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Generalised anxiety disorder (GAD) is a common psychiatric illness characterised by selective morpho-functional brain alterations. The breath of neuroimaging studies investigating the neural basis of GAD is extensive; however, its pathophysiology is still largely unknown. Specifically for proton Magnetic Resonance Spectroscopy (¹H MRS) investigations, which have the aim of identifying differences in metabolite levels between conditions in key brain areas, often showed contrasting results. Indeed, there are selected ¹H MRS studies reporting deficits of key metabolites in GAD patients; however, collectively the literature remains mixed with respect to consistency of major findings. In this review, we evaluate published ¹H MRS studies on GAD with the final aim of providing a comprehensive overview of the extent of neurometabolic dysfunctions associated with GAD. Interestingly, the majority of the studies reviewed showed altered metabolite levels in the dorsolateral prefrontal cortex and hippocampus suggesting regional specificity. These results also provide evidence of the utility of ¹H MRS not only for elucidating the pathophysiology of neuropsychiatric diseases, but also for the identification of more beneficial and targeted pharmacological interventions. Additionally, future studies are warranted to overcome methodological differences observed across the studies.

Subsequent to a randomised, double-blind, double dummy clinical trial assessing the efficacy of silexan compared to placebo and paroxetine in patients suffering from generalised anxiety disorder (GAD), a 1week follow-up phase was added in order to assess possible withdrawal symptoms of silexan after abrupt discontinuation.Participants received silexan 80 mg/d, silexan 160 mg/d, paroxetine 20 mg/d, or placebo at a ratio of 1:1:1:1. Study medication was discontinued after the 10 week active treatment phase of the original trial. Whereas paroxetine was tapered as indicated, silexan administration was discontinued abruptly. Assessment of possible withdrawal effects was done using the Physician Withdrawal Checklist questionnaire (PWC-20).During the 1 week down-titration phase, mean total PWC-20 scores had reduced by 0.19 in placebo, 0.23 in silexan 80, 0.65 in silexan 160, and 0.51 in paroxetine. The median change in all four groups was 0.00. In none of the treatment groups withdrawal effects occurred after discontinuation.Values assessed for the silexan groups indicate the absence of a dependency potential of this preparation.

Title: Exploring the effects of yoga for generalised anxiety disorder (GAD), with or without comorbidity: A systematic review of randomised and non-randomised controlled trials. Background: Yoga is a philosophical system and a spiritual practice originating from a five-thousand-year-old Eastern discipline and is recommended as a therapy for a variety of medical conditions. Given the high prevalence of GAD and the deleterious consequences it has on the patient, effective treatments are considered crucial. Objective: To systematically assess and meta-analyse the effects of yoga interventions in reducing anxiety in patients with GAD. Research question: How may yoga alleviate anxiety amongst patients with GAD, with or without comorbidities? Methods: A comprehensive systematic literature search was completed using search engine databases, including MedLine® ovid and PsycINFO® ovid during a period from September 2019 to April 2020. Risk of bias was assessed using adapted versions of the Cochrane Collaboration tools. A meta-analysis was conducted using the random-effect model to obtain standardised mean differences with 95 % confidence intervals. Results: Of 565 studies identified through the literature search, four studies met inclusion criteria (N = 704). All studies were assessed at serious risk of bias. Except for one study (Chad-Friedman et al., 2019), all reported significant results favouring the yoga intervention. A meta-analysis revealed evidence for large short-term effects of yoga on anxiety compared with treatment-as-usual and wait-list control (SMD = -0.92, 95 % CI = -1.28, -0.56, p < 0.001). Results suggest that yoga reduces anxiety symptoms for GAD patients. Conclusion: The limited number of included studies and their low methodological quality prevents any firm conclusions from being drawn. High-quality studies are required to determine the effect of yoga on GAD.

Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative. Key learning aims (1) To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service. (2) To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions. (3) To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.

Background: General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients providing evidence-based treatment recommendations and fortnightly monitoring of symptom progress. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices among GPs, practice staff, and youth patients. Methods: A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14-17 years who visited their participating GP during the screening period alongside their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who were experiencing symptoms and were not currently visiting their GP, nor had previously sought help for mental health issues. Feasibility and acceptability of the service among GPs, practice staff, and youth patients was assessed using a battery of questionnaires. Results: Five GPs and 6 practice staff participated in the trial. A total of 46 youth patients were approached and 28 consented to participate. Of these, 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service, and that they would use it again. Youth patients also reported the service was easy to understand and didn’t cause distress. Conclusions: Although young people account for a small proportion of patients visiting their GP, the Youth StepCare service appears to be a useful tool for identifying youth with undeclared symptoms which can be easily embedded into general practice. Further research would benefit from exploring reasons for lower GP uptake and a larger trial is required to determine the efficacy of the service on symptom reduction.

