BACKGROUND Generalized anxiety disorder(GAD)is a relatively common mental disorder.Recently,inflammation,an important factor for the development of depression,has attracted increasing attention.Several studies have sh...BACKGROUND Generalized anxiety disorder(GAD)is a relatively common mental disorder.Recently,inflammation,an important factor for the development of depression,has attracted increasing attention.Several studies have shown that inflammatory cytokines can affect the pathophysiological processes of several nervous system diseases.We hypothesized that there is a correlation between the levels of lipopolysaccharide(LPS)-stimulated inflammatory cytokines and the clinical symptoms of GAD.AIM To investigate the predictive effect of LPS-stimulated inflammatory cytokines on symptoms of GAD.METHODS This was a cross-sectional study in which 89 patients with GAD diagnosed at The First Hospital of Hebei Medical University from January 2022 to December 2022 and 70 individuals without anxiety and depression(controls)during the same period were included.Fasting venous blood was collected from all the subjects in heparin tubes,and another 3 ml of blood was supplemented with LPS(10 ng/ml).The plasma levels of 12 cytokines[Interleukin(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,tumor necrosis factor(TNF)-α,interferon(IFN)-γ,IL-17A,IL-12p70,and IFN-α]were detected.RESULTS Post-LPS stimulation,the levels of IL-1β,IL-6,IL-8,IL-10,and TNF-αin both the control and GAD groups were significantly elevated above those in the nonstimulated groups,with IL-6 and IL-8 showing marked increases.Increases in IL-8 and TNF-αwere statistically significant in the GAD group(P<0.05).IL-1β,IL-6,IL-8,IL-10,and TNF-αwere found to be significantly correlated with Hamilton Anxiety Rating Scale(HAMA)scores(P<0.05).A negative correlation was observed between IL-10 levels and HAMA scores.Further analysis revealed that TNF-αwas associated with mental anxiety,whereas IL-1β,IL-8,and IL-10 were associated with physical anxiety symptoms,with IL-10 showing a negative correlation with physical anxiety.IL-6 was associated with both mental and physical aspects of anxiety.CONCLUSION The physical symptoms of GAD are related to inflammatory factors.IL-1β,IL-8,IL-10,and TNF-a can be used as predictors of physical or mental anxiety in patients with GAD.展开更多
The aim of this present study is to examine the efficacy of attribution retraining group therapy （ARGT） and to compare the responses of outpatients with major depression disorder （MDD）, generalized anxiety disord...The aim of this present study is to examine the efficacy of attribution retraining group therapy （ARGT） and to compare the responses of outpatients with major depression disorder （MDD）, generalized anxiety disorder （GAD） and obsessive-compulsive disorder （OCD）. We carried out a prospective uncontrolled intervention study with a 8-weeks of ARGT on sixty three outpatients with MDD, GAD or OCD. Hamilton rating scale for depression, Hamilton rating scale for anxiety, Yale-Brown obsessive-compulsive scale, attribution style questionnaire, self-esteem scale, index of well-being, and social disability screening schedule were administered before and after treatment. Significant improvement in symptoms and psychological and social functions from pre- to posttreatment occurred for all participants. The changes favored MDD patients. Our study suggested that ARGT may improve the symptoms and psychological-social functions of MDD, GAD, and OCD patients. MDD patients showed the best response.展开更多
BACKGROUND： Study results of event-refated potential in obsessive compulsive disorder （OCD） remain controversial, potentially as a result of different instruments utilized and their differing technical characterist...BACKGROUND： Study results of event-refated potential in obsessive compulsive disorder （OCD） remain controversial, potentially as a result of different instruments utilized and their differing technical characteristics. OBJECTIVE： To investigate the differences in several common event-related potentials, Le. contingent negative variations, P300, and mismatch negativity （MMN）, in OCD patients, depression patients, generalized anxiety disorder （GAD） patients, and healthy controls. DESIGN, TIME AND SETTING： A case-control study was performed in the Department of Electrophysiology, Shanghai Mental Health Center from May 2002 to December 2005. PARTICIPANTS： A total of 38 OCD patients, 20 depression patients, and 18 GAD patients, who were diagnosed according to the criteria of Chinese Classification of Mental Disorders （Version 3）, formulated by the Chinese Psychiatry