Fundamental frequency during cognitive preparation and its impact on therapy outcome for panic disorder with Agoraphobia.

BACKGROUND: Cognitive preparation plays a crucial role in CBT with exposure for panic disorder and agoraphobia. High emotional arousal while developing the exposure rationale might impair patients' cognitive capacities for processing information about treatment and impede therapeutic outcome. OBJECTIVE: This study investigates whether patients' vocally encoded emotional arousal, assessed by fundamental frequency (f0), during rationale development is associated with premature treatment dropout, insight into the rationale, and symptom reduction. METHODS: Patients' (N = 197, mean age 36.1 years, 79.2% female) f0 during rationale development was measured based on treatment videos from a randomized controlled trial of CBT for panic disorder and agoraphobia. Insight was rater assessed. Symptom severity was self- and rater assessed at the beginning and end of therapy. RESULTS: Higher f0 mean during rationale development was associated with lower probability of insight and less reduction in avoidance behavior. f0 was not associated with dropout. Insight was associated with lower probability of dropout and partially mediated the association between f0 and avoidance reduction. DISCUSSION: This study highlights the importance of emotional arousal during cognitive preparation for exposure. Therapists should ensure that patients are not too highly aroused while learning about the exposure rationale as an important step in treatment.

Running for extinction? Aerobic exercise as an augmentation of exposure therapy in panic disorder with agoraphobia.

Exposure-based Cognitive Behavioral Therapy (eb-CBT) represents the most evidence-based psychotherapeutic approach in anxiety disorders. However, its efficacy may be limited by a delay in onset of action and a substantial number of patients does not respond sufficiently to treatment. In this context, aerobic exercise was found to be effective in reducing clinical anxiety as well as to improve (elements of) disorder-specific CBT in some mental disorders. We therefore investigated the effect of aerobic exercise supplementary to an eb-CBT in panic disorder and agoraphobia (PD/AG). 77 patients with PD/AG performed a 30 min treadmill task with moderate or low intensity (70% or 30% of the maximal oxygen uptake [VO2max]) prior to five exposure sessions within a standardized seven-week CBT. At baseline, after completing the treatment period (post) and six month after post (follow-up), several measures of (un)specific psychopathology (Hamilton Anxiety Rating Scale [Ham-A], Mobility Inventory [MI], Panic and Agoraphobia Scale [PAS], Agoraphobic Cognitions Questionnaire [ACQ], Body Sensations Questionnaire [BSQ]) were established to assess for clinical changes. All patients experienced a significant improvement of symptoms from baseline to post (for all measures p < .001) but repeated-measures analyses of variance found a trend towards a significant time × group interaction in the Ham-A in favor for the moderate intense exercise group (f[1, 74] = 4.15, p = .045, α=.025). This trend, however, disappeared at follow-up since the low-intense exercise group further improved significantly in Ham-A after post. Our findings therefore might point to an accelerating effect of moderate-intense exercise within an exposure-based CBT for AG/PD.

[How frequently are depressive disorders recognized in primary care patients? : A cross-sectional epidemiological study in Germany]. / Wie häufig werden Patienten mit depressiven Störungen in der hausärztlichen Praxis erkannt? : Eine epidemiologische Querschnittsstudie.

