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1.
Int Immunopharmacol ; 97: 107724, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33951558

RESUMO

BACKGROUND: Vaccination is crucial to limit the pandemic spread of SARS-CoV-2/COVID-19. Therefore, besides the development and supply of vaccines, it is essential that sufficient individuals are willing to get vaccinated, but concerning proportions of populations worldwide show vaccine hesitancy. This makes it important to determine factors that are associated with vaccine acceptance. METHODS: 1779 adults of a non-probability convenience sample in Germany were assessed with an online survey in a cross-sectional survey period from 1st to 11th January 2021 (a few days after the beginning of vaccinations in Germany). RESULTS: 64.5% of the sample stated that they absolutely would accept the vaccination, 13.8% would rather accept it, 10.4% were undecided, and 5.2% would rather not and 6.0% absolutely not get vaccinated. COVID-19-related anxiety, and fears of infection and health-related consequences correlated significantly positively with vaccine acceptance (all p < .001). In contrast, social (p = .006) and economic fears (p < .001) showed significant negative associations with vaccination willingness. The broader constructs of unspecific anxiety and depressive symptoms were not significantly associated with vaccine acceptance. Vaccine acceptance differed between users/non-users of social media and official websites to gain information about the pandemic (p < .001). CONCLUSIONS: COVID-19-related anxiety and health-related fears were associated with higher vaccine acceptance, whereas the fear of social and economic consequences showed the contrary direction. These findings highlight the need to differentiate between several types of fears and anxiety to predict their influence on vaccine acceptance, and provide important information and an essential base for future studies and interventions.

2.
J Anxiety Disord ; 79: 102377, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33662702

RESUMO

Especially individuals with mental disorders might experience an escalation of psychopathological symptoms during the COVID-19 pandemic. Therefore, we investigated the role of anxiety, depressive, and other mental disorders for levels and longitudinal changes of COVID-19-related fear, anxiety and depressive symptoms during the first months of the COVID-19 pandemic in Germany. In a longitudinal observational design with four assessment waves from March, 27th until June, 15th 2020, a total of 6,551 adults from Germany was assessed. 4,175 individuals participated in one, 1,070 in two, 803 in three, and 503 in all four waves of data collection. Multilevel analyses revealed that across all assessment waves, COVID-19-related fear, anxiety, and depressive symptoms were significantly higher in individuals with vs. without anxiety, depressive, and other mental disorders. All symptoms decreased on average over time, and this decrease was significantly stronger in individuals with vs. without anxiety disorders, and particularly driven by individuals with generalized anxiety disorder. Our findings suggest that individuals with mental disorders, especially anxiety disorders - and in particular those with a generalized anxiety disorder - seem to be vulnerable to experience psychological strain in the context of the pandemic, might likely overestimate potential threat, and should be targeted by preventive and therapeutic interventions.


Assuntos
Pandemias , Adulto , Ansiedade/epidemiologia , Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Alemanha/epidemiologia , Humanos
3.
Brain Behav ; : e01964, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33230969

RESUMO

BACKGROUND: The COVID-19 pandemic is related to multiple stressors and therefore may be associated with psychological distress. The aim of this study was to longitudinally assess symptoms of (un-)specific anxiety and depression along different stages of the pandemic to generate knowledge about the progress of psychological consequences of the pandemic and to test the role of potential risk and resilience factors that were derived from cross-sectional studies and official recommendations. METHODS: The present study uses a longitudinal observational design with four waves of online data collection (from March 27 to June 15, 2020) in a convenience sample of the general population in Germany. A total of N = 2376 participants that completed at least two waves of the survey were included in the analyses. FINDINGS: Specific COVID-19-related anxiety and the average daily amount of preoccupation with the pandemic decreased continuously over the four waves. Unspecific worrying and depressive symptoms decreased on average but not on median level. Self-efficacy, normalization, maintaining social contacts, and knowledge, where to get medical support, were associated with fewer symptoms relative to baseline. Suppression, unhealthy habits, and a longer average daily time of thinking about the pandemic were correlated with a relative increase of symptoms. INTERPRETATION: Our findings provide insight into the longitudinal changes of symptoms of psychological distress along the first three months of the COVID-19 pandemic in Germany. Furthermore, we were able to reaffirm the anticipated protective and risk factors that were extracted from previous studies and recommendations.

