Treatment of mixed anxiety and depressive disorder: results from a observational study of the efficacy and tolerability of agomelatine

Objective: to study the efficacy, safety and tolerability of agomelatine in mixed anxiety and depressive disorder.Patients and methods. Agomelatine was administered to 30 patients diagnosed with mixed anxiety and depressive disorder for 3 months. The patients' condition was assessed using a battery of psychometric methods – the Hamilton Depression Scale, the Hamilton Anxiety Scale, and a short form of the SF-12v2 quality of life questionnaire.Results and discussion. It was shown that agomelatine effectively reduces both symptoms of depression and anxiety, begins to have a therapeutic effect a week after the start of administration, however, the drug shows the best clinical effect when administered for a period of three months or more. The predictors of complete remission on agomelatine therapy in this sample were: the presence of sleep disorders (early and medium, but not late insomnia), a greater severity of somatized anxiety, the presence of complaints of decreased workplace performance and activity.Conclusion. Our study has shown that agomelatine is an effective, safe and well-tolerated drug in the treatment of mixed anxiety and depressive disorder.

Optimization of therapy in patients with lichen ruber planus by means of cranial electrotherapy stimulation

Rationale: Taking into account the significance of psychogenic factor in the onset of lichen planus, its correction is advisable. Transcranial electric stimulation is promising, given its autonomous regulating, analgesic, antipruritic, reparative and regenerative, and immunomodulatory effects, in addition to the anti-stress one.Aim: To assess the effectiveness of the combination therapy including cranial electrotherapy stimulation (CES) with lichen ruber planus.Materials and methods: This was an open label, prospective, comparative study in 61 patients with common typical form of lichen ruber planus (39 (63%) women and 22 (37%) men) aged 18 to 74 years (mean age 41 ± 14.29 years). The duration of the disease was 11.88 ± 10.15 months (range, 1 to 42 months). The patients were adaptively randomized into two groups of similar gender distribution, age, and disease duration. The patients in the comparison group (n = 30) were treated conventionally in accordance with the Federal Clinical Guidelines (chloroquine, hydroxyzine, topical corticosteroids). The main group (n = 31) was administered similar therapy; however, instead of hydroxyzine, CES was performed. The duration of in-patient treatment in both groups was 14 days, with the follow-up lasting for up to 3 months. The results of treatment were assessed by dynamics of pathological changes of the skin (Index of Lichen Planus, ILP), impact of dermatosis on various domains of the patient’s life (Dermatology Life Quality Index, DLQI), changes in psychological status (Hamilton Anxiety Scale and Hamilton Depression Scale). In addition, the impact of pruritus on the patients' daily activities was assessed by Behavioral Rating Scores questionnaire (BRS).Results: At baseline, there were no significant differences between the groups in ILP (p = 0.801), DLQI (p = 0.501), BRS (p = 0.521), Hamilton Anxiety Scale (p = 0.301), and Hamilton Depression Scale (p = 0.493). At the end of treatment, ILP in the CES group decreased 3.25-fold (p < 0.001), whereas in the group treated with conventional therapy the decrease was 2.1-fold (p < 0.001); DLQI decreased 2.5-fold (p < 0.001) and 1.8-fold (p < 0.001), respectively. The corresponding decreases of Hamilton Anxiety Scale in the treatment groups were 2.3-fold and 1.3-fold, respectively, and those in Hamilton Depression Scale – 2-fold and 1.6-fold, respectively (all p < 0.001). In addition, statistically significant intergroup differences were found for ILP (p = 0.04), DQLI (p < 0.001), Hamilton Anxiety and Depression scale scores (p = 0.021 and p = 0.006, respectively). As for the BRS changes, in both groups there was an equally significant (p < 0.001) decrease, but the intergroup differences were not statistically significant (p = 0.485).Conclusion: The proposed combination therapy of patients with lichen ruber planus including CES has led to a decrease in the indicators of the skin process activity within a shorter time period than in the patients under conventional treatment. In addition, the patients of both groups showed normalization of psychological parameters and improvement in dermatological quality of life; however, only in the CES group, these changes were significant.

DOES PREOPERATIVE ANXIETY AFFECT EARLY OUTCOMES OF OPEN-HEART SURGERY?

