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1.
J Investig Med ; 68(7): 1228-1234, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32747387

RESUMO

Healthcare providers commonly experience symptoms of anxiety during public health crises and pandemics. The objective of the study was to identify the frequency of symptoms of generalized anxiety disorder (GAD) in general practitioners and to estimate the association with particular psychosocial and demographic factors. This is a cross-sectional study, where a total of 531 general practitioners completed an online form that contained sociodemographic variables, questions about fear and perceptions concerning medical work during the COVID-19 pandemic, 7-Item Generalized Anxiety Disorder Scale (GAD-7), questionnaire on psychosomatic problems and Fear of COVID-19 Scale. The presence of symptoms of GAD was defined by a GAD-7 score of 10 or more points. Voluntary and anonymous participation, acceptance of terms, and informed consent were requested. A p value of <0.05 was considered statistically significant. Symptoms of GAD were identified in 4 out of 10 Colombian general practitioners; the following psychosocial and demographic factors were associated with a greater presence of these symptoms: female gender, social discrimination, anguish, job disappointment, nightmares, stress and other symptoms of fear regarding the pandemic. Conversely, feeling protected by the state or employer, being satisfied with their job as a physician, and trusting government measures and information were associated with a lower presence of symptoms of GAD. These findings highlight the importance of timely psychotherapeutic and psychopharmacological interventions in these individuals. The authors suggest mental health providers should be deployed during times of crisis to decrease the risk of developing mental illness.


Assuntos
Transtornos de Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Clínicos Gerais/psicologia , Pneumonia Viral/psicologia , Estresse Psicológico/epidemiologia , Adulto , Transtornos de Ansiedade/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Fatores Socioeconômicos , Inquéritos e Questionários , Avaliação de Sintomas , Adulto Jovem
2.
Niger Postgrad Med J ; 27(3): 224-229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687123

RESUMO

Background: Tension-type headache (TTH) is one of the most common reasons patients seek medical treatment. Psychiatric co-morbidities such as anxiety and depression have been commonly observed in patients with TTH. Objective: The objective was to study the prevalence and severity of co-morbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) in patients with TTH. Materials and Methods: The present cross-sectional study was conducted in the Tertiary Health Care Centre in Central Rural India, with a sample size of 85. Data were recorded in the predesigned, semi-structured questionnaire. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS) were used to categorise the co-morbid anxiety and depression. Results: About 48.2% of the study participants were in the age group of 31-40 years with a mean age of 36.8 ± 7.1 years. Higher proportions of female study participants (64.7%) were observed. Majority of the study participants were literate (76.5%), employed (57.7%), married (78.8%) and had rural residence (54.1%). The prevalence of co-morbid GAD was 70.6%, whereas the prevalence of co-morbid MDD was 54.1%. According to HAM-A, 31.8% had mild, 21.2% had moderate, while 17.6% had severe anxiety levels. According to HDRS, 34.1% had mild, 16.5% had moderate and 3.5% had severe co-morbid depression. Conclusion: TTH is frequently associated with co-morbid GAD and MDD.


Assuntos
Transtornos de Ansiedade/epidemiologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Transtorno Depressivo Maior/epidemiologia , Cefaleia do Tipo Tensional/epidemiologia , Adolescente , Adulto , Transtornos de Ansiedade/diagnóstico , Grupo com Ancestrais do Continente Asiático/psicologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Prevalência , Escalas de Graduação Psiquiátrica , População Rural , Índice de Gravidade de Doença , Fatores Socioeconômicos , Inquéritos e Questionários , Cefaleia do Tipo Tensional/diagnóstico , Centros de Atenção Terciária
3.
PLoS One ; 15(7): e0235256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614881

RESUMO

Responses to affect include cognitive processes (i.e., perseverative vs. non-perseverative) and valence (i.e., modulation of positive vs. negative affect). However, little research has examined how the factor structure of responses to affect is defined along one or both of these dimensions. The present study conducted an exploratory factor analysis (EFA) of items from assessments of repetitive negative thinking, rumination on positive affect (PA), and dampening. We also examined the associations between emergent factors and measures of depressive symptoms, social anxiety symptoms, and non-social state anxiety. EFA results suggested a three-factor model of repetitive negative thinking, dampening, and rumination on PA. There was a significant association between repetitive negative thinking and dampening factors, but not between other factors. Repetitive negative thinking and dampening were associated with greater internalizing symptoms, whereas rumination on PA was associated with fewer internalizing symptoms. These findings clarify the structure of these responses to affect and their differential associations with symptoms, which may be used to tailor cognitive interventions for anxiety and/or depression.


