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1.
Ugeskr Laeger ; 183(22)2021 05 31.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34060453

RESUMO

Up to half of all patients with bipolar affective disorder (BP), develop a comorbid anxiety disorder during their lifetime. The consequences of comorbid anxiety in BP compared to BP without comorbid anxiety are serious, including more frequent and severe depressions and twice the risk of substance abuse and suicide attempts. In this review we argue, that due to the poorer prognosis of these conditions, it is important to diagnose comorbid anxiety when present, and to ensure proper treatment, which should be performed by a psychiatrist preferably specialised in affective disorders.


Assuntos
Transtorno Bipolar , Ansiedade , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Comorbidade , Humanos , Transtornos do Humor/epidemiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34067758

RESUMO

Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The rationale for delivering CBT in groups is that patients can model themselves through each other due to their similarities in symptoms. However, there has recently been a shift towards transdiagnostic CBT protocols, in which patients with varied diagnoses participate in the same groups. This shift challenges the rationale of delivering CBT in groups, and it is therefore highly important to understand if and how group cohesion develops in mixed diagnoses CBT groups. The current study used a qualitative comparative framework to investigate the patients' experiences of group cohesion in diagnosis-specific versus transdiagnostic CBT groups. Twenty-three patients were interviewed with semi-structured interviews upon completion of the treatment. Participants had a primary diagnosis of MDD, panic disorder, agoraphobia or social anxiety disorder. A comparative thematic analysis was carried out. Three themes were found: the move from differences to similarities, the role of group cohesion in group CBT and factors helpful and hindering to group cohesion. Group cohesion developed across groups and was considered highly important in both diagnosis-specific and transdiagnostic CBT groups.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Agorafobia , Ansiedade , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Humanos , Resultado do Tratamento
3.
Prax Kinderpsychol Kinderpsychiatr ; 70(5): 445-464, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34187341

RESUMO

Depressive disorders in early childhood are associated with high psychosocial impairment and tend to remain stable over time without adequate treatment. Short-term psychoanalytic therapy is a common form of child psychotherapy, yet there is a lack of empirical evaluation of this approach for young children with depressive disorders. Therefore, this secondary evaluation of a study on the treatment of anxiety disorders used an uncontrolled pre-post design in a clinical setting to investigate whether children with depressive comorbidity would evidence significant diagnostic and symptomatic remission after treatment with manualized short-term Psychoanalytic Child Therapy (PaCT). Nineteen children who had an anxiety disorder and a (subclinical) depressive disorder (assessed with the Preschool Age Psychiatric Assessment using DSM-IV criteria) were treated with PaCT. After treatment, 15 of 19 children (78.94 %) were remitted and 15 of 17 children (88.24 %; 2 were lost to follow-up) were free of depressive disorders at the 6-month follow-up. Further analyses revealed significant effects for pre- to post and pre- to follow-up comparisons regarding internalizing symptoms and overall problems using parent- and (nursery-)teacher-ratings. These results suggest that short-term PaCT shows promise as a treatment for childhood depressive disorders.


Assuntos
Transtorno Depressivo , Terapia Psicanalítica , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Criança , Pré-Escolar , Depressão , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Humanos , Projetos Piloto
4.
Front Public Health ; 9: 655357, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34017813

RESUMO

Background: The 2016 wildfires in Fort McMurray (Alberta, Canada) led to a massive displacement of 88,000 people and destroyed 2,400 homes. Although no direct human fatality resulted, many individuals feared for their lives or those of their loved ones. Objectives: (1) To estimate the prevalence of post-traumatic stress, major depressive, insomnia, generalized anxiety, and substance use disorders in the adult population of Fort McMurray 1 year after the evacuation; (2) To identify pre-, peri-, and post-disaster correlates of mental health disorders. Methods: A phone survey using random digit sampling was used to survey evacuees. A total of 1,510 evacuees (response rate = 40.2%, 55.5% women, mean age = 44.11, SD = 12.69) were interviewed between May 9th and July 28th, 2017. Five validated scales were administered: the PTSD Symptoms Checklist (PCL-5), the Insomnia Severity Index (ISI), the depression and anxiety subscales of the Patient Health Questionnaire (PHQ-9, GAD-7), and the CAGE Substance Abuse Screening Tool. Results: One year after the wildfires, 38% had a probable diagnosis of either post-traumatic stress, major depressive, insomnia, generalized anxiety, or substance use disorder, or a combination of these. Insomnia disorder was the most common, with an estimated prevalence of 28.5%. Post-traumatic stress, major depressive and generalized anxiety disorders were almost equally prevalent, with ~15% each. The estimated prevalence of substance use disorder was 7.9%. For all five mental health disorders, having a mental health condition prior to the fires was a significant risk factor, as well as having experienced financial stress or strain due to the economic decline already present in Fort McMurray. Five post-disaster consequences were significant predictors of four of the five disorders: decrease in work, decrease in social life, poorer current health status, increase in drug and alcohol use, and higher level of stress experienced since the fires. Conclusion: One year after the fires, more than one third of the evacuees had clinically significant psychological symptoms, including those of insomnia, post-traumatic stress, depression, anxiety, and substance use. This study helped identify individuals more at risk for mental health issues after a natural disaster and could guide post-disaster psychosocial support strategies.