Association, were selected from the Outpatient Department of Shanghai Mental Health Center. Patients with two or more the above diseases were excluded. In addition, 28 healthy people, gender and age matched, were selected as controls. METHODS： Contingent negative variations, P300, and MMN were recorded by a Nicolet Spirit Instrument. All electrodes were attached at Cz according to the Intemationa11020 system, with the mastoid leads as reference and Fpz as ground. MAIN OUTCOME MEASURES： Amplitude and latency of contingent negative variations, P300, and MMN. RESULTS： The contingent negative variations, P300, and MMN were different （P 〈 0.01）. OCD patients showed an increased MI amplitude compared with controls, depression, and GAD patients （P 〈 0.01）. Target P300 amplitudes were significantly lower in OCD, depression, and GAD patients compared with controls （P 〈 0.01）. Moreover, N2 latency and latency of MMN were prolonged in OCD and depression groups compared with controls （P 〈 0.05）. CONCLUSION： Event-related potentials were different in depression, GAD, and OCD patients and healthy controls. In particular, OCD patients exhibited unique characteristics.展开更多
Generalized anxiety disorder(GAD)has harmful effects on physical and mental health and quality of life.Coloring therapy has been reported to have a positive effect on improving patient anxiety and depression.But there...Generalized anxiety disorder(GAD)has harmful effects on physical and mental health and quality of life.Coloring therapy has been reported to have a positive effect on improving patient anxiety and depression.But there are no reported clinical trials examining their effectiveness as a treatment for GAD.This study was planned to evaluate the effectiveness of coloring therapy combined with conventional therapy in improving anxiety,depression,and positive and negative emotions with GAD.This randomized controlled study comprising 88 GAD patients was selected for intervention in different wards.The control group(n=45)was given conventional antianxiety medication and physical therapy,and the experimental group(n=43)received coloring therapy combined with conventional therapy.The Self-Rating Depression Scale,Self-Rating Anxiety Scale(SAS),Hamilton Depression Scale,Hamilton Anxiety Scale(HAMA),and Positive and Negative Affect Scale were assessed in both groups before and 3 weeks after the intervention.After the intervention,there were statistical differences in intra-and inter-group comparisons of anxiety,depression,and positive and negative mood scales in the experimental and control groups(p<.05).The minus in anxiety/positive emotions pre-and postintervention in the experimental group was statistically significant compared to that in anxiety/positive emotions pre-and postintervention in the control group(HAMA:d=1.45,95%confidence interval[CI](0.34,2.57),p=.011;SAS:d=3.87,95%CI(1.73,6.00),p=.001;positive:d=1.76,95%CI(0.17,3.34),p=.030).The minus in depressive/negative emotions pre-and postintervention in the experimental group was not statistically significant compared with that in depressive/negative emotions pre-and postintervention in the control group(p>.05).For GAD patients,adding coloring therapy based on conventional drug therapy and physical therapy can not only reduce depression and negative emotions but also have better effects on reducing anxiety and improving positive emotions than conventional therapy.展开更多
Objective:To observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders.Methods:A total of 202 generalized anxiety disorders patients were r...Objective:To observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders.Methods:A total of 202 generalized anxiety disorders patients were randomly allocated to a control condition(Paroxetine combined with cognitive therapy) or a treatment condition(Yiqiyangxin Chinese medicine compound combined with cognitive therapy).Subsequently,scores of Hamilton Anxiety Scale(HAMA), Zung Self-rating Anxiety Scale(SAS) and blood routine,urine routine,liver function,renal function,electrocardiogram were detected before treatment,3 months,6 months after treatment and 6 months after medicine withdrawal,respectively.Results:HAMA and SAS scores were significantly reduced in two groups(P【0.001) after treatment,but the differences in HAMA and SAS scores,apparent effect and effectiveness were not significant(P】0.05).HAMA and SAS scores were significantly increased in two groups(P【0.05) after medicine withdrawal,and there were significant differences in HAMA and SAS scores,recurrent disease and adverse reaction(P【0.001). The incidence of recurrent disease and adverse reaction in treatment group was low.Both two groups showed no apparent abnormality in blood routine,urine routine,liver and renal function, and electrocardiogram.Conclusions:Yiqiyangxin Chinese medicine compound combined with cognitive therapy can significantly reduce the recurrence after medicine withdrawal and is effective on generalized anxiety disorders.Furthermore,the incidence of adverse reactions is low. The treatment program is worthy clinic application in the further.展开更多
