Search

Background: Inflammatory responses and inflammatory cytokines have been implicated in the pathogenesis of affective disorders, particularly major depression. Given the limited evidence relating to the potential role of proinflammatory cytokines in generalised anxiety disorder (GAD), we aimed to examine peripheral proinflammatory cytokines in Chinese patients with GAD.Methods: A case-controlled cross-sectional study design, with recruitment of 48 patients with first episode GAD and 48 matched healthy controls. All participants completed measures of anxiety using well-established questionnaires, and serum levels of pro-inflammatory cytokines were measured using multiplex technology.Results: Serum levels of CRP, IL-1α, IL-2, IL-6, IL-8, IL-12, IFN-γ, and GM-CSF were significantly higher in the GAD group in comparison to the control group (p < 0.05). Pearson correlation revealed significant positive correlations between anxiety measures and serum levels of CRP, IL-1α, IL-6, IL-8, IFN-γ, and GM-CSF (p < 0.05).Limitations: The cross-sectional study design does not permit definite conclusions on causal directions between inflammation and GAD. The study was limited to a panel of 8 cytokines and does not exclude the possibility of other important cytokines being involved.Conclusions: These findings indicate an elevated peripheral proinflammatory response, and provide further support for low grade inflammation in GAD. Further research may identify an 'inflammatory signature' for diagnosis and treatment response, and guide the search for novel pharmacological interventions. [ABSTRACT FROM AUTHOR]

Patients receiving ketamine for refractory depression and anxiety report dissociative symptoms in the first 60 min post-dose. The most commonly used instrument to assess this is the Clinician-Administered Dissociative States Scale (CADSS), developed based on the assessment of patients with dissociative symptoms. Its psychometric properties for ketamine-induced dissociation have not been reported. We evaluated these from a study using 0.25-1 mg/kg ketamine and midazolam (as an active control) in 18 patients with treatment-resistant anxiety. Dissociation ratings were increased by ketamine in a dose-dependent manner. In contrast, midazolam showed no effect on ratings of dissociation. For individual CADSS items, the magnitude of change and the ketamine dose at which changes were observed were not homogenous. The Cronbach alpha for the total scale was high (0.937), with acceptable item-rest correlations for almost all individual items. Purposefully removing items to maximise alpha did not lead to meaningful improvements. Acceptable internal consistency was still observed after removing items which lacked evidence of responsiveness at lower doses. The high Cronbach alpha values identified in this study suggests that the CADSS is an internally consistent instrument for evaluating ketamine-induced dissociation in clinical trials in anxiety, although it does not capture symptoms such as thought disorder. [ABSTRACT FROM AUTHOR]

Background: People with anxiety disorders represent a significant part of a general practitioner's patient population. However, there are organisational obstacles for optimal treatment, such as a lack of coordination of illness management and limited access to evidence-based treatment such as cognitive behavioral therapy. A limited number of studies suggest that collaborative care has a positive effect on symptoms for people with anxiety disorders. However, most studies are carried out in the USA and none have reported results for social phobia or generalised anxiety disorder separately. Thus, there is a need for studies carried out in different settings for specific anxiety populations. A Danish model for collaborative care (the Collabri model) has been developed for people diagnosed with depression or anxiety disorders. The model is evaluated through four trials, of which three will be outlined in this protocol and focus on panic disorder, generalised anxiety disorder and social phobia. The aim is to investigate whether treatment according to the Collabri model has a better effect than usual treatment on symptoms when provided to people with anxiety disorders.Methods: Three cluster-randomised, clinical superiority trials are set up to investigate treatment according to the Collabri model for collaborative care compared to treatment-as-usual for 364 patients diagnosed with panic disorder, generalised anxiety disorder and social phobia, respectively (total n = 1092). Patients are recruited from general practices located in the Capital Region of Denmark. For all trials, the primary outcome is anxiety symptoms (Beck Anxiety Inventory (BAI)) 6 months after baseline. Secondary outcomes include BAI after 15 months, depression symptoms (Beck Depression Inventory) after 6 months, level of psychosocial functioning (Global Assessment of Functioning) and general psychological symptoms (Symptom Checklist-90-R) after 6 and 15 months.Discussion: Results will add to the limited pool of information about collaborative care for patients with anxiety disorders. To our knowledge, these will be the first carried out in a Danish context and the first to report results for generalised anxiety and social phobia separately. If the trials show positive results, they could contribute to the improvement of future treatment of anxiety disorders.Trial Registration: ClinicalTrials.gov, ID: NCT02678624 . Retrospectively registered 7 February 2016; last updated 15 August 2016. [ABSTRACT FROM AUTHOR]