Assuntos
Transtorno Depressivo Maior , Transtornos de Estresse Pós-Traumáticos , Incêndios Florestais , Adulto , Alberta , Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/diagnóstico
5.
Artigo em Russo | MEDLINE | ID: mdl-34037352

RESUMO

OBJECTIVE: The study was the comparative characterization of depressed patients depending on the presence of comorbid anxiety. MATERIAL AND METHODS: Thirty patients of the Clinic of neuroses named after acad. I.P. Pavlov Clinic of Neuroses. Comparison groups included 15 patients with comorbid anxiety and depressive disorders and 15 patients with depressive disorder without comorbid anxiety. The groups were comparable by sex and age. Clinical-catamnestic, clinical-therapeutic, and clinical-scale methods, including the Hamilton Depression and Anxiety Scales, were used during the study. RESULTS: The structure of clinically diagnosed comorbid anxiety and depressive disorders was shown to be characterized by high representation of somato-vegetative symptoms and higher level of depression in comparison to depressive disorder without comorbid anxiety. According to psychometric assessment results, the level of anxiety did not differ in comparison groups, while clinically, according to ICD-10 criteria, anxiety was not diagnosed, indicating a discrepancy between clinical and scale assessments of anxiety and depressive disorders and greater accuracy of clinical and scale assessment of the condition. The effectiveness of combined treatment, including psychotropic therapy and psychotherapy, was lower in patients with comorbidity of anxiety and depression according to parameters of the degree of reduction of psychopathological symptoms, duration of treatment, and quality of remission. The structure of incomplete remission was similar in patients with comorbid anxiety and depressive disorders and depression. CONCLUSION: The obtained data suggest the expediency of continuous systematization of affective disorders and the need to improve the diagnostic criteria of comorbid anxiety and depressive disorders on the basis of combined clinical and scale assessment.


Assuntos
Transtornos de Ansiedade , Depressão , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Comorbidade , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , Resultado do Tratamento
6.
Artigo em Russo | MEDLINE | ID: mdl-34037369

RESUMO

The direct neurotropic and neurotoxic effect of the SARS-CoV-2 virus on the central nervous system, as well as the stressful effect of various factors of the COVID-19 pandemic, contribute to the development of the so-called post-COVID syndrome. The clinical picture of the syndrome includes asthenic, anxiety-asthenic, and depressive manifestations. When prescribing psychopharmacotherapy to patients who have undergone COVID-19, it is recommended to assess the potential benefits and risks in the aspect of using drugs not only with therapeutic antiasthenic and anxiolytic properties, but with minimally expressed undesirable effects and adverse drug interactions.


Assuntos
COVID-19 , Pandemias , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/tratamento farmacológico , Humanos , SARS-CoV-2
7.
Artigo em Russo | MEDLINE | ID: covidwho-1244384

RESUMO

The direct neurotropic and neurotoxic effect of the SARS-CoV-2 virus on the central nervous system, as well as the stressful effect of various factors of the COVID-19 pandemic, contribute to the development of the so-called post-COVID syndrome. The clinical picture of the syndrome includes asthenic, anxiety-asthenic, and depressive manifestations. When prescribing psychopharmacotherapy to patients who have undergone COVID-19, it is recommended to assess the potential benefits and risks in the aspect of using drugs not only with therapeutic antiasthenic and anxiolytic properties, but with minimally expressed undesirable effects and adverse drug interactions.


