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1.
J Nerv Ment Dis ; 208(11): 843-847, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32910074

RESUMO

Individuals with generalized anxiety disorder (GAD) report poorer quality of life (QOL) than do nonanxious controls. Further, although positive affect (PA) and negative affect (NA) have been shown to predict QOL, no previous literature has tested this relationship in the context of individuals with GAD. In the present study, we evaluated the unique and interactive contributions of PA and NA on QOL within a sample of individuals diagnosed with GAD (N = 50). Specifically, a hierarchical regression was conducted to evaluate the unique contributions of PA, NA, and their interaction on QOL, over and above symptoms of depression. PA and depression symptoms were both significant predictors of QOL, whereas neither the main effect for NA nor the PA × NA interaction was statistically significant. Results suggest that, for those with GAD, PA uniquely contributes to QOL. Strategies to upregulate PA may be a useful treatment target for increasing QOL in individuals with GAD.

2.
Cogn Behav Ther ; 49(6): 439-454, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32631134

RESUMO

Previous studies examining the dose-response curve in psychotherapy have suggested that 11-19 sessions may be necessary for at least 50% of individuals to show clinically significant improvement. However, this curve has not been examined specifically for cognitive-behavioral therapy (CBT) for anxiety disorders, for which a more rapid recovery curve may be expected. Survival analysis was used to assess the dose-response curve for 201 patients with anxiety disorders who received weekly CBT at an anxiety specialty clinic. The primary outcome measure was the Outcome Questionnaire-45.2, which patients completed prior to each treatment session. Sixty-four percent of the sample achieved reliable change, and this response occurred in approximately five sessions on average. Fifty percent of the sample achieved clinically significant improvement, which occurred in approximately eight sessions on average. The findings suggest that earlier response may be expected in CBT for anxiety disorders, and are discussed in terms of potential ways to further improve response rates for this treatment.

3.
Hum Brain Mapp ; 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32596977

RESUMO

The ENIGMA group on Generalized Anxiety Disorder (ENIGMA-Anxiety/GAD) is part of a broader effort to investigate anxiety disorders using imaging and genetic data across multiple sites worldwide. The group is actively conducting a mega-analysis of a large number of brain structural scans. In this process, the group was confronted with many methodological challenges related to study planning and implementation, between-country transfer of subject-level data, quality control of a considerable amount of imaging data, and choices related to statistical methods and efficient use of resources. This report summarizes the background information and rationale for the various methodological decisions, as well as the approach taken to implement them. The goal is to document the approach and help guide other research groups working with large brain imaging data sets as they develop their own analytic pipelines for mega-analyses.

4.
Assessment ; : 1073191120918024, 2020 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-32362128

RESUMO

Hoarding disorder (HD) is a new psychiatric diagnosis in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition and preliminary evidence suggests that cognitive-behavioral treatments are effective in treating this condition. However, it has been demonstrated that individuals with HD generally display poor compliance during treatment, which may lead to poor outcomes. Treatment compliance can be conceptualized as either within-session or between-session compliance, but currently there are no validated measures of within-session or between-session compliance specifically for HD. The aim of this study was to provide an initial validation of the CBT Compliance Measure and the Patient Exposure/Response Prevention Adherence Scale for Hoarding in a sample of participants with HD who were undergoing group cognitive behavioral therapy (CBT) for HD (N = 70). Both measures, which were administered at each relevant treatment session, demonstrated a unidimensional structure, good reliability, as well as predictive validity, and are thus promising in the measurement of within-session and between-session compliance with CBT for HD.