Music performance anxiety (MPA) is considered a social anxiety disorder (SAD). Recent conceptualisations, however, challenge existing MPA definitions, distinguishing MPA from SAD. In this study, we aim to provide a systematic analysis of MPA interdependencies to other anxiety disorders through graphical modeling and cluster analysis. Participants were 82 music students (Mage=23.5 years, SD=3.4; 69.5% women) with the majority being vocal (30.5%), string (24.4%) or piano (19.5%) students. MPA was measured using the German version of the Kenny Music Performance Anxiety Inventory (K-MPAI). All participants were tested for anxiety-related symptoms using the disorder-specific anxiety measures of the DSM-5, including agoraphobia (AG), generalised anxiety disorder (GAD), panic disorder (PD), separation anxiety disorder (SEP), specific phobia (SP), social anxiety disorder (SAD) and illness anxiety disorder (ILL). We found no evidence of MPA being primarily connected to SAD, finding GAD acted as a full mediator between MPA and any other anxiety type. Our graphical model remained unchanged considering severe cases of MPA only (K-MPAI≥105). By means of cluster analysis, we identified two participant sub-groups of differing anxiety profiles. Participants with pathological anxiety consistently showed more severe MPA. Our findings suggest that GAD is the strongest predictor for MPA amongst all major DSM-5 anxiety types.

Aims and methodWe evaluated routine use, acceptability and response rates for the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Scale (GAD-7) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) within adult community mental health teams. Measures were repeated 3 months later. Professionals recorded the setting, refusal rates and cluster diagnosis.ResultsA total of 245 patients completed 674 measures, demonstrating good initial return rates (81%), excellent scale completion (98–99%) and infrequent refusal/unsuitability (11%). Only 32 (13%) returned follow-up measures. Significant improvements occurred in functioning (P = 0.01), PHQ-9 (P = 0.02) and GAD-7 (P = 0.003) scores (Cohen's d = 0.52–0.77) but not in SWEMWBS (P = 0.91) scores. Supercluster A had higher initial PHQ-9 and GAD-7 scores (P < 0.001) and lower SWEMWBS scores (P = 0.003) than supercluster B. Supercluster C showed the greatest functional impairment (P = 0.003).Clinical implicationsPHQ-9 and GAD-7 appear acceptable as patient-reported outcome measures in community mental health team. SWEMWBS seems insensitive to change. National outcome programmes should ensure good follow-up rates.

We investigated the association between cognitive control and individual differences in cortisol response to stress in participants with generalised anxiety disorder (GAD) and in never-disordered controls (CTL). To assess cognitive control, participants completed an affective version of the reading span task, which measures working memory capacity (WMC) in the presence of negative and neutral distractors. Participants then completed a standard psychosocial stressor and provided salivary cortisol samples throughout. The relation between WMC and cortisol response to stress was dependent on diagnostic group and distractor valence. Within the GAD group, greater WMC in the presence of neutral distractors was associated with attenuated cortisol response to stress, and greater WMC in the presence of negative distractors was associated with faster cortisol recovery from stress. In contrast, within the CTL group, WMC was unrelated to cortisol stress reactivity or recovery.

The Generalised Anxiety Disorder-7 (GAD-7) is a self-report scale used to assess general anxiety symptoms. Although the GAD-7 has been found to be a valid scale among adults, studies examining its psychometric properties among adolescents in high-income countries are notably limited and particularly non-existent in low- and middle-income countries. The current study addresses this lacuna by investigating the factorial validity, construct validity, internal consistency and discriminant accuracy of the GAD-7. Data were collected from 553 adolescents (boys = 231; average age = 16.85) recruited from a senior high school in Ghana, a sub-Saharan African country, using cross-sectional self-report methodology. The result supports a unidimensional structure of the GAD-7 that was invariant across gender. The GAD-7 correlates significantly with measures of anxiety, suicidal tendencies and mental well-being, suggesting construct validity. The internal consistency of the GAD-7, based on the mean inter-item correlation value of 0.24 and Cronbach’s a = 0.69, is adequate. The GAD-7 similarly discriminated between individuals at high risk of suicidal tendencies and depression from those with low or no risk, with area under curve values of 0.71 and 0.70, respectively. The GAD-7 is a reliable and valid measure to screen for generalised anxiety disorder among adolescents in Ghana.

