Clinical Characteristics of the Respiratory Subtype in Panic Disorder Patients

Objective

Panic disorder has been suggested to be divided into the respiratory and non-respiratory subtypes in terms of its clinical presentations. The present study aimed to investigate whether there are any differences in treatment response and clinical characteristics between the respiratory and non-respiratory subtypes of panic disorder patients.

Methods

Among the 48 patients those who completed the study, 25 panic disorder patients were classified as the respiratory subtype, whereas 23 panic disorder patients were classified as the non-respiratory subtype. All patients were treated with escitalopram or paroxetine for 12 weeks. We measured clinical and psychological characteristics before and after pharmacotherapy using the Panic Disorder Severity Scale (PDSS), Albany Panic and Phobic Questionnaire (APPQ), Anxiety Sensitivity Index-Revised (ASI-R), State-Trait Anxiety Inventory (STAI-T, STAI-S), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D).

Results

The prevalence of the agoraphobia was significantly higher in the respiratory group than the non-respiratory group although there were no differences in gender and medication between the two groups. The respiratory group showed higher scores on the fear of respiratory symptoms of the ASI-R. In addition, after pharmacotherapy, the respiratory group showed more improvement in panic symptoms than the non-respiratory group.

Conclusion

Panic disorder patients with the respiratory subtype showed more severe clinical presentations, but a greater treatment response to SSRIs than those with non-respiratory subtype. Thus, classification of panic disorder patients as respiratory and non-respiratory subtypes may be useful to predict clinical course and treatment response to SSRIs.     

Effectiveness of mindfulness‐based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder

Background: Mindfulness‐based cognitive therapy (MBCT) has been widely used to treat patients with depressive disorder to prevent relapse. The objective of this study was to examine the effectiveness of newly developed MBCT program as an adjuvant to pharmacotherapy in the treatment of patients with panic disorder or generalized anxiety disorder. Methods: Forty‐six patients with panic disorder or generalized anxiety disorder were assigned to either MBCT or an anxiety disorder education (ADE) program for a period of 8 weeks. The Hamilton Anxiety Rating Scale (HAM‐A), Hamilton Depression Rating Scale (HAM‐D), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Symptom Checklist‐90‐Revised (SCL‐90‐R) were used to assess the patients at 0 week and after the two programs had been running for 2, 4, and 8 weeks. Results: The MBCT group demonstrated significantly more improvement than the ADE group according to all anxiety (HAM‐A, p<0.01; BAI, p<0.01; anxiety subscale of SCL‐90‐R, p=0.01) and depression (HAM‐D, p<0.01; BDI, p<0.01; depression subscale of SCL‐90‐R, p<0.01) scale scores. The obsessive‐compulsive and phobic subscales of the SCL‐90‐R also showed significantly more improvement in the MBCT group. However, no significant improvement was observed in the MBCT group versus the ADE group in terms of the somatization, interpersonal sensitivity, paranoid ideation, or psychoticism subscale scores of the SCL‐90‐R. Conclusions: MBCT may be effective at relieving anxiety and depressive symptoms in patients with panic disorder or generalized anxiety disorder. However, well‐designed, randomized controlled trials are needed. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Psychological characteristics of early remitters in patients with panic disorder

We aimed to examine whether anxiety sensitivity and agoraphobic fear could affect the time taken to remission after 24 weeks of open-label escitalopram treatment of patients with panic disorder (PD). We recruited 158 patients, and 101 patients completed the study. Clinical severity and psychological characteristics were assessed at baseline and 4, 12, and 24 weeks after the treatment, using the Clinical Global Impression-Severity (CGI-S), the Hamilton Rating Scales for Anxiety and Depression, the Anxiety Sensitivity Index-Revised (ASI-R), the Albany Panic and Phobia Questionnaire (APPQ), and the Panic Disorder Severity Scale (PDSS). Remission was defined as the absence of full panic attacks and PDSS scores of 7 or less. Completing patients were stratified according to the time taken to remit: early (n=20) and late (n=58) remission and non-remission groups (n=23). There were no significant differences among the three groups at baseline on the CGI-S and the PDSS mean scores. However, early remitters had significantly lower scores than late remitters and non-remitters on the ASI-R and APPQ. In conclusion, anxiety sensitivity and agoraphobic fear can affect the time to remission after pharmacotherapy, and clinicians should consider the psychological characteristics of PD patients in order to achieve an optimal response to pharmacotherapy.     

