Cognitions in generalized anxiety disorder and panic disorder patients.

Breitholtz E, Westling BE, Ost LG.

University of Uppsala, Sweden.

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

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9879036&dopt=Abstract anxiety medicine




Combining pharmacotherapy with psychotherapy in the treatment of anxiety disorder.

Pasnau RO.

Neuropsychiatric Institute and Hospital, UCLA School of Medicine, Los Angeles, California 90024-1759, USA.

Anxiety disorders are more prevalent than any other mental health problem in the USA, but afflicted patients are often untreated or treated only by a primary care physician. Anxiety disorders can be understood in the context of the interplay of biological, psychosocial, and behavioral factors. Psychiatry has defined effective treatment that integrates education, psychotherapy and psychopharmacology. A combination of treatment approaches may be beneficial. Anxiety related symptoms, other than a true anxiety disorder, may be precipitated by normal stresses of daily life. These patients may also benefit from treatments used in anxiety disorders. Anxiety can also occur secondary to medical disorders and medications, as well as being present as part of other psychiatric syndromes. Diagnosis requires a history, physical examination and laboratory tests. Anxiety disorders, although common, are easily overlooked because patients may present with somatic complaints rather than admit to having emotional problems. Anxiety disorders are divided into seven categories in DSM IV, with each allowing for a differential treatment approach. Non-pharmacological treatments are the first line of treatment, and may include behavior therapy and cognitive therapy. The physician-patient relationship is itself a powerful treatment tool. Key areas in which the psychiatrist can help the patient cope are outlined. Benefits and risks of drug treatment for anxiety disorders are discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9895146&dopt=Abstract anxiety medicine




Effect of anxiety on the rate of gastric emptying of liquids.

Lydon A, McGinley J, Cooke T, Duggan PF, Shorten GD.

Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Ireland.

The efficacy of preoperative fasting is reduced in the presence of any factor which delays gastric emptying. We examined the association between anxiety and gastric emptying in adult patients undergoing elective surgery. Immediately before operation, 21 patients completed both a Spielberger state trait inventory (used to quantify current anxiety state (STAIs) and anxiety predisposition (STAIt)), and the Amsterdam preoperative anxiety and information scale (used to quantify anxiety and need for information). Gastric emptying was measured using the paracetamol absorption technique. Four to 10 weeks later, gastric emptying and STAI were measured again. Patients were more anxious before than after operation (STAIs = mean 35.4 (SD 10.9) and 25 (4.1), respectively; P = 0.0004). Neither anxiety state (P = 0.40) nor measures of anxiety relative to anxiety predisposition (P = 0.86) influenced gastric emptying (as measured by area under the paracetamol absorption-time curve). This contrasts with previous findings that anxiety in patients with low anxiety predisposition scores delays gastric emptying.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9924224&dopt=Abstract anxiety medicine




Maternal and child's anxiety--effect on child's behaviour at dental appointments and treatments.

Bankole OO, Aderinokun GA, Denloye OO, Jeboda SO.

Department of Preventive Dentistry, College of Medicine, University College Hospital, Ibadan, Nigeria.

The objective of this study was to assess the influence of pre-existing dental anxiety and maternal anxiety on the behaviour of some Nigerian children during dental appointments. Two hundred and sixty children aged 2-15 years participated in this study. They were treated at the three government dental establishments in Ibadan, a city in South Western Nigeria, over a six-month period. The children's behaviour during different stages of treatment was determined by the Frankl's Behaviour Rating Scale. The outcome of the study revealed a high association between the level of pre-existing dental anxiety in the children and their behaviour during various phases of treatment (P<0.05). During initial stages of treatment, prophylaxis, administration of local anaesthesia and tooth extraction, children with high level of anxiety were less cooperative. In addition, a general tendency towards cooperative behaviour was observed among patients whose mothers had low anxiety levels. This study shows the importance of correct assessment of the pre-operative dental anxiety status in children as well as the level of anxiety in their mothers. The level of dental anxiety in children and their mothers appears to be predictive of their behaviour in the oral care setting. In circumstances where the level of pre-operative and maternal anxiety are high, efforts should first be geared toward instituting appropriate behaviour management skills like behaviour shaping and modelling to bring about a higher level of cooperation before embarking on treatment. By paying special attention to these children, it is possible that the dentist would succeed in improving acceptance of treatment in them thereby increasing cooperation at subsequent dental visits.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15027778&dopt=Abstract anxiety medicine




Inhibition of anxiety in rats by antisense to cholecystokinin precursor protein.

