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The purpose of this study is to explore and compare the effects of drug therapy alone and amitriptyline combined with music therapy on postpartum anxiety and depression in women. The Hamilton Anxiety Scale (HAM-A), Edinburgh Postpartum Depression Scale (EPDS), and World Health Organization Quality of Life Assessment Tool (WHO QOL BREF) were used to analyze the treatment effects of the control group and intervention group on postpartum anxiety and depression in women. There was no significant difference in population baseline data between the control group and the intervention group (p>0.05); There was a significant difference in HAM-A scores between the two groups (p<0.05). In the EPDS score, there was a significant difference between the two groups (p<0.05), but after intervention in both groups, the treatment effect of the intervention group was significantly more significant than that of the control group (p<0.01). In the WHOQOL-BREF score, there were significant differences in physiological, psychological, and independence fields (p<0.05), except for no significant differences in the environmental field (p>0.05). Combining music therapy with conventional drug amitriptyline therapy can effectively alleviate and reduce postpartum anxiety and depression levels in women, improve their quality of life (except in the environmental field), and provide an effective reference plan for postpartum care for women to a certain extent. [ABSTRACT FROM AUTHOR]

Background/Objectives: The anxiolytic effect of transcutaneous electrical nerve stimulation (TENS) is associated with the activation of endogenous inhibitory mechanisms in the central nervous system. Both low-frequency, high-amplitude TENS (LF-TENS) and high-frequency, low-amplitude TENS (HF-TENS) are capable of activating opioid, GABA, serotonin, muscarinic, and cannabinoid receptors. However, there has been no comparative analysis of the effectiveness of HF-TENS and LF-TENS in the treatment of GAD. The purpose of our research was to study the effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of patients with GAD compared with sham TENS. Methods: The effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of GAD was studied using Generalized Anxiety Disorder 7-item scale (GAD-7) and the Hamilton Anxiety Rating Scale (HAM-A). 40 patients underwent sham TENS, 40 patients passed HF-TENS (50 Hz—50 μs—sensory response) and 41 patients completed LF –TENS (1 Hz—200 μs—motor response) for 30 days daily. After completion of treatment, half of the patients received weekly maintenance therapy for 6 months. Electroencephalography was performed before and after treatment. Results: Our study showed that a significant reduction in the clinical symptoms of GAD as assessed by GAD-7 and HAM-A was observed after HF-TENS and LF-TENS by an average of 42.4%, and after sham stimulation only by 13.5% for at least 2 months after the end of treatment. However, LF-TENS turned out to be superior in effectiveness to HF-TENS by 51% and only on electroencephalography leads to an increase in PSD for the alpha rhythm in the occipital regions by 24% and a decrease in PSD for the beta I rhythm in the temporal and frontal regions by 28%. The prolonged effect of HF-TENS and LF-TENS was maintained without negative dynamics when TENS treatment was continued weekly throughout the entire six-month observation period. Conclusions: A prolonged anxiolytic effect of direct TENS of the right median nerve has been proven with greater regression of clinical and neurophysiological manifestations of GAD after LF-TENS compared to HF-TENS. Minimal side effects, low cost, safety, and simplicity of TENS procedures are appropriate as a home treatment modality. [ABSTRACT FROM AUTHOR]

Background: Substance use disorder (SUD) often co-occurs with mood disorders like anxiety and depression. This study investigates the relationship between SUD and mood disorders using a dimensional approach. Methods: A total of 290 participants, including 145 with SUD and 145 healthy controls, were assessed. The General Health Questionnaire (GHQ-12) evaluated mental health, followed by interviews using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). Demographic information, substance use behaviours, and mental health symptoms were collected and analysed. Results: Of the participants, 90% were men and 10% women; 68.2% were married. Most SUD patients were smokers (71.0%) and alcohol users (35.8%), with others using drugs or tobacco (33.7% and 19.3%). The majority (84.8%) used drugs for a high. HAM-D results showed moderate to severe depression in 7.5% of SUD patients and 5.5% of controls. HAM-A results indicated 80.6% of the SUD group had anxiety, compared to 88.9% of controls with no anxiety. Conclusion: SUD patients frequently experience concurrent anxiety and depression, highlighting the need for dual diagnosis and integrated treatment for SUD and mood disorders. [ABSTRACT FROM AUTHOR]

