The gut-brain vascular axis in neuroinflammation.

The multifaceted microbiota characterizing our gut plays a crucial role in maintaining immune, metabolic and tissue homeostasis of the intestine as well as of distal organs, including the central nervous system. Microbial dysbiosis is reported in several inflammatory intestinal diseases characterized by the impairment of the gut epithelial and vascular barriers, defined as leaky gut, and it is reported as a potential danger condition associated with the development of metabolic, inflammatory and neurodegenerative diseases. Recently, we pointed out the strict connection between the gut and the brain via a novel vascular axis. Here we want to deepen our knowledge on the gut-brain axis, with particular emphasis on the connection between microbial dysbiosis, leaky gut, cerebral and gut vascular barriers, and neurodegenerative diseases. The firm association between microbial dysbiosis and impairment of the vascular gut-brain axis will be summarized in the context of protection, amelioration or boosting of Alzheimer, Parkinson, Major depressive and Anxiety disorders. Understanding the relationship between disease pathophysiology, mucosal barrier function and host-microbe interaction will foster the use of the microbiome as biomarker for health and disease as well as a target for therapeutic and nutritional advances.

Three types of university students with subthreshold depression characterized by distinctive cognitive behavioral skills.

Subthreshold depression impairs young people's quality of life and places them at greater risk of developing major depression. Cognitive behavioral therapy (CBT) is an evidence-based approach for addressing such depressive states. This study identified subtypes of university students with subthreshold depression and revealed discrete profiles of five CBT skills: self-monitoring, cognitive restructuring, behavioral activation, assertive communication, and problem solving. Using data from the Healthy Campus Trial (registration number: UMINCTR-000031307), a hierarchical clustering analysis categorized 1,080 students into three clusters: Reflective Low-skilled, Non-reflective High-skilled, and Non-reflective Low-skilled students. Non-reflective Low-skilled students were significantly more depressed than other students (p < .001). The severity of depression seemed to be related to the combination of self-monitoring skills and other CBT skills. Considering the high prevalence of poor self-monitoring skills in persons with autism, the most severe depression was observed in the significant association between Non-reflective Low-skilled students and autistic traits (p = .008). These findings suggest that subthreshold depression can be categorized into three subtypes based on CBT skill profiles. The assessment of autistic traits is also suggested when we provide CBT interventions for Non-reflective Low-skilled students.

Evaluation of oral health, taste perception, nutritional status and emotional well-being in post-menopausal women.

BACKGROUND: In postmenopausal women (PMW), vasomotor symptoms, emotional oscillations and sleep disturbances can affect physiological and psychological functioning. However, the effect of menopause on oral health-related parameters is not been thoroughly studied. OBJECTIVE: To evaluate oral health, taste perception, eating habits, nutritional status and emotional well-being in PMW compared with a group of young and healthy pre-menopausal women (PrMW). MATERIALS AND METHODS: Two groups (Group I: PMW and Group II: PrMW) with 30 participants each, participated in the cross-sectional study. The study proforma contained measures of oral health, taste perception, nutritional status and anxiety levels of the women in both groups using validated and previously used tools were designed and implemented. The data were analysed with student t, Mann-Whitney U, and chi-squared tests to evaluate the differences between the two groups. RESULTS: The cross-sectional study indicates no major differences in oral health, taste perception, nutritional and emotional status between PMW and PrMW. Nonetheless, there was a significant difference in perception of 'front teeth lengthening in size' and change in hot and cold sensations between the groups. Furthermore, the study group with PMW tends to have fewer natural teeth than the reference group. CONCLUSION: Overall, menopause does not appear to affect oral health, taste perception, nutrition or emotional health. It is suggested that oral health and taste perception, as well as nutritional and emotional status, are associated with gradual aging processes that may or may not be affected by menopause.

Within Clinic Reliability and Usability of a Voice-Based Amazon Alexa Administration of the General Anxiety Disorder 7 (GAD 7).