4.
J Anxiety Disord ; 76: 102311, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33007710

RESUMO

BACKGROUND: Aerobic exercise (AE) demonstrated an overall medium treatment effect in anxiety disorders (AD) but there is evidence for an "intensity-response" relationship. High intensity interval training (HIIT) was highly effective on a range of (mental) health parameters. However, so far no randomised-controlled trial (RCT) investigated the efficacy of HIIT in AD. METHODS: 33 patients with generalized anxiety disorder (GAD) were randomly assigned to 12-day HIIT or a training of lower intensity (LIT). Anxiety, comorbid depression, stress-related bodily symptoms and perceived control over anxiety related stimuli (PC) were assessed at baseline, post-training and 30 days after baseline by using the Penn State Worry Questionnaire (PSWQ), the Hamilton Inventories for Anxiety and Depression (Ham-A, Ham-D), the Screening for Somatoform Symptoms-7 (SOMS-7) and the Anxiety Control Questionnaire (ACQ-R). RESULTS: Both interventions showed moderate or large effects on all clinical measures. However, effects for HIIT were generally about twice as high as for LIT. PC negatively correlated with GAD severity in the whole sample at baseline but an association of training-induced changes in PC and worrying were exclusively detectable in HIIT. CONCLUSION: HIIT was highly effective and fast acting in GAD. Therefore, it may complement first-line treatment approaches in this condition.

5.
BJPsych Open ; 6(5): e91, 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32812525

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic may cause psychological distress in the general population and has the potential to cause anxiety regarding COVID-19. No validated questionnaires exist for the measurement of specific COVID-19 anxiety. We modified the DSM 5 - Severity Measure for Specific Phobia-Adult scale specifically for anxiety regarding COVID-19, and report the psychometric properties from an online study with 6262 participants from the general population in Germany. We analysed internal consistency as well as concordant validity. The scale showed good internal consistency (α = 0.86) and good concordant validity (rs = 0.60) with the 2-item Generalized Anxiety Disorder measure and rs = 0.61 with self-rating of limitations in daily life caused by COVID-19 anxiety.

6.
Brain Behav ; 10(9): e01745, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32633464

RESUMO

BACKGROUND: The current COVID-19 pandemic comes with multiple psychological stressors due to health-related, social, economic, and individual consequences and may cause psychological distress. The aim of this study was to screen the population in Germany for negative impact on mental health in the current COVID-19 pandemic and to analyze possible risk and protective factors. METHODS: A total of 6,509 people took part in an online survey in Germany from 27 March to 6 April. The questionnaire included demographic information and ascertained psychological distress, anxiety and depressive symptoms, and risk and protective factors. RESULTS: In our sample, over 50% expressed suffering from anxiety and psychological distress regarding the COVID-19 pandemic. Participants spent several hours per day thinking about COVID-19 (M = 4.45). Psychological and social determinants showed stronger associations with anxiety regarding COVID-19 than experiences with the disease. CONCLUSIONS: The current COVID-19 pandemic does cause psychological distress, anxiety, and depression for large proportions of the general population. Strategies such as maintaining a healthy lifestyle and social contacts, acceptance of anxiety and negative emotions, fostering self-efficacy, and information on where to get medical treatment if needed, seem of help, while substance abuse and suppression of anxiety and negative emotions seem to be associated with more psychological burden.