BACKGROUND: Primary care physicians (PCPs) play a crucial role for guideline-oriented intervention in patients with depression. OBJECTIVES: Based on a diagnostic screening questionnaire, this study investigates the sensitivity of PCPs to recognize patients with depression as well as the factors facilitating recognition and concordant diagnostic decisions. METHOD: In a cross-sectional epidemiological study in six regions of Germany, 3563 unselected patients filled in questionnaires on mental and physical complaints and were diagnostically evaluated by their PCP (N = 253). The patient reports on an established Depression-Screening-Questionnaire (DSQ), which allows the approximate derivation of an ICD-10 depression diagnosis, were compared with the physician diagnosis (N = 3211). In a subsample of discordant cases a comprehensive standardized clinical-diagnostic interview (DIA-X/CIDI) was applied. RESULTS: On the study day, the prevalence of ICD-10 depression was 14.3% according to the DSQ and 10.7% according to the physician diagnosis. Half of the patients identified by DSQ were diagnosed with depression by their physician and two thirds were recognized as mental disorder cases. More severe depression symptomatology and the persistent presence of main depression symptoms were related to better recognition and concordant diagnostic decisions. Diagnostic validation interviews confirmed the DSQ diagnosis in the majority of the false-negative cases. Indications for at least a previous history of depression were found in up to 70% of false-positive cases. CONCLUSION: Given the high prevalence of depression in primary care patients, there is continued need to improve the recognition and diagnosis of these patients to assure guideline-oriented treatment.

[Simple guideline-oriented supportive tools in primary care: Effects on adherence to the S3/NV guideline unipolar depression]. / Niederschwellige leitlinienorientierte supportive Materialien (NILS) in der primärärztlichen Versorgung: Effekte auf die Orientierung an der S3/NV-Leitlinie Unipolare Depression.

Simple guideline-oriented supportive tools in primary care: Effects on adherence to the S3/NV guideline unipolar depression Objectives: Does the provision of supportive tools improve guideline-oriented recognition and treatment of patients with depression in primary care? METHODS: In a nested intervention study, as part of a larger epidemiological study program in German primary care, 46 randomly drawn practices received tools to facilitate identification and treatment decisions.Pre-post effects were compared to 42 matched control practices without intervention. RESULTS: The proportion of correctly identified depression cases was similar in the intervention (47.2%) and the control group (42.3%, p = 0.537). Compared to controls, practitioners in the intervention group rated their competence in case identification and treatment at post-intervention more positively (p = 0.016). No effects were observed regarding the usage of the tools, practitioners' attitudes towards national depression guidelines, and depression treatment procedures. CONCLUSIONS: Since provision of guideline-oriented tools did not improve recognition and quality of treatment, delineation of alternative strategies for enhanced guideline adherence in primary care for depression is warranted.

[Subjective Adverse Effects during Outpatient CBT: Associations to Patient and Therapist Variables and to the Therapeutic Alliance]. / Subjektiv erlebte Nebenwirkungen ambulanter Verhaltenstherapie: Zusammenhänge mit Patientenmerkmalen, Therapeutenmerkmalen und der Therapiebeziehung.

Background Empirical data on variety, frequency, and prerequisites for unwanted side effects of psychotherapies are important regarding the planning, realization, and quality assurance of treatment. The study describes adverse effects of outpatient psychotherapy treatment and their association with patient, therapist and treatment characteristics. Methods To reduce memory bias, 70 outpatient psychotherapy patients fulfilled the Inventory for the Assessment of Negative Effects of Psychotherapy (INEP). Data on patients' characteristics (sex, age, impairment), therapists' sex, and therpeutic alliance were collected. Results 84 % percent of patients reported at least one unwanted side effect (range 1-13; m=3.4; sd=3.43). Patients, age, number and kind of pretreatments, and the quality of the therapeutic alliance were associated with the frequency of unwanted negative effects. Discussion Unwanted side effects during outpatient psychotherapy are common phenomena and need careful attention in patient education and during the treatment itself.

The role of maternal anxiety and depressive disorders prior to and during pregnancy and perinatal psychopathological symptoms for early infant diseases and drug administration.