Individuals with high levels of worry are more likely than others to attend to possible threats, although the extent of top-down attentional control processes on this bias is unknown. We compared the performance of high ( n = 26) and low worriers ( n = 26) on a probe discrimination task designed to assess attention to threat cues, under cognitive load or no-load conditions. The expected difference between groups was confirmed, with high worriers being more likely to attend to threat cues than low worriers. Importantly however, there were no significant effects involving condition (cognitive load vs. no-load), nor any significant association with self-perceived attentional control ability. These results suggest that pathological worriers are more likely to attend to threat than are individuals with low levels of worry, regardless of task demands on limited cognitive control resources. This finding is consistent with the dominance of habitual bottom-up influences over top-down control processes in biased attention to threat. [ABSTRACT FROM AUTHOR]

Introduction: Previous investigations have demonstrated that major depression is associated with particular patterns of cytokine signalling. The primary aim of this study was to examine peripheral pro-inflammatory and anti-inflammatory cytokines and immune balance in Generalised Anxiety Disorder (GAD). Methods: A case-controlled cross-sectional study design was employed: 54 patients with GAD and 64 healthy controls were recruited. Participants completed self-report measures of anxiety and depression. Two pro-inflammatory and two anti-inflammatory cytokines were measured using multiplex technology. Results: Case-control logistic regression analyses revealed significant differences in serum levels of IL-10, TNF-α, and IFN-γ between GAD and control groups after adjusting for age, gender, body mass index, smoking and alcohol consumption: these group differences were independent of the presence or degree of depression. Comparison of pro-inflammatory to anti-inflammatory cytokine ratios indicated that there were significantly higher ratios of TNF-α/IL10, TNF-α/IL4, IFN-γ/IL10, and IFN-γ/IL4 in the GAD group compared to the control group. Conclusions: This study is the first to investigate both pro- and anti-inflammatory cytokines and their balance in patients with GAD in comparison to healthy controls. The findings indicate a relatively increased pro-inflammatory response and decreased anti-inflammatory response and provide the first demonstration of an altered cytokine balance in GAD. Serum cytokine levels in GAD were independent of the presence of depression. [ABSTRACT FROM AUTHOR]

Background: Generalised anxiety disorder (GAD) is an anxiety disorder characterised by excessive anxiety and worry. Worry is seen as a key‐defining feature of GAD. Several cognitive‐behavioural models of working with worry in GAD exist. More recently, there have been efforts to adapt emotion‐focused therapy (EFT) for GAD. This study focused on task analysis, observing therapist and client processes (using qualitative observations as well as observer‐used measures) in the clinically developed, two‐chair dialogue for worry (an intervention inspired by a similar EFT task of working with self‐criticism in depression). Method: A task analysis methodological approach was applied to 34 worry dialogues from eight clients. The worry dialogues were qualitatively analysed, focusing on therapist and client processes in the task and also using observer‐based measures such as Classification of Affective‐Meaning States, Client Emotion Arousal Scale and Client Emotion Productivity Scale. Results: A tentative model of worry transformation using the two‐chair dialogue for worry is presented. The model consists of marker identification, enactment of the worry, deepening the toll of the worry, articulation of the need towards the worry and the worry softening or the client's standing up to the worry. The results also focus on the progression in the dialogues across the series of dialogues. Implications: The model has an immediate practical application as it can inform therapists' actions when working with worry processes in GAD clients. Implications for future research are also discussed. A video abstract of this article can be viewed at: https://vimeo.com/182527407 [ABSTRACT FROM AUTHOR]

