scholarly journals When Anxiety and Depression Coexist: The Role of Differential Diagnosis Using Clinimetric Criteria

2021 ◽  
pp. 1-10
Author(s):  
Fiammetta Cosci ◽  
Giovanni A. Fava
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Clinical Judgment ◽  
Anxiety And Depression ◽  
Advantages And Disadvantages ◽  
Clinical Presentations ◽  
Average Patient ◽  
Meta Analyses ◽  
Selection Of

Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their relationship has been a source of controversy. Reviews generally base their conclusions on randomized controlled trials and meta-analyses that refer to the average patient and often clash with the variety of clinical presentations that may occur when anxiety and depression coexist. The aim of this review was to examine the literature according to profiling of subgroups of patients based on clinimetric criteria, in line with the recently developed concept of medicine-based evidence. We critically reviewed the literature pertaining to the specific presentations of anxiety and depression, outlining the advantages and disadvantages of each treatment approach. The following prototypic cases were presented: depression secondary to an active anxiety disorder, depression in patients with anxiety disorders under treatment, anxious depression, anxiety as a residual component of depression, and demoralization secondary to anxiety disorder. We argue that the selection of treatment when anxiety and depression coexist should take into account the modalities of presentation and be filtered by clinical judgment. Very different indications may ensue when the literature is examined according to this perspective.

scholarly journals The Effectiveness of Psychological Therapies for Anxiety Disorders in Adolescents: A Meta-Analysis

2021 ◽  
Author(s):  
Holly J. Baker ◽  
Peter J. Lawrence ◽  
Jessica Karalus ◽  
Cathy Creswell ◽  
Polly Waite
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Symptom Severity ◽  
Meta Analysis ◽  
Post Treatment ◽  
Adolescent Anxiety ◽  
Psychological Therapies ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Active Controls

AbstractAnxiety disorders are common in adolescence but outcomes for adolescents are unclear and we do not know what factors moderate treatment outcome for this age group. We conducted meta-analyses to establish the effectiveness of psychological therapies for adolescent anxiety disorders in (i) reducing anxiety disorder symptoms, and (ii) remission from the primary anxiety disorder, compared with controls, and examine potential moderators of treatment effects. The protocol was registered with PROSPERO (CRD42018091744). Electronic databases (Web of Science, MEDLINE, Psycinfo, EMBASE) were searched from January 1990 to December 2019. 2511 articles were reviewed, those meeting strict criteria were included. Random effects meta-analyses were conducted. Analyses of symptom severity outcomes comprised sixteen studies (CBT k = 15, non-CBT k = 1; n = 766 adolescents), and analyses of diagnostic remission outcomes comprised nine (CBT k = 9; n = 563 adolescents). Post-treatment, those receiving treatment were significantly more likely to experience reduced symptom severity (SMD = 0.454, 95% CI 0.22–0.69) and remission from the primary anxiety disorder than controls (RR = 7.94, 95% CI 3.19–12.7) (36% treatment vs. 9% controls in remission). None of the moderators analysed were statistically significant. Psychological therapies targeting anxiety disorders in adolescents are more effective than controls. However, with only just over a third in remission post-treatment, there is a clear need to develop more effective treatments for adolescents, evaluated through high-quality randomised controlled trials incorporating active controls and follow-up data.

The Role of Microbiology in Models of Dental Caries: Reaction Paper

1995 ◽  
Vol 9 (3) ◽  
pp. 255-269 ◽  
Author(s):  
G.H. Bowden
Keyword(s):  
Process Selection ◽  
Advantages And Disadvantages ◽  
Test Models ◽  
Plaque Development ◽  
In Vitro Systems ◽  
Selection Of

Models of the caries process have made significant contributions toward defining the roles of bacteria in caries. Microbiologists use a variety of in vitro systems to model aspects of the caries process. Also, in situ models in humans provide information on the microbiology of caries in vivo. These models do not involve the entire process leading to natural caries; consequently, the results from such studies are used to deduce the roles of bacteria in natural caries. Therefore, they can be described as Inferential Caries Models. In contrast, animal models and some clinical trials in humans involve natural caries and can be described as Complete Caries Models. Furthermore, these models are used in two distinct ways. They can be used as Exploratory Models to explore different aspects of the caries process, or as Test Models to determine the effects of anticaries agents. This dichotomy in approach to the use of caries models results in modification of the models to suit a particular role. For example, if we consider Exploratory Models, the in situ appliance in humans is superior to others for analyzing the microbiology of plaque development and demineralization in vivo. The chemostat and biofilm models are excellent for exploring factors influencing bacterial interactions. Both models can also be used as Test Models. The in situ model has been used to test the effects of fluoride on the microflora and demineralization, while the chemostat and biofilm models allow for the testing of antibacterial agents. Each model has its advantages and disadvantages and role in analysis of the caries process. Selection of the model depends on the scientific question posed and the limitations imposed by the conditions available for the study.

