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1.
Nord J Psychiatry ; 73(4-5): 293-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31157577

RESUMO

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders. Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety. Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered. Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The 'need to control thoughts' aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD. Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.


Assuntos
Transtornos de Ansiedade/psicologia , Emoções/fisiologia , Metacognição/fisiologia , Transtorno de Pânico/psicologia , Inquéritos e Questionários , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/terapia
2.
Arch Psychiatr Nurs ; 33(2): 211-213, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30927992

RESUMO

Advanced Practice Providers recognize and treat the most common side effects patients bring to our attention with the use of antidepressants, including insomnia, weight gain, emotional flattening, and sexual side effects. (https://www.psychcongress.com/article/top-5-side-effects-psychotropics-and-how-manage-them). We are, however, less intuitive and competent at picking up the high risk and rare, problem prone side effects our patients may experience related to the medications we prescribe, particularly in the more medically complex patients. In addition, the medically complex patient may mask a psychiatric concern as the psychiatric provider finds themselves caught up in the ambiguity of numerous somatic symptoms a patient presents with versus the psychiatric concerns that bear our attention. Autoimmune disorders often blur this line all too well affecting both psychiatric and physical well-being.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Citalopram/uso terapêutico , Depressão/tratamento farmacológico , Edema/etiologia , Doença de Hashimoto/complicações , Adulto , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/diagnóstico , Depressão/diagnóstico , Feminino , Humanos , Vortioxetina/uso terapêutico
3.
Behav Ther ; 50(3): 659-671, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030881

RESUMO

Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Emoções/fisiologia , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Adulto , Agorafobia/diagnóstico , Agorafobia/psicologia , Agorafobia/terapia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Cognição/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Autorrelato , Resultado do Tratamento
4.
J Affect Disord ; 250: 218-225, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30870771

RESUMO

BACKGROUND: As many as 20% of women will experience an anxiety disorder during the perinatal period. Women with pre-existing anxiety disorders are at increased risk of worsening during this time, yet little is known about its predictors. STUDY AIM: To investigate the psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. METHODS: Thirty-five (n = 35) pregnant women with pre-existing DSM-5 anxiety disorders were enrolled in this prospective study investigating the psychosocial (e.g., childhood trauma, intolerance of uncertainty, depression) and biological risk factors (e.g. C-reactive protein, interleukin-6, tumor necrosis factor-α) for anxiety worsening in the postpartum period. Anxiety worsening was defined as an increase of ≥50% or greater on Hamilton Anxiety Rating Scale scores from the third trimester of pregnancy (32.94 ± 3.35 weeks) to six weeks postpartum. RESULTS: Intolerance of uncertainty, depressive symptom severity, and obsessive-compulsive disorder symptoms present in pregnancy were significant predictors of anxiety worsening in the postpartum. LIMITATIONS: Sample heterogeneity and limited sample size may affect study generalizability. CONCLUSIONS: To our knowledge, this is the first longitudinal study to investigate psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. Continued research investigating these risk factors is needed to elucidate whether they differ from women experiencing new-onset anxiety disorders in the perinatal period, and those in non-puerperal groups. Identifying these risk factors can guide the development of screening measures for early and accurate symptom detection. This can lead to the implementation of appropriate interventions aimed at decreasing the risk of perinatal anxiety worsening.


Assuntos
Transtornos de Ansiedade/diagnóstico , Depressão Pós-Parto/diagnóstico , Adolescente , Adulto , Transtornos de Ansiedade/sangue , Transtornos de Ansiedade/psicologia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Criança , Depressão Pós-Parto/sangue , Depressão Pós-Parto/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Interleucina-6/sangue , Estudos Longitudinais , Transtorno Obsessivo-Compulsivo/sangue , Transtorno Obsessivo-Compulsivo/diagnóstico , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/psicologia , Terceiro Trimestre da Gravidez , Gestantes/psicologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fator de Necrose Tumoral alfa/sangue , Adulto Jovem
5.
J Affect Disord ; 250: 333-340, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30875677