Assuntos
Afeto , Transtornos de Ansiedade/diagnóstico , Ansiedade/diagnóstico , Depressão/diagnóstico , Transtorno Depressivo/diagnóstico , Adolescente , Adulto , Cognição , Feminino , Humanos , Masculino , Otimismo , Pessimismo , Autorrelato , Adulto Jovem
4.
Health Qual Life Outcomes ; 18(1): 151, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32450852

RESUMO

BACKGROUND: Increased violent events happen in the general hospitals in China and yet non-psychiatric departments do not have tools for violence-tendency screening. METHODS: The current study developed and evaluated two Inpatient Psychological Experience Questionnaires (IPEQs) for the screening of violence-related six mental health disorders: (Inpatient Psychological Experience Questionnaire-1 (IPEQ-1): anxiety, depression and suicidality; Inpatient Psychological Experience Questionnaire-2 (IPEQ-2): paranoid personality disorder, emotionally unstable personality disorder and histrionic personality disorder). Two initial IPEQs (IPEQ-1: 37 items and IPEQ-2: 30 items) were developed and assessed by domain experts. Then 1210 inpatients were recruited and divided into three groups (160, 450 and 600 samples, respectively) for IPEQs item selection and evaluation. During the two-stage item selection, three statistical methods including Pearson's correlation coefficient, exploratory factor analysis and item response theory were applied. For the item evaluation, Cronbach's alpha coefficient, test-retest reliability, criterion-related validity and construct validity of the final questionnaires were measured. RESULTS: Twelve items were selected for each IPEQs. Cronbach's alpha coefficients were 0.91 and 0.78 for IPEQ-1 and IPEQ-2, respectively. Test-retest replication ratios were 0.95 and 0.87 for IPEQ-1 and IPEQ-2, respectively. Correlation coefficients between different disorders and their related-tools scores were [0.51, 0.44] and [0.40, 0.44] for IPEQ-1 and IPEQ-2, respectively and were significant (P < 0.01). Confirmatory factor analysis supported the validity of the final IPEQs (P < 0.05), and the model fit index met the criterion generally. CONCLUSION: The IPEQs developed in this study could be effective and easy-to-use tools for screening inpatients with violence-intendancy in non-psychosomatic departments.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos da Personalidade/diagnóstico , Inquéritos e Questionários/normas , Violência/prevenção & controle , Adulto , China , Análise Fatorial , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Reprodutibilidade dos Testes
5.
Orv Hetil ; 161(15): 594-600, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32323963

RESUMO

Introduction: Anxiolytic drug dependence is a cause for growing concern worldwide including Hungary. Psychiatric patients and patients with other drug addictions are at increased risk for anxiolytic drug dependence. Yet, there is only limited scientific information about the real extent of this issue. Aim: To examine the frequency of use of benzodiazepine-containing drugs and comparing the consumption habits of patients treated in psychiatric and addiction rehabilitation wards in a hospital in Budapest. Method: The survey was based on an anonymously and voluntarily completed questionnaire during a face-to-face interview of 103 patients in two wards. The 19-item questionnaire targeted anxiolytic drug use and related behavioral patterns. Statistical analysis: Socio-demographic data were given with means and standard deviations or with percentages as appropriate. For the comparison between the two groups of patients, t-test, Mann­Whitney U-test or chi-square test were used in accordance with the distribution of the sample. Results: Symptoms indicating anxiolytic dependence, use of multiple anxiolytics, and combination of anxiolytic drugs with alcohol were very frequent in both wards. However, there were some significant differences between the two samples. Anxiolytic drug abuse and illicit drug use were significantly more frequent in patients at the addiction ward. Indicators of social status, particularly the place of residence, significantly influenced non-prescription misuse of anxiolytic drugs. Conclusions: The results draw attention to the high frequency of anxiolytic drug misuse and dependence in psychiatric and addiction patients warranting urgent action to confront this challenge. Orv Hetil. 2020; 161(15): 594­600.


