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Introduction: Manual‐based treatments, such as cognitive behavioural therapy and metacognitive therapy, are effective for patients with generalised anxiety disorder (GAD), but no studies have examined non‐manualised clinically representative treatment for GAD. Methods: The sample consisted of 103 patients with GAD who completed non‐manualised eclectic outpatient treatment at a local psychiatric outpatient clinic from 2020 to 2023. Questionnaires before and after treatment measured GAD symptoms, depressive symptoms, functioning, health and treatment satisfaction. Results: There were significant improvements with large effect sizes (Cohen's d using pooled standard deviations) for GAD symptoms (d = 1.30, p <.001), depressive symptoms (d = 1.22, p <.001) and functioning (d = 0.87, p <.001). There was a medium improvement in health (d = −0.66, p <.001). Regarding GAD symptoms, half of the sample achieved clinically significant change (scoring below cut‐off at post‐treatment and achieving reliable improvement), and 69% showed reliable improvement (statistically significant change). Most patients (72%–84%) were satisfied with their treatment. Conclusion: Clinically representative treatment is associated with improvement in GAD, but the effect sizes were smaller than in manual‐based treatments. Research using randomised controlled trial designs comparing manual‐based treatment to clinically representative treatment is needed to establish relative efficacy and for refining treatment guidelines in Norway. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety disorders have a prevalence rate of 2.57% and significantly impact well-being and productivity. The course of anxiety disorders is characterised by fluctuating symptom severity, a high relapse rate, and chronicity. Patients with anxiety disorders are typically prescribed antidepressants or anti-anxiety medications, but these treatments often have limited long-term efficacy. Combining pharmacotherapy with non-pharmacological techniques, such as Progressive Muscle Relaxation (PMR), may enhance the effectiveness of treatment for anxiety disorders. Aim: To assess and compare the Hamilton Anxiety Rating Scale (HAM-A) scores at six-month between Group-E (who received Escitalopram exclusively) and Group-E+PMR (who received Escitalopram in addition to PMR). Additionally, the aim was also to compare the baseline HAM-A scores with those obtained after six months within each group. Materials and Methods: A randomised clinical study was conducted in the Department of Psychiatry at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, Punjab, India, from March 2020 to March 2021. The study was carried out following approval from the Institutional Ethics Committee (IEC). Participants were individuals aged 18 to 45 years who visited the Psychiatry Department's Outpatient Department (OPD) and met the ICD-10 criteria for Neurotic, stress-related, and somatoform disorders (F40-F48). One hundred and seventeen participants were randomly allocated to the two groups using a simple randomization method. Group-E received a daily dose of 10 mg Escitalopram for six months, while Group-E+PMR received the same dosage of Escitalopram along with Jacobson’s PMR exercises lasting 20 minutes, twice daily, at their place of residence. The HAM-A scale was employed to assess anxiety levels in both groups. Paired t-tests were conducted to compare pre- and post-treatment HAM-A scores within each group, while independent t-tests were used to compare scores between the groups. Statistical analysis was carried out using SPSS version 24.0 and a significance level of p

Numerous studies suggest that subjects suffering from a mental health condition before the COVID‐19 pandemic were at higher risk of contagion, but mostly are cross‐sectional or retrospective. The BIOVAL‐D‐COVID‐19 is a longitudinal cohort study design with 922 subjects who full filled two evaluations from an online survey of Spanish residents before and during the pandemic. Mental health conditions assessed were: Major Depressive Episode (MDE), Generalised Anxiety Disorder (GAD), Suicidal Thoughts and Behaviours (STB) and subthreshold of panic and bipolar disorder (BD). Mental health screening instruments used were: the Spanish version of the Composite International Diagnostic Interview (CIDI) version 3.0 for the evaluation of MDE, the GAD‐7 scale to evaluate GAD; STB was evaluated with four items from the CIDI questionnaire. Panic Disorder and BD were screened from a modified and self‐reported version of the CIDI. A bivariate plus five logistic regression models were developed for each mental health condition adjusted by socio‐demographic variables; employment status; general and physical health; comorbidity; and including all previous variables and the other mental health conditions. We found in bivariate model that MDE; GAD and STB were statistically significant risk factors of contagion of COVID‐19. The logistic regression models developed reveal that having a previous GAD (aOR 3.30 1.31–8.31) or STB (aOR 2.16 CI 95% 1.01–4.62) was statistically significant associated with COVID‐19 contagion, independently of all variables included. MDE was not a risk factor of contagion when it was adjusted by comorbidity (aOR 0.99 CI 95% 0.47–2.09). It is recommended to detect those subjects with previous GAD or STB as vulnerable groups of infection to reduce contagion rates. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety disorders have a prevalence rate of 2.57% and significantly impact well-being and productivity. The course of anxiety disorders is characterised by fluctuating symptom severity, a high relapse rate, and chronicity. Patients with anxiety disorders are typically prescribed antidepressants or anti-anxiety medications, but these treatments often have limited long-term efficacy. Combining pharmacotherapy with non-pharmacological techniques, such as Progressive Muscle Relaxation (PMR), may enhance the effectiveness of treatment for anxiety disorders. Aim: To assess and compare the Hamilton Anxiety Rating Scale (HAM-A) scores at six-month between Group-E (who received Escitalopram exclusively) and Group-E+PMR (who received Escitalopram in addition to PMR). Additionally, the aim was also to compare the baseline HAM-A scores with those obtained after six months within each group. Materials and Methods: A randomised clinical study was conducted in the Department of Psychiatry at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, Punjab, India, from March 2020 to March 2021. The study was carried out following approval from the Institutional Ethics Committee (IEC). Participants were individuals aged 18 to 45 years who visited the Psychiatry Department's Outpatient Department (OPD) and met the ICD-10 criteria for Neurotic, stress-related, and somatoform disorders (F40-F48). One hundred and seventeen participants were randomly allocated to the two groups using a simple randomization method. Group-E received a daily dose of 10 mg Escitalopram for six months, while Group-E+PMR received the same dosage of Escitalopram along with Jacobson's PMR exercises lasting 20 minutes, twice daily, at their place of residence. The HAM-A scale was employed to assess anxiety levels in both groups. Paired t-tests were conducted to compare pre- and post-treatment HAM-A scores within each group, while independent t-tests were used to compare scores between the groups. Statistical analysis was carried out using SPSS version 24.0 and a significance level of p<0.05 was adopted for the statistical assessments. Results: Both groups were comparable in terms of sociodemographic variables, mean age, and baseline HAM-A scores. The majority of participants, 70 (70%), were females. Significant improvements were noted in the HAM-A scores at six-month mark compared to baseline for both, Group-E and Group-E+PMR (p<0.001). Furthermore, Group-E+PMR exhibited a significant decrease in the HAM-A score at six months compared to Group-E (p<0.001), indicating more substantial improvements. Conclusion: Escitalopram and Escitalopram combined with PMR treatment effectively lowered anxiety. However, the incorporation of PMR Exercises alongside Escitalopram demonstrated more favourable outcomes in individuals with anxiety disorders. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Generalised anxiety disorder (GAD) is a frequent and severe disorder among older adults. For older adults with GAD the effect of the recommended treatment, cognitive behaviour therapy (CBT), is reduced. Physical exercise (PE) may enhance the effect of CBT by improving cognitive function and increasing levels of brain-derived neurotrophic factor (BDNF), a predictor of the effect of CBT in patients with anxiety. The aim of the study was to assess the feasibility of a randomized controlled trial (RCT) investigating treatment effect of the combination of CBT and PE for GAD in a sample of older adults, including procedures for assessment and treatment. METHODS: Four participants aged 62-70 years (M = 65.5, SD = 3.2) with a primary diagnosis of GAD were included. Participants received 15 weeks of PE in combination with 10 weeks of CBT. Participants completed self-report measures, and clinical, biological, physiological and neuropsychological tests at pre-, interim- and post-treatment. RESULTS: Procedures, protocols, and results are presented. One participant dropped out during treatment. For the three participants completing, the total adherence to PE and CBT was 80% and 100%, respectively. An independent assessor concluded that the completers no longer fulfilled the criteria for GAD after treatment. Changes in self-report measures suggest symptom reduction related to anxiety and worry. The sample is considered representative for the target population. CONCLUSIONS: The results indicate that combining CBT and PE for older adults with GAD is feasible, and that the procedures and tests are suitable and manageable for the current sample. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02690441. Registered on 24 February 2016, https://clinicaltrials.gov/ct2/show/NCT02690441 .

