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Wang H, Zhang G, Li X, Pu S. The effect of tennis batting sound on anxiety: a randomized controlled trial and basic acoustic analysis. Front Psychol 2023; 14:1233599. [PMID: 38130970 PMCID: PMC10733858 DOI: 10.3389/fpsyg.2023.1233599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose To investigate the potential role of the unique sound of tennis in alleviating anxiety. Previous research has consistently shown that exercise can mitigate anxiety, primarily attributed to the impact of increased physical activity on hormonal and neurostructural changes. However, in daily life we find that one of the reasons people are drawn to tennis is its distinctive sound. In this study, we specifically examined the influence of this sound on anxiety. Methods and results In a randomized controlled experiment involving 96 participants reporting chronic anxiety (n1 = n2 = 48), we found that the control group exhibited an average reduction of 0.00156 in anxiety scores 4 weeks before and after the study. On the other hand, the experimental group, exposed to tennis stroke sound stimuli, showed an average reduction of 0.02896 in anxiety scores after 4 weeks, with some individuals even experiencing a decrease from anxiety to mild anxiety. Furthermore, the analysis of sound data revealed that the sound of tennis exhibited a pleasing timbre, with the primary sound frequencies ranging from 100 to 2,800 Hz. The rhythm of the sound had an average interval of approximately 1.758″ (± 0.41), corresponding to speed of approximately 93.6 km/h. The sound exhibited a steady rhythm, orderly variations in pitch, and a soothing timbre. Conclusion This study confirms that the sound of tennis alone contributes to anxiety relief, attributed to its suitable loudness, steady rhythm, and orderly variations in pitch, all of which align with human auditory characteristics. This indicates that a considerable portion of the anxiety-alleviating effects of tennis attributed to its comforting sound.
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Affiliation(s)
- Hao Wang
- School of Physical Education, China West Normal University, Nanchong, China
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Tenzek KE, Lattimer TA, Heneveld K, Lapan E, Neurohr M, Gillis S. Mediated depictions of mental health, chronic care and literacy: a narrative analysis of Randall's mental health journey in the television series, This is Us. Front Psychiatry 2023; 14:1204973. [PMID: 37398586 PMCID: PMC10312097 DOI: 10.3389/fpsyt.2023.1204973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Mental health and delivery of care is a global issue, that was only magnified by COVID-19. Over the past 3 years, people's time spent watching television increased, while the way that mental health care was delivered changed. Audiences can gain insight into mental health issues through positive or negative mediated depictions on television. We argue that mental health is a chronic condition and the importance of literacy through different domains is critical for how the characters in media content and audience viewers make sense of mental health. Method The current study uses qualitative narrative analysis to examine the narrative probability and fidelity at the intersection of mental health depictions, the chronic care model, and different types of literacy in the award-winning series, This is Us. Results Findings reveal that Randall's experiences with mental health (N = 38 episodes) depict moments of narrative coherence and fidelity to varying degrees. We see Randall's experiences align most with the self-management support and community elements of the CCM, but the overall depiction is unbalanced. Randall's literacy level is high, but if inspected on a deeper level, analysis points to differing levels of health and mental health literacy, thus enabling and constraining positive and realistic portrayals of mental health. Discussion Implications for mental health as a chronic issue and care delivery through CCM are discussed along with the importance of different types of literacy for audience members who may be struggling with a mental health disorder or trying to navigate the health care system. We offer recommendations for using Randall's narrative as a teaching tool, integrating CCM into clinical visits to help guide delivery of care and understand literacy levels, and finally future work should continue this line of work from an Entertainment-Education perspective.
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Popa CO, Sava FA, Muresan S, Schenk A, Cojocaru CM, Muntean LM, Olah P. Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder. Front Psychol 2022; 13:1008981. [PMID: 36248526 PMCID: PMC9554655 DOI: 10.3389/fpsyg.2022.1008981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Generalized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual’s quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR). Materials and methods This study included 66 participants (Mage = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ). Results Both interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen’s d = 2.76) and worries (Cohen’s d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes. Conclusion This research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.
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Affiliation(s)
- Cosmin Octavian Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Florin Alin Sava
- Department of Psychology, West University of Timișoara, Timișoara, Romania
| | - Simona Muresan
- Department of Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
- *Correspondence: Simona Muresan,
| | - Alina Schenk
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Cristiana Manuela Cojocaru
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
- Cristiana Manuela Cojocaru,
| | - Lorena Mihaela Muntean
- Department of Psychiatry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Peter Olah
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
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Faruqui NA, Prium DH, Mowna SA, Ullah MA, Araf Y, Sarkar B, Zohora US, Rahman MS. Gut microorganisms and neurological disease perspectives. FUTURE NEUROLOGY 2021. [DOI: 10.2217/fnl-2020-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The gastrointestinal tract of every healthy human consists of a unique set of gut microbiota that collectively harbors a diverse and complex community of over 100 trillion microorganisms, including bacteria, viruses, archaea, protozoa and fungi. Gut microbes have a symbiotic relationship with our body. The composition of the microbiota is shaped early in life by gut maturation, which is influenced by several factors. Intestinal bacteria are crucial in maintaining immune and metabolic homeostasis and protecting against pathogens. Dysbiosis of gut microbiota is associated not only with intestinal disorders but also with extraintestinal diseases such as metabolic and neurological disorders. In this review, the authors examine different studies that have revealed the possible hypotheses and links in the development of neurological disorders associated with the gut microbiome.
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Affiliation(s)
- Nairita Ahsan Faruqui
- Department of Mathematics and Natural Sciences, Biotechnology Program, School of Data & Sciences, BRAC University, Dhaka, Bangladesh
| | - Durdana Hossain Prium
- Department of Mathematics and Natural Sciences, Biotechnology Program, School of Data & Sciences, BRAC University, Dhaka, Bangladesh
| | - Sadrina Afrin Mowna
- Department of Mathematics and Natural Sciences, Biotechnology Program, School of Data & Sciences, BRAC University, Dhaka, Bangladesh
| | - Md. Asad Ullah
- Department of Biotechnology & Genetic Engineering, Faculty of Biological Sciences, Jahangirnagar University, Dhaka, Bangladesh
| | - Yusha Araf
- Department of Genetic Engineering & Biotechnology, School of Life Sciences, Shahjalal University of Science & Technology, Sylhet, Bangladesh
| | - Bishajit Sarkar
- Department of Biotechnology & Genetic Engineering, Faculty of Biological Sciences, Jahangirnagar University, Dhaka, Bangladesh
| | - Umme Salma Zohora
- Department of Biotechnology & Genetic Engineering, Faculty of Biological Sciences, Jahangirnagar University, Dhaka, Bangladesh
| | - Mohammad Shahedur Rahman
- Department of Biotechnology & Genetic Engineering, Faculty of Biological Sciences, Jahangirnagar University, Dhaka, Bangladesh
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Abstract
Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry. Around half of the patients treated for GAD will fail to respond to initial treatment. Treatment-resistant (or refractory) GAD is defined as failure to respond to at least 1 trial of antidepressant therapy at adequate dose and duration. Review of the literature indicates several potential medication classes and individual agents that can be used as augmentation strategies to treat residual symptoms when recommended therapy per clinical practice guidelines fails. A thorough literature search revealed 2 medication classes with the largest amount of data to support their use in treatment-resistant GAD treatment: gamma-aminobutyric acid–related agents and atypical antipsychotics. This article focuses on evidence-based recommendations for the use of these agents as adjunctive therapies for patients with treatment-resistant GAD. Different pharmacologic approaches to use these agents are demonstrated through 2 patient cases in which patients have failed first-line treatment options.