A discussion of various aspects of panic disorder depending on presence or absence of agoraphobia

ObjectiveThe quality of life of individuals with panic disorder and agoraphobia can be improved by the alleviation of agoraphobia. In other words, examining panic disorder in terms of whether agoraphobia is present is crucial. The current study examined panic disorder from this perspective.MethodsSubjects were 253 patients who met the diagnostic criteria for panic disorder (lifetime) according to the Mini International Neuropsychiatric Interview (MINI). Of those patients, 179 had agoraphobia and 74 did not. Statistical analysis was used to examine gender differences in the presence (or absence) of agoraphobia, comorbidities, and the effects of the presence of agoraphobia (severity, assessment of depression, assessment of anxiety, and personality) in these patients.ResultsResults indicated gender differences in the presence (or absence) of agoraphobia. Compared to patients without agoraphobia, significantly more patients with agoraphobia were female (p < .001), and had a higher prevalence of comorbidities. Patients with agoraphobia had a higher suicide risk (p < .05), more hypomanic episodes (current) (p < .05), and more frequent episodes of social phobia (p < .05). In addition, patients with agoraphobia had more severe panic disorder and a higher level of neuroticism, sensitivity to anxiety, and trait anxiety [PDSS-J, P&A, NEO-N: p < .01, ASI, STAI (Trait Anxiety): p < .05].ConclusionsThe current findings suggest that when treating a panic disorder, diagnosing the presence of agoraphobia is extremely important.     

Characteristics of responders and non-responders to risperidone monotherapy or placebo in co-occurring bipolar disorder and anxiety disorder

Clinical characteristics predicting response and remission to psychopharmacological treatment of bipolar disorder (BD) and co-occurring anxiety disorders have been understudied. We hypothesized that non-response to risperidone or placebo in individuals with co-occurring BD and anxiety symptoms would be associated with a more severe clinical course of BD, and certain demographic variables. This study was a secondary analysis of a randomized, double-blind, parallel, 8-week study comparing risperidone monotherapy and placebo in individuals with BD plus current panic disorder, current generalized anxiety disorder (GAD), or lifetime panic disorder (n = 111) [31]. We compared clinical characteristics of responders (50% improvement on the Hamilton Anxiety Scale [HAM-A]) and non-responders as well as remitters (HAM-A < 7) and non-remitters in risperidone treatment (n = 54) and placebo (n = 57) groups. For non-responders in the risperidone group, co-occurring lifetime panic disorder was significantly more common than for non-responders in the placebo group. Apart from this, no significant differences in course of illness or demographics were found either between or across groups for patients with BD and co-occurring anxiety symptoms receiving risperidone or placebo in this acute phase study.     

Functional Impairment in Patients with Panic Disorder

Objective Anxiety and depression and sociodemographic factors such as age, gender, education level, income, and marital status among people with panic disorder (PD) are associated with functional impairment in the areas of work, social, and family. Although both PD-specific scales such as the Panic Disorder Severity Scale (PDSS) and Anxiety Sensitivity Inventory-Revised (ASI-R) and early trauma have been investigated, their relationship with functional impairment in PD patients has not been clarified. Methods This study included 267 PD patients. The PDSS, Beck Depression Inventory (BDI), ASI-R, and Early Trauma Inventory were used. Pearson’s correlation and multiple linear regression analyses were performed. The Sheehan Disability Scale (SDS) was administered to assess the functional impairment level in PD patients. Results Our findings showed that high levels of PDSS, BDI, and ASI-R were significantly correlated with the functional impairment among PD patients. Multiple regression analyses showed that PDSS, BDI, and ASI-R can predict the functional impairment levels, and PDSS and ASI-R were significantly associated with lost and underproductive days in PD patients. Conclusion Panic-specific symptoms, depression, and AS are associated with functional impairment level in PD patients. Elevated symptom severity can play a role by affecting productivity and daily responsibilities in PD patients.     