BACKGROUND: Maternal mental health prior to and during pregnancy has been shown to be associated with inflammatory diseases and gastrointestinal complaints in the offspring. Unfortunately, many studies merely focused on perinatal distress without consideration of lifetime anxiety and depressive disorders. AIMS: To prospectively investigate associations of anxiety and depressive disorders prior to and during pregnancy as well as perinatal distress with infants' inflammatory diseases, gastrointestinal complaints and corresponding drug administration. STUDY DESIGN: Prospective-longitudinal study initiated in 2009/2010. SUBJECTS: N=306 (expectant) mothers with and without DSM-IV lifetime anxiety and depressive disorders (Composite International Diagnostic Interview for Women) and low vs. high severity of psychopathological symptoms during pregnancy (Brief Symptom Inventory) enrolled in early pregnancy and repeatedly assessed during peripartum period. OUTCOME MEASURES: Infant inflammatory diseases, gastrointestinal complaints and drug administration assessed via questionnaire (maternal report) at four months postpartum (n=279). RESULTS: Severe psychopathological symptoms during pregnancy were associated with inflammatory diseases and anti-infective medication, whereas anxiety and depressive disorders prior to and during pregnancy were related to gastrointestinal complaints (diarrhea, colic complaints) and corresponding medication. CONCLUSIONS: These results have to be discussed with caution, because information on infants' diseases were based exclusively on maternal self-reports. However, they suggest promising directions regarding our current knowledge about the relevance of maternal perinatal distress for infant inflammatory diseases (e.g. fetal programming). Moreover, the association between maternal anxiety and depressive disorders and infant gastrointestinal complaints may be explained by an anxious misinterpretation of 'normal' infant signals or a transmission of adverse gut microbiota, respectively.

A prospective-longitudinal study on the association of anxiety disorders prior to pregnancy and pregnancy- and child-related fears.

This study aimed to investigate the relation between anxiety disorders prior to pregnancy and specific pregnancy- and child-related fears during pregnancy and after delivery. 306 expectant mothers were interviewed regarding anxiety (and depressive) disorders prior to pregnancy and pregnancy- and child-related fears (e.g. fear of labor pain, fear of infant injury) using the Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy- and child-related fears were particularly pronounced in women with multiple anxiety disorders and women with comorbid anxiety and depressive disorders prior to pregnancy. Further analyses revealed associations between particular anxiety disorders and specific pregnancy- and child-related fears. Results remained stable when considering potential confounders such as maternal age, education, marital status, parity, prior abortion and preterm delivery or low birth weight. Our study suggests that especially women with multiple anxiety and/or comorbid depressive disorders may benefit from early targeted interventions to prevent an escalation of anxiety and fears over the peripartum period.

Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study.

BACKGROUND: Peripartum anxiety and depressive disorders are associated with adverse consequences for mother and child. Thus, it is important to examine risk factors, correlates and course patterns of anxiety and depressive disorders during pregnancy and after delivery. METHODS: In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) Study, n=306 expectant mothers were recruited from gynaecological outpatient settings in Germany and completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Anxiety and depressive disorders and potential risk factors/correlates were assessed with the Composite International Diagnostic Interview for Women (CIDI-V), medical records and additional questionnaires. RESULTS: Although peripartum anxiety and depressive disorders appeared to be persistent in some women, others reported major changes with heterogeneous courses and shifts between diagnoses and contents. There was a considerable amount of incident disorders. Strongest predictors for peripartum anxiety and depressive disorders were anxiety and depressive disorders prior to pregnancy, but psychosocial (e.g. maternal education), individual (e.g. low self-esteem), and interpersonal (e.g. partnership satisfaction, social support) factors were also related. LIMITATION: Knowing the aims of the study, some participants may have been more encouraged to report particular symptoms, but if so, this points to the importance of a comprehensive assessment in perinatal care. CONCLUSION: Peripartum time is a sensitive period for a considerable incidence or persistence/recurrence of anxiety and depressive disorders albeit the course may be rather heterogeneous. Interventional studies are needed to examine whether an alteration of associated factors could help to prevent peripartum anxiety and depressive disorders.

Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy.