INTRODUCTION. Generalised anxiety disorder (GAD) is the least studied anxiety disorder, as patients present with comorbid mood disorders. Finding effective treatment methods for GAD is of the utmost importance; therefore, it is essential to develop novel medicinal products for GAD. Proper clinical programme design is key to obtaining reliable data on the effectiveness and safety of a medicinal product. Currently, the Russian Federation lacks methodological guidelines for clinical studies of these medcinal products, and there is a need for developing such guidelines.AIM. This review aimed to assess the possibility of applying the methodological approaches described in international guidelines to Russian clinical trials to develop medicinal products for GAD.DISCUSSION. Having analysed the main provisions of the Guideline on the clinical investigation of medicinal products indicated for generalised anxiety disorder by the European Medicines Agency (EMA), the authors of this review outlined the main stages of clinical development and the methodology for using clinical data to evaluate the safety and efficacy of medicinal products for GAD. Clinical development programmes for these medicinal products should take into account research staging and mandatory long-term safety and additive effect assessments. This review highlights aspects of selecting the design, population, and primary and secondary endpoints for a clinical trial. Particular attention is paid to the consideration of comorbidities in patients.CONCLUSION. The provisions set forth in the EMA guideline can inform the development of national guidelines for studying medicinal products for GAD.

Background: There is paucity of data regarding the prevalence of common mental disorders (CMDs) in people living with HIV (PLHIV) in Ekurhuleni Health District (EHD), South Africa. Also, there is an association between CMDs and poor HIV treatment outcomes. Guidelines therefore recommend that healthcare practitioners screen for CMDs in PLHIV. Aim: To determine the prevalence and correlates of CMDs in PLHIV in primary health care facilities in Ekurhuleni district. Setting: Seven primary health facilities in Ekurhuleni district. Methods: A cross-sectional study was conducted in which data were collected from 403 randomly selected participants, using a questionnaire that incorporated the scores of the Patient Health Questionnaire (PHQ)-9, generalised anxiety disorder (GAD)-7 and substance use disorder (SUD) criteria of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). The proportion screening positive for CMDs was calculated. ‘R’ statistical software was used for univariate and multivariate analysis, with a confidence interval (CI) of 95%. Results: Most participants (63%) were female and the mean age was 43 ± 11 years. Forty per cent of participants screened positive for CMDs, 16.6%, 15.1% and 24.1% screened positive for depression, GAD and SUD, respectively. Common mental disorders were associated with poor adherence and HIV non-suppression, while increasing age and being female were associated with reduced risk of CMDs. The risk of severe SUDs in males was 11 times compared to females. During assessment, clinicians screened only 16%, 14% and 40% of the cohort for depression, GAD and SUDs, respectively. Conclusion: The prevalence of CMDs remains high. Adherence to recommendations to screen for CMDs in PLHIV is low. Contribution: This study reveals a low CMD screening rate, estimates the prevalence of CMDs in PLHIV in Ekurhuleni district, and its impact.

Generalised anxiety disorder (GAD) is a highly prevalent, chronic and impairing disorder. The aim of this study was to qualitatively describe the transformation in emotional processing across 16 sessions of a successful emotion‐focused therapy (EFT) treatment for GAD. A theoretical framework derived from the EFT model of in‐session emotional transformation proposed by Pascual‐Leone and Greenberg was used as the basis for qualitative analysis. Additionally, the Classification of Affective Meaning States, the Client‐Expressed Arousal Scale‐III and the Client Emotional Productivity Scale‐Revised were utilised by observer–raters to classify moment‐by‐moment shifts in client affective‐meaning states, emotional arousal and emotional productivity. Results supported the emotion transformation model. The client presented in a state of poorly differentiated but highly aroused distress provoked by identifiable interpersonal and intrapersonal triggers. Emotional and behavioural avoidance provoked by fear of pain was evident. Accessing core pain and responding to attendant needs with compassion and protective anger was shown to facilitate the higher order emotional processing states of grief, relief and agency. Implications are proposed, including that addressing core emotional vulnerability may be a critical intervention in the successful treatment of GAD. [ABSTRACT FROM AUTHOR]

Introduction: Generalized anxiety disorder (GAD) is a chronic uncontrollable excessive anxiety towards a variety of topics. It is one of the most prevalent anxiety diseases, affecting approximately 6% worldwide. Virtual reality (VR) based interventions have received much attention from researchers for the management of mental health problems. This systematic review was conducted to assess the effects of immersive virtual reality techniques and non-immersive techniques in treating patients with GAD. Methods: An extensive systematic literature review was implemented, from inception up to 9 July 2021. Comparative clinical studies that assessed the outcomes of VRT in patients with GAD were included for meta-analysis. Single arm studies were included for systematic review only. Results: A total of six articles with 239 participants with GAD were included in systematic review. The mean age of the included participants ranged from 38.33 to 59.87 years. There was no statistically significant difference between VRT and control groups regarding the anxiety levels (SMD 0.01; 95%CI −0.52, 0.54; P = 0.97), mean depression scores (SMD 1.34; 95%CI −0.80, 3.49; P = 0.22), PSWQ (MD −4.26; 95%CI −10.93, 2.40; P = 0.21), and discomfort status (MD −1.41; 95%CI −3.86, 1.05; P = 0.22). Conclusions: VR improved relatively the manifestations of GAD, reflecting on the patient's quality of life. However, the existing evidence is inconclusive to support the superiority of VR as a substitute for traditional therapies. [ABSTRACT FROM AUTHOR]

Generalised Anxiety Disorder (GAD) is a prevalent, chronic mental health disorder. The measurement of regional brain gamma-aminobutyric acid (GABA) offers insight into its role in anxiety and is a potential biomarker for treatment response. Research literature suggests Piper methysticum (Kava) is efficacious as an anxiety treatment, but no study has assessed its effects on central GABA levels. This study investigated dorsal anterior cingulate (dACC) GABA levels in 37 adult participants with GAD. GABA was measured using proton magnetic resonance spectroscopy (1H-MRS) at baseline and following an eight-week administration of Kava (standardised to 120 mg kavalactones twice daily) (n = 20) or placebo (n = 17). This study was part of the Kava for the Treatment of GAD (KGAD; ClinicalTrials.gov: NCT02219880), a 16-week intervention study. Compared with the placebo group, the Kava group had a significant reduction in dACC GABA (p = 0.049) at eight weeks. Baseline anxiety scores on the HAM-A were positively correlated with GABA levels but were not significantly related to treatment. Central GABA reductions following Kava treatment may signal an inhibitory effect, which, if considered efficacious, suggests that GABA levels are modulated by Kava, independent of reported anxiety symptoms. dACC GABA patterns suggest a functional role of higher levels in clinical anxiety but warrants further research for symptom benefit. Findings suggest that dACC GABA levels previously un-examined in GAD could serve as a biomarker for diagnosis and treatment response. [ABSTRACT FROM AUTHOR]