Excessive and uncontrollable worry is a defining feature of Generalized Anxiety Disorder. An important endeavor in the treatment of pathological worry is to understand why some people are unable to stop worrying once they have started. Worry perseveration is associated with a tendency to deploy goal-directed worry rules (known as ‘as many as can’ worry rules; AMA). These require attention to the goal of the worry task and continuation of worry until the aims of the ‘worry bout’ are achieved. This study examined the association between the tendency to use AMA worry rules and neural and autonomic responses to a perseverative cognition induction. To differentiate processes underlying AMA worry rule use from trait worry, we also examined the relationship between scores on the Penn State Worry Questionnaire and neural and autonomic responses following the same induction. We used resting-state functional magnetic resonance brain imaging while measuring emotional bodily arousal from heart rate variability (where decreased HRV indicates stress-related parasympathetic withdrawal) in 19 patients with GAD and 21 control participants. Seed-based analyses were conducted to quantify brain changes in functional connectivity with the amygdala. The tendency to adopt an AMA worry rule was associated with validated measures of worry, anxiety, depression, and rumination. AMA worry rule endorsement predicted a stronger decrease in HRV and was positively associated with increased connectivity between right amygdala and locus coeruleus, a brainstem noradrenergic projection nucleus. Higher AMA scores were also associated with increased connectivity between amygdala and rostral superior frontal gyrus. Higher PSWQ scores amplified decreases in functional connectivity between right amygdala and subcallosal cortex, bilateral inferior frontal gyrus, middle frontal gyrus, and areas of parietal cortex. Our results identify neural mechanisms underlying the deployment of AMA worry rules. We propose that the relationship between AMA worry rules and increased connectivity between the amygdala and prefrontal cortex represents attempts by high worriers to maintain arousal and distress levels in order to feel prepared for future threats. Furthermore, we suggest that neural mechanisms associated with the PSWQ represent effortful inhibitory control during worry. These findings provide unique information about the neurobiological processes that underpin worry perseveration.

The role of the father in generalised anxiety disorder While the behavioural sciences have done much research on generalised anxiety disorder (GAD), a justifiable pastoral therapeutic approach, combined with unique etiological insights into a therapy for the individual who suffers from it, is needed. In this study the correlation between the individual’s father image and her/his image of God, as well as its influence on the development of GAD is researched. The correlation between father- and God images and the symptomatology of GAD are graphically indicated. It highlights the phenomenon that a negative father image, which leads to a distortion of the individual’s image of God, results in existential insecurity. This deprivation of security is identified as a causal factor for GAD. Some suggestions concerning pastoral therapy to people suffering from GAD are offered.

Few studies have examined potential differences between social anxiety disorder (SAD) and generalised anxiety disorder (GAD) in the sensitivity to detect emotional expressions. The present study aims to compare the detection of emotional expressions in SAD and GAD. Participants with a primary diagnosis of GAD (n = 46), SAD (n = 70), and controls (n = 118) completed a morph movies task. The task presented faces expressing increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expressions. Participants used a slide bar to view the movie frames from left to right, and to stop at the first frame where they perceived an emotion. The frame selected thus indicated the intensity of emotion required to identify the facial expression. Participants with GAD detected the onset of facial emotions at lower intensity of emotion than participants with SAD (p = 0.002) and controls (p = 0.039). In a multiple regression analysis controlling for age, race, and depressive symptom severity, lower frame at which the emotion was detected was independently associated and GAD diagnosis (B = –5.73, SE = 1.74,p < 0.01). Our findings suggest that individuals with GAD exhibit enhanced detection of facial emotions compared to those with SAD or controls. [ABSTRACT FROM AUTHOR]

Background: Rett Syndrome (RTT), caused by a loss-of-function in the epigenetic modulator: X-linked methyl-CpG binding protein 2 (MeCP2), is a pervasive neurological disorder characterized by compromised brain functions, anxiety, severe mental retardation, language and learning disabilities, repetitive stereotyped hand movements and developmental regression. An imbalance in the sympathetic and the parasympathetic nervous system (dysautonomia) and the resulting autonomic storms is a frequent occurrence in patients with RTT. The prototypical beta blocker propranolol has been used to manage sympathetic hyperactivity in patients with RTT. Case presentation: A 13 year old girl with RTT was referred to the Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust. Her clinical picture included disordered breathing with concomitant hyperventilation and apnoea, epilepsy, scoliosis, no QT prolongation (QT/QTc [372/467 ms on automated electrocardiogram [ECG], but manually calculated to be 440 ms]), no cardiac abnormalities (PR interval: 104 ms, QRS duration: 78 ms), and generalised anxiety disorder (ICD-10-CM Diagnosis Code F41.1). She was also constipated and was fed via percutaneous endoscopic gastrostomy (PEG). To manage the dysautonomia, propranolol was given (5 mg and 10 mg) and in parallel her physiological parameters, including heart rate, skin temperature and skin transpiration, were monitored continuously for 24 h as she went about her activities of daily living. Whilst her skin temperature increased and skin transpiration decreased, unexpectedly there was a significant paradoxical increase in the patient's average heart rate following propranolol treatment. Conclusion: Here, we present a unique case of a paradoxical increase in heart rate response following propranolol treatment for managing dysautonomia in a child with RTT. Further studies are warranted to better understand the underlying dysautonomia in patients with RTT and the impact this might have on treatment strategies in rare disorders such as RTT. [ABSTRACT FROM AUTHOR]