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Zhu LJ, Chang L, Shi HJ, Li N. Systemic administration of ZLc-002 exerts anxiolytic-like effects by dissociation of nNOS from CAPON in adult mice. Biochem Biophys Res Commun 2020; 523:299-306. [PMID: 31864709 DOI: 10.1016/j.bbrc.2019.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
Anxiety is recognized as primary clinical phenotype of psychiatric disorders. However, many patients with anxiety have not yet received effective treatment. Our previous study demonstrated that hippocampal nNOS-CAPON interaction is implicated in anxiety-related behaviors, and blocking nNOS-CAPON interaction in the hippocampus produces anxiolytic-like effects. Here, ZLc-002, a small molecule inhibitor of nNOS-CAPON coupling, was evaluated for anxiolytic-like properties after systemic administered using anxiety behavioral tests, including open-field (OF), elevated plus maze (EPM), novelty-suppressed feeding (NSF) and light-dark (LD) tests. We reported that ZLc-002 when administered intraperitoneally at the dose of 40 or 80 mg/kg/d for 14 days produces anxiolytic-like effects. Furthermore, the similar effects of ZLc-002 were observed when administered intravenously at the dose of 10, 20 or 40 mg/kg/d for 7 days. More importantly, the mice dosing with 80 mg/kg/d ZLc-002 intraperitoneally or 40 mg/kg/d ZLc-002 intravenously for 3 days exerted significant behavioral effects. However, intragastric administration with ZLc-002 was devoid of effect on anxiety behaviors, even at high doses. Furthermore, intraperitoneal or intravenous treatment of ZLc-002 significantly disrupted the interaction between nNOS and CAPON in the hippocampus of adult mice, and there was a significant anxiolytic-like effect of ZLc-002 at day 3 after intrahippocampal microinjection. Our results verified that systemic administration of putative small molecule inhibitor of nNOS-CAPON can be used for the treatment of anxiety disorders.
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Affiliation(s)
- Li-Juan Zhu
- Key Laboratory of Developmental Genes and Human Diseases, MOE, Department of Histology and Embryology, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, PR China.
| | - Lei Chang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, 211166, PR China
| | - Hu-Jiang Shi
- Key Laboratory of Developmental Genes and Human Diseases, MOE, Department of Histology and Embryology, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, PR China
| | - Na Li
- Key Laboratory of Developmental Genes and Human Diseases, MOE, Department of Histology and Embryology, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, PR China
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The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152735. [PMID: 31370266 PMCID: PMC6696211 DOI: 10.3390/ijerph16152735] [Citation(s) in RCA: 300] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022]
Abstract
Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2–38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.
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9
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Wise JM, Cepeda SL, Ordaz DL, McBride NM, Cavitt MA, Howie FR, Scalli L, Ehrenreich-May J, Wood JJ, Lewin AB, Storch EA. Open Trial of Modular Cognitive-Behavioral Therapy in the Treatment of Anxiety Among Late Adolescents with Autism Spectrum Disorder. Child Psychiatry Hum Dev 2019; 50:27-34. [PMID: 29855820 DOI: 10.1007/s10578-018-0817-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Given the high rates of comorbid anxiety and autism spectrum disorder (ASD) in the adolescent and young adult population, effective treatment protocols to address anxiety symptoms are of importance to help promote greater independence across settings. While research supports the use of cognitive-behavioral therapy (CBT) across younger age groups with ASD, the literature is limited on interventions benefitting adolescents and young adults with comorbid anxiety disorders and ASD. Therefore, this open trial utilized a modified CBT manual for seven participants between the ages of 16 and 20 years, consisting of a 16-week modularized CBT treatment, including psychoeducation, cognitive therapy, and exposure therapy. Measures of anxiety and depression were completed at baseline and post-treatment. Findings demonstrated significant reductions on clinician-rated measures of anxiety. While findings are encouraging, additional studies examining the efficacy of CBT for this population with ASD and clinical anxiety are necessary to further identify beneficial treatment components.
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Affiliation(s)
- Jillian M Wise
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 400, Houston, TX, 77030, USA
| | | | - Nicole M McBride
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Mark A Cavitt
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Flora R Howie
- Developmental and Behavioral Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Leanne Scalli
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | - Jeffrey J Wood
- Departments of Education and Psychiatry, University of California, Los Angeles, CA, USA
| | | | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 400, Houston, TX, 77030, USA.
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Kamal BS, Kamal F, Lantela DE. Cannabis and the Anxiety of Fragmentation-A Systems Approach for Finding an Anxiolytic Cannabis Chemotype. Front Neurosci 2018; 12:730. [PMID: 30405331 PMCID: PMC6204402 DOI: 10.3389/fnins.2018.00730] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/21/2018] [Indexed: 01/08/2023] Open
Abstract
Cannabis sativa is a medicinal herb with a diverse range of chemotypes that can exert both anxiolytic and anxiogenic effects on humans. Medical cannabis patients receiving organically grown cannabis from a single source were surveyed about the effectiveness of cannabis for treating anxiety. Patients rated cannabis as highly effective overall for treating anxiety with an average score of 8.03 on a Likert scale of 0 to 10 (0 = not effective, 10 = extremely effective). Patients also identified which strains they found the most or least effective for relieving their symptoms of anxiety. To find correlations between anxiolytic activity and chemotype, the top four strains voted most and least effective were analyzed by HPLC-MS/MS to quantify cannabinoids and GC-MS to quantify terpenes. Tetrahydrocannabinol (THC) and trans-nerolidol have statistically significant correlations with increased anxiolytic activity. Guiaol, eucalyptol, γ-terpinene, α-phellandrene, 3-carene, and sabinene hydrate all have significant correlations with decreased anxiolytic activity. Further studies are needed to better elucidate the entourage effects that contribute to the anxiolytic properties of cannabis varieties.