Abstract Background Generalised anxiety disorder (GAD) is a frequent and severe disorder among older adults. For older adults with GAD the effect of the recommended treatment, cognitive behaviour therapy (CBT), is reduced. Physical exercise (PE) may enhance the effect of CBT by improving cognitive function and increasing levels of brain-derived neurotrophic factor (BDNF), a predictor of the effect of CBT in patients with anxiety. The aim of the study was to assess the feasibility of a randomized controlled trial (RCT) investigating treatment effect of the combination of CBT and PE for GAD in a sample of older adults, including procedures for assessment and treatment. Methods Four participants aged 62–70 years (M = 65.5, SD = 3.2) with a primary diagnosis of GAD were included. Participants received 15 weeks of PE in combination with 10 weeks of CBT. Participants completed self-report measures, and clinical, biological, physiological and neuropsychological tests at pre-, interim- and post-treatment. Results Procedures, protocols, and results are presented. One participant dropped out during treatment. For the three participants completing, the total adherence to PE and CBT was 80% and 100%, respectively. An independent assessor concluded that the completers no longer fulfilled the criteria for GAD after treatment. Changes in self-report measures suggest symptom reduction related to anxiety and worry. The sample is considered representative for the target population. Conclusions The results indicate that combining CBT and PE for older adults with GAD is feasible, and that the procedures and tests are suitable and manageable for the current sample. Trial registration ClinicalTrials.gov, NCT02690441. Registered on 24 February 2016, https://clinicaltrials.gov/ct2/show/NCT02690441 .

Rationale: Cannabis-based medicinal products (CBMPs) have been identified as novel therapeutics for generalised anxiety disorder (GAD) based on pre-clinical models; however, there is a paucity of high-quality evidence on their effectiveness and safety. Objectives: This study aimed to evaluate the clinical outcomes of patients with GAD treated with dried flower, oil-based preparations, or a combination of both CBMPs. Methods: A prospective cohort study of patients with GAD (n = 302) enrolled in the UK Medical Cannabis Registry prescribed oil or flower-based CBMPs was performed. Primary outcomes were changes in generalised anxiety disorder-7 (GAD-7) questionnaires at 1, 3, and 6 months compared to baseline. Secondary outcomes were single-item sleep quality scale (SQS) and health-related quality of life index (EQ-5D-5L) questionnaires at the same time points. These changes were assessed by paired t-tests. Adverse events were assessed in line with CTCAE (Common Terminology Criteria for Adverse Events) v4.0. Results: Improvements in anxiety, sleep quality and quality of life were observed at each time point (p < 0.001). Patients receiving CBMPs had improvements in GAD-7 at all time points (1 month: difference −5.3 (95% CI −4.6 to −6.1), 3 months: difference −5.5 (95% CI −4.7 to −6.4), 6 months: difference −4.5 (95% CI −3.2 to −5.7)). Thirty-nine participants (12.9%) reported 269 adverse events in the follow-up period. Conclusions: Prescription of CBMPs in those with GAD is associated with clinically significant improvements in anxiety with an acceptable safety profile in a real-world setting. Randomised trials are required as a next step to investigate the efficacy of CBMPs. [ABSTRACT FROM AUTHOR]

• Low-grade inflammation may occur in association with several mental disorders of early adulthood, but associations with novel markers of chronic inflammation such as soluble urokinase plasminogen activator receptor (suPAR) are less well-established. • We measured levels of 10 plasma inflammatory markers (IFN-γ, IL-6, IL-8, IL-10, TNF-α, CRP, sVCAM1, sICAM1, suPAR and alpha-2-macroglobulin) in 781 participants in the Avon Longitudinal Study of Parents and Children at age 24. • We found evidence for higher levels of IL-6 and suPAR in 24-year-olds with psychotic disorder compared to controls, with weaker evidence for higher levels of suPAR in individuals with depressive disorder compared to controls. • In secondary analyses we found preliminary evidence that plasma suPAR levels were associated with psychiatric co-morbidity. Low-grade inflammation may occur in association with several mental disorders of early adulthood, though associations with markers of chronic inflammation such as soluble urokinase plasminogen activator receptor (suPAR) are less well-established. We aimed to examine associations between acute and chronic inflammatory markers and mental disorders, as well as psychiatric co-morbidity, in young adults aged 24 years in the Avon Longitudinal Study of Parents and Children. Included were 781 participants (of 4019 who attended at age 24 years) who completed psychiatric assessments and provided plasma samples. Of these, 377 met criteria for psychotic disorder, depressive disorder or generalised anxiety disorder and 404 did not. Plasma concentrations of IFN-γ, IL-6, IL-8, IL-10, TNF-α, CRP, sVCAM1, sICAM1, suPAR and alpha-2-macroglobulin were measured using immunoassays. Logistic regression compared standardised inflammatory marker levels in cases and controls. Negative binomial regression evaluated associations between inflammatory markers and co-morbidity (number of mental disorders). Models were adjusted for sex, body mass index, cigarette smoking, cannabis use and employment status, then additionally for childhood trauma. For psychotic disorder, there was evidence for associations with IL-6 (odds ratio[OR] 1.68, 95 %CI 1.20–2.34) and suPAR (OR 1.74, 95 %CI 1.17–2.58). There was weaker evidence for an association between suPAR and depressive disorder (OR 1.31, 95 %CI 1.05–1.62). There was little evidence for associations between inflammatory markers and generalised anxiety disorder. There was weak evidence for an association between suPAR and co-morbidity (β 0.10, 95 %CI 0.01–0.19). There was little evidence for additional confounding by childhood trauma. There was evidence that 24-year-olds with psychotic disorder had raised plasma IL-6 and suPAR concentrations compared to controls. These findings have implications regarding the role of inflammation in mental disorders in early adulthood. [ABSTRACT FROM AUTHOR]

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. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02690441 . Registered on 24 February 2016.

Abstract Background During the COVID-19 pandemic, internet-delivered psychotherapeutic interventions (IPI) move increasingly into the focus of attention. Method We reviewed 39 randomized controlled studies of IPIs with 97 study arms (n = 4122 patients) for anxiety disorders (panic disorder/agoraphobia, generalized anxiety disorder, and social anxiety disorder) and performed a meta-analysis. Most studies were conducted with cognitive behavioural approaches (iCBT). Results were compared with a previous meta-analysis examining medications and face-to-face (F2F) psychotherapy. Results In direct comparisons, IPIs were as effective as F2F-CBT and superior to waitlist controls. Programs with more intensive therapist contact yielded higher effect sizes (ES). We compared the obtained ES with a previous comprehensive meta-analysis of 234 studies. In this comparison, iCBT was less effective than individual F2F-CBT and medications, not different from pill placebos, and more effective than psychological placebo and waitlist (p > .0001 for all comparisons). ES of IPIs may be overestimated. Treatments were only compared to waitlist, which is not a sufficient control condition. 97% of the studies were not blinded with regard to the main outcome measure. 32% of the participants received antianxiety drugs during the trials. In 89%, participants were recruited by advertisements rather than from clinical settings, and 63% of the participants had an academic background (students or university employees) which might affect the generalizability of the findings. Remote diagnoses were often made by students without completed training in psychotherapy. In only 15% of the studies, diagnoses were made in personal contact with a psychiatrist or psychologist. In 44% of the studies, the ‘therapists’ maintaining remote contact with the participants were mostly students without completed psychotherapy education. Conclusions IPIs may be a useful tool when face-to-face psychotherapy is not easily available, or as an add-on to standard psychotherapeutic or psychopharmacological treatments but should perhaps not be used as monotherapy. We have suggested standards for future research and the practical use of IPIs.