Objective Studies have only recently begun to explore the role of interpersonal factors in relation to anxiety sensitivity, a trait that has been hypothesised as a risk factor for the development of anxiety disorders. Therefore, the goal of this research was to further investigate the relations between anxiety sensitivity, worry, generalised anxiety disorder symptoms, and parent and peer attachment, more specifically-perceived parent and peer alienation on a clinical sample for the first time. The mediating role of anxiety sensitivity between perceptions of alienation and current worry and generalised anxiety disorder symptoms was also examined. Methods Analyses were conducted on a total sample of 72 psychiatric patients with diagnosed anxiety or depression disorder, who completed the Generalized Anxiety Disorder Questionnaire- IV, Penn State Worry Questionnaire, Inventory of Parent and Peer Attachment, and Anxiety Sensitivity Index. All patients were Caucasian, and 48.6% of participants were men ( Mage = 44.2 years) and 51.2% were women ( Mage = 41.1 years). Results Participants with higher intensity of worry and generalised anxiety disorder symptoms reported higher perceptions of being alienated only from their peers. Also, anxiety sensitivity mediated the relation between perceptions of alienation from peers and worry and generalised anxiety disorder symptoms. Conclusion Perceptions of peer rather than parent alienation appear to be a salient construct in relation to the present levels of anxiety sensitivity, uncontrollable worry, and generalised anxiety disorder symptoms in individuals with a diagnosis of mental illness. Implications for cognitive-behavioural therapy practitioners are also shortly discussed. [ABSTRACT FROM AUTHOR]

Objective: To analyse the utilization of health care services of people who tested positive for GAD compared to those who tested negative.Setting: A cross-sectional study from the Northern Finland 1966 Birth Cohort.Subjects: A total of 10,282 members followed from birth in a longitudinal study were asked to participate in a follow-up survey at the age of 46. As part of this survey they filled in questionnaries concerning health care utilization and their illness history as well as the GAD-7 screening tool. Althogether 5,480 cohort members responded to the questionnaries.Main outcome measures: Number of visits in different health care services among people who tested positive for GAD with the GAD-7 screening tool compared to those who tested negative.Results: People who tested positive for GAD had 112% more total health care visits, 74% more total physician visits, 115% more visits to health centres, 133% more health centre physician visits, 160% more visits to secondary care, and 775% more mental health care visits than those who tested negative.Conclusion: People with GAD symptoms utilize health care services more than other people.Key PointsGeneralised anxiety disorder (GAD) is a common but poorly identified mental health problem in primary care.People who tested positive for GAD utilise more health care services than those who tested negative.About 58% of people who tested positive for GAD had visited their primary care physician during the past year.Only 29% of people who tested positive for GAD had used mental health services during the past year. [ABSTRACT FROM PUBLISHER]

This article describes the conceptualisation and treatment, based on Wells' metacognitive model (2012), of a case of generalised anxiety disorder in a young woman of 18 years of age. The intervention comprised the Socratic dialogue, re-attribution, behavioural experiments and the Detached Mindfulness technique. The article also emphasises the most distinctive aspects of the therapeutic relationship. At the end of the treatment, the patient reported a remission of symptoms with major improvements and clear changes in metacognitive processing. The results were maintained at three and six months after the end of treatment and confirm the effectiveness of metacognitive therapy for generalised anxiety disorder. [ABSTRACT FROM AUTHOR]

