scholarly journals Influence of baseline severity on antidepressant efficacy for anxiety disorders: Meta-analysis and meta-regression

2016 ◽  
Vol 208 (6) ◽  
pp. 515-521 ◽  
Author(s):  
Ymkje Anna de Vries ◽  
Peter de Jonge ◽  
Edwin van den Heuvel ◽  
Erick H. Turner ◽  
Annelieke M. Roest
Keyword(s):  
Anxiety Disorder ◽  
Treatment Group ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Post Traumatic Stress ◽  
Short Term Treatment ◽  
Compulsive Disorder ◽  
Baseline Severity ◽  
Antidepressant Efficacy ◽  
Meta Regression

BackgroundAntidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range.AimsTo examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive–compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder.MethodFifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction.ResultsIncreased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% CI –0.13 to 0.20, P = 0.65) for GAD, –0.06 (95% CI –0.20 to 0.09, P = 0.43) for SAD, 0.04 (95% CI –0.07 to 0.16, P = 0.46) for OCD, 0.16 (95% CI –0.22 to 0.53, P = 0.37) for PTSD and 0.002 (95% CI –0.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (β = 0.11, 95% CI 0.05 to 0.17, P = 0.001).ConclusionsNo relationship between baseline severity and drug–placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.

scholarly journals The association of personality disorders with the prospective 7-year course of anxiety disorders

2010 ◽  
Vol 41 (5) ◽  
pp. 1019-1028 ◽  
Author(s):  
E. B. Ansell ◽  
A. Pinto ◽  
M. O. Edelen ◽  
J. C. Markowitz ◽  
C. A. Sanislow ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Personality Disorders ◽  
Prognostic Significance ◽  
Post Traumatic Stress ◽  
Structured Interviews ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

BackgroundThis study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.MethodParticipants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia.ResultsEstimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia.ConclusionsFindings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.

scholarly journals Spectrum of Anxiety Disorders Among Medical Students in a Nigerian Medical School: A Cross-Sectional Study With Standardized Screening Tools

2018 ◽  
Vol 8 (2) ◽  
pp. 132
Author(s):  
A. T. Chinawa ◽  
J. M. Chinawa ◽  
E. Aniwada ◽  
Oge Amadi ◽  
A. C. Ndukuba ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Medical Students ◽  
Anxiety Disorders ◽  
Marital Status ◽  
Simple Random Sampling ◽  
Screening Tools ◽  
P Value ◽  
Post Traumatic Stress ◽  
Cross Sectional ◽  
Compulsive Disorder

BACKGROUND: Anxiety disorders among medical students constitute a global problem, and also reflect the mental state of the general population. There is paucity of data on the spectrum of such disorders among medical students in Nigeria.AIM: The study aims to determine the prevalence of anxiety disorders among medical students, and the effect of socio-demographic characteristics.METHODS: A total of 217 medical students from the second to the final years of study at Enugu State University of Science and Technology in south-east Nigeria were enrolled by simple random sampling. Five pretested, self- administered standardized questionnaires were used as screening tools for anxiety disorders. Data were analyzed using the Statistical Package for Social Sciences program (SPSS version 20). A p-value less than 0.05 was taken as statistically significant.RESULTS: Thirty one (14.3%) of the enrolled medical students fulfilled the screening criteria for anxiety disorders. Specifically, generalized anxiety disorder (GAD) was significantly related to gender (p =0.017) and the year of study (p =0.017). Post-traumatic stress disorder (PTSD) was significantly related to the year of study (p =0.037), and social anxiety disorder (SAD) to the year of study (p =0.003) and gender (p =0.04). Similarly, panic disorder was significantly related to the year of study (p =0.025) while specific phobia was significantly associated with marital status (p =0.003), parental monthly income (p =0.022) and student’s monthly allowance (p =0.002). Finally, obsessive-compulsive disorder was significantly related to marital status (p =0.034) and year of study (p =0.028).CONCLUSION: Medical students in Nigeria are prone to a spectrum of anxiety disorders. This susceptibility is influenced by socio-demographic characteristics.

TMS in the study and treatment of anxiety disorders

2012 ◽  
Author(s):  
Benjamin Greenberg ◽  
Sarah H. Lisanby
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Therapeutic Effects ◽  
Post Traumatic Stress ◽  
Obsessive Compulsive ◽  
Systematic Testing ◽  
Compulsive Disorder ◽  
Current State ◽  
Post Traumatic ◽  
Disorder Treatment

A few studies of transcranial magnetic stimulation (TMS) as an anxiety disorder treatment have been reported. In treatment studies, the focal application of TMS in the treatment of anxiety disorders has been guided by the present understanding of the neurocircuitry underlying these disorders. This article reviews the current state of the literature on the uses of TMS in the study and treatment of anxiety disorders, and discusses the implications for understanding their patho-etiology. Investigation of the possible therapeutic effects of repetitive TMS in obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or any anxiety disorder remains at a preliminary stage. There have been promising initial observations in OCD, which require systematic testing in controlled studies. As far as PTSD is concerned, the available data suggest that additional TMS work is required. The observations need to be replicated in controlled settings to determine whether this approach will have value in treating 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.