Open-longitudinal study of the effect of dissociative symptoms on the response of patients with panic disorder to venlafaxine

The relationship between Panic Disorder (PD) and dissociation is well known. In this study we aimed to investigate whether or not dissociative experiences affect the response to PD drug treatment. For this purpose, standart dose of venlafaxine was preferred for treatment. 63 patients with PD were included in the study. Venlafaxine treatment with increasing dose was administered to each patient during a 10-week period. The Panic Disorder Severity Scale (PDSS) and the Dissociation Questionnaire (DIS-Q) were applied to the patients at the beginning of the study. Patients were divided into two groups based on DIS-Q scores. PDSS was applied again to both groups at the end of 10-week treatment.No difference between sociodemographic data and PDSS scores of two groups – patients with low DIS-Q scores (<2.5) and high DIS-Q scores (>2.5) – was found at the beginning. At the end of the study, a significant decrease in PDSS scores measured in both groups was detected. However, the decrease in PDSS score for the group with lower DIS-Q score was at a higher percentage (z = −3.822, p = 0.0001).These results depict that dissociative symptoms accompanying PD affect psychopharmacological treatment in a negative way. Reevaluation of dissociative symptoms at the beginning and end of treatment would help in planning personal therapy.     

Pre-treatment peripheral biomarkers associated with treatment response in panic symptoms in patients with major depressive disorder and panic disorder: A 12-week follow-up study

ObjectivePeripheral biomarkers have been studied to predict treatment response of panic symptoms. We hypothesized that depressive disorder (MDD) vs. panic disorder (PD) would exhibit different peripheral biomarkers, and their correlation with severity of panic attacks (PA) would also differ.MethodsForty-one MDD patients, 52 PD patients, and 59 healthy controls were followed for 12 weeks. We measured peripheral biomarkers along with the Panic Disorder Severity Scale (PDSS) at each visit—pre-treatment, 2, 4, 8, and 12 weeks on a regular schedule. Peripheral biomarkers including serum cytokines, plasma and serum brain-derived neurotrophic factor (BDNF), leptin, adiponectin, and C-reactive protein (CRP) were quantified using enzyme-linked immunosorbent assay (ELISA).ResultsPatients with MDD and PD demonstrated significantly higher levels of pre-treatment IL-6 compared to controls, but no differences were seen in plasma and serum BDNF, leptin, adiponectin, and CRP. Pre-treatment leptin showed a significant clinical correlation with reduction of panic symptoms in MDD patients at visit 5 (p = 0.011), whereas pre-treatment IL-6 showed a negative correlation with panic symptom reduction in PD patients (p = 0.022). An improvement in three panic-related items was observed to be positively correlated with pre-treatment leptin in MDD patients: distress during PA, anticipatory anxiety, and occupational interference.ConclusionHigher pre-treatment leptin was associated with better response to treatment regarding panic symptoms in patients with MDD, while higher IL-6 was associated with worse response regarding panic symptoms in PD patients. Different predictive peripheral biomarkers observed in MDD and PD suggest the need for establishing individualized predictive biomarkers, even in cases of similar symptoms observed in different disorders.     

Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: A randomized controlled trial with a three-year follow-up

BackgroundInternet-delivered treatment may reduce barriers to care in those unwilling or unable to access traditional forms of treatment.ObjectiveTo assesses the efficacy of web-based therapist-assisted cognitive behavioral treatment (web-CBT) of panic symptoms.DesignA randomized waiting-list controlled trial with an uncontrolled three-year follow-up.ParticipantsA community sample of 58 participants with chronic panic symptoms of varying severity (immediate treatment: n = 27, waiting-list control: n = 31).Outcome measuresThe primary outcome measures were a one-week Panic Diary and the Panic Disorder Severity Scale – Self-Report (PDSS-SR); secondary measures were the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), the Mobility Inventory – Alone subscale (MI-AAL), and the Depression Anxiety Stress Scales (DASS-42).ResultsIn the RCT, 54 participants (93%) completed posttest measurements. With regard to the primary outcome measures, intention-to-treat ANCOVAs revealed that participants in the treatment condition improved more than the participants in the waiting-list control condition (p < .03), with a pooled between-group effect size of d = .7. After three years (n = 47; 81% study compliance), effects were more pronounced.ConclusionThe results demonstrate the efficacy of therapist-assisted web-CBT in the treatment of panic symptoms.     

Assessment of COVID-19 trauma responses. Who has been more traumatized during the pandemic?

