Epidemiology and prognostic implications of panic disorder and generalized anxiety disorder in patients with coronary artery disease: rationale and design for a longitudinal cohort study

Different corpus callosum in panic disorder

BACKGROUND

Despite hypotheses regarding the neurobiology of panic disorder (PD), its neurobiological basis is still unknown. Study results support that the individual differences in corpus callosum (CC) properties could reflect trait based alterations that predispose individuals to higher anxiety sensitivity, and to disorders associated with stress such as PD. Neuroimaging studies with panic disorder have not been sufficient to explain the pathophysiology of the disease. The aim of this study is to provide additional information for studies examining the etiology of PD by comparing the corpus callosum, a region associated with attention, anxiety, and somatic complaints, on sagittal MRI images of PD patients with the corpus callosum of healthy individuals.

METHODS

T2-weighted MRI images of 164 patients diagnosed with PD and 78 controls selected from Hospital Information System (HIS) and meeting the study criteria were evaluated by shape analysis method.

RESULTS

There were differences between the shapes and areas of the CC in the mid-sagittal images of the PD patients and healthy controls.

CONCLUSIONS

This study findings highlighted the variable dimensional and subregional properties of CC in PD patients. This study could shed light on future studies about PD etiology, diagnosis and treatment.

Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case-control study

Background

The pathogenesis of cognitive impairment (CI) in coronary artery disease (CAD) patients is still unclear and numerous influence factors could affect the CI status. The current studies suggest that sleep quality and behavior pattern are significant influence factors associated with CAD susceptibility.

Methods

A total of 223 participants including 90 CAD patients with CI and 133 controls were enrolled into this retrospective study. Demographic information, laboratory test results, clinical diagnostic data, and questionnaire survey were collected to recognize the influencing factors of CI in CAD patients. Appropriate statistical methods are used to analyze these collected data.

Results

Univariate analysis results of demographic information, laboratory test results, and questionnaire survey data revealed that the differences in fatigue symptom, age, HDL, TG, and sleep quality were statistically significant (p = 0.006, p = 0.000, p = 0.019, p = 0.028, and p = 0.037, respectively). Logistic regression analysis showed that age, fatigue, and sleep quality were the influence factors for CI in CAD population (p = 0.000, p = 0.035, and p = 0.017).

Conclusions

Sleep quality, fatigue, and age were associated with the increased susceptibility of CI in CAD patients. Both CI state and its related factors were involved in the pathological process of CAD, these findings could offer additional information for the prevention and control of CAD.

Comparative Effectiveness of Interventional Therapy versus Exercise Rehabilitation in Stable Angina Patients with Severe Coronary Artery Stenosis

Background

Management strategies for stable angina include pharmacotherapy, revascularization, and exercise-based cardiac rehabilitation (CR). The optimal treatment for stable angina patients with severe coronary artery stenosis remains unclear. This study aimed to compare interventional therapy with exercise rehabilitation in this population.

Methods

Fifty stable angina patients with severe coronary stenosis who underwent stent implantation were included in the optimal medical therapy (OMT) plus percutaneous coronary intervention (PCI) group, and 50 patients who did not undergo interventional treatment were included in OMT plus CR group receiving exercise rehabilitation guidance for one year. Cardiovascular composite endpoint events, cardiopulmonary fitness, and quality of life scale scores were assessed after one year.

Results

No significant difference in incidence of cardiovascular composite endpoint events was observed between OMT plus PCI group with OMT plus CR group (20.0% vs 14.6%) after one year. Cardiopulmonary fitness represented as peak VO2 (19.2±3.5 vs 17.6±3.2 mL/kg/min), peak load (120±19 vs 108±20 W), and AT (13.5±1.5 vs 12.1±1.3 mL/kg/min) were significantly higher in the rehabilitation group than the intervention group after one year. Both groups showed improvement in their quality of life, but the rehabilitation group improved in more scales.

Conclusion

Interventional therapy did not reduce cardiovascular events compared to exercise-based rehabilitation in stable angina patients with severe coronary artery stenosis, but the rehabilitation can improve cardiovascular fitness and quality of life more.

Biobehavioral approach to distinguishing panic symptoms from medical illness

Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.

