scholarly journals Functioning and disability levels in primary care out-patients with one or more anxiety disorders

2010 ◽  
Vol 40 (12) ◽  
pp. 2059-2068 ◽  
Author(s):  
C. D. Sherbourne ◽  
G. Sullivan ◽  
M. G. Craske ◽  
P. Roy-Byrne ◽  
D. Golinelli ◽  
...  
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Well Being ◽  
Post Traumatic Stress ◽  
Co Morbidity ◽  
Post Traumatic ◽  
Relative Differences

BackgroundAnxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of combinations of anxiety disorders in primary care out-patients.MethodA total of 1004 patients with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) or post-traumatic stress disorder (PTSD) provided data on their mental and physical functioning, and disability. Multivariate regressions compared functional levels for patients with different numbers and combinations of disorders.ResultsOf the patients, 42% had one anxiety disorder only, 38% two, 16% three and 3% all four. There were few relative differences in functioning among patients with only one anxiety disorder, although those with SAD were most restricted in their work, social and home activities and those with GAD were the least impaired. Functioning levels tended to deteriorate as co-morbidity increased.ConclusionsOf the four anxiety disorders examined, GAD appears to be the least disabling, although they all have more in common than in distinction when it comes to functional impairment. A focus on unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders, which is the modal presentation in primary care.

Elevated circulatory level of GABAA – antagonistic neurosteroids in patients with combat-related post-traumatic stress disorder

2000 ◽  
Vol 30 (5) ◽  
pp. 1227-1231 ◽  
Author(s):  
B. SPIVAK ◽  
R. MAAYAN ◽  
M. KOTLER ◽  
R. MESTER ◽  
I. GIL-AD ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Control Male ◽  
Chronic Ptsd ◽  
Co Morbidity ◽  
Post Traumatic ◽  
Circulatory Level

Background. Post-traumatic stress disorder (PTSD) is a multisystem neurobiological disorder with chronic alterations in various neurochemical systems. Levels of the GABAA – antagonistic neurosteroids plasma dehydroepiandrosterone (DHEA) and its sulphate derivate, dehydro-epiandrosterone sulphate (DHEAS) may be relevant to depressive and anxiety disorders, including PTSD.Methods. We assessed the circulatory levels of morning plasma DHEA and DHEAS in 21 male out-patients with untreated chronic combat-related PTSD (CR-PTSD), and 18 healthy control male subjects.Results. Compared with the control subjects, the PTSD patients showed significantly higher plasma DHEA and DHEAS levels.Conclusions. Chronic CR-PTSD may be associated with increased circulatory level of neuroactive steroids with inhibitory activity at the GABAA receptors. Neurosteroid-induced decreased GABA-ergic tone may be relevant to the symptomatology and pathophysiology of chronic PTSD, as well as to the frequent co-morbidity of PTSD with depression and anxiety disorders.

Ketamine’s dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders

2017 ◽  
Vol 31 (10) ◽  
pp. 1302-1305 ◽  
Author(s):  
Paul Glue ◽  
Natalie J Medlicott ◽  
Sarah Harland ◽  
Shona Neehoff ◽  
Bridie Anderson-Fahey ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Post Traumatic Stress ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Post Traumatic ◽  
Resistant Depression

The N-methyl-D-aspartate receptor antagonist ketamine has rapid onset activity in treatment-resistant depression, post-traumatic stress disorder and obsessive compulsive disorder. Due to similarities in brain network activity in depression and anxiety disorders, we hypothesized that ketamine might also be active in other refractory anxiety disorders. We evaluated the efficacy and safety of ketamine in 12 patients with refractory generalized anxiety disorder and/or social anxiety disorder who were not currently depressed, using an ascending single dose study design (0.25, 0.5, 1 mg/kg administered subcutaneously) at weekly intervals. Within 1 h of dosing, patients reported reduced anxiety, which persisted for up to seven days. A dose-response profile was noted for anxiolytic effects, dissociative side effects, and changes in blood pressure and heart rate, with minor changes at 0.25 mg/kg, and progressively greater and more durable changes at the higher doses. Ten of 12 patients were treatment responders at 0.5–1 mg/kg. Ketamine was safe and well tolerated in this population. Ketamine may be a potential therapeutic alternative for patients with refractory generalized anxiety disorder/social anxiety disorder. Along with its demonstrated effectiveness in patients with treatment-resistant depression, obsessive compulsive disorder and post-traumatic stress disorder, these data raise the intriguing possibility that ketamine may have broad efficacy in disorders characterized by negative emotional states, and that these disorders may share a common precipitating neurobiology.

scholarly journals Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being

2001 ◽  
Vol 31 (7) ◽  
pp. 1237-1247 ◽  
Author(s):  
M. CREAMER ◽  
P. BURGESS ◽  
A. C. MCFARLANE
Keyword(s):  
Mental Health ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Well Being ◽  
Post Traumatic Stress ◽  
Co Morbidity ◽  
Australian Community ◽  
Post Traumatic ◽  
Health And Well Being

Background. We report on the epidemiology of post-traumatic stress disorder (PTSD) in the Australian community, including information on lifetime exposure to trauma, 12-month prevalence of PTSD, sociodemographic correlates and co-morbidity.Methods. Data were obtained from a stratified sample of 10641 participants as part of the Australian National Survey of Mental Health and Well-being. A modified version of the Composite International Diagnostic Interview was used to determine the presence of PTSD, as well as other DSM-IV anxiety, affective and substance use disorders.Results. The estimated 12-month prevalence of PTSD was 1·33%, which is considerably lower than that found in comparable North American studies. Although females were at greater risk than males within the subsample of those who had experienced trauma, the large gender differences noted in some recent epidemiological research were not replicated. Prevalence was elevated among the never married and previously married respondents, and was lower among those aged over 55. For both men and women, rape and sexual molestation were the traumatic events most likely to be associated with PTSD. A high level of Axis 1 co-morbidity was found among those persons with PTSDConclusions. PTSD is a highly prevalent disorder in the Australian community and is routinely associated with high rates of anxiety, depression and substance disorders. Future research is needed to investigate rates among other populations outside the North American continent.

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