Background and ObjectiveTo evaluate the effect of cognitive and sociodemographic characteristics of healthcare and non-healthcare workers on their traumatic responses to the COVID-19 pandemic.MethodsData were collected using an online survey between August-September 2020. The survey included the following scales: Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), and Impact of Event Scale-Revised (IES-R). Traumatic responses were categorized into three types: avoidance (IES-R_A), intrusion (IES-R_I), and hyperarousal (IES-R_H).ResultsThe study included a total of 672 participants, comprised of 399 (59.4%) men, and 273 (40.6%) women with a mean age of 39.25 ± 933 years. The results indicated that women had higher IES-R_I (r = .5.78, p < 0.001), IES-R_A (r = 4.47, p < 0.001), and IES-R_H (r = .5.20, p < 0.001) scores compared to men. Patients with a history of psychiatric diseases had significantly higher IES-R_I (r = ?3.82, p < 0.001), IES-R_A (r = ?2.00, p < 0.05), and IES-R_H (r = ?4.06, p < 0.001) scores compared to patients with no history of psychiatric diseases. Non-healthcare workers had significantly higher IES-R_A (r = ?2.69, p < 0.01) scores compared to healthcare workers.ConclusionFemale gender and a positive history of psychiatric diseases were found to lead to an increase in the frequency of all three traumatic responses to COVID-19. Contrary to expectation, being a healthcare worker was not found as a factor facilitating trauma response formation in our study.     

Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea: Contribution of daytime sleepiness to residual depressive symptoms

BackgroundAlthough extensive studies have indicated a relationship between obstructive sleep apnea (OSA) and depressive symptoms, the effect of continuous positive airway pressure (CPAP) treatment on residual depressive symptoms in patients with both major depressive disorder (MDD) and coexisting OSA has not been examined.MethodsSeventeen patients with continued MDD despite pharmacotherapy such as antidepressants and/or benzodiazepines, who also had comorbid OSA, were required to complete the Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRSD), and Epworth sleepiness scale (ESS) at the commencement of the study and then again after 2 months of CPAP treatment.ResultsBDI and HRSD scores decreased from 19.7 to 10.8 and 16.7 to 8.0 after 2 months of CPAP treatment (both p < 0.01). We also found significant correlations among the improvement rates in BDI, HRSD and ESS scores (R = 0.86 and 0.75, both p < 0.01). The mixed effect model demonstrated a significant ESS effect on BDI and HRSD.ConclusionsThe results suggest that MDD patients with residual depressive symptoms despite pharmacotherapy who also have symptoms of suspected OSA, such as loud snoring, obesity, and daytime sleepiness, should be evaluated for sleep apnea by polysomnography and treated with an appropriate treatment such as CPAP. CPAP treatment may result in a significant improvement of residual depressive symptoms due to the improvement of daytime sleepiness in these patients.     

Impact of the chronic use of benzodiazepines prescribed for seizure control on the anxiety levels of patients with epilepsy

In a cross-sectional study, we evaluated the impact of the chronic use of benzodiazepines (BDZ) prescribed for seizure control on the anxiety levels of patients with temporal lobe epilepsy. We assessed the anxiety level of 99 patients with temporal lobe epilepsy with (n = 15) or without (n = 84) BDZ for seizure control, using the Beck Anxiety Inventory (BAI) or the Hamilton Anxiety Scale (HAMA). Independent risk factors for high anxiety levels were being a female patient (O.R. = 2.93; 95% C.I. = 1.05–8.16; p = 0.039), having uncontrolled seizures (O.R. = 4.49; 95% C.I. = 1.66–12.11; p = 0.003) and having a history of a psychiatric disorder (O.R. = 4.46; 95% C.I. = 1.63–12.21; p = 0.004). However, there were no statistically significant differences in anxiety levels between patients utilizing or not utilizing BDZ prescribed exclusively for seizure control. We concluded that in our study, patients with chronic use of BDZ prescribed exclusively for seizure control showed similar anxiety levels than patients who were not using this class of drug. Additional studies are needed to define better strategies for the treatment of anxiety disorders in epilepsy.     

Psychiatric disorders in temporal lobe epilepsy: An overview from a tertiary service in Brazil