The purpose of this study was to prospectively examine the relationships between maternal DSM-IV-TR anxiety disorders, depressive disorders, and body mass index (BMI) with arterial hypertension and blood pressure during pregnancy. In the Maternal Anxiety in Relation to Infant Development (MARI) study, N = 306 women were enrolled in early pregnancy and repeatedly assessed during peripartum period. DSM-IV-TR anxiety and depressive disorders prior to pregnancy, lifetime anxiety/depression liability, and BMI during early pregnancy were assessed with the Composite International Diagnostic Interview for Women (CIDI-V). Based on their prepregnancy status, all participants were assigned to one of the following initial diagnostic groups: no anxiety nor depressive disorder (no AD), pure depressive disorder (pure D), pure anxiety disorder (pure A), and comorbid anxiety and depressive disorder (comorbid AD). Blood pressure measurements were derived from medical records. Arterial hypertension during pregnancy was defined by at least two blood pressure values ≥140 mmHg systolic and/or ≥90 mmHg diastolic. N = 283 women with at least four documented blood pressure measurements during pregnancy were included in the analyses. In this sample, N = 47 women (16.6 %) were identified with arterial hypertension during pregnancy. Women with comorbid AD (reference group: no AD) had a significantly higher blood pressure after adjustment for age, parity, smoking, occupation, household income, and education (systolic: linear regression coefficient [ß] = 3.0, 95 % confidence interval [CI] = 0.2-5.7; diastolic, ß = 2.3, 95 % CI = 0.1-4.4). Anxiety liability was associated with an increased risk of hypertension (odds ratio [OR] = 1.1, 95 % CI = 1.0-1.3) and a higher systolic blood pressure (ß = 0.4, 95 % CI = 0.0-0.7). The adjusted interaction model revealed a significant interaction between the diagnostic group pure A and BMI for hypertension (ORIT = 1.5, 95 % CI = 1.1-2.1). Especially, women with a lifetime history of comorbid anxiety and depression and obese pregnant women with a lifetime history of pure anxiety disorder should be informed about their heightened risk of hypertension, monitored with regular blood pressure measurements, and provided with strategies for prevention and early intervention such as changes in diet and physical activity.

Maternal anxiety disorders predict excessive infant crying: a prospective longitudinal study.

PURPOSE: To prospectively examine relations between maternal DSM-IV-TR anxiety and depressive disorders and excessive infant crying. METHODS: Based on the prospective longitudinal Maternal Anxiety in Relation to Infant Development Study, n=306 expectant mothers were enrolled during early pregnancy and repeatedly interviewed until 16 months post partum. Lifetime and prospective information on maternal anxiety and depressive disorders was assessed via standardised diagnostic interviews (Composite International Diagnostic Interview for Women). Excessive crying (crying for ≥3 h per day on ≥3 days per week for ≥3 weeks) was assessed via Baby-DIPS. During the first 16 months after delivery, n=286 mother-infant dyads were available and included in the analyses. RESULTS: Excessive crying was reported by n=29 mothers (10.1%). Infants of mothers with anxiety disorders prior to pregnancy were at higher risk for excessive crying than infants of mothers without any anxiety disorder prior to pregnancy (OR=2.54, 95% CI 1.11 to 5.78, p=0.027). Risk was even increased when considering additionally incident anxiety disorders until delivery (OR=3.02, 95% CI 1.25 to 7.32, p=0.014) and until 16 months post partum (OR=2.87, 95% CI 1.13 to 7.28, p=0.027). Associations remained stable when adjusting for sociodemographic and perinatal covariates. Maternal depressive disorders prior to pregnancy were not significantly associated with excessive crying in this sample. IMPLICATIONS: Maternal lifetime and incident anxiety disorders revealed to be a robust predictor for excessive crying. Thus, early identification and monitoring of women with anxiety disorders is important to identify mother-infant dyads at risk for excessive crying.

Analysis of gastrin-releasing peptide gene and gastrin-releasing peptide receptor gene in patients with agoraphobia.