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Affiliation(s)
- Brishna S Kamal
- Whistler Therapeutics, Whistler, BC, Canada.,Whistler Medical Marijuana, Whistler, BC, Canada
| | | | - Daniel E Lantela
- Whistler Therapeutics, Whistler, BC, Canada.,Whistler Medical Marijuana, Whistler, BC, Canada
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Stupar-Rutenfrans S, Ketelaars LEH, van Gisbergen MS. Beat the Fear of Public Speaking: Mobile 360° Video Virtual Reality Exposure Training in Home Environment Reduces Public Speaking Anxiety. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 20:624-633. [PMID: 29039704 DOI: 10.1089/cyber.2017.0174] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With this article, we aim to increase our understanding of how mobile virtual reality exposure therapy (VRET) can help reduce speaking anxiety. Using the results of a longitudinal study, we examined the effect of a new VRET strategy (Public Speech Trainer, PST), that incorporates 360° live recorded VR environments, on the reduction of public speaking anxiety. The PST was developed as a 360° smartphone application for a VR head-mounted device that participants could use at home. Realistic anxiety experiences were created by means of live 360° video recordings of a lecture hall containing three training sessions based on graded exposure framework; empty classroom (a) and with a small (b) and large audience (c). Thirty-five students participated in all sessions using PST. Anxiety levels were measured before and after each session over a period of 4 weeks. As expected, speaking anxiety significantly decreased after the completion of all PST sessions, and the decrement was the strongest in participants with initially high speaking anxiety baseline levels. Results also revealed that participants with moderate and high speaking anxiety baseline level differ in the anxiety state pattern over time. Conclusively and in line with habituation theory, the results supported the notion that VRET is more effective when aimed at reducing high-state anxiety levels. Further implications for future research and improvement of current VRET strategies are discussed.
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Affiliation(s)
- Snežana Stupar-Rutenfrans
- 1 University College Roosevelt (Utrecht University), Academic Core Department, Middelburg, the Netherlands .,2 NHTV University of Applied Sciences, Academy for Digital Entertainment, Breda, the Netherlands
| | - Loes E H Ketelaars
- 2 NHTV University of Applied Sciences, Academy for Digital Entertainment, Breda, the Netherlands
| | - Marnix S van Gisbergen
- 2 NHTV University of Applied Sciences, Academy for Digital Entertainment, Breda, the Netherlands
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Three-dimensional scoring of zebrafish behavior unveils biological phenomena hidden by two-dimensional analyses. Sci Rep 2017; 7:1962. [PMID: 28512334 PMCID: PMC5434067 DOI: 10.1038/s41598-017-01990-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/05/2017] [Indexed: 11/21/2022] Open
Abstract
The study of zebrafish behavior represents a cornerstone upon which basic researchers promise to advance knowledge in life sciences. Although zebrafish swim in a three-dimensional (3D) space, their behavior in the lab is almost exclusively scored in two dimensions, whereby zebrafish are recorded using a single camera providing 2D videos. Whether this dimensional reduction preserves the reliability of data has not been addressed. Here we show that, compared to a 3D observation, 2D data are flawed by over-reporting and under-reporting of locomotory differences. Specifically, we first reconstructed 3D trajectories through the integration of synchronous information derived from two cameras, and then compared them with the original 2D views in classical experimental paradigms assessing shoaling tendency, fear, anxiety, and general locomotion. Our results suggest that traditional behavioral scoring of individual zebrafish performed in 2D may undermine data integrity, thereby requiring a general reconsideration of scoring zebrafish behavior to incorporate a 3D approach. We then demonstrate that, compared to 2D, a 3D approach requires a reduced number of subjects to achieve the same degree of validity. We anticipate these findings to largely benefit animal welfare by reducing the number of experimental subjects, without affecting statistical power.
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Baldwin DS, den Boer JA, Lyndon G, Emir B, Schweizer E, Haswell H. Efficacy and safety of pregabalin in generalised anxiety disorder: A critical review of the literature. J Psychopharmacol 2015; 29:1047-60. [PMID: 26259772 DOI: 10.1177/0269881115598411] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The aim of this review is to summarise the literature on the efficacy and safety of pregabalin for the treatment of generalised anxiety disorder (GAD). Of 241 literature citations, 13 clinical trials were identified that were specifically designed to evaluate the efficacy and safety of pregabalin in GAD, including 11 randomised double-blind trials and two open-label studies. Pregabalin efficacy has been consistently demonstrated across the licensed dose range of 150-600 mg/day. Efficacy has been reported for pregabalin monotherapy in elderly patients with GAD, patients with severe anxiety, and for adjunctive therapy when added to a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor in patients who have failed to respond to an initial course of antidepressant therapy. The two most common adverse events with pregabalin are somnolence and dizziness, both of which appear to be dose-related. Pregabalin appears to have a low potential for causing withdrawal symptoms when long-term therapy is discontinued; however, tapering over the course of at least one week is recommended. A review of available evidence indicates that pregabalin is a well-tolerated and consistently effective treatment for GAD, with a unique mechanism of action that makes it a useful addition to the therapeutic armamentarium.
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Affiliation(s)
- David S Baldwin
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Johan A den Boer
- PRA Health Sciences, AE Zuidlaren, the Netherlands Department of Nuclear Medicine and Molecular Imaging, University of Groningen, Groningen, the Netherlands
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Abstract
Introduction Mexazolam is indicated for the management of anxiety with or without psychoneurotic conditions. In adult patients, the recommended daily dosage of mexazolam is 1–3 mg, administered three times daily. The objective of this article is to review the available information on the benzodiazepine (BZD) mexazolam and its clinical utility in treating patients with anxiety. Methods The PubMed database was searched using the keyword “mexazolam” with no date or language restrictions applied to the search. As only 11 papers were retrieved, some previously published manuscripts of interest known by the authors (not indexed on PubMed) have been added for completeness. Relevant information was selected for inclusion by the authors. Results A number of early studies demonstrated the ability of mexazolam to reduce anxiety symptoms with few side effects in patients with disorders associated with anxiety. Following on from this preliminary evidence, controlled studies directly comparing mexazolam with other BZDs showed that the drug is more effective than bromazepam and oxazolam, and is at least as effective as alprazolam. A larger, multicenter, phase IV study also showed that mexazolam 2 or 3 mg/day rapidly improved Hamilton Anxiety Rating Scale scores and substantially reduced the frequency and severity of numerous somatic anxiety symptoms in patients with anxiety disorders. With regard to safety, the clinical evidence indicates that mexazolam is generally well tolerated, with a low incidence of drowsiness and sedation. Furthermore, the lack of psychomotor or cognitive performance impairment following mexazolam administration may lead to better treatment compliance. Conclusion The available clinical evidence suggests that mexazolam is an effective therapeutic option for the management of anxiety. However, larger, well-controlled clinical trials are needed to directly compare and contrast mexazolam’s efficacy and safety with other BZDs. Electronic supplementary material The online version of this article (doi:10.1007/s40120-014-0016-7) contains supplementary material, which is available to authorized users.