This is the second in a series of studies assessing the usability and reliability of a novel voice-based delivery system of mental health screening assessments. The previous study demonstrated the reliability and patient preference of a voice-based format of the Patient Health Questionnaire 9 (PHQ 9) for measuring major depression compared to a traditional paper format. Through this study, we further examined the Amazon Alexa tool in the administration of the General Anxiety Disorder 7 (GAD 7). With a replicated methodology to the first study, 40 newly administered patients completed the GAD 7 in one format at their first session and the alternate format at their follow up. Results from the new in clinic population replicated the findings observed in the first PHQ 9 study: GAD 7 assessment scores for the Alexa and paper version showed a high degree of reliability (α = 0.77), patients showed higher overall positive attitudes for the voice-based GAD 7 format, and subscales for attractiveness, stimulation, and novelty were significantly higher for the voiced-based format. Results also demonstrated 42 (84%) of the 50 patients who completed the voice-based format responded as being willing to use the device from home. With new recommendations of universal screening of anxiety disorders for patients below the age of 65 and rapid changes in virtual mental healthcare, convenient screenings are more important than ever. We believe this novel clinical assessment tool has the potential to improve patient behavioral healthcare while mitigating the workload of healthcare professionals.

Development and validation of the Post-Pandemic Fear of Viral Disease scale and its relationship with general anxiety disorder: a cross-sectional survey from Pakistan.

BACKGROUND: Given the worldwide reach of COVID-19, media coverage has amplified the psychological and social effects of this pandemic causing a widespread fear. Despite substantial research on the short-term psychological impact of COVID-19, its long-term consequences on mental health remain relatively unexplored. This research aims to develop and validate a Post-Pandemic Fear of Viral Disease (PPFVD) scale and to see its relationship with general anxiety disorder among the Pakistani population. METHODS: A cross-sectional online-based survey was conducted with 457 respondents in August and September 2022. We adopted the modified fear of coronavirus scale (FCV-19 S) consisting of seven items and the Generalized Anxiety Disorder (GAD) questionnaire to measure anxiety disorder. Confirmatory factor analysis was applied using the maximum likelihood estimation method. Scale dimensions and item reliability were tested for their validity and goodness of fit. SPSS and AMOS were used for data management and analyses. RESULTS: All inter-item correlations were found to be significant and ranged between 0.30 and 0.70. The value of Cronbach's alpha was 0.887, indicating good reliability. Corrected item-total correlations ranged between 0.632 and 0.754. Factor loadings ranged from 0.664 to 0.810, indicating a good internal consistency. Overall, these results clearly demonstrate that the one-factor solution model for PPFVD presents a good fit to the data. The composite reliability (CR = 0.747) was also good. CONCLUSIONS: The COVID-19 pandemic has negatively affected the mental health of people globally. This measurement scale can be trusted and used to test the PPFVD in the post-pandemic situation. Prospective research might validate this instrument in newly emerging scenarios and test it with diverse ethnic groups.

Mental health and associated risk factors of Puerto Rico Post-Hurricane María.

BACKGROUND: Mental health disorders have an increased prevalence in communities that experienced devastating natural disasters. Maria, a category 5 hurricane, struck Puerto Rico on September 20, 2017, weakening the island's power grid, destroying buildings and homes, and limiting access to water, food, and health care services. This study characterized sociodemographic and behavioral variables and their association with mental health outcomes in the aftermath of Hurricane Maria. METHODS: A sample of 998 Puerto Ricans affected by Hurricane Maria was surveyed between December 2017 and September 2018. Participants completed a 5-tool questionnaire: Post-Hurricane Distress Scale, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder (GAD) 7, and Post-Traumatic Stress Disorder checklist for DSM-V. The associations of sociodemographic variables and risk factors with mental health disorder risk outcomes were analyzed using logistic regression analysis. RESULTS: Most respondents reported experiencing hurricane-related stressors. Urban respondents reported a higher incidence of exposure to stressors when compared to rural respondents. Low income (OR = 3.66; 95% CI = 1.34-11.400; p < 0.05) and level of education (OR = 4.38; 95% CI = 1.20-15.800; p < 0.05) were associated with increased risk for severe mental illness (SMI), while being employed was correlated with lower risk for GAD (OR = 0.48; 95% CI = 0.275-0.811; p < 0.01) and lower risk for SIM (OR = 0.68; 95% CI = 0.483-0.952; p < 0.05). Abuse of prescribed narcotics was associated with an increased risk for depression (OR = 2.94; 95% CI = 1.101-7.721; p < 0.05), while illicit drug use was associated with increased risk for GAD (OR = 6.56; 95% CI = 1.414-39.54; p < 0.05). CONCLUSION: Findings underline the necessity for implementing a post-natural disaster response plan to address mental health with community-based social interventions.

