Search

Anxiety is a pervasive emotional state where, phenomenologically, subjects often report changes in their experience of time and space. However, a systematic and quantified examination of time and space experience in terms of a self-report scale is still missing which eventually could also be used for clinical differential diagnosis. Based on historical phenomenological literature and patients' subjective reports, we here introduce, in a first step, the Scale for Time and Space Experience of Anxiety (STEA) in a smaller sample of 19 subjects with anxiety disorders and, in a second step, validate its shorter clinical version (cSTEA) in a larger sample of 48 anxiety subjects. The main findings are (i) high convergent and divergent validity of STEA with both Beck Anxiety Inventory (BAI) (r = 0.7325; p < 0.001) and Beck Depression Inventory (BDI) (r = 0.7749; p < 0.0001), as well as with spontaneous mind wandering (MWS) (r = 0.7343; p < 0.001) and deliberate mind wandering (MWD) (r = 0.1152; p > 0.05), (ii) statistical feature selection shows 8 key items for future clinical usage (cSTEA) focusing on the experience of temporal and spatial constriction, (iii) the effects of time and space experience (i.e., for both STEA and cSTEA scores) on the level of anxiety (BAI) are mediated by the degree of spontaneous mind wandering (MWS), (iv) cSTEA allows for differentiating high levels of anxiety from the severity of comorbid depressive symptoms, and (v) significant reduction in the cSTEA scores after a therapeutic intervention (breathing therapy). Together, our study introduces a novel fully quantified and highly valid self-report instrument, the STEA, for measuring time-space experiences in anxiety. Further we develop a shorter clinical version (cSTEA) which allows assessing time space experience in a valid, quick, and simple way for diagnosis, differential diagnosis, and therapeutic monitoring of anxiety. • Anxiety is closely related to constricted time and space experiences. • The dynamic of thoughts, i.e., mind wandering, may serve as the mediator between the time and space experiences and anxiety. • cSTEA allow a valid and simple way to assess clinical phenomenology of anxiety. [ABSTRACT FROM AUTHOR]

There is still limited information about how, and to what extent, patients with Persistent Postural-Perceptual Dizziness (PPPD) feel inadequate in their daily lives. This study aims to evaluate the physical, functional, and emotional disability related to dizziness in patients diagnosed with PPPD, and to investigate the frequency of anxiety disorder, depression, and migraine. The files of patients who were diagnosed PPPD in the neurology outpatient clinic at our hospital were retrospectively reviewed. The results of the Dizziness Handicap Inventory (DHI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI), which were implemented for treatment planning, were evaluated. Headache complaints were examined for whether they were compatible with migraine. Of the 65 patients diagnosed with Persistent postural-perceptual dizziness, 89% were female, 11% were male, and the mean age was 39. The total mean score of the DHI was 55.3. 86.1% of the patients experienced moderate or severe dizziness handicap. Moderate or severe depression was identified in 50.8% of the patients, moderate or severe anxiety in 80.8%, and migraine comorbidity in 70.8% of the patients. The majority of the patients with PPPD were in the young-middle age group and female. It was concluded that dizziness, migraine, depression, and anxiety disorder highly adversely affected the health-related quality of life of the patients. [ABSTRACT FROM AUTHOR]

In differentiated thyroid cancer (DTC), the standard treatment includes total thyroidectomy and lifetime levothyroxine (LT4) replacement. However, long-term exogenous LT4 has become controversial due to the adverse effects of oversuppression. The study included 191 patients (aged 18–76 years) with a prospective diagnosis of non-metastatic DTC and 79 healthy individuals. The patients with DTC were stratified into three groups according to their TSH levels: suppressed thyrotropin if TSH was below 0.1 μIU/ml, mildly suppressed thyrotropin if TSH was between 0.11 and 0.49 μIU/ml, and low-normal thyrotropin if THS was between 0.5 and 2 μIU/ml. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Short Symptom Inventory (SSI), and Pittsburgh Sleep Quality Index (PSQI) were administered to all participants. It was found that the BDI, BAI, SSI and PSQI scores were worse in patients with DTC (p=0.024, p=0.014, p=0.012, and p=0.001, respectively). According to theTSH levels, the mean ASI was found to be higher in the suppressed and mildly suppressed thyrotropin groups (19±14.4 vs. 10.6±11.1; 16.4±14.9 vs. 10.6±11.1, p=0.024, respectively), the mean SSI was found higher in the suppressed group (61.0±55.5 vs. 35.1±37.0, p=0.046), and the mean PSQI was higher in all three groups (7.94±3.97 vs. 5.35±4.13; 7.21±4.59 vs. 5.35±4.13; 7.13±4.62 vs. 5.35±4.13, p=0.006) when compared with the controls. No significant difference was found between the groups. A positive correlation was detected in the duration of LT4 use and BDI and SSI, and a weak, negative correlation was detected between TSH levels and ASI and PSQI. Based on our study, it was found that depression, anxiety disorders, and sleep problems were more prevalent in patients with DTC, being more prominent in the suppressed TSH group. These results were inversely correlated with TSH values and positively correlated with the duration of LT4 use. Unnecessary LT4 oversuppression should be avoided in patients with DTC. [ABSTRACT FROM AUTHOR]