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Both C, Kojda G, Lange-Asschenfeldt C. Pharmacotherapy of generalized anxiety disorder: focus and update on pregabalin. Expert Rev Neurother 2013; 14:29-38. [DOI: 10.1586/14737175.2014.853617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Linden M, Bandelow B, Boerner RJ, Brasser M, Kasper S, Möller HJ, Pyrkosch L, Volz HP, Wittchen HU. The best next drug in the course of generalized anxiety disorders: the "PN-GAD-algorithm". Int J Psychiatry Clin Pract 2013; 17:78-89. [PMID: 22917251 DOI: 10.3109/13651501.2012.722645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Today, there are many pharmacotherapeutic options for generalized anxiety disorder (GAD). The question is, which is the best medication for a particular patient at a particular moment? This is especially challenging because GAD is by definition a chronic disorder and new interventions should learn from earlier experiences. An algorithm which can help to use pretreatment information for drug selection is the "Pretreatment - Next Treatment (PN) - Algorithm". This article introduces an PN-algorithm for GAD. METHODS AND RESULTS For the development of a GAD-specific PN-algorithm, all possible pharmacological options for GAD are reviewed and brought into a rank order on the basis of scientific evidence regarding efficacy, tolerability, or price: (1) pregabalin, (2) venlafaxine XR, (3) selective serotonin reuptake inhibitors, (4) tricyclic antidepressants, (5) buspirone, (6) antipsychotics, (7) benzodiazepines, and (8) hydroxyzine. Based on this hierarchy and patient-specific information, a decision algorithm is derived, which allows to assess and evaluate pretreatment and to select the drug with no contraindications, limited negative or convincing positive effects, or the option which has not been used so far but which is the next compound in the hierarchy. CONCLUSIONS The "PN-GAD-algorithm" can be easily translated into a checklist to support clinical decision-making. It can also help to increase patient empowerment and cooperation in long-term treatment.
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Affiliation(s)
- Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité University Medicine, Berlin, Germany.
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Parmentier H, García-Campayo J, Prieto R. Comprehensive review of generalized anxiety disorder in primary care in Europe. Curr Med Res Opin 2013; 29:355-67. [PMID: 23356728 DOI: 10.1185/03007995.2013.770731] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This review aims to summarize meta-analyses and other relevant data relating to the efficacy and safety of the various treatment options for generalized anxiety disorder (GAD) in Europe. In addition, it will provide an overview of the prevalence, burden, and recognition of the disorder, with a view to raise awareness of GAD and inform primary care practitioners. RESEARCH DESIGN AND METHODS Relevant research or review articles on psychological or pharmacological treatments for GAD published in the English language between March 2006 and March 2012 were identified via a literature search in PubMed and ISI Web of Knowledge and from the Cochrane Library. Other relevant references/clinical guidelines were individually selected by the authors. RESULTS Prevalence rates of GAD vary across Europe but its economic and social burden is increasing. A large proportion of patients with GAD present with symptoms in primary care. However, due to the disorder's complexity and the incidence of comorbid diseases, some primary care physicians may lack the knowledge or confidence to effectively recognize, manage, and/or treat the disorder. This is despite psychological and pharmacological treatments being available for the effective management of GAD. CONCLUSIONS GAD remains a difficult disorder to detect and comorbid complications add to its economic and social burden. Early detection and intervention reduces the societal burden and improves GAD patients' quality of life and functional ability. Primary care practitioners play a key role in identifying and treating patients with GAD.
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Affiliation(s)
- H Parmentier
- 53 Smitham Bottom Lane, Purley, Surrey, CR8 3DF, UK.
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19
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Wensel TM, Powe KW, Cates ME. Pregabalin for the Treatment of Generalized Anxiety Disorder. Ann Pharmacother 2012; 46:424-9. [DOI: 10.1345/aph.1q405] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the efficacy and tolerability of pregabalin in the treatment of generalized anxiety disorder (GAD). Data Sources: A search of PubMed (1966-December 2011) and International Pharmaceutical Abstracts (1970-December 2011) was conducted using the MeSH and free-text terms pregabalin, anxiety disorders, and anxiety. Study Selection and Data Extraction: All English-language articles identified through the search were evaluated for inclusion. Only randomized controlled trials involving the use of pregabalin for the treatment of GAD were included in the review. Data Synthesis: Eight published trials were identified through the search strategy. Successful treatment of GAD with pregabalin versus placebo and active comparators has been reported in clinical trials. Pregabalin lowered total Hamilton Rating Scale for Anxiety scores within 1 week and was effective against both somatic and psychic subcomponents. In 1 controlled clinical trial, pregabalin was found to be effective in patients aged 65 years and older. Another trial demonstrated improved relapse rates when pregabalin, compared with placebo, was used for up to 6 months. The most commonly experienced adverse events were somnolence, dizziness, headache, and dry mouth. Conclusions: Available evidence suggests that pregabalin is effective and well tolerated in the treatment of GAD. As somnolence and dizziness are common adverse effects, caution should be used in elderly patients. Pregabalin rapidly relieves anxiety, a benefit that it may have over many other currently available therapeutic options besides benzodiazepines. While not a first-line therapy in GAD, pregabalin offers another treatment option in patients who do not respond to or who suffer intolerable adverse effects from other agents.
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Affiliation(s)
- Terri M Wensel
- McWhorter School of Pharmacy, Samford University, Birmingham, AL
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Abstract
Given the enormous contribution of anxiety disorders to the burden of disease, it is key to optimize their prevention and treatment. In this critical review we assess advances in the pharmacotherapy of anxiety disorders, as well as remaining challenges, in recent decades, the field has seen rigorous clinical trial methods to quantify the efficacy and safety of serendipitously discovered agents, more focused development of medications with selective mechanisms of action, and the gradual translation of insights from laboratory research into proof-of-principle clinical trials. On the positive side, a considerable database of studies shows efficacy and relative tolerability of the selective serotonin reuptake inhibitors in the major anxiety disorders, and secondary analyses of such datasets have informed questions such as optimal definition of response and remission, optimal dose and duration, and comparative efficacy of different agents. Significant challenges in the field include barriers to appropriate diagnosis and treatment of anxiety disorders, failure of a significant proportion of patients to respond to first-line pharmacotherapy agents, and a limited database of efficacy or effectiveness studies to guide treatment in such cases.
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Affiliation(s)
- Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Stowell KR, Florence P, Harman HJ, Glick RL. Psychiatric evaluation of the agitated patient: consensus statement of the american association for emergency psychiatry project Beta psychiatric evaluation workgroup. West J Emerg Med 2012; 13:11-6. [PMID: 22461916 PMCID: PMC3298217 DOI: 10.5811/westjem.2011.9.6868] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/15/2011] [Accepted: 09/29/2011] [Indexed: 11/11/2022] Open
Abstract
It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents to the emergency setting. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this article and Project BETA (Best practices in Evaluation and Treatment of Agitation), but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed.