Cohen H, Kaplan Z, Kotler M.

Ministry of Health Mental Health Center, Faculty of Health Sciences, Anxiety and Stress Research Unit, Ben Gurion University of the Negev, Beer-Sheva, Israel.

BACKGROUND: Cholecystokinin (CCK) and its analogs generates anxiety in humans and measurable anxiety-like behaviors in rats. CCK receptor blockers have had mixed results as a treatment approach for anxiety disorders. Since CCK is a peptide, we explored another strategy to reduce CCK levels in brain by antisense oligodeoxynucleotide inhibition of DNA transcription or messenger RNA (mRNA) translation for CCK precursor protein. METHODS: Antisense oligodeoxynucleotide complementary to the start coding region of rat CCK-precursor was intracerebroventricularly (icv) infused into rats three times at 24-hour intervals. Control groups received infusions of either a scramble sequence oligodeoxynucleotide or vehicle. On the fourth day, rats were assessed in the elevated plus maze paradigm. RESULTS: Compared to vehicle and scramble sequence oligodeoxynucleotide control, icv CCK-antisense exogenous administration for 3 days significantly diminished anxiety behavior in rats. CONCLUSIONS: Antisense inhibition of CCK-mediated anxiety could have therapeutic potential in human anxiety disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9807648&dopt=Abstract anxiety medicine




Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam.

Beekman AT, Bremmer MA, Deeg DJ, van Balkom AJ, Smit JH, de Beurs E, van Dyck R, van Tilburg W.

Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.

OBJECTIVE: To study the prevalence and risk factors of anxiety disorders in the older (55-85) population of The Netherlands. METHOD: The Longitudinal Aging Study Amsterdam (LASA) is based on a random sample of 3107 older adults, stratified for age and sex, which was drawn from the community registries of 11 municipalities in three regions in The Netherlands. Anxiety disorders were diagnosed using the Diagnostic Interview Schedule in a two-stage screening design. The risk factors under study comprise vulnerability, stress and network-related variables. Both bivariate and multivariate statistical methods were used to evaluate the risk factors. RESULTS: The overall prevalence of anxiety disorders was estimated at 10.2%. Generalized anxiety disorder was the most common disorder (7.3%), followed by phobic disorders (3.1%). Both panic disorder (1.0%) and obsessive compulsive disorder (0.6%) were rare. These figures are roughly similar to previous findings. Ageing itself did not have any impact on the prevalence in both bivariate and multivariate analyses. The impact of other factors did not change much with age. Vulnerability factors (female sex, lower levels of education, having suffered extreme experiences during World War II and external locus of control) appeared to dominate, while stresses commonly experienced by older people (recent losses in the family and chronic physical illness) also played a part. Of the network-related variables, only a smaller size of the network was associated with anxiety disorders. CONCLUSIONS: Anxiety disorders are common in later life. The risk factors support using a vulnerability-stress model to conceptualize anxiety disorders. Although the prevalence of risk factors changes dramatically with age, their impact is not age-dependent. The risk factors indicate which groups of older people are at a high risk for anxiety disorders and in whom active screening and treatment may be warranted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9818308&dopt=Abstract anxiety medicine




The influence of perinatal loss on anxiety in multigravidas.

Cote-Arsenault D.