Assuntos
Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Hipnóticos e Sedativos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/complicações , Ansiolíticos/efeitos adversos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Humanos , Hungria , Hipnóticos e Sedativos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Inquéritos e Questionários
6.
BMC Psychol ; 8(1): 40, 2020 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-32336292

RESUMO

BACKGROUND: Metacognition has been shown as a key contributor to Obsessive Compulsive Disorder as well as other anxiety-related disorders, yet its role in the development and maintenance of these disorders remains unclear. This study aims to investigate whether anxiety sensitivity traits are related to obsessive-compulsive symptoms in the general population and whether the relationship between anxiety sensitivity and obsessive-compulsive symptoms is mediated by metacognition. METHODS: Non-clinical volunteers (N = 156, mean age: 23.97, 121 females) completed measures related to state/trait anxiety, anxiety sensitivity, obsessive compulsive symptoms and metacognition. RESULTS: A direct relationship between anxiety sensitivity and obsessive-compulsive symptoms was established. Further analysis revealed that metacognition was the strongest mediator of this relationship, even when accounting for state and trait anxiety. CONCLUSIONS: Results suggest that the relationships between traits of anxiety sensitivity and obsessive-compulsive symptoms are partially attributable to the role of metacognition.


Assuntos
Ansiedade/psicologia , Metacognição , Transtorno Obsessivo-Compulsivo/psicologia , Transtornos de Ansiedade/diagnóstico , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
8.
Plast Reconstr Surg ; 145(4): 744e-753e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221209

RESUMO

Male rhinoplasty is unique in that it requires precise preoperative planning to achieve a successful result. Better communication and clarity are paramount with male rhinoplasty patients because the patients may be less attentive. It is important for the surgeon to screen the patients for any psychosocial disorders. Through a series of cases, male rhinoplasty techniques are highlighted. Masculine features should be preserved, and the nose should not be feminized or oversculpted. Another key component in any rhinoplasty case is proper skin care, especially during the postoperative period. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.


Assuntos
Masculinidade , Planejamento de Assistência ao Paciente , Satisfação do Paciente , Seleção de Pacientes , Rinoplastia/psicologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/psicologia , Comunicação , Estética , Humanos , Masculino , Período Pós-Operatório , Rinoplastia/efeitos adversos , Rinoplastia/métodos , Higiene da Pele
9.
Rev. clín. med. fam ; 13(1): 81-84, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193918

RESUMO

El síndrome de Ekbom, también conocido como delirio de parasitosis, consiste en la creencia de estar infestado por insectos u organismos vivientes que recorren el cuerpo de quien lo padece sin que haya evidencia de ello. Las quejas suelen estar centradas en esta idea de parasitación, no obstante también se puede acompañar de ansiedad o depresión. Este trastorno puede ser sin patología médica asociada (primario) o con patología orgánica asociada (secundario). Se presenta el caso de un varón de 81 años que presenta un cuadro compatible con este síndrome, así como la respuesta al tratamiento con antipsicóticos y antidepresivos


Ekbom's syndrome, also known as delusional parasitosis, consists of the belief of being infested with insects or living organisms which crawl through the body when there is no evidence of such infestation. Complaints are usually focused on this idea of parasitization; however it can also be accompanied by anxiety or depression. This condition can be primary (with no associated disorders) or secondary (with associated organic diseases). We present the case of an 81 year-old man with this syndrome, and his response to treatment with antipsychotics and antidepressants


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Síndrome das Pernas Inquietas/diagnóstico , Antipsicóticos/uso terapêutico , Antidepressivos/uso terapêutico , Delusões/diagnóstico , Síndrome das Pernas Inquietas/classificação , Transtornos de Ansiedade/diagnóstico , Diagnóstico Diferencial
10.
Adv Exp Med Biol ; 1191: 219-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002932

RESUMO

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


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Humanos
11.
Adv Exp Med Biol ; 1191: 561-576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002946

RESUMO

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


Assuntos
Transtornos de Ansiedade , Idoso , Ansiolíticos/uso terapêutico , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/psicologia , Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Doenças Cardiovasculares/complicações , Comorbidade , Humanos , Psicoterapia , Inibidores de Captação de Serotonina/uso terapêutico
12.
Adv Exp Med Biol ; 1191: 35-59, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002921