Assuntos
COVID-19 , Pandemias , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/tratamento farmacológico , Humanos , SARS-CoV-2
8.
Cogn Behav Ther ; 50(3): 179-184, 2021 05.
Artigo em Inglês | MEDLINE | ID: covidwho-1238117

RESUMO

The novel 2019 SARS-2-CoV causing COVID-19 has had a devastating impact on the entire world. COVID-19 is a broad-based stressor, and research to date has documented increases in mental health problems, including anxiety, depression, and substance use, since the onset of COVID-19. By taking a transdiagnostic approach, scholars can help elucidate mechanisms and vulnerability as well as resiliency related to behavioral health problems in the context of COVID-19. The aim of the current special issue of Cognitive Behaviour Therapy was to showcase ongoing research focused on transdiagnostic factors in the context of COVID-19. The purpose of this issue is to highlight the significance of this work in the pandemic for research and practice; illustrate some of the many domains currently being explored via innovative approaches; and explicate fruitful areas for programmatic study. We hope that readers will recognize the important role of transdiagnostic models and their potential to offset the mental, addictive, and physical health disease burden of COVID-19.


Assuntos
Transtornos de Ansiedade/diagnóstico , Ansiedade/diagnóstico , Comportamento Aditivo/diagnóstico , COVID-19/psicologia , Depressão/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Comportamento Aditivo/psicologia , Depressão/psicologia , Transtorno Depressivo/psicologia , Humanos , Pandemias , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia
9.
Cogn Behav Ther ; 50(3): 179-184, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34018469

RESUMO

The novel 2019 SARS-2-CoV causing COVID-19 has had a devastating impact on the entire world. COVID-19 is a broad-based stressor, and research to date has documented increases in mental health problems, including anxiety, depression, and substance use, since the onset of COVID-19. By taking a transdiagnostic approach, scholars can help elucidate mechanisms and vulnerability as well as resiliency related to behavioral health problems in the context of COVID-19. The aim of the current special issue of Cognitive Behaviour Therapy was to showcase ongoing research focused on transdiagnostic factors in the context of COVID-19. The purpose of this issue is to highlight the significance of this work in the pandemic for research and practice; illustrate some of the many domains currently being explored via innovative approaches; and explicate fruitful areas for programmatic study. We hope that readers will recognize the important role of transdiagnostic models and their potential to offset the mental, addictive, and physical health disease burden of COVID-19.


Assuntos
Transtornos de Ansiedade/diagnóstico , Ansiedade/diagnóstico , Comportamento Aditivo/diagnóstico , COVID-19/psicologia , Depressão/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Comportamento Aditivo/psicologia , Depressão/psicologia , Transtorno Depressivo/psicologia , Humanos , Pandemias , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia
10.
Trials ; 22(1): 327, 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952313

RESUMO

BACKGROUND: Most people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Nevertheless, specialised mental health care may be required for specific patients. Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for an appointment with specialists, (b) long travel distances to specialists, particularly in rural and remote areas, and (c) patients' reservations about mental health specialist care (including fear of being stigmatised by seeking such care). To mitigate those barriers, technology-based integrated care models have been proposed. The purpose of this study is to examine the effectiveness and cost-effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care. METHODS: In an individually randomised, prospective, two-arm superiority trial with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in general practices in Germany. The intervention includes a newly developed treatment model based on video consultations with focus on diagnostics, treatment planning, and short-term intervention by mental health specialists. We will systematically compare the effectiveness, cost-effectiveness, and adverse effects of this new model with usual care by the GP: the primary outcome is the absolute change in the mean depressive and anxiety symptom severity measured on the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) from baseline to 6 months after baseline assessment. Follow-up in both groups will be conducted by blinded outcome assessors at 6 months and 12 months after baseline. The main analysis will be based on the intention-to-treat principle. We will optimise the likelihood of treatment effectiveness by strict inclusion criteria for patients, enhanced intervention integrity, and conducting a process evaluation. DISCUSSION: To the best of our knowledge, this is the first confirmatory study on a video-based, integrated care model for the treatment of anxiety and depressive disorders in GP patients in Germany. TRIAL REGISTRATION: ClinicalTrials.gov, United States National Institutes of Health NCT04316572 . Prospectively registered on 20 March 2020.


