Clinical correlates of state and trait anxiety in multiple sclerosis

BACKGROUND

Anxiety represents one of the most prevalent psychiatric symptoms in multiple sclerosis (MS), impacting the overall disease burden and quality of life. This psychopathological feature can be expressed as state (S-ANX) and trait (T-ANX) anxiety, but few studies specifically evaluated these two components in MS. The present study was aimed at investigating the prevalence and specific correlates of S-ANX and T-ANX in a cohort of people with MS (PwMS).

METHODS

88 in- and out-patients with MS were consecutively recruited. S-ANX and T-ANX were evaluated with the two subscales of the State and Trait Anxiety Inventory. Bivariate analyses were performed to compare PwMS who displayed clinically significant S-ANX and T-ANX and those who did not. Two logistic regression models were run in order to identify variables significantly associated with S-ANX and T-ANX.

RESULTS

S-ANX and T-ANX presented a prevalence of 42% and 45.5%, respectively. S-ANX was more frequent in subjects hospitalized due to recent MS onset. PwMS and S-ANX more frequently had a recent relapse, as well as evidence of disease activity on brain magnetic resonance imaging. Subjects with T-ANX were more often females and displayed higher severity of fatigue. Depressive features at the Beck Depression Inventory were more severe in both S-ANX and T-ANX subjects. PwMS with S-ANX reported a higher prevalence of T-ANX and vice versa. At the logistic regressions, depression severity displayed a significant association with S-ANX and T-ANX. We also detected positive associations between S-ANX and inpatient status, as well as between T-ANX and female sex.

CONCLUSION

Both S-ANX and T-ANX are highly prevalent features in PwMS. These two components of anxiety should be adequately identified and discriminated in the clinical practice. The higher severity of depression in PwMS with clinically significant anxiety should not be neglected.

Personality and psychopathology in Ménière's disease

INTRODUCTION AND OBJECTIVES

Psychological factors in vertigo patients have been extensively studied but the role of anxiety and personality traits in the clinical course of Ménière's disease (MD) is unknown. The objectives of this study are to identify and characterize psychopathology in MD and to find risk factors for an increased rate and intensity of crisis and chronic symptoms.

MATERIALS AND METHODS

We performed a transversal study in all patients diagnosed with definite MD in our department during a 5-year period. Sample subjects were interviewed in 3 steps: first, an otorhinolaryngologist collected information about clinical and pharmacological background of MD; second, a psychiatrist screened for mood, anxiety and personality disorders; in a third stage, the patient completed the DHI (Dizziness Handicap Inventory), STAI-Y (State Trait Anxiety Inventory), NEO-PI-R (Neo Personality Inventory Reviewed) and VAS (Visual Analogue Scale) for vertigo and dizziness. Statistical analysis was performed to search for risk factors for multiple and intense crisis and chronic symptoms.

RESULTS

Thirty-four patients completed all 3 phases of the study. A predominant dysfunctional personality trait was identified in 80% of patients (predominantly cluster C type), 35% were being treated with psychiatric medication and 34.4% had a considerable mood or anxiety disorder. All patients scored high (>7) in VAS during crisis. There was a statistically significant positive correlation between crisis rate and STAI, anxiety-subscale (N1) in NEO-PI-R, VAS and DHI scores (p<.044). Crises were more common in bilateral MD (p=.041). DHI scores were higher with higher STAI and N1 (p=.001). Disease duration and pure tone average were found to have a positive moderate correlation (p=.017).

CONCLUSIONS

The positive correlations between crisis rate, chronic dizziness and anxiety-related personality traits reveal a bidirectional and intimate relationship between personality, anxiety and MD, affecting these patients' quality of life. These results support the relevance of prospecting adjuvant psychological and psychiatric approaches to these patients.

Personality and psychopathology in Ménière's disease

INTRODUCTION AND OBJECTIVES

Psychological factors in vertigo patients have been extensively studied but the role of anxiety and personality traits in the clinical course of Ménière's disease (MD) is unknown. The objectives of this study are to identify and characterize psychopathology in MD and to find risk factors for an increased rate and intensity of crisis and chronic symptoms.

MATERIALS AND METHODS

We performed a transversal study in all patients diagnosed with definite MD in our department during a 5-year period. Sample subjects were interviewed in 3 steps: first, an otorhinolaryngologist collected information about clinical and pharmacological background of MD; second, a psychiatrist screened for mood, anxiety and personality disorders; in a third stage, the patient completed the DHI (Dizziness Handicap Inventory), STAI-Y (State Trait Anxiety Inventory), NEO-PI-R (Neo Personality Inventory Reviewed) and VAS (Visual Analogue Scale) for vertigo and dizziness. Statistical analysis was performed to search for risk factors for multiple and intense crisis and chronic symptoms.