5.
J Gerontol B Psychol Sci Soc Sci ; 75(7): 1475-1483, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30624724

RESUMO

OBJECTIVES: Assessing late-life anxiety using an instrument with sound psychometric properties including cross-cultural invariance is essential for cross-national aging research and clinical assessment. To date, no cross-national research studies have examined the psychometric properties of the frequently used Geriatric Anxiety Inventory (GAI) in depth. METHOD: Using data from 3,731 older adults from 10 national samples (Australia, Brazil, Canada, The Netherlands, Norway, Portugal, Spain, Singapore, Thailand, and United States), this study used bifactor modeling to analyze the dimensionality of the GAI. We evaluated the "fitness" of individual items based on the explained common variance for each item across all nations. In addition, a multigroup confirmatory factor analysis was applied, testing for measurement invariance across the samples. RESULTS: Across samples, the presence of a strong G factor provides support that a general factor is of primary importance, rather than subfactors. That is, the data support a primarily unidimensional representation of the GAI, still acknowledging the presence of multidimensional factors. A GAI score in one of the countries would be directly comparable to a GAI score in any of the other countries tested, perhaps with the exception of Singapore. DISCUSSION: Although several items demonstrated relatively weak common variance with the general factor, the unidimensional structure remained strong even with these items retained. Thus, it is recommended that the GAI be administered using all items.

6.
Behav Ther ; 50(6): 1150-1163, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31735249

RESUMO

Clinically significant anxiety is associated with an array of attentional symptoms (e.g., difficulty concentrating; unwanted thought) that are subjectively experienced as severe. However, neuropsychological findings are mixed with respect to the presence of cognitive deficits that can account for these symptoms. Contextualizing predictions from established clinical theories (e.g., Attentional Control Theory) within contemporary, neurobiologically derived models of cognitive control (Dual Mechanisms of Control Theory), the present study investigated the relationship between "cold" proactive and reactive cognitive control, task effort, and subjective attentional symptoms (difficulty concentrating; unwanted thought) in a mixed clinical sample of individuals with generalized anxiety disorder (GAD) and/or obsessive-compulsive disorder (OCD) and a comparison sample of healthy controls. Clinical status moderated the relationship between attentional symptoms (attentional focusing and trait worry) and proactive cognitive control response time. Clinical status also moderated the relationship between trait worry and task effort. Higher trait worry was associated with slower proactive control and lower effort in healthy participants, but faster proactive control in clinical participants. Self-reported attentional focusing showed differential validity vis-à-vis proactive control response time in clinical versus healthy participants. Post-hoc conditional effects analysis suggested more accurate self-appraisals in healthy controls, but was not significant after correction for multiple comparisons. Preliminary evidence suggested that differences in task effort in anxious versus healthy adults may relate to subjective attentional symptoms in GAD and OCD.


Assuntos
Transtornos de Ansiedade/psicologia , Atenção , Cognição , Adulto , Ansiedade/psicologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/psicologia , Autorrelato
7.
J Anxiety Disord ; 64: 71-78, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31048095

RESUMO

Generalized anxiety disorder (GAD) is defined in part by excessive and uncontrollable worry. However, little is known about cognitive control abilities in adults with GAD. The present study examined cognitive control over negative and neutral material in a mixed clinical sample of adults with GAD and/or obsessive-compulsive disorder and a comparison healthy control sample. Participants completed a novel emotional variant of the AX-CPT (eAX-CPT) to index proactive and reactive cognitive control in the presence of negative and neutral distractor stimuli. Participants with GAD demonstrated enhanced cognitive control specifically over negative emotional distractors, relative to neutral distractors (within-subjects) and relative to OCD and controls (between-subjects). Findings were specific to GAD versus trait worry; however, higher trait worry predicted better cognitive control in GAD only. These findings are inconsistent with deficit-based cognitive models of GAD and may be better accounted for by models that conceptualize worry as an intentional (albeit maladaptive) cognitive control or emotion regulation strategy that is actively maintained by individuals with GAD in order to avoid engaging with more distressing emotional information.


Assuntos
Transtornos de Ansiedade/psicologia , Cognição , Emoções , Transtorno Obsessivo-Compulsivo/psicologia , Adulto , Ansiedade/psicologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino
8.
J Consult Clin Psychol ; 87(7): 590-602, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31008633