Objective To systematically review the accuracy of the GAD-7 and GAD-2 questionnaires for identifying anxiety disorders. Methods A systematic review of the literature was conducted to identify studies that validated the GAD-7 or GAD-2 against a recognized gold standard diagnosis. Pooled estimates of diagnostic test accuracy were produced using random-effects bivariate metaanalysis. Heterogeneity was explored using the I 2 statistic. Results A total of 12 samples were identified involving 5223 participants; 11 samples provided data on the accuracy of the GAD-7 for identifying generalized anxiety disorder (GAD). Pooled sensitivity and specificity values appeared acceptable at a cutoff point of 8 [sensitivity: 0.83 (95% CI 0.71–0.91), specificity: 0.84 (95% CI 0.70–0.92)] although cutoff scores 7–10 also had similar pooled estimates of sensitivity/specificity. Six samples provided data on the accuracy of the GAD-2 for identifying GAD. Pooled sensitivity and specificity values appeared acceptable at a cutoff of 3 [sensitivity: 0.76 (95% CI 0.55–0.89), specificity: 0.81 (95% CI 0.60–0.92)]. Four studies looked at the accuracy of the questionnaires for identifying any anxiety disorder. Conclusions The GAD-7 had acceptable properties for identifying GAD at cutoff scores 7–10. The GAD-2 had acceptable properties for identifying GAD at a cutoff score of 3. Further validation studies are needed. [ABSTRACT FROM AUTHOR]

Background: Intolerance of uncertainty (IU), negative beliefs about worry (NBW), positive beliefs about worry (PBW), negative problem orientation (NPO) and cognitive avoidance (CA) have been found to be integral in the conceptualisation of Generalised Anxiety Disorder (GAD) in adults, yet they have rarely been investigated in children with GAD. This study sought to determine (a) whether IU, NBW, PBW, NPO and CA differ between children diagnosed with GAD and non-anxious children and (b) to examine whether IU, NBW, PBW, NPO and CA differ between parents of children diagnosed with GAD and parents of children without an anxiety disorder.Methods: Participants were 50 children (aged 7-12 years), plus one of their parents. The 25 GAD children and 25 non-anxious children were matched on age and gender. Parents and children completed clinical diagnostic interviews, as well as a battery of questionnaires measuring worry, IU, NBW, PBW, NPO and CA.Results: Children with GAD endorsed significantly higher levels of worry, IU, NBW, NPO and CA, but not PBW compared to non-anxious children. Parents of children with GAD did not differ from parents of non-anxious children on any of the variables.Limitations: The study was limited by it's use of modified adult measures for some variables and a lack of heterogeneity in the sample.Conclusions: The cognitive variables of IU, NBW, NPO and CA may also be important in the conceptualisation and treatment of GAD in children as they are in adults. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether personality disorders were associated with later Major Depressive Disorder (MDD) or Generalised Anxiety Disorder (GAD) in breast cancer patients. This longitudinal and multicentric study included 120 French non-metastatic breast cancer patients. After cancer diagnosis (T1) and 7 months after diagnosis (T3), we assessed MDD and GAD (Mini International Neuropsychiatric Interview 5.0). We assessed personality disorders 3 months after diagnosis (VKP). We used multiple logistic regression analysis to determine what were the factors associated with GAD and MDD at T3. At T3, prevalence rate was 10.8% for MDD and 19.2% for GAD. GAD at T3 was significantly and independently associated with GAD at T1 and with existence of a personality disorder, no matter the cluster type. MDD at T3 was significantly and independently associated with MDD at T1 and with the existence of a cluster C personality disorder. Initial cancer severity and the type of treatment used were not associated with GAD or MDD at T3. Breast cancer patients with personality disorders are at higher risk for GAD and MDD at the end of treatment. Patients with GAD should be screened for personality disorders. Specific interventions for patients with personality disorders could prevent psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: Anxiety and related disorders include generalised anxiety disorder, obsessive–compulsive disorder, panic disorder, post-traumatic stress disorder and phobic disorders (intense fear of an object or situation). These disorders share the psychological and physical symptoms of anxiety, but each disorder has its own set of characteristic symptoms. Anxiety disorders can be difficult to recognise, particularly in older people (those aged over 65 years). Older people tend to be more reluctant to discuss mental health issues and there is the perception that older people are generally more worried than younger adults. It is estimated that between 3 and 14 out of every 100 older people have an anxiety disorder. Despite treatment, some people will continue to have symptoms of anxiety. People are generally considered to be ‘resistant’ or ‘refractory’ to treatment if they have an inadequate response or do not respond to their first treatment. Older adults with an anxiety disorder find it difficult to manage their day-to-day lives and are at an increased risk of comorbid depression, falls, physical and functional disability, and loneliness. Objective: To evaluate the effectiveness of pharmacological, psychological and alternative therapies in older adults with an anxiety disorder who have not responded, or have responded inadequately, to treatment. Data sources: Electronic databases (MEDLINE, MEDLINE In-Process and Other Non-Indexed citations, EMBASE, The Cochrane Library databases, PsycINFO and Web of Science) were searched from inception to September 2013. Bibliographies of relevant systematic reviews were hand-searched to identify additional potentially relevant studies. ClinicalTrials.gov was searched for ongoing and planned studies. Review methods: A systematic review of the clinical effectiveness of treatments for treatment-resistant anxiety in older adults was carried out. Results: No randomised controlled trial or prospective comparative observational study was identified meeting the prespecified inclusion criteria. Therefore, it was not possible to draw any conclusions on clinical effectiveness. Limitations: As no study was identified in older adults, there is uncertainty as to which treatments are clinically effective for older adults with an anxiety disorder who have not responded to prior treatment. The comprehensive methods implemented to carry out this review are a key strength of the research presented. However, this review highlights the extreme lack of research in this area, identifying no comparative studies, which is a marked limitation. Conclusions: Specific studies evaluating interventions in older adults with an anxiety disorder who have not responded to first-line treatment are needed to address the lack of evidence. The lack of evidence in this area means that older adults are perhaps receiving inappropriate treatment or are not receiving a particular treatment because there is limited evidence to support its use. At this time there is scope to develop guidance on service provision and, as a consequence, to advance the standard of care received by older adults with a treatment-resistant anxiety disorder in primary and secondary care. Evaluation of the relative clinical effectiveness and acceptability of pharmacological and psychological treatment in older adults with an anxiety disorder that has not responded to first-line treatment is key future research to inform decision-making of clinicians and patients. An important consideration would be the enrolment of older adults who would be representative of older adults in general, i.e. those with multiple comorbid physical and mental disorders who might require polypharmacy. Study registration: The protocol for the systematic review is registered on PROSPERO (registration number CRD42013005612). Funding: The National Institute for Health Research Health Technology Assessment programme.

