Cost-Effectiveness and Cost-Utility Analysis of the Treatment of Emotional Disorders in Primary Care: PsicAP Clinical Trial. Description of the Sub-study Design.

Introduction: In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU). Methods: Multicenter, randomized controlled trial involving 300 patients recruited from PC centers in Madrid, Spain, with symptoms or possible diagnosis of anxiety, mood (mild or moderate), or somatoform disorders. Patients will be randomized to one of two groups: an experimental group, which will receive group-based transdiagnostic cognitive-behavioral therapy (TD-CBT); and a control group, which will receive TAU (mainly pharmacological interventions) prescribed by their general practitioner (GP). Clinical assessment will be performed with the Patient Health Questionnaire (PHQ). Direct and indirect costs will be calculated and relevant socio-demographic variables will be registered. The Spanish version of the EuroQol 5D-5L will be administered. Patients will be assessed at baseline, immediately after treatment finalization, and at 6 and 12 months post-treatment. Discussion: To our knowledge, this is the first study to compare TD-CBT to TAU in the PC setting in Spain. This is the first comparative economic evaluation of these two treatment approaches in PC. The strength of the study is that it is a multicenter, randomized, controlled trial of psychotherapy and TAU for EDs in PC. Trial registration: Protocol code: ISCRCTN58437086; 20/05/2013.                                        EUDRACT: 2013-001955-11.                                        Protocol Version: 6, 11/01/2014.

A multi-factor model of panic disorder: results of a preliminary study integrating the role of perfectionism, stress, physiological anxiety and anxiety sensitivity / Modelo multifactorial del trastorno de pánico: resultados de un estudio preliminar sobre el papel del perfeccionismo, estrés, ansiedad fisiológica y sensibilidad a la ansiedad

Background: Panic disorder (PD) is a highly prevalent and disabling mental health problem associated with different factors including perfectionism, stress, physiological anxiety, and anxiety sensitivity regarding physical concerns; however, no studies have analyzed the joint relationship between these factors and PD in a multi-factor model using structural equation modeling. Method: A cross-sectional study was carried out to collect data on these factors and self-reported DSM-IV past-year PD symptoms in a large sample of the general population (N=936). Results: Perceived stress had a significant effect in increasing physiological anxiety, which in turn had an important association with physical concerns. Perfectionism and perceived stress had an indirect relation with past year PD via the mediator role of physiological anxiety and physical concerns. Physical concerns, on one hand, seemed to mediate the impact between perfectionism and PD and, on the other, partially mediated the role between physiological anxiety and PD. Conclusions: Although there is considerable evidence on the association between each of these factors and PD, this model can be considered a broader and productive framework of research on the nature and treatment of PD

Antecedentes: el trastorno de pánico (TP) es un desorden mental altamente prevalente e incapacitante asociado a diferentes factores como el perfeccionismo, estrés, ansiedad fisiológica, y sensibilidad a la ansiedad referente a preocupaciones físicas; sin embargo, no existen estudios que hayan analizado conjuntamente la relación entre dichos factores y el TP en un modelo multifactorial utilizando ecuaciones estructurales. Método: con el objetivo de recoger información sobre estos factores y síntomas autoinformados de TP en el último año según criterios DSM-IV, se llevó a cabo un estudio transversal en una amplia muestra de la población general (N=936). Resultados: el estrés percibido tuvo un efecto significativo a la hora de incrementar la ansiedad fisiológica, que a su vez se asoció de modo importante con las preocupaciones físicas. El perfeccionismo y el estrés percibido se relacionaron indirectamente con el TP durante el último año a través del efecto mediador de la ansiedad fisiológica y las preocupaciones físicas. Las preocupaciones físicas, por un lado, parece ser que mediaron el impacto entre el perfeccionismo y el TP y, por otro lado, mediaron parcialmente la relación entre ansiedad fisiológica y TP. Conclusiones: a pesar de la evidencia existente acerca de la relación entre cada uno de estos factores y el TP, se puede considerar este modelo como un marco teórico que recoge la investigación de forma conjunta y productiva sobre la naturaleza y tratamiento del TP

Perievent panic attacks and panic disorder after mass trauma: a 12-month longitudinal study.