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Affiliation(s)
- Keith R Stowell
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
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Reinhold JA, Mandos LA, Rickels K, Lohoff FW. Pharmacological treatment of generalized anxiety disorder. Expert Opin Pharmacother 2011; 12:2457-67. [PMID: 21950420 DOI: 10.1517/14656566.2011.618496] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is a chronic, relapsing, debilitating disorder, associated with markedly impaired social and occupational functioning. Pharmacological treatment is considered standard care and several drug classes are now FDA approved for the treatment of GAD. While there are clear data for the efficacy of short-term acute treatment, long-term treatment and treatment-resistant GAD remain challenging. AREAS COVERED This article describes current pharmacological treatment options for GAD, with focus on benzodiazepines, azapirones, antidepressants and anticonvulsant and antipsychotic drugs. Recent findings from placebo-controlled clinical trials are reviewed and evidence-based clinical implications are discussed. A PubMed search was completed using the terms: 'generalized anxiety disorder AND treatment' and 'generalized anxiety disorder AND therapy'. Additional pivotal trials were included for a historical perspective (older landmark trials that established efficacy and safety for older drug classes in the treatment of GAD). EXPERT OPINION Efficacy for treatment of GAD has been established for several different drug classes. At present, based on clear efficacy and good tolerability, first-line treatment with either a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) is indicated. If an initial, at least moderate, clinical response is achieved under antidepressant therapy, treatment should be at least continued for 12 months.
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Affiliation(s)
- Jennifer A Reinhold
- University of the Sciences, Philadelphia College of Pharmacy, Department of Pharmacy Practice/Pharmacy Administration, PA, USA
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Linden M, Zubrägel D, Bär T. Occupational functioning, sickness absence and medication utilization before and after cognitive-behaviour therapy for generalized anxiety disorders. Clin Psychol Psychother 2010; 18:218-24. [DOI: 10.1002/cpp.712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dankert ME, Brensinger CM, Ralph LN, Seward DA, Bilker WB, Siegel SJ. Psychiatric health care provider attitudes towards implantable medication. Psychiatry Res 2010; 177:167-71. [PMID: 20378184 DOI: 10.1016/j.psychres.2008.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 12/21/2008] [Accepted: 12/30/2008] [Indexed: 10/19/2022]
Abstract
Medication nonadherence is a major problem in psychiatry. Introduction of implantable psychiatric medication could alleviate the need to take daily medication, significantly decreasing the rate of nonadherence. This survey assessed psychiatric health care professionals' opinions regarding implants. An email was sent to potential participants including an explanation of the study and a link to an online survey. Email addresses of faculty in the Department of Psychiatry were obtained from websites of United States medical schools. To assess which provider characteristics were most important in consideration of implants, logistic regression models were employed. For assessing which patient characteristics were associated with providers' opinions, logistic regression models using generalized estimating equations tested associations between patient factors and implant decision. Eighty-six percent of respondents supported implants for a subset of patients. Four provider characteristics influenced support for implants including type of work, caseload, percent of patients with schizophrenia and percent of patients with bipolar disorder. Seven patient characteristics significantly influenced provider opinions including illness severity, length of illness, medication compliance, diagnosis, type of medication, family support, and patient age. Although dozens of factors influence the future of implants, the surveyed population showed moderate to strong support for this novel treatment.
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Affiliation(s)
- Mary E Dankert
- Stanley Center for Experimental Therapeutics in Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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Tolerance, sensitization and dependence to diazepam in Balb/c mice exposed to a novel open space anxiety test. Behav Brain Res 2010; 209:154-64. [PMID: 20117142 DOI: 10.1016/j.bbr.2010.01.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 01/18/2010] [Accepted: 01/24/2010] [Indexed: 02/05/2023]
Abstract
Balb/c mice were exposed to an elevated platform that is extended on two opposite sides with lowered steep slopes. They were tested for 12min per session in 6 successive days. They received i.p. administration of either saline or one dose of diazepam (DZP 0.5, 1, 3mg/kg) in sessions 1-3, and saline in sessions 4 and 5. All groups of mice received a single dose of DZP (1mg/kg) in session 6. DZP produced inverted U-shaped dose-responses on the number of entries into different areas of the apparatus, with a peak in mean response at 1mg/kg whereas its effect on the duration of entries was mostly comparable between the 3 doses. It increased the number of crossings on the surface of the platform and facilitated entries onto the slopes. DZP-treated mice crossed frequently onto and spent longer time on the slopes in sessions 1-3 whereas saline-treated mice remained on the platform in sessions 1-6. Withdrawal of DZP in sessions 4-5 increased the latency of first entry and decreased the number and duration of entries onto the slopes which was reversed with the administration of 1mg/kg of DZP in the next session. This ON-OFF the drug may be due to the half-life of DZP which is very short in mice and rats ( approximately 0.88h). It also indicates that DZP-treated mice did not benefit from previous experience of entries onto the slopes which suggests a possible "state-dependent" effect. Administration of DZP after repeated exposures to the test did not facilitate entries onto the slopes but instead increased significantly the number of crossings on the surface of the platform; this increase was much higher than that observed in mice initially treated with DZP and exposed to the test. There is no evidence of habituation in saline-treated mice: the number of crossings on the platform was comparable between the first 5 sessions of the test. These results demonstrate that repeated exposures to the same anxiogenic environment resulted in avoidance responses developing tolerance and approach responses developing sensitization. They suggest that tolerance and sensitization are two opposite sides of the habituation process to the same stimulus and may account for the maintained state of anxiety.
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Gao K, Sheehan DV, Calabrese JR. Atypical antipsychotics in primary generalized anxiety disorder or comorbid with mood disorders. Expert Rev Neurother 2009; 9:1147-58. [PMID: 19673604 DOI: 10.1586/ern.09.37] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Generalized anxiety disorder (GAD) is a chronic, highly prevalent and debilitating disorder that commonly co-occurrs with mood disorders. Current available agents for GAD are limited either by their slow onsets of actions, unsatisfactory anxiolytic effects or potential for abuse/dependence. Atypical antipsychotics have been studied as alternatives. Olanzapine, risperidone and quetiapine immediate release have been explored in the treatment of refractory GAD and risperidone in bipolar anxiety with randomized, double-blind, placebo-controlled trials, but the results were not consistent. By contrast, quetiapine extended release (quetiapine-XR) 150 mg/day monotherapy yielded consistent anxiolytic effects across three studies that were superior to placebo and as effective as paroxetine 20 mg/day and escitalopram 10 mg/day but with an earlier onset of action. In a 52-week treatment of GAD, quetiapine-XR was superior to placebo in the prevention of anxiety relapses. Overall, atypical antipsychotics were relatively well tolerated, with common side effects of somnolence and sedation. However, in contrast to antidepressants and benzodiazepines, the long-term risk and benefit of atypical antipsychotics in the treatment of GAD is yet to be determined.