7.
Artigo em Inglês | MEDLINE | ID: mdl-32691135

RESUMO

In context of the current COVID-19 pandemic the consumption of pandemic-related media coverage may be an important factor that is associated with anxiety and psychological distress. Aim of the study was to examine those associations in the general population in Germany. 6233 participants took part in an online-survey (March 27th-April 6th, 2020), which included demographic information and media exploitation in terms of duration, frequency and types of media. Symptoms of depression, unspecific anxiety and COVID-19 related anxiety were ascertained with standardized questionnaires. Frequency, duration and diversity of media exposure were positively associated with more symptoms of depression and unspecific and COVID-19 specific anxiety. We obtained the critical threshold of seven times per day and 2.5 h of media exposure to mark the difference between mild and moderate symptoms of (un)specific anxiety and depression. Particularly the usage of social media was associated with more pronounced psychological strain. Participants with pre-existing fears seem to be particularly vulnerable for mental distress related to more immoderate media consumption. Our findings provide some evidence for problematical associations of COVID-19 related media exposure with psychological strain and could serve as an orientation for recommendations-especially with regard to the thresholds of critical media usage.

8.
J Neural Transm (Vienna) ; 127(11): 1527-1537, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32468273

RESUMO

While DNA methylation patterns have been studied for a role in the pathogenesis of anxiety disorders, the role of the enzymes establishing DNA methylation-DNA methyltransferases (DNMTs)-has yet to be investigated. In an effort to investigate DNMT genotype-specific effects on dimensional anxiety traits in addition to the categorical phenotype of panic disorder, 506 panic disorder patients and 3112 healthy participants were assessed for anxiety related cognition [Agoraphobic Cognitions Questionnaire (ACQ)], anxiety sensitivity [Anxiety Sensitivity Index (ASI)] as well as pathological worry [Penn State Worry Questionnaire (PSWQ)] and genotyped for five single nucleotide polymorphisms (SNPs) in the DNMT3A (rs11683424, rs1465764, rs1465825) and DNMT3B (rs2424932, rs4911259) genes, which have previously been found associated with clinical and trait-related phenotypes. There was no association with the categorical phenotype panic disorder. However, a significant association was discerned between DNMT3A rs1465764 and PSWQ scores in healthy participants, with the minor allele conveying a protective effect. In addition, a marginally significant association between questionnaire scores (PSWQ, ASI) in healthy participants and DNMT3B rs2424932 was detected, again with the minor allele conveying a protective effect. The present results suggest a possible minor role of DNMT3A and DNMT3B gene variation in conveying resilience towards anxiety disorders. As the observed associations indicated a protective effect of two SNPs particularly with pathological worry, future studies are proposed to explore these variants in generalized anxiety disorder rather than panic disorder.

9.
Nervenarzt ; 91(5): 417-421, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32221635

RESUMO

BACKGROUND: In the current COVID-19 pandemia, health workers from all professions are facing great challenges in coping with the crisis. In this situation health professionals are confronted with specific stressors and risks not only for the physical but also for the mental health. OBJECTIVE: This article summarizes the first recommendations for the reduction of stress and psychological burden in health professionals during the current COVID-19 pandemia. METHODS: The recommendations of the World Health Organization, the United Nations and the International Red Cross Society are summarized. Recommendations for the reduction of stress and psychological distress in health professionals as well as important factors that team leaders can consider in order to reduce psychological distress in employees are presented. RESULTS: The normalization of strong emotions and stress, the fulfillment of basic needs, social support, clear communication and distribution of tasks, flexible working hours and the utilization of psychosocial and psychological help without stigmatization seem to be particularly important measures. CONCLUSION: This article presents guidelines for health professionals and team leaders in healthcare that help to maintain mental health during the COVID-19 pandemia.