RESUMO

Electrocortical network dynamics are integral to brain function. Linear and nonlinear connectivity applications enrich neurophysiological investigations into anxiety disorders. Discrete EEG-based connectivity networks are unfolding with some homogeneity for anxiety disorder subtypes. Attenuated delta/theta/beta connectivity networks, pertaining to anterior-posterior nodes, characterize panic disorder. Nonlinear measures suggest reduced connectivity of ACC as an executive neuro-regulator in germane "fear circuitry networks" might be more central than considered. Enhanced network complexity and theta network efficiency at rest define generalized anxiety disorder, with similar tonic hyperexcitability apparent in social anxiety disorder further extending to task-related/state functioning. Dysregulated alpha connectivity and integration of mPFC-ACC/mPFC-PCC relays implicated with attentional flexibility and choice execution/congruence neurocircuitry are observed in trait anxiety. Conversely, state anxiety appears to recruit converging delta and beta connectivity networks as panic, suggesting trait and state anxiety are modulated by discrete neurobiological mechanisms. Furthermore, EEG connectivity dynamics distinguish anxiety from depression, despite prevalent clinical comorbidity. Rethinking mechanisms implicated in the etiology, maintenance, and treatment of anxiety from the perspective of EEG network science across micro- and macroscales serves to shed light and move the field forward.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Eletroencefalografia , Rede Nervosa , Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/fisiopatologia , Medo , Humanos
13.
Adv Exp Med Biol ; 1191: 187-196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002930

RESUMO

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


Assuntos
Transtornos de Ansiedade/classificação , Transtornos de Ansiedade/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Fatores Etários , Ansiedade/complicações , Ansiedade/psicologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Depressão/complicações , Depressão/psicologia , Humanos , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/diagnóstico
14.
Adv Exp Med Biol ; 1191: 197-218, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002931

RESUMO

The present chapter is an overview of possible biomarkers which distinguish anxiety disorders as classified by the DSM-5. Structural or activity changes in the brain regions; changes in N-acetylaspartate/creatine, dopamine, serotonin, and oxytocin; hearth rate variability; hypothalamic-pituitary-adrenal axis activity; error-related negativity; respiratory regulation; and genetic variants are proposed. However, their clinical utility is questionable due to low specificity and sensitivity: the majority does not distinguish subjects with different anxiety disorders, and they might be influenced by stress, comorbidity, physical activity, and psychotropic medications. In this framework, the staging model, a clinimetric tool which allows to define the degree of progression of a disease at a point in time and where the patient is located on the continuum of the course of the disease, is proposed since several DSM anxiety disorders take place at different stages of the same syndrome according to the staging model. Thus, a stage-specific biomarker model for anxiety disorders is hypothesized and illustrated.


Assuntos
Transtornos de Ansiedade/classificação , Transtornos de Ansiedade/diagnóstico , Biomarcadores/análise , Manual Diagnóstico e Estatístico de Transtornos Mentais , Dopamina/metabolismo , Humanos , Sistema Hipotálamo-Hipofisário , Ocitocina/metabolismo , Sistema Hipófise-Suprarrenal , Serotonina/metabolismo
15.
Clin Pediatr (Phila) ; 59(4-5): 445-449, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32066264

RESUMO

Adolescents with diabetes are at increased risk for depression and anxiety, which when untreated negatively affects diabetes control. During a 6-month period, the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) screening tool was utilized. Those with a positive screen then completed the Patient Health Questionnaire for Adolescents (PHQ-A) and the Generalized Anxiety Disorder 7-item (GAD-7) scale. In this article, we report on the correlations in outcomes between the PHQ-4 and the PHQ-A and GAD-7 and its clinical utility for determining the need for standard versus acute behavioral health care. Over 6 months, 77 patients aged 10 to 18 years screened positive on the PHQ-4. Thirty-two patients had positive screening with the PHQ-A and/or the GAD-7. Thoughts of self-harm were reported by 13 (40%), with 1 experiencing current/active symptoms. The PHQ-4 as a screening tool was able to identify adolescents with symptoms of depression and/or anxiety who would benefit from further evaluation by a behavioral health provider.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Diabetes Mellitus Tipo 1 , Programas de Rastreamento , Adolescente , Criança , Feminino , Humanos , Escalas de Graduação Psiquiátrica
16.
Behav Ther ; 51(1): 190-202, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32005336