Introduction: Anxiety disorders have a lifetime prevalence of 34% with a similar level of heritability (31%) yet lack objective markers that could differentiate patients with underlying conditions. Up to 60%-70% of pa...Introduction: Anxiety disorders have a lifetime prevalence of 34% with a similar level of heritability (31%) yet lack objective markers that could differentiate patients with underlying conditions. Up to 60%-70% of patients with Ehlers-Danlos syndrome have anxiety that meets criteria of generalized anxiety disorder, their clinical-DNA findings worth examining as biomarkers for patients with generalized anxiety. Method: Of the 1899 patients diagnosed with Ehlers-Danlos syndrome, 1261 were systematically evaluated for 80 history and 40 physical findings and separated into 826 who reported anxiety and 435 who did not. The most consistently reported or management-directing 60 of these clinical findings were, along with variations in genes relevant to these disorders, examined for association with anxiety. Results: Among the 30 anxiety- associated findings judged most predictive of Ehlers-Danlos syndrome in patients with anxiety were expected ones of adrenergic stimulation (difficulty concentrating-87% frequency and 1.26 anxiety/no anxiety ratio;chronic fatigue-84%, 1.17;sleep issues 69%, 1.52 that are criteria for generalized anxiety disorder) or of cholinergic suppression (e.g., frequent nausea 64%, 1.26). Less associated but more discriminating for underlying disease were those reflective of neuromuscular impact (e.g., chronic daily headaches 76%, 1.12);hypermobility (e.g., awareness of flexibility 72%, 1.03), or skin changes (e.g., elasticity around jaw 71%, 1.06). Anxiety-associated DNA variants included 54 of 88 in collagen type I/V/VII/IX genes, 14 of 16 in sodium channel SCN9A/10A/ 11A genes, 59 of 85 in POLG/MT-DNA genes, and 21 of 28 in profilaggrin- FLG genes that respectively impacted tissue laxity, sensory neural, autonomic-mitochondrial, and autonomic-inflammatory functions. Conclusion: Analysis of pathogenetic mechanisms in Ehlers-Danlos syndrome selected some 50 clinical-DNA findings useful for its diagnosis in those with generalized anxiety disorders.展开更多
Background: Patients with generalized anxiety disorder (GAD) are among the highest users of healthcare resources. The broadening of the DSM-IV criteria for GAD has been a subject of controversy in the literature, but ...Background: Patients with generalized anxiety disorder (GAD) are among the highest users of healthcare resources. The broadening of the DSM-IV criteria for GAD has been a subject of controversy in the literature, but its consequences have not been analyzed to date. Objective: The purpose of this study was to analyze how the broadening of the DSM-IV criteria affects healthcare resource utilization and related costs. Methods: A multicentre, prospective, observational study was conducted in randomly selected outpatient psychiatric clinics between October 2007 and April 2008. Patients diagnosed according to DSM-IV or broader criteria (1 month of excessive or non-excessive worry and only 2 associated DSM-IV symptoms) for the first time were consecutively enrolled. Socio-demographic data, healthcare resources and corresponding costs were collected over a 6-month period. Results: A total of 3549 patients were systematically recruited, 1815 in the DSM-IV criteria group (DG) and1264 inthe broad criteria group (BG). Treatments prescribed were similar for antidepressants in both groups (77.0% in the DG vs. 75.3% in the BG, p = 0.284), and slightly higher in the DG for benzodiazepines (71.5% vs. 67.2% respectively, p = 0.011) and anticonvulsants (72.1% vs. 67.0% respectively, p = 0.002). Healthcare resource utilization was statistically reduced to a similar extent in both groups as a consequence of treatment, yielding a reduction in the cost of illness of €1196 (SD = 1158) and €1112 (SD = 874) respectively;p = 0.304, over a 6-month period. Conclusion: The broadening of the GAD criteria could lead to earlier diagnosis not necessarily associated with an increase in healthcare resource utilization or costs to the National Health System in the six-month follow-up.展开更多