PurposeTo evaluate the frequency and intensity of psychiatric disorders in a group of temporal lobe epilepsy (TLE) patients from a tertiary-care center.MethodsClinical and sociodemographic data of 73 patients were collected and a neuropsychiatric evaluation was performed with the following instruments: Mini-Mental State Examination (MMSE), structured clinical interview (MINI-PLUS), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS).ResultsPatients with TLE showed a high frequency of lifetime psychiatric disorders (70%), the most frequent being mood disorders (49.3%). At assessment, 27.4% of the patients were depressed and 9.6% met criteria for bipolar disorder. Nevertheless, depression had not been properly diagnosed nor treated. Anxiety disorders were also frequent (42.5%), mainly generalized anxiety disorder (GAD) (21.9%). Obsessive compulsive disorder (OCD) was present in 11.0% and psychotic disorders in 5.5% of the sample. Patients with left mesial temporal sclerosis (LMTS) exhibited more psychopathologic features, mainly anxiety disorders (p = 0.006), and scored higher on HAM-A and HAM-D (p < 0.05 in both).ConclusionTLE is related to a high frequency of psychiatric disorders, such as anxiety and depression, which are usually underdiagnosed and undertreated. Damage to the left mesial temporal lobe, seen in LMTS, seems to be an important pathogenic lesion linked to a broad range of psychopathological features in TLE, mainly anxiety disorders. The present study prompts discussion on the recognition of the common psychiatric disorders in TLE, especially on the Brazilian setting.     

Comparison of factor structure models for the Beck Anxiety Inventory among cardiac rehabilitation patients

ObjectiveIndividuals with cardiovascular disease (CVD) experience greater rates of distress symptoms, such as anxiety and depressive symptoms, than the general population. These psychological outcomes have been linked to greater risk for negative outcomes following a cardiac event; however, research examining the relationship between specific components of anxiety and outcomes in CVD is limited. Further, prior research has not investigated the structure of anxiety symptoms in CVD. This study sought to compare previously established one, two, and four-factor models of the Beck Anxiety Inventory (BAI) in individuals enrolled in cardiac rehabilitation (CR).MethodsOur sample included 208 individuals with CVD recruited during enrollment in a phase II CR program. Participants completed the BAI at enrollment in CR (Time 1) and again 12 weeks later at CR completion (Time 2, n = 151).ResultsConsistent with prior literature, 41% of our sample reported at least mild symptoms of anxiety (BAI > 8), and the BAI proved to be a reliable measure within this sample (α = 0.89). Confirmatory factor analysis (CFA) results indicated that a second-order model with four first order factors, consisting of cognitive, autonomic, neuromotor, and panic components, fit our data well. A multi-group CFA approach supported measurement invariance across time.ConclusionThese results suggest that anxiety following CVD can be evaluated based on cognitive, autonomic, neuromotor, and panic components as well as the encompassing anxiety construct.     

Neuropsychological and psychiatric assessments following bilateral deep brain stimulation of the subthalamic nucleus in Japanese patients with Parkinson’s disease

The physical benefits of subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD) patients are well documented, but the mental benefits are uncertain, particularly in Japanese patients. This study evaluated the clinical and neuropsychological characteristics before and after STN-DBS surgery in Japanese PD patients. PD patients (n = 13, age 67.0 ± 7.8 years) were evaluated pre-surgery (baseline) and at 1 and 6 months post-surgery by two trained psychiatrists. The motor symptoms were assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score. The neuropsychological and psychiatric tests performed were the Mini-Mental State Examination, the Wisconsin Card Sorting Test (WCST), the Verbal Fluency Test (VFT), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HAM-A). The UPDRS motor score (p < 0.001) and HAM-A score (p = 0.004) showed significant improvement at 1 month post-surgery, but a significant decline was observed in the WCST total error (p = 0.005) and the semantic VFT score (p < 0.001). The phonetic VFT also showed a substantial decline (p = 0.015) at 1 month post-surgery. At 6 months post-surgery, the improvement in the UPDRS motor score was maintained, and the scores on the neuropsychological and psychiatric tests had returned to baseline. Although bilateral STN-DBS did not appear to have long-term effects on neuropsychological and psychiatric outcomes, the microlesion effects associated with STN-DBS appear to increase the risk of transient cognitive and psychiatric complications. These complications should be monitored by careful observation of neurological and psychiatric symptoms.     

Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder

Objective

Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder.

Methods

We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI).

Results

There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001).

Conclusion

IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.     

Adult separation anxiety disorder in complicated grief: an exploratory study on frequency and correlates