RESUMO

Hope is a trait that represents the capacity to identify strategies or pathways to achieve goals and the motivation or agency to effectively pursue those pathways. Hope has been demonstrated to be a robust source of resilience to anxiety and stress and there is limited evidence that, as has been suggested for decades, hope may function as a core process or transdiagnostic mechanism of change in psychotherapy. The current study examined the role of hope in predicting recovery in a clinical trial in which 223 individuals with 1 of 4 anxiety disorders were randomized to transdiagnostic cognitive behavior therapy (CBT), disorder-specific CBT, or a waitlist controlled condition. Effect size results indicated moderate to large intraindividual increases in hope, that changes in hope were consistent across the five CBT treatment protocols, that changes in hope were significantly greater in CBT relative to waitlist, and that changes in hope began early in treatment. Results of growth curve analyses indicated that CBT was a robust predictor of trajectories of change in hope compared to waitlist, and that changes in hope predicted changes in both self-reported and clinician-rated anxiety. Finally, a statistically significant indirect effect was found indicating that the effects of treatment on changes in anxiety were mediated by treatment effects on hope. Together, these results suggest that hope may be a promising transdiagnostic mechanism of change that is relevant across anxiety disorders and treatment protocols.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Esperança/fisiologia , Autorrelato , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/psicologia , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Resultado do Tratamento , Adulto Jovem
17.
PLoS One ; 15(1): e0227364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895938

RESUMO

OBJECTIVES: Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. METHODS: 274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training. RESULTS: SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001). CONCLUSIONS: Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.


Assuntos
Transtornos de Ansiedade , Transtorno Depressivo , Entrevista Psicológica/métodos , Transtornos da Personalidade , Atenção Secundária à Saúde/métodos , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Comorbidade , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/epidemiologia , Escalas de Graduação Psiquiátrica , Psiquiatria , Psicoterapia , Suécia , Adulto Jovem
18.
Rev. neurol. (Ed. impr.) ; 70(2): 45-52, 16 ene., 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-187247

RESUMO

Introducción: Varios estudios han encontrado que individuos con esclerosis múltiple (EM) presentan tasas altas de ansiedad y depresión; sin embargo, hay pocos informes sobre ansiedad social en individuos con EM. Objetivo: Analizar la prevalencia del trastorno de ansiedad social y otras comorbilidades psiquiátricas en pacientes con EM en comparación con los controles pareados. Sujetos y métodos: Durante un intervalo de seis meses, incluimos a 50 pacientes con EM que fueron observados durante visitas programadas regularmente y a 50 participantes de la población general pareados por sexo y edad. Todos los participantes completaron el inventario de fobia social (SPIN) y la escala de depresión, ansiedad y estrés de 21 ítems. Definimos síntomas de ansiedad social clínicamente significativos los que tenían un resultado en el SPIN mayor o igual a 19. Resultados: La edad media de los pacientes con EM era de 41,9 años (el 54%, mujeres). Las evaluaciones psicológicas notificadas demostraron que los participantes con EM tenían más probabilidad de presentar síntomas positivos de ansiedad social (OR = 7,37; IC 95% = 1,99-27,30; p < 0,001), depresión (OR = 3,76; IC 95% = 1,41-10,10; p = 0,006), estrés (OR = 2,67; IC 95% = 1,09-6,52; p = 0,029) y ansiedad general (OR = 4,70; IC 95% = 1,93-11,40; p < 0,001) que la población general. Se observaron correlaciones moderadas entre ansiedad social y depresión (p = 0,006), ansiedad general (p = 0,001) y estrés (p < 0,001) en los pacientes con EM. Conclusiones: Los pacientes con EM tienen un riesgo más elevado de presentar síntomas de ansiedad social que la población hispana en general