Assuntos
Transtornos de Ansiedade , Depressão , Saúde Mental , Atenção Primária à Saúde , Telemedicina , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Análise Custo-Benefício , Depressão/diagnóstico , Depressão/terapia , Alemanha , Humanos , Estudos Prospectivos , Especialização , Resultado do Tratamento
11.
BMC Geriatr ; 21(1): 324, 2021 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022795

RESUMO

BACKGROUND: Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist's role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults. METHODS: We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant's manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes. DISCUSSION: This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov, number NCT03768544 , on December 7, 2018.


Assuntos
Transtornos de Ansiedade , Terapia Cognitivo-Comportamental , Idoso , Ansiedade , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários , Telefone , Resultado do Tratamento
12.
Behav Ther ; 52(3): 734-744, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33990246

RESUMO

Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable worry accompanied by symptoms of physiological arousal. Although individuals with GAD report greater subjective arousal than healthy individuals, they show equivalent or even attenuated physiological reactions to threat. This may result from using physiological measures better suited to fear than anxiety. To test this possibility, 102 adults with and without GAD were assessed for restlessness, a core physiological symptom of GAD. They were exposed to an in vivo threat task designed to elicit anxiety in the laboratory. Throughout the task, restlessness was measured physiologically with actigraphy sensors on both ankles and both wrists, and subjectively with self-report ratings. The GAD group reported higher subjective restlessness than the no-GAD group, and in the subset of cases who had restlessness as a clinically significant symptom, actigraphy scores were reliably elevated as well. However, although actigraphy scores increased with proximity to the threat, the increases did not differ by group. These findings provide initial validation for actigraphy as a novel measure of motor restlessness in GAD. In addition, they underscore the value of measuring restlessness using multiple assessment methods. These methods suggest that, in GAD, restlessness reflects a chronic state of arousal rather than a heightened physiological reaction to threat.


Assuntos
Actigrafia , Agitação Psicomotora , Adulto , Ansiedade/diagnóstico , Transtornos de Ansiedade/diagnóstico , Nível de Alerta , Humanos
13.
Epilepsy Behav ; 118: 107943, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33839449

RESUMO

OBJECTIVE: Recent epilepsy quality measure recommendations for depression and anxiety screening endorse ultra-brief screeners, the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2). Thus, it is important to assess how symptom detection may be affected using ultra-brief screeners compared with slightly longer, well-validated instruments: Neurological Disorders Depression Inventory-Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7). The objective was to compare symptom detection by brief versus ultra-brief depression and anxiety screeners in a large real-world epilepsy clinic sample. METHODS: This was a prospective, cross-sectional assessment of consecutive patients in an adult tertiary epilepsy practice who completed the GAD-7 and NDDI-E with embedded ultra-brief scales (GAD-2; GAD-Single Item: GAD-SI; NDDI-E 2 item: NDDIE-2) on a tablet and had clinic staff administered ultra-brief PHQ-2 (yes/no version) documented in the medical record at the same visit. Prevalences of positive anxiety and depression screens were calculated for each instrument overall, and by epilepsy status. Concordance correlation coefficients (CCC) were calculated comparing the ultra-brief with brief anxiety and depression instruments, and receiver operating curves (ROC) were calculated using the longer instruments as alternative standards. RESULTS: Among N = 422 individuals the prevalence of positive anxiety screen by GAD-7 was 24% and positive depression screen by NDDI-E was 20%. Positive anxiety and depression screens were significantly less prevalent among seizure-free individuals than those with continued seizures. The verbally administered yes/no PHQ-2 had only 1 positive screen (0.2%). Other than poor concordance between the PHQ-2 and NDDI-E, the screener pairs had acceptable concordance (CCC 0.79 to 0.92). Areas under the ROC curves were acceptable for the NDDIE-2, GAD-2 and GAD-SI (0.96, 0.98, and 0.89, respectively). SIGNIFICANCE: In this sample, clinic staff interview-administered yes/no PHQ-2 had exceedingly low sensitivity compared with the NDDI-E self-reported on a tablet. Further investigation is warranted to assess if poor detection is due to characteristics of this PHQ-2 in epilepsy samples, or method of administration in this clinic. The other ultra-brief anxiety and depression instruments demonstrated good concordance with the longer, well-validated instruments and may be useful in clinical practice.


