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Depression, Comorbid Anxiety Disorders, and Heart Rate Variability in Physically Healthy, Unmedicated Patients: Implications for Cardiovascular Risk  [PDF]
Andrew H. Kemp, Daniel S. Quintana, Kim L. Felmingham, Slade Matthews, Herbert F. Jelinek
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0030777
Abstract: Context There is evidence that heart rate variability (HRV) is reduced in major depressive disorder (MDD), although there is debate about whether this effect is caused by medication or the disorder per se. MDD is associated with a two to fourfold increase in the risk of cardiac mortality, and HRV is a robust predictor of cardiac mortality; determining a direct link between HRV and not only MDD, but common comorbid anxiety disorders, will point to psychiatric indicators for cardiovascular risk reduction. Objective To determine in physically healthy, unmedicated patients whether (1) HRV is reduced in MDD relative to controls, and (2) HRV reductions are driven by MDD alone, comorbid generalized anxiety disorder (GAD, characterized by anxious anticipation), or comorbid panic and posttraumatic stress disorders (PD/PTSD, characterized by anxious arousal). Design, Setting, and Patients A case-control study in 2006 and 2007 on 73 MDD patients, including 24 without anxiety comorbidity, 24 with GAD, and 14 with PD/PTSD. Seventy-three MDD and 94 healthy age- and sex-matched control participants were recruited from the general community. Participants had no history of drug addiction, alcoholism, brain injury, loss of consciousness, stroke, neurological disorder, or serious medical conditions. There were no significant differences between the four groups in age, gender, BMI, or alcohol use. Main Outcome Measures HRV was calculated from electrocardiography under a standardized short-term resting state condition. Results HRV was reduced in MDD relative to controls, an effect associated with a medium effect size. MDD participants with comorbid generalized anxiety disorder displayed the greatest reductions in HRV relative to controls, an effect associated with a large effect size. Conclusions Unmedicated, physically healthy MDD patients with and without comorbid anxiety had reduced HRV. Those with comorbid GAD showed the greatest reductions. Implications for cardiovascular risk reduction strategies in otherwise healthy patients with psychiatric illness are discussed.
Are Nutrition and Dietetics Students More Prone to Eating Disorders Related Attitudes and Comorbid Depression and Anxiety than Non-Dietetics Students?  [PDF]
Aliye Ozenoglu, G?kce Unal, Aydan Ercan, Hatice Kumcagiz, Kamil Alakus
Food and Nutrition Sciences (FNS) , 2015, DOI: 10.4236/fns.2015.614131
Abstract: It was aimed to investigate the eating attitudes and its relationships with anxiety and depression at Nutrition and Dietetics students. Students of Nutrition and Dietetics Departments were included in study group (n: 135) and non-medical students (n: 69) were in control group. Eating attitudes test (EAT-40), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied to all students and some anthropometric measurements were taken. Body mass index (BMI) and percent of body fat were higher at students in study group than students in control group. There were no significant differences between groups with respect to EAT, BDI and BAI scores. But, BMI and body fat percentage in girls were significantly lower than boys. Both EAT and BDI scores were significantly higher in girls than boys but BAI scores did not differ significantly. It was concluded that students training on Nutrition and Dietetics might have obsessions related to body image. But results of this study revealed that especially young women were more susceptible to eating disorders and depression.
Anxiety and Depression Disorders in Chronic Non-Specific Low Back Pain in Lomé (Togo)  [PDF]
Kodjo Kakpovi, Kokou M. A. Soedje, Viwalé E. S. Koffi-Tessio, Kodjo E. Ahoble, Eyram Fianyo, Prénam Houzou, Komi C. Tagbor, Kolou S. Dassa, Owonayo Oniankitan, Moustafa Mijiyawa
Open Journal of Rheumatology and Autoimmune Diseases (OJRA) , 2017, DOI: 10.4236/ojra.2017.71001
Abstract: Chronic non-specific low back pain has an important psychological impact. Objectives: To determine the prevalence of anxiety and depressive disorders (ADD) and factors associated to their apparition in patients suffering from chronic non-specific low back pain in rheumatological consultation in Lomé. Patients and Methods: It was a cross-sectional study, conducted from October 1st, 2015 to 31st March 2016. This study focused on all patients suffering from common chronic low back pain without psychiatric history in the Rheumatology Ward at the Sylvanus Olympio’s Teaching Hospital of Lomé and who have given their consent. The psychological evaluation was carried out through Hamilton scale. The processing, the statistical treatment and analysis of our data have been carried out using Epiinfo software, version 7.1.5. The investigation was approved by the local Ethics Committee. Results: 48 (39 women and 09 men) out of 123 patients with chronic lower back pain presented anxiety and depressive disorders (ADD) accounting for a prevalence rate of 39%. Their average age was 50.3 years old. The most frequent ADD was: psychic anxiety (58.6%), depressive mood (51.3%), difficulties to feel asleep (47.9%) and disturbed or agitated sleep (43.1%). Factors associated with the anxiety and depressive disorders in common chronic low back pain were: female gender (p = 0.02), dependent children (p = 0.02), occupation (reseller (p = 0.002), liberal profession (p = 0.009), monthly financial income (p = 0.002), surroundings family (0.009), medical history (p = 0.0002) and pain’s intensity > 7 (p = 0.04). Conclusion: This study shows the high frequency of anxiety and depressive disorders in common chronic low back pain and their influence by socio-economic and demographic factors.