Introduction: Several studies have found that individuals with multiple sclerosis (MS) experience relatively high rates of anxiety and depression; however, there are few reports about social anxiety in individuals with MS. Aim: To analyze the prevalence of social anxiety disorder and other psychiatric comorbidities in MS patients compared to matched controls. Subjects and methods: We included 50 patients with MS that were seen during regularly scheduled visits and 50 sex- and age-matched participants from the general population within a six-month interval. All included participants completed the Social Phobia Inventory (SPIN) and the Depression, Anxiety and Stress Scale with 21 items (DASS-21). We defined clinically significant social anxiety symptoms as SPIN scores = 19. Results: The MS patients’ mean age was 41.9 years (54% female). The self-reported psychosocial assessments showed that MS participants were more likely to present positive social anxiety symptoms (OR = 7.37; 95% CI = 1.99-27.30; p < 0.001), depression (OR = 3.76; 95% CI = 1.41-10.10; p = 0.006), stress (OR = 2.67; 95% CI = 1.09-6.52; p = 0.029), and general anxiety (OR = 4.70; 95% CI = 1.93-11.40; p < 0.001) than the general population. There were moderate correlations between social anxiety and depression (p = 0,006), general anxiety (p = 0,001), and stress (p < 0,001) in MS patients. Conclusions: Patients with MS had a higher risk of presenting social anxiety symptoms than a matched control group in a Hispanic population


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Esclerose Múltipla/psicologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/diagnóstico , Estudos de Casos e Controles , Equador , Transtornos de Ansiedade/psicologia , Inquéritos e Questionários , Estudos Prospectivos , Estudos Transversais
19.
Ann Clin Psychiatry ; 32(1): 5-11, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990964

RESUMO

BACKGROUND: We examined whether a self-report measure of the DSM-5 anxious distress specifier, the Clinically Useful Depression Outcome Scale Anxious Distress Specifier Subscale (CUDOS-A), was as valid as a broader measure of the severity of anxiety, the Clinically Useful Anxiety Outcome Scale (CUXOS), in patients with depression. METHODS: Two hundred ninety-four patients with major depressive disorder were administered a semi-structured interview. The patients completed self-report measures of depression, anxiety, and irritability. Sensitivity to change was examined in a subset of patients. RESULTS: Both the CUDOS-A and CUXOS were more highly correlated with measures of anxiety than with measures of the other symptom domains. Patients with anxiety disorders scored significantly higher on both measures than did patients with no current anxiety disorder. Both measures were equally correlated with measures of coping, general well-being, and functioning. A large effect size of treatment was found for both measures (CUDOS-A: d = 1.2; CUXOS: d = 1.3). CONCLUSIONS: Both the CUDOS-A and CUXOS were valid self-report measures of anxiety symptom severity in patients with depression. Because anxiety is common in patients with depression, the addition of a small number of items assessing the DSM-5 anxious distress criteria should be added to depression measures and used in measurement-based care efforts.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humor Irritável , Escalas de Graduação Psiquiátrica/normas , Angústia Psicológica , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autorrelato , Índice de Gravidade de Doença
20.
J Couns Psychol ; 67(1): 40-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31204836

RESUMO

Research indicates that patient outcome expectation (OE) correlates with improvement, and that this association may be mediated by better patient-therapist alliances. However, despite OE and alliance being dyadic and dynamic constructs, most research on these direct and indirect associations has assessed these variables from only one dyad member's perspective and at single time points. Addressing these gaps, we used a longitudinal actor-partner interdependence model to first examine OE-alliance associations. Namely, we assessed "actor" effects (relation between each member's OE at 1 session and his or her own next session alliance) and "partner" effects (relation between each member's partner's OE at 1 session and his or her own next session alliance). Second, we tested whether significant actor or partner effects of OE on alliance translated into better patient outcomes (indirect effects). Analyses were conducted at within- and between-dyad levels. Data derived from a generalized anxiety disorder trial in which 85 patients received 15 sessions of either cognitive-behavioral therapy (CBT) or CBT integrated with motivational interviewing. After every session, patients and therapists rated OE and alliance, and patients rated their worry. At the within-dyad level, there were OE-alliance actor effects for both patients and therapists. There was also a within-dyad partner effect; when patients had greater OE at one session their therapists reported better next-session alliances. Finally, all within-dyad effects in turn related to lower subsequent worry. Results reveal ways in which session-by-session fluctuations in both patient and therapist OE translate into better outcomes through their influence on alliance quality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/tendências , Motivação/fisiologia , Relações Profissional-Paciente , Adulto , Transtornos de Ansiedade/diagnóstico , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Entrevista Motivacional/métodos , Entrevista Motivacional/tendências , Resultado do Tratamento , Adulto Jovem
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