Objective: The present study examined whether patients with binge/purge and restricting anorexia nervosa (AN-BP and AN-R), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified feeding and eating disorder (OSFED) differ in generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and depression symptom patterns and overall comorbid symptom severity at admission. We also assessed between-group differences in the patterns of change and overall comorbid symptom severity change from admission to discharge from routine eating disorder (ED) treatment at higher levels of care (HLOC)., Method: The initial sample included 3730 adults routinely assessed for GAD, depression, and OCD at admission and discharge from treatment., Results and Conclusions: ED diagnostic groups exhibited somewhat different symptom patterns (e.g., AN-R and ARFID were more prone to GAD and OCD than depression symptoms; BED exhibited the opposite pattern) and overall symptom severity at admission (i.e., AN-BP and OSFED had the highest overall comorbid symptom severity; BED had the lowest). Although the overall symptom improvement was significantly greater in ARFID and BED than in AN-BP, AN-R, and OSFED, ED patients collectively and within each diagnostic group improved significantly in GAD, OCD, and depression symptoms following routine ED treatment at HLOC., (© 2024 Eating Disorders Association and John Wiley & Sons Ltd.)

Although rare, neurological complications following electroconvulsive therapy (ECT) can have significant consequences. Recognizing patient populations that may be at high risk of neurological complications following ECT can reduce the likelihood of these patients developing such complications. We report a case of a patient with a history of polycythemia vera presenting with a worsening episode of depression with psychotic features who demonstrated a significant change in neurological status following ECT, suspected to be due to cerebral ischemia. This case report highlights the risk factors for cerebral ischemia in patients with polycythemia vera while undergoing ECT and provides important clues that may assist in distinguishing neuropsychiatric disturbances associated with polycythemia vera from the complications of a primary psychiatric illness., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Intrator et al.)

Introduction: Migraine is a disabling headache disorder. Many psychiatric disorders co-exist with migrainous headache which largely remain undiagnosed leading to greater risk of morbidity and significantly impacts quality of life. Migraine patients are particularly at risk for mood and anxiety disorders which negatively impact the prognosis and poor headache outcome. Hence, defining the exact nature of underlying psychiatric conditions in migraine are relevant issues in the clinical practice. Aim: To find the association of psychiatric morbidity and quality of life in migrainous (with and without aura) and non-migrainous subjects and to assess the correlation between severity of migraine and quality of life. Materials and Methods: It was a hospital based cross-sectional study conducted amongst the patients and their healthy attendants visiting the Psychiatry OPD of Rajindra Hospital, Patiala from May 2018 to April 2019, after obtaining ethical clearance. A total of 392 subjects of both gender and in the age group 18-65 years, who gave informed consent were enrolled. Group 1 (n=196) consisted of cases i.e., migrainous patients as per International Classification of Headache Disorders 3rd Edition, ß version (ICHD-3) criteria and Group 2 (n=196) consisted non-migrainous controls. Psychiatric morbidity was assessed using Mini International Neuropsychiatric Interview (MINI) and confirmed on International Classification of Diseases 10th edition (ICD-10). Severity of migraine was assessed on Migraine Disability Assessment Test (MIDAS) and its impact on quality of life (QOL) by using 36 Item Short Form questionnaire (SF-36 questionnaire). Variables were compared using the independent t-test and chi-square test. Pearson correlation was used to study the relationship between severity of migraine with QOL in subjects with and without psychiatric morbidity. Results: Psychiatric morbidity was found among 65.3% (n=128) and 19.9% (n=39) subject in Group 1 and Group 2, respectively. Major Depressive Disorder (37.2%, n=73) was the most common psychiatric morbidity, followed by Generalized Anxiety Disorder (8.7%, n=17), Manic episode and Panic disorder each (5.1%, n=10), Hypomanic episode & Obsessive Compulsive Disorder each (3.1%, n=6), Dysthymia (2%, n=4) and Post Traumatic Stress disorder (1%, n=2). Between groups, the association of migraine with Major Depressive Disorder (p=0.001), General Anxiety Disorder (GAD) (p=0.024), Manic episode (p=0.005), Hypomanic episode (p=0.048) was statistically significant but more in migrainous patients than non-migrainous subjects. Migrainous patients had lower QOL in physical and psychological health domains of SF-36 than in non-migrainous subjects. Furthermore, migrainous patients with or without psychiatric morbidity had significantly negative correlation in all domains of SF-36. Conclusion: Psychiatric morbidity was significantly higher in migrainous patients than non-migrainous subjects with poor quality of life in migrainous patients causing significant disability with an increase in severity of migraine. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, internet-delivered psychotherapeutic interventions (IPI) move increasingly into the focus of attention. Method: We reviewed 39 randomized controlled studies of IPIs with 97 study arms (n = 4122 patients) for anxiety disorders (panic disorder/agoraphobia, generalized anxiety disorder, and social anxiety disorder) and performed a meta-analysis. Most studies were conducted with cognitive behavioural approaches (iCBT). Results were compared with a previous meta-analysis examining medications and face-to-face (F2F) psychotherapy. Results: In direct comparisons, IPIs were as effective as F2F-CBT and superior to waitlist controls. Programs with more intensive therapist contact yielded higher effect sizes (ES). We compared the obtained ES with a previous comprehensive meta-analysis of 234 studies. In this comparison, iCBT was less effective than individual F2F-CBT and medications, not different from pill placebos, and more effective than psychological placebo and waitlist (p >.0001 for all comparisons). ES of IPIs may be overestimated. Treatments were only compared to waitlist, which is not a sufficient control condition. 97% of the studies were not blinded with regard to the main outcome measure. 32% of the participants received antianxiety drugs during the trials. In 89%, participants were recruited by advertisements rather than from clinical settings, and 63% of the participants had an academic background (students or university employees) which might affect the generalizability of the findings. Remote diagnoses were often made by students without completed training in psychotherapy. In only 15% of the studies, diagnoses were made in personal contact with a psychiatrist or psychologist. In 44% of the studies, the 'therapists' maintaining remote contact with the participants were mostly students without completed psychotherapy education. Conclusions: IPIs may be a useful tool when face-to-face psychotherapy is not easily available, or as an add-on to standard psychotherapeutic or psychopharmacological treatments but should perhaps not be used as monotherapy. We have suggested standards for future research and the practical use of IPIs. [ABSTRACT FROM AUTHOR]