The lability of behavior as a marker of comorbid depression and anxiety  [PDF]
Irina N. Trofimova, William Sulis
Advances in Bioscience and Biotechnology (ABB) , 2010, DOI: 10.4236/abb.2010.13027
Abstract: This study examines nine dynamical and three emotional aspects of behavior in depression and anxiety, singly and comorbidly. The study employs the Structure of Temperament Questionnaire Compact (STQ 77), whose 12 scales assess the energetic, lability and sensitivity aspects of behavior in the physical, social, mental and emotional domains. The STQ 77 was administered to 86 patients with Major Depression, 85 patients with an anxiety disorder, 43 patients with comorbid depression and anxiety, and 71 subjects without depression or anxiety disorder all presenting to a private outpatient clinical practice. Results: 1) Depression was associated with self-reports of increased impulsivity and rigidity of behavior; 2) Depressed patients reported significantly lower physical energy, tempo of physical activity and plasticity of behavior. The presence of comorbid anxiety further worsened these effects; 3) The ability to sustain attention on a mental task and to learn new information was lower in depressed patients than in other groups. Conclusions: comorbid depression and anxiety might be associates, decreasing adaptivity and the self-regulatory balance of behavior, leading to the de- velopment of extremes in behavioral reactivity (impulsivity and rigidity).v
The Association between Hypertension and Depression and Anxiety Disorders: Results from a Nationally-Representative Sample of South African Adults  [PDF]
Anna Grimsrud, Dan J. Stein, Soraya Seedat, David Williams, Landon Myer
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0005552
Abstract: Objective Growing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa. Methods Data come from a nationally-representative survey of adults (n = 4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between self-reported hypertension and anxiety disorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions. Results Overall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12-month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12-month anxiety disorders [Odds ratio (OR) = 1.55, 95% Confidence interval (CI) = 1.10–2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxiety disorders (OR = 2.25, 95% CI = 1.46–3.45), but not 12-month depressive disorders or comorbid anxiety-depression. Conclusions These are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders.
Association of Comorbidity with Depression Treatment Adequacy among Privately Insured Patients Initiating Depression Treatment  [PDF]
Yong Joo Rhee, Mara Gustafson, Michael Ziffra, David C. Mohr, Neil Jordan
Open Journal of Depression (OJD) , 2015, DOI: 10.4236/ojd.2015.42002
Abstract: This study examined the association among comorbidity, type of depression treatment, and depression treatment adequacy among privately insured depression patients using claims data from 165,569 employees. Individuals newly diagnosed with depression (n = 2364) were identified using ICD-9 diagnosis codes. Logistic regression models were used to determine if certain medical and psychiatric comorbidities were associated with depression treatment type (medication only, psychotherapy only, or combined treatment) and treatment adequacy. Approximately half of the sample (56.7%) received medication only, 26.8% received psychotherapy and medication, and 16.5% received psychotherapy only. The medication only group had the highest rate (50.2%) of receiving minimally adequate treatment, while those who received the combined treatment had the lowest rate (21.0%). Patients with comorbid anxiety disorders were significantly more likely to receive combined treatment or psychotherapy alone. Those who had comorbid musculoskeletal pain were significantly more likely to receive combined treatment. After controlling for treatment type, patients with comorbid diabetes and asthma had higher rates of receiving adequate treatment than patients with other comorbid conditions. There is a continous need for practice-system level interventions to improve the proportion of privately insured patients with new depressive episodes who receive adequate depression treatment.
The Comorbidity Of Depression And Anxiety In A Sample Of Iranian Patients
H. Kaviani,H. Ghasemzadeh
Tehran University Medical Journal , 2003,
Abstract: This study was carried out to examine the comorbidity of depression and anxiety disorders."nMaterials and Methods: 261 depressed (n=153) and anxious (n=108) patients were psychiatrically interviewed, and then tested by two scales, BAI and BD1; 261 healthy subjects (matched with depressed and anxious patients) completed BAT and BDl as well."nResults: The results showed that %55.6 of depressed and %58.3 of anxious patients had respectively a comorbid anxiety and depression disorders."nConclusion: The detection of symptoms overlap revealed that depressed patients experienced most of the anxiety symptoms, and anxious patients reported most of the depression symptoms. The prevalence of depression and anxiety symptoms among healthy subjects will be discussed.
