Top PDF How do we treat generalized anxiety disorder?

How do we treat generalized anxiety disorder?

How do we treat generalized anxiety disorder?

Кључ не ре чи: ге не ра ли зо ва ни анк си о зни по ре ме ћај; ле че ње; ан ти де пре си ви; пси хо те ра пи ја?. Како лечимо генерализовани анксиозни поремећај.[r]

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Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache

Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache

The interview was conducted by trained agents from the Family Health Program who presented the study objectives to the household resident and, if eligible, they were invited to participate. Only the person who answered the door was invited to par- ticipate. If this person was not eligible we asked for another eligible person in the household (only one person per household). We chose one person per household for the following reasons: (i) in this kind of personal-interview survey, if others are present during the interview, those who have already heard all the questions may give different answers from the initial respondent; (ii) the initial respondent may be compelled to answer personal questions; and (iii) more households can be evaluated by this method.
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Rev. Bras. Psiquiatr.  vol.33 número2

Rev. Bras. Psiquiatr. vol.33 número2

Objective: This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents – the PROTAIA Project. Method: Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises ive phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase. Results: A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identiied 138 individuals with at least one anxiety disorder (apart from speciic phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8%), social anxiety disorder (n = 57; 41.3%) and separation anxiety disorder (n = 49; 35.5%) were the most frequent disorders. Conclusion: The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors.
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J. bras. psiquiatr.  vol.64 número3

J. bras. psiquiatr. vol.64 número3

Objective: To evaluate, in a community sample of adolescents, the presence of comorbidi- ties in different anxiety disorders. Methods: This is a cross-sectional study, initially composed of 2,457 adolescents, aged between 10-17 years old, from public schools of the area covered by the Basic Health Unit of a university hospital. We applied the Screen for Child Anxiety Rela- ted Emotional Disorders (SCARED) to assess for anxiety disorders. Then, 138 positive cases in the screening were assessed for mental disorders through the Schedule for Affective Disor- der and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL). Results: Patients with anxiety disorders had more association with other anxiety disorders, as well as depression, and enuresis. The most common comorbidity described in our study was between generalized anxiety disorder and separation anxiety disorder (OR = 4.21, 95% CI 1.88, 9.58). Significant association was observed between other disorders such as enure- sis and separation anxiety disorder (OR = 3.81, 95% CI 1.16, 12.49), as well as depression and generalized anxiety disorder (OR = 3.40; 95% CI 1.52, 7.61). Conclusion: Our study showed a relevant presence of comorbidities adolescents with anxiety disorders, selected from a com- munity sample, especially regarding other anxiety disorders. Nevertheless, further studies are needed to confirm our findings.
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(São Paulo, online)  vol.4 número1

(São Paulo, online) vol.4 número1

In our study, the inclusion criteria were as follows: (1) articles that described a relationship between polymorphisms and generalized anxiety disorder, (2) a case-control study design, and (3) articles that provided sufficient genotype data for estimating an odds ratio with a 95% confidence interval. We excluded articles that did not examine the association of polymorphisms with Generalized Anxiety Disorder, review articles and meta-analyses.

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Attentional bias modulation by reappraisal in patients with generalized anxiety disorder: an event-related potential study

Attentional bias modulation by reappraisal in patients with generalized anxiety disorder: an event-related potential study

In the present study, we did not find that emotional regulation had any effect on P200 amplitude, in either GAD patients or normal controls. This suggests that the early stage of emotional word processing was not influenced by emotion regulation. This result is consistent with Huang and Luo’s study (30) that the P200 amplitude reflecting negative emotion was significantly higher than that for positive emotion, indicating that attention nega- tivity bias occurs very early in emotion perception. In our study, the P200 amplitude in response to negative words was higher than the P200 amplitude in response to neutral words in GAD patients, whether or not negative emotions were first downregulated, but this effect was not seen in normal controls. This is particularly significant, as it suggests that this is a characteristic response to negative stimulus in GAD, and these patients’ negative bias could
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Rev. Bras. Psiquiatr.  vol.28 número3