Initial assessment of the feasibility and efficacy of a scalable digital CBT for generalized anxiety and associated health behaviors in a cardiovascular disease population

Generalized anxiety disorder (GAD) is a significant yet modifiable risk factor for worse cardiovascular disease (CVD) outcomes. The treatment of GAD in an accessible manner represents an unmet need in CVD, given that patients with CVD experience numerous barriers to in-person treatment engagement. This paper presents the rationale and design for an investigation of a strategy to enhance care for patients with CVD by introducing a scalable, affordable, and system-friendly digital intervention that targets a prominent modifiable risk factor (generalized anxiety and associated worry) for negative health behaviors in CVD. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the degree to which a digital cognitive behavior therapy (dCBT), relative to a waitlist control group, engages anxiety and worry outcomes in a sample of 90 adults who have experienced an acute CVD event and who have comorbid GAD symptoms. We also investigate the degree to which dCBT leads to greater changes in GAD symptoms compared to the control condition and whether reductions in these symptoms are associated with corresponding reductions in cardiac anxiety and cardiac health behaviors (including smoking, physical activity, heart-healthy diet, and medication adherence). We propose that by targeting GAD symptoms in CVD in a way that does not tax ongoing medical care provision, we have the potential to improve the uptake of effective care and address both GAD and associated health behaviors.

[Functional cardiovascular symptoms]

This review provides an update on the diagnosis, differential diagnosis and management of functional cardiovascular symptoms. Typical heart-related symptoms like non-cardiac chest pain and palpitations are frequently complemented by other symptoms like dyspnea, sweating, trembling, dizziness and also further somatic symptoms like pain and fatigue. Functional cardiac symptoms are frequent, with rates of up to 30 % in chest pain units. The differential diagnosis comprises gastrointestinal disorders like gastro-esophageal reflux disease and also mental disorders, particularly panic and other anxiety disorders. Successful management depends on an attitude of realizing and confirming the reality and seriousness of the symptoms despite the absence of a clear structural organic cause. Good cooperation with psychotherapists is helpful for stepped care strategies that start with supportive communication with the patient and biopsychosocial self-help activities, leading, if necessary, to formal psychotherapy.

Heartbeat tracking task performance, an indicator of interoceptive accuracy, is associated with improvement of exercise tolerance in patients undergoing home-based cardiac rehabilitation

Aims

Interoception is the sensing function of physiological conditions and is crucial in self-regulation and decision-making. We examined the association of heartbeat tracking task performance, an indicator of interoceptive accuracy, with the degree of improvement in exercise tolerance in patients undergoing home-based cardiac rehabilitation.

Methods and results

Participants underwent baseline peak oxygen uptake (VO₂) measurements and a heartbeat tracking task. The heartbeat tracking task score varies between 0 and 1, with higher scores indicating a better heartbeat perception. After 6 months of home-based exercise training, peak VO₂ was measured again, and the percentage change (%Δ peak VO₂) relative to the peak VO₂ at baseline was calculated. Univariate regression analysis was performed to examine the association between %Δ peak VO₂ and the heartbeat tracking task score. Multiple regression analysis was performed to determine the predictors of %Δ peak VO₂. Of 120 participants, 100 patients (age 65.9 ± 11.9 years; 86% male) were included. There was a significant positive association between %Δ peak VO₂ and the heartbeat tracking task score at baseline (R ² = 0.236, P < 0.001). In multiple regression analysis, the percentage of measured peak VO₂ to the predicted value (%predicted peak VO₂) (β = -0.248, P = 0.002), exercise adherence (β = 0.364, P < 0.001), and heartbeat tracking task score at baseline (β = 0.372, P < 0.001) were significantly associated with %Δ peak VO₂.

Conclusions

Heartbeat tracking task performance, an indicator of interoceptive accuracy, at baseline is associated with the degree of improvement in exercise tolerance.

Associations of Spiritual Well-Being and Hope with Health Anxiety Severity in Patients with Advanced Coronary Artery Disease

Background and Objectives: Health anxiety is one of the most common problems in patients with coronary artery disease. The present study tested whether health anxiety severity could be predicted by spiritual well-being and hope in patients with advanced coronary artery disease. Materials and Methods: In a cross-sectional study, 100 patients with advanced coronary artery disease were recruited from hospitals and healthcare centers in Iran. Patients completed self-report scales, including the Spiritual Well-Being Scale, Adult Hope Scale, and Short Health Anxiety Inventory. Hierarchical multiple regression analyses were used to empirically explore the relations among variables. Results: Results indicated that patients who reported higher levels of hope (β = 0.42, p < 0.01) and spiritual well-being (β = 0.20, p < 0.05) reported lower levels of health anxiety. Agency (β = 0.58, p < 0.01) scores were a significant negative predictor of health anxiety severity. Additionally, religious spirituality scores (β = 0.28, p < 0.01) were shown to significantly negatively predict health anxiety level. However, the pathways components of hope and existential spirituality were not significant predictors. Conclusion: The findings of the present study indicate that spiritual well-being and hope could be important factors in determining health anxiety for adults with coronary artery disease, and their role is worthy of further exploration to help improve health anxiety for patients with coronary artery disease.