Objective:To observe the clinical effect of Jieyu decoction in treating generalized anxiety disorder with stagnation-heat in liver meridian type.Methods:There were 72 cases of generalized anxiety disorders outpatient ...Objective:To observe the clinical effect of Jieyu decoction in treating generalized anxiety disorder with stagnation-heat in liver meridian type.Methods:There were 72 cases of generalized anxiety disorders outpatient and inpatient patients,and 36 in the control and treatment group.The control group was given oral Deanxit;the treatment group was given Jieyu decoction granules,and necessary psychological counseling was given to patients in both groups.Changes in traditional Chinese medicine syndrome scoring scale,Hamilton scale(HAMA),dynamic electrocardiogram heart rate variability and other indicators were recorded and compared between the two groups.Results:The total effective rate of the control group was 76.5%,and the total effective rate of the treatment group was 80.0%.The curative effect of the treatment group and the control group was significantly higher than that before treatment(P<0.05),and there was no significant difference in the overall curative effect between the two groups(P>0.05).The HAMA scale score of the two groups was significantly lower than that before treatment(P<0.05),and there was no significant difference in the reduction rate of HAMA score between the two groups(P>0.05).The traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with that before treatment(P<0.05).The traditional Chinese medicine syndrome scores of the treatment group were significantly different from that of the control group after 8 weeks of treatment(P<0.05).Two groups of heart rate variability in 24 h period of standard deviation between the average normal R-R(SDNN),24 h per 5 min normal R-R period between the standard deviation(SDANN),root mean square of phase difference between adjacent R-R(RMSSD)and the number of cardiac 50 ms accounted for the percentage of the total number of cardiac(PNN50)than before treatment significantly increased(P<0.05),8 weeks after treatment the SDNN,SDANN than the control group no significant difference(P>0.05),RMSSD,PNN50 significantly difference compared with control group(P<0.05).Conclusion:Jieyu decoction has good efficacy and high safety in the treatment of generalized anxiety disorder of the type of liver meridian and heat stagnation,which is suitable for clinical promotion and application.展开更多
The extent of viral spread and strategies in dealing with the COVID-19 pandemic have been different in each country.There are overall increased mental health concerns in many countries but it is unclear what the gener...The extent of viral spread and strategies in dealing with the COVID-19 pandemic have been different in each country.There are overall increased mental health concerns in many countries but it is unclear what the general public individuals who do not have heighten vulnerability to stressors for existing mental diseases or significant physical illnesses were experiencing during the pandemic.We evaluated the stressors and mental health of general public in South Korea that has a relatively low confirmed cases and deaths.Responses on the on-line survey questions were used to assess the mental and physical symptoms in association with individuals’reported stressors.Individuals with the symptoms of the generalized anxiety disorder(GAD)were reported in 58.9%,and major depression(MD)in 23.2%,mostly in minimal to mild degrees,cut-off scores of 5 and 10,respectively by the validated screening tools,GAD-7 and PHQ-9.Both GAD and MD symptoms were in 21.5%of the respondents.The total number of stress had significant association with the scores of GAD-7,PHQ-9,physical symptoms,sleep difficulties and resilience(p<0.01).GAD scores were also associated with sleep difficulties(p<0.01)and raising young children(p<0.05).MD scores were associated with sleep difficulties,job-dissatisfaction,and educational level(p<0.05).The limitations of the study include small sample size,usage of smartphone or email,potential under-reporting by stigma in the socio-cultural context and evolving nature of pandemic.We conclude that keeping careful watch for mental symptoms,stressors,sleep difficulties and other physical symptoms are important even for the individuals without previous mental illnesses during the pandemic era.展开更多
基金The 2023 Scientific Research Fund Project of Hebei Provincial Health and Family Planning Commission,No.20231081The"Spark"Youth Research Project,The First Hospital of Hebei Medical University,No.XH202302.
