Showing papers on "Mixed anxiety-depressive disorder published in 2006"

The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?

Abstract: BACKGROUND: Syndromes for which no physical or pathological changes can be found tend to be researched and managed in isolation although hypotheses suggest that they may be one entity. The objectives of our study were to investigate the co-occurrence, in the general population, of syndromes that are frequently unexplained and to evaluate whether they have common associated factors. METHODS: We conducted a population-based cross-sectional survey that included 2,299 subjects who were registered with a General Medical Practice in North-west England and who completed full postal questionnaires (response rate 72%). The study investigated four chronic syndromes that are frequently unexplained: chronic widespread pain, chronic oro-facial pain, irritable bowel syndrome, and chronic fatigue. Validated instruments were used to measure the occurrence of syndromes and to collect information on a variety of associated factors: demographic (age, gender), psychosocial (anxiety, depression, illness behaviour), life stressors, and reporting of somatic symptoms. RESULTS: We found that 587 subjects (27%) reported one or more syndromes: 404 (18%) reported one, 134 (6%) reported two, 34 (2%) reported three, and 15 (1%) reported all four syndromes. The occurrence of multiple syndromes was greater than would be expected by chance (P < 0.001). There were factors that were common across syndromes: female gender [odds ratio (OR) = 1.8; 95% confidence interval (95% CI) 1.5-2.2], high levels of aspects of health anxiety like health worry preoccupation (OR = 3.5; 95% CI 2.8-4.4) and reassurance seeking behaviour (OR = 1.4; 95% CI 1.1-1.7), reporting of other somatic symptoms (OR = 3.6; 95% CI 2.9-4.4), and reporting of recent adverse life events (OR = 2.3; 95% CI 1.9-2.8). CONCLUSION: This study has shown that chronic syndromes that are frequently unexplained co-occur in the general population and share common associated factors. Primary care practitioners need to be aware of these characteristics so that management is appropriate at the outset.

Disease and psychological status in ankylosing spondylitis

Abstract: Objectives. Psychological factors may be important in the assessment and management of ankylosing spondylitis (AS). Our primary objective was to describe associations between disease and psychological status in AS, using AS-specific assessment tools and questionnaires. Our secondary objectives were to identify patient subgroups based on such associations and to determine the stability of the measures over time. Methods. A total of 110 patients were assessed at 6-monthly intervals up to four times using tools to measure disease [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Metrology Index (BASMI)], psychological [Hospital Anxiety and Depression Questionnaire (HADS), Health Locus of Control—Form C Questionnaire (HLC-C)] and generic health [Short form (SF)-36] status. Results. Eighty-nine participants completed all four assessments. Throughout the study, BASDAI, BASFI and BASMI scores correlated significantly with anxiety, depression, internality and health status, but not with levels of belief in chance or powerful others. Clinically anxious or depressed subgroups had significantly worse BASDAI and BASFI, but not BASMI, scores. BASMI scores were the least closely linked to psychological status. Mean scores for disease, psychological and health status were clinically stable over the 18 months period. Conclusions. Disease status scores in AS correlated significantly with anxiety, depression, internality and health status. Interpretation of AS disease scores should take an account of psychological status and the choice of measures used. These findings have important potential applications in AS management and monitoring, including the identification of patients for biological therapies.

Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare.