RESULTS

Thirty-four patients completed all 3 phases of the study. A predominant dysfunctional personality trait was identified in 80% of patients (predominantly cluster C type), 35% were being treated with psychiatric medication and 34.4% had a considerable mood or anxiety disorder. All patients scored high (>7) in VAS during crisis. There was a statistically significant positive correlation between crisis rate and STAI, anxiety-subscale (N1) in NEO-PI-R, VAS and DHI scores (p<.044). Crises were more common in bilateral MD (p=.041). DHI scores were higher with higher STAI and N1 (p=.001). Disease duration and pure tone average were found to have a positive moderate correlation (p=.017).

CONCLUSIONS

The positive correlations between crisis rate, chronic dizziness and anxiety-related personality traits reveal a bidirectional and intimate relationship between personality, anxiety and MD, affecting these patients' quality of life. These results support the relevance of prospecting adjuvant psychological and psychiatric approaches to these patients.

Influence of trait anxiety, child maltreatment, and adulthood life events on depressive symptoms

BACKGROUND

Various personality traits mediate the association between childhood stress and depressive symptoms in adulthood. The aim of this study was to clarify the indirect effects of the experience of child maltreatment on depressive symptoms and appraisal of life events in adulthood through trait anxiety.

SUBJECTS AND METHODS

A total of 404 participants who were volunteer subjects from the community were studied using the following self-administered questionnaire surveys: Patient Health Questionnaire-9, which measures depressive symptoms; State-Trait Anxiety Inventory Form Y, which measures trait anxiety; the Child Abuse and Trauma Scale, which measures child maltreatment; and Life Experiences Survey, which measures negative and positive appraisal of adulthood life events.

RESULTS

Structural equation modeling demonstrated that the experience of child maltreatment increased depressive symptoms in adulthood as well as the negative appraisal of life events in adulthood through an increase in trait anxiety. Furthermore, trait anxiety affected depressive symptoms in adulthood through its influence on the negative appraisal of adulthood life events. The following indirect effect was also significant: the experience of child maltreatment increased the negative appraisal of adulthood life events via trait anxiety and subsequently influenced adult depressive symptoms.

LIMITATIONS

The subjects of this study are volunteer subjects from the community including healthy people, and hence the results may not be generalizable to major depressive patients. Recall bias should be considered when interpreting the results. Because this study is a cross-sectional study, the causality between the experience of child maltreatment and depression is not clear.

CONCLUSION

This study suggests that trait anxiety may play a mediating role in the influence of the experience of child maltreatment on depressive symptoms in adulthood and negative appraisal of adulthood life events.

Fasciatherapy and Reflexology compared to Hypnosis and Music Therapy in Daily Stress Management

BACKGROUND

Patients suffering from stress symptoms due to every-day life who are looking for a non-pharmacological response to their relief expectation are many. Furthermore, early reckoning of the day-to-day stress which may lead to clinical diagnosis is the best way of preventing the stress-related diseases. Among the many alternative medicinal options, there is little evidence that fasciatherapy (Fs) and reflexology (Rf) are effective in this field.

PURPOSE

assess incidence of fasciatherapy Danis Bois Method (DBM) and of reflexology on patients' stress level in everyday-life, and provide a more informed choice among the numerous mind and body techniques by comparing them with hypnosis (Hp) and music therapy (Mt).

SETTINGS

Specialized Complementary and Alternative Medicine (CAM) centres for outpatients.

PARTICIPANTS

308 individuals (average age = 50.53 SD 14.37, 93 males, 215 females) going to the centres for health care, but free from serious diseases and not heavily medicated respecting the inclusion criteria and providing valid forms.

RESEARCH DESIGN

Four armed, non-randomized observational pragmatic trial with pretest-posttest repeated measures, on separate samples of natural groups.

INTERVENTION

According to the centre participants where they used to be treated, they were exposed to a single semi-standardized session of a technique of their choice: Fs, Rf, Hp, Mt. Volunteers had a controlled non-intervention resting (Rt) session.

MAIN OUTCOME MEASURES

Mean STAI-Y assessing anxiety as reflecting the stress level: MANCOVA and ANCOVA performed with Tukey's HSD.

RESULTS

MANCOVA indicates a significant reduction of anxiety (p < .01) in each condition, resting included. ANCOVA performance adjusting on stress level in T0 (41.73) and on the mean sumscore of the trait (44.89), Fs (-13.92), Rf (-15.92), and Hp (-15.88) were equally effective on the stress level decrease. Mt (-10.0) and Rt (-6.38) showed the same level of effectiveness.

CONCLUSIONS

The results suggest fasciatherapy DBM, hypnosis, and reflexology could be used as non-pharmacological and safe interventions in stress management. Though showing a lesser efficiency, music therapy could be useful in different circumstances.

Anxiety in Multiple Sclerosis: psychometric properties of the State-Trait Anxiety Inventory

OBJECTIVE

The aims of the present study were to examine psychometric properties of the Spielberger State-Trait Anxiety Inventory (STAI-Y-1 and STAI-Y-2, respectively) in a Multiple Sclerosis (MS) population and to identify a cut-off score to detect those MS patients with high level of state and/or trait anxiety who could be more vulnerable to development of depression and/or cognitive defects.