A gastrin-releasing peptide receptor (GRPR) knock-out mouse model provided evidence that the gastrin-releasing peptide (GRP) and its neural circuitry operate as a negative feedback-loop regulating fear, suggesting a novel candidate mechanism contributing to individual differences in fear-conditioning and associated psychiatric disorders such as agoraphobia with/without panic disorder. Studies in humans, however, provided inconclusive evidence on the association of GRP and GRPR variations in agoraphobia with/without panic disorder. Based on these findings, we investigated whether GRP and GRPR variants are associated with agoraphobia. Mental disorders were assessed via the Munich-Composite International Diagnostic Interview (M-CIDI) in 95 patients with agoraphobia with/without panic disorder and 119 controls without any mental disorders. A complete sequence analysis of GRP and GRPR was performed in all participants. We found no association of 16 GRP and 7 GRPR variants with agoraphobia with/without panic disorder.

[Protective factors for postpartum depression]. / Was halt Schwangere gesund? Protecktive Faktoren fur postpartale Depression.

OBJECTIVES: This article examines the associations between protective factors und the occurrence of postpartum depressive symptoms. METHODS: Using a prospective-longitudinal design 303 pregnant women were examined at 3 points in time (T1: 1st trimester, T2: 3rd trimester, T3: 3-5 months postpartum). The analyses are based on T1 and T3. RESULTS: Sense of coherence (SOC-L9, Schumacher et al. 2000) at 1st trimester was on average 51.7 (SD = 7.2) - significantly above the mean of a comparison sample. 37 women (15.4 %) had a score of 10 or more on the Edinburgh Postnatal Depression Scale (EPDS, Cox et al. 1987) 3 to 5 months postpartum. Pregnant women who stated that their pregnancy had been planned and desired, with a higher marital and overall life satisfaction as well as a higher sense of coherence, had a significantly lower risk for the development of postpartum depression. Using multiple regression it was found that only sense of coherence significantly predicted postpartum depression. CONCLUSIONS: The results suggest that a higher sense of coherence at first trimester is an important protective factor for the occurrence of postpartum depression.

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: a two-year follow-up study.

OBJECTIVE: Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors that will be maintained and adapted to the demands of new situations. The long-term outcomes are therefore crucial in testing the durability of CBT. METHOD: A two-year follow-up assessment was undertaken on a subsample of n = 146 PD/AG patients from a multicenter randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in the presence of the therapist (T+) or on their own following therapist preparation (T-). RESULTS: Both variations of CBT had high response rates and, overall, maintained the level of symptomatology observed at post-treatment with high levels of clinical significance. Effect sizes 24 months following treatment were somewhat lower than at the 6-month follow up. Once patients reached responder status, they generally tended to remain responders at subsequent assessments. Differences were observed for patients that obtained additional treatment during the follow-up period. Expert opinion and subjective appraisal of treatment outcome differed. No robust baseline predictors of 2-year outcome were observed. CONCLUSION: Most patients maintain clinically meaningful changes two years following treatment across multiple outcome measures. Approximately 1/3 of patients continued to experience meaningful residual problems.

Maternal anxiety disorders prior to conception, psychopathology during pregnancy and early infants' development: a prospective-longitudinal study.