IntroductionComplicated grief (CG) has been the subject of increasing attention in the past decades but its relationship with separation anxiety disorder (SEPAD) is still controversial. The aim of the current study was to explore the prevalence and clinical significance of adult SEPAD in a sample of help-seeking individuals with CG.Methods151 adults with CG, enrolled in a randomized controlled trial comparing the effectiveness of (CG) treatment to that of interpersonal therapy, were assessed by means of the Inventory of Complicated Grief (ICG), the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HAM-D), the Work and Social Adjustment Scale (WSAS), the Adult Separation Anxiety Questionnaire (ASA-27), the Grief Related Avoidance Questionnaire (GRAQ), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), and the Impact of Events Scale (IES).Results104 (68.9%) individuals with CG were considered to have SEPAD (ASA-27 score ≥22). Individuals with SEPAD were more likely to have reported a CG related to the loss of another close relative or friend (than a parent, spouse/partner or a child) (p = .02), as well as greater scores on the ICG (p = <.001), PDEQ (p = .004), GRAQ (p < .001), intrusion (p < .001) and avoidance (p = <.001) IES subscales, HAM-D (p < .001) and WSAS (p = .006). ASA-27 total scores correlated with ICG (p < .0001), PDEQ (p < .001) GRAQ (p < .0001) scores and both the IES intrusion (p < .0001) and IES avoidance (p < .0001) subscale scores. People with SEPAD had higher rates of lifetime post-traumatic stress disorder (PTSD) (p = .04) and panic disorder (PD) (p = .01).ConclusionsSEPAD is highly prevalent among patients with CG and is associated with greater symptom severity and impairment and greater comorbidity with PTSD and PD. Further studies will help to confirm and generalize our results and to determine whether adult SEPAD responds to CG treatment and/or moderates CG treatment response.     

Adjunctive high-frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) was not effective in obsessive–compulsive disorder but improved secondary depression

BackgroundThere is preliminary evidence that repetitive transcranial magnetic stimulation (rTMS) may be useful in obsessive–compulsive disorder (OCD) patients.MethodsOur objective was to examine efficacy of adjunctive right prefrontal high-frequency (rapid) rTMS treatment in OCD patients. 42 patients with OCD were randomly assigned to 10 sessions of add-on high-frequency right prefrontal active rTMS (10 Hz, 110% of motor threshold, 4 s per train, 20 trains per session) or sham stimulation. They were rated on Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A) and Clinical Global Impression-Severity of Illness (CGI-S) at baseline, day 14 and day 28. The dose of antiobsessive drug was kept constant throughout the period of assessment.ResultsFor YBOCS scores, repeated measures ANOVA showed significant main effect of treatment, but no effect of treatment over time (Pillai's Trace F = 1.39, p = .262). However, significant effect of treatment over time as shown by interaction effect for both HAM-D (Pillai's Trace F = 3.67, p = .035, η² = .158) and HAM-A scores (Pillai's Trace F = 5.22, p = .01, η² = .211) were seen.ConclusionAdjunctive high-frequency right prefrontal rTMS does not have any significant effect in the treatment of OCD. However, it is modestly effective in the treatment of comorbid depressive symptoms in patients with OCD.     

Modelling the effect of minor orthopaedic day surgery on patient mood at the early post-operative period: A prospective population-based cohort study

ObjectiveThe effect of minor orthopaedic day surgery (MiODS) on patient's mood.MethodsA prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of general anaesthesia (GA) were included. The Medical Outcomes Study – Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and post-operatively.ResultsThe mean physical component score of SF-36 before surgery was 45.3 (SD = ±10.1) and 8 weeks following surgery was 44.9 (SD = ±11.04) [n = 148, p = 0.51, 95% CI = (?1.03 to 1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov = 69.44) corresponded to a correlation coefficient, r = 0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well with χ² (df = 1) = 0.86 for which p = 0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected.ConclusionsMiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.     

Validity of the body adiposity index in adults with Down syndrome

The purpose of this investigation was to determine the agreement between the body adiposity index (BAI) and dual energy X-ray absorptiometry (DXA) for measuring BF% in adults with Down syndrome (DS). Twenty adults (male: n = 10; female: n = 10) with Down syndrome volunteered to participate in this study. Criterion BF% was determined by DXA and predicted BF% was estimated by the BAI method. There was a significant mean difference (p < 0.001) between DXA BF% (39.94 ± 10.80%) and the BAI BF% (42.60 ± 8.19%). The correlation between the two BF% variables was large and significant (r = 0.73, p < 0.001). However, the standard error of the estimate and total error was 7.79% and 7.86%, respectively. Additionally, the 95% limits of agreement ranged from 12.21% below to 17.52% above the constant error of 2.65%. Our findings suggest that on average, the BAI significantly overestimated BF% when compared to DXA values. Though there was a strong correlation between both methods, the wide limits of agreement suggest there is large amount of individual error when estimating BF% via the BAI. Therefore, the use of the BAI for individuals with DS does not appear to be accurate for estimating BF%.