Background: This study was designed to inspect the effectiveness of Mindfulness Yoga and Progressive resistance exercise on anxiety and depression among Parkinson's disease. Purpose: To compare the effectiveness of Mindfulness Yoga and Progressive resistance exercise on anxiety and depression among Parkinson's disease Materials and Methods: The study was conducted with a sample size of 28 participants. The subjects were selected from Sri Saga Physiotherapy Centre, according to inclusion and exclusion criteria. Patients were completely explained about the safety and simplicity of the procedure and informed consent were obtained from the patient. For all the subjects Pre-test outcome measure were assessed using Hamilton anxiety and Hamilton depression scale. The subjects was divided into two groups based on concealed envelope method. Group A were given mindfulness yoga for 4 weeks of duration of 30 mins and Group-B were given Progressive resistance exercise for 4 weeks (10 reps*3 sets where 10RM=1kg). At the end of 4th week post outcome measures were analyzed using Hamilton anxiety and Hamilton depression scale and statistically tabulated. Result: Statistical analysis of Hamilton anxiety and Hamilton depression scale examination post-test values revealed the constantly significant differences, with P value of < 0.0001. Conclusion: Mindfulness yoga was found to be more effective than progressive resistance exercise in reducing anxiety and depression symptoms among Parkinson's patients. [ABSTRACT FROM AUTHOR]

Background: Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder having significant deterioration in patients’ socio-occupational functioning. Stressful life events (SLE) were noted before onset of this disorder. The previous study with Indian population found positive correlation between stressful and traumatic life events and OCD, but was with small sample size and thus result couldn’t be generalized. Aims and Objectives: The aim of the study was to examine the role of life events in patients with OCD and to find out correlation between them, if any. Materials and Methods: Consecutive 30 OPD patients fulfilling ICD-10 DCR criteria for OCD were rated with Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Presumptive Stressful Life Events Scale (PSLES). A group of 30 healthy controls from unrelated patient party were also rated on PSLES. Finally, both groups were statistically compared in terms of life events. Results: Two groups were identical in distribution of age and sex. The frequency of life events, 1-year (P=0.000) and lifetime (P=0.000), were significantly higher in OCD group in comparison to healthy controls. There was significant positive correlation between PSLES scores and YBOCS scores. Step-wise linear regression analysis found positively predictability of PSLES score to OCD severity. Conclusion: OCD patients have statistically significant SLE before the onset of their disorder and total number of life events has positive correlation with severity of OCD.

Background Schizophrenia is a debilitating disorder making it a challenge for clinicians to manage its heterogeneous symptom profile. Antipsychotics remain the main modality of its treatment. However, some symptoms persist after an optimal dose of antipsychotics. The affective and cognitive symptoms need a holistic approach for resolution. Biofeedback is a noninvasive procedure showing its effectiveness in various mental illnesses. Integration of biofeedback adjunctive to medications can help in attaining treatment goals in schizophrenia. Objectives It is to determine the role of biofeedback as an adjunctive therapy technique to traditional pharmacotherapy in patients with schizophrenia in improving affective symptoms. Methodology Sixty patients diagnosed with schizophrenia were selected for the study after fulfilling the inclusion and exclusion criteria. Patients were allotted to either the test group or control group by alternate allocation method. All patients were titrated to an optimal fixed dose of antipsychotic medications during 1st week of allotment to study. Biofeedback therapy was given 3 sessions per week for 3 weeks to patients in the test group. Positive and negative syndrome scale (PANSS) was applied for all patients at baseline. Hamilton Anxiety Rating Scale (HAM-A) and Calgary Depression Scale for Schizophrenia (CDSS) were applied at baseline and after 4 weeks to measure anxiety and depressive symptoms respectively. After 4 weeks the results were compared between both groups using statistical analysis. Conclusion The outcome of the study found that biofeedback therapy is effective in reducing anxiety and depressive symptoms in patients receiving biofeedback therapy compared to those who did not receive it. Recommendation Further studies in a larger cohort are needed to formulate sound and consistent conclusions.