Abstract: ContextIn the 1980-1988 Iran-Iraq War, extensive use of chemical weapons resulted in high rates of morbidity and mortality. While much is known about the physical consequences of chemical warfare, there is a paucity of information about the long-term effects of chemical attacks on mental health.ObjectiveTo assess the long-term psychological impact of chemical warfare on a civilian population.Design, Setting, and ParticipantsCross-sectional randomized survey conducted in July 2004 of 153 civilians in 3 towns exposed to warfare in northwestern Iran: Oshnaviyeh (low-intensity conventional warfare), Rabat (high-intensity conventional warfare), and Sardasht (both high-intensity conventional warfare and chemical weapons).Main Outcome MeasuresFull or partial posttraumatic stress disorder (PTSD) diagnosis, anxiety symptoms, and depressive symptoms were assessed using Farsi versions of the Clinician-Administered PTSD Scale, Hamilton Scale for Anxiety, and Beck Depression Inventory, respectively.ResultsOverall participation rate was 93%. Respondents had a mean age of 45 years and were all of Kurdish ethnicity. Among individuals exposed to both high-intensity warfare and chemical weapons, prevalence rates for lifetime PTSD, current PTSD, major anxiety symptoms, and severe depressive symptoms were 59%, 33%, 65%, and 41%, respectively. Among the low-intensity warfare group, the corresponding rates were 8%, 2%, 18%, and 6%, respectively, while intermediate rates were found among those exposed to high-intensity warfare but not to chemical weapons (31%, 8%, 26%, and 12%, respectively). Compared with individuals exposed to low-intensity warfare, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (odds ratio [OR], 18.6; 95% confidence interval [CI], 5.8-59.4), current PTSD (OR, 27.4; 95% CI, 3.4-218.2), increased anxiety symptoms (OR, 14.6; 95% CI, 6.0-35.6), and increased depressive symptoms (OR, 7.2; 95% CI, 3.3-15.9). Exposure to high-intensity warfare but not to chemical weapons was also significantly associated with lifetime PTSD (OR, 5.4; 95% CI, 1.7-17.6), compared with those in the low-intensity warfare group. Further, compared with individuals exposed to high-intensity warfare alone, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (OR, 3.4; 95% CI, 1.5-7.4), current PTSD (OR, 6.2; 95% CI, 2.0-20.1), increased anxiety symptoms (OR, 5.6; 95% CI, 2.5-12.6), and increased depressive symptoms (OR, 3.7; 95% CI, 1.8-7.2).ConclusionExposure to chemical warfare is an extreme traumatic event that has long-lasting adverse consequences on mental health.

The Relationship of Hope and Illness-Related Uncertainty to Emotional Adjustment and Adherence Among Pediatric Renal and Liver Transplant Recipients

Abstract: Objective To examine, using partial least squares (PLS) modeling, the associations among hope, illness-related uncertainty, anxiety, depression, and adherence in a sample of children with renal and liver transplantations. Methods Seventy pediatric renal and liver transplant recipients and their caregivers participated in a 3-month study which involved completing questionnaires and monitoring adherence via self-report and electronic monitoring (MEMS™ caps). A PLS estimation procedure was used to examine the associations among constructs in the theoretical model. Results Hope and uncertainty were associated with both depressive symptoms and anxiety, and depressive symptoms were associated with treatment adherence. The association of hope and adherence to treatment was fully mediated by depressive symptoms. Conclusions Findings suggest mechanisms for identifying patients that may be at risk for nonadherence and components for intervention programs to improve adherence rates among pediatric transplant recipients.

Outcome of subacute low back pain: influence of patients' and rheumatologists' characteristics

Abstract: Objectives. To assess the outcome of subacute low back pain, to identify the characteristics of patients and physicians which were related to outcome and to evaluate the influence of rheumatologists’ beliefs about back pain on their following the guidelines for physical and occupational activity. Methods. Design: a longitudinal descriptive survey. Setting: a secondary care practice in France. Participants: 266 rheumatologists; 440 patients with subacute low back pain. Outcome measures: the main outcome measure was persistence of back pain 3 months after baseline evaluation. A self-administered questionnaire for physicians assessed attitudes and beliefs about back pain [Fear-Avoidance Beliefs Questionnaire (FABQ)], and one for patients assessed pain, perceived handicap and disability (Quebec Scale), anxiety and depression (Hospital Anxiety Depression Questionnaire), and beliefs about back pain (FABQ). Results. Forty per cent of patients had persistent low back pain at 3 months; 5.5% of these had sciatica. A total of 10% of rheumatologists and 68% of patients at baseline had a high FABQ physical score (phys; >14). Determinants of outcomes were work-related back pain [odds ratio (OR) ¼ 3.37; 95% confidence interval (CI) 1.08–5.17], anxiety (OR ¼ 2.41; 95% CI 1.44–4.09), sex (female OR ¼ 2.03; 95% CI 1.30–3.18) and patients’ beliefs about back pain at work (OR ¼ 1.02; 95% CI 1.00–1.05). Physicians with high FABQ physical scores were less likely to follow guidelines on prescribing rest and occupational activity for back pain. Conclusion. Back pain commonly persists 3 months later in patients with subacute low back pain. Patients and rheumatologists still have negative beliefs about back pain. Rheumatologists’ beliefs influence their following guidelines on physical and occupational activities. National education programmes about low back pain are needed in France.