Functional impairment related to painful physical symptoms in patients with generalized anxiety disorder with or without comorbid major depressive disorder: post hoc analysis of a cross-sectional study
Irene Romera, ángel L Montejo, Fernando Caballero, Luis Caballero, José Arbesú, Pepa Polavieja, Durisala Desaiah, Inmaculada Gilaberte
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-69
Abstract: This is a post hoc analysis of a cross-sectional study. Functioning, in the presence (overall pain score >30; Visual Analog Scale) or absence of PPS, was assessed using the Sheehan Disability Scale (SDS) in three groups of patients; 1) GAD and comorbid MDD (GAD+MDD+), 2) GAD without comorbid MDD (GAD+MDD-), 3) controls (GAD-MDD-). ANCOVA models were used.Of those patients with GAD+MDD+ (n = 559), 436 (78.0%) had PPS, compared with GAD+MDD- (249 of 422, 59%) and controls (95 of 336, 28.3%). Functioning worsened in both GAD groups in presence of PPS (SDS least squares mean total score: 16.1 vs. 9.8, p < 0.0001, GAD+MDD+; 14.3 vs. 8.2, p < 0.0001, GAD+MDD-). The presence of PPS was significantly associated with less productivity.Functional impairment related to the presence of PPS was relevant. Clinical implications should be considered.Generalized anxiety disorder (GAD), a mental disorder highly prevalent in primary care patients (8%-14%), is generally associated with a significant impairment in patients' functioning [1,2]. Patients with GAD experience functional impairments, such as diminished social relationships, poorer well-being, and less satisfaction with life [3], that lead to reduced quality of life in the areas of interaction with friends, self-realization, subjective well-being [4,5], and work [6]. These patients are more likely to have absences from work and short-term disabilities; therefore, the indirect costs of the disease attributable to low productivity are increased [7]. The level of impairment is substantial and is even comparable to that of major depression [8]. As expected, the highest level of functional impairment occurs when GAD is comorbid with depression, which is a common feature in primary care [1,8].The pathological feature most uniquely associated with GAD and that differentiates it from other anxiety disorders is excessive, pervasive, and uncontrollable worrying [9-12]. Such worrying in patients with GAD is frequently accompanied by a ho
Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit
Soares-Filho, Gast?o L. F.;Freire, Rafael C.;Biancha, Karla;Pacheco, Ticiana;Volschan, André;Valen?a, Alexandre M.;Nardi, Antonio E.;
Clinics , 2009, DOI: 10.1590/S1807-59322009000300011
Abstract: objective: to determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. introduction: patients arriving at a chest pain unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. methodology: patients were assessed by the "hospital anxiety and depression scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. results: according to the protocol, 59 (45.4%) of 130 patients studied presented chest pain of determined cause, and 71 (54.6%) presented chest pain of indefinite cause. in the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. in the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. conclusion: the high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. when coronary arterial disease is present, this may decrease complications and shorten hospital stay. when psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.
Assessment of clinical depression comorbid with posttraumatic stress disorder  [PDF]
Simonovi? Maja,Grbe?a Grozdanko,Milenkovi? Tatjana,Radisavljevi? Mi?a
Vojnosanitetski Pregled , 2008, DOI: 10.2298/vsp0803199s
Abstract: Background/Aim. Comorbidity of the posttraumatic stress disorder (PTSD) and depression is often recognized in the clinical practice. The aim of the paper was to determine the severity of depression and the group of symptoms which are the most prominent in clinical depression comorbid with PTSD. Methods. Totally 60 patients were assessed and divided into the experimental and control group using the Structured Clinical Interview for DSM-IV Axis I Disorders, Investigator Version (SCID-I, modified) (SCID for DSM-IV) and ICD-10 diagnostic criteria. The presence and the severity of the disorders were assessed by means of the following instruments: Clinician-Administrated PTSD Scale for DSM-IV (CAPS-DX), Montgomery-Asberg Depression Rating Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HAMD). The differences between groups were evaluated using Student t test and by means of the correlation analysis of the data with p < 0.05. Results. The obtained results showed that depression witch was comorbid with PTSD was of significant clinical severity with 31.20 score on HAMD and 30.43 score on MADRS in PTSD-D group. The group of the symptoms: lassitude, inability to feel, suicidal thoughts and inner tension contributed mostly to the global severity of the comorbid clinical depression on MADRS. The group of the symptoms: suicide and somatic symptoms, gastrointestinal, guilt, hypochondriasis, work and activity, anxiety psychic, agitation, and weight loss, genital symptoms and anxiety somatic contributed mostly to the global severity of comorbid clinical depression on HAMD. The average score was 16.03 and 16.97 on HAMD and MADRS, respectively in PTSD group. Conclusion. Depression which is comorbid with posttraumatic stress