Background: Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder having significant deterioration in patients' socio-occupational functioning. Stressful life events (SLE) were noted before onset of this disorder. The previous study with Indian population found positive correlation between stressful and traumatic life events and OCD, but was with small sample size and thus result couldn't be generalized. Aims and Objectives: The aim of the study was to examine the role of life events in patients with OCD and to find out correlation between them, if any. Materials and Methods: Consecutive 30 OPD patients fulfilling ICD-10 DCR criteria for OCD were rated with Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Presumptive Stressful Life Events Scale (PSLES). A group of 30 healthy controls from unrelated patient party were also rated on PSLES. Finally, both groups were statistically compared in terms of life events. Results: Two groups were identical in distribution of age and sex. The frequency of life events, 1-year (P=0.000) and lifetime (P=0.000), were significantly higher in OCD group in comparison to healthy controls. There was significant positive correlation between PSLES scores and YBOCS scores. Step-wise linear regression analysis found positively predictability of PSLES score to OCD severity. Conclusion: OCD patients have statistically significant SLE before the onset of their disorder and total number of life events has positive correlation with severity of OCD. [ABSTRACT FROM AUTHOR]

Mitigating rating inconsistency can improve measurement fidelity and detection of treatment response. The International Society for CNS Clinical Trials and Methodology convened an expert Working Group that developed consistency checks for ratings of the Hamilton Anxiety Rating Scale (HAM-A) and Clinical Global Impression of Severity of anxiety (CGI S) that are widely used in studies of mood and anxiety disorders. Flags were applied to 40,349 HAM-A administrations from 15 clinical trials and to Monte Carlo-simulated data as a proxy for applying flags under conditions of inconsistency. Thirty-three flags were derived these included logical consistency checks and statistical outlier-response pattern checks. Twenty-percent of the HAM-A administrations had at least one logical scoring inconsistency flag, 4 % had two or more. Twenty-six percent of the administrations had at least one statistical outlier flag and 11 % had two or more. Overall, 35 % of administrations had at least one flag of any type, 19 % had one and 16 % had 2 or more. Most of administrations in the Monte Carlo- simulated data raised multiple flags. Flagged ratings may represent less-common presentations of administrations done correctly. Conclusions-Application of flags to clinical ratings may aid in detecting imprecise measurement. Flags can be used for monitoring of raters during an ongoing trial and as part of post-trial evaluation. Appling flags may improve reliability and validity of trial data. • A set of expert consensus and statistical flags to help identify possible errors in HAMA ratings. • Flags elaborated in paper can be applied. • Flags represent actual patterns of inconsistencies found. • Application of flags to ratings may improve reliability of ratings and validity of trials. [ABSTRACT FROM AUTHOR]

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious new β-coronavirus that primarily affects the lungs. Because of its unprecedented spread, in a relatively short interval, it is declared a global pandemic. Binding to the angiotensin-converting enzyme 2 receptors, SARS-CoV-2 is easily disseminated through air. Apart from the established clinical panel, individuals exposed to prolonged chronic stress also manifest gastrointestinal (GI) symptoms similar to those exhibited by SARS-CoV-2-infected patients.The present study aims to assess the incidence of GI deficiencies and prevalence of anxiety among healthy medical staff by applying the Visual Analog Scale for Irritable Bowel Syndrome (VAS-IBS) and Hamilton Anxiety Rating Scale (HAM-A) during this global crisis.We found significant differences on several items of the VAS-IBS: regarding the incidence of diarrhea (p = 0.04), bloating/gases (p = 0.02), and nausea/vomiting (p = 0.01) from the physical spectrum. After stratification based on age of the participants and after we applied Kruskal-Wallis test because of heterogeneity between groups, we noted two situations in which the null hypothesis is rejected: nausea/vomiting in women between 20 and 30 years, and between 30 and 40, and between 40 and 50 years, respectively (p = 0.026/0.029). Anxiety was prevalent among young and middle-class people after the centralization of HAM-A data, where 40.4% of the participants had various forms of anxiety: mild (n = 13; 13.82%), severe (n = 13; 13.82%), and moderate (n = 12; 12.76%).This study demonstrates that VAS-IBS is a reliable tool for assessing the incidence of GI deficiencies, as well as HAM-A for anxiety. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the factors associated with anxiety in type 2 diabetes mellitus patients (T2DM) by using Hamilton Anxiety Rating Scale (HAM-A). A cross-sectional quantitative study was conducted after necessary ethical approval from Medicare Hospital Rawalpindi and Capital Development Authority Hospital Islamabad in accordance with Declaration of Helsinki. Three hundred thirty-eight patients with type 2 diabetes mellitus were selected by non-stratified random sampling technique from August 2016 to February 2017. Majority of the T2DM patients (n = 258, 66.5%) had mild anxiety, followed by mild to moderate anxiety (n = 82, 21.1%). A significant association (p < 0.01) was observed between anxiety and patients’ gender, education, and occupation; whereas, statistically insignificant association (p > 0.05) was observed between HAM-A score and patients’ age, family history, and life style. Linear regression analysis revealed gender (OR = − 0.308, CI-0.57-0.299) as a significant predictor (p < 0.01) for anxiety. Findings of this study demonstrate that large proportion of the diabetic patients is suffering with type of anxiety. A significant association of anxiety was identified with gender, education, and occupation of type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Penile cancer, which is a considerable challenge for countries in the developing world, is a mutilated affection for the patient, considering both the local modifications that are determined by it, as well as from the treatment point of view. In this way, for the more advanced disease phase, aggressive therapy with partial or total penectomy is still the conventional and necessary treatment. There are very few studies about the extent and nature of the psychological effects of penile cancer. Thus, considering that psychological/psychiatric dysfunctions in patients with penectomy are likely to be common and taking into account the current contradictions that exist regarding this area of research, we decided to evaluate the impact of penile cancer and/or partial or total penectomy on levels of anxiety and depression, as studied through some specific scales such as the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A). We found increased anxiety and depression, especially in the case of the group with total penectomy, but also in the biopsy group, which comprised patients that had lesions in the terminal stage, such as an inextirpable tumor. The most reduced levels of depression and anxiety were observed in the postectomy group. Our findings presented here and further knowledge about the psychological, social and sexual aspects of these specific patients will help health professionals and organizations to identify treatment options and/or make recommendations for rehabilitation and support services. Additionally, there is a continuous need to identify and assess proper scales to measure the psychological/psychiatric trauma in this group of patients, as well as focusing on the identification of the exact patients that require professional psychological intervention.