文摘BACKGROUND Generalized anxiety disorder(GAD)is a relatively common mental disorder.Recently,inflammation,an important factor for the development of depression,has attracted increasing attention.Several studies have shown that inflammatory cytokines can affect the pathophysiological processes of several nervous system diseases.We hypothesized that there is a correlation between the levels of lipopolysaccharide(LPS)-stimulated inflammatory cytokines and the clinical symptoms of GAD.AIM To investigate the predictive effect of LPS-stimulated inflammatory cytokines on symptoms of GAD.METHODS This was a cross-sectional study in which 89 patients with GAD diagnosed at The First Hospital of Hebei Medical University from January 2022 to December 2022 and 70 individuals without anxiety and depression(controls)during the same period were included.Fasting venous blood was collected from all the subjects in heparin tubes,and another 3 ml of blood was supplemented with LPS(10 ng/ml).The plasma levels of 12 cytokines[Interleukin(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,tumor necrosis factor(TNF)-α,interferon(IFN)-γ,IL-17A,IL-12p70,and IFN-α]were detected.RESULTS Post-LPS stimulation,the levels of IL-1β,IL-6,IL-8,IL-10,and TNF-αin both the control and GAD groups were significantly elevated above those in the nonstimulated groups,with IL-6 and IL-8 showing marked increases.Increases in IL-8 and TNF-αwere statistically significant in the GAD group(P<0.05).IL-1β,IL-6,IL-8,IL-10,and TNF-αwere found to be significantly correlated with Hamilton Anxiety Rating Scale(HAMA)scores(P<0.05).A negative correlation was observed between IL-10 levels and HAMA scores.Further analysis revealed that TNF-αwas associated with mental anxiety,whereas IL-1β,IL-8,and IL-10 were associated with physical anxiety symptoms,with IL-10 showing a negative correlation with physical anxiety.IL-6 was associated with both mental and physical aspects of anxiety.CONCLUSION The physical symptoms of GAD are related to inflammatory factors.IL-1β,IL-8,IL-10,and TNF-a can be used as predictors of physical or mental anxiety in patients with GAD.
基金supported by national science and technology support projects (No.2009BA177B07)Natural Science Foundation of Jiangsu Province,China (No.PBBS1-102350)
文摘The aim of this present study is to examine the efficacy of attribution retraining group therapy （ARGT） and to compare the responses of outpatients with major depression disorder （MDD）, generalized anxiety disorder （GAD） and obsessive-compulsive disorder （OCD）. We carried out a prospective uncontrolled intervention study with a 8-weeks of ARGT on sixty three outpatients with MDD, GAD or OCD. Hamilton rating scale for depression, Hamilton rating scale for anxiety, Yale-Brown obsessive-compulsive scale, attribution style questionnaire, self-esteem scale, index of well-being, and social disability screening schedule were administered before and after treatment. Significant improvement in symptoms and psychological and social functions from pre- to posttreatment occurred for all participants. The changes favored MDD patients. Our study suggested that ARGT may improve the symptoms and psychological-social functions of MDD, GAD, and OCD patients. MDD patients showed the best response.
基金the National Natural Science Foundation of China, No. 30770772, 30971046the Foundation of Shanghai Science and Technology Commission, No. 09411968200 the Major State Basic Research Development Program of China (973 program), No. S2009051026
文摘BACKGROUND： Study results of event-refated potential in obsessive compulsive disorder （OCD） remain controversial, potentially as a result of different instruments utilized and their differing technical characteristics. OBJECTIVE： To investigate the differences in several common event-related potentials, Le. contingent negative variations, P300, and mismatch negativity （MMN）, in OCD patients, depression patients, generalized anxiety disorder （GAD） patients, and healthy controls. DESIGN, TIME AND SETTING： A case-control study was performed in the Department of Electrophysiology, Shanghai Mental Health Center from May 2002 to December 2005. PARTICIPANTS： A total of 38 OCD patients, 20 depression patients, and 18 GAD patients, who were diagnosed according to the criteria of Chinese Classification of Mental Disorders （Version 3）, formulated by the Chinese Psychiatry Association, were selected from the Outpatient Department of Shanghai Mental Health Center. Patients with two or more the above diseases were excluded. In addition, 28 healthy people, gender and age matched, were selected as controls. METHODS： Contingent negative variations, P300, and MMN were recorded by a Nicolet Spirit Instrument. All electrodes were attached at Cz according to the Intemationa11020 system, with the mastoid leads as reference and Fpz as ground. MAIN OUTCOME MEASURES： Amplitude and latency of contingent negative variations, P300, and MMN. RESULTS： The contingent negative variations, P300, and MMN were different （P 〈 0.01）. OCD patients showed an increased MI amplitude compared with controls, depression, and GAD patients （P 〈 0.01）. Target P300 amplitudes were significantly lower in OCD, depression, and GAD patients compared with controls （P 〈 0.01）. Moreover, N2 latency and latency of MMN were prolonged in OCD and depression groups compared with controls （P 〈 0.05）. CONCLUSION： Event-related potentials were different in depression, GAD, and OCD patients and healthy controls. In particular, OCD patients exhibited unique characteristics.