RESUMO

OBJECTIVE: Hoarding disorder (HD) is a common and potentially debilitating psychiatric disorder. Thus far, psychological treatments have yielded modest effects and/or were time-consuming and costly to deliver. The aim of the present study was to test the efficacy of a brief group cognitive-behavioral therapy (CBT) for adults with HD and to test hypothesized mediators of treatment outcome. METHOD: Eighty-seven adults with a primary diagnosis of HD were randomized to either immediate CBT or wait list. CBT consisted of 16 weekly, 90-min group sessions that emphasized in-session practice of discarding and refraining from acquiring, decision-making and problem-solving training, emotional distress tolerance, motivational interviewing strategies, and contingency management. Participants were assessed at pretreatment, midtreatment, and posttreatment by an independent evaluator unaware of treatment condition. RESULTS: CBT was efficacious for the symptoms of HD compared with wait list. Saving-related cognitions, but not subjective cognitive impairment, partially mediated treatment outcomes. CONCLUSION: Brief Group CBT is an efficacious and feasible treatment for adults with HD, and is partially mediated by reductions in maladaptive beliefs about possessions. Superiority trials comparing CBT to active treatments, and additional research into mechanisms of treatment outcome, are warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental , Transtorno de Acumulação/terapia , Psicoterapia de Grupo , Adulto , Emoções , Feminino , Transtorno de Acumulação/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Resultado do Tratamento
10.
Front Psychol ; 9: 539, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29725312

RESUMO

Objective: The Difficulties in Emotion Regulation Scale (DERS) is a widely used self-report measure of subjective emotion ability, as defined by a prominent clinically derived model of emotion regulation (Gratz and Roemer, 2004). Although the DERS is often used in treatment and research settings for adults with emotional (i.e., anxiety, mood, obsessive-compulsive, or trauma-related) disorders, its psychometric properties are not well-characterized in this population. Method: We examined the psychometric properties of the DERS and three popular short forms (DERS-16; DERS-18; and DERS-SF) in a large (N = 427) sample of treatment-seeking adults with one or more DSM-5 emotional disorders. Results: For the original DERS, internal consistency was strong for all subscales except Awareness. A bifactor structure consisting of one general emotion dysregulation factor and five uncorrelated specific factors corresponding to the original DERS subscales (excluding Awareness) provided the best fit. A series of structural equation models (SEMs) demonstrated unique incremental contributions of the general factor and several specific factors to explaining concurrent clinical severity. The general factor and one specific factor (Goals) also prospectively predicted treatment outcome following a naturalistic course of outpatient cognitive-behavioral therapy (CBT) in a subset of participants (n = 202) for whom discharge data were available. Specifically, more severe emotion dysregulation at intake predicted better CBT response, while more severe impairment in goal-directed activity when distressed predicted worse CBT response. All three short forms showed a robust bifactor structure and good internal consistency and convergent validity vis-à-vis the original measure, albeit with a slight decrement in incremental utility (1-3% less variance explained in clinical severity). Conclusion: With the Awareness items excluded, the DERS showed good internal consistency and a robust bifactor latent structure. The general factor and several specific factors incrementally and prospectively predicted clinical severity and treatment outcome, which suggests that the DERS may have clinical and predictive utility in treatment-seeking adults with emotional disorders. Additional research is needed to establish convergent and discriminant validity in this population. The use of a short form in lieu of the full DERS may be sufficient for many general clinical and research purposes, particularly when participant burden is a concern.

11.
Brain Connect ; 7(5): 289-298, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28478685

RESUMO

Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are currently considered distinct diagnostic categories. Accumulating data suggest the study of anxiety disorders may benefit from the use of dimensional conceptualizations. One such dimension of shared dysfunction is emotion regulation (ER). The current study evaluated dimensional (ER) and categorical (diagnosis) neurocorrelates of resting-state functional connectivity (rsFC) in participants with GAD and SAD and healthy controls (HC). Functional magnetic resonance imaging (fMRI) rsFC was estimated between all regions of the default mode network (DMN), salience network (SN), and bilateral amygdala (N = 37: HC-19; GAD-10; SAD-8). Thereafter, rsFC was predicted by both ER, (using the Difficulties in Emotion Regulation Scale [DERS]), and diagnosis (DSM-5) within a single unified analysis of covariance (ANCOVA). For the ER dimension, there was a significant association between impaired ER abilities and anticorrelated rsFC of amygdala and DMN (L.amygdala-ACC: p = 0.011, beta = -0.345), as well as amygdala and SN (L.amygdala-posterior cingulate cortex [PCC]: p = 0.032, beta = -0.409). Diagnostic status was significantly associated with rsFC differences between the SAD and HC groups, both within the DMN (PCC-MPFC: p = 0.009) and between the DMN and SN (R.LP-ACC: p = 0.010). Although preliminary, our results exemplify the potential contribution of the dimensional approach to the study of GAD and SAD and support a combined categorical and dimensional model of rsFC of anxiety disorders.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Conectoma/métodos , Rede Nervosa/fisiopatologia , Fobia Social/fisiopatologia , Adolescente , Adulto , Algoritmos , Medicina Baseada em Evidências , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Vias Neurais/fisiopatologia , Reprodutibilidade dos Testes , Descanso , Sensibilidade e Especificidade , Adulto Jovem
12.
Behav Res Ther ; 90: 32-40, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27960095