RESUMO

BACKGROUND: A growing body of literature supports the potential existence of a new clinical entity, Acute suicidal affective disturbance (ASAD), which is characterized by rapid-onset, acute suicidality. This study aimed to evaluate whether current ASAD symptoms (i.e., suicidal intent, thwarted belongingness, perceived burdensomeness, disgust with others and oneself, agitation, irritability, insomnia, and nightmares) comprise a psychopathological network distinct from anxiety and depression symptoms. METHODS: A sample of 167 psychiatric inpatients completed self-report measures of current ASAD, anxiety, and depression symptoms. RESULTS: Network analyses revealed three distinct clusters of symptoms corresponding to ASAD, anxiety, and depression symptom self-report measure items. Namely, ASAD symptoms not only demonstrated strong associations with each other, but they also exhibited weak associations with symptoms of anxiety and depression. LIMITATIONS: This study utilized a cross-sectional design and distinct self-report measures to assess all constructs, which may have led to methodological confounds that influenced the observed network structure. CONCLUSIONS: Overall, our findings provide further evidence for ASAD as a syndrome with strongly interrelated symptoms. Furthermore, results indicate that ASAD may represent a construct distinct from anxiety and depression, underscoring its potential diagnostic value. Additional research is needed to replicate these findings across other high-risk populations, as well as to examine how ASAD symptoms may relate to other psychiatric symptoms.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos do Humor/diagnóstico , Ideação Suicida , Adolescente , Adulto , Idoso , Estudos Transversais , Depressão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Adulto Jovem
6.
Psychiatry Res ; 274: 372-376, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30852430

RESUMO

The diagnosis of patients suffering from both anxiety and depression is complex due to mixed effects of the two disorders. This complexity has hardened the task to find an adapted treatment for these patients. Consequently, several instruments, known as depression anxiety scales, have been developed and are now used internationally by physicians to determine the diagnosis of anxiety and depression and treat the patients accordingly. This study aims at testing the consistency and reliability of one of the main anxiety and depression scale which is composed of 14 items, the Hospital Anxiety and Depression Scale (HADS). We have used explanatory factor analysis (EFA) and factor extraction by principal component analysis (PCA) with orthogonal varimax (Kaiser Normalization) rotation on a cohort of 9706 French depressed patients. The relevance of the 14 items included in the HADS was also scrutinized by measuring the internal consistency and reliability of the global HADS removing each item one by one. Our conclusion is that the HADS could potentially gain in consistency in the detection of anxiety, notably through the revision of two of the anxiety items.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Inquéritos e Questionários/normas , Adulto , Análise Fatorial , Feminino , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Psicometria , Reprodutibilidade dos Testes
7.
Behav Ther ; 50(2): 270-284, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30824245

RESUMO

Depressed individuals are less reactive than healthy individuals to positive stimuli in the laboratory, but accumulating evidence suggests that they are more emotionally reactive to positive events in their daily lives. The present study probed the boundaries of this curious "mood brightening" effect and investigated its specificity to major depressive disorder (MDD) vis-à-vis generalized anxiety disorder (GAD), its closest boundary condition. We used ecological momentary assessment to measure reactions to positive events over one week in individuals with MDD (n = 38), GAD (n = 36), comorbid MDD-GAD (n = 38), and no psychopathology (n = 33). Depressed individuals responded to positive events with larger changes in affect, cognition, reported withdrawal (but not approach) behavior, and symptoms than healthy controls. More severe depression assessed before the sampling week predicted greater brightening. Altered reactivity to positive events was relatively specific to MDD when compared with GAD, similar to patterns found for other positive emotional processes. The robustness, scope, and relative specificity of the brightening effect highlights the need to resolve conflicting findings across laboratory and non-laboratory studies to advance understanding of altered reactivity in emotional disorders.


Assuntos
Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/psicologia , Avaliação Momentânea Ecológica , Emoções , Otimismo/psicologia , Adolescente , Adulto , Afeto/fisiologia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Emoções/fisiologia , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Comportamento Social , Adulto Jovem
8.
Medicine (Baltimore) ; 98(11): e14838, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882674

RESUMO

The aim of the present case-control study was to explore the association between BDNF Val66Met (rs6265) polymorphism and generalized anxiety disorder in Mexican individuals, and whether this polymorphism plays a role in the symptomatology of anxiety.A total of 212 subjects were included in the study. Around 75 patients with generalized anxiety disorder were diagnosed by psychiatrists based on the DSM-IV instrument and 137 unrelated subjects psychiatrically healthy were used as comparison group. The subclinical symptomatology in patients was assessed with the State-Trait Anxiety Inventory. BDNF rs6265 genotypes were analyzed using the polymerase chain reaction end-point method.The association between BDNF Val66Met with the risk for generalized anxiety disorder was evaluated using 4 inheritance models. The present study showed that carrying the Met allele confers increased risk for the presence of generalized anxiety disorder (χ = 4.7, P = .03; OR (95%) 1.96 (1.05-3.56)) when patients with generalized anxiety disorder were compared with the comparison group.Our results provide evidence of an association between the Val66Met polymorphism of the BDNF gene and generalized anxiety disorder in a Mexican population. However, no association was observed between this polymorphism and the symptomatology of anxiety.


