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Objective: To test the hypotheses that anxiety and depression are associated with etiology, disease severity and mortality in patients hospitalized with acute dyspnea., Methods: The Hospital Anxiety and Depression Scale was completed within 48h of admission in 185 patients. A subscale score of ≥8 was regarded as clinically significant. The etiology and severity of dyspnea on admission and all-cause mortality during follow-up (median, 2.3years) were recorded., Results: Anxiety and depression were more prevalent in patients with chronic obstructive pulmonary disease (COPD) (n=53; 42% and 31%) and heart failure (HF) (n=80; 33% and 23%) than in other causes of acute dyspnea (15% and 11%). Psychological distress was not associated with clinical status or cardiac biomarkers. Anxiety, but not depression, was associated with increased mortality, also when adjusting for cardiac biomarkers in multivariate Cox analysis. In contrast, anxiety was not associated with mortality after adjustment for body mass index, history of COPD and disease severity (hazard ratio, 1.67; 95% confidence interval, 0.92-3.00)., Conclusion: Psychological distress was associated with COPD and HF as etiology of acute dyspnea, but not with disease severity. Anxious patients had a higher mortality rate, but this association was related to the presence and severity of COPD., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To examine the associations between depressive/anxiety disorders (DAs), perceived health-related quality of life (HRQOL) and mortality in dialysis patients., Methods: Patients were assessed for depressive and DAs with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. The HRQOL was assessed with the Medical Outcome Short Form 36 (MOS SF-36), and the Beck Depression Inventory and Hospital Anxiety and Depression Scale were also applied. Sociodemographic, clinical and laboratory data were also collected., Results: Patients with depressive disorders reported more impaired HRQOL on four of the eight subscales, while those with a depressive disorder comorbid with DA reported more impairment on all MOS SF-36 subscales compared to those without any psychiatric disorder. During the observation period, 50% of those with depression, 28% of those with anxiety and 33% of patients with DA disorder died. A survival analysis did not indicate that patients with depressive or DAs had a higher mortality than patients without such disorders., Conclusion: Dialysis patients with depressive disorders reported impaired HRQOL, whereas those with DAs did not. Patients with DA reported the most serious HRQOL impairment. No evidence was obtained to support the hypothesis that depressive and DAs contributed to compromised survival in dialysis patients. In patients with depression, DAs should also be assessed as they significantly contribute to impaired HRQOL., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: The objective was to test the hypotheses that cytokine levels are elevated in community-residing persons at high risk for obstructive sleep apnea with major depressive disorder (MDD) compared to nondepressive persons and that cytokine levels show stronger correlations with somatic than psychological symptoms of depression., Method: A case-control study within the cross-sectional Akershus Sleep Apnea Project was performed. Two controls matched for age, gender, metabolic syndrome and obstructive sleep apnea were drawn for each case of MDD., Results: Group comparisons revealed no significant difference in the levels of 17 cytokines [interleukin-1β, -2,-4, -5, -6, -7, -8, -10, -12(p70), -13 and -17; tumor necrosis factor-α; interferon-γ; granulocyte colony-stimulating factor; granulocyte-monocyte colony-stimulating factor; macrophage chemoattractant protein-1 and monocyte inhibitory protein-1β] between persons with (n=34) and without MDD (n=68). There was no association between cytokines levels and MDD in multivariate regression analyses. The concentration of interleukin-4 was significantly more positively correlated with psychological than somatic symptoms (r=0.046 vs. -0.143, respectively, P=0.024), while no different correlations were observed for other cytokines., Conclusion: The cytokine levels were not elevated in MDD, and cytokine levels were not more strongly associated with somatic than psychological symptoms of depression. The depression-specific effect on inflammation may be weak in community-based samples with prevalent somatic comorbidity., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: The objective of the study was to identify the prevalence of depression, anxiety and somatoform disorders in dialysis patients according to dialysis modality and to compare dialysis patients with and without psychiatric comorbidity regarding clinical characteristics, health-related quality of life (HRQoL) and markers of nutrition and inflammation., Methods: One hundred and nine patients were assessed for depression, anxiety and somatoform disorder with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The Short Form 36 was used. Sociodemographic, clinical and laboratory data were collected., Results: About one third, 30.3%, had a current psychiatric disorder regardless of dialysis modality (depression, 22%; anxiety, 17%; somatoform disorders, 1%), and these reported more impairment on HRQoL dimensions. In the multivariate analysis, significant correlations between psychiatric comorbidity and C-reactive protein (CRP≥6 mmol/L) [odds ratio (OR), 3.6; 95% confidence interval (CI), 1.3-9.9; P=.015] and body mass index (BMI≤21 kg/m(2)) (OR, 4.2; 95% CI, 1.4-12.7; P=.011) were observed., Conclusion: Depressive and anxiety disorders were common in dialysis patients and were associated with impaired HRQoL, while prevalence of somatoform disorders was low. A strong correlation between psychiatric comorbidity, CRP and BMI indicates that special attention should be given to patients with CRP≥6 mmol/L and BMI≤21 kg/m(2)., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: The aims were to (a) study the characteristics and outcome in patients with noncardiac chest pain or benign palpitations referred for cardiac evaluation, (b) compare psychological characteristics in the two groups, (c) identify predictors of outcome (d) and explore characteristics of patients who wanted psychological treatment., Methods: The patients (N=154) were first evaluated by a psychiatrist and than by a cardiologist at the initial attendance and by self report after 6 months., Results: Thirty nine percent had at least one DSM-IV psychiatric disorder at attendance. At the 6-month follow-up, 43% still had clinically significant