基金the National Natural Science Foundation of China(grant number 31672295)。
文摘Generalized anxiety disorder(GAD)has harmful effects on physical and mental health and quality of life.Coloring therapy has been reported to have a positive effect on improving patient anxiety and depression.But there are no reported clinical trials examining their effectiveness as a treatment for GAD.This study was planned to evaluate the effectiveness of coloring therapy combined with conventional therapy in improving anxiety,depression,and positive and negative emotions with GAD.This randomized controlled study comprising 88 GAD patients was selected for intervention in different wards.The control group(n=45)was given conventional antianxiety medication and physical therapy,and the experimental group(n=43)received coloring therapy combined with conventional therapy.The Self-Rating Depression Scale,Self-Rating Anxiety Scale(SAS),Hamilton Depression Scale,Hamilton Anxiety Scale(HAMA),and Positive and Negative Affect Scale were assessed in both groups before and 3 weeks after the intervention.After the intervention,there were statistical differences in intra-and inter-group comparisons of anxiety,depression,and positive and negative mood scales in the experimental and control groups(p<.05).The minus in anxiety/positive emotions pre-and postintervention in the experimental group was statistically significant compared to that in anxiety/positive emotions pre-and postintervention in the control group(HAMA:d=1.45,95%confidence interval[CI](0.34,2.57),p=.011;SAS:d=3.87,95%CI(1.73,6.00),p=.001;positive:d=1.76,95%CI(0.17,3.34),p=.030).The minus in depressive/negative emotions pre-and postintervention in the experimental group was not statistically significant compared with that in depressive/negative emotions pre-and postintervention in the control group(p>.05).For GAD patients,adding coloring therapy based on conventional drug therapy and physical therapy can not only reduce depression and negative emotions but also have better effects on reducing anxiety and improving positive emotions than conventional therapy.
基金supported in part by Research Program in Higher Edueational Intuitions of the Education Department in Hainan(No.Hjsk2011-53)Natural Seientific Research Funds of Hainan in 2011(No.710247)Scientific Research Funds of Hainan Medical University in 2009(No.2009-035)
文摘Objective:To observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders.Methods:A total of 202 generalized anxiety disorders patients were randomly allocated to a control condition(Paroxetine combined with cognitive therapy) or a treatment condition(Yiqiyangxin Chinese medicine compound combined with cognitive therapy).Subsequently,scores of Hamilton Anxiety Scale(HAMA), Zung Self-rating Anxiety Scale(SAS) and blood routine,urine routine,liver function,renal function,electrocardiogram were detected before treatment,3 months,6 months after treatment and 6 months after medicine withdrawal,respectively.Results:HAMA and SAS scores were significantly reduced in two groups(P【0.001) after treatment,but the differences in HAMA and SAS scores,apparent effect and effectiveness were not significant(P】0.05).HAMA and SAS scores were significantly increased in two groups(P【0.05) after medicine withdrawal,and there were significant differences in HAMA and SAS scores,recurrent disease and adverse reaction(P【0.001). The incidence of recurrent disease and adverse reaction in treatment group was low.Both two groups showed no apparent abnormality in blood routine,urine routine,liver and renal function, and electrocardiogram.Conclusions:Yiqiyangxin Chinese medicine compound combined with cognitive therapy can significantly reduce the recurrence after medicine withdrawal and is effective on generalized anxiety disorders.Furthermore,the incidence of adverse reactions is low. The treatment program is worthy clinic application in the further.