Gendered racial microaggressions and emerging adult Black women's social and general anxiety: Distress intolerance and stress as mediators.

There is robust evidence that gendered racial microaggressions affect Black women's mental health. However, few studies have examined how this form of discrimination affects Black women's social anxiety in addition to their general anxiety, as well as the underlying mechanisms related to gendered racial microaggressions and anxiety. OBJECTIVE: The purpose of this study was to examine the associations between gendered racial microaggressions stress (GRMS) and gendered racial microaggressions frequency (GRMF), and Black women's social anxiety and general anxiety symptoms. We also examined the mediating roles of distress intolerance and stress in these associations. METHOD: One hundred and sixty-three Black women, between the ages of 18 and 25 years old, completed a cross-sectional survey. Regression analyses were used to examine the associations between gendered racial microaggressions and social anxiety and general anxiety, and mediation analyses examined the indirect effect of gendered racial microaggressions on the outcome variables through distress intolerance and stress. RESULTS: GRMS was associated with greater social and general anxiety through the mechanisms of distress intolerance and stress. GRMF was associated with reduced social anxiety and was not associated with general anxiety. CONCLUSIONS: Intervention efforts should be aimed to prevent the experience of gendered racial microaggressions to prevent subsequent stress and mental health outcomes for Black women.

Response to the coronavirus disease 2019 pandemic of dental hygienists in South Korea-Part II: Fear and anxiety.

OBJECTIVES: The purpose of this cross-sectional study was to evaluate the mental fear and anxiety about coronavirus disease 2019 (COVID-19) among Korean clinical dental hygienists and to investigate factors influencing the anxiety felt after the outbreak of COVID-19. METHODS: A questionnaire on mental fear (Fear-C) and anxiety for COVID-19 was conducted among 500 clinical dental hygienists in South Korea. Fear-C was identified with eight questions. The General Anxiety Disorder-7 (GAD-7) questionnaire was scored for the pre-COVID-19 situation (GADBefore ) and the current situation going through the pandemic (GADAfter ). The scores for the responses to the questionnaire were 0 points for strong negative and 3 points for strong positive. Higher scores indicate higher levels of fear and anxiety. All data were analysed using IBM SPSS Statistics, and the statistical significance was set at α = 0.05. RESULTS: The average Fear-C was 16.11 ± 3.89 out of 24.00. There were significant differences in Fear-C when the type of work organization and symptoms related to COVID-19 (Sx-C) differed. Significant differences were confirmed in GADBefore according to age range, systemic diseases, and Sx-C (p < 0.05). There was no difference in GADAfter for all general characteristics, except Sx-C (p > 0.05). In the regression model of GADAfter , Sx-C (ß = 0.526), Fear-C (ß = 0.358), and GADBefore (ß = 0.515) were positively related to GADAfter (p < 0.001), respectively. CONCLUSIONS: Most dental hygienists complained of Fear-C. GADAfter was significantly higher than GADBefore . The factor that had the greatest impact on GADAfter was Sx-C.

Fear of positive evaluation differentially predicts social anxiety: a six-month longitudinal panel study.