Systematic Review and Meta-Analysis of Anxiety and Depression in Youth With Epilepsy

2020 ◽  
Vol 45 (2) ◽  
pp. 133-144 ◽  
Author(s):  
Amelia J Scott ◽  
Louise Sharpe ◽  
Max Loomes ◽  
Milena Gandy
Keyword(s):  
Systematic Review ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Control Sample ◽  
Separation Anxiety Disorder ◽  
Anxiety And Depression ◽  
Healthy Controls ◽  
Pooled Prevalence

Abstract Objective The aim of this systematic review and meta-analysis was to provide an estimate of the prevalence of anxiety and depressive disorders in youth with epilepsy (YWE). It also aimed to calculate the overall magnitude of observed differences in anxiety and depressive symptoms reported by YWE compared with healthy controls and investigate whether any factors moderated anxiety and depression outcomes in YWE. Methods Following prospective registration, electronic databases were searched up until October 2018. Studies were included if they reported on the rate of anxiety or depression in samples of YWE, and/or if they used valid measures of anxious or depressive symptomatology in YWE compared with a healthy control sample. Results Twenty-three studies met inclusion criteria. The overall pooled prevalence of anxiety disorders in YWE was 18.9% (95% confidence interval [CI] 12.0%–28.5%), and for depression the pooled prevalence was 13.5% (95% CI 8.8%–20.2%). In samples of YWE compared with healthy controls, significantly higher anxiety (d = 0.57, 95% CI 0.32–0.83, p < .000) and depressive (d = 0.42, 95% CI 0.16–0.68, p < .000) symptomatology was reported. Conclusions YWE report anxiety and depressive disorders and symptoms to a significantly higher degree than youth without epilepsy. There is also evidence that certain anxiety disorders (e.g. generalized anxiety disorder, separation anxiety disorder) are particularly elevated, perhaps reflecting the unique impact of epilepsy on youth psychopathology. Research is needed to understand the risk factors associated with anxiety and depressive disorders in epilepsy, and better understand how these symptoms change across development.

scholarly journals Anxiety in Children with Selective Mutism: A Meta-analysis

2019 ◽  
Vol 51 (2) ◽  
pp. 330-341 ◽  
Author(s):  
Jim Driessen ◽  
Jan Dirk Blom ◽  
Peter Muris ◽  
Roger K. Blashfield ◽  
Marc L. Molendijk
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Meta Analysis ◽  
A Priori ◽  
Selective Mutism ◽  
Research Strategies ◽  
Prevalence Data ◽  
Systematic Assessment ◽  
Pooled Prevalence

Abstract This study evaluates the current conceptualization of selective mutism (SM) as an anxiety disorder in the DSM-5 using a meta-analytic approach. In the absence of any systematic assessment of anxiety in the field of SM, we pooled prevalence data of comorbid anxiety disorders in a random-effects meta-analysis. On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%). However, considerable heterogeneity was present, which remained unexplained by a priori specified moderators. The finding that SM is often diagnosed in combination with anxiety disorders, indicates that these disorders are not discrete, separable categories. Moreover, this finding does not help to elucidate the relation between SM and anxiety as an etiological mechanism or symptomatic feature. Broadening our research strategies regarding the assessment of anxiety is paramount to clarify the role of anxiety in SM, and allow for proper classification.

Parenting and Parental Anxiety and Depression as Predictors of Treatment Outcome for Childhood Anxiety Disorders: Has the Role of Fathers Been Underestimated?