School of Nursing, College of Human Services and Health Professions, Syracuse University, NY 13244, USA. dycotear syr.edu

OBJECTIVE: To compare multigravid women with and without a history of perinatal loss on state anxiety, pregnancy anxiety, and optimism. DESIGN: Comparative descriptive; cross-sectional. SETTING: Private obstetric offices in a small northeastern city in the United States. PARTICIPANTS: The sample included 160 women who were between 17 and 28 weeks gestation: 96 multigravidas with no history of loss and 74 women with a history of one or two losses. MAIN OUTCOME MEASURES: State anxiety, pregnancy anxiety, optimism, and perinatal loss history. RESULTS: No group differences were found on demographic variables, state anxiety, or optimism. However, pregnancy anxiety was higher in women with a history of perinatal loss. Pregnancy anxiety was also correlated with desire to see care provider more often and number of phone calls between visits, and was not correlated with the number of living children. CONCLUSION: Women experiencing pregnancy subsequent to perinatal loss have greater pregnancy anxiety: That is, they are more concerned about their pregnancies and their babies than women without a history of perinatal loss. State anxiety and optimism do not differentiate these two groups. This heightened anxiety should be acknowledged and more frequent contact with the care provider should be offered.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14565741&dopt=Abstract anxiety medicine




Anxiety and depression: a common feature of health care seeking patients with irritable bowel syndrome and food allergy.

Addolorato G, Marsigli L, Capristo E, Caputo F, Dall'Aglio C, Baudanza P.

Institute of Internal Medicine, Catholic University Sacro Cuore, Rome, Italy.

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic disorder of the gastrointestinal tract. The etiology of IBS is still unclear and the relationship between foods and IBS is controversial; psychological factors have always been considered as a major cause of IBS and we recently showed a possible association via anxiety and depression between IBS and food allergy (FA). The aim of the present study was to confirm our preliminary observation. METHODOLOGY: Sixty-high IBS, 44 FA, 48 non-healthy controls with lactose intolerance (LI) and 52 healthy controls were considered for the study. All the subjects were given the State and Trait Anxiety Inventory and the Zung depression scale. RESULTS: The percentage of subjects with high levels of state anxiety, trait anxiety and depression was significantly higher in IBS than in both LI and healthy controls; psychological findings in patients with FA were very similar to those of IBS. There were higher levels of state anxiety in LI compared to healthy controls. CONCLUSIONS: A higher prevalence of state anxiety found in patients complaining of bowel symptoms could be linked to the presence of chronic ill status. The higher presence of trait anxiety and depression in IBS and FA patients could be responsible for an increase in the activity of the autonomic nervous system and could provoke motility alterations through mast cell mediator release as well as enhancing release due to allergen crosslinking with IgE at the mast cell surface. However, it is debatable whether psychological findings are characteristic of all IBS or FA patients, or just represent the subset that see physicians.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9840105&dopt=Abstract anxiety medicine




Anxiety-performance relationships in cricketers: testing the zone of optimal functioning hypothesis.

Thelwell RC, Maynard IW.

Centre for Sport Science, Chichester Institute, Bishop Otter College, West Sussex, UK.

This study extended Hanin's 1980 Zone of Optimal Functioning hypothesis by assessing both intensity and direction components of competitive state anxiety. 20 volunteer semiprofessional cricketers responded to the modified Competitive State Anxiety Inventory-2 prior to ten matches. For each game, players' performances were intraindividually evaluated by three qualified cricket coaches using subjective criteria. Separate Cognitive Anxiety and Somatic Anxiety 'below,' 'in,' and 'above' zones for Intensity and Direction of state anxiety were identified via repeated empirical assessments. Two two-way analyses of variance were computed for Intensity and Direction of anxiety (Cognitive Anxiety Zone Level x Somatic Anxiety Zone Level) with standardized performance scores as the dependent variable. A significant interaction was found between the zone levels for Cognitive and Somatic Anxiety Direction and performance scores. Examination of the Zone of Optimal Functioning hypothesis that focuses on the interactions between Cognitive and Somatic Anxiety and in particular the directional elements of the modified inventory seems warranted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9842623&dopt=Abstract anxiety medicine