Assuntos
Infecções por Coronavirus , Pessoal de Saúde/psicologia , Pandemias , Pneumonia Viral , Angústia Psicológica , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Local de Trabalho/psicologia , Humanos , Organização Mundial da Saúde
10.
Clin EEG Neurosci ; 51(5): 317-324, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31914806

RESUMO

Panic disorder (PD) has been linked to abnormalities in information processing. However, only little evidence has been published for sensory gating in PD. Sensory gating describes the brain's ability to exclude stimuli of low relevance from higher level information processing, thereby sustaining efficient cognitive processing. Deficits in sensory gating have been associated with various psychiatric conditions, most prominently schizophrenia. In this case-control event-related potential study, we tested 32 patients with PD and 39 healthy controls in a double click paradigm. Both groups were compared with regard to pre-attentive (P50), early-attentive (N100), and late-attentive (P200) sensory gating indices. Contrary to a hypothesized deficit, PD patients and healthy controls showed no differences in P50, N100 and P200 values. These results suggest that sensory gating seems to be functional across the pre-attentive, early-attentive, and late-attentive time span in this clinical population. Given this consistency across auditory sensory gating indices, further research aiming to clarify information processing deficits in PD should focus on other neurophysiological markers to investigate information processing deficits in PD (eg, P300, error-related negativity or mismatch negativity).

11.
Mol Psychiatry ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712720

RESUMO

Panic disorder (PD) has a lifetime prevalence of 2-4% and heritability estimates of 40%. The contributory genetic variants remain largely unknown, with few and inconsistent loci having been reported. The present report describes the largest genome-wide association study (GWAS) of PD to date comprising genome-wide genotype data of 2248 clinically well-characterized PD patients and 7992 ethnically matched controls. The samples originated from four European countries (Denmark, Estonia, Germany, and Sweden). Standard GWAS quality control procedures were conducted on each individual dataset, and imputation was performed using the 1000 Genomes Project reference panel. A meta-analysis was then performed using the Ricopili pipeline. No genome-wide significant locus was identified. Leave-one-out analyses generated highly significant polygenic risk scores (PRS) (explained variance of up to 2.6%). Linkage disequilibrium (LD) score regression analysis of the GWAS data showed that the estimated heritability for PD was 28.0-34.2%. After correction for multiple testing, a significant genetic correlation was found between PD and major depressive disorder, depressive symptoms, and neuroticism. A total of 255 single-nucleotide polymorphisms (SNPs) with p < 1 × 10-4 were followed up in an independent sample of 2408 PD patients and 228,470 controls from Denmark, Iceland and the Netherlands. In the combined analysis, SNP rs144783209 showed the strongest association with PD (pcomb = 3.10 × 10-7). Sign tests revealed a significant enrichment of SNPs with a discovery p-value of <0.0001 in the combined follow up cohort (p = 0.048). The present integrative analysis represents a major step towards the elucidation of the genetic susceptibility to PD.

12.
J Anxiety Disord ; 68: 102149, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31698111

RESUMO

The apparent efficacy of d-cycloserine (DCS) for enhancing exposure treatment for anxiety disorders appears to have declined over the past 14 years. We examined whether variations in how DCS has been administered can account for this "declining effect". We also investigated the association between DCS administration characteristics and treatment outcome to find optimal dosing parameters. We conducted a secondary analysis of individual participant data obtained from 1047 participants in 21 studies testing the efficacy of DCS-augmented exposure treatments. Different outcome measures in different studies were harmonized to a 0-100 scale. Intent-to-treat analyses showed that, in participants randomized to DCS augmentation (n = 523), fewer DCS doses, later timing of DCS dose, and lower baseline severity appear to account for this decline effect. More DCS doses were related to better outcomes, but this advantage leveled-off at nine doses. Administering DCS more than 60 minutes before exposures was also related to better outcomes. These predictors were not significant in the placebo arm (n = 521). Results suggested that optimal DCS administration could increase pre-to-follow-up DCS effect size by 50%. In conclusion, the apparent declining effectiveness of DCS over time may be accounted for by how it has been administered. Optimal DCS administration may substantially improve outcomes. Registration: The analysis plan for this manuscript was registered on Open Science Framework (https://osf.io/c39p8/).