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Affiliation(s)
- Keming Gao
- Department of Psychiatry, Mood and Anxiety Clinic in the Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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27
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Keeton CP, Kolos AC, Walkup JT. Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management. Paediatr Drugs 2009; 11:171-83. [PMID: 19445546 DOI: 10.2165/00148581-200911030-00003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pediatric generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry about a variety of events and is accompanied by physical symptoms such as headaches, tension, restlessness, gastrointestinal distress, and heart palpitations. Symptoms impose marked distress and interfere with social, emotional, and educational functioning. GAD occurs in over 10% of children and adolescents, has an average age of onset of 8.5 years, and is more often reported in girls. Common co-occurring conditions include separation anxiety disorder and social phobia. Assessment involves a multi-informant, multi-method approach involving the child, parents, and school teachers. A clinical interview should be conducted to assess for the three primary ways anxiety presents: behaviors, thoughts, and somatic symptoms. Several semi-structured diagnostic interviews are available, and the Anxiety Disorders Interview Schedule is increasingly used. Rating scales completed by the patient, caregivers, and teachers provide useful information for diagnosis and symptom monitoring. Several scales are available to assess patients for the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) GAD diagnosis; however, instruments generally cannot distinguish children with GAD from children with similar anxiety disorders. Both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy for the treatment of pediatric anxiety disorders including GAD. Evidence suggests that the combination of CBT plus sertraline offers additional benefit compared with either treatment alone. With pharmacotherapy, systematic tracking of treatment-emergent adverse events such as headaches, stomach aches, behavioral activation, worsening symptoms, and emerging suicidal thoughts is important. Recommended starting doses are fluvoxamine 25 mg/day, fluoxetine 10 mg/day, and sertraline 25 mg/day, though lower starting doses are possible. Dosing can be adjusted as often as weekly with the goal of achieving a high-quality response, while minimizing side effects. Long-term treatment with medication has not been well studied; however, to achieve optimal long-term outcome extended use of medication may be required. It is recommended to continue medication for approximately 1 year following remission in symptoms, and when discontinuing medication to choose a stress-free time of the year. If symptoms return, medication re-initiation should be considered seriously.
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Affiliation(s)
- Courtney Pierce Keeton
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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28
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Lenze EJ, Rollman BL, Shear MK, Dew MA, Pollock BG, Ciliberti C, Costantino M, Snyder S, Shi P, Spitznagel E, Andreescu C, Butters MA, Reynolds CF. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. JAMA 2009; 301:295-303. [PMID: 19155456 PMCID: PMC2840403 DOI: 10.1001/jama.2008.977] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders in older adults; however, few data exist to guide clinicians in efficacious and safe treatment. Selective serotonin reuptake inhibitors (SSRIs) are efficacious for younger adults with GAD, but benefits and risks may be different in older adults. OBJECTIVE To examine the efficacy, safety, and tolerability of the SSRI escitalopram in older adults with GAD. DESIGN, SETTING, AND PARTICIPANTS A randomized controlled trial in primary care practices and related specialty clinics in Pittsburgh, Pennsylvania, of 177 participants aged 60 years or older with a principal diagnosis of GAD randomized to receive either escitalopram or placebo and conducted between January 2005 and January 2008. INTERVENTIONS Twelve weeks of 10 to 20 mg/d of escitalopram (n = 85) or matching placebo (n = 92). MAIN OUTCOME MEASURES Cumulative response defined by Clinical Global Impressions-Improvement score of much or very much improved; time to response; and anxiety and role functioning changes measured by the Clinical Global Impressions-Improvement scale, Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, Late-Life Function and Disability Instrument activity limitations subscale, and the role-emotional impairment and social function subscales of the Medical Outcome Survey 36-item Short Form. RESULTS In the primary analytic strategy in which participants (n = 33) were censored at the time of dropout, mean cumulative response rate for escitalopram was 69% (95% confidence interval [CI], 58%-80%) vs 51% (95% CI, 40%-62%) for placebo (P = .03). A conservative intention-to-treat analysis showed no difference in mean cumulative response rate between escitalopram and placebo (57%; 95% CI, 46%-67%; vs 45%; 95% CI, 35%-55%; P = .11). Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning (Clinical Global Impressions-Improvement scale: effect size, 0.93; 95% CI, 0.50-1.36; P < .001; Penn State Worry Questionnaire: 0.30; 95% CI, 0.23-0.48; P = .01; activity limitations: 0.32; 95% CI, 0.01-0.63; P = .04; and the role-emotional impairment and social function: 0.96; 95% CI, 0.03-1.90; P = .04). Adverse effects of escitalopram (P < .05 vs placebo) were fatigue or somnolence (35 patients [41.1%]), sleep disturbance (12 [14.1%]), and urinary symptoms (8 [9.4%]). CONCLUSIONS Older adults with GAD randomized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks; however, response rates were not significantly different using an intention-to-treat analysis. Further study is required to assess efficacy and safety over longer treatment durations. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00105586.
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Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, Box 8134, St Louis, MO 63110, USA.
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De Berardis D, Serroni N, Carano A, Scali M, Valchera A, Campanella D, D'Albenzio A, Di Giuseppe B, Moschetta FS, Salerno RM, Ferro FM. The role of duloxetine in the treatment of anxiety disorders. Neuropsychiatr Dis Treat 2008; 4:929-35. [PMID: 19183783 PMCID: PMC2626928 DOI: 10.2147/ndt.s2546] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Anxiety disorders (ADs) are the most common type of psychiatric disorders, with a mean incidence of 18.1% and a lifetime prevalence of 28.8%. Pharmacologic options studied for treating ADs may include benzodiazepines, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic drug (NaSSA) and dual-reuptake inhibitors of serotonin and norepinephrine (SNRIs). In this context, the development of SNRIs (venlafaxine and duloxetine) has been particularly useful. As a dual-acting intervention that targets two neurotransmitter systems, these medications would appePar promising for the treatment of ADs. The purpose of this review was to elucidate current facts and views about the role of duloxetine in the treatment of ADs. In February 2007, duloxetine was approved by FDA for the treatment of generalized anxiety disorder (GAD). The results of trials evaluating the use duloxetine in the treatment of GAD are supportive on its efficacy even if further studies on long-term use are needed. Apart from some interesting case reports, no large studies are, to date, present in literature about duloxetine and other ADs such as panic disorder, social anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. Therefore, the clinical efficacy and the relative good tolerability of duloxetine may be further investigated to widen the therapeutic spectrum of ADs.
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Affiliation(s)
- Domenico De Berardis
- Department of Oncology and Neurosciences, Institute of Psychiatry, "G. D'Annunzio" University of Chieti, Italy.