Background: The gene of tryptophan hydroxylase is widely recognized as a major candidate gene in many psychiatric disorders. However, no study has been done which investigates tryptophan hydroxylase 2 gene polymorphism in anxiety and depressive disorders in Kashmiri population (India). Objectives: To study tryptophan hydroxylase 2 (TPH2) C 11993 A gene polymorphism in anxiety and depressive disorders. Method: Sixty patients of depression disorder, 60 patients of anxiety disorder and 40 unrelated healthy volunteers (control) were studied in a case control design. Polymorphism was determined using polymerase chain reaction (PCR) and agarose gel electrophoresis after digestion with HAP II enzyme. Genotypes and allele frequencies were compared using Chi-square tests, Fischer’s exact test, odds ratio, 95% confidence interval (C.I) and p-value of

Abstract: Objective: To explore the validity of the GAD-7 scale as an outcome measure of disability in primary care. Methods: A random sample of 212 subjects was recruited in primary care clinics; 50% diagnosed with generalized anxiety disorder (GAD) by DSM-IV criteria and 50% concurrent matched controls. The GAD-7, the Hamilton Anxiety Scale (HAM-A), and the abridged 12-item version of World Health Organization Disability Scale (WHO-DAS-II) were administered. The number of visits to primary care and specialty clinics was also recorded. Results: Strong and significant (p<0.001) correlations were found between GAD-7 and HAM-A (r=0.852) and WHO-DAS-II (r=0.704) scores, particularly for Participation in Society (r=0.741), Understanding and Communication (r=0.679), and Life Activities (0.638) dimensions. Moderate but significant correlations were also found between GAD-7 score and the number of visits to Primary Care (r=0.393) and Specialty clinics (r=0.373). In all cases, an overall relation was observed between GAD-7 severity levels and disability scores [F (3,208)=25.4, p<0.001] as assessed by the WHO-DAS II, with higher mean disability values related to higher severity levels. Conclusions: The GAD-7 scale has been shown to highly correlate not only with specific anxiety but also with disability measures. It has been shown that more severe GAD levels correlate with higher disability states and tend to demand more health care attention. As the GAD-7 is self-administered and is not time consuming, this instrument could be a good choice to explore the level of patient disability in subjects with GAD in primary care settings. [ABSTRACT FROM AUTHOR]