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Terapia Combinada/métodos , Ciclosserina/administração & dosagem , Ciclosserina/uso terapêutico , Terapia Implosiva/métodos , Adolescente , Adulto , Idoso , Ansiedade/psicologia , Ansiedade/terapia , Transtornos de Ansiedade/tratamento farmacológico , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
13.
Neuropsychobiology ; 78(1): 31-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947222

RESUMO

Panic disorder (PD) is associated with increased body vigilance and reduced cognitive resources directed at non-fear-related stimuli, particularly in the absence of stimulus-rich environments. To date, only few studies have investigated whether this deficit in PD is reflected in reduced mismatch negativity (MMN), an event-related potential indexing preattentive sensitivity to unexpected stimulus changes. We tested 35 patients affected by PD and 42 matched healthy controls in an oddball paradigm, using frequency and duration deviant stimuli to measure auditory MMN. PD patients displayed reduced duration MMN amplitudes in comparison to healthy controls. No group differences were detected for duration MMN latency, as well as frequency MMN indices. Results support the notion of reduced processing of non-fear-related stimuli in PD patients, particularly with regard to the preattentive processing of sound duration deviants. Additionally, our findings are in line with clinical studies reporting divergent deficits in preattentive processing of frequency and duration deviants.


Assuntos
Atenção , Percepção Auditiva , Transtorno de Pânico/psicologia , Adulto , Atenção/fisiologia , Percepção Auditiva/fisiologia , Encéfalo/fisiopatologia , Eletroencefalografia , Feminino , Humanos , Masculino , Transtorno de Pânico/fisiopatologia , Transtorno de Pânico/terapia
14.
J Anxiety Disord ; 64: 16-23, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30875662

RESUMO

Patients with anxiety disorders have a lower heart rate variability (HRV) than healthy controls. Low HRV is associated with cardiovascular disease and dysfunction of the autonomic nervous system (ANS). The aim of the present study was to investigate if HRV in patients with agoraphobia with or without panic disorder can be influenced by cognitive behavioral therapy (CBT). 73 patients with agoraphobia with or without panic disorder were included in the study. Heart rate (HR) and HRV were recorded at rest before and after CBT and during in-vivo exposure. No changes in HR and HRV were observed throughout therapy. During in-vivo exposure HRV increased significantly and HR exhibited a tendency to decrease. Despite clinical improvement of anxiety symptoms, ANS activity at rest did not seem to be influenced by CBT. However, during in-vivo exposure, HRV changed significantly, indicating a higher parasympathetic activity at the end of exposure.


Assuntos
Agorafobia/complicações , Agorafobia/fisiopatologia , Terapia Cognitivo-Comportamental , Frequência Cardíaca , Transtorno de Pânico/complicações , Adulto , Agorafobia/psicologia , Agorafobia/terapia , Sistema Nervoso Autônomo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/psicologia
15.
J Nerv Ment Dis ; 207(3): 184-187, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30724830

RESUMO

High-intensity interval training (HIIT) may produce strong physiological but also psychological effects within a short period. However, it is questionable if this type of training is applicable and effective in patients with panic disorder (PD) because they are more vulnerable to the adverse effects of exercise. Twelve PD patients performed a 12-day HIIT trial. Every second day, patients performed 10 high-intensive 1-minute intervals at 77% to 95% of their maximum heart rate separated by 1-minute intervals with moderate to low intensity. All patients completed the 12-day training period. PD severity, agoraphobia, depression, general disorder severity, and endurance performance improved substantially with moderate to large effects sizes. Moreover, the increase in endurance performance was correlated with the reduction of depression and agoraphobia. HIIT was well tolerated by patients with PD and may induce rapid and strong therapeutic effects. A randomized controlled clinical trial is needed to verify our findings.