Objective: It is known that the risk of anxiety disorders and depression in infertile women increases and their quality of life deteriorates. Temperamental characteristics are considered as predictors of mood disorders. The aim of this study was to investigate temperamental characteristics in infertile women and their effects on depression and anxiety levels, and the quality of life, and to reveal the differences and level of relationship compared to healthy women. Method: Fourty-four female patients with primary infertility and 30 healthy female controls were included in this study. Temperamental characteristics of the participants were assessed with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A). Depression and anxiety severity were evaluated with Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). To evaluate the quality of life, Short Form 36 (SF-36) health survey questionnaire was also applied. Results: Hyperthymic temperament scores were higher in infertile women than the control group (p=0.001). BDI scores were positively correlated with depressive and cyclothymic temperament scores, and BAI scores were positively correlated with depressive and anxious temperament scores. A negative correlation was found between hyperthymic temperament and BAI and BDI scores. Hyperthymic temperament scores were positively correlated with both physical and mental subdimension scores of the quality of life scale. Conclusion: In this study, hyperthymic temperament in infertile women was shown to be protective against anxiety and depression and it also improves the quality of life. Additional studies are needed to clarify the relationship between hyperthymic temperament and ovarian hormones or other biological parameters. [ABSTRACT FROM AUTHOR]

Background: Models of collaborative care and consultation liaison propose organizational changes to improve the quality of care for people with common mental disorders, such as anxiety and depression. Some literature suggests only short-term positive effects of consultation liaison on patient-related outcomes, whereas collaborative care demonstrates both short-term and long-term positive effects. To our knowledge, only one randomized trial has compared the effects of these models. Collaborative care was superior to consultation liaison in reducing symptoms of depression for up to 3 months, but the authors found no difference at 9-months' follow-up. The Collabri Flex Trial for Depression and the Collabri Flex Trial for Anxiety aim to compare the effects of collaborative care with those of a form of consultation liaison that contains potential contaminating elements from collaborative care. The trials build on knowledge from the previous cluster-randomized Collabri trials.Methods: Two randomized, investigator-initiated, parallel-group, superiority trials have been established: one investigating the effects of collaborative care vs consultation liaison for depression and one investigating the effects of collaborative care vs consultation liaison for generalized anxiety, panic disorder and social anxiety disorder at 6-months' follow-up. Participants are recruited from general practices in the Capital Region of Denmark: 240 in the depression trial and 284 in the anxiety trial. The primary outcome is self-reported depression symptoms (Beck Depression Inventory (BDI-II)) in the depression trial and self-reported anxiety symptoms (Beck Anxiety Inventory (BAI)) in the anxiety trial. In both trials, the self-reported secondary outcomes are general psychological problems and symptoms (Symptom Checklist 90-Revised), functional impairment (Sheehan Disability Scale) and general well-being (World Health Organization-Five Well-Being Index). In the depression trial, BAI is an additional secondary outcome, and BDI-II is an additional secondary outcome in the anxiety trial. Explorative outcomes will also be collected.Discussion: The results will supplement those of the cluster-randomized Collabri trials and provide pivotal information about the effects of collaborative care in Denmark.Trial Registration: ClinicalTrials.gov, NCT03113175 and NCT03113201 . Registered on 13 April 2017. [ABSTRACT FROM AUTHOR]

Background: Alpha-asymmetry neurofeedback (ALAY) was applied to patients with major depressive disorder (MDD) based on the theory of frontal alpha asymmetry. Neurophysiological studies have found a higher high-beta activity of electroencephalography (EEG) at the posterior cortex among patients with comorbid MDD and anxiety symptoms. The present study examined the effects of ALAY and high-beta down-training (Beta) neurofeedback in symptoms of depression and anxiety and EEG parameters.Method: Eighty-seven patients with comorbid MDD and anxiety symptoms were allocated to the ALAY, Beta, or control groups. Both neurofeedback groups received ten-session neurofeedback. All participants completed the Beck Depression Inventory II (BDI-II), Beck Anxiety Inventory (BAI), and five minutes resting EEG recording at pre-test and post-test. EEG raw signals were transformed into an A1 score [log (F4 alpha) - log (F3 alpha)], P3 and P4 high-beta power.Results: BDI-II and BAI scores decreased at post-test in both ALAY and Beta groups, but no significant difference between the two groups. No significant interaction effect in A1 score at pre-test and post-test between the ALAY, Beta, and control groups. The P3 high-beta was significantly decreased in the Beta group, an increase in the control group, and no change in the ALAY group at post-test compared to the pre-test.Conclusions: Both neurofeedback groups decreased symptoms of depression and anxiety. The Beta group was more effective in decreasing high-beta power at the parietal cortex compared to other groups. This non-invasive psychological intervention can be used in the future for patients with comorbid MDD and anxiety symptoms. [ABSTRACT FROM AUTHOR]

