Duration of Untreated Illness as a Predictor of Treatment Response and Clinical Course in Generalized Anxiety Disorder

ABSTRACTIntroduction:The aim of the present study was to investigate the impact of the duration of untreated illness (DUI)—defined as the time elapsing between the onset of generalized anxiety disorder (GAD) and the first adequate pharmacologic treatment—on treatment response and clinical course in a sample of subjects with GAD.Methods:One hundred patients with GAD, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria, were enrolled and their main demographic and clinical features collected. Patients were then treated with selective serotonin reuptake inhibitors or venlafaxine for 8 weeks in open-label conditions. Treatment response and other clinical variables were analyzed after dividing the sample into two groups according to DUI (DUI ≤12 months and DUI >12 months).Results:When the DUI was computed with respect to the first antidepressant treatment (DUI-AD), a higher improvement (Clinical Global Impressions-Severity of Illness scale) after the pharmacologic treatment was found in the group with a shorter DUI (analysis of variance with repeated measures: time effect F=654.975, P<.001; group effect: F=4.369, P=.O39). When computed with respect to the first treatment with benzodiazepines (DUI-BDZ), the two groups did not show any significant difference in treatment response (time effect: F=652.183, P<.001; group effect: F=0.009, P=.924). In addition, patients with a longer DUI (DUI-BDZ or DUI-AD) showed an earlier age at onset, a longer duration of illness and a higher rate of comorbid psychiatric disorders with onset later than GAD.Conclusion:Results from this preliminary study seem to suggest that a shorter DUI-AD may determine a better response to pharmacologic treatment in patients with GAD, and that a longer DUI (DUI-BDZ and DUI-AD) may be associated to a worse clinical course. Further investigation on the relationship between DUI and GAD is needed.

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COMBINATORIAL PHARMACOGENOMIC TESTING IMPROVES GENERALIZED ANXIETY DISORDER TREATMENT RESPONSE AND DECREASES BENZODIAZAPINE USE

European Neuropsychopharmacology ◽

10.1016/j.euroneuro.2017.08.272 ◽

2019 ◽

Vol 29 ◽

pp. S933

Author(s):

Arun Tiwari ◽

Clement Zai ◽

Gwyneth Zai ◽

Sheraz Cheema ◽

Nicole Braganza ◽

...

Keyword(s):

Anxiety Disorder ◽

Treatment Response ◽

Generalized Anxiety Disorder ◽

Generalized Anxiety ◽

Disorder Treatment

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Measurement Invariant but Non-Normal Treatment Responses in Guided Internet Psychotherapies for Depressive and Generalized Anxiety Disorders

Assessment ◽

10.1177/10731911211062500 ◽

2021 ◽

pp. 107319112110625

Author(s):

Tom H. Rosenström ◽

Ville Ritola ◽

Suoma Saarni ◽

Grigori Joffe ◽

Jan-Henry Stenberg

Keyword(s):

Anxiety Disorder ◽

Treatment Response ◽

Generalized Anxiety Disorder ◽

Health Assessment ◽

Psychotherapy Research ◽

Self Report ◽

Generalized Anxiety ◽

Equivalence Testing ◽

Sum Scores ◽

Normally Distributed

Assessment of treatment response in psychotherapies can be undermined by lack of longitudinal measurement invariance (LMI) in symptom self-report inventories, by measurement error, and/or by wrong model assumptions. To understand and compare these threats to validity of outcome assessment in psychotherapy research, we studied LMI, sum scores, and Davidian Curve Item Response Theory models in a naturalistic guided internet psychotherapy treatment register of 2,218 generalized anxiety disorder (GAD) patients and 3,922 depressive disorder (DD) patients (aged ≥16 years). Symptoms were repeatedly assessed by Generalized Anxiety Disorder Assessment-7 (GAD-7) or Beck Depression Inventory. The symptom self-reports adhered to LMI under equivalence testing, suggesting sum scores are reasonable proxies for disorder status. However, the standard LMI assumption of normally distributed latent factors did not hold and inflated treatment response estimates by 0.2 to 0.3 standard deviation units compared with sum scores. Further methodological research on non-normally distributed latent constructs holds promise in advancing LMI and mental health assessment.

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Cognitive functions in young adults with generalized anxiety disorder

European Psychiatry ◽

10.1016/j.eurpsy.2018.10.008 ◽

2018 ◽

Vol 56 (1) ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Kiara Leonard ◽

Amitai Abramovitch

Keyword(s):

Anxiety Disorder ◽

Cognitive Load ◽

Generalized Anxiety Disorder ◽

Cognitive Functions ◽

Theoretical Models ◽

Generalized Anxiety ◽

Neuropsychological Battery ◽

Compensatory Mechanisms ◽

Neuropsychological Profile ◽

The Impact

AbstractBackground:Anxiety and worry are central symptoms of Generalized Anxiety Disorder (GAD) that have been theorized to negatively impact cognitive functions. However, most of the research has focused on threat-related or emotionally-charged stimuli, and a surprisingly small number of investigations examined ‘cold’ cognitive functions using classic neuropsychological tests. Such investigations are particularly important given that some theoretical models suggest compensatory mechanisms associated with anxiety that in certain circumstances may result in intact performance. The aim of the present study is to assess the neuropsychological profile associated with GAD, using a comprehensive neuropsychological battery.Methods:A sample of 23 college students meeting criteria for DSM-5 GAD and 20 control participants completed a psychometrically valid comprehensive computerized neuropsychological battery and clinical questionnaires.Results:The GAD sample presented with significantly elevated symptomatic rates of anxiety, worry, depression and stress. However, no significant differences were found on any neuropsychological outcome measures or domain indexes. Effect sizes were small, some of which favored the GAD sample.Conclusion:Despite substantial psychopathological burden, GAD exhibited intact cognitive functioning. These results support the Cognitive Control Theory of Anxiety, suggesting that elevated primary anxiety may not impact ‘cold’ cognitive functions in the absence of threat or substantial cognitive load. Given that this is one of the only studies employing a comprehensive neuropsychological battery in GAD, more research is needed in this population to replicate these results and to examine the impact of anxiety on cognitive functions at varying degrees of cognitive load in this population.