Assuntos
Agorafobia/terapia , Terapia por Exercício/métodos , Treinamento Intervalado de Alta Intensidade/métodos , Transtorno de Pânico/terapia , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Resultado do Tratamento
16.
Eur Arch Psychiatry Clin Neurosci ; 269(5): 529-542, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30194668

RESUMO

INTRODUCTION: While physical activity (PA) can play an important role in the treatment of mental disorders (MD), large proportions of patients with MD do not meet PA recommendations. The aim of this trial was to evaluate whether structured psychological intervention (MoVo-LISA) is effective in helping outpatients with MD to increase their level of PA. As active control group (CG) we modified MoVo-LISA to target healthy diet behavior. METHODS: N = 83 outpatients with MD (F1-F4) were randomized to the two conditions. PA (self-report and accelerometry), dietary behavior, social-cognitive determinants of health behavior change, psychiatric symptoms and health-related quality of life were assessed at baseline, 1 and 12 weeks after the intervention. RESULTS: Significant time*group interaction effects for objectively measured PA, dietary behavior and fruit and vegetable consumption indicated differential effects of the interventions on these outcomes. PA increased in the MoVo-LISA group (IG) from baseline to follow-up while it decreased in CG. IG showed a significant higher level of objectively measured PA at follow-up compared to CG. Dietary behavior and fruit and vegetable consumption significantly increased from baseline to follow-up in CG, but not IG. IG showed a significant increase in some, but not all social cognitive determinants of health behavior change. CONCLUSIONS: MoVo-LISA is effective in helping outpatients with MD to increase their level of PA in short- and mid-term. The used intervention strategies are effective for the promotion of healthy diet in patients with MD as well.


Assuntos
Dieta Saudável/psicologia , Exercício Físico/psicologia , Transtornos Mentais/psicologia , Qualidade de Vida/psicologia , Acelerometria , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Promoção da Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Autorrelato
17.
Nord J Psychiatry ; 72(5): 325-335, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29644923

RESUMO

BACKGROUND: Patients' characteristics and antidepressants are discussed to be relevant in the context of phobic exposure. AIMS: To identify patients characteristics associated with a differential course of fear during disorder-specific symptom provocation as well as to elucidate the effect of selective serotonin-(noradrenalin-) reuptake inhibitors [SS(N)RI] on development of fear in the context of re-exposure to the phobic stimuli. METHODS: Twenty-eight clinically well-characterized patients with panic disorder and agoraphobia (PD/AG) were classified into subjects who show a reduction of fear ('Fear-') during a symptom provocation via a picture-based paradigm (T1) and those who did not ('Fear+'). Subsequently, SS(N)RI treatment was administered to all patients and subjects were re-exposed to the feared stimuli after 8 weeks of treatment (T2). Moreover, brain activity within the 'fear network' was measured via functional magnetic resonance imaging (fMRI) at T1 and T2. RESULTS: Fear - were significantly younger and demonstrated increased exposure-related fear as well as stronger activity in several fear-related brain areas than Fear+. We found significant improvements in all clinical parameters after pharmacological intervention for the whole sample (T1-T2; all measures p < .02). However, reduction of fear as well as activation in (para)limbic structures during symptom provocation were now attenuated in Fear - but increased in Fear+. CONCLUSIONS: Advanced age may predict a therapeutically unfavorable course of fear during agoraphobic symptom provocation. Since we found no negative impact of medication on fear development at all, there was some evidence that SS(N)RI treatment might improve the individual ability to get involved with the agoraphobic stimuli while conducting disorder-specific exposure.


Assuntos
Agorafobia/tratamento farmacológico , Agorafobia/psicologia , Medo/psicologia , Inibidores de Captação de Serotonina/uso terapêutico , Adulto , Agorafobia/diagnóstico por imagem , Transtornos de Ansiedade/diagnóstico por imagem , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/psicologia , Encéfalo/diagnóstico por imagem , Medo/efeitos dos fármacos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico por imagem , Transtorno de Pânico/tratamento farmacológico , Transtorno de Pânico/psicologia , Resultado do Tratamento
18.
J Psychiatr Res ; 101: 34-41, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29539585

RESUMO

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.