This study investigated whether (a) fear of negative evaluation (FNE) and fear of positive evaluation (FPE) prospectively predict the other, (b) FPE predicts social anxiety controlling for FNE, and (c) FPE predicts social anxiety symptoms but not general anxiety and depression. Data were collected from a student sample at two time points over six months. The cross-lagged structural equation modeling results revealed that FNE and FPE do not prospectively predict the other, FPE positively predicts social anxiety symptoms controlling for FNE, and FPE does not significantly predict general anxiety or depression. These results confirmed that FNE and FPE are distinctively related to social anxiety. Moreover, the study findings indicated that FPE may be a factor unique to social anxiety.

Conditioned generalisation in generalised anxiety disorder: the role of concurrent perceptual and conceptual cues.

Previous research in extinction indicates no difference in US expectancies for aversive and non-aversive unconditioned stimuli (USs). In this study, we bridged these topics by examining how concurrent perceptual and conceptual cues influence conditioned generalisation of generalised anxiety disorder (GAD) patients by using non-aversive USs. The study included two consecutive phases: acquisition and generalisation. In the acquisition phase, we used blue and purple images as the perceptually conditioned stimuli, images of animals and household items as the conceptually conditioned stimuli, and non-aversive images as unconditioned stimuli (US). In the generalisation phase, we used images containing both conceptual and perceptual cues (e.g. blue animals) as the generalisation stimuli. Participants rated the US expectancy for all images. We found that compared with the control group, the patients exhibited generalisation in response to stimuli that included conditional conceptual cues. These results reveal novel evidence of generalisation in GAD and may have implications for considering the concept-based information in extinction treatment.

Is psychological flexibility a mediator between perceived stress and general anxiety or depression among suspected patients of the 2019 coronavirus disease (COVID-19)?

This study is aimed to investigate the status of general anxiety and depression among suspected patients of COVID-19 and explore whether psychological flexibility can serve as a mediator between perceived stress and general anxiety or depression. Total of 180 participants completed the online questionnaire which comprised demographic information, the Perceived Stress Scale (PSS), the 7-item Generalized Anxiety Disorder scale (GAD-7), the 9-item Patients Health Questionnaire (PHQ-9), the Acceptance and Action Questionnaire-II (AAQ-II) and the Cognitive Fusion Questionnaire (CFQ). Statistical methods including correlation analysis, multiple linear regression analysis and structural equation model were used in this study. The scores of 23.9% (43/180) and 34.4% (62/180) of participants were higher than the cut points of GAD-7 and PHQ-9 respectively. Psychological flexibility was significantly correlated with perceived stress, general anxiety and depression. Multiple regression analyses showed the possible mediation effect of psychological flexibility between perceived stress and general anxiety or depression. The structural equation model confirmed that psychological flexibility partially mediated between perceived stress and general anxiety or depression. Our findings suggested the potential benefit of Acceptance and Commitment Therapy (ACT) as a psychological support approach in suspected patients of COVID-19 because ACT targets psychological flexibility.

Early childhood caries: Are maternal psychosocial factors, decision-making ability, and caries status risk indicators for children in a sub-urban Nigerian population?

OBJECTIVE: Early childhood caries (ECC) is caries in children below the age of 72 months. The aim of the study was to determine the association of maternal psychosocial factors (general anxiety, dental anxiety, sense of coherence, parenting stress, fatalism, social support, depressive symptoms, and executive dysfunction), decision-making abilities, education, income and caries status with the prevalence and severity of ECC among children resident in Ile-Ife, Nigeria. METHODS: A dataset of 1549 mother-child (6-71-months-old) dyads collected through examinations and a household survey, using validated psychometric tools to measure the psychosocial factors, were analyzed. The DMFT for the mothers and the dmft for the child were determined. The association between maternal psychosocial factors, education, income, and decision-making ability, the prevalence of maternal caries, and the prevalence of ECC was determined using logistic regression analysis. RESULTS: The prevalence of maternal caries was 3.3%, and the mean (standard deviation-SD) DMFT was 0.10 (0.76). The ECC prevalence was 4.3%, and the mean (SD) dmft was 0.13 (0.92). There was no significant difference between the prevalence and severity of maternal caries and ECC by maternal age, education, income, or decision-making abilities. There was also no significant difference in maternal caries, ECC prevalence and ECC severity by maternal psychosocial factors. The only significant association was between the prevalence of caries in the mother and children: children whose mothers had caries were over six times more likely to have ECC than were children with mothers who had no caries (AOR: 6.67; 95% CI 3.23-13.79; p < 0.001). CONCLUSION: The significant association between ECC and maternal caries prevalence suggests that prenatal oral health care for mothers may reduce the risk for ECC.