Rev. Bras. Psiquiatr. vol.28 número3

Objective: There is evidence that asthma is associated with increased frequency of psychiatric symptoms and mental disorders. Our aim was to assess the frequency of anxiety and depressive disorders in a sample of asthmatic outpatients and observe if there is any relationship between this comorbidity and the severity of asthma. Method: Sixty-two consecutive patients of two outpatient asthma clinics located in university hospitals were evaluated. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview 4.4 Version. Results: Twenty-seven patients (43.5%) met criteria for at least one psychiatric diagnosis. The most frequent diagnoses were major depression (24%), generalized anxiety disorder (20.9%) and panic disorder/agoraphobia spectrum disorders (17.7%). We found no significant differences in the prevalence of anxiety disorders and depression between the groups with mild/ moderate and severe asthma. Despite the high frequency of depression and anxiety disorders, only 4 (6.5%) patients were under psychiatric treatment and 13 (20.9%) patients were taking benzodiazepines. Twelve of 15 (80%) patients who reported present use of psychotropic medication were not under psychiatric treatment at the moment of the study. Conclusions: Our results support the high morbidity of anxiety and depressive disorders in asthmatic patients, independent of the severity of asthma.
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Rev. Bras. Psiquiatr.  vol.39 número3

Rev. Bras. Psiquiatr. vol.39 número3

Regarding the outcome of generalized anxiety disorder, there was no association with the dietary patterns; how- ever, we observed that women who reported below- recommended intake of beans had a higher prevalence of anxiety compared to those who had adequate consump- tion of this food group. Our results are in accordance with a study that showed that moderate consumption of beans by women in the perimenopausal period was a protective factor against mental disorders. 39 The 2008/2009 House- hold Budget Survey indicated a decrease in consumption of foods that are considered healthy and popular in Brazilian culture, such as beans, fruits and vegetables, in parallel with an increase in consumption of processed foods, sau- sages, soft drinks, and sweets. These findings reveal an inadequate dietary pattern, low in essential micronutrients and high in energy density. 40 In addition, a plausible mech- anism that may elucidate our findings is that beans are an important source of iron; when stores of this mineral are depleted, the activity of the enzymes required for synth- esis, function, and degradation of dopamine, serotonin, and norepinephrine – neurotransmitters that modulate mood – can be impaired. 41
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Rev. Bras. Psiquiatr.  vol.39 número4

Rev. Bras. Psiquiatr. vol.39 número4

To inform these decisions, we look to studies such as Paskulin et al., where in 712 southern Brazilian women, low intakes of healthy foods and high intakes of refined sugars during pregnancy were related to an increased prevalence of maternal mental disorder. 4 Importantly, major depressive disorder and generalized anxiety were examined as separate outcomes; this is useful because major depressive disorder and generalized anxiety are highly comorbid, and previous studies examining the association between maternal diet and generalized anxiety showed inconsistent results. 1
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Rev. Bras. Psiquiatr.

Rev. Bras. Psiquiatr.

they represented the vast majority of the respondents (92%). We investigated the following categories: any anxiety dis- order (panic, agoraphobia, social or generalized anxiety disorder), any mood diagnosis (the presence of a depres- sive or manic episode) and psychotic diagnosis. Insuffi- cient power prevented us from performing analyses with specific maternal diagnostic categories, such as sub- stance use disorder and ADHD. An ‘any mental disorder’ variable (present/absent) was also created to encompass any current anxiety, mood, or substance use disorder, psychosis or ADHD. In eight subjects this variable could not be computed due to missing data regarding psy- chotic syndrome (n=11) and ADHD (n=16). This discrep- ancy occurred because the missing data did not impact the ‘any mental disorder’ value if another maternal
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Psychol. Neurosci.  vol.3 número1