Assuntos
Depressão , Epilepsia , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Humanos , Programas de Rastreamento , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes
14.
Praxis (Bern 1994) ; 110(5): 263-267, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33849287

RESUMO

The Coupling of Pain, Anxiety, and Stress Abstract. There is considerable neurobiological, clinical and epidemiological evidence that the systemic phenomena of anxiety and pain closely interact. Both perceptions trigger stress activation processes and are in turn modulated by long-term stress. This overview illustrates the coupling of pain, anxiety and stress with some clinical examples. The relations shown here should help us to gain a holistic view of the individual patient and his/her psychosocial reality, in which nociceptive, affective and vegetative symptoms are often interdependent and mutually reinforcing each other.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Ansiedade , Transtornos de Ansiedade/diagnóstico , Feminino , Humanos , Masculino , Dor
16.
Z Kinder Jugendpsychiatr Psychother ; 49(5): 201-212, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33834844

RESUMO

Discrimination of anxiety disorders by parent ratings: A study based on the Questionnaire for Anxiety and Obsessive-Compulsive Disorders (FBB-ANZ) Abstract. Parent ratings are often used for screening during the diagnostic evaluation of anxiety disorders. Clinically, it is important to correctly differentiate between anxiety and other psychiatric disorders and to distinguish specific anxiety disorders. The present study examined the validity of the screening results obtained by the Parent Questionnaire for Anxiety and Obsessive-Compulsive Disorders (FBB-ANZ). We examined whether the FBB-ANZ discriminated (1) anxiety and other psychiatric disorders and (2) specific anxiety disorders in children and adolescents using ROC analyses. 972 parents of 4;00-11;11-year-old children and 12;00-17;11-year-old adolescents with anxiety disorders, depressive episodes, or externalizing disorders completed the FBB-ANZ. Discrimination of anxiety disorders and externalizing disorders in children (AUC = .72) and adolescents (AUC = .76) as well as depressive episodes in children (AUC = .77) was moderate. Good discrimination of different anxiety disorders was found only for separation anxiety in children (AUC = .84) and adolescents (AUC = .87). The results indicate the limited diagnostic benefit of parent ratings for discriminating different anxiety disorders in children and adolescents. Potential explanations for the results are critically discussed.


Assuntos
Transtorno Obsessivo-Compulsivo , Adolescente , Ansiedade , Transtornos de Ansiedade/diagnóstico , Criança , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Pais , Escalas de Graduação Psiquiátrica , Psicometria , Inquéritos e Questionários
17.
Int J Mol Sci ; 22(9)2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33919012

RESUMO

The autonomic nervous system (ANS) plays a crucial role both in acute and chronic psychological stress eliciting changes in many local and systemic physiological and biochemical processes. Salivary secretion is also regulated by ANS. In this study, we explored salivary proteome changes produced in thirty-eight University students by a test stress, which simulated an oral exam. Students underwent a relaxation phase followed by the stress test during which an electrocardiogram was recorded. To evaluate the effect of an olfactory stimulus, half of the students were exposed to a pleasant odor diffused in the room throughout the whole session. Saliva samples were collected after the relaxation phase (T0) and the stress test (T1). State anxiety was also evaluated at T0 and T1. Salivary proteins were separated by two-dimensional electrophoresis, and patterns at different times were compared. Spots differentially expressed were trypsin digested and identified by mass spectrometry. Western blot analysis was used to validate proteomic results. Anxiety scores and heart rate changes indicated that the fake exam induced anxiety. Significant changes of α-amylase, polymeric immunoglobulin receptor (PIGR), and immunoglobulin α chain (IGHA) secretion were observed after the stress test was performed in the two conditions. Moreover, the presence of pleasant odor reduced the acute social stress affecting salivary proteome changes. Therefore, saliva proteomic analysis was a useful approach to evaluate the rapid responses associated to an acute stress test also highlighting known biomarkers.


Assuntos
Transtornos de Ansiedade/diagnóstico , Biomarcadores/metabolismo , Proteoma/metabolismo , Saliva/metabolismo , Proteínas e Peptídeos Salivares/metabolismo , Estresse Psicológico/diagnóstico , Estudantes/psicologia , Adulto , Transtornos de Ansiedade/metabolismo , Biomarcadores/análise , Feminino , Humanos , Masculino , Proteoma/análise , Estresse Psicológico/metabolismo , Universidades , Adulto Jovem
18.
JMIR Mhealth Uhealth ; 9(4): e26038, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-33792548