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Rynn M, Russell J, Erickson J, Detke MJ, Ball S, Dinkel J, Rickels K, Raskin J. Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trial. Depress Anxiety 2008; 25:182-9. [PMID: 17311303 DOI: 10.1002/da.20271] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Generalized anxiety disorder (GAD), a prevalent and chronic illness, is associated with dysregulation in both serotonergic and noradrenergic neurotransmission. Our study examined the efficacy, safety, and tolerability of duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, for short-term treatment of adults with GAD. In a 10-week, double-blind, progressive-titration, flexible-dose trial, 327 adult outpatients with a DSM-IV-defined GAD diagnosis were randomized to duloxetine 60-120 mg (DLX, N=168) or placebo (PLA, N=159) treatment. The primary efficacy measure was mean change from baseline to endpoint in Hamilton Anxiety Scale (HAMA) total score. Secondary outcome measures included response rate (HAMA total score reduction > or =50% from baseline), Clinician Global Impression-Improvement (CGI-I) scores, and Sheehan Disability Scale (SDS) scores. Patients who received duloxetine treatment demonstrated significantly greater improvement in HAMA total scores (P=.02); a higher response rate (P=.03), and greater improvement (P=.04) than patients who received placebo. Duloxetine-treated patients were also significantly more improved than placebo-treated patients on SDS global functional (P<.01) and work, social, and family/home impairment scores (P<.05). The rate of discontinuation due to adverse events (AEs) was higher for the duloxetine group compared with the placebo group (P=.002). The AEs most frequently associated with duloxetine were nausea, dizziness, and somnolence. Duloxetine was an efficacious, safe, and well-tolerated treatment that resulted in clinically significant improvements in symptom severity and functioning for patients with GAD.
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Affiliation(s)
- Moira Rynn
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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31
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Duration of untreated illness as a predictor of treatment response and clinical course in generalized anxiety disorder. CNS Spectr 2008; 13:415-22. [PMID: 18496479 DOI: 10.1017/s1092852900016588] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of the present study was to investigate the impact of the duration of untreated illness (DUI)-defined as the time elapsing between the onset of generalized anxiety disorder (GAD) and the first adequate pharmacologic treatment-on treatment response and clinical course in a sample of subjects with GAD. METHODS One hundred patients with GAD, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria, were enrolled and their main demographic and clinical features collected. Patients were then treated with selective serotonin reuptake inhibitors or venlafaxine for 8 weeks in open-label conditions. Treatment response and other clinical variables were analyzed after dividing the sample into two groups according to DUI (DUI <or=12 months and DUI >12 months). RESULTS When the DUI was computed with respect to the first antidepressant treatment (DUI-AD), a higher improvement (Clinical Global Impressions-Severity of Illness scale) after the pharmacologic treatment was found in the group with a shorter DUI (analysis of variance with repeated measures: time effect F=654.975, P<.001; group effect: F=4.369, P=.039). When computed with respect to the first treatment with benzodiazepines (DUI-BDZ), the two groups did not show any significant difference in treatment response (time effect: F=652.183, P<.001; group effect: F=0.009, P=.924). In addition, patients with a longer DUI (DUI-BDZ or DUI-AD) showed an earlier age at onset, a longer duration of illness and a higher rate of comorbid psychiatric disorders with onset later than GAD. CONCLUSION Results from this preliminary study seem to suggest that a shorter DUI-AD may determine a better response to pharmacologic treatment in patients with GAD, and that a longer DUI (DUI-BDZ and DUI-AD) may be associated to a worse clinical course. Further investigation on the relationship between DUI and GAD is needed.
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Martin JLR, Sainz-Pardo M, Furukawa TA, Martín-Sánchez E, Seoane T, Galán C. Benzodiazepines in generalized anxiety disorder: heterogeneity of outcomes based on a systematic review and meta-analysis of clinical trials. J Psychopharmacol 2007; 21:774-82. [PMID: 17881433 DOI: 10.1177/0269881107077355] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
No systematic review or meta-analysis using a hard outcome has been conducted on the role of benzodiazepines for generalized anxiety disorder (GAD). The objective of this study was to assess the effectiveness and efficacy of benzodiazepines in the treatment of GAD based on trial drop-out rates. We used a systematic review of randomized controlled trials that compared any of the three best established benzodiazepines (diazepam, Lorazepam and aLprazolam) against placebo. Our primary outcome for effectiveness was withdrawal for any reason. Our secondary outcome tapping efficacy was withdrawal due to lack of efficacy, and that tapping side effects was withdrawals due to adverse events. We included 23 trials. Pooled analysis indicated less risk of treatment discontinuation due to lack of efficacy for benzodiazepines, compared to placebo, relative risk (RR) 0.29 (95% CI 0.18-0.45; p < 0.00001). Nevertheless, pooled analysis showed no conclusive results for risk of all-cause patient discontinuation, RR 0.78 (95% CI 0.62-1.00; p = 0.05). Meta-regression model showed that 74% of the variation in logRR across the studies was explained by year of publication (p <0.001). This systematic review did not find convincing evidence of the short-term effectiveness of the benzodiazepines in the treatment of GAD. On the other hand, for the outcome of efficacy, this review found robust evidence in favour of benzodiazepines. Due to the heterogeneity induced by year of publication, three hypotheses are plausibLe when it comes to being able to account for the differences between efficacy and effectiveness observed in the outcomes (publication bias, quality of the trial literature and a non-differential response to the placebo effect).
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Affiliation(s)
- Jose Luis R Martin
- Department of Clinical Research, Castile-La Mancha Health Research Foundation (FISCAM), Toledo, Spain.
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Fontanesi LB, Ferreira R, Cabral A, Castilho VM, Brandão ML, Nobre MJ. Brainstem areas activated by diazepam withdrawal as measured by Fos-protein immunoreactivity in rats. Brain Res 2007; 1166:35-46. [PMID: 17669374 DOI: 10.1016/j.brainres.2007.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 07/03/2007] [Accepted: 07/05/2007] [Indexed: 11/21/2022]
Abstract
In the 1970s, chronic treatment with benzodiazepines was supposed not to cause dependence. However, by the end of the decade several reports showed that the interruption of a prolonged treatment with diazepam leads to a withdrawal syndrome characterized, among other symptoms, by an exaggerated level of anxiety. In laboratory animals, signs that oscillate from irritability to extreme fear-like behaviors and convulsions have also been reported. In recent years many studies have attempted to disclose the neural substrates responsible for the benzodiazepines withdrawal. However, they have focused on telencephalic structures such as the prefrontal cortex, nucleus accumbens and amygdala. In this study, we examined the Fos immunoreactivity in brain structures known to be implicated in the neural substrates of aversion in rats under spontaneous diazepam-withdrawal. We found that the same group of structures that originally modulate the defensive responses evoked by fear stimuli, including the dorso-medial hypothalamus, the superior and inferior colliculus and the dorsal periaqueductal gray, were most labeled following diazepam withdrawal. It is suggested that an enhanced neural activation of neural substrates of fear in the midbrain tectum may underlie the aversive state elicited in diazepam-withdrawn rats.