Family-genetic studies suggest that anxiety disorders run in families and that mechanisms of familial transmission might act as early as during pregnancy. The aims of the Maternal Anxiety in Relation to Infant Development (MARI) Study are to prospectively investigate the course of pregnancy in women with and without anxiety disorders prior to conception from early pregnancy to postpartum focussing on (a) maternal psychopathology, (b) maternal perinatal health, and (c) offspring outcomes that are supposed to be early indicators/ antecendents for later anxiety disorders. The MARI Study is a prospective-longitudinal study program with seven waves of assessment: T1 (baseline: week 10 to 12 of gestation), T2 (week 22 to 24 of gestation), T3 (week 35 to 37 of gestation), T4 (10 days postpartum), T5 (2 months postpartum), T6 (4 months postpartum), and T7 (16 months postpartum). Overall, N = 306 pregnant women were enrolled during early pregnancy (T1) and allocated to one of the following initial diagnostic groups: no AD: no anxiety nor depressive disorder prior to pregnancy (N = 109), pure D: pure depressive disorder(s) prior to pregnancy (N = 48), pure A: pure anxiety disorder(s) prior to pregnancy (N = 84), and comorbid AD: comorbid anxiety and depressive disorders prior to pregnancy (N = 65). Overall, N = 284 mothers could be retained until T6 (retention rate: 92.8 %) and N = 274 until T7 (retention rate: 89.5 %). Clinical and psychosocial measures were used including a standardized diagnostic interview (CIDI-V) with dimensional scales and standardized observation paradigms (mother-infant-relationship, infant temperament and neuropsychological development). Dimensional anxiety and depression liability indices were developed to reflect the severity of anxiety and depressive disorders prior to pregnancy and to ease longitudinal modelling. Findings from this study will contribute to improved knowledge about the natural course of anxiety disorders during transition to parenthood and associated outcomes that are assumed to be early indicators of later psychopathology in the offspring. Results are expected to provide new insights into mechanisms of familial transmission and clues for targeted prevention and early intervention.

Exercise capacity affects quality of life in patients with pulmonary hypertension.

BACKGROUND: The objective of this prospective study was to evaluate the impact of exercise capacity, mental disorders, and hemodynamics on quality-of-life (QoL) parameters in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Sixty-three patients with invasively diagnosed PAH (n = 48) or CTEPH (n = 15) underwent a broad panel of assessments, including cardiopulmonary exercise testing (CPET), 6-minute walking distance (6-MWD), World Health Organization functional class (WHO-FC), and assessment of hemodynamics. QoL was evaluated by the 36-item Medical Outcome Study Short Form Health Survey Questionnaire (SF-36). Exercise capacity, hemodynamics, age, gender, and mental disorders (anxiety and depression) were assessed for association with QoL subscores by uni- and multivariate regression analyses. RESULTS: Exercise capacity, WHO-FC, oxygen therapy, symptoms of right heart failure, right atrial pressure, and mental disorders were significantly associated with QoL (p < 0.05). In the stepwise backward selection multivariate analysis, depression remained an independent parameter in seven of eight subscales of the SF-36. Furthermore, peak oxygen uptake (peakVO2) during CPET, 6-MWD, anxiety, long-term oxygen therapy, right heart failure, and age remained independent factors for QoL. Hemodynamic parameters at rest did not independently correlate with any domain of the SF-36 QoL subscores. CONCLUSIONS: Mental disorders, exercise capacity, long-term oxygen therapy, right heart failure, and age play important role in the quality of life in patients with PAH and CTEPH.

Premenstrual symptoms are associated with psychological and physical symptoms in early pregnancy.

The reproductive life of women is characterised by a number of distinct reproductive events and phases (e.g. premenstrual phase, peripartum, perimenopause). The hormonal transitions during these phases are often associated with both psychological and physical symptoms. Associations between these reproductive phases have been shown by numerous studies. However, the relationship between symptoms during the premenstrual phase and during early pregnancy has received little attention thus far, although early pregnancy is a time of dramatic hormonal as well as physical adaptation. Findings are based on a prospective longitudinal study with N = 306 pregnant women (MARI study). Three hundred five women that had menstrual bleeding in the year before pregnancy rated the severity of psychological and physical symptoms during premenstrual phases in the year preceding pregnancy. Besides this, they rated the severity of the same symptoms during early pregnancy (weeks 10 to 12 of gestation). The overall severity of premenstrual symptoms was significantly associated with the overall severity of early pregnancy symptoms (b = 0.4, 95% CI = 0.3-0.5; p < 0.001). The overall severity of early pregnancy symptoms was best predicted by the severity of premenstrual irritability. The best predictor for a particular symptom in early pregnancy mostly was the corresponding premenstrual symptom. The associations between premenstrual and early pregnancy symptoms support the reproductive hormone sensitivity hypothesis that some women are prone to repeatedly experience specific psychological and physical symptoms during different reproductive phases. The findings further imply that the nature of symptoms might be rather consistent between different reproductive phases.