Aim Decoding facial expression is important for psychological well-being. This study examined facial emotion recognition of simple/complex and pleasant/unpleasant emotions in patients with major depressive disorder ( MDD) and anxiety disorders ( AnD). Methods Patients with MDD ( n = 37), AnD ( n = 36) and healthy controls ( HC) ( n = 40) participated in this study. The recognition accuracy of emotional faces was calculated. Results Patients with MDD had significantly lower recognition accuracy compared to HC. Patients with MDD exhibited lower recognition accuracy for simple emotions compared to patients with AnD and HC, and lower accuracy for complex emotions compared only to HC. Patients with AnD and HC showed comparable recognition accuracy for simple emotions, which were lower than that of patients with MDD. However, in recognition accuracy of complex emotions, AnD was not significantly different from either MDD or HC. Conclusions Patients with MDD and AnD have a distinctive difficulty with the recognition of facial expressions. The recognition of complex emotions in patients with MDD and AnD should be studied further. [ABSTRACT FROM AUTHOR]

Background: Shame is an acknowledged part of several psychopathological conditions, but is underrepresented in clinical research. Cook's Internalized Shame Scale (ISS) is the most promising measure, but has mostly been used for testing small clinical samples biased toward depressive pathology and female participants. Aims: To contribute to establishing indicators of pathological shame in outpatients with depression and anxiety disorder, and to contribute to establishing norms for the ISS in Scandinavia. Method: The ISS was administered to n = 200 gender balanced non-patient and outpatient samples. A total of 100 patients each were diagnosed as suffering from a depression or anxiety disorder. The diagnoses were supported by Beck's Depression (BDI) and Anxiety Inventory (BAI). The analyses used were the principal component analysis (PCA) and confirmatory factor analysis (CFA) for item structure and sample equivalence, ANOVAs, t-tests and Mann–Whitney non-parametric statistics for index scores, and the receiver operating curve (ROC) for break-off. Results: Patients' ISS score were similar to the results from previous research, the effect size of patient–non-patient difference was 0.68, correlations indicated a higher level of shame in depression than in anxiety, and the BDI–BAI correlation was 0.56 for both clinical samples. The PCA showed three factors that were identified as: “Inadequacy”, “Emptiness”, and “Vulnerability”. Conclusions: The ISS is a viable instrument, which indicates a widespread shame pathology in both depressive and anxious out-patients. The instrument may not be uni-dimensional, but exploration of factor variation may be a promising goal for further research. Clinical implications: Assessment of shame should be included in diagnosis and treatment of emotional disorder. [ABSTRACT FROM AUTHOR]

Introduction: Identifying the predictors of response to psychiatric and psychotherapeutic treatment may be useful for increasing treatment efficacy in pharmacoresistant depressive patients. Objectives: The goal of this study was to examine the influence of dissociation, hope, personality trait and selected demographic factors in treatment response of this group of patients. Methods: Pharmacoresistant depressive inpatients were enrolled in the study. All patients completed Clinical Global Impression - both objective and subjective form (CGI), Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI) at baseline and after six weeks of combined pharmacotherapy and psychotherapy treatment as outcome measures. Internalized Stigma Of Mental Illness Scale (ISMI), Dissociative Experience Scale (DES), Adult Dispositional Hope Scale (ADHS), and Temperament and Character Inventory (TCI-R) were completed at start of treatment with intention to find predictors of treatment efficacy. Results: The study included 72 patients hospitalized for the pharmacoresistant major depression, 63 of them finished the study. Mean scores of BDI-II, BAI, subjCGI, and objCGI significantly decreased during the treatment. BDI-II relative change statistically significantly correlated with the total ISMI score, Discrimination Experience, and Harm Avoidance. Strongest factors connected to BDI-II relative change were duration of disorder and Discrimination Experience. The strongest factor connected to objCGI relative change was Discrimination Experience. The existence of comorbid personality disorder did not influence the treatment response Conclusions: According to our results, the patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment. [ABSTRACT FROM AUTHOR]