文摘Introduction: Anxiety disorders have a lifetime prevalence of 34% with a similar level of heritability (31%) yet lack objective markers that could differentiate patients with underlying conditions. Up to 60%-70% of patients with Ehlers-Danlos syndrome have anxiety that meets criteria of generalized anxiety disorder, their clinical-DNA findings worth examining as biomarkers for patients with generalized anxiety. Method: Of the 1899 patients diagnosed with Ehlers-Danlos syndrome, 1261 were systematically evaluated for 80 history and 40 physical findings and separated into 826 who reported anxiety and 435 who did not. The most consistently reported or management-directing 60 of these clinical findings were, along with variations in genes relevant to these disorders, examined for association with anxiety. Results: Among the 30 anxiety- associated findings judged most predictive of Ehlers-Danlos syndrome in patients with anxiety were expected ones of adrenergic stimulation (difficulty concentrating-87% frequency and 1.26 anxiety/no anxiety ratio;chronic fatigue-84%, 1.17;sleep issues 69%, 1.52 that are criteria for generalized anxiety disorder) or of cholinergic suppression (e.g., frequent nausea 64%, 1.26). Less associated but more discriminating for underlying disease were those reflective of neuromuscular impact (e.g., chronic daily headaches 76%, 1.12);hypermobility (e.g., awareness of flexibility 72%, 1.03), or skin changes (e.g., elasticity around jaw 71%, 1.06). Anxiety-associated DNA variants included 54 of 88 in collagen type I/V/VII/IX genes, 14 of 16 in sodium channel SCN9A/10A/ 11A genes, 59 of 85 in POLG/MT-DNA genes, and 21 of 28 in profilaggrin- FLG genes that respectively impacted tissue laxity, sensory neural, autonomic-mitochondrial, and autonomic-inflammatory functions. Conclusion: Analysis of pathogenetic mechanisms in Ehlers-Danlos syndrome selected some 50 clinical-DNA findings useful for its diagnosis in those with generalized anxiety disorders.
文摘Background: Patients with generalized anxiety disorder (GAD) are among the highest users of healthcare resources. The broadening of the DSM-IV criteria for GAD has been a subject of controversy in the literature, but its consequences have not been analyzed to date. Objective: The purpose of this study was to analyze how the broadening of the DSM-IV criteria affects healthcare resource utilization and related costs. Methods: A multicentre, prospective, observational study was conducted in randomly selected outpatient psychiatric clinics between October 2007 and April 2008. Patients diagnosed according to DSM-IV or broader criteria (1 month of excessive or non-excessive worry and only 2 associated DSM-IV symptoms) for the first time were consecutively enrolled. Socio-demographic data, healthcare resources and corresponding costs were collected over a 6-month period. Results: A total of 3549 patients were systematically recruited, 1815 in the DSM-IV criteria group (DG) and1264 inthe broad criteria group (BG). Treatments prescribed were similar for antidepressants in both groups (77.0% in the DG vs. 75.3% in the BG, p = 0.284), and slightly higher in the DG for benzodiazepines (71.5% vs. 67.2% respectively, p = 0.011) and anticonvulsants (72.1% vs. 67.0% respectively, p = 0.002). Healthcare resource utilization was statistically reduced to a similar extent in both groups as a consequence of treatment, yielding a reduction in the cost of illness of €1196 (SD = 1158) and €1112 (SD = 874) respectively;p = 0.304, over a 6-month period. Conclusion: The broadening of the GAD criteria could lead to earlier diagnosis not necessarily associated with an increase in healthcare resource utilization or costs to the National Health System in the six-month follow-up.
基金Supported by Xi'an Municipal Health Commission Project(SZL201933),Xi'an Hospital of Traditional Chinese Medicine(YJ201922).