2008 ◽  
Vol 37 (4) ◽  
pp. 747-758 ◽  
Author(s):  
Juliette M. Liber ◽  
Brigit M. van Widenfelt ◽  
Arnold W. Goedhart ◽  
Elisabeth M. W. J. Utens ◽  
Adelinde J. M. van der Leeden ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Anxiety Disorders ◽  
Childhood Anxiety ◽  
Anxiety And Depression ◽  
Parental Anxiety ◽  
Childhood Anxiety Disorders

scholarly journals The role of sex and gender in the changing levels of anxiety and depression during the COVID-19 pandemic: A cross-sectional study

2021 ◽  
Vol 17 ◽  
pp. 174550652110629
Author(s):  
Hoda Seens ◽  
Shirin Modarresi ◽  
James Fraser ◽  
Joy C MacDermid ◽  
David M Walton ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety And Depression ◽  
Generalized Anxiety ◽  
Sex And Gender ◽  
Health Questionnaire ◽  
Cross Sectional ◽  
Maximum Score ◽  
Patient Health ◽  
And Gender

Background: Several studies have assessed the impact of the COVID-19 pandemic on anxiety and depression, but have not focused on the role of sex and gender. This study compared changes in the levels of anxiety and depression (pre- and post-COVID) experienced by individuals of various sexes and genders. Methods: We used a cross-sectional online survey that assessed pre- and post-COVID symptoms of anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-9). General linear modeling (fixed model factorial analysis of variance) was used to evaluate changes in anxiety and depression between pre- and post-pandemic periods and explore differential effects of sex and gender on those changes. Results: Our study included 1847 participants from 43 countries and demonstrated a percentage increase of 57.1% and 74.2% in anxiety and depression, respectively. For the Generalized Anxiety Disorder-2 scale (maximum score 6), there was a mean increase in anxiety by sex for male, female, and other of 1.0, 1.2, and 1.4, respectively; and by gender for man, woman, and others of 0.9, 1.3, and 1.6, respectively. For the Patient Health Questionnaire-9 (maximum score 27), there was a mean increase in depressive symptoms by sex for male, female, and other of 3.6, 4.7, and 5.5 respectively; and by gender for man, woman, and others of 3.3, 4.8, and 6.5, respectively. Conclusion: During COVID-19, there was an increase in anxiety and depressive symptoms for all sexes and genders, with the greatest increases reported by those identifying as non-male and non-men.

Neuroimaging of anxiety disorders

2020 ◽  
pp. 938-947
Author(s):  
Gregor Leicht ◽  
Christoph Mulert
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Treatment Strategies ◽  
Panic Attacks ◽  
Anterior Cingulate ◽  
Therapeutic Interventions ◽  
Human Models ◽  
Neural Processes ◽  
Pathophysiological Role

Neuroimaging has extensively contributed to the identification of the neurobiological basis of anxiety and the pathophysiological mechanisms underlying anxiety disorders. Studies in human models of anxiety, as well as investigations in anxiety disorder patients, consistently demonstrated the pathophysiological role of a ‘fear network’ comprising the amygdala, insula, medial prefrontal cortex, and anterior cingulate cortex. This chapter reviews the main neuroimaging findings from human models of anxiety disorders such as fear conditioning, fear generalization, and pharmacologically induced panic attacks. Moreover, the chapter summarizes evidence from research in patients aiming to identify the neural processes underlying the pathophysiology of clinically relevant anxiety disorders. Finally, the chapter provides an overview on neurobiological aspects of successful therapeutic interventions, which might prospectively contribute to the refinement of existing approaches, the prediction of the success of certain treatment strategies in individual patients, and the development of more effective options for the treatment of anxiety disorders.

scholarly journals Treatment of anxiety disorders

2017 ◽  
Vol 19 (2) ◽  
pp. 93-107 ◽  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Burden Of Illness ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
Level Of Evidence ◽  
Randomized Controlled Studies ◽  
Meta Analyses

Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.

Anxiety Disorders

Depression ◽  
2019 ◽  
pp. 89-101
Author(s):  
Carly Yasinski ◽  
Bonnie Seifert ◽  
Callan M. Coghlan ◽  
Barbara O. Rothbaum
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Theoretical Models ◽  
Response To Treatment ◽  
Anxiety And Depression ◽  
Negative Consequences ◽  
Post Traumatic Stress ◽  
Obsessive Compulsive ◽  
Post Traumatic ◽  
High Level

This chapter discusses the similarities, differences, and comorbidities between depression and anxiety disorders broadly defined, including generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. The high level of comorbidity between anxiety disorders and depression is explicated, and the negative consequences of this comorbidity, including higher severity, functional impairment, and worse response to treatment, are discussed. Major theoretical models for differentiating anxiety and depression, including the tripartite model, the integrative hierarchical model, and the quadripartite model, are explained. Translational research, including neurological, psychophysiological, and genetic underpinnings of the similarities and differences between anxiety and depression, is reviewed. The chapter concludes with broad treatment implications and recommendations.

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