Introduction: Dissociation is imporant feature of the patients wiht anxiety disorders and depressive disorders. Objectives: Goal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders. Methods: The sample consisted of inpatients with neurotic spectrum disorders and depressive disorder. The participants completed Beck Depression Inventory, Beck Anxiety Inventory, subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale, at the start and the end of the therapeutic program Results: The total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment were referred for hospitalization for the six-week complex therapeutic program, were enrolled in this study. 606 of them were statistically analyzed. The patients' ratings significantly reduced during the treatment. Patients without comorbid personality disorder improved significantly more than patients with comorbid personality disorder in the reduction of depressive symptoms. However, there were no significant differences in change of anxiety and severity of disorder between the patients with and without personality disorders. The higher degree of dissociation at the beginning of the treatment predicted minor improvement. Conclusions: Dissociation presents an important factor influencing treatment effectiveness in the treatmentresistant patients with anxiety/depression with or without personality disorders. [ABSTRACT FROM AUTHOR]

Introduction: Hope has a direct effect on the effectiveness of psychotherapy. Dissociation proved to be one of the important factors influencing treatment efficacy in anxiety disorders. Selfstigma complicated adherence of the patients to the treatment. Objectives: The hypothesis is that the increase of self-stigma is connected with the level of dissociation and both lead to a decrease in self-esteem and could also decrease treatment effectiveness in patients with anxiety disorders. Methods: A total of 109 patients were evaluated the start and end of therapy by the following scales: Mini International Neuropsychiatric Interview; The Internalized Stigma of Mental Illness Scale; Adult Dispositional Hope Scale; Temperament and Character Inventory - Revised Version; Clinical Global Impression (CGI; objective and subjective); Beck Anxiety Inventory; Beck Depression Inventory - Second Edition; Dissociative Experiences Scale. The therapeutic program included 25 group sessions and 5 individual therapy sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. Results: Greater improvement in psychopathology, assessed by the relative change of the objective CGI, was associated with lower initial levels of dissociation, pathological dissociation, harm-avoidance, and self-stigma, and higher levels of hope and self-directedness. There were differences in the relative changes in objective CGI between the subgroups with and without a comorbid personality disorder. The patients without comorbid personality disorder improved significantly more than those with that disorder. Conclusions: Treatment effectiveness in anxiety disorders is related to self-stigma, hope, harm-avoidance, self-directedness, and dissociation. [ABSTRACT FROM AUTHOR]

Introduction In the last decade, accumulating evidence has been produced on the role of dissociation in Obsessive Compulsive Disorder (OCD). Understanding which dissociation dimensions are specific to OCD could suggest the integration of therapeutic strategies for dissociation in the treatment of patients with OCD. Objectives The current study explored the role of dissociation in a sample of patients with OCD, patients with anxiety disorders and healthy controls with the aim to understand which dissociation dimensions could be specific to OCD. Method One hundred seventy-one participants were included in the study (56% females, mean age = 35.96, SD = 12.61), of which 52 were patients with primary OCD, 59 were patients with Anxiety Disorders (AD), and 60 were healthy controls. The Dissociative Experiences Scale (DES), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were administered. Results Patients with OCD had significantly higher dissociative amnesia symptoms than patients with AD and health controls ( F = 6.08, P < 0.01) and higher depersonalization/derealization symptoms than healthy controls but not than patients with AD. Patients with OCD did not report significantly higher dissociative absorption than healthy controls and patients with AD. Conclusions Strategies targeting dissociative amnesia and depersonalization/derealization symptoms in OCD are discussed. Future studies should examine which OCD subtypes are more strongly associated to dissociation dimensions. [ABSTRACT FROM AUTHOR]

Introduction: The aim of study was to establish the efficacy of CBT or short psychodynamic psychotherapy on non-selected and medication-resistant patients with anxiety disorders and to search for predictors of response. Method: Short psychodynamic psychotherapy or systematic CBT was tailored according the needs of each patient. Pharmacology treatment remained mainly unchanged during the trial period. Outcome measures were: Clinical Global Impression - Severity of Illness scale (CGI), Dissociative Experience Scale (DES), Somatoform Dissociation Questionnaire (SDQ-20), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI). The primary outcome measures were clinical response defined as 30% decrease in BAI and remission defined as a 1 or 2 points in CGI. Results: 190 patients were included into the study and 15 dropped out. Altogether 175 patients completed at least 5 of 6 weeks of intensive psychotherapy program. Patients of all diagnostic groups showed significant improvement in CGI, BAI, BDI. At the end of the treatment 51.1% of the patients achieved clinical response and 42.3% clinical remission. The main characteristics present at the beginning of the trial increasing probability of achieving response or remission during the treatment were BAI score lower than 25, BDI score lower than 20, no comorbidity with personality disorder, no comorbid depression, no being divorced or widowed. Conclusion: Therapeutic efficacy of the intensive psychotherapeutics programs for anxiety disorders was predicted with level of anxiety and depression, comorbidity with depression and personality disorders and marital status. [ABSTRACT FROM AUTHOR]