This article appraises the ability of several measures, assessing symptomatology theoretically relevant to generalised anxiety disorder (GAD), to accomplish successful classification of individuals with DSM-IV GAD and individuals with mood or other anxiety disorders. Participants were 197 individuals (average age = 36.43; 67.5% female) receiving treatment at a clinic, who completed pretreatment self-report measures. Receiver operator characteristic analyses and logistic regression analyses were employed to determine the classificatory abilities, including sensitivity and specificity, of several GAD relevant measures. The Penn State Worry Questionnaire (PSWQ) accomplished significant classification in both comparison group dyads: GAD-Anxiety and GAD-Mood. Whereas the general distress of depression subscale of the Mood and Anxiety Symptoms Questionnaire (MASQ) accomplished significant classification in the GAD-Anxiety group dyad, both the general distress of anxiety and anxious arousal subscales of the MASQ did so in the GAD-Mood group dyad. Only the PSWQ significantly predicted the presence of GAD, while controlling for other symptom variables. Though evidence supports the uniqueness of some symptoms of GAD, including worry, often considered pathognomonic to GAD, the modest areas under the curve, sensitivity, and specificity of the measures afford tenuous support for the utility of these measures. The lack of highly sensitive and specific symptomatology comport with critiques of GAD as a diagnostically delimited category. [ABSTRACT FROM AUTHOR]

In the current studies, we explore the relationship between anxiety / perceived stress and time perspectives. Study 1 tested the relationship between the dimensions of the Zimbardo Time Perspective Inventory (ZTPI) and anxiety in a male sample. Study 2 examined the relationship between time perspectives and perceived stress in a sample of students. Both studies considered the Deviation of the Balanced Time Perspective (DBTP). In Study 1 psychiatrists of the Mental Health Centre of the Armed Forces in Athens diagnosed generalised anxiety in a number of male participants of the overall sample ( n = 204). All participants completed a validated Greek translation of the ZTPI. In Study 2 a sample of students ( n = 71) of Panteion University completed the Greek translations of the ZTPI and the Perceived Stress Scale (PSS-14 items). In Study 1 a negative correlation between Future orientation and anxiety was found. The DBTP was higher in persons with anxiety. In Study 2 the Past Negative and Present Fatalistic orientations correlated with high-perceived stress as assumed. Furthermore, high-perceived stress was associated with a higher DBTP. The ZTPI is particularly important for the explanation of perceived stress. DBTP, Past Negative and Present Fatalistic perspectives are important factors of influence. The measurement of anxiety should be re-examined. [ABSTRACT FROM AUTHOR]