Anxiety disorders are one of the leading mental health concerns worldwide and have a serious impact on patients' quality of life. This case study addresses the question of whether acupuncture can be an effective treatment for anxiety. A 53-year-old male patient with a chief complaint of three years of anxiety that had been aggravated by economic and social hardship experienced during the COVID-19 pandemic was treated with four weekly treatments of acupuncture. At the end of the course of treatment, the patient reported improvement of his anxiety as well as alleviation of associated symptoms including worrying, insomnia and muscular pain. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and policy measures enacted to contain the spread of the coronavirus have had nationwide psychological effects. This study aimed to assess the impact of the first 15 months of the COVID-19 pandemic on the level of anxiety (GAD-7 scale) and depression (PHQ-9 scale) of the Belgian adult population. A longitudinal study was conducted from April 2020 to June 2021, with 1838 respondents participating in 6 online surveys. Linear mixed models were used to model the associations between the predictor variables and the mental health outcomes. Results showed that the prevalence of symptoms of anxiety and depression was higher in times of stricter policy measures. Furthermore, after the initial stress from the outbreak, coping and adjustment were observed in participants, as symptoms of anxiety and depression decreased during times of lower policy restrictions to almost the same level as in pre-COVID times (2018). Though time trends were similar for all population subgroups, higher levels of both anxiety and depression were generally found among women, young people, people with poor social support, extraverts, people having pre-existing psychological problems, and people who were infected/exposed to the COVID-19 virus. Therefore, investment in mental health treatment programs and supports, especially for those risk groups, is crucial. [ABSTRACT FROM AUTHOR]

Objective: Inflated responsibility beliefs encompass responsibility attitudes, the general tendency to accept responsibility, and responsibility interpretations, the appraisals of specific intrusive thoughts as indicating personal responsibility for harm. While inflated responsibility beliefs are central to obsessive-compulsive disorder, it is unclear whether they are also related to other disorder symptomology. Consequently, the current study investigated whether inflated responsibility beliefs predicted unique variance in symptoms of depression and generalised anxiety disorder in a non-clinical sample, after controlling for negative affect. Method: Participants were undergraduate psychology students and community members (N = 182, 43 males, 136 females, 3 non-binary), aged 18-70 years (M = 27.71, SD = 11.86) recruited through convenience and snowball sampling. A cross-sectional, correlational design was employed, whereby participants completed an online questionnaire. Data were analysed using two separate hierarchical multiple regression analyses, one with generalised anxiety disorder symptoms as the criterion and one with depression symptoms as the criterion. Results: After controlling for negative affect and age, an increase in responsibility attitudes uniquely predicted a significant small increase in generalised anxiety disorder symptoms, sr2 = .03, 95% CI [.02, .08], p

Abstract Background A number of studies have shown the positive effects of acupuncture on state anxiety. However, the efficacy of acupuncture in treating anxiety disorder remains unclear. This review and meta-analysis aimed to explore whether acupuncture has a positive effect on anxiety disorder. Methods Randomised controlled trials (RCTs) published in English and Chinese were found through various electronic databases, including PubMed, Scopus, the Cochrane Central Register of Controlled Trials, Embase, and the Chinese databases WanFang data, VIP Chinese Sci tech periodical database, and China National Knowledge Infrastructure. The primary outcome variable was extent of anxiety symptoms. The secondary outcomes included side effects and dropout rate. Effect sizes were pooled by random-effects modelling using Rev Man 5.3. Results Twenty RCTs were included in this systematic review and meta-analysis. All included studies were designed for patients with generalised anxiety disorder (GAD), and 18 studies were published in Chinese. Egger’s test showed that the asymmetry of the funnel plot in all studies was not significant (t = − 0.34, p = 0.74). The meta-analysis of anxiety symptoms showed that acupuncture was more effective than the control condition, with a standard mean effect size of − 0.41 (95% CI − 0.50 to − 0.31; p

Anxiety is today increasingly talked about as if it were a condition or illness from which one suffers. This obscures the sense in which it may be said to have a meaning, that meaning being that the self is currently ill‐equipped to handle its predicaments. It also obscures the sense in which anxiety's apt 'prevention' and 'treatment' most often come from education rather than from psychological medicine, in particular from those disciplines we style the humanities. This short reflection‐prompting piece unpacks the above claims from the perspective of the author's two professions: philosophy and clinical psychology. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has adversely affected people’s physical and mental health necessitating a comprehensive public and mental health strategy focusing on venerable populations including Healthcare Professionals (HCPs). Anxiety is a common mental health problem and untreated anxiety may cause immediate and long-term adverse health effects. Currently, the data on the psychological impact of COVID-19 among specialities of HCPs is sparse. Aim: To study the prevalence of anxiety and its severity among different specialities of HCPs during COVID-19 pandemic. Materials and Methods: This cross-sectional survey was conducted among HCPs from 1st October, 2020 to 20th February, 2021 at Kishori Ram Hospital and Diabetes Care Centre, Bathinda, Punjab, India, during COVID-19 pandemic in India using e-copies and hard copies of anonymously complete voluntary survey proforma. The proforma included socio-demography variables and a validated pretested structured Generalised Anxiety Disorder Scale (GAD-7) questionnaire distributed physically and by social media platforms to Indian doctors and medical students of >18 years of age from all over India. From all responses received, 2246 were found to be valid responses from HCPs comprising of 1624 from medical specialities, 225 surgical specialities, 101 emergency/critical care specialities and 296 from students/dental speciality. No HCPs other than doctors with valid MBBS/BDS degrees or MBBS/BDS students were included. Valid responses were analysed according to the speciality in relation to prevalence of anxiety, its severity, age and gender. Mann-Whitney U test was used to compare GAD-7 score among different specialty group. Results: About 972 (43.3%) were in 20 to 40 years age group including 655 (67.4%) medical, 42 (4.3%) surgical, 37 (3.8%) emergency/critical care and 238 (24.5%) from students/dental speciality. Male HCPs were 1513 and female HCPs were 733. Prevalence of anxiety was 79.3% among all HCPs. According to gender groups, prevalence of anxiety was 78.1% in males and 81.6% in females. According to age groups the prevalence of anxiety was 81.3% in 20-40 years age group, 81.6% in 41-60 years and 61.5% in >60 years age group. Among specialities, prevalence of anxiety was 78% in medical speciality group, 86.7% in surgical speciality group, 92.1% in emergency/critical care group and 76.4% in students/dental speciality group. Results showed maximum mean score in emergency/critical care speciality group and minimum mean score in medical speciality group. Conclusion: High prevalence of anxiety and its severity among HCPs across specialities highlights the adverse mental health impact of the COVID-19 pandemic underscoring the need for appropriate mental health support with multidisciplinary comprehensive mental healthcare measures.

Since its inclusion in the DSM-III , various theories and treatment approaches have been developed for generalised anxiety disorder (GAD). Aaron T. Beck was the first to offer a cognitive conceptualisation of GAD in Anxiety Disorders and Phobias: A Cognitive Perspective. This original cognitive model of GAD was initially found to be promising in treating GAD but has not been developed further. Other theoretical models and treatments of GAD have gained more research attention, such as the Intolerance of Uncertainty model and Meta-Cognitive model. This article offers a brief overview of multiple theories and treatment approaches of GAD followed by an extensive discussion about the original cognitive model and a revised cognitive model of GAD in the Beckian tradition. Specifically, this paper describes how known key psychological maintenance factors of anxiety disorders, i.e. threat beliefs, safety-seeking behaviours and selective attention, can be used to conceptualise the experience of people with GAD and guide treatment. This is done with theoretical discussion as well as clinical examples. Finally, the paper offers suggestions for key ingredients to be included in cognitive therapy for GAD and future directions for research. Key learning aims: (1) To understand the clinical implications of the original cognitive model and the revised model of generalised anxiety disorder presented here. (2) To understand the role of inflated responsibility for safety, safety-seeking behaviours and elevated evidence requirements in generalised anxiety disorder. (3) To understand and be able to implement treatment recommendations of the revised cognitive model of generalised anxiety disorder. [ABSTRACT FROM AUTHOR]