Psychosocial status during the prevalence of COVID-19 disease: the comparison between healthcare workers and general population.

The prevalence of COVID-19 disease continues to be a significant psychosocial status among health care workers (HCWs) and the general population worldwide. This cross sectional study aimed to compare the psychosocial status between healthcare workers and general population during the prevalence of COVID-19 disease in southeast Iran. Totally 415 health care workers of a medical service center for COVID-19 patients and 1023 people of general population participated in the study. An online socio-demographic characteristics questionnaire, General Health Questionnaire (GHQ -28), and Generalized Anxiety Disorder 7-item (GAD-7) were utilized to evaluate psychosocial status. According to GHQ, the psychological disorders of the HCWs were significantly higher than that of the general population (P < 0.001). According to GAD-7, no significant difference was found between general population and HCWs. Multivariate logistic analysis showed no difference between general population and HCWs in the psychological disorder. Although HCWs suffered from psychological disorders more than general population, nearly one third to half of the participants in both groups had psychosocial disorders.

Does presence of metabolic syndrome impact anxiety and depressive disorder screening results in middle aged and elderly individuals? A population based study.

BACKGROUND: Depressive and anxiety disorders are common in primary care setting but often remain undiagnosed. Metabolic syndrome (MetS) is also prevalent in the general population and can impair recognition of common mental disorders due to significant co-morbidity and overlap with psychiatric symptoms included in self-reported depression/anxiety screening tools. We investigated if MetS has an impact on the accuracy of current major depressive disorder (MDD) and generalized anxiety disorder (GAD) screening results using the Hospital Anxiety and Depression scale (HADS). METHODS: A total of 1115 (562 men; mean age 62.0 ± 9.6 years) individuals of 45+ years of age were randomly selected from the general population and evaluated for current MetS; depressive and anxiety symptoms (HADS); and current MDD and GAD (Mini International Neuropsychiatric Interview [MINI]). RESULTS: The MetS was diagnosed in 34.4% of the study participants. Current MDD and GAD were more common in individuals with MetS relative to individuals without MetS (25.3% vs 14.2%, respectively, p < 0.001; and 30.2% vs 20.9%, respectively, p < 0.001). The ROC analyses demonstrated that optimal thresholds of the HADS-Depression subscale for current MDE were ≥9 in individuals with MetS (sensitivity = 87%, specificity = 73% and PPV = 52%) and ≥8 in individuals without MetS (sensitivity = 81%, specificity = 78% and PPV = 38%). At threshold of ≥9 the HADS-Anxiety subscale demonstrated optimal psychometric properties for current GAD screening in individuals with MetS (sensitivity = 91%, specificity = 85% and PPV = 72%) and without MetS (sensitivity = 84%, specificity = 83% and PPV = 56%). CONCLUSIONS: The HADS is a reliable screening tool for current MDE and GAD in middle aged and elderly population with and without MetS. Optimal thresholds of the HADS-Depression subscale for current MDD is ≥9 for individuals with MetS and ≥8 - without MetS. Optimal threshold of the HADS-Anxiety subscale is ≥9 for current GAD in individuals with and without MetS. The presence of MetS should be considered when interpreting depression screening results.