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Association between fecal microbiota and generalized anxiety disorder: Severity and early treatment response

Journal of Affective Disorders ◽

10.1016/j.jad.2019.08.014 ◽

2019 ◽

Vol 259 ◽

pp. 56-66 ◽

Cited By ~ 16

Author(s):

Yi-huan Chen ◽

Jie Bai ◽

Di Wu ◽

Shou-fen Yu ◽

Xiao-ling Qiang ◽

...

Keyword(s):

Anxiety Disorder ◽

Treatment Response ◽

Generalized Anxiety Disorder ◽

Early Treatment ◽

Fecal Microbiota ◽

Generalized Anxiety ◽

Early Treatment Response

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Insomnia and Quality of Life in Generalized Anxiety Disorder: Impact on Clinical Presentation and Response to Pregabalin and Venlafaxine-XR

European Psychiatry ◽

10.1016/s0924-9338(09)70767-9 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

M.A. Mychaskiw ◽

J.M. Alvir ◽

B.K. Herman ◽

S. Pallanti ◽

A. Joshi

Keyword(s):

Quality Of Life ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Sleep Problems ◽

Generalized Anxiety ◽

Medical Outcomes ◽

Double Blind ◽

Disturbance Factor ◽

The Impact

Aims:To assess the impact of insomnia on quality of life (QoL) and functioning in patients with generalized anxiety disorder (GAD), and evaluate the efficacy of pregabalin and venlafaxine-XR in improving sleep and QoL.Methods:A double-blind trial in adults who met DSM-IV criteria for GAD, with a HAM-A total score ≥20,randomized to 8-weeks of flexible-dose treatment with pregabalin (300-600 mg/d, N=121), venlafaxine-XR (75-225 mg/d, N=125), or placebo (N=128).Results:At baseline, 64% of all subjects had insomnia (according to the Medical Outcomes Study Sleep scale [MOS]-Sleep Problems Index [SPI] criteria).While HAM-A total scores (minus the insomnia item) were similar for patients with and without baseline insomnia (25.7 vs. 25.0) those with reported significantly more impairment on the Quality of Life, Enjoyment, and Satisfaction Questionnaire (Q-LES-Q; 45.4 vs. 53.6; p< 0.0001) and Sheehan Disability Scale (SDS; 17.5 vs.14.3; p< 0.0001) than those without. At endpoint, there was a significantly greater mean improvement in MOS-sleep disturbance factor and MOS-SPI with pregabalin (-29.0 and -21.1, respectively) than venlafaxine-XR (-14.7 and -11.0) or placebo (-15.2 and -12.5; all p< 0.05). In more pregabalin (64%) than venlafaxine-XR (51%) or placebo (52%) subjects, abnormal baseline sleep had normalized by endpoint. Endpoint change in MOS-SPI significantly correlated with improvement in both Q-LES-Q and SDS-total scores (Spearman r-values, -0.48 and 0.46, respectively; both p< 0.0001; all subjects).Conclusion:Significantly greater impairment in QoL and functioning was observed in patients with high (vs. low) levels of insomnia. Pregabalin produced significantly greater improvement in insomnia than venlafaxine-XR or placebo.

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Impact of Progression of Parkinson's Disease and Various Other Factors on Generalized Anxiety Disorder

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_52_18 ◽

2018 ◽

Vol 09 (03) ◽

pp. 287-290 ◽

Cited By ~ 2

Author(s):

Abdul Qayyum Rana ◽

Hamza Ansari ◽

Abdul Rehman M. Qureshi ◽

Eraad Rahman

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Ethnically Diverse ◽

Influential Factors ◽

Generalized Anxiety ◽

Increased Risk ◽

The Impact ◽

The Relationship

ABSTRACT Objective: While much research has been conducted toward understanding the relationship between prevalence of Parkinson's disease (PD) and generalized anxiety, little has been done considering additional influential factors in the relationship by means of a large ethnically diverse sample. Our study strives to fulfill these deficits in the literature as we set out to determine the impact of progression of PD, age, gender, and Hoehn and Yahr (H and Y) staging of PD on generalized anxiety. Methods: A retrospective chart review analysis was performed on PD patients who were regularly examined in a community-based PD and movement disorders center from 2005 to 2010. Results: This study consisted of 310 patients with PD among whom 12% had generalized anxiety. Neither age nor gender was significant onset predictors at P = 0.05. The impact of progression of H and Y Stages 2–3 and 2–4 increased the odds of generalized anxiety disorder (GAD) prevalence though it was statistically insignificant at P = 0.05. Conclusions: Clinicians should not expect the risk of developing anxiety to depend on gender nor change as a function of age though it may increase with symptomatic progression of PD as outlined by H and Y. To the best of our knowledge, this is the largest and most ethnically diverse prevalence study with a focus on generalized anxiety and PD. Significant Outcomes and Limitations: The symptomatic progression of PD, but not age or gender, may be associated with an increased risk for GAD. This study lacked adjustment for potential confounders such as depression and PD medications.

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