Pregabalin belongs to a group of anti-epileptic drugs that act on the alpha 2/delta subunit of the G protein of voltage-gated calcium channels. As a consequence of its pharmacological effect, pregabalin reduces the levels of intracellular calcium ions and enhances pre- and postsynaptic inhibition in the central nervous system, which translates directly into its clinical action. The expanding indications for pregabalin, not only in the treatment of neuropathic pain, but also in neurology and psychiatry, mean that the drug is accepted by an increasing number of patients with different pharmacokinetic characteristics. Pregabalin treatment can be started at lower doses of 25-50-75 mg at a time, and then slowly up-titrated to an effective and well-tolerated dose. Doses may also need to be reduced in patients with renal insufficiency. Pregabalin dosing in elderly patients is based on an established adult regimen, but with a prolonged titration period. It is worth recalling that the recommended dose of pregabalin in the case of neuropathic pain should be 300-600 mg per day. Therefore, different doses of the drug are needed to ensure optimal efficacy and reduce the risk of side effects. Considering the pharmacokinetic profile of pregabalin, the drug should be available in various doses for individualised use. This is of particular importance due to its linear pharmacokinetics, which allows achieving doses that are effective and well-tolerated by the patient in a much more effective way than in the case of gabapentin, which in turn is a condition for compliance. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has adversely affected people's physical and mental health necessitating a comprehensive public and mental health strategy focusing on venerable populations including Healthcare Professionals (HCPs). Anxiety is a common mental health problem and untreated anxiety may cause immediate and long-term adverse health effects. Currently, the data on the psychological impact of COVID-19 among specialities of HCPs is sparse. Aim: To study the prevalence of anxiety and its severity among different specialities of HCPs during COVID-19 pandemic. Materials and Methods: This cross-sectional survey was conducted among HCPs from 1st October, 2020 to 20th February, 2021 at Kishori Ram Hospital and Diabetes Care Centre, Bathinda, Punjab, India, during COVID-19 pandemic in India using e-copies and hard copies of anonymously complete voluntary survey proforma. The proforma included sociodemography variables and a validated pretested structured Generalised Anxiety Disorder Scale (GAD-7) questionnaire distributed physically and by social media platforms to Indian doctors and medical students of >18 years of age from all over India. From all responses received, 2246 were found to be valid responses from HCPs comprising of 1624 from medical specialities, 225 surgical specialities, 101 emergency/critical care specialities and 296 from students/dental speciality. No HCPs other than doctors with valid MBBS/BDS degrees or MBBS/BDS students were included. Valid responses were analysed according to the speciality in relation to prevalence of anxiety, its severity, age and gender. Mann-Whitney U test was used to compare GAD-7 score among different specialty group. Results: About 972 (43.3%) were in 20 to 40 years age group including 655 (67.4%) medical, 42 (4.3%) surgical, 37 (3.8%) emergency/critical care and 238 (24.5%) from students/dental speciality. Male HCPs were 1513 and female HCPs were 733. Prevalence of anxiety was 79.3% among all HCPs. According to gender groups, prevalence of anxiety was 78.1% in males and 81.6% in females. According to age groups the prevalence of anxiety was 81.3% in 20-40 years age group, 81.6% in 41-60 years and 61.5% in >60 years age group. Among specialities, prevalence of anxiety was 78% in medical speciality group, 86.7% in surgical speciality group, 92.1% in emergency/critical care group and 76.4% in students/dental speciality group. Results showed maximum mean score in emergency/critical care speciality group and minimum mean score in medical speciality group. Conclusion: High prevalence of anxiety and its severity among HCPs across specialities highlights the adverse mental health impact of the COVID-19 pandemic underscoring the need for appropriate mental health support with multidisciplinary comprehensive mental healthcare measures. [ABSTRACT FROM AUTHOR]

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Background: Generalised anxiety disorder (GAD) has been an uneasy member of the anxiety disorders group since its inclusion in the third edition of the DSM. Multiple theories and treatment protocols for GAD and its defining symptom, excessive worry, have comparable efficacy in treating GAD symptoms. Crucially, these theories of GAD and excessive worry fail to explain when and why worry is excessive and when it is adaptive. Aims: In this paper we propose a cognitive behavioural account of the difference between excessive and adaptive states of worry and explore the theme of threat and the function of safety-seeking behaviours as seen in GAD. Specifically, we incorporate the concept of inflated responsibility in a cognitive behavioural analysis of threat appraisal and safety-seeking behaviours in excessive worry and GAD. Conclusion: It is proposed that when worry is used as a strategy intended to increase safety from perceived social or physical threat then it should be conceptualised as a safety-seeking behaviour. However, when worry is used as a strategy to solve a problem which the person realistically can resolve or to deal explicitly with the feeling of anxiety then it functions as an adaptive coping behaviour. We also propose that the theme of threat in GAD centres on an inflated sense of responsibility for external everyday situations, and the function of safety-seeking behaviours is to attain certainty that responsibility has been fulfilled. The clinical implications of this cognitive behavioural analysis of excessive worry are discussed, as well as future research directions. [ABSTRACT FROM AUTHOR]

Background Generalised anxiety disorder (GAD) is the most common anxiety disorder in older people. First-line management includes pharmacological and psychological therapies, but many do not find these effective or acceptable. Little is known about how to manage treatment-resistant generalised anxiety disorder (TR-GAD) in older people. Objectives To examine the acceptability, feasibility and preliminary estimates of the effectiveness of acceptance and commitment therapy (ACT) for older people with TR-GAD. Participants People aged ≥65 years with TR-GAD (defined as not responding to GAD treatment, tolerate it or refused treatment) recruited from primary and secondary care services and the community. Intervention Participants received up to 16 one-to-one sessions of ACT, developed specifically for older people with TR-GAD, in addition to usual care. Measurements Co-primary outcomes were feasibility (defined as recruitment of ≥32 participants and retention of ≥60% at follow-up) and acceptability (defined as participants attending ≥10 sessions and scoring ≥21/30 on the satisfaction with therapy subscale). Secondary outcomes included measures of anxiety, worry, depression and psychological flexibility (assessed at 0 and 20 weeks). Results Thirty-seven participants were recruited, 30 (81%) were retained and 26 (70%) attended ≥10 sessions. A total of 18/30 (60%) participants scored ≥21/30 on the satisfaction with therapy subscale. There was preliminary evidence suggesting that ACT may improve anxiety, depression and psychological flexibility. Conclusions There was evidence of good feasibility and acceptability, although satisfaction with therapy scores suggested that further refinement of the intervention may be necessary. Results indicate that a larger-scale randomised controlled trial of ACT for TR-GAD is feasible and warranted. [ABSTRACT FROM AUTHOR]

Client characteristics are widely understood to influence alliance development. However, few studies have examined the role of client ambivalence about therapeutic change. Building on past research demonstrating associations between ambivalence and therapy relationship variables, such as resistance, this study examined whether greater ambivalence was associated with poorer alliance quality. Further, it examined whether motivational interviewing (MI), which involves strategies for managing ambivalence, moderated this relationship. Using data from a randomised controlled trial of cognitive‐behavioural therapy (CBT) for 71 individuals who completed treatment for generalised anxiety disorder, this study tested whether ambivalence, operationalised as observed motivational language against change (counter‐change talk; CCT), in session 1 was related to client‐rated alliance quality over time, and whether this relationship varied between two treatments: MI integrated with CBT (MI‐CBT) or CBT alone. CCT predicted lower client alliance ratings at the early, middle and late stages of therapy. At the late stage, treatment group was a significant moderator, such that CCT was associated with poorer alliances for CBT alone, but not for MI‐CBT. Results suggest that early ambivalence can predict early and middle phase alliance problems in both treatments and that, without explicit strategies for managing ambivalence, early CCT is strongly associated with poorer alliances during the late stage of CBT treatment. This research highlights the importance for clinician responsivity to early motivational markers. [ABSTRACT FROM AUTHOR]