Screening for general anxiety disorders in postmenopausal women with symptomatic pelvic organ prolapse.

OBJECTIVE: This study aimed to investigate the prevalence of general anxiety disorder (GAD) among postmenopausal women with symptomatic pelvic organ prolapse (POP) and to identify its associated factors. METHODS: A cross-sectional study was conducted among postmenopausal women with symptomatic POP. Sociodemographic data and medical histories were obtained. Participants completed the POP Quantification (POP-Q), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the Pelvic Floor Distress Inventory (PFDI-20) measures. Measures of GAD were obtained using the Generalized Anxiety Disorder-7 (GAD-7). The data were analyzed using independent sample t-tests, the Mann-Whitney U-test, χ2 tests, Fisher's exact tests and logistic regression. RESULTS: Of the 177 participants interviewed, 19.2% had symptoms of GAD. There were no statistically significant differences in the sociodemographic characteristics or the POP-Q stage between women with and without GAD (p > 0.05). GAD was significantly associated with higher PFDI-20 and PFIQ-7 subscale scores (p < 0.05). After multiple logistic regression analyses, only the PFIQ-7 subscale UIQ-7 (odds ratio = 1.025, 95% confidence interval 1.007-1.043, p = 0.005) and the PFDI-20 subscale CRADI-8 (odds ratio = 1.025, 95% confidence interval 1.004-1.047, p = 0.021), which represented the impact on quality of life from lower urinary tract symptoms and the distress caused by bowel dysfunction, were risk factors that were independently associated with GAD. CONCLUSIONS: GAD is prevalent in almost one-fifth of postmenopausal women with symptomatic POP. GAD is not associated with the severity of the POP-Q stage but is associated with higher scores for lower urinary tract and bowel dysfunction caused by POP.

How is anxiety related to math performance in young students? A longitudinal study of Grade 2 to Grade 3 children.

Both general and math-specific anxiety are related to proficiency in mathematics. However, it is not clear when math anxiety arises in young children, nor how it relates to early math performance. This study therefore investigated the early association between math anxiety and math performance in Grades 2 and 3, by accounting for general anxiety and by further inspecting the prevalent directionality of the anxiety-performance link. Results revealed that this link was significant in Grade 3, with a prevalent direction from math anxiety to performance, rather than the reverse. Longitudinal analyses also showed an indirect effect of math anxiety in Grade 2 on subsequent math performance in Grade 3. Overall, these findings highlight the importance of monitoring anxiety from the early stages of schooling in order to promote proficient academic performance.

Relationship of coping ways and anxiety with Pregnancy Specific-stress.

OBJECTIVES: To explore whether coping strategies and general anxiety are associated with pregnancy-specific stress (PSS) and how much of variance of PSS is explained with these variables. METHODS: A cross sectional study was conducted at two teaching hospitals between November 2013 and December 2015. Total 190 pregnant women (60 women at 6-13-weeks of gestation, 60 at 13-26 weeks, and 70 at 27-40 weeks of gestation) completed the study. The participants completed three questionnaires including; Pregnancy experience scale (PES-41), Ways of Coping Questionnaire (WCQ), and State-Trait anxiety inventory (SATI). Pearson coefficients and analysis of regression was done to assess the correlations between variables. RESULTS: Pregnant women who experienced higher mean level of pregnancy specific-stress had significantly higher mean level of occult anxiety, overt anxiety, and total anxiety than women who did not experience PSS. Although there was a positive and significant relationship between intensity of hassles and uplifts and ways of coping, the correlation between PSS and ways of coping was not significant. The results of analysis regression showed that general anxiety during pregnancy predicted 25% of the variance of PSS (F=4.480, ß=0.159). Also, ways of coping predicted 38% of the variance in pregnancy Hassles (F=7.033, ß=0.194). CONCLUSION: The ways of coping predicted the variance of pregnancy hassles, but does not evaluate pregnancy specific-stress. To think about PSS in terms of general anxiety may help to clarify past findings and to guide future research and interventions.