Health-related quality of life of patients with implantable cardioverter defibrillators compared with that of pacemaker recipients

Abstract: Aims Studies indicate a poorer quality of life (QoL) for implantable cardioverter defibrillator (ICD) patients than for the general population. However, studies comparing the QoL of ICD patients with that of patients with other implantable cardiac devices are scarce. We hypothesized that ICD patients had a poorer QoL than pacemaker patients. Methods and results All ICD patients living in Iceland at the beginning of 2002 (44 subjects), and a comparison group of 81 randomly selected patients with pacemakers were invited to participate. The Icelandic Quality of Life Questionnaire (IQL), the General Health Questionnaire (GHQ), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) were submitted to measure QoL, psychiatric distress, and symptoms of anxiety and depression. The ICD and pacemaker groups did not differ on IQL, BAI, BDI, or GHQ scores. ICD patients were as a group more fearful of death ( P =0.056) and showed more concerns about returning to work ( P =0.072), although these items fell just short of statistical significance. Conclusion Contrary to our expectations, ICD patients had a comparable QoL with pacemaker recipients and were not more likely to suffer from anxiety, depression, or general psychiatric distress. These findings are encouraging in view of expanding ICD indications.

The role of psychological factors in response to treatment in neurocardiogenic (vasovagal) syncope.

Abstract: Aims Studies have established a link between vasovagal syncope (VVS) and anxiety, depression, and functional impairment. This study examines the prevalence of psychological problems in patients with VVS and whether non-responders are psychologically different from those whose symptoms respond to conservative treatment. Methods and results Subjects with tilt-confirmed VVS completed the hospital anxiety and depression scale (HADS) (measures current levels of anxiety and depression) and the syncope functional status questionnaire (SFSQ) (syncope-specific quality-of-life measure) and participated in a semi-structured interview to ascertain potential triggers, thought content, and coping strategies. In this study, 41 subjects participated. There was no difference in gender and age duration of symptoms between responders ( n =21) and non-responders ( n =20). Non-responders were significantly more anxious ( P =0.003) and depressed ( P =0.003) and had a higher level of state ( P =0.008) and trait ( P =0.004) anxiety than responders. Non-responders reported more fear/worry ( P =0.02), a significantly higher degree of impairment owing to syncope ( P =0.01), and a greater number of perceived triggers ( P =0.039); on average, participants reported eight negative thoughts about the consequences of VVS, with particular emphasis on threats of physical harm or death. Non-responders had higher levels of avoidance/protection coping and rumination. Conclusion This study has confirmed that patients with VVS have a significant degree of psychological distress, which is worthy of consideration in its own right, out with management purely aimed at reducing syncopal or pre-syncopal symptoms. Further, this distress may actually influence the natural history of what is a chronic relapsing condition and may in fact be more relevant to the patient than the number of syncopal episodes that they are experiencing.

Parent–Adolescent Communication and Psychological Symptoms among Adolescents with Chronically Ill Parents

Abstract: Objective To examine the psychological adjustment of adolescents living with a chronically ill parent and the relationship between psychological symptoms and communication with both their healthy and ill parents. Method Adolescents, healthy parents, and ill parents from 38 families completed questionnaires regarding adolescent psychological symptoms, including posttraumatic stress symptoms, and parent-adolescent communication. Results Adolescent anxiety, depression, and behavior problems were within the subclinical ranges while approximately one-third of adolescents reported clinical levels of posttraumatic stress symptoms. Openness, but not problems, in communication between adolescents and their parents varied as a function of the parent's health status (healthy or ill) and parent sex. Adolescents reported poorer communication with healthy mothers; however only the quality of communication with healthy parents was related to adolescent psychological symptoms. Conclusions Many adolescents with severely ill parents appear to experience clinically significant posttraumatic stress symptoms, therefore assessment for these symptoms in this population is important. Communication with a healthy parent may serve significant and unique functions for adolescents with ill parents, making communication between adolescents and their healthy parent a potentially useful target for clinical intervention.

In search of mixed anxiety-depressive disorder: a primary care study.

Abstract: The diagnosis of mixed anxiety-depressive disorder, as proposed in DSM-IV, is intended to be useful in settings such as primary care, where low-level anxiety and depressive symptoms may cause clinically significant impairment but are undiagnosable using current criteria. Evidence of the prevalence of this diagnosis is, however, lacking, particularly since the publication of the proposed diagnostic criteria in DSM-IV. Our study examined symptoms of anxiety and depression in 65 primary care patients screened for anxiety and depression while visiting their doctor. Results indicated that of the 37 patients without a diagnosable anxiety or depressive disorder, none had symptoms of depression and anxiety accompanied by interference that the patient deemed significant and attributable to his or her symptoms. These data dispute the need for a mixed anxiety-depression category (beyond mood and anxiety syndromes currently in DSM-IV) in future editions of the DSM.