In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to characterise the nature and effectiveness of existing imagery-related interventions in treatment of worry. PsycInfo, CENTRAL, EMBASE, Medline, Medline Epub, and PubMed were searched for studies examining the relationship between worry/GAD and mental imagery, or interventions using imagery in treatment of worry/GAD. We assessed study quality and used qualitative narrative synthesis to comprehensively map study results. The search yielded 2589 abstracts that were assessed for eligibility independently by two authors. From this, 183 full texts were screened and 50 qualitatively synthesised. Twenty-seven reported an association between worry/GAD and an aspect of mental imagery. Here, overactive negative and worry imagery, and diminished positive future imagining, were associated with worry/GAD. Twenty-three studies reported an intervention. This literature suggested mixed findings regarding efficacy, including for imaginal exposure as an independent technique for GAD. Findings support dysfunctional negative imagining and diminished positive prospective imagery in GAD. General imagining abilities remain intact, which is promising for efforts to utilise imagery in treatment. Further research is warranted to develop innovative clinical applications of imagery in treatment of GAD. • Negative and worrisome images are more negative in high worry/GAD than healthy control. • Positive imagining is diminished in high worry/GAD when images are of the future. • General capacity for mental imagery appears intact in high worry/GAD. • The content of negative intrusive imagery in GAD may indicate worry themes. • Few articles found existing imagery techniques for GAD superior to a comparator. [ABSTRACT FROM AUTHOR]

Abstract 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.

Abstract 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. Trial registration ClinicalTrials.gov, NCT02690441. Registered on 24 February 2016.

Introduction: Generalised anxiety disorder (GAD) is one of the most common mental disorders. The psychosocial factors that may lead to generalised anxiety disorders include stress, traumatic events, conscious and unconscious internal conflicts, and low social and economic status. Imprisonment and forced isolation may favour the development of depression or anxiety disorders in inmates. Thus, this study aimed to analyse the prevalence of generalised anxiety disorder (GAD) in the population of inmates detained in one of the largest penitentiary units in north-eastern Poland.Materials and Methods: The data comes from 2017 and includes information on 635 male inmates incarcerated at the Czerwony Bór Prison. The information comes from the health records of individual inmates, kept by the prison outpatient clinician, and documented consultations with doctors of units outside the prison. The classification of generalised anxiety disorders (F41.1) was made in accordance with the 10th Revision of the International Statistical Classification of Diseases and Health Problems and the clinical diagnosis made by a psychiatrist. The Mann-Whitney test was used to compare quantitative data without normal distribution, chi-squared test or Fisher exact test for comparing qualitative data. A one-dimensional and multi-dimensional logistic regression model was used to examine the impact of the prison type on the prevalence of generalised anxiety disorder.Results: Generalised anxiety disorder was observed among 44 prisoners (6.9%), most often in the age range 30–39 years and among men younger than 30 years, respectively 40.9 and 31.8% of all diagnosed. The average age of patients was 34.6 years. The least number of prisoners with GAD was in the age group 50–59 (2.3%). Nearly 66% of patients were prisoners detained in a closed type prison; the chance of generalised anxiety disorder was three times higher than among the prisoners in a half-open and open type facility. Generalised anxiety disorder was diagnosed significantly more often with those currently serving a prison sentence than those before incarceration.Conclusions: In Polish conditions, the importance of the problem associated with GAD is evidenced by a significant increase in its prevalence in the prison environment and a three times higher chance of developing generalised anxiety disorder among prisoners in a closed type institution, which calls for highly organised psychiatric care and increased availability of psychological assistance for prisoners.

Evidence supports moderate-to-large reductions in anxiety, depression, and perceived stress after smoking cessation; however, much of the available evidence has focused on young adults. Therefore, this study quantified associations between smoking and smoking cessation on prevalent and incident generalised anxiety disorder (GAD) and major depression (MDD) in a nationally representative sample of Irish older adults. Participants (n = 6201) were community dwelling adults aged ≥50 years resident in Ireland. Smoking status and self-reported doctor diagnosis of anxiety or depression prior to baseline were assessed at baseline (i.e., Wave 2). At baseline and 2-, 4-, and 6-year follow-up (i.e., Waves 3–5), GAD and MDD were assessed by the Composite International Diagnostic Interview Short-Form. Logistic regression quantified cross-sectional and prospective associations (odds ratios (ORs) and 95% confidence intervals (95%CIs)) between smoking status and mental health. Prevalence and incidence of GAD was 9.1% (n = 566) and 2.8% (n = 148), respectively. Prevalence and incidence of depression was 11.1% (n = 686) and 6.4% (n = 342), respectively. Following full adjustment, current smokers had higher odds of prevalent GAD (OR = 1.729, 1.332–2.449; p < 0.001) and MDD (OR = 1.967, 1.548–2.499; p < 0.001) than non-smokers. Former smokers had higher odds of prevalent GAD than non-smokers (OR = 1.276, 1.008–1.616; p < 0.001). Current smokers did not have higher odds of incident MDD (OR = 1.399, 0.984–1.990; p = 0.065) or GAD than non-smokers (1.039, 0.624–1.730; p = 0.881). Findings may have important implications for interventions designed to curb tobacco abuse, which tend to be less successful among those with anxiety and depression. [ABSTRACT FROM AUTHOR]

Introduction: Generalised anxiety disorder (GAD) is one of the most common mental disorders. The psychosocial factors that may lead to generalised anxiety disorders include stress, traumatic events, conscious and unconscious internal conflicts, and low social and economic status. Imprisonment and forced isolation may favour the development of depression or anxiety disorders in inmates. Thus, this study aimed to analyse the prevalence of generalised anxiety disorder (GAD) in the population of inmates detained in one of the largest penitentiary units in north-eastern Poland. Materials and Methods: The data comes from 2017 and includes information on 635 male inmates incarcerated at the Czerwony Bór Prison. The information comes from the health records of individual inmates, kept by the prison outpatient clinician, and documented consultations with doctors of units outside the prison. The classification of generalised anxiety disorders (F41.1) was made in accordance with the 10th Revision of the International Statistical Classification of Diseases and Health Problems and the clinical diagnosis made by a psychiatrist. The Mann-Whitney test was used to compare quantitative data without normal distribution, chi-squared test or Fisher exact test for comparing qualitative data. A one-dimensional and multi-dimensional logistic regression model was used to examine the impact of the prison type on the prevalence of generalised anxiety disorder. Results: Generalised anxiety disorder was observed among 44 prisoners (6.9%), most often in the age range 30–39 years and among men younger than 30 years, respectively 40.9 and 31.8% of all diagnosed. The average age of patients was 34.6 years. The least number of prisoners with GAD was in the age group 50–59 (2.3%). Nearly 66% of patients were prisoners detained in a closed type prison; the chance of generalised anxiety disorder was three times higher than among the prisoners in a half-open and open type facility. Generalised anxiety disorder was diagnosed significantly more often with those currently serving a prison sentence than those before incarceration. Conclusions: In Polish conditions, the importance of the problem associated with GAD is evidenced by a significant increase in its prevalence in the prison environment and a three times higher chance of developing generalised anxiety disorder among prisoners in a closed type institution, which calls for highly organised psychiatric care and increased availability of psychological assistance for prisoners. [ABSTRACT FROM AUTHOR]