The aim of the current study was to identify and evaluate cutoffs for mild, moderate, and severe ranges of Hamilton Anxiety Rating Scale (HAM-A) scores. Data were from a four-week randomized trial of treatment for generalized anxiety disorder. Measures included the HAM-A, SF-36, Hospital Anxiety and Depression Scale (HADS), and Clinical Global Impressions of Severity (CGI-S) scale. HAM-A cutoffs were identified based on literature review, expert panel input, and MANOVA models. The optimal cutoff set was evaluated based on association with clinician CGI-S ratings. The sample included 144 patients (56.3% female; 73.6% white; mean age = 35.7 years; mean baseline HAM-A score = 23.7). The optimal HAM-A score ranges were: mild anxiety = 8-14; moderate = 15-23; severe ≥ 24 (scores ≤ 7 were considered to represent no/minimal anxiety). Analysis of variance (ANOVA) models found statistically significant differences among these groups in the SF-36 and HADS. The HAM-A severity ranges closely corresponded to clinicians' CGI-S ratings. The study represents the first step towards developing severity ranges for the HAM-A. These cutoffs should be used with caution and validated in larger samples. If the proposed cutoffs are accepted for general use, they could make results more meaningful and interpretable for researchers, clinicians, and patients. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Background: Based on a traditional belief, Echium amoenum (Boraginaceae) dried flowers are used in Iran as an anxiolytic remedy and also as a mood enhancer. In this study, efficacy of an aqueous extract of E. amoenum in patients with mild to moderate major depressive disorder (a score ≥18 on the Hamilton depression rating scale) was evaluated. Methods: 35 patients were randomly assigned to receive daily either placebo or 375 mg of E. amoenum aqueous extract in a 6-week double blind, parallel-group trial. Patients were assessed in weeks 0, 1, 2, 4 and 6 by the Hamilton Rating Scale for Depression (HAM-D17), the Hamilton Rating Scale for Anxiety (HAM-A14), and a score sheet on adverse effects. Results: In week 4, the extract showed a significant superiority over placebo in reducing depressive symptoms. The effect on anxiety was not significant. Headache, somnolence, vomiting, dry mouth, constipation and blurred vision are the most commonly reported side effects. However, with regards to these side effects, no significant difference between placebo and drug treated groups was observed. Limitations: This study is performed with a small sample size, only with one dose and for 6 weeks. Conclusion: E. amoenum aqueous extract may have some antidepressant activity. [Copyright &y& Elsevier]

Many evidences support the anxiety-headache-depression syndrome as a distinct disorder, and also its association with psychiatric illness. This study highlights the importance of prospective research for studying the developmental course and consequences of headache syndromes. The relevant information for the sample of 100 patients was recorded on a Performa designed for this purpose comprising of socio-demographic variables like age, gender and triggering factors. The correlation-coefficient indicated a significant positive relationship between the anxiety and depression in chronic headache patients. These findings implicate high prevalence of anxiety and depression in the general population, and indicate an association between headache and psychological disorders. Also, various psychotherapies should be applied to the headache patients so as to treat them right at the onset level of anxiety and depression. [ABSTRACT FROM AUTHOR]

Background: The gene of tryptophan hydroxylase is widely recognized as a major candidate gene in many psychiatric disorders. However, no study has been done which investigates tryptophan hydroxylase 2 gene polymorphism in anxiety and depressive disorders in Kashmiri population (India). Objectives: To study tryptophan hydroxylase 2 (TPH2) C 11993 A gene polymorphism in anxiety and depressive disorders. Method: Sixty patients of depression disorder, 60 patients of anxiety disorder and 40 unrelated healthy volunteers (control) were studied in a case control design. Polymorphism was determined using polymerase chain reaction (PCR) and agarose gel electrophoresis after digestion with HAP II enzyme. Genotypes and allele frequencies were compared using Chi-square tests, Fischer's exact test, odds ratio, 95% confidence interval (C.I) and p-value of <0.05 was considered to be statistical significant. Results: The mean age ± SD of anxiety, depression and control group was 32.73±10.99, 32.20±10 and 29.75±10.12 respectively and the difference was found to be statistically non significant (p=0.349).The mean HAM-A (Hamilton rating scale for anxiety) score and HAM-D (Hamilton rating scale for depression) score was high in both groups (anxiety and depression) and found to be statistically significant (p=0.001).Depression group had AA genotype (55.2%) than control (37.5%) and was found to be statistically non significant (p=0.890).Comparison of allelic frequency revealed no association of A allele in anxiety group (76.67%) compared with control (75.5%) and was found to be statistically non significant (p= 0.866), OR 1.09 (0.56-2.11). Conclusion: TPH2C 11993 A gene was not found to be associated with major depressive disorder (MDD) and anxiety disorder in Kashmiri population. [ABSTRACT FROM AUTHOR]