Assuntos
Agorafobia/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Terapia Implosiva/métodos , Transtorno de Pânico/terapia , Adulto , Terapia Combinada , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Adulto Jovem
19.
Depress Anxiety ; 34(11): 1040-1048, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28556577

RESUMO

BACKGROUND: Physical activity has shown to be effective in anxiety disorders. For specific phobia, no studies are available that systematically examined the effects of an aerobic exercise intervention on phobic fear within a randomized-controlled design. Therefore, we investigated the acute effect of a standardized aerobic training on clinical symptoms of dental phobia as well as on stress-related neurobiological markers. METHODS: Within a crossover design, 30 patients with dental phobia (mean age: 34.1 years; mean score of the Dental Anxiety Scale: 18.8) underwent two minor dental interventions separated by 7 days. Dental treatment was performed after 30 min of physical activity at either 20% VO2 max (control) or 70% VO2 max (intervention), respectively. To control for habituation, patients were randomly assigned to one of the two conditions prior to the first intervention. Moreover, saliva samples were collected at five times in order to determine changes in salivary cortisol (sC) and alpha-amylase (sAA) due to treatment. RESULTS: In comparison to baseline, aerobic exercise within 70% VO2 max significantly reduced clinical anxiety and sC concentrations before, during, and after the dental treatment. In contrast, the control condition led to decreased sAA levels at different time points of measurement. Habituation occurred at the second study day, independent of the order. CONCLUSIONS: Our study provides evidence for an effect of moderate-intense exercise on clinical symptoms and sC in patients with dental phobia. Therefore, acute aerobic exercise might be a simple and low-cost intervention to reduce disorder-specific phobic fear.


Assuntos
Ansiedade ao Tratamento Odontológico/fisiopatologia , Ansiedade ao Tratamento Odontológico/terapia , Exercício Físico/psicologia , Hidrocortisona/sangue , alfa-Amilases/sangue , Adulto , Nível de Alerta/fisiologia , Estudos Cross-Over , Ansiedade ao Tratamento Odontológico/psicologia , Medo/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escala Visual Analógica , Adulto Jovem
20.
Eur Arch Psychiatry Clin Neurosci ; 267(7): 639-650, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28194516

RESUMO

INTRODUCTION: Physical activity (PA) can play an important role in improving the mental and physical health in patients with mental disorders but is not well studied in this population. The aim of this study was to assess the status of PA in outpatients with mental disorders, compare the convergence of self-rating and accelerometer measurement and examine the influence of social cognitive variables from the Motivation-Volition (MoVo) model and clinical measures on PA. METHODS: Eighty-four patients were recruited from three psychiatric outpatient clinics and local psychiatrists (Distribution of ICD-10-Diagnoses: F3.x = 59.5%, F4.x = 20.2%, F2.x = 17.9%, F1.x = 2.4%). PA, Self-efficacy, Outcome-expectancies, Intention, Self-concordance, Action- and Coping-planning, Health-related Quality of Life (SF-12) and Psychiatric Symptoms (SCL-27) were assessed through questionnaires. PA was assessed objectively by accelerometers. RESULTS: Most of the participants did not reach PA recommendations. Subjective and objective measurement of PA showed good accordance for total PA on group level but lower accordance on individual level. Motivational and volitional determinants of health behavior change showed a similar pattern of correlations with PA as in populations without mental disorders. CONCLUSION: Outpatients with mental disorders have the ability and are willing to perform PA but a large proportion of our sample did not meet PA recommendations. To assess group levels of PA, subjective and objective measurement seem equally apt, for individual diagnostics, a combination of both should be considered. Social cognitive determinants of health behavior change seem to be as helpful for the design of PA interventions for patients with mental disorders as they are in other populations.


Assuntos
Transtornos Cognitivos/etiologia , Exercício Físico/fisiologia , Comportamentos Relacionados com a Saúde/fisiologia , Transtornos Mentais , Comportamento Social , Adulto , Idoso , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Escalas de Graduação Psiquiátrica , Autorrelato , Estatística como Assunto , Inquéritos e Questionários , Adulto Jovem
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