The aim of this review is to summarise the literature on the efficacy and safety of pregabalin for the treatment of generalised anxiety disorder (GAD). Of 241 literature citations, 13 clinical trials were identified that were specifically designed to evaluate the efficacy and safety of pregabalin in GAD, including 11 randomised double-blind trials and two open-label studies. Pregabalin efficacy has been consistently demonstrated across the licensed dose range of 150-600 mg/day. Efficacy has been reported for pregabalin monotherapy in elderly patients with GAD, patients with severe anxiety, and for adjunctive therapy when added to a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor in patients who have failed to respond to an initial course of antidepressant therapy. The two most common adverse events with pregabalin are somnolence and dizziness, both of which appear to be dose-related. Pregabalin appears to have a low potential for causing withdrawal symptoms when long-term therapy is discontinued; however, tapering over the course of at least one week is recommended. A review of available evidence indicates that pregabalin is a well-tolerated and consistently effective treatment for GAD, with a unique mechanism of action that makes it a useful addition to the therapeutic armamentarium. [ABSTRACT FROM AUTHOR]

The metacognitive model and therapy has proven to be a promising theory and intervention for emotional disorders in adults. The model has also received empirical support in normal and clinical child samples. The purpose of the present study was to adapt metacognitive therapy to children (MCT-c) with generalised anxiety disorder (GAD) and create suggestions for an adapted manual. The adaptation was based on the structure and techniques used in MCT for adults with GAD. However, the developmental limitations of children were taken into account. For instance, therapy was aided with worksheets, practical exercises and delivered in a group format. Overall, the intervention relied heavily on practising MCT techniques in vivo with therapist assistance. A detailed description of how the manual was adapted for this age group is given, and examples from a group of four children are presented in a case series. Findings indicate that the adapted version of the metacognitive techniques and manual for children is feasible. [ABSTRACT FROM AUTHOR]

Objective: This article provides a brief review of the practical implications of the current diagnostic conceptualisation of generalised anxiety disorder (GAD) and an update on its pharmacotherapy. Conclusions: The diagnostic criteria for GAD need to be refined, to better reflect its clinical features and to make GAD more clinically useful. Various pharmacological agents are effective for GAD and to some extent, allow a tailored treatment approach. In addition to effectiveness, the choice of medication is influenced by the speed of therapeutic action, tolerability and habit-forming properties. [ABSTRACT FROM AUTHOR]

The tendency to draw negative conclusions from ambiguous information (interpretation bias) is prevalent across emotional disorders and plays a key role in the development and maintenance of pathological worry and anxious mood. Assessing interpretation bias using valid and reliable measures is central to empirical research. A commonly used measure of interpretation bias is the scrambled sentences test (SST), originally relating to depression. Given the association between interpretation bias and worry, we aimed to develop and psychometrically evaluate a new version of the SST with items pertaining to common worry domains for use in worry and anxiety research. In Studies 1–3 (analogue samples, combined N = 288), the new worry SST showed excellent construct validity (moderate-to-strong associations with worry and anxiety-related measures), and reliability (split-half and test-retest reliability). We confirmed construct validity in Study 4 (N = 215 individuals with generalised anxiety disorder). Furthermore, we demonstrated version specificity in analogue and clinical samples: the worry SST was associated with trait worry but not trait rumination, while the original depression SST largely showed the opposite pattern. Overall, the new worry SST is a psychometrically robust measure that may be especially useful for research into cognitive processes underpinning worry and anxiety. • Worry is associated with a tendency to make negative interpretations. • Valid and reliable tools are needed to assess interpretations in relation to worry. • We created a scrambled sentences test (SST) version for worry and anxiety research. • Worry SST reliability (including 2-week test-retest reliability) was excellent. • Worry SST showed specificity: scores predicted trait worry but not trait rumination. [ABSTRACT FROM AUTHOR]