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Affiliation(s)
- Lucas Baptista Fontanesi
- Instituto de Neurociências & Comportamento-INeC, Campus USP, Ribeirão Preto, 14040-901 SP, Brazil
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Reyes JC, Robles RR, Colón HM, Marrero CA, Matos TD, Calderón JM, Shepard EW. Severe anxiety symptomatology and HIV risk behavior among Hispanic injection drug users in Puerto Rico. AIDS Behav 2007; 11:145-50. [PMID: 17122902 DOI: 10.1007/s10461-006-9090-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.
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Affiliation(s)
- Juan C Reyes
- Center for Addiction Studies, Universidad Central del Caribe, School of Medicine, P.O.Box 60327, Bayamón, Puerto Rico, 00960-6032, Argentina.
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Abstract
Generalized anxiety disorder (GAD) is a common, chronic and disabling anxiety disorder with considerable comorbidity with depression as well as with other anxiety disorders. Although tricyclic antidepressants and benzodiazepines have been found to be efficacious in patients with GAD, tolerability problems and other risks limit their use in clinical practice. In placebo-controlled, acute (<8 weeks) trials, several medications, including the selective serotonin reuptake inhibitors ([SSRIs] escitalopram, paroxetine, and sertraline) and others (venlafaxine, buspirone, pregabalin), have demonstrated efficacy in patients with GAD. Indeed, current guidelines for the treatment of GAD recommend SSRIs as first-line pharmacological therapy because of their efficacy and tolerability profiles. Although GAD is a chronic condition that is usually present for years, with symptoms typically fluctuating in intensity over time, there have been few randomized, controlled trials of pharmacotherapy beyond the acute phase of treatment. However, data from recent relapse-prevention studies and longer-term maintenance studies with paroxetine, venlafaxine and escitalopram strongly support the value of continued treatment for at least a further 6 months. This article focuses on pharmacological treatment, and reviews recently available data from acute, long-term and relapse-prevention trials in patients with GAD. In addition, issues relating to the natural course of GAD are highlighted as important considerations to guide selection of pharmacotherapy.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Bastos VH, Machado D, Cunha M, Portella CE, Cagy M, Furtado V, Piedade R, Ribeiro P. Medidas eletrencefalográficas durante a aprendizagem de tarefa motora sob efeito do bromazepam. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:443-51. [PMID: 16059596 DOI: 10.1590/s0004-282x2005000300015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neuromoduladores alteram constantemente as relações neurais pré-existentes no sistema nervoso. O bromazepam é utilizado com freqüência na prática clínica para diminuir padrões de ansiedade. Poucos são os experimentos correlacionando este ansiolítico às tarefas motoras. Neste contexto, o presente experimento visa analisar as alterações motoras e eletrocorticais decorrentes da administração de diferentes doses de bromazepam mediante a prática motora, e relacionar o efeito da droga a performance motora mão-dominante versus não dominante. Sujeitos saudáveis (39), de ambos os sexos, entre 20 a 30 anos compuseram a amostra. Os grupos controle (placebo) e experimental (bromazepam de 3mg e 6mg) foram treinados na tarefa de datilografia num modelo duplo-cego randomizado. Resultados do teste Stroop (atenção) não demonstraram diferenças no escore bruto e no tempo de execução do mesmo. Em contrapartida, nos resultados comportamentais foram observados um efeito principal entre blocos nas variáveis tempo de execução e erros cometidos durante a pratica motora. Os dados eletrofisiológicos evidenciaram interações significantes para: lateralidade/condição/momento; lateralidade/condição; lateralidade/momento; condição/momento; condição/setor.
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Affiliation(s)
- Victor Hugo Bastos
- Laboratório de Mapeamento Cerebral e Integração Sensório-Motora, Instituto de Psiquiatria, Brazil.
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Barrett RJ, Smith RL. Evidence for PTZ-like cues as a function of time following treatment with chlordiazepoxide: implications for understanding tolerance and withdrawal. Behav Pharmacol 2005; 16:147-53. [PMID: 15864069 DOI: 10.1097/00008877-200505000-00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present study used a two-lever, drug-discrimination procedure to train rats to discriminate between the cues associated with 5 mg/kg of the anxiolytic, chlordiazepoxide (CDP) and 15 mg/kg of the anxiogenic, pentylenetetrazol (PTZ), to investigate the relationship between withdrawal and acute tolerance. Training doses of the two drugs were chosen so that rats responded about equally on both levers when tested on saline (SAL). Following acquisition of the discrimination, rats were injected with 10 mg/kg CDP and tested for lever choice at various intervals from 6 h to 192 h. These tests revealed that cues associated with CDP withdrawal lasted approximately three times longer than the cues associated with the drug's primary effects. At the shortest retest interval (6 h) after treatment with 10 mg/kg CDP, rats responded primarily on the CDP lever, followed by a shift to predominant responding on the PTZ lever at the 16 h and 24 h intervals before returning to predrug, baseline levels at the longer intervals (48-192 h). In order to investigate the relationship between tolerance and withdrawal to the cue properties of CDP, CDP dose-response curves were determined 24 h following treatment with SAL or 10 mg/kg CDP. Acute tolerance, as defined by a rightward, parallel shift in the dose-response function, was observed in the rats pretreated with CDP. Furthermore, it was evident that the baseline shift associated with CDP withdrawal, rather than a weaker drug cue, accounted for acute tolerance. The results from this study are relevant to evaluating the role positive and negative reinforcement play in motivating compulsive drug use.
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Affiliation(s)
- R J Barrett
- Veterans Administration Medical Center, Departments of Psychology and Pharmacology, Vanderbilt University, Vanderbilt School of Medicine, Nashville, Tennessee 37212, USA.
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Nyström C. Effects of long-term benzodiazepine medication. A prospective cohort study: methodological and clinical aspects. Nord J Psychiatry 2005; 59:492-7. [PMID: 16316903 DOI: 10.1080/08039480500360864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Benzodiazepine (BDZ) drug impact on mental functions was explored in a cohort study of 30 psychiatric outpatients on long-term BDZ medication. A new questionnaire, the Drug Impact on Mental Processes (DIMP) was used and evaluated. The patients were rated three times: on inclusion in the study, after about 18 months and, finally, only a few days later. Test-retest reliability was evaluated for the two last ratings and was found acceptable for 19/23 items. The DIMP scores indicated negative effects on crisis reaction, intensified defence mechanisms and reduced cognitive, emotional and conative functions. Long-term BDZ treatment intensified passive coping. The drug impact on mental functions ranged between a mild and a moderate degree. The clinical outcomes of the patients' psychiatric disorders were evaluated at a 1-year follow-up after continued or discontinued BDZ treatment. In the subgroup that had discontinued the BDZ treatment at follow-up, significantly more patients reported reduced severity of their psychiatric disorders and significantly more patients had paid jobs. The overall clinical improvement after discontinued BDZ treatment may be explained by recovery from an addiction syndrome. It may also be related to a shift from passive to active coping.
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Affiliation(s)
- Curt Nyström
- Institute of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Sweden.
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