Panic attacks frequently lead to psychopathological disorders, including panic disorder. Even though panic disorder is a highly comorbid and disabling mental health problem associated with stressful life or traumatic events, perievent panic attacks and their association with panic disorder have hardly been investigated as a central topic after mass trauma. Using data from a longitudinal population-based assessment of Madrid residents after the March 11, 2004 train bombings (N = 1,589), with assessments conducted 1, 6, and 12 months after the attacks, the rate of perievent panic attacks was 10.9%. Level of exposure, previous life stressors, and negative emotionality were associated with perievent panic attacks (ß = .12, .15, and .10, respectively), which in turn mediated the relationship between exposure to the terrorist event and panic disorder in the following year. Previous life stressors (ß = .15) and low social support (ß = -.14) were directly associated with panic disorder during the subsequent year. The most vulnerable individuals who experienced perievent panic attacks were 3.7 times, 95% confidence interval [CI] = [2.1, 6.4], more likely to suffer from panic disorder in the following year. Results suggest that early identification of perievent panic attacks following mass trauma may be helpful for reducing panic disorder.

Doce sesiones de tratamiento cognitivo conductual en un caso de trastorno de pánico con agorafobia / Twelve sessions of cognitive-behavioural treatment in a case Panic Disorder with Agoraphobia

El trastorno de pánico, con y sin agorafobia, es el resultado de prestar atención e interpretar errónea y catastróficamente las sensaciones fisiológicas hasta el punto de que se viven como peligrosas (Clark et al., 1997). A continuación se expone el caso de un varón de 20 años de edad, que solicita una intervención psicológica aduciendo un problema grave de ansiedad. Padece agorafobia desde hace 3 años, sin haber sufrido ataques de pánico hasta hace 3 meses, momento a partir del cual ha comenzado a sufrir los mismos de modo inesperado y recurrente. La medicación recetada por su médico de cabecera desde entonces no favorece la remisión de los síntomas. Basándonos en el modelo cognitivo del pánico de Clark (1986), se aplico un tratamiento cognitivo –conductual – centrándonos especialmente en la psicoeducación, el papel de los sesgos cognitivos, las anticipaciones catastrofistas y creencias irracionales acerca de las sensaciones corporales – en doce sesiones de una periodicidad semanal, más tres sesiones de seguimiento. Se lograron alcanzar y mantener los objetivos planteados: eliminar los ataques de pánico, disminuir los niveles de ansiedad y depresión, enfrentarse a las situaciones temidas sin sufrir ansiedad (viajar en avión o en trasporte público, acudir al cine o al teatro, etc) y retirar la medicación sin sufrir recaídas. Por último, se muestran los resultados obtenidos de la evaluación pre y post tratamiento mediante el empleo de varios instrumentos de evaluación (AU)

Panic disorder, with and without agoraphobia, is the result of paying attention to and interpreting physiological sensations in an erroneous and catastrophic manner, up to the point that these sensations are believed to entail dangerous consequences. We present a case study of a 20 year old Psychology undergraduate student, who requests a psychological intervention due to a serious anxiety problem. He has suffered from agoraphobia for three years, without ever having experienced a single panic attack; three months ago he suffered his first and subsequent unexpected panic attacks. The drug treatment prescribed by his GP has not favoured any kind of symptom remission. Based on Clark´s Cognitive Model of Panic (1986), we implemented a cognitive treatment (focusing on psychoeducation and the role played by cognitive biases, and catastrophic and irrational misinterpretations of bodily sensations), in 12 weekly, 60 minute sessions, plus three additional follow-up sessions. Successful results were obtained and maintained at follow-up; panic attacks were completely eradicated, anxiety and depression levels were reduce, feared situations were confronted without suffering anxiety (travelling by plane or public transport, going to movie theatres, etc.) and medication was discontinued without suffering a relapse. Lastly, pre and post-treatment results obtained through the use of several assessment instruments are discussed (AU)

Los trastornos de ansiedad en las publicaciones de autores españoles / Anxiety disorders in spanish author´s published articles

En el presente estudio se revisan los trabajos publicados en la base de datos PSYCINFO desde le año 1994 hasta el 2005, publicados por autores españoles, sobre trastornos de ansiedad. El propósito de esta revisión es analizar los diferentes parámetros de este campo de investigación, tales como su número (comparado con el mimo por parte del resto de autores), las revistas de publicación más relevantes y los instrumentos de evaluación más utilizados. Se presentan los datos de esta revisión, tras cotejar los mismos con lo publicado por autores de otros países, y se analizan y discuten los resultados. Como conclusión se dibuja un panorama en el cual la investigación sobre los trastornos de ansiedad por parte de autores con afiliación española muestra una clara tendencia al alza y supone el 3,9% de la producción total

The articles on anxiety disorders published by Spanish authors, since 1994 up util 2005, in the Psycinfo database are reviewed in this study, Different parameters are ecamined, such us the number of articles (compared to that of the rest of authors in the same field of study), the most relevant journals and the different assessment instruments used. After comparing the data with what has been published by other authors, the results are analysed and discussed. This review offers a clear vision of the increasing amount of research being undertaken on anxiety disorders. During the aforementioned range of years, Spanish authors have carried out 3.9% of all the research in this field