RESUMO

Recent clinical trial research suggests that baseline low end-tidal CO2 (ETCO2, the biological marker of hyperventilation) may predict poorer response to cognitive-behavioral therapy (CBT) for anxiety-related disorders. The present study examined the predictive value of baseline ETCO2 among patients treated for such disorders in a naturalistic clinical setting. Sixty-nine adults with a primary diagnosis of a DSM-5 anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder completed a 4-min assessment of resting ETCO2, and respiration rate (the first minute was analyzed). Lower ETCO2 was not associated with a diagnosis of panic disorder, and was associated with lower subjective distress ratings on certain measures. Baseline ETCO2 significantly predicted treatment dropout: those meeting cutoff criteria for hypocapnia were more than twice as likely to drop out of treatment, and ETCO2 significantly predicted dropout beyond other pre-treatment variables. Weekly measurement suggested that the lower-ETCO2 patients who dropped out were not responding well to treatment prior to dropout. The present results, along with previous clinical trial data, suggest that lower pre-treatment ETCO2 is a negative prognostic indicator for CBT for anxiety-related disorders. It is suggested that patients with lower ETCO2 might benefit from additional intervention that targets respiratory abnormality.


Assuntos
Transtornos de Ansiedade/metabolismo , Dióxido de Carbono/metabolismo , Terapia Cognitivo-Comportamental , Hiperventilação/psicologia , Hipocapnia/psicologia , Transtorno Obsessivo-Compulsivo/metabolismo , Pacientes Desistentes do Tratamento , Transtornos de Estresse Pós-Traumáticos/metabolismo , Estresse Psicológico/metabolismo , Adulto , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Testes Respiratórios , Feminino , Humanos , Hiperventilação/metabolismo , Hipocapnia/complicações , Masculino , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/fisiopatologia , Transtorno Obsessivo-Compulsivo/terapia , Taxa Respiratória/fisiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia , Estresse Psicológico/complicações , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Resultado do Tratamento , Adulto Jovem
13.
J Anxiety Disord ; 43: 1-7, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27467027

RESUMO

Generalized anxiety disorder (GAD) is characterized by emotion regulation difficulties, which are associated with abnormalities in neural circuits encompassing fronto-limbic regions including the dorsolateral prefrontal cortex (DLPFC). The aim of this study was to determine whether DLPFC neuromodulation improves emotion regulation in patients with GAD. This is a secondary analysis from a randomized-controlled trial comparing 30 sessions of low-frequency right-sided active (n=13) versus sham (n=12, sham coil) repetitive transcranial magnetic stimulation (rTMS) at the right DLPFC in patients with GAD. Results indicated statistically significant improvements in self-reported emotion regulation difficulties at posttreatment and 3-month follow-up in the active group only. Improvements were found primarily in the domains of goal-directed behaviors and impulse control and were significantly associated with a global clinician rating of improvement. These preliminary results support rTMS as a treatment for GAD and suggest improved emotion regulation as a possible mechanism of change.