Psychol. Neurosci. vol.3 número1

About 20 years ago, Deakin and Graeff proposed that whereas generalized anxiety disorder is produced by the overactivity of 5-HT excitatory projections from dorsal raphe nucleus to the areas of prefrontal cortex and amygdala which process distal threat, panic attacks are a dysfunction of 5-HT inhibitory projections from dorsal raphe nucleus to the dorsal periaqueductal gray matter, thereby releasing the responses to proximal threat, innate fear or anoxia. Besides, they suggested that the decrease in 5-HT1A neurotransmission in the hippocampus results in learned helplessness and depression. Accordingly, the Deakin Graeff hypothesis provided a uniied frame to the widespread use of 5-HT selective reuptake inhibitors in generalized anxiety, panic disorder and depression. Competitor hypotheses implicate panic attacks with the abnormal functioning of locus coeruleus, basolateral amygdala, dorsomedial hypothalamus or an as-yet-unknown suffocation alarm system. Conversely, cognitive psychologists suggest that panic attacks result from the catastrophic (cortical) interpretation of bodily symptoms. In any event, translational models of panic attack are expected to reproduce the main features of clinical panic, namely, the patient’s higher sensitivity to both lactate and CO2, the drug speciic sensitivity, the lack of stress hormone responses during panic attacks, the higher vulnerability of women and the high comorbidity with agoraphobia, major depression and childhood separation anxiety. Therefore, here we review the main steps in the experimental approach to anxiety disorders which are paving the route towards a translational model of panic attack. Keywords: Panic, Anxiety, Stress, Suffocation, Serotonin, Periaqueductal Gray Matter
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Rev. Bras. Psiquiatr.  vol.27 número1

Rev. Bras. Psiquiatr. vol.27 número1

Methods: All randomized controlled trials assessing the use of antidepressants in generalized anxiety disorder up to may 2002 were included. Non randomized trials and those that included patients with both generalized anxiety disorder and another Axis I co-morbidity were excluded. Relative risks, weighted mean difference and number needed to treat were estimated. People who died or dropped out were regarded as having had no improvement. Results: Results: Results: Results: Results: Antidepressants (imipramine, venlafaxine and paroxetine) were found to be superior to placebo in treating generalized anxiety disorder. The calculated number needed to treat for antidepressants in generalized anxiety disorder was 5.15. Dropout rates did not differ between antidepressants and placebo. Conclusion:
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How we see electronic games

How we see electronic games

Theories regarding the influences of electronic games drive scientific study, popular debate, and public policy. The fractious interchanges among parents, pundits, and scholars hint at the rich phenomenological and psychological dynamics that underlie how people view digital technologies such as games. The current research applied Martin Heidegger’s concept of interpretive frameworks (Heidegger, 1987) and Robert Zajonc’s exposure-attitude hypothesis (Zajonc, 1968) to explore how attitudes towards technologies such as electronic games arise. Three studies drew on representative co- horts of American and British adults and evaluated how direct and indirect experiences with games shape how they are seen. Results indicated this approach was fruitful: negative attitudes and beliefs linking games to real-world violence were prominent among those with little direct exposure to electronic gaming contexts, whereas those who played games and reported doing so with their children tended to evaluate gaming more positively. Further findings indicated direct experience tended to inform the accuracy of beliefs about the effects of digital technology, as those who had played were more likely to believe that which is empirically known about game effects. Results are discussed with respect to ongoing debates regarding gaming and broader applications of this approach to understand the psychological dynamics of adapting to technological advances.
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So, are we going to treat cancer now?

So, are we going to treat cancer now?

Entretanto, um extrato melhor purificado para aplicação parenteral estava sendo desenvolvido e testado em animais de laboratório com deter- minados tipos de câncer, “com resultados promissores”. Nosso colega, no seu inglês carregado, e progressivamente empolgado pela perspectiva de ter lançado pela sua filial um produto que poderia ser um breakthrough da indústria farmacêutica, e que pudesse atingir vendas na cifra dos milhões de dólares, propôs um estudo clínico multicêntrico colaborativo, de fase III- IV, envolvendo os vários grupos participantes. Foi quando se levantou um colega europeu (se não londrino, pelo menos de comportamento britâni- co), mais experiente e menos impulsivo, membro do conselho científico da empresa, e disse a todos: “So, are we going to treat cancer now?”.
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Trends Psychiatry Psychother.  vol.39 número3

Trends Psychiatry Psychother. vol.39 número3

One study used multiple simple mediation analyses to propose that mindfulness influences depression and anxiety symptoms through emotional regulatory mechanisms (rumination, reappraisal, worry, and non-acceptance) by considering emotional regulation a path through which mindfulness stimulates mental health. Emotional regulation is a practice by which individuals temper their emotions in response to environmental difficulties to achieve certain aims. The association between emotional regulation difficulties and psychopathology has primarily been found in mood and anxiety disorders. Rumination may be a contributor to anxiety, particularly due to repetitive thoughts about future negative events. For depression, rumination may involve repetitive thoughts about present and past negative consequences. However, reappraisal could work specifically with depressive and anxiety symptoms. 3
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Rev. Bras. Psiquiatr.  vol.29 número2 en a16v29n2