Prevalence of current anxiety disorders in people with bipolar disorder during euthymia: a meta-analysis

2016 ◽  
Vol 47 (6) ◽  
pp. 1107-1115 ◽  
Author(s):  
B. Pavlova ◽  
R. H. Perlis ◽  
O. Mantere ◽  
C. M. Sellgren ◽  
E. Isometsä ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Diagnostic Criteria ◽  
Meta Analysis ◽  
Fold Increase ◽  
Post Traumatic Stress ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Increase Risk

BackgroundAnxiety disorders are highly prevalent in people with bipolar disorder, but it is not clear how many have anxiety disorders even at times when they are free of major mood episodes. We aimed to establish what proportion of euthymic individuals with bipolar disorder meet diagnostic criteria for anxiety disorders.MethodWe performed a random-effects meta-analysis of prevalence rates of current DSM-III- and DSM-IV-defined anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, specific phobia, obsessive–compulsive disorder, post-traumatic stress disorder, and anxiety disorder not otherwise specified) in euthymic adults with bipolar disorder in studies published by 31 December 2015.ResultsAcross 10 samples with 2120 individuals with bipolar disorder, 34.7% met diagnostic criteria for one or more anxiety disorders during euthymia [95% confidence interval (CI) 23.9–45.5%]. Direct comparison of 189 euthymic individuals with bipolar disorder and 17 109 population controls across three studies showed a 4.6-fold increase (risk ratio 4.60, 95% CI 2.37–8.92, p < 0.001) in prevalence of anxiety disorders in those with bipolar disorder.ConclusionsThese findings suggest that anxiety disorders are common in people with bipolar disorder even when their mood is adequately controlled. Euthymic people with bipolar disorder should be routinely assessed for anxiety disorders and anxiety-focused treatment should be initiated if indicated.

Panic Attacks and Anxiety Disorders

2020 ◽  
Author(s):  
Curtis Wittmann
Keyword(s):  
Emergency Department ◽  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Stress Disorder ◽  
Acute Stress ◽  
Panic Attacks ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

This review discusses the acute diagnosis and management of panic and anxiety disorders. Anxiety disorders are among the most common psychiatric disorders in the country and are a relatively common cause of presentation to the emergency department. Most anxiety disorders can be conceptualized as fear- or phobia-based disorders, including panic disorder, specific phobia, social phobia, acute stress disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Each of these disorders is discussed, including prevalence and common clinical presentations. The initial evaluation of patients with a suspected or diagnosed anxiety disorder will be based on their current symptoms. Some patients may be highly agitated and may require deescalation or sedation to perform a reasonable history and physical examination. To achieve this, providers should ensure their own safety first, with attention to the physical layout of the emergency department, ensuring that they are closer to the room exit than the patient (so that they cannot be trapped). The presence of police or security may be necessary to provide optimal care and an appropriate evaluation. Typical treatment of acute exacerbations of anxiety disorders includes medical management, most often benzodiazepines, which can provide immediate relief. Psychiatric consultation may be necessary in certain cases. For most patients, outpatient management rather than inpatient admission will lead to the most effective management of their anxiety.   Key words: anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, stress disorder This review contains 1 highly rendered figure, 17 tables, and 29 references.

scholarly journals Cognitive behavioral therapy in anxiety disorders: current state of the evidence

2011 ◽  
Vol 13 (4) ◽  
pp. 413-421 ◽  
Keyword(s):  
Anxiety Disorder ◽  
Cognitive Behavioral Therapy ◽  
Anxiety Disorders ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Post Traumatic Stress ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Current State ◽  
Meta Analyses

A plethora of studies have examined the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for adult anxiety disorders. In recent years, several meta-analyses have been conducted to quantitatively review the evidence of CBT for anxiety disorders, each using different inclusion criteria for studies, such as use of control conditions or type of study environment. This review aims to summarize and to discuss the current state of the evidence regarding CBT treatment for panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Overall, CBT demonstrates both efficacy in randomized controlled trials and effectiveness in naturalistic settings in the treatment of adult anxiety disorders. However, due to methodological issues, the magnitude of effect is currently difficult to estimate. In conclusion, CBT appears to be both efficacious and effective in the treatment of anxiety disorders, but more high-quality studies are needed to better estimate the magnitude of the effect.

scholarly journals Serum Cholesterol Level Comparison: Control Subjects, Anxiety Disorder Patients, and Obsessive-Compulsive Disorder Patients

2002 ◽  
Vol 47 (6) ◽  
pp. 557-561 ◽  
Author(s):  
Helmut Peter ◽  
Iver Hand ◽  
Fritz Hohagen ◽  
Anne Koenig ◽  
Olaf Mindermann ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Cholesterol Level ◽  
Normal Control ◽  
Serum Cholesterol ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Control Subjects ◽  
Cholesterol Levels

Objective: To determine whether panic disorder is associated with elevated serum cholesterol levels. Serum cholesterol levels of panic disorder patients are reported to be elevated. This could explain the higher-than-expected cardiovascular mortality in this population. Some evidence exists wherein cholesterol levels are also increased in patients with general anxiety disorder and phobias. To date, there are only 2 reports on cholesterol levels of obsessive-compulsive disorder (OCD) patients, giving controversial results. Method: We compared serum cholesterol levels of anxiety disorder patients, OCD patients, and normal control subjects with each other ( n = 60 in each group). Serum cholesterol was measured in each subject before treatment. Subjects of the 3 groups were matched by age and sex. Results: Patients with anxiety disorders and OCD had elevated cholesterol levels, compared with normal control subjects. Cholesterol levels in OCD patients were comparable with those in patients with phobia. Conclusions: Our data support the assumption that elevation in cholesterol level is not a specific feature of panic disorder (as most assumed), but more generally associated with anxiety disorders. Increased cholesterol levels in patients with anxiety disorders and OCD may be of clinical relevance.

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