Assuntos
Transtornos de Ansiedade , Fator Neurotrófico Derivado do Encéfalo/genética , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/genética , Transtornos de Ansiedade/psicologia , Sintomas Comportamentais/diagnóstico , Correlação de Dados , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Predisposição Genética para Doença , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Escalas de Graduação Psiquiátrica
9.
Psychiatry Res ; 272: 756-764, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30832196

RESUMO

Several studies suggest that anxiety disorders (AD) involve dysregulation of the autonomic nervous system (ANS) and hypothalamic-pituitary (HPA) axis. However, it is unknown if alterations in these biological systems are premorbid markers of AD risk or a state-dependent feature of anxiety. This study examined ANS and HPA-axis response to a laboratory stressor in healthy child offspring of parents with (n = 55) and without (n = 98) a history of AD. High frequency heart rate variability (HF-HRV) was assessed during sitting and standing baseline conditions and during a speech task where participants remained standing. Salivary cortisol was measured at baseline and at 15, 30, 45 and 60 min post-speech. Subjective anxiety was assessed with a visual analogue scale. Children of parents with AD displayed reduced HRV and a blunted cortisol response to the speech task compared to children of non-anxious parents. No risk group effect was found for anxiety ratings. These preliminary data suggest that healthy children of anxious parents exhibit altered stress reactivity to an acute laboratory stressor. Further research is needed to confirm findings and identify mechanisms that may account for altered self-regulation processes to a stressor in children at familial risk for AD.


Assuntos
Transtornos de Ansiedade/metabolismo , Transtornos de Ansiedade/psicologia , Filho de Pais Incapacitados/psicologia , Pais/psicologia , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia , Adolescente , Transtornos de Ansiedade/diagnóstico , Criança , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisário/metabolismo , Masculino , Sistema Hipófise-Suprarrenal/metabolismo , Saliva/metabolismo , Estresse Psicológico/diagnóstico
10.
J Affect Disord ; 250: 363-370, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30877859

RESUMO

BACKGROUND: The anxiety and their related disorders (AD) are the most prevalent of all mental health conditions, disproportionately affecting women. The value of perinatal AD screening is well established but there is very limited evidence to support the applicability of existing anxiety screening instruments. To our knowledge, no previous studies have evaluated an AD screening instrument in a perinatal population using full gold standard methodology. OBJECTIVE: To assess the accuracy of the most commonly used and/or recommended screening tools for perinatal AD (i.e., the Edinburgh Postnatal Depression Scale (EPDS) and its anxiety subscale (EPDS-3A), and the Generalized Anxiety Disorder 7 and 2-item Scales (GAD-7 and GAD-2) alongside a clinically derived alternative; the Anxiety Disorder - 13 (AD-13). METHODS: 310 Canadian women completed mood and anxiety questionnaires at approximately 3-months postpartum. Those scoring at/above cut-off on one or more questionnaire completed a diagnostic interview for depression and all AD (n = 115). The accuracy of each scale was assessed via ROC analyses. RESULTS: Only the AD-13 met the standard of a clinically useful screening measure, with an area under the curve (AUC) above 0.8. This was achieved with and without the inclusion of the related disorders. No other measure demonstrated an AUC above 0.8, either including or excluding the related disorders. CONCLUSIONS: Neither the EPDS/EPDS 3-A, nor the GAD-7/GAD-2 can be recommended for widespread use as a perinatal AD screening tool. The high performance of the AD-13 is a good indication that an effective alternative is well within reach.