Rev. Bras. Psiquiatr. vol.29 número2 en a16v29n2

She responds to an advertisement in the newspaper to find symptomatic volunteers for a study of a new anxiolytic. The advertisement describes some of the typical features of generalized anxiety disorder (GAD), including excessive worr y, tension, cognitive dysfunction and insomnia. In a telephone conversation with an experienced research nurse she describes, for the first time and anonymously, worries regarding her daughter ’s future that impair her ability to relax and to focus on important job matters. Although she has an excellent work record and a good income, she worries both about her commitments as a mother and about the p r o s p e c t s o f h e r d a u g h t e r i n a w o r l d o f u n c e r t a i n t y. Subsequent to being unable to stop worrying she has developed difficulties concentrating, become irritable, restless, and unable to sleep well. She goes to work without feeling rested. Her dentist has remarked about her tense jaws and that she grinds her teeth. A tendency to dyspepsia has been aggravated by her worries. In spite of regular exercises she feels tense, particularly in her shoulders, and experiences palpitations when in meetings. She is now at a point when her functioning at work and at leisure is impaired due to her excessive worries.
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Psychological balance in high level athletes: gender-based differences and sport-specific patterns.

Psychological balance in high level athletes: gender-based differences and sport-specific patterns.

Our study encountered a few of the limitations typically associated with epidemiological studies. The professional bias induced by the fact that 61% of athletes were seen by psychologists and 38% by physicians probably resulted in lower rates of psychopathology than would have been reported by psychologists only. Even though psychologists identified more athletes with one disorder, physicians found as many individuals with 2 or more disorders as psychologists. This could be partially due to differing sensitivities for recognizing disorders that may difficult to diagnose. For instance, among eating disorders, psychologists diagnosed more EDNOS, minor EDs, than physicians, but physicians identified anorexia and bulimia as often as psychologists. In the realm of high level sport, the fear of stigmatization for psychological problems could be especially strong; elite athletes work extremely hard to excel, and might therefore be particularly unwilling to disclose anything that could reveal emotional or mental fragility. Despite these limitations, our study had the merit of being based on in-person consultations by health professionals. This study is the first to examine the prevalence of the major types of psychopathology over a nationwide sample of high level athletes; the results obtained are encouraging, as they assert the psychological balance of this population despite the stress imposed by athletic careers. The expected sex-based differences in the prevalence of various disorders are demonstrated, showing that the
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Rev. Bras. Psiquiatr.  vol.25 número2

Rev. Bras. Psiquiatr. vol.25 número2

Given the small sample size we examined the association between childhood anxiety disorders and current disorders by examining patients with or without childhood anxiety. There was no association between any anxiety disorder in childhood and depression (61.1% vs. 33.3%, p=.47, chi-square test with Yates correction) or any anxiety disorder and adult comorbidity (22.2% vs. 16.6%, p=.77, chi-square test with Yates correction). Using stricter criteria for anxiety disorder in childhood, i.e. the presence of at least two childhood anxi- ety disorders, 7,9,10 ten (76.9%) patients with these diagnoses
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Arq. NeuroPsiquiatr.  vol.66 número3A

Arq. NeuroPsiquiatr. vol.66 número3A

This case highlights the importance of care that must be taken against lithium neurotoxicity and the potentially disabling effects in patients on continuous use of lithium, particularly in those with bipolar disorder. Many authors have defended the use of psycho-educational measures with the purpose of reducing complications from lithium treatment 18 . On the other hand, the diagnosis of cerebel-

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The water crisis in southern Portugal: how did we get there and how should we solve it

The water crisis in southern Portugal: how did we get there and how should we solve it

The analysis of the evolution of the water use in the Algarve during the second half of the 20th century and the casuistic interventions of the central water authority shows the reasons for the water crises faced by the Algarve region in times of drought. History has shown that water supply cannot rely on a single origin, surface or groundwater (or even desalination, or treated wastewater). In this article we have presented a decision-support system that will help to manage the allocation of resources (extractions from each source) by one of the major stakeholders in the region. It is hoped that future (next three to four years) operational results will make the remaining stakeholders and central administration follow the path of integrated water resources management, by including all stakeholders and all available sources, with the least environmental impact, lowest social cost, and greater sustainability.
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