© 2019 Elsevier B.V. Background: Cranial electrotherapy stimulation (CES) is a well-tolerated neuromodulation treatment with demonstrated trial efficacy in anxiety disorders. The aim of the current study was to demonstrate its clinical and cost effectiveness during and after CES in people with generalised anxiety disorder (GAD) who had not responded to low intensity psychological treatment in a routine health service. Methods: Consecutive sample of eligible patients with GAD waiting for individual cognitive behaviour therapy (CBT) selected from two publicly funded services in England. They received 60 min per day Alpha-Stim CES for 6–12 weeks. Primary outcome was remission on the GAD-7 scale at 12 and 24 weeks. Cost effectiveness was examined using a cost minimisation model of direct health costs. Results: Of 161 patients recruited, 72 (44.7%) and 77 (47.8%) achieved remission on the GAD-7 at 12 and 24 weeks respectively with 122 (75.8%) receiving at least 6 weeks CES. Mean (sd) GAD-7 score at baseline significantly improved from 15.77 (3.21) to 8.92 (5.42) and 8.99 (6.18) at 12 and 24 weeks respectively (p < 0.001). 80 (49.7%) participants required further individual CBT. CES provided a saving of £540.88 per patient (95% CI −£327.12, £648.69). Limitations: Participants were not randomised and there was no control group. Only 48 (29.9%) participants completed every assessment. Conclusion: In patients with generalised anxiety disorder not responding to low intensity psychological treatment, 6–12 weeks daily Alpha Stim CES may be effective after treatment and 3 months later, thereby reducing the need for individual CBT and saving health costs.

Background Poor recruitment is the most common reason for premature discontinuation of randomised controlled trials (RCTs). An RCT of medication versus psychological therapy for generalised anxiety disorder (GAD) was discontinued prematurely by the UK National Institute of Health Research funders because of recruitment failure. In order to inform future research studies, this article explores the reasons for poor recruitment and aspects which could have been improved. Methods The trial recruited participants via psychological well-being practitioners (PWPs) employed within local Improving Assess to Psychological Therapies (IAPT) services at four sites in England. For this study, we initially examined the recruitment data to identify reasons why potential participants were reluctant to participate in the trial. We then investigated reasons the PWPs did not identify more potential participants. Finally, we performed retrospective analyses of a computerised clinical records system used by the IAPT services in this study. These analyses aimed to establish the number of potential participants who had not been approached about the trial as well as whether there were additional factors affecting the numbers of people who might be eligible to take part. Data were obtained for all patients assessed during the period from the date on which recruitment commenced until the closure of the trial. Results Three quarters of those patients identified as possibly suitable for the trial declined to take part; the great majority did so because they did not want to be randomly assigned to receive medication. Our retrospective database analyses showed that only around 12% of potentially eligible patients for the trial were identified by the PWPs at the pilot sites. The results also indicated that only 5% of those noted at entry to the IAPT services to have a score of at least 10 on the GAD-7 questionnaire (a self-completed questionnaire with high sensitivity and specificity for GAD) would have been eligible for the trial. Conclusions Our findings suggest that poor recruitment to RCTs can be significantly affected by participants’ treatment preferences and by factors influencing the recruiting clinicians. It may also be important not to include too many restrictions on inclusion criteria for pragmatic trials aiming for generalisable results. Trial registration ISCRTN14845583. Registration date: 5 February 2015.