Assuntos
Transtornos de Ansiedade/diagnóstico , Depressão Pós-Parto/diagnóstico , Programas de Rastreamento/métodos , Período Pós-Parto/psicologia , Estresse Psicológico/diagnóstico , Adulto , Transtornos de Ansiedade/psicologia , Canadá/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Questionário de Saúde do Paciente/estatística & dados numéricos , Prevalência , Escalas de Graduação Psiquiátrica , Curva ROC , Fatores de Risco , Saúde da Mulher
11.
Psychiatr Prax ; 46(5): 274-280, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30891726

RESUMO

OBJECTIVE: As of yet, there exists no German-language self-rating questionnaire as a screening for anxiety disorders in people with an intellectual disability. Therefore the Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID) was translated into German and its psychometric properties were assessed. METHODS: Internal consistency and concurrent validity were tested in 34 adults with learning difficulties and mild and moderate intellectual disability. Convergent validity was estimated by using data from a clinical sample of 38 persons without intellectual disability. RESULTS: The GAS-ID discriminates between intellectually disabled subjects with an anxiety disorder and subjects without comorbid mental disorders resulting in a sensitivity of 100 % and a specificity of 87 %. It also demonstrates a very good internal consistency (Cronbachs α = 0.90) and a high convergent validity (with BAI: r = 0.76). CONCLUSION: The German GAS-ID is a reliable, valid and economically applicable self-report screening instrument for assessing anxiety in people with intellectual disability. However, minor revision of items and future research is needed to investigate the validity of the GAS-ID.


Assuntos
Transtornos de Ansiedade/diagnóstico , Deficiência Intelectual , Psicometria , Adulto , Ansiedade , Alemanha , Humanos , Reprodutibilidade dos Testes
12.
Ann Acad Med Singapore ; 48(2): 55-62, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30926977

RESUMO

INTRODUCTION: Family history of psychopathology is a risk factor for mood and anxiety disorders in children, but little is known about rates of parental psychopathology among treatment-seeking youth with affective disorders in the Asia Pacific region. This study examined patterns of emotional and behavioural problems in parents of clinically-referred youth in Singapore. We hypothesised that parents would have higher rates of affective disorders compared to the Singapore national prevalence rate of 12%. MATERIALS AND METHODS: In this cross-sectional study, 47 families were recruited from affective disorders and community-based psychiatry programmes run by a tertiary child psychiatry clinic. All children had a confirmed primary clinical diagnosis of depression or an anxiety disorder. Parents completed the Mini International Neuropsychiatric Interview (MINI) to assess for lifetime mood and anxiety disorders. They also completed the Adult Self Report (ASR) and Adult Behavior Checklist (ABCL) to assess current internalising and externalising symptoms. RESULTS: Consistent with our hypothesis, 38.5% of mothers and 10.5% of fathers reported a lifetime mood and anxiety disorder. Nearly 1/3 of mothers had clinical/subclinical scores on current internalising and externalising problems. A similar pattern was found for internalising problems among fathers, with a slightly lower rate of clinical/subclinical externalising problems. CONCLUSION: Our findings are consistent with previous overseas studies showing elevated rates of affective disorders among parents - particularly mothers - of children seeking outpatient psychiatric care. Routine screening in this population may help to close the current treatment gap for adults with mood and anxiety disorders.


Assuntos
Transtornos de Ansiedade , Transtornos do Humor , Pais/psicologia , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Criança , Estudos Transversais , Saúde da Família/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Relações Pais-Filho , Poder Familiar/psicologia , Escalas de Graduação Psiquiátrica , Psicopatologia , Singapura/epidemiologia
13.
Psychiatry Res ; 271: 721-725, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30791347

RESUMO

Historically, asthma has had a mixed association with mental health. More research is needed to examine the associations between asthma and specific psychiatric disorders, and whether these associations hold true across racial groups in the general population of the United States. Using the Collaborative Psychiatric Epidemiology Surveys, we examined the associations between lifetime asthma and specific DSM-IV psychiatric disorders, adjusting for sociodemographic characteristics and smoking status. We found that when looking at the entire sample, self-reported diagnosis of asthma was associated with greater odds of reporting mood disorders (AOR: 1.36; 95% CI: 1.05-1.74). Asthma was not significantly associated with total anxiety disorders (AOR 1.25; 95% CI: 0.98-1.60), though it was specifically associated with generalized anxiety disorder. Asthma was associated with greater odds of having alcohol use disorders (AOR: 1.71; 95% CI: 1.24-2.37), but was not associated with total eating disorders (AOR:1.36; 95% CI: 1.17-2.51) (though it was significantly associated with higher odds for binge eating disorder, but lower odds of reporting bulimia). The strength and the significance of the associations between asthma and psychiatric disorders varied when stratified by race, underscoring the importance of examining race as a potential explanation for the mixed findings observed previously in the literature.