文摘Objective:To observe the clinical effect of Jieyu decoction in treating generalized anxiety disorder with stagnation-heat in liver meridian type.Methods:There were 72 cases of generalized anxiety disorders outpatient and inpatient patients,and 36 in the control and treatment group.The control group was given oral Deanxit;the treatment group was given Jieyu decoction granules,and necessary psychological counseling was given to patients in both groups.Changes in traditional Chinese medicine syndrome scoring scale,Hamilton scale(HAMA),dynamic electrocardiogram heart rate variability and other indicators were recorded and compared between the two groups.Results:The total effective rate of the control group was 76.5%,and the total effective rate of the treatment group was 80.0%.The curative effect of the treatment group and the control group was significantly higher than that before treatment(P<0.05),and there was no significant difference in the overall curative effect between the two groups(P>0.05).The HAMA scale score of the two groups was significantly lower than that before treatment(P<0.05),and there was no significant difference in the reduction rate of HAMA score between the two groups(P>0.05).The traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with that before treatment(P<0.05).The traditional Chinese medicine syndrome scores of the treatment group were significantly different from that of the control group after 8 weeks of treatment(P<0.05).Two groups of heart rate variability in 24 h period of standard deviation between the average normal R-R(SDNN),24 h per 5 min normal R-R period between the standard deviation(SDANN),root mean square of phase difference between adjacent R-R(RMSSD)and the number of cardiac 50 ms accounted for the percentage of the total number of cardiac(PNN50)than before treatment significantly increased(P<0.05),8 weeks after treatment the SDNN,SDANN than the control group no significant difference(P>0.05),RMSSD,PNN50 significantly difference compared with control group(P<0.05).Conclusion:Jieyu decoction has good efficacy and high safety in the treatment of generalized anxiety disorder of the type of liver meridian and heat stagnation,which is suitable for clinical promotion and application.
文摘The extent of viral spread and strategies in dealing with the COVID-19 pandemic have been different in each country.There are overall increased mental health concerns in many countries but it is unclear what the general public individuals who do not have heighten vulnerability to stressors for existing mental diseases or significant physical illnesses were experiencing during the pandemic.We evaluated the stressors and mental health of general public in South Korea that has a relatively low confirmed cases and deaths.Responses on the on-line survey questions were used to assess the mental and physical symptoms in association with individuals’reported stressors.Individuals with the symptoms of the generalized anxiety disorder(GAD)were reported in 58.9%,and major depression(MD)in 23.2%,mostly in minimal to mild degrees,cut-off scores of 5 and 10,respectively by the validated screening tools,GAD-7 and PHQ-9.Both GAD and MD symptoms were in 21.5%of the respondents.The total number of stress had significant association with the scores of GAD-7,PHQ-9,physical symptoms,sleep difficulties and resilience(p<0.01).GAD scores were also associated with sleep difficulties(p<0.01)and raising young children(p<0.05).MD scores were associated with sleep difficulties,job-dissatisfaction,and educational level(p<0.05).The limitations of the study include small sample size,usage of smartphone or email,potential under-reporting by stigma in the socio-cultural context and evolving nature of pandemic.We conclude that keeping careful watch for mental symptoms,stressors,sleep difficulties and other physical symptoms are important even for the individuals without previous mental illnesses during the pandemic era.
文摘目的探究双相情感障碍(BD)与广泛性焦虑障碍(GAD)人群之间的心率变异性(HRV)的差异。方法将57例BD患者(BD组)和60例GAD患者(GAD组)分别开展HRV检测,并对两者的心率变异相关指标24 h全程NN间期的标准差(SDNN-24)、全程NN间期的标准差(SDNN)、全程每5 min NN间期平均值的标准差(SDANN)、全部相邻NN之差的均方根(rMSSD)、相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)、总功率(TP)、低频(LF)、高频(HF)、LF与HF之间的比值(LF/HF)结果进行组间统计差异比较。结果GAD组病程短于BD组(P<0.01)。GAD组的时阈指标SDNN-24、SDANN低于BD组(P<0.01)。相关分析结果显示,GAD组病程与TP、LF、HF、SDNN均呈负相关(P<0.05)。结论GAD的自主神经功能失调要比BD患者更加严重;GAD患者的病程会影响其HRV频阈指标。