RESUMO

BACKGROUND: Connected mental health, which refers to the use of technology for mental health care and technology-based therapeutic solutions, has become an established field of research. Biofeedback is one of the approaches used in connected mental health solutions, which is mainly based on the analysis of physiological indicators for the assessment and management of the psychological state. Biofeedback is recommended by many therapists and has been used for conditions including depression, insomnia, and anxiety. Anxiety is associated with several physiological symptoms, including muscle tension and breathing issues, which makes the inclusion of biofeedback useful for anxiety detection and management. OBJECTIVE: The aim of this study was to identify interventions using biofeedback as a part of their process for anxiety management and investigate their perceived effectiveness. METHODS: A systematic literature review of publications presenting empirically evaluated biofeedback-based interventions for anxiety was conducted. The systematic literature review was based on publications retrieved from IEEE Digital Library, PubMed, ScienceDirect, and Scopus. A preliminary selection of papers was identified, examined, and filtered to include only relevant publications. Studies in the final selection were classified and analyzed to extract the modalities of use of biofeedback in the identified interventions, the types of physiological data that were collected and analyzed and the sensors used to collect them. Processes and outcomes of the empirical evaluations were also extracted. RESULTS: After final selection, 13 publications presenting different interventions were investigated. The interventions addressed either primarily anxiety disorders or anxiety associated with health issues such as migraine, Parkinson disease, and rheumatology. Solutions combined biofeedback with other techniques including virtual reality, music therapy, games, and relaxation practices and used different sensors including cardiovascular belts, wrist sensors, or stretch sensors to collect physiological data such as heart rate, respiration indicators, and movement information. The interventions targeted different cohorts including children, students, and patients. Overall, outcomes from the empirical evaluations yielded positive results and emphasized the effectiveness of connected mental health solutions using biofeedback for anxiety; however, certain unfavorable outcomes, such as interventions not having an effect on anxiety and patients' preferring traditional therapy, were reported in studies addressing patients with specific physical health issues. CONCLUSIONS: The use of biofeedback in connected mental health interventions for the treatment and management of anxiety allows better screening and understanding of both psychological and physiological patient information, as well as of the association between the two. The inclusion of biofeedback could improve the outcome of interventions and boost their effectiveness; however, when used with patients suffering from certain physical health issues, suitability investigations are needed.


Assuntos
Ansiedade , Saúde Mental , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Biorretroalimentação Psicológica , Criança , Humanos , Estudantes
19.
Br J Gen Pract ; 71(707): e450-e457, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33824158

RESUMO

BACKGROUND: In the UK between 1998 and 2008, GPs' recording of anxiety symptoms increased, but their recording of anxiety disorders decreased. The reason for this decline is not clear, nor are the treatment implications for primary care patients. AIM: To understand GPs' and patients' views on the value of diagnosing anxiety disorders in primary care. DESIGN AND SETTING: In-depth interviews were conducted with 15 GPs and 20 patients, purposively sampled from GP practices in Bristol and the surrounding areas. METHOD: Interviews were held either in person or by telephone. A topic guide was used to ensure consistency across the interviews. The interviews were audio-recorded, transcribed verbatim, and analysed thematically. RESULTS: GPs reported preferring to use symptom rather than diagnostic codes in order to avoid assigning potentially stigmatising labels, and because they felt diagnostic codes could encourage some patients to adopt a 'sick role'. In addition, their decision to use a diagnostic code depended on symptom severity and chronicity, and these were hard to establish in a time-limited clinical consultation. In contrast, patients commented that receiving a diagnosis helped them to understand their symptoms, and encouraged them to engage with treatment. CONCLUSION: GPs may be reluctant to diagnose an anxiety disorder, but patients can find a diagnosis helpful in terms of understanding their symptoms and the need for treatment. As limited consultation time can discourage discussions between GPs and patients, followup appointments and continuity of care may be particularly important for the management of anxiety in primary care.


Assuntos
Clínicos Gerais , Transtornos de Ansiedade/diagnóstico , Atitude do Pessoal de Saúde , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa
20.
Sr Care Pharm ; 36(5): 226-227, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33879282

RESUMO

Despite the support systems that may be available, the scope of the recent pandemic is debilitating on a multitude of levels including, but not limited to, psychological, social, and financial. Older people already coping with mental distress on the sidelines of chronic illness, may be further compromised. The older person with chronic obstructive pulmonary disease (COPD) often struggles to withstand the anxiety and depression that is intertwined with symptoms of worsening respiratory function.


Assuntos
Depressão , Doença Pulmonar Obstrutiva Crônica , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/etiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Depressão/epidemiologia , Depressão/etiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/epidemiologia
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