Background Generalised anxiety disorder (GAD) is a frequent and severe anxiety disorder among older adults. GAD increases the risk of developing other disorders such as depression and coronary heart disease. Older adults with GAD exhibit a poorer response to cognitive behaviour therapy (CBT) compared to younger patients with GAD. The normal age-related cognitive decline can be a contributor to reduced treatment efficacy. One strategy for improving treatment efficacy is to combine CBT with adjunctive interventions targeted at improving cognitive functions. Physical exercise is a viable intervention in this regard. Increased levels of brain-derived neurotrophic factor may mediate improvement in cognitive function. The present study aims to investigate the proposed effects and mechanisms related to concomitant physical exercise. Methods The sample comprises 70 participants aged 60–75 years, who have GAD. Exclusion criteria comprise substance abuse and unstable medication; inability to participate in physical exercise; and conditions which precludes GAD as primary diagnosis. The interventions are individual treatment in the outpatient clinic at the local psychiatric hospital, with two experimental arms: (1) CBT + physical exercise and (2) CBT + telephone calls. The primary outcome measure is symptom reduction on the Penn State Worry Questionnaire. Other measures include questionnaires, clinical interviews, physiological, biological and neuropsychological tests. A subset of 40 participants will undergo magnetic resonance imaging (MRI). After inclusion, participants undergo baseline testing, and are subsequently randomized to a treatment condition. Participants attend five sessions of the add-on treatment in the pre-treatment phase, and move on to interim testing. After interim testing, participants attend 10 sessions of CBT in parallel with continued add-on treatment. Participants are tested post-intervention within 2 weeks of completing treatment, with follow-up testing 6 and 12 months later. Discussion This study aims to develop better treatment for GAD in older adults. Enhancing treatment response will be valuable from both individual and societal perspectives, especially taking the aging of the general population into account. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Generalised Anxiety Disorder (GAD) can have a significant detrimental effect on the lives of sufferers. Research into the psychological process involved in worry has an important role in the prevention and treatment of problems such as GAD. Negative problem orientation (NPO) has been identified as an important psychological construct involved in worry (Gosselin, Ladouceur & Pelletier, 2005). The focus of this meta-analytic review was to further our understanding of the relationship between NPO and worry, and a related construct called intolerance of uncertainty (IU). The review identified 31 articles reporting correlations between measures of NPO and worry. These articles detailed a total of 33 independent effect sizes. Using a random-effects model and raw and attenuation-corrected values, NPO was found to be significantly correlated to worry (r = 0.57, CI = 0.55–0.60, k = 33, N = 5376). The type of NPO measure moderated the relationship between NPO and worry. In addition, NPO was found to be significantly correlated with IU (r= 0.71, CI = 0.69–0.73, k = 14, N = 3072) and more strongly correlated with IU than with worry (p

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.

The purpose of this study was to examine the role of anger in the relationships between various internalising symptoms and direct and indirect aggression. A sample of 241 adolescents aged 12–17 years completed the Screen for Child Anxiety Related Emotional Disorders, Centre for Epidemiological Studies Depression scale (CES-D) and the Buss–Warren Aggression Questionnaire (AQ-15). Symptoms of panic disorder, generalised anxiety disorder and depression, but not social phobia, were positively correlated with anger, direct aggression and indirect aggression. When considered simultaneously in regression analyses, only symptoms of depression contributed to variance in the anger and aggression variables. However, using indirect effect modelling, no direct relationships were found between the internalising symptom variables and the aggression variables. Instead, the data suggested that the relationship between internalising symptoms and aggression is mediated by the emotion of anger. These findings suggest that the degree to which anger co-occurs with internalising symptoms may play an important role in an individual’s propensity to engage in aggressive behaviour.

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 Points Generalised 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.

SummaryThe diagnosis of generalised anxiety disorder is a distraction of no value. It is highly unreliable, co-occurring with many other disorders of firmer diagnostic status, and has intrinsic connections to personality dysfunction. It is argued that classification would be heartily relieved to rid itself of this unnecessary appendage and for the symptom of anxiety to remain as a descriptive term only.Declaration of interestNone.

Generalised anxiety disorder (GAD) is one of the most common anxiety disorders, yet its mechanisms remain poorly understood. In the current study, we assessed threat processing and negative affect under conditions of uncertainty and ambiguity in a sample of treatment-seeking individuals with GAD (n = 34) and in community controls (n = 34). Participants completed a laboratory aversive learning task based on that used by Grupe and Nitschke (2011). A bias in threat expectancy was observed in GAD participants relative to controls for an ambiguous cue that had not been mentioned in the instructions. GAD participants also overestimated the number of times this ambiguous cue had been followed by an aversive outcome, relative to an instructed uncertain cue (50 %). This covariation bias was not observed in controls. GAD participants also reported significantly stronger negative affect towards the ambiguous cue than the uncertain cue, a pattern that was not observed in controls, although the group interaction did not reach significance. These results provide preliminary evidence that ambiguity - rather than uncertainty per se - may be a particularly powerful trigger for biased threat appraisal and negative affect in GAD.

