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1.
Adv Exp Med Biol ; 1191: 219-235, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32002932

RESUMEN

Although anxiety and depression have been considered as two distinct entities according to the diagnostic criteria, anxious depression (comorbid anxiety and depression) is relatively a common syndrome. According to the DSM-5 criteria, it uses "with anxious distress specifier" to define anxious depression in its MDD section. Anxious depression is known to have different neurobiological profiles compared to non-anxious depression. Several studies have revealed significant differences between anxious depression and non-anxious depression regarding the hypothalamic-pituitary-adrenal (HPA) axis function, structural and functional brain imaging findings, inflammation markers, etc. Patients with anxious depression were significantly more likely to be found in primary care setting and more likely to be associated with female gender, non-single, unemployed, less educated, and more severe depression. Previous reports also showed that patients with anxious depression had more frequent episodes of major depression and a higher risk of suicidal ideation and previous suicide attempts than those with non-anxious depression. Although anxious depression is known to be associated with poor treatment outcomes in several studies, recent researches have sought to find better treatment strategy to improve patients with anxious depression.


Asunto(s)
Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/terapia , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/terapia , Ansiedad/complicaciones , Ansiedad/diagnóstico , Ansiedad/terapia , Trastornos de Ansiedad/diagnóstico , Comorbilidad , Depresión/complicaciones , Depresión/diagnóstico , Depresión/terapia , Trastorno Depresivo Mayor/diagnóstico , Humanos
2.
Adv Exp Med Biol ; 1191: 561-576, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32002946

RESUMEN

Recent data has linked anxiety and its disorders in late life to increased morbidity and mortality, especially related to a higher cardiovascular burden and an increased cognitive decline. Clinically, anxiety symptoms may be more difficult to elicit in older adults who are less accurate in identifying anxiety symptoms and tend to minimize symptoms and to attribute symptoms to physical illness. Although SSRIs have proven more effective than psychotherapy in late-life anxiety, many elderly anxious subjects prefer psychotherapeutic interventions. These interventions appear to work best when tailored for the needs, expectations, and cultural background of older anxious subjects.


Asunto(s)
Trastornos de Ansiedad , Anciano , Ansiolíticos/uso terapéutico , Ansiedad/complicaciones , Ansiedad/diagnóstico , Ansiedad/psicología , Ansiedad/terapia , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Enfermedades Cardiovasculares/complicaciones , Comorbilidad , Humanos , Psicoterapia , Inhibidores de la Captación de Serotonina/uso terapéutico
3.
Adv Exp Med Biol ; 1191: 187-196, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32002930

RESUMEN

Under the partial influences of paradigm shift form category to dimension, the Diagnostic and Statistical Manual of Mental Disorder (DSM) was revised to the fifth edition (DSM-5); however, due to the lack of consistent biological makers and processes and the restricted availability of dimensional meta-structure, the revisions for the DSM-5 were based on a combination of categorical and dimensional approaches. Anxiety disorders were more clearly and consistently defined in the DSM-5 with the removal of obsessive compulsive, acute stress, and post-traumatic stress disorders. Differences between the childhood and adulthood categories of anxiety disorders were decreased, and overall, the symmetrical classification of anxiety subtypes was increased, since separation anxiety disorder and selective mutism were considered anxiety disorders, not neurodevelopmental disorders. Additionally, based on growing evidence, agoraphobia is distinct from panic disorder. Next, considering cultural syndromes including taijin kyofusho, khyal cap, trung gio attacks, and ataque de nervios, cultural influences are considered a significant factor for definitions and presentations of anxiety disorders. Controversies in the DSM-5 criteria for anxiety disorders are lowering the diagnostic thresholds of anxiety disorders and limiting the dichotomous view of anxiety and depression when defining generalized anxiety disorder. Further studies of alternative approaches to the restrictions of the DSM-5 criteria of anxiety disorders, including transdiagnostic specifiers and dimensional assessment tools, may be required.