Aim: We aim to determine the preoperative anxiety levels of patients with open-heart surgery and examine the relationship between anxiety levels and postoperative complications. Material and Methods: In our prospective study, 200 patients who will undergo open-heart surgery preoperative anxiety levels were measured using the Hamilton anxiety scale (HAM-A). Anxiety levels and the development of complications were investigated. Results: Preoperative anxiety was more common in females (p=0.001). The length of stay in the intensive care unit (p=0.006) and the hospital stay (p=0.005) were found to be longer in patients with high anxiety. It was observed that high preoperative anxiety severity increased the risk of developing postoperative complications (p=0.000024). Conclusion: We can say that preoperative anxiety, which is not considered very important, is seen more frequently than expected for patients who will undergo open-heart surgery. In our study, it was observed that high anxiety levels increased the risk of postoperative complications.

Estudio comparativo de niveles de ansiedad generados por el COVID- 19 en pacientes con diagnóstico previo de reacción al estrés

El objetivo de la presente investigación es establecer la diferencia entre los niveles de ansiedad antes y después de la pandemia COVID- 19, en una muestra de 30 pacientes con diagnóstico previo de reacciones de estrés (CIE 10: F43.0, F43.8). Para este estudio, se empleó una metodología de diseño no experimental y de alcance descriptivo- comparativo, de corte longitudinal. La evaluación se realizó a través del empleo de la Escala de Ansiedad de Hamilton (Hamilton Anxiety Scale- HAS). La edad de los examinados tenía una media (Ẋ) de 28,27 años, con una distribución de género mayoritariamente femenino (60%). Entre los resultados se encontró que, en un 60% de los casos, los niveles de ansiedad encontrados en el postest son mayores que los hallados en el pretest y que dichas diferencias son estadísticamente significativas, (p<.05). Se concluye que dicho incremento es mayor en personas jóvenes y jóvenes adultos, de género femenino, con una instrucción primaria o secundaria y de condiciones socioeconómicas bajas; paralelamente, la condición de estar casado funcionó como un factor protector ante la ansiedad

P12.08 Efficacy of trazodone slow release in insomnia associated with high-dose steroid therapy in neuro-oncological patients

BACKGROUND Insomnia linked to therapeutical intake of intravenous (IV) megadoses of steroid (Mgds, 8–16 mg) is a common side effect in neuro-oncology patients. Hypno-inducing drugs (IP) and Benzodiazepines (BDZ) can provoke drug interference and daytime sedation. Trazodone (Trz) is an atypical antidepressant with poor liver metabolism; it has moderate histamine-1 (H1) receptor antagonism and possesses some anxiolytic and hypnotic properties. We tested the use of the Trz retard (RP) formulation as a hypnotic drug in patients undergoing a therapeutic regimen with IV Mgds. To evaluate anxiety and side effects. MATERIAL AND METHODS 10 patients (6 females and 4 males) admitted to the Neuro-oncology Department of the Neurological Institute “Carlo Besta” treated with Mgds IV. The average age was 55 years and the mean HAM-A score was 25. Instruments included the Hamilton Anxiety Scale (HAM-A), the Clinical Global Impression (CGI), and the Pittsburgh Sleep Quality Index (PSQI). Trz RP was administered at a dosage of 25-50-75 mg/day in the evening. RESULTS All 10 patients reported improved hypnotic profiles within the third day of Trz RP administration. Four patients improved on the first day. Reduction of the HAM-A score was found on the third day. No adverse events (epilepsy, daytime sedation, incontinence) were observed in 3 weeks. CONCLUSIONS Trz RP proved to have a swift beneficial effect on sleep and anxiety without side effects in the short term. Trz may be preferred to IP and BDZ in patients receiving IV Mgds, considering the lack of daytime sedation and the reduced pharmacological inference. Larger samples will enable future research to better describe the characteristics and the indication of Trz.

Comparative Assessment of Anxiety, Pain, and Discomfort During Rapid Maxillary Expansion Using Two Different Activation Protocols in Patients With Cleft Lip and Palate

Objective The aim of this study was to compare and assess the pain perception, anxiety, and discomfort between two different rapid maxillary expansion (RME) protocols in patients with unilateral cleft lip and palate (UCLP). Design This is a prospective study. Setting The study was done in a comprehensive cleft care center. Patien and Participants The sample included 26 patients between ages 6 and 9 years with a history of repaired UCLP. Interventions The patients were randomly allotted into 2 groups—Group A and Group B. Group A received 1 RME activation per day and Group B received 2 activations per day. The participants after RME activation completed a self-report questionnaire and ranked the pain and anxiety levels using Faces pain scale and Hamilton anxiety scale, respectively. The evaluation was done every day for 1 week. Main Outcome Measure The Faces Pain Scale, Hamilton Anxiety Scale, and self-report questionnaires assessed the pain, anxiety, and discomfort experienced by the patients after 2 different types of RME activation protocols. Results Group B experienced significantly higher pain in the molars than Group A ( P < .001). There was no significant difference between the 2 RME activation protocols regarding anxiety and jaw discomfort. Conclusion Patients who received 2 activations per day experienced significantly higher levels of pain in the molars compared to the patients who received a single activation per day. There were no significant differences between the 2 activation protocols in terms of pain in the palate, tongue, anxiety, and jaw discomfort.