Assuntos
Asma/diagnóstico , Asma/epidemiologia , Inquéritos Epidemiológicos , Saúde Mental , Autorrelato/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Asma/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
15.
J Headache Pain ; 20(1): 13, 2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30755160

RESUMO

BACKGROUND: The highest prevalence of migraine is detected among people who are of working age. The aim of this study was to assess the burden of migraine in an occupational health care setting using real world data collected as a part of routine clinical practice. METHODS: This retrospective register study included migraineurs using occupational health care at the private health care provider Terveystalo. An age and gender matched control population was established for comparison. Electronic medical records were assessed for overall and migraine related health care visits, sick-leaves and comorbidities. Stratification to acute and prophylactic treatment groups along with prophylactic treatment lines was based on prescriptions. RESULTS: Among the 369,383 individuals in the study cohort, 7.4% women and 2.1% men were identified having a diagnosis of migraine. Prophylactic medication was prescribed to 13% of migraine patients and exclusively acute medication to 37%. Although migraine related visits and sick-leave days were significantly lower than overall visits or sick-leave days, both increased by prophylactic treatment line. The number of visits rose from 13.8 to 26.2 and sick-leave days from 16.8 to 30.4 per patient-year, in those without prophylaxis vs. ≥3 prophylactic treatments. Moreover, migraine patients had 1.7-fold increase in visits and 1.8-fold increase in sick leave days on average per patient-year, when compared to the control population. Depression and anxiety were 1.8-fold more common among patients with migraine, and the frequency also increase by treatment line. CONCLUSIONS: Migraine burden increased by each failed treatment line and was associated with increased comorbidity. In addition, migraine patients had significantly higher extent of visits and sick-leave days as well as extent of comorbidities when compared to their age- and gender-matched counterparts.


Assuntos
Efeitos Psicossociais da Doença , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/terapia , Saúde do Trabalhador/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Licença Médica/tendências , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Estudos de Coortes , Comorbidade , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Prevalência , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
16.
Psychiatry Res ; 272: 311-315, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30597382

RESUMO

Recent adult etiologic studies indicated evidence linking increased inflammatory parameters with psychiatric disorders. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are easily obtainable clinical markers of inflammation and have been found to be increased in various medical and mental disorders. In this study, we aimed to investigate the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with obsessive-compulsive disorder (OCD). Secondarily, the effect of comorbid anxiety disorder with OCD on the inflammatory response was investigated. Sixty drug-naïve adolescents with OCD aged 12 to 18 years were enrolled in the patient group. Twenty-three of the OCD group had comorbid anxiety disorder (AD) and 37 had no comorbidities. One hundred twenty-eight adolescents in the same age range with no psychiatric disorders were recruited as the healthy control group. The severity of OCD symptoms was evaluated using the Children's Yale-Brown Obsessive Compulsive Scale. There were statistically significant differences in the neutrophil-lymphocyte ratio, white blood cell, neutrophil, and platelet counts among the three groups, even after adjusting for age and sex. The adolescents with OCD and AD had the highest neutrophil-lymphocyte ratio and white blood cell counts. A comorbid anxiety disorder diagnosis in addition to obsessive-compulsive disorder may increase the inflammatory response.


Assuntos
Transtornos de Ansiedade/sangue , Plaquetas/metabolismo , Mediadores da Inflamação/sangue , Linfócitos/metabolismo , Neutrófilos/metabolismo , Transtorno Obsessivo-Compulsivo/sangue , Adolescente , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Criança , Comorbidade , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia
17.
Psychiatry Res ; 272: 316-318, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30597383

RESUMO

This study aimed to compare pregnant and non-pregnant women in terms of the current prevalence of mood and anxiety. The study sample included 1154 women evaluated on the first day postpartum and 328 control subjects. Mood and anxiety disorders were determined by structured psychiatric interview. The prevalence rate of any mood or anxiety disorder was 18.2% during pregnany. Generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and comorbidity among anxiety disorders were more prevalent during pregnancy compared to the control subjects. The present results suggest that pregnant women may be at increased risk of depression and anxiety disorders.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/psicologia , Adulto , Transtornos de Ansiedade/diagnóstico , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Transtornos do Humor/diagnóstico , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/diagnóstico , Prevalência , Tamanho da Amostra
18.
Psychiatry Res ; 272: 349-358, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30599438

RESUMO

Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.