Post-traumatic stress disorder (PTSD) in cardiology and oncology--which diagnostic tools should be used?

OBJECTIVES: PTSD prevalence rates in cardiac and cancer patients greatly vary probably due to diverging samples, designs and assessments. Aim of this study was therefore to compare prevalence rates of PTSD as well as instruments assessing PTSD in different cardiac and cancer patient groups. METHODS: A total of 274 cardiac and cancer patients were examined with the Post-Traumatic Stress Scale 10 (PTSS-10) and the Impact of Event Scale - revised (IES-R). Presence of PTSD was validated by Structured Clinical Interview for DSM-IV (SCID). RESULTS: Diagnostic criteria for the existence of PTSD were met by 29.2% of all patients via PTSS-10, by 7.6% in IES-R and by 4.8% in SCID, indicating substantial discrepancy among assessments. This is further underlined by the moderate correlation between self-reports and poor agreement with the standardised interview. CONCLUSION: A structured interview is the "gold standard" for diagnosing PTSD in cardiac and cancer patients. Questionnaires can be used as screening instruments when they reliably assess trauma-related diagnostic criteria. Further studies are necessary to clarify the specifics of trauma criteria in medical setting.

Changes in the prevalence, treatment and control of hypertension in Germany? A clinical-epidemiological study of 50.000 primary care patients.

INTRODUCTION: Medical societies have developed guidelines for the detection, treatment and control of hypertension (HTN). Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001. METHODS: Using standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT) study (2003) were analyzed. Physician's diagnosis of hypertension (HTN(doc)) was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician's diagnosis or the patient's self-reported diagnosis of hypertension (HTN(doc,pat)), physician's or patient's self-reported diagnosis or a BP measurement with a systolic BP ≥ 140 mmHg and/or a diastolic BP ≥ 90 (HTN(doc,pat,bp)) and diagnosis according to the National Health and Nutrition Examination Survey (HTN(NHANES)). The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg) since 2001. Factors associated with pharmacotherapy and control were determined. RESULTS: The overall prevalence rate for hypertension was 35.5% according to HTN(doc) and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD), hyperlipidemia and diabetes mellitus (DM). Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity. CONCLUSIONS: Rates of treated and controlled hypertension according to NHANES criteria in DETECT remained low between 2001 and 2003, although there was some minor improvement.

Heart-focused anxiety in the general population.

OBJECTIVE: Heart-focused anxiety is a common phenomenon that is related to psychological disorders and cardiac diseases. We investigated heart-focused anxiety in the general population and provided standard values using the Cardiac Anxiety Questionnaire (CAQ). Furthermore, we assessed the reliability of the CAQ and investigated the influence of social variables on heart-focused anxiety. METHODS AND RESULTS: The questionnaire was applied to 2,396 individuals (age range: 18-92; mean age 49 ± 17, 50% male). Three aspects of heart-focused anxiety (fear, attention, and avoidance) were captured by the CAQ. To test the influence of age, gender, and social factors, we performed analyses of variance, correlative statistics, and regression analyses. Heart-focused anxiety showed a linear increase with age (P < 0.001). No gender differences were observed. The degree of anxiety was affected by relationship (P < 0.001), level of education (P < 0.001), employment (P < 0.001), and income (P < 0.001). CONCLUSION: We evaluated heart-focused anxiety in the general population and validated the CAQ. Using percentiles based on a normative sample allows screening for heart-focused anxiety in patients with or without cardiac diseases and the measurement of therapy success after psychotherapeutic or pharmacological intervention.