MATERIAL AND METHODS

The STAI-Y-1 and STAI-Y-2 was completed by a group of patients (n = 175) affected by MS and a group of healthy subjects (n = 150) matched for age, educational level, and gender. In MS patients internal consistency, divergent and discriminant validities were evaluated. Construct validity was examined by exploratory factor analysis for each scale.

RESULTS

There was no missing data, no floor or ceiling effects for both scales. The two scales showed high internal consistency, good divergent, and Known-groups validities. To identify high levels of state and trait anxiety in a patient with MS, we proposed three gender specific screening cut-off values (1, 1.5, 2 SD) for the STAI-Y-1 and the STAI-Y-2.

CONCLUSIONS

The findings showed that the STAI-Y-1 and the STAI-Y-2 are a valid tool for clinical use in MS patients and can be useful to measure the severity of anxiety and to identify those patients with high anxiety to introduce them in specific non-pharmacological intervention.

Patient-controlled analgesia with inhaled methoxyflurane versus conventional endoscopist-provided sedation for colonoscopy: a randomized multicenter trial

OBJECTIVE

Inhaled methoxyflurane (Penthrox, Medical Device International, Melbourne, Australia) has been used extensively in Australasia (Australia and New Zealand) to manage trauma-related pain. The aim is to evaluate the efficacy, safety, and outcome of Penthrox for colonoscopy.

DESIGN

Prospective randomized study.

SETTING

Three tertiary endoscopic centers.

PATIENTS

Two hundred fifty-one patients were randomized to receive either Penthrox (n = 125, 70 men, 51.4 ± 1.1 years old) or intravenous midazolam and fentanyl (M&F; n = 126, 72 men, 54.9 ± 1.1 years old) during colonoscopy.

MAIN OUTCOME MEASUREMENT

Discomfort (visual analogue scale [VAS] pain score), anxiety (State-Trait Anxiety Inventory Form Y [STAI-Y] anxiety score), colonoscopy performance, adverse events, and recovery time.

RESULTS

Precolonoscopy VAS pain and STAI-Y scores were comparable between the 2 groups. There were no differences between groups in (1) pain VAS or STAI Y-1 anxiety scores during or immediately after colonoscopy, (2) procedural success rate (Penthrox: 121/125 vs M&F: 124/126), (3) hypotension during colonoscopy (7/125 vs 8/126), (4) tachycardia (5/125 vs 3/126), (5) cecal arrival time (8 ± 1 vs 8 ± 1 minutes), or (6) polyp detection rate (30/125 vs 43/126). Additional intravenous sedation was required in 10 patients (8%) who received Penthrox. Patients receiving Penthrox alone had no desaturation (oxygen saturation [SaO(2)] < 90%) events (0/115 vs 5/126; P = .03), awoke quicker (3 ± 0 vs 19 ± 1 minutes; P < .001) and were ready for discharge earlier (37 ± 1 vs 66 ± 2 minutes; P < .001) than those receiving intravenous M&F.

LIMITATIONS

Inhaled Penthrox is not yet available in the United States and Europe.

CONCLUSIONS

Patient-controlled analgesia with inhaled Penthrox is feasible and as effective as conventional sedation for colonoscopy with shorter recovery time, is not associated with respiratory depression, and does not influence the procedural success and polyp detection.

Effect of a homeopathic-complex medicine on state and trait anxiety and sleep disorders: a retrospective observational study

PURPOSE

The primary objective of this open-label, retrospective, observational study was to examine change in indicators of anxiety changed after treatment period of at least 1 month with the homeopathic-complex medicine Datif-PC(®). A secondary objective was to describe the quantitative changes in the sleep pattern of the subjects included in the study.

METHODS

The study population consisted of 71 subjects suffering from mild to moderate anxiety, who were treated with a homeopathic-complex medicine. The subjects had attended at least 2 consultations during the year 2010, with the second visit taking place at least 30 days after the first baseline visit. At both visits, subjects were administered the State-Trait Anxiety Inventory (STAI)-Y questionnaire (consisting of trait and state subscales) to assess their level of anxiety. Sleep quality was assessed based on the subjects' self-reported number of hours slept and number of night-time awakenings, before and after treatment.

RESULTS

Compared to baseline, the average (STAI)-state score at visit 2 decreased by more than 6 points, while the STAI-trait score decreased by more than 3 points. This was statistically significant (p < 0.0001) for both subscales. These findings were stable in subgroup analyses (gender, age and anxiety level). The average number of hours slept per night increased significantly at visit 2 compared to baseline (from 5.1 ± 1.1 to 5.56 ± 0.9 h, p < 0.0001). A marked decrease in the average number of night-time awakenings was also observed at the second visit (-42%, p < 0.0001).

CONCLUSIONS

This retrospective observational study suggests that treatment of anxiety and sleep disorders with Datif-PC(®) can produce notable improvements even in a short period of time. Furthermore, the observed effects were not affected by sex, age or baseline anxiety. Further controlled, randomized studies are justified.