complaints and/or impaired function. Patients with palpitations were more likely to be female, younger and less likely to attribute cardiac symptoms to heart disease, but had otherwise similar psychological features to noncardiac chest pain patients. Depression score at attendance predicted significant complaints at follow-up. Interest in psychological treatment was associated with more fear of bodily sensations, more impaired function, and greater tendency to attribute symptoms to heart disease., Conclusion: Psychiatric disorders were common. The 6-month outcome was poor and was associated with the depression score at attendance. Patients with fear of bodily symptoms and impaired function were most interested in psychological treatment., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background and Purpose: The aim of this study was to identify clinical factors in the acute stage that can predict anxiety, depression and apathy at 4 months after stroke., Methods: One hundred four consecutive stroke patients in a stroke unit were assessed within the first 2 weeks and after 4 months. Assessments included anxiety and depression symptoms on the Hospital Anxiety and Depression Scale (HADS) [HADS Anxiety subscale (HADS-A) > or = 8 and HADS Depression subscale (HADS-D) > or = 8], physical impairment, functional disability, somatic comorbidity upon admission, assessment of apathy (score > or = 34 on the Apathy Evaluation Scale) and a psychiatric Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of anxiety disorder (anxiety) or depression (depression) on follow-up. Logistic regression analysis was used to identify factors associated with anxiety, depression and apathy., Results: Anxiety and depression at 4 months were significantly associated with HADS-A scores of > or = 8 upon admission [odds ratio (OR)=4.4; 95% confidence interval (95% CI)=1.7-11.9; P=.003 and OR=2.9; 95% CI=1.0-7.9; P=.043, respectively]. Apathy at 4 months was significantly associated with somatic comorbidity upon admission (OR=3.0; 95% CI=1.0-8.3; P=.036) and had a borderline association with HADS-D scores of > or = 8 (OR=8.4; 95% CI=1.0-72.0; P=.051) upon admission., Conclusion: Assessment with HADS within the first 2 weeks of stroke can contribute to the detection of patients at risk for clinically significant anxiety, depression and apathy at 4 months after stroke., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: The aim was to investigate the association between panic disorder (PD) and long-term outcomes in terms of psychiatric morbidity, psychological distress and health-related quality of life (HRQOL), and to identify predictors of poor outcome for PD in chest pain patients., Method: Nine-year follow-up study of chest pain patients (n=199) referred to cardiology outpatient investigation. Assessments included Structured Clinical Interview for DSM-IV, Symptom Checklist-90-R (SCL-90-R), Illness Attitude Scale, Agoraphobia Cognitions Questionnaire, the Mobility Inventory for Agoraphobia, Personality Diagnostic Questionnaire and the Medical Outcome Study Short Form-36. At baseline, 76 patients suffered from PD., Results: Of 184 eligible patients, 150 participated in the follow-up study. Panic disorder at baseline was associated with a higher prevalence of comorbid Axis I disorders, psychological distress and poorer HRQOL at follow-up compared with patients without PD. Of the participants with PD at baseline (n=55), 14 suffered from persistent PD at follow-up. Patients with persistent PD had particularly poor outcomes regarding comorbid Axis I disorders, suicidal ideation (21%) and HRQOL. A mean baseline SCL-90-R somatization score above 1.4 predicted a 5-fold increased risk of persistent PD., Conclusion: Chest pain patients with PD have a negative long-term outcome and those who score high on somatization require special attention because of particularly poor outcomes.

Objective: The aims of this study were to (a) study the persistence of panic disorder (PD); (b) investigate the association between PD at baseline and outcome [chest pain, psychiatric morbidity, health care utilization, suicidal thoughts, work impairment and health-related quality of life (HRQOL)]; (c) study the course of pain, distress, symptom attribution and HRQOL; and (d) describe treatment and perceived treatment needs of patients with PD., Method: A 1-year follow-up study of 199 chest-pain patients referred to cardiac outpatient investigation was completed. Assessments included Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID), Short-Form McGill Pain Questionnaire, Symptom Checklist-90-Revised, the Illness Attitude Scales, the 36-item Short-Form Health Survey and a chest-pain questionnaire., Results: At follow-up, 57 of the 153 patients reassessed with the SCID suffered from PD. Forty-three of the 55 patients (78%) who were diagnosed with PD at baseline still suffered from PD at follow-up. PD at baseline was associated with pain persistence, psychiatric morbidity (current major depression, pain disorder and simple phobia), significantly higher scores on psychological distress, hypochondriasis, negative outcome expectation, lower scores on seven of the eight dimensions of HRQOL and more general practitioner consultations. Only 6% of the patients with PD used effective treatment, and 3% reported a treatment need at follow-up., Conclusion: Despite chronic distress and impairment, we found significant undertreatment of PD, which needs to be addressed in future studies.

This cross-sectional psychiatric and cardiological study compared patients with and without coronary artery disease (CAD) with respect to psychiatric morbidity, psychological factors, pain characteristics, medical morbidity and the prevalence of coronary risk factors. The 199 participants had been referred to cardiological outpatient clinics for the investigation of chest pain and had no history of heart disease. Current panic disorder occurred significantly more often in non-CAD patients (41% vs. 22%). No significant differences were found for other psychiatric disorders and psychological variables. Non-CAD patients reported significantly longer histories of pain and a higher prevalence of atypical chest pain. In other respects, there were surprisingly few differences between the groups. High morbidity of both psychiatric disease (pain disorder, 19%; any current psychiatric disorder, 72%) and somatic conditions (musculoskeletal disease, 33%; dyspepsia, 23%) was found with no significant differences between the groups. In these patients, multifactorial complaints may explain chest pain in both patient groups. The physicians should attend to psychiatric disorders in non-CAD as well as in CAD patients.