Assuntos
Transtornos de Ansiedade/terapia , Emoções , Estimulação Magnética Transcraniana , Adulto , Transtornos de Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Resultado do Tratamento
14.
J Affect Disord ; 201: 112-5, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27195516

RESUMO

BACKGROUND: The Overall Anxiety Severity and Impairment Scale (OASIS) is a brief, transdiagnostic measure used to assess anxiety severity and related interference. The OASIS has demonstrated strong psychometric properties in previous investigations, however, it has yet to be validated using a transdiagnostic clinician-rated measure. METHODS: We evaluated the factor structure, convergent and discriminant validity, and illness severity cut-scores of the OASIS in a sample of outpatients (N=202). RESULTS: A confirmatory factor analysis indicated an unidimensional structure provided the best fit. The OASIS demonstrated good convergent validity and internal consistency. Using the Clinical Global Impression-Severity Scale (CGI-S), ROC curves showed OASIS scores of 6, 10 and 12 to indicate moderate, marked and severe illness severity, respectively. CONCLUSIONS: The OASIS is a unidimensional self-report measure with good convergent validity and data from the current study provide illness severity cut-scores.


Assuntos
Transtornos de Ansiedade/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Adulto , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Análise Fatorial , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Psicometria/métodos , Curva ROC , Reprodutibilidade dos Testes , Autorrelato , Índice de Gravidade de Doença
15.
Br J Psychiatry ; 209(3): 222-8, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27198484

RESUMO

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) holds promise for treating generalised anxiety disorder (GAD) but has only been studied in uncontrolled research. AIMS: This is the first randomised controlled trial (clinicaltrials.gov: NCT01659736) to investigate the efficacy and neural correlates of rTMS in GAD. METHOD: Twenty five participants (active n = 13; sham, n = 12) enrolled. rTMS was targeted at the right dorsolateral prefrontal cortex (DLPFC, 1 Hz, 90% resting motor threshold). RESULTS: Response and remission rates were higher in the active v. sham groups and there were significant group × time interactions for anxiety, worry and depressive symptoms, favouring active v. sham. In addition, right DLPFC activation during a decision-making gambling task increased at post-treatment for active rTMS only, and changes in neuroactivation correlated significantly with changes in worry symptoms. CONCLUSIONS: Findings provide preliminary evidence that rTMS may improve GAD symptoms in association with modifying neural activity in the stimulation site.


Assuntos
Transtornos de Ansiedade/terapia , Córtex Pré-Frontal/fisiologia , Estimulação Magnética Transcraniana , Adulto , Tomada de Decisões/fisiologia , Método Duplo-Cego , Feminino , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Projetos Piloto , Resultado do Tratamento , Adulto Jovem
16.
Behav Ther ; 46(6): 764-74, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26520219

RESUMO

Internet-guided self-help (iGSH) has amassed significant empirical support for a variety of psychiatric conditions; however, it is not known who responds best to these treatments. This open trial examined the clinical outcomes and predictors of a 17-week iGSH program for obsessive-compulsive disorder (OCD). Therapist support was provided either in person or by phone 9 times for an average of 13minutes per session. Twenty-four patients initiated treatment, and 17 of these (70.8%) completed. Results of the intent-to-treat sample indicated statistically significant improvements at posttreatment with large treatment effects for OCD symptoms as assessed by the Yale Brown Obsessive-Compulsive Scale (d=0.87), and small to moderate improvements in depression (d=0.19), functioning (d=0.53), and quality of life (d=-0.18). These outcomes were largely maintained over a 6-month follow-up. Readiness to reduce avoidance of OCD triggers and attendance to therapist sessions were moderately associated with posttreatment response, and correctly classified the responder status (defined as clinically significant change) of nearly 9 out of 10 patients at posttreatment. These same variables did not predict responder status at 6-month follow-up. These results lend further empirical support to iGSH as a treatment for OCD and provide direction on the development of predictor models to identify patients who are and are not likely to acutely respond to iGSH.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Internet , Transtorno Obsessivo-Compulsivo/terapia , Qualidade de Vida , Terapia Assistida por Computador/métodos , Adulto , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Escalas de Graduação Psiquiátrica , Telemedicina/métodos , Resultado do Tratamento
18.
Psychol Assess ; 27(3): 874-82, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25664634