Background: Routine anxiety screening is needed among HIV test seekers, given the lack of health-care professionals with the ability to identify individuals with generalised anxiety. Aim: The aim of this study was to determine the effectiveness of the Beck anxiety inventory (BAI) in predicting caseness for generalised anxiety disorder (GAD) among persons seeking HIV testing, using the structured clinical interview for the DSM-5 (SCID-5) as the gold standard. Setting: Five HIV testing sites in the Western Cape region of South Africa. Method: We recruited 500 persons seeking HIV testing from five non-medical testing sites in the Western Cape, South Africa. We used receiver operating curve analysis to determine the optimal cut-off point on the BAI to discriminate between GAD caseness and non-caseness. Results: 3.4% of the sample met the DSM-5 criteria for a diagnosis of GAD. Using an optimal cut-off point of 21.5, the sensitivity and specificity of the BAI were 82% and 80%, respectively. The positive predictive value was 13%, while the negative predictive value was 99%. Conclusion: Our data suggest that while the BAI may be used to screen for GAD, it is likely to yield a high number of false positives. A two-tiered method may be useful to mitigate against case over-identification. Thus, in a public health setting, persons screening positive on the BAI should receive a diagnostic interview to determine whether they are true cases for GAD. Within resource-constrained communities in South Africa, referral trajectories should be integrated with routine screening and HIV testing.

Introduction: Previous studies have shown anxiety and depression can contribute to poorer outcomes in asthma. Outpatients are monitored via the Asthma Control Questionnaire (ACQ-6) and the Asthma Quality of Life Questionnaire (mini-AQLQ). These do not specifically address anxiety or depression but anecdotal evidence suggests correlation between asthma control and these comorbidities. Aim: GAD and PHQ-9 seek to identify anxiety and depression respectively. We aimed to discover if the added use of these questionnaires would provide further information on the presence of these comorbidities. We hypothesised that ACQ-6 and AQLQ are predictive of GAD and PHQ-9 scores. Method: 300 patients attending asthma clinic completed ACQ-6, AQLQ, GAD and PHQ-9 questionnaires and scores were recorded. Data were analysed for correlation between ACQ-6 and AQLQ with PHQ-9 and GAD scores. ROC curves were generated comparing AQLQ and ACQ-6 with GAD to assess the sensitivity of this relationship. Results: Average ACQ-6 was 2.9 and AQLQ was 3.5. Average GAD score was 9.3 approaching the threshold for moderate anxiety. Average PHQ-9 was 10.8, over the limit for significant depression. This highlights the presence of these comorbidities in our asthmatics. Poorer ACQ-6 and AQLQ were associated with worse PHQ-9 (p Conclusions: Anxiety and depression are prevalent in our asthma patients. Adverse ACQ-6 and AQLQ scores are associated with the presence of anxiety and depression. This nullifies the need to burden patients with additional questionnaires to identify these conditions.

Background: Anxiety disorders are the most prevalent class of lifetime mental disorders according to South African research. However, little is known about the prevalence of factors that might complicate treatment among adults in a psychiatric outpatient setting. Aim: To explore the psychiatric comorbidities and psychosocial stressors among a population of adults treated for anxiety disorders at the outpatient unit of a tertiary psychiatric facility in Bloemfontein. Methods: In this retrospective cross-sectional study, clinical files of all mental healthcare users receiving treatment were reviewed to identify those with a current or previous diagnosis of one or more of the following anxiety disorders: generalised anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD) and agoraphobia. Results: Of the 650 available records, 103 (15.8%) included at least one anxiety disorder. Of those, 65.1% had GAD, 34.0% had panic disorder and 29.1% had SAD. Agoraphobia was diagnosed in 14.6% of patients almost exclusively as comorbid with panic disorder. Additional psychiatric disorders were present for 98.1% of patients and 36.9% had multiple anxiety disorders. The patients had a history of relational problems (64.1%), educational and occupational stressors (55.3%), abuse and neglect (28.2%), other problems related to the social environment (24.3%) and self-harm (23.3%). Conclusion: Clinical practice should take the high rates of comorbidity into account and the importance of integrated substance-related interventions in mental healthcare settings is clear. Diagnostic practices regarding agoraphobia without panic, and the comorbidity of anxiety and personality disorders should receive further attention. Clinicians should be aware of the potential impact of the frequently reported psychosocial stressors.