Objective: Inflated responsibility beliefs encompass responsibility attitudes, the general tendency to accept responsibility, and responsibility interpretations, the appraisals of specific intrusive thoughts as indicating personal responsibility for harm. While inflated responsibility beliefs are central to obsessive-compulsive disorder, it is unclear whether they are also related to other disorder symptomology. Consequently, the current study investigated whether inflated responsibility beliefs predicted unique variance in symptoms of depression and generalised anxiety disorder in a non-clinical sample, after controlling for negative affect. Method: Participants were undergraduate psychology students and community members (N = 182, 43 males, 136 females, 3 non-binary), aged 18-70 years (M = 27.71, SD = 11.86) recruited through convenience and snowball sampling. A cross-sectional, correlational design was employed, whereby participants completed an online questionnaire. Data were analysed using two separate hierarchical multiple regression analyses, one with generalised anxiety disorder symptoms as the criterion and one with depression symptoms as the criterion. Results: After controlling for negative affect and age, an increase in responsibility attitudes uniquely predicted a significant small increase in generalised anxiety disorder symptoms, sr2 =.03, 95% CI [.02,.08], p <.001, but not depression symptoms. Responsibility interpretations did not predict significant unique variance in depression or generalised anxiety disorder symptoms. Conclusions: Results suggest responsibility attitudes relate to symptoms of some disorders (i.e., generalised anxiety disorder), but not all psychopathology (i.e., depression). Responsibility attitudes should potentially be considered in aetiological models of generalised anxiety disorder. Results suggest responsibility interpretations are not transdiagnostic, although measurement difficulties render this unclear. KEY POINTS What is already known about this topic: Inflated responsibility beliefs were first discussed in relation to obsessive-compulsive disorder (OCD) and have since been established as central to OCD symptomology. However, it remains unclear whether inflated responsibility beliefs are specific to OCD or represent a general cognitive bias, due to inconsistent study methodology and findings. While reasonably strong evidence exists to suggest that inflated responsibility beliefs may be associated with symptoms of generalised anxiety disorder, these studies have used problematic measures. Limited research has examined the association between inflated responsibility beliefs and depression symptoms, and available research has produced conflicting findings. What this topic adds: The current study is the first to examine responsibility beliefs in relation to symptoms of depression and generalised anxiety disorder using the Responsibility Attitudes Scale/Responsibility Interpretations Questionnaire. Increased responsibility attitudes predicted increased generalised anxiety disorder symptoms but did not predict variance in depression symptoms in the current non-clinical sample. Responsibility interpretations did not predict variance in generalised anxiety disorder symptoms or depression symptoms in the current sample. Findings suggest responsibility attitudes may be somewhat transdiagnostic, evident in some disorders (e.g., generalised anxiety disorder) but not all disorders (e.g., depression). Findings are broadly consistent with the idea that responsibility interpretations might be specific to OCD (although this was not assessed directly in the current study). [ABSTRACT FROM AUTHOR]

INTRODUCTION The currently accepted psychopharmacological treatment for generalised anxiety disorder in adults is associated with several adverse effects which threaten its acceptability. In this line, vortioxetine has been proposed as an alternative with less adverse effects in the treatment of this pathology. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including five primary studies, all corresponding to randomized trials evaluating the effectiveness of vortioxetine in adult patients with generalized anxiety disorder without current treatment. We conclude that there is uncertainty whether vortioxetine increases the response to treatment or improves anxious symptoms, because the certainty of the existing evidence has been assessed as very low. Furthermore, vortioxetine may increase nausea (low certainty evidence).

Introduction: World Health Organisation (WHO) declared 2019 Coronavirus Disease (COVID-19) infection as a pandemic. Government of India imposed a nationwide lockdown to break the chain of transmission in the community to halt the pandemic. The unprecedented measure led to severe emotional distress among the general population, especially women. Aim: To assess the burden of anxiety disorder perceived by women during the COVID-19 pandemic and their precipitating factors. Materials and Methods: An observational cross-sectional study was conducted among the women residing in West Bengal for more than six months and has access to electronic media, internet services, and/or with an account in any social media. The online survey was conducted via electronic communication and the snowball sampling method was used to recruit 980 study participants. An electronic version of a semistructured questionnaire was developed with a consent form attached to it and the link of the questionnaire was sent through e-mails, WhatsApp, and other social media to the contacts of the researcher. A self-administered questionnaire obtained information regarding socio-demographic features, personal history, past history of chronic morbidity, family history, and anxiety disorder by Generalised Anxiety Disorder-7 item (GAD-7) scale. Chi-square test and multiple logistic regression were used as a test of significance. The data was compiled, analysed, and presented. Results: Around 203 (20.7%) adult women were suffering from reasonable anxiety. Socio-demographic factors like residence, religion, education, and profession were more significantly associated but age, family type, and marital status were not significantly associated. Addiction, chronic morbidity, and experience of recurrent non-specific signs and symptoms had a significant association with reasonable anxiety. The regression model explained that working women had less chance and those with recurrent non-specific symptoms had more chance to suffer from reasonable anxiety. Conclusion: The study assessed the burden of anxiety disorder faced by women during the pandemic. It has provided further insight into the risk factors associated with it and a person’s vulnerability to anxiety disorder. Thus, it helped in developing targeted intervention strategies for the vulnerable segment of the population.

Introduction: World Health Organisation (WHO) declared 2019 Coronavirus Disease (COVID-19) infection as a pandemic. Government of India imposed a nationwide lockdown to break the chain of transmission in the community to halt the pandemic. The unprecedented measure led to severe emotional distress among the general population, especially women. Aim: To assess the burden of anxiety disorder perceived by women during the COVID-19 pandemic and their precipitating factors. Materials and Methods: An observational cross-sectional study was conducted among the women residing in West Bengal for more than six months and has access to electronic media, internet services, and/or with an account in any social media. The online survey was conducted via electronic communication and the snowball sampling method was used to recruit 980 study participants. An electronic version of a semistructured questionnaire was developed with a consent form attached to it and the link of the questionnaire was sent through e-mails, WhatsApp, and other social media to the contacts of the researcher. A self-administered questionnaire obtained information regarding socio-demographic features, personal history, past history of chronic morbidity, family history, and anxiety disorder by Generalised Anxiety Disorder-7 item (GAD-7) scale. Chi-square test and multiple logistic regression were used as a test of significance. The data was compiled, analysed, and presented. Results: Around 203 (20.7%) adult women were suffering from reasonable anxiety. Socio-demographic factors like residence, religion, education, and profession were more significantly associated but age, family type, and marital status were not significantly associated. Addiction, chronic morbidity, and experience of recurrent non-specific signs and symptoms had a significant association with reasonable anxiety. The regression model explained that working women had less chance and those with recurrent non-specific symptoms had more chance to suffer from reasonable anxiety. Conclusion: The study assessed the burden of anxiety disorder faced by women during the pandemic. It has provided further insight into the risk factors associated with it and a person's vulnerability to anxiety disorder. Thus, it helped in developing targeted intervention strategies for the vulnerable segment of the population. [ABSTRACT FROM AUTHOR]