RESUMO

Traditionally, hoarding symptoms were coded under obsessive-compulsive disorder (OCD), however, in DSM-5 hoarding symptoms are classified as a new independent diagnosis, hoarding disorder (HD). This change will likely have a considerable impact on the self-report scales that assess symptoms of OCD, since these scales often include items measuring symptoms of hoarding. This study evaluated the psychometric properties of one of the most commonly used self-report measures of OCD symptoms, the Obsessive-Compulsive Inventory-Revised (OCI-R), in a sample of 474 individuals with either OCD (n = 118), HD (n = 201), or no current or past psychiatric disorders (n = 155). Participants with HD were diagnosed according to the proposed DSM-5 criteria. For the purposes of this study the OCI-R was divided into two scales: the OCI-OCD (measuring the five dimensions of OCD) and the OCI-HD (measuring the hoarding dimension). Evidence of validity for the OCI-OCD and OCI-HD was obtained by comparing scores with the Saving Inventory Revised (SI-R), the Hoarding Rating Scale (HRS) and the Beck Anxiety Inventory (BAI). Receiver operating curves for both subscales indicated good sensitivity and specificity for cut-scores determining diagnostic status. The results indicated that the OCI-OCD and OCI-HD subscales are reliable and valid measures that adequately differentiate between DSM-5 diagnostic groups. Implications for the future use of the OCI-R in OCD and HD samples are discussed.


Assuntos
Transtorno de Acumulação/diagnóstico , Transtorno Obsessivo-Compulsivo/diagnóstico , Adulto , Estudos de Casos e Controles , Feminino , Transtorno de Acumulação/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/psicologia , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários
19.
Artigo em Inglês | MEDLINE | ID: mdl-31544016

RESUMO

Hoarding disorder (HD) is characterized by excessive saving and difficulty discarding possessions, which results in severe clutter and functional impairment. HD shows patterns of elevated comorbidity with the inattentive subtype of attention deficit-hyperactivity disorder (ADHD-I). ADHD-I symptoms are associated with more severe HD pathology (Tolin & Villavicencio, 2011), but the mechanisms underlying this association are unclear. The present study used serial mediation analyses in a sample of individuals with HD (n = 32) and healthy controls (n = 26) to test one potential pathway: ADHD-I symptoms lead to poor memory confidence, which leads to excessive saving of possessions to facilitate remembering, which in turn leads to clutter and corresponding functional impairment. The model provided a strong fit for the data, accounting for over 90% of the variance in functional impairment. Alternate models that did not include ADHD-I symptoms and poor memory confidence provided a weaker fit. These findings support and extend leading cognitive-behavioral conceptualizations of HD (e.g., Frost & Hartl, 1996) and point to inattention symptoms and memory confidence as potential targets for HD prevention and intervention research.

20.
Am J Geriatr Psychiatry ; 22(12): 1418-26, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23954040

RESUMO

OBJECTIVES: The factor structure and clinical correlates of the Geriatric Anxiety Inventory were determined within a sample of patients with cognitive impairment. METHODS: Using a cross-sectional design, data were collected within an outpatient Memory Disorders Center. Clinical participants were diagnosed with either mild dementia (N = 45) or cognitive impairment, no dementia (N = 55). A comparison group of participants without subjective memory complaints (N = 50) was also included. The Geriatric Anxiety Inventory was administered and scored as both the 20-item version and 5-item short form. Measures of cognitive status, depressive symptoms, and functioning were also completed. RESULTS: Clinical participants reported more severe anxiety than did participants in the comparison group; however, the two patient groups did not differ. Principal components analysis revealed a four-factor structure of the Geriatric Anxiety Inventory. Item endorsement on factors characterized by excessive worry and difficulty making decisions were associated with a nearly twofold (odds ratio [OR]: 1.86) and nearly sixfold (OR: 5.70) odds of having cognitive impairment, respectively. The short-form version was composed of a single factor, and item endorsement was associated with a twofold increased odds of having cognitive impairment (OR: 2.02). CONCLUSION: Psychometric properties of the Geriatric Anxiety Inventory are acceptable among patients with cognitive impairment. Anxiety symptoms were common, and symptoms characterized by excessive worry and difficulty making decisions demonstrated the strongest associations with cognitive status.


Assuntos
Ansiedade/diagnóstico , Transtornos Cognitivos/diagnóstico , Demência/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/instrumentação , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Transtornos Cognitivos/epidemiologia , Comorbidade , Demência/epidemiologia , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade
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