Cannabis use for medical and recreational purposes is increasing. Inhibitory activity of cannabinoids (CB) at the CB1 and CB2 receptors centrally and peripherally mediate the therapeutic effects that are wielded for palliation of pain, anxiety, inflammation, and nausea in indicated conditions. Cannabis dependence is also associated with anxiety; however, the direction of causality is unknown, such as whether anxiety disorders lead to cannabis use, or whether cannabis contributes to the development of anxiety disorder. The evidence hints that both may have validity. Here we present a case of cannabis-associated panic attacks following 10 years of chronic cannabis dependence in an individual with no prior psychiatric history. The patient is a 32-year-old male with no significant past medical history who presented complaining of five-minute episodes of palpitations, dyspnea, upper extremity paresthesia, subjective tachycardia, and cold diaphoresis occurring in a variety of circumstances for the past two years. His social history was significant for 10 years of smoking marijuana multiple times daily, which he had quit over two years ago. The patient denied past psychiatric history or known anxiety problems. Symptoms were unrelated to activity and only relieved with deep breathing. The episodes were not associated with chest pain, syncope, headache, or emotional triggers. The patient had no family history of cardiac disease or sudden death. The episodes were refractory to the elimination of caffeine, alcohol, or other sugary beverages. The patient had already stopped smoking marijuana when the episodes began. Due to the unpredictable nature of the episodes, the patient reported a growing fear of being in public. On laboratory workup, metabolic and blood panels were within normal limits, as well as thyroid studies. Electrocardiogram showed normal sinus rhythm, and continuous cardiac monitoring revealed no arrhythmias or abnormalities despite the patient indicating multiple triggered events within the duration of monitoring. Echocardiography also showed no abnormalities. With organic cardiac causes of the subjective palpitation episodes ruled out, a psychogenic etiology of the episodes was presumed, and the patient was referred to behavioral health services. In conclusion, cannabis-induced anxiety or panic disorders should be considered in patients with no prior psychiatric history presenting with anxiety-like attacks following a period of cannabis dependence or current use. These patients should be advised to cease cannabis use and referred to behavioral medicine., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Johnson et al.)

Background We aimed to assess available evidence on risk factors associated with the onset of panic disorder (PD) and/or generalised anxiety disorder (GAD) in cohort studies in the general adult population. Methods Systematic review using MEDLINE, PsycINFO and Embase. Search terms included panic disorder, generalised anxiety disorder, cohort studies and risk factors. Results We finally selected 21 studies, involving 163,366 persons with a median follow-up of 5 years. 1) Sociodemographic factors: PD was associated with age, female gender, and few economic resources. GAD was associated with age, non-Hispanics and Blacks, being divorced or widowed, and few economic resources. 2) Psychosocial factors: PD was associated with smoking and alcohol problems. GAD was associated with stressful life events in childhood and adulthood, and personality. 3) Physical and mental health factors: PD was associated with the number of physical diseases suffered and the joint hypermobility syndrome. PD was also associated with a parental history of mental disorders, as well as with other anxiety disorders and other mental health problems in the person affected. GAD was associated with a parental history of mental disorders, as well as with other anxiety disorders and other mental health problems in the person affected, plus already having received psychiatric care. Limitations Few studies examined the same risk factors. Conclusions Sociodemographic, psychosocial and mental-physical health risk factors were determinant for the onset of PD and GAD in the general adult population. These findings could be useful for developing preventive interventions in PD and GAD. [ABSTRACT FROM AUTHOR]

The aim of this study was to provide a preliminary examination of a disorder-specific treatment program for children with generalised anxiety disorder (GAD) that employed strategies targeting underlying cognitive factors. Forty-two children with a primary diagnosis of GAD, aged between 7 and 12 years, were randomly assigned to either a treatment (TX) or waitlist (WLC) condition. Clinical diagnostic interviews as well as parent and child questionnaires were completed at pre- and post-assessment for both conditions, and at 3-month follow-up for the TX group. For the completer analyses at post-treatment, 52.9 % of children in the TX group (0% in the WLC group) were free of their primary GAD diagnosis. By 3-month follow-up, 100% of children in the TX group were free of their GAD diagnosis, 50% were free of all diagnoses. Overall, there is preliminary evidence that a disorder-specific treatment program for children with GAD is effective in treating this chronic and disabling disorder. [ABSTRACT FROM AUTHOR]

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees. [ABSTRACT FROM PUBLISHER]