Objective: In this maintenance treatment study, we sought to evaluate the effect on anxiety ratings, safety and tolerability of 3 months of weekly ketamine in 20 patients with treatment-refractory DSM IV generalised anxiety disorder (GAD) and/or social anxiety disorder (SAD), and subsequent assessment of remission post-treatment. Methods: This was an uncontrolled open-label study in 20 patients who had been responders in an ascending dose ketamine study. The study was undertaken in a university clinic. Patients received one or two weekly ketamine doses of 1 mg/kg injected subcutaneously for 3 months. Data were collected from December 2015–June 2017. Results: There were 10 women (50%) and 10 men (50%); 15 patients (75%) met criteria for GAD and 18 (90%) for SAD. One hour after dosing, Fear Questionnaire ratings decreased by ~50%, as did Hamilton Anxiety ratings. Clinician Administered Dissociative States Scale mean scores declined over time, from 20 points at week 1 to 8.8 points at week 14. Compared with pre-dose values, mean systolic and diastolic blood pressure increased by ~10 mm Hg at 30 min. The most common adverse events were nausea, dizziness and blurred vision. Of the 20 patients, 18 reported improved social functioning and/or work functioning during maintenance treatment. Conclusions: Weekly ketamine dosing was safe and well tolerated, and post-dose dissociative symptoms tended to reduce after repeated dosing. Patients reported marked improvements in functionality and in their personal lives. Maintenance ketamine may be a therapeutic alternative for patients with treatment refractory GAD/SAD. Trial Registration: http://www.anzctr.org.au/ACTRN12615000617561

Background Generalised anxiety disorder (GAD) is a chronic and debilitating condition characterised by high co-morbidity. Alongside pharmacological treatment, cognitive behavioural therapy (CBT) is an established psychological therapy for GAD. Its effectiveness is limited, however, with only an estimated 50% of clients presenting in the non-clinical range after a course of treatment. Furthermore, not all clients prefer CBT as a psychological therapy. Recently, emotion-focused therapy (EFT) was developed for GAD and was tested in an open trial with promising results. Methods/design The present research project is a feasibility testing randomised controlled trial (RCT) that compares the efficacy of EFT with an established treatment for GAD, CBT. Sixty clients presenting in a primary care psychology/counselling service will be randomly assigned to one of two conditions: EFT or CBT. Outcomes will be assessed using several measures (Generalised Anxiety Disorder-7, Generalised Anxiety Disorder Severity Scale, Patient Health Questionnaire-9, and Clinical Outcome in Routine Evaluation – Outcome Measure). Clients will be assessed prior to and at the end of therapy, as well as at 6-month follow-up. On the basis of findings from the initial open EFT trial with regard to the optimal length of therapy, it is proposed that therapy last between 16 and 20 sessions. Discussion This study aims to test the feasibility of a full comparison RCT. It will test subject recruitment, therapist adherence to manualised treatment, and client retention rates. It will also provide estimates of comparative outcomes that can inform power calculations for a definitive trial. Trial registration ISRCTN Registry, ISRCTN52689081. Registered on 24 October 2017.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of antidepressants in GAD in adults, specifically: 1. to determine the efficacy of antidepressants in alleviating symptoms of GAD, in comparison to placebo; 2. to review the acceptability of antidepressants in GAD, by investigating the adverse effects, including the general prevalence of adverse effects, compared to placebo.

The ‘parent distortion’ hypothesis regarding assessment of a child’s anxiety state was examined in the mothers of 128 boys with an autism spectrum disorder. Mothers’ own generalised anxiety disorder (GAD) and their ratings of their sons’ GAD were compared with the boys’ self-ratings and the ratings of the boys given by a clinician. Boys’ cortisol concentrations were also explored for their association with these three sources of GAD ratings. Results indicated that mothers’ GAD was significantly and directly correlated with the ratings they gave for their sons’ but that only mothers who were above-minimally anxious gave ratings of their sons’ anxiety that significantly agreed with those from the clinicians. Minimally-anxious mothers appeared to underestimate their sons’ anxiety, and these effects generalised to their sons’ self-ratings of anxiety. Associations between the boys’ cortisol concentrations suggested an interaction between the presence of the diurnal fluctuation in boys’ cortisol concentrations and mothers’ anxiety states. 2015 Published by Elsevier Ltd.