Assuntos
Anorexia Nervosa/psicologia , Transtornos Dismórficos Corporais/psicologia , Bulimia Nervosa/psicologia , Hipocondríase/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno de Pânico/psicologia , Adulto , Afeto/fisiologia , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/epidemiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/epidemiologia , Bulimia Nervosa/diagnóstico , Bulimia Nervosa/epidemiologia , Comorbidade , Feminino , Humanos , Hipocondríase/diagnóstico , Hipocondríase/epidemiologia , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/epidemiologia , Autorrelato/normas
19.
Drug Alcohol Depend ; 196: 31-39, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30660937

RESUMO

BACKGROUND: We assessed the impact of comorbid depression and anxiety disorders as well as positive and negative emotional states on alcohol consumption in alcohol dependent men and women. METHODS: Per day alcohol consumption during 90 days before enrolment was assessed by the Time Line Follow Back (TLFB) in 287 men and 156 women meeting DSM-IV-TR criteria for alcohol dependence. Propensity to drink in negative/positive emotional states was assessed using the Inventory of Drug Taking Situations (IDTS). Psychiatric comorbidities, including major depressive disorder (MDD), substance-induced depression (SID), anxiety disorders (AnxD), or substance-induced anxiety (SIA) were identified by Psychiatric Research Interview of Substance and Mood Disorders (PRISM). RESULTS: In the combined group, increased number of drinks per day and number of heavy drinking days correlated with increased IDTS scores (all p < 0.0001), while the lifetime history of MDD was associated with fewer drinking days (p = 0.045) but not average number of drinks per day. Male sex was associated with higher alcohol consumption per day (p < 0.0001), but not with the number of drinking days (p > 0.05). Lifetime MDD history was associated with less drinking days (p = 0.0084) and less heavy drinking days (p = 0.021) in alcohol dependent men, while current MDD was associated with higher alcohol use per day in alcohol dependent women (p = 0.044). CONCLUSIONS: Our findings suggest that emotional states and lifetime MDD history have sex-specific impact on alcohol use in alcohol dependent men and women. The mechanisms underlying these findings and their relevance to treatment outcomes need to be examined in future studies.


Assuntos
Sintomas Afetivos/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoólicos/psicologia , Alcoolismo/psicologia , Transtorno Depressivo Maior/psicologia , Caracteres Sexuais , Adulto , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Emoções/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
J Affect Disord ; 247: 81-87, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30658244

RESUMO

OBJECTIVE: The aim of this study was to improve clinical identification of patients with a prolonged treatment course for depressive and anxiety disorders early in treatment. METHOD: We conducted a cohort study in 1.225 adult patients with a depressive or anxiety disorders in psychiatric specialty care setting between 2007 and 2011, with at least two Brief Symptom Inventory (BSI) assessments within 6 months. With logistic regression, we modelled baseline age, gender, ethnicity, education, marital status, housing situation, employment status, psychiatric comorbidity and both baseline and 1st follow-up BSI scores to predict prolonged treatment course (>2 years). Based on the regression coefficients, we present an easy to use risk prediction score. RESULTS: BSI at 1st follow-up proved to be a strong predictor for both depressive and anxiety disorders (OR = 2.17 (CI95% 1.73-2.74); OR = 2.52 (CI95% 1.86-3.23)). The final risk prediction score included BSI 1st follow-up and comorbid axis II disorder for depressive disorder, for anxiety disorders BSI 1st follow-up and age were included. For depressive disorders, for 28% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was60% (sensitivity 0.38, specificity 0.81). For anxiety disorders, for 35% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was 52% (sensitivity 0.55, specificity 0.75). CONCLUSIONS: A high level of symptoms at 2-6 months of follow-up is a strong predictor for prolonged treatment course. This facilitates early identification of patients at risk of a prolonged course of treatment; in a relatively easy way by a self-assessed symptom severity.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Tratamento Farmacológico , Psicoterapia , Adolescente , Adulto , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Pacientes Ambulatoriais , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Autoavaliação , Adulto Jovem
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