ANXIETY AND DEPRESSION AFFECTING QUALITY OF LIFE DURING COVID-19 IN IT SECTOR WORKERS, DUE TO WORK FROM HOME

Background- Everyone has anxiety from time to time, but chronic anxiety can interfere with your quality of life. Depression is a mood disorder that involves a persistent feeling of sadness and loss of interest.Major life events,such as bereavement or the loss of a job,can lead to depression. Aim & Objectives:- The objective of this study was to demonstrate that anxiety and depression has a significant affect on QOL during covid-19 in IT sector workers due to work from home . Study Design-An survey design study was conducted. Methods-: Written consent from participants was taken.Qol was assessed by the Qol scale,Hamilton anxiety scale and patient health questionnaire (degree of depression severity).Statistical analysis was done . Result – There was mild correlation between the severity of anxiety and depression but also There was no correlation between QoL. Conclusion – It was seen that there was increase in Anxiety and Depression due to the external environmental factors but it didn't affect the Quality of life.

Clinical case: OnLine intervention proposal for a patient with symptoms of depression and anxiety

Anxiety and depression are some of the biggest mental health issues that have been increasing because of the actual contingency that was established because of the coronavirus (COVID-19). Therefore, several studies have developed treatment proposals, an objective that is shared within this case study. The work carried out is a proposal for an intervention based on the Cognitive Behavioral Theory to a 21-year-old female patient, who manifests symptoms of depression and anxiety. The patient was evaluated with the State-Trait Anxiety Inventory, Hamilton Anxiety Scale, Manifest Anxiety Scale in Adults-C, Hamilton Evaluation Scale for Depression, and the Beck-II Depression Inventory. To expand the data, resources such as the Clinical Map of Pathogenesis and the Map of Scope of Goals were used for the functional analysis of the behavior for the formulation of the case. On the other hand, based on the collection of data from the patient and the results obtained, it was determined that the proposal of the most effective strategies for the case was the following: 1. psychoeducation, 2. cognitive restructuring technique, 3. training in breathing techniques, 4. relaxation technique training, 5. sleep hygiene training, and 6. mindfulness technique.

LEVEL OF SATISFACTION ON COMMUNICATION AND LEVEL OF ANXIETY AMONG SUSPECT COVID PATIENTS

Background: The COVID pandemic has created a huge impact on the emotional level of individuals around the globe. When one is suspected to develop or have the infection, the amount of stress individuals go through is enormous. Communication specially by the health care workers when they are hospitalized will bring a positive impact on their coping. Objectives: The objectives of the study were to assess the suspect COVID patients level of satisfaction on communication, to assess the suspect COVID patients level of anxiety, to find the relationship between the suspect COVID patients level of satisfaction on communication and their level of anxiety, to find the association between the suspect COVID patients level of satisfaction on communication and their demographic variables and to find the association between level of anxiety of suspect COVID patients and their demographic variables. Methods: A correlational study to assess the suspect COVID patients level of satisfaction on communication and their level of anxiety was carried out in the suspect COVID areas of Christian Medical College. Patients who fulfilled the inclusion criteria were recruited using consecutive sampling technique. Patients were given information on the study and informed consent was obtained. Data was collected by interviewing the patients using a Likert scale on the level of satisfaction on communication and the level of anxiety using Hamilton Anxiety Scale. Results: Data was analyzed using descriptive and inferential statistics (SPSS Version 21). Majority of the subjects were found to be between the age group 41 to 60 years. Also, most of them (64%) were male. And around 60% of them had only schooleducation. It was found that 47% of the subjects were found to have mild anxiety and only 41% were highly satisfied with the level of communication. Also, it was proved that as the level of satisfaction on communication increases, the level of anxiety decreases (r=-0.5 at p=0.01). There was also significant association found with education and level of satisfaction on communication (p=0.028) and education and level of anxiety (p=0.017) Conclusion: The findings of this study reveal that we need to develop right communication models in times of pandemics and strategize coping measures that will help individuals going through such crisis.