Cognitive functions in depression and anxiety disorders : findings from a population-based study

Abstract: This doctorial thesis examines cognitive functions in depression and anxiety disorders in a population-based sample that includes mostly untreated persons. It is well established that depression is associated with cognitive impairments. However, in spite of the fact that most of the depressed persons are untreated, almost all available evidence in this field is based on in-and outpatient samples. Also, little attention has been paid to cognitive functioning in anxiety disorders. The thesis includes four empirical studies that were based on data from the PART study, an ongoing population-based study of mental health in Stockholm, Sweden. The specific objectives of Study I were to examine whether there is an association between depression and cognitive abilities including episodic memory, verbal ability, psychomotor speed (TMT-A), and executive function (TMT-B) as well as to examine whether potential cognitive deficits vary as a function of DSM-IV defined depression diagnoses. Similarly, in Study II we aimed to examine the relationship between anxiety disorders and cognitive functioning in the same abilities as in Study I and whether the observed cognitive impairments varied as a function of anxiety diagnosis. In Study III, the major objective was to study cognitive functioning in recovery from depression by following up a sample of depressed persons three years later. Study IV, finally, aimed to investigate premorbid markers of depression with a specific focus on low episodic memory performance. This was accomplished by prospective examination of a cohort of depression-free persons three years after the baseline examination, at which a group of these persons received a depression diagnosis. Results from Study I indicated that depressive disorder was associated with cognitive dysfunction. Depression-related deficits were observed in tests tapping episodic memory and executive function. Further, we found that persons diagnosed with Major Depressive Disorder and Mixed Anxiety Depressive Disorder showed significant deficits in episodic memory functioning, whereas Dysthymia was associated with impaired executive function. Minor Depressive Disorder was not found to be associated with cognitive dysfunction. The pattern of results in Study II was comparable to the observations in Study I. We found anxiety-related impairments in episodic memory that remained even after controlling for comorbid depression. Specifically, Panic Syndrome (PD), Social Phobia (SP), and Obsessive Compulsive Disorder (OCD) were associated with episodic memory dysfunction, whereas Specific Phobia was not. In addition, we observed executive dysfunction in anxiety and then specifically in persons affected by PD and OCD. However, these deficits were non-significant after controlling for alcohol abuse/dependence, suggesting that excessive alcohol use may explain parts of these findings. Results from Study III demonstrated that the recovered persons suffered a continuous cognitive dysfunction. Results from Study IV suggested that low episodic memory performance, as measured by the sum of free and cued recall, was a significant risk factor for developing depression three years later independently of demographic, clinical and socioeconomic factors. Taken together, the findings from this thesis extend the picture of cognitive dysfunction in depression and anxiety disorders by including untreated persons sampled from the population. Further, the present findings suggest that episodic memory impairments persist beyond the recovery from depression and that low cognitive performance is present already three years before depression diagnoses. The overall conclusion that can be drawn from the thesis is that depression in particular, but also anxiety, are serious conditions that affect cognitive functioning indicating that these disorders are associated with brain dysfunction. This, in turn, may have a large negative impact, not only for the working and social lives of the persons affected by depression and anxiety, but also for society as a whole.

1303: Anxiety, depression and caregiver burden in patients with heart failure and their primary caregivers — a longitudinal pilot study

Abstract: index below 25 and between 25 and 30 (P <0.001). Significant increase in VO2 max for body mass index superior at 30 (P >0.05). High significant increase in VO2 max for left ventricular ejection fraction FEVG>54 (P <0.001) and high significant for FEVG between 30 and 54 (P <0.01). For FEVG below 30, VO2 max didn’t increase significantly (P >0.05) but number of subjects was small (n =4). The increase in VO2 max was higher between 30 and 60 sessions or 100 and 200 days of rehabilitation (P <0.001) because the training was regular and sustained. After supervised rehabilitation, patients are encouraged to continue exercise training. A little more than one third of the patients continued the exercises regularly once or twice a week. Improvement was maintained in proportion to the intensity of the training. This was not influenced by patients’ age. Conclusions: A regular and supervised rehabilitation program after cardiac diseases allows to obtain a clinical relevant increase in VO2 max. The gains in physical capacity is observed at all ages, independently of sex and of BMI, for all FEVG. These results encourage us in insisting that patients follow regular long term exercise.