Associations of Anger and Fear to Later Self-Regulation and Problem Behavior Symptoms.

The mediating and moderating roles of self-regulation in the associations of dispositional anger and fear to later conduct and anxiety symptoms were tested. Mothers and teachers rated children's anger and fear at 54 months (N = 191), and mothers reported on children's symptoms of anxiety and conduct disorders at 72 and 84 months (Ns = 169 and 144). Children's self-regulatory ability was assessed using the Tower of Hanoi task at 72 months. Children's self-regulation mediated the association between early dispositional fear and 84-month mother-reported anxiety disorder symptoms above and beyond the effects of earlier generalized anxiety symptoms. Children's anger directly predicted relatively high mother-reported conduct and anxiety disorder symptoms. Findings are discussed in terms of the importance of considering self-regulation as potential mechanism relating early childhood dispositional reactivity to later psychopathology symptoms.

Who is afraid of math? Two sources of genetic variance for mathematical anxiety.

BACKGROUND: Emerging work suggests that academic achievement may be influenced by the management of affect as well as through efficient information processing of task demands. In particular, mathematical anxiety has attracted recent attention because of its damaging psychological effects and potential associations with mathematical problem solving and achievement. This study investigated the genetic and environmental factors contributing to the observed differences in the anxiety people feel when confronted with mathematical tasks. In addition, the genetic and environmental mechanisms that link mathematical anxiety with math cognition and general anxiety were also explored. METHODS: Univariate and multivariate quantitative genetic models were conducted in a sample of 514 12-year-old twin siblings. RESULTS: Genetic factors accounted for roughly 40% of the variation in mathematical anxiety, with the remaining being accounted for by child-specific environmental factors. Multivariate genetic analyses suggested that mathematical anxiety was influenced by the genetic and nonfamilial environmental risk factors associated with general anxiety and additional independent genetic influences associated with math-based problem solving. CONCLUSIONS: The development of mathematical anxiety may involve not only exposure to negative experiences with mathematics, but also likely involves genetic risks related to both anxiety and math cognition. These results suggest that integrating cognitive and affective domains may be particularly important for mathematics and may extend to other areas of academic achievement.

A randomized, double-blind, fixed-dose study comparing the efficacy and tolerability of vortioxetine 2.5 and 10 mg in acute treatment of adults with generalized anxiety disorder.

BACKGROUND: Vortioxetine is a recently approved multimodal antidepressant with anxiolytic properties in preclinical studies. OBJECTIVE: This double-blind, placebo-controlled study assessed the efficacy and tolerability of vortioxetine in subjects with a primary diagnosis of generalized anxiety disorder. METHODS: Subjects (n = 457) were randomized 1:1:1 to treatment with placebo or vortioxetine 2.5 or 10 mg once daily. The primary efficacy endpoint was reduction in Hamilton Anxiety Scale (HAM-A) total scores from baseline after 8 weeks of treatment. Key secondary outcomes were changes from baseline in HAM-A total scores for the 2.5 and 10 mg dose, Hospital Anxiety and Depression anxiety subscore, 36-Item Short-Form Health Survey, Sheehan Disability Scale, and Clinical Global Impression-Improvement Scale score, as well as HAM-A response rate at week 8. RESULTS: Neither vortioxetine dose achieved a statistically significant improvement over placebo on the primary endpoint (least-squares mean difference ± standard error from placebo: -0.87 ± 0.803 [p = 0.279] for 2.5 mg and -0.81 ± 0.791 [p = 0.306] for 10 mg vortioxetine) or on any secondary efficacy endpoints. Common adverse events (≥5% in either vortioxetine group) were nausea, dry mouth, headache, diarrhea, constipation, and vomiting. CONCLUSIONS: Vortioxetine 2.5 and 10 mg treatment did not significantly improve generalized anxiety disorder symptoms versus placebo. Vortioxetine was safe and well tolerated in this patient population.