wald statistic = 5.94, P?=?0.015, odds ratio = 4.35, 95% confidence interval 1.33-14.20).

Conclusions: Our study demonstrates an imbalance of OxS in drug-free BD, especially BD-D. Lithium reduces the GSH-Px and MDA levels in BD patients. The reduction in MDA levels may predict individual responsiveness to lithium.     

Antiphospholipid antibodies are associated with positive screening for common mental disorders in women with previous pregnancy loss. The NOHA-PSY observational study

Objectives: Case reports describe neuropsychiatric manifestations associated with antiphospholipid antibodies (aPlAbs). In patients sharing the same symptoms fulfilling the antiphospholipid syndrome (APS) clinical criteria, the prevalence of common mental disorders has, however, never been studied.

Methods: We observed women with three consecutive abortions before the 10th week of gestation or one foetal loss at or beyond the 10th week. We compared the prevalence of common psychiatric disorders detected through screening using the Mini International Neuropsychiatric Interview, 10 years after inclusion, in women with APS (n?=?506), women negative for aPlAbs but carrying the F5rs6025 or F2rs1799963 thrombogenic polymorphism (n?=?269), and women with negative thrombophilia screening results as controls (n?=?764).

Results: Similar prevalence values were obtained for controls and women bearing one of the two thrombogenic polymorphisms. Women with APS more frequently had mood disorders (relative risk (RR) 1.57 (1.262–1.953), P?=?.0001) and anxiety (RR 1.645 (1.366–1.979), P?Conclusions: Women with obstetric APS have a higher risk of positive screening for common mental disorders than women without APS.     

Mental health problems of second generation children and adolescents with migration background

Objective: Despite the growing number of young second-generation immigrant (SGI) children and adolescents, studies about their mental health are rare. The objective of this study was to investigate the mental health problems of SGI children and adolescents in Istanbul, Turkey.

Methods: In a clinical sample the mental health of 54 SGIs and 50 native children and adolescents were examined using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) and Children’s Global Assessment Scale. The assessments were carried out by a blinded rater.

Results: SGI children had higher rates of psychiatric disorders such as depression (p?=?0.001), post-traumatic stress disorder (PTSD) (p?=?0.011) and anxiety disorders (p?=?0.013), more comorbid disorders and lower functionality scores compared to their native counterparts (p?=?0.001).

Conclusions: SGI children seem to have higher rates of psychiatric disorders most probably due to migration-induced burdens. The professionals treating SGI children should have more awareness for these problems to be able to approach them in a culture and language sensitive way.     

Psychiatric morbidity in dermatological conditions

Abstract

Objective. A relationship between psychological factors and skin diseases has long been hypothesized. The objective of this study is to investigate the association of dermatology conditions with depression, anxiety and personality disorders. Method. A total of 144 dermatology outpatients and 100 controls were selected and assessed by the Structured Clinical Interview for DSM III-R personality disorders and the Hospital Anxiety and Depression Scale for presence of personality disorders and anxiety and depression. Results. A total of 77 (70%) of the patients and 26 (20%) of the control group reported moderate to severe anxiety and depression. Twenty-two patients (15.27%) and five controls (5%) suffered from personality disorders. Obsessive-compulsive personality disorder was the most diagnosed personality disorder followed by avoidant, borderline and dependent personalities. Conclusion. The association between dermatological diseases and psychiatric and personality morbidity underscores the deep emotional suffering that can be associated with skin diseases and confirms the importance of psychiatric evaluation of dermatology patients. Our findings highlight the need for a biopsychosocial approach to patients with skin disease.     

Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial

Abstract

Purpose:

No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia.

Methods:

Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15?minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1?second (FEV₁). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity.

Results:

Our results showed that changes between the pre- and post-test values of FVC (F?=?12.50, P?=?0.02) and FEV₁ (F?=?12.81, P?=?0.01) (P?<?0.05) in the ITG were significantly (P?<?0.05) greater. Changes in EMG activation of the diaphragm (F?=?13.75, P?=?0.003) and external intercostal (F?=?14.33, P?=?0.002) (P?<?0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P?<?0.05) greater than those in patients of the RMTG and the CG at post-test.

Conclusions:

Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.     

Hypoesthesia in generalised anxiety disorder and major depression disorder

Abstract

Objective: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia role in distinguishing between patients with generalised anxiety disorder (GAD) and major depression disorder (MDD).

Methods: This study examines the presence of malleolar hypoesthesia in patients with GAD (n?=?47) compared to patients with MDD (n?=?48) and healthy individuals (controls; n?=?99). The Wartenberg wheel, a medical device for neurological use, was employed to determine the presence of hypoesthesia on both sides of the ankles.

Results: The data revealed: i) MDD patients showed higher hypoesthesia than GAD patients (p?=?.008), ii) participants with hypoesthesia had higher anxiety and depression scores than participants without hypoesthesia (all p?<?.001) and iii) logistic regression model indicated that hypoesthesia can be a predictor of MDD relative to GAD diagnosis (Odds Ratio: 17.43 (1.40–217.09; p?=?.026)).

Conclusions: Malleolar hypoesthesia was higher in MDD than GAD. The detection of hypoesthesia may help to investigate the differential etiology between MDD and GAD diagnosis.     

The effect of individual enabling and support on empowerment and depression severity in persons with affective disorders: outcome of a randomized control trial

Purpose: To evaluate the effect of Individual Enabling and Support (IES) on empowerment and depression severity as compared to Traditional Vocational Rehabilitation (TVR) in people with affective disorders at 12?months follow-up. Additionally, longitudinal changes within the intervention groups and the correlation over time between empowerment and depression severity were evaluated.

Method: A single-blind randomized controlled trial of two intervention groups, IES (n?=?33) and TVR (n?=?28), was performed with measurement points at baseline, 6, and 12?months. Individuals with affective disorders, including depression and bipolar disorder diagnoses were included. The Empowerment Scale and Montgomery–Åsberg Depression Self-Rating Scale were administered, and Intention-To-Treat analysis was applied. The study was registered with the trial number ISRCTN93470551.

Result: There was a statistically significant difference between the intervention groups on empowerment and depression severity at 12?months. Within-group analysis showed that IES-participants increased their perceived empowerment and decreased their depression severity between measurement points, this was not seen among TVR-participants. A moderate, inverse relationship was detected between empowerment and depression.

Conclusion: IES is more effective in increasing empowerment and decreasing depression severity after a 12-month intervention than is TVR. This study was limited by a small sample size and larger trials in different contexts are needed.