Asunto(s)
Trastornos de Ansiedad/clasificación , Trastornos de Ansiedad/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Factores de Edad , Ansiedad/complicaciones , Ansiedad/psicología , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/psicología , Depresión/complicaciones , Depresión/psicología , Humanos , Trastornos por Estrés Postraumático/clasificación , Trastornos por Estrés Postraumático/diagnóstico
4.
Adv Exp Med Biol ; 1191: 237-261, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32002933

RESUMEN

Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).


Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/psicología , Enfermedad Crónica , Comorbilidad , Humanos , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Trastorno de Pánico/psicología , Trastorno de Pánico/terapia
5.
Adv Exp Med Biol ; 1191: 367-388, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32002938

RESUMEN

This chapter reviews the role of benzodiazepines (BZs) in the treatment of anxiety disorders, specifically panic disorder with or without agoraphobia, generalized anxiety disorder, and social anxiety disorder (social phobia). BZs pharmacology, classification, efficacy, adverse effects, withdrawal symptoms, possible dependence, and abuse; their positioning among pharmacological treatment; and guidance on how to use them are discussed.


Asunto(s)
Trastornos de Ansiedad/tratamiento farmacológico , Benzodiazepinas/uso terapéutico , Agorafobia/complicaciones , Agorafobia/tratamiento farmacológico , Trastornos de Ansiedad/complicaciones , Humanos , Trastorno de Pánico/complicaciones , Trastorno de Pánico/tratamiento farmacológico
6.
Muscle Nerve ; 61(1): 69-73, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31573094

RESUMEN

BACKGROUND: The revised 15-item Myasthenia Gravis (MG) Quality of Life Questionnaire (MGQoL15R) is a validated scale of quality of life in patients with MG. We aimed to study the factors causing the variability within the Arabic version of the MGQoL15R (MGQoL15R-A). METHOD: A standardized questionnaire was completed by 118 patients. Correlations and hierarchical regression analyses were used to assess the contribution of sociodemographic variables, clinical factors, Patient Health Questionnaire-9 (PHQ9-A), and Generalized Anxiety Disorder-7 (GAD7-A) to the variability in the MGQoL15R-A. RESULTS: The MGQoL15R-A was highly correlated with PHQ9-A (r = 0.76), and moderately correlated with GAD7-A (r = 0.52). Clinical factors and PHQ9-A independently explained 30.4% and 34.5% of the variability, respectively. Among the clinical factors, uncontrolled MG status, relapse within the past year, and a higher number of current MG therapies were significantly associated with a higher MGQoL15R-A score. CONCLUSIONS: MG severity and depressive symptoms (measured by PHQ9-A) can affect the MGQoL15R-A score.


Asunto(s)
Depresión/complicaciones , Depresión/psicología , Miastenia Gravis/psicología , Adulto , Anciano , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/psicología , Árabes , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Reproducibilidad de los Resultados , Factores Socioeconómicos , Encuestas y Cuestionarios , Traducciones
7.
Psychiatr Hung ; 35(1): 58-67, 2020.
Artículo en Húngaro | MEDLINE | ID: mdl-31854323

RESUMEN

INTRODUCTION: Several long-term follow-up studies investigate the progression of adolescent onset major depressive disorder but much less explore short and long-term consequences and prognosis into adulthood of childhood- onset depression. The aim of the present study is to follow childhood-onset depression, lifetime comorbid psychiatric disorders and suicidal behavior into adulthood. METHODS: Subjects (N=166) were 25.95+2.42 years old on average, 54.2% were women. Follow-up period lasted for a mean of 14.74+1.31 years. Psychiatric diagnosis was assessed by a DSM-IV based semi-structured interview. Subjects reported on 4 stages of suicidal behavior as one of the symptoms of depressive disorder. RESULTS: The onset of the first depressive episode was at the mean age of 10.17+2.34 years. 40,4% of the sample had only 1 episode while recurrent depressive episode presented in 32.5% above 18 years of age. Lifetime comorbid psychiatric disorders were present in more than 1/3 of the sample. The most frequent lifetime comorbidity was anxiety (42.4%), and specific phobia among anxiety disorders. Lifetime attention deficit-hyperactivity disorder and oppositional/conduct disorder were also frequent (25.9% and 16.9%, respectively). Suicidal behavior was not present life-time in 19.1% of the sample. Thoughts of death and thoughts of suicide were quite frequent (80.8% and 69.5%, respectively), specific plans and suicidal attempt were more frequent in girls (plan:female vs male 53.9% vs 38.4%, attempt: 33.3% vs 9.6%) during follow-up. CONCLUSION: About one-third of childhood-onset depression had recurrence above 18 years of age, which is lower than the recurrence rate for adolescent onset depression. A high rate of lifetime comorbidity was found between depression and anxiety disorders. The assessment of the actual level of suicidal behavior is important in the prevention of selfdestructive behavior.


Asunto(s)
Depresión/diagnóstico , Depresión/psicología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Suicidio/psicología , Adolescente , Adulto , Edad de Inicio , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Niño , Comorbilidad , Depresión/complicaciones , Trastorno Depresivo Mayor/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Factores de Riesgo , Adulto Joven
8.
Pediatrics ; 144(5)2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31582535

RESUMEN

OBJECTIVES: To evaluate the proportion of pediatric patients with concurrent diagnoses of hyperthyroidism and mental health conditions (MHCs) by using the Military Health System database. We hypothesized that the prevalence of mental health disorders would be higher in patients with hyperthyroidism compared with in the nonhyperthyroid population. METHODS: The prevalence of hyperthyroidism and MHCs was calculated by using data extracted from the Military Health System Data Repository on military beneficiaries between 10 and 18 years old who were eligible to receive care for at least 1 month during fiscal years 2008 through 2016. Prevalence ratios were used to compare MHC diagnoses in those with versus without a diagnosis of hyperthyroidism. RESULTS: There were 1894 female patients and 585 male patients diagnosed with hyperthyroidism during the study period. Prevalence ratios for MHCs in those with versus without hyperthyroidism ranged from 1.7 (attention-deficit/hyperactivity disorder [ADHD]) to 4.9 (bipolar disorder). Strikingly, suicidality was nearly 5 times more likely in patients diagnosed with hyperthyroidism than in patients who were never diagnosed with hyperthyroidism. For each of the MHCs examined, with the exception of suicidality, the MHC diagnosis was more commonly made before the diagnosis of hyperthyroidism, with the highest proportion of patients being diagnosed with ADHD before receiving a diagnosis of hyperthyroidism (68.3%). CONCLUSIONS: There is a clear association between hyperthyroidism and each of the following MHCs: ADHD, adjustment disorder, anxiety, bipolar disorder, depression, and suicidality. This study highlights the need to consider this association when evaluating patients with overlapping symptoms and for effective mental health screening tools and resources for clinicians.


Asunto(s)
Hipertiroidismo/psicología , Trastornos Mentales/complicaciones , Adolescente , Trastornos de Ansiedad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno Bipolar/complicaciones , Niño , Diagnóstico Tardío , Trastorno Depresivo/complicaciones , Femenino , Humanos , Hipertiroidismo/diagnóstico , Masculino , Trastornos Mentales/diagnóstico , Prevalencia , Ideación Suicida
9.
Rev Esp Salud Publica ; 932019 10 10.
Artículo en Español | MEDLINE | ID: mdl-31597911

RESUMEN

OBJECTIVE: Neurotic disorders are one of the main health problems of Western societies. Its impact on labor productivity grows exponentially with an increase in its incidence and the duration of temporary disability (TD) processes. To know the characteristics of the patients belonging to a mutual of work accidents who had transient disability due to neurotic disorders, their temporal and geographic distribution, their comorbidities and those variables that affected their duration. METHODS: Retrospective descriptive study of the workers protected from a mutual of work accidents, national scope, who studied a disability period between 2006-2016 with diagnoses included between codes 300 and 300.9 of the CIE-9-CM, corresponding to Neurotic Disorders. We analyze clinical-demographic variables of patients, comorbidities during studied period and distributions by year and province, by Bayesian inference. We performed a logistic regression for the dependent variable duration of the TD adjusted for age, sex, toxic consumption, consultations, year, regulatory base and payment type. RESULTS: We registered 56,619 processes in Spain, which corresponded to 1.5% of the total TD processes served in the period. The highest percentage of cases was grouped between 2007 and 2009, when 11% of the population were registered annually. The variables associated with an increase in this duration were: older age, male sex, psychiatric and psychological consultations, diagnostic year, regulatory base (whose average was 50.5 euros) and type of payment (delegate in 78.2% of cases and direct in 21.8%). The prevalence by provinces was more marked in the north and the islands (Barcelona, Lleida, Las Palmas, Islas Baleares, Coruña, Cantabria, Girona, Álava, Tarragona, Pontevedra y Asturias they have more than 6%).The durations of the disability were greater in the east of the country. The most prevalent comorbidities during the study period were low back pain (with an average of 65.1 days of IT anxiety), cervical pain (with an average of 67 days) and digestive disorders (with an average of 59.4 days). CONCLUSIONS: There are comorbidities and variables associated with the temporary disability derived from neurotic disorders, with geographical differences. Deepening their knowledge and impact could promote better preventive and therapeutic approaches that allow an earlier functional recovery.


Asunto(s)
Accidentes de Trabajo/psicología , Trastornos de Ansiedad/terapia , Personas con Discapacidad/psicología , Ausencia por Enfermedad , Adulto , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/epidemiología , Teorema de Bayes , Comorbilidad , Femenino , Geografía , Humanos , Incidencia , Modelos Logísticos , Dolor de la Región Lumbar/complicaciones , Masculino , Prevalencia , Estudios Retrospectivos , España/epidemiología
10.
J Clin Neurosci ; 69: 21-25, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31473092

RESUMEN

This study evaluated suicidality and its risk factors in patients with tension-type headache (TTH). We recruited new patients with TTH who visited general hospitals. We recorded their clinical characteristics and conducted the Headache Impact Test-6 (HIT-6) and the Insomnia Severity Index (ISI) for assessment. We also interviewed the patients to identify major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidality with the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI). The frequency of suicidality was compared between TTH patients and healthy controls. Major risk factors for suicidality were also determined. A total of 332 TTH patients with the same number of healthy controls were recruited from five general hospitals. Suicidality was observed in 82 (24.7%) TTH patients. The frequency of suicidality was significantly higher in patients with TTH than in the controls. Furthermore, the frequency of suicidality was higher in patients with chronic TTH (CTTH) than in the controls. The major risk factors for suicidality were MDD, GAD, a low education level, insomnia, chronicity of TTH, and pericranial tenderness. Suicidal ideation or attempt seems to be a common feature in TTH. Therefore, it is important to identify risk factors related to suicidality in TTH patients, which may help reduce suicidality.


Asunto(s)
Ideación Suicida , Cefalea de Tipo Tensional/psicología , Adulto , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/psicología , Estudios de Casos y Controles , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Factores de Riesgo
11.
J Consult Clin Psychol ; 87(10): 952-961, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556671

RESUMEN

OBJECTIVE: This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community. METHOD: Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N = 101; 45% female, 23% Native Hawaiian or Pacific Islander, Mage = 42.5, SD = 12.75). Among patients prescribed buprenorphine (n = 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphine-waivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit. RESULTS: Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p < .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months. CONCLUSIONS: Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Medicina de las Adicciones , Buprenorfina/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Atención Primaria de Salud , Salud Rural , Adulto , Trastornos de Ansiedad/complicaciones , Buprenorfina/administración & dosificación , Trastorno Depresivo/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Narcóticos/administración & dosificación , Trastornos Relacionados con Opioides/complicaciones , Estudios Retrospectivos
12.
Tijdschr Psychiatr ; 61(9): 635-643, 2019.
Artículo en Holandés | MEDLINE | ID: mdl-31560783

RESUMEN

BACKGROUND: Antidepressants remain controversial, partly due to allegations that disappointing results were buried and because of their modest average efficacy.
AIM: To investigate bias in the antidepressant literature and the possibilities for predicting which patients with depression or anxiety do receive significant benefits from antidepressants.
METHOD: We investigated bias by comparing information from the US Food and Drug Administration with the published literature. To predict response, we used patient data from randomized trials.
RESULTS: Of all studies on depression or anxiety, 50% and 72% were positive, compared to 95% and 96% of all published studies. Safety outcomes were poorly reported in published articles and unpublished studies were often 'bundled' into pooled-trials publications with positive conclusions. We found an association between severity and antidepressant efficacy for some, but not all, anxiety disorders; previous research has found inconsistent evidence for this association for depression. Furthermore, patients with depression that showed early improvement were more likely to attain a good response, irrespective of which symptoms improved.
CONCLUSION: These results demonstrate the severe impact of bias on the antidepressant literature. Severity and early improvement predicted a good response, but more information is needed to improve predictions. The increased accessibility of individual patient data will hopefully soon enable further progress in this area.


Asunto(s)
Antidepresivos/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Trastornos de Ansiedad/complicaciones , Trastorno Depresivo/complicaciones , Diagnóstico Dual (Psiquiatría) , Medicina Basada en la Evidencia , Humanos , Resultado del Tratamiento
13.
Psychiatr Hung ; 34(2): 172-182, 2019.
Artículo en Húngaro | MEDLINE | ID: mdl-31417006

RESUMEN

An increasing number of studies deal with the potential correspondence between suicidal behaviour and creativity nowadays. Psychobiographical analysis of the life of well known artists may help the better understanding of this phenomenon. In the present study predictive and protective factors of suicide are presented through the case of the well known suicidal poet and writer, Sylvia Plath. The most important predictive factors of suicide in her case are: affective disorder, comorbid anxiety disorder, prior attempt of suicide, and also her seriously affected personality, that mainly appears in her affective dependence. Her life events, both causes and effects of these, are also predisposing suicide. The early loss of her father, ambivalent relation with her mother and her marriage foredoomed to failure are the most significant of them. Although she used to write since her early childhood, the constant fluctuation of her psychological state had serious effect on her ability to write and also her motivation, both being an additional source of stress, due to her performance pressure. The fear of the acceptance of her works could also lay to increased amount of stress and anxiety on her sensitive personality. Her tragical life events, her psychiatric illness and her relentless templets towards herself could cause such a pressing stress, that neither creation, nor motherhood (the most important protective factor for women) could predominate. Neither moving to England, nor her last confessional book, "The Bell Jar" could cure her many kind of wounds, and these factors together lead to the suicide.


Asunto(s)
Creatividad , Trastornos del Humor/historia , Trastornos del Humor/psicología , Factores Protectores , Suicidio/historia , Suicidio/psicología , Trastornos de Ansiedad/complicaciones , Femenino , Historia del Siglo XX , Humanos , Trastornos del Humor/complicaciones , Madres/psicología , Motivación , Factores de Riesgo , Estrés Psicológico/complicaciones , Escritura/historia
15.
Rev Assoc Med Bras (1992) ; 65(6): 801-809, 2019 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-31340308

RESUMEN

BACKGROUND: Depression and anxiety disorders (DAD) are the most prevalent mental health conditions worldwide. Among the adult population served in basic care, it is estimated that depression affects about 14.3% of these individuals worldwide, and between 21.4% and 31% in Brasil. Anxiety affects up to 33.7% of the population during their lifetimes. OBJECTIVES: estimate the prevalence proportions of DAD among patients in a municipality in Northeast Brasil and study the association between DAD and cardiovascular risk factors. METHODS: a cross-sectional study with the medical records of patients from primary care centers in Jaboatão dos Guararapes, Pernambuco. Patients aged ≥ 18 years and regularly followed-up were included. Exclusion criteria: a history of traumatic brain injury, alcohol or drug abuse, previous stroke, medical conditions or medications that mimic DAD symptoms. Subjects were divided into two groups depending on the presence or absence of DAD, and cardiovascular risk factors were compared between groups. RESULTS: A total of 1030 subjects were initially included, of whom 215 (20%) were excluded. No-DAD subjects had more history of myocardial infarction and alcoholism. The prevalence of depression was 10.3%, anxiety disorder was 27.1%, and mixed DAD represented 4.5%. There was a significant association between DAD and hypertension (OR = 2.11; 95%CI: 1.16 -3.84; p=0.01), obesity (OR = 4.47; 95%CI: 1.74 -11.46; p=0.002), and hyperlipidemia (OR = 3.88; 95%CI: 1.81-8.3; p<0.001). CONCLUSION: DAD were associated with an increased risk for arterial hypertension, obesity, and hyperlipidemia.


Asunto(s)
Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Trastorno Depresivo/complicaciones , Trastorno Depresivo/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Estadísticas no Paramétricas
16.
Plast Reconstr Surg ; 144(1): 24-33, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31246794

RESUMEN

BACKGROUND: Revision procedures address contour irregularities and aesthetic concerns following autologous breast reconstruction. Mental health diagnoses are known to influence patient satisfaction with reconstruction. The authors aimed to identify oncologic, reconstructive, and demographic factors, including mental health diagnoses, associated with the number of revisions after autologous breast reconstruction. METHODS: The medical records of all adult women undergoing abdominal free flap-based breast reconstruction at a major academic institution between 2011 and 2016 were reviewed. Multivariate logistic regression was used to identify factors associated with receipt of revisions. Negative binomial regression was used to identify characteristics associated with number of revisions received. RESULTS: Of 272 patients identified, 55.2 percent received one revision, 23.2 percent received two revisions, and 10.3 percent received three or more revisions after autologous breast reconstruction (median, one; range, zero to five). After adjustment on multivariate analysis, anxiety (OR, 4.34; p = 0.016) and bilateral reconstruction (OR, 3.10; p = 0.017) were associated with receipt of any revisions; other oncologic and reconstructive factors including breast cancer stage, receipt of radiation therapy, and type or timing of free flap reconstruction were not associated with revisions. Using univariate negative binomial regression, anxiety (incidence rate ratio, 1.34; p = 0.006), Caucasian race (incidence rate ratio, 1.24; p = 0.02), and bilateral reconstruction (incidence rate ratio, 1.39; p = 0.04) were predictive of increased numbers of revisions received. After stepwise selection on multivariate analysis, anxiety remained the only significant predictor of increased numbers of revisions. CONCLUSIONS: Preoperative anxiety significantly influences the number of revisions after autologous breast reconstruction. Further research is necessary to better understand the interplay among mental health, patient preference, and outcomes in breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Asunto(s)
Trastornos de Ansiedad/complicaciones , Neoplasias de la Mama/cirugía , Colgajos Tisulares Libres , Mamoplastia/psicología , Adulto , Neoplasias de la Mama/psicología , Trastorno Depresivo/complicaciones , Femenino , Humanos , Mamoplastia/métodos , Persona de Mediana Edad , Satisfacción del Paciente , Cuidados Preoperatorios , Recto del Abdomen/trasplante , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Trasplante Autólogo
17.
Curr Psychiatry Rep ; 21(6): 40, 2019 04 29.
Artículo en Inglés | MEDLINE | ID: mdl-31037466

RESUMEN

PURPOSE OF REVIEW: The current review aims at providing an overview of relevant aspects of anxiety symptoms and anxiety disorders (AD) in adults patients with epilepsy (PWE). RECENT FINDINGS: Firstly, the appropriate diagnosis of type of anxiety symptoms and AD in PWE will be presented. Anxiety symptoms are often peri-ictal and classified in relation to their temporal occurrence to seizures. Anxiety symptoms are of three types: preictal (preceding a seizure), ictal (presenting as part of the seizure symptoms and signs), and postictal (occurring within 72 h of a seizure). AD are diagnosed in the interictal period and occur independently of seizures. Four specific AD in PWE can be objectified: anticipatory anxiety of epileptic seizures (AAS), seizure phobia, epileptic social phobia, and epileptic panic disorder. Secondly, the bidirectional pathophysiological relationship between anxiety and epilepsy will be described. Anxiety is a trigger for seizures in some patients, and the notion of stress and arousal is essential to understand the relationship between anxiety and seizure. Moreover, seizures arising from the limbic network especially involving amygdala, which may express fear-related semiology, provide insight into the pathophysiology of AD comorbidities. Thirdly, the methods of screening for AD and anxiety symptoms will be detailed. Fourthly, the pharmacological and psychobehavioral management of anxiety symptoms and AD in PWE will be presented. Arousal-based approaches for preictal and ictal symptoms and anxiety-based approaches for postictal and interictal symptoms will be presented. Despite lack of evidence-based approaches, it is recognized that management of epilepsy is not only about controlling seizures, but also depends heavily on detecting, correctly diagnosing, and appropriately managing anxiety symptoms and AD comorbidities, in order to maximize quality of life. Improving self-control and self-efficacy is of fundamental importance in the management of PWE. Further rigorously designed studies focusing on anxiety symptoms and AD are essential to improve the overall care of PWE.


Asunto(s)
Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/terapia , Epilepsia/complicaciones , Epilepsia/terapia , Ansiedad/complicaciones , Ansiedad/diagnóstico , Ansiedad/terapia , Trastornos de Ansiedad/diagnóstico , Comorbilidad , Humanos , Calidad de Vida , Convulsiones/complicaciones , Convulsiones/terapia
18.
Neuropsychology ; 33(5): 711-724, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31144830

RESUMEN

OBJECTIVE: It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. METHOD: To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. RESULTS: Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. CONCLUSION: These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Trastornos de Ansiedad/fisiopatología , Atención/fisiología , Conmoción Encefálica/fisiopatología , Disfunción Cognitiva/fisiopatología , Trastornos de Combate/fisiopatología , Función Ejecutiva/fisiología , Trastornos del Humor/fisiopatología , Trastornos por Estrés Postraumático/fisiopatología , Veteranos , Adulto , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/epidemiología , Conmoción Encefálica/complicaciones , Conmoción Encefálica/epidemiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Trastornos de Combate/complicaciones , Trastornos de Combate/epidemiología , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/complicaciones , Trastornos del Humor/epidemiología , Pruebas Neuropsicológicas , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/epidemiología , Estados Unidos/epidemiología , Veteranos/estadística & datos numéricos
19.
J Autism Dev Disord ; 49(9): 3602-3610, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31134428

RESUMEN

Family accommodation occurs frequently among families of children with OCD and anxiety disorders, with higher levels of accommodation repeatedly associated with greater symptom severity, lower functioning, and poorer treatment outcomes for children. This is the first examination of family accommodation of restricted and repetitive behaviors (RRBs) in children with autism spectrum disorder (ASD). Parents of children with ASD (N = 86) completed questionnaires assessing their children's RRBs and parental accommodation of these symptoms. Most participants (80%) reported engaging in accommodation at least once a month and family accommodation was significantly positively correlated with RRB severity. These results suggest accommodation of RRBs follows a pattern similar to that reported in obsessive compulsive and anxiety disorders, and highlight avenues for potential parent-based interventions.


Asunto(s)
Trastornos de Ansiedad/psicología , Trastorno del Espectro Autista/psicología , Familia/psicología , Trastorno Obsesivo Compulsivo/psicología , Adaptación Psicológica , Adolescente , Trastornos de Ansiedad/complicaciones , Actitud , Trastorno del Espectro Autista/complicaciones , Niño , Relaciones Familiares , Femenino , Humanos , Masculino , Trastorno Obsesivo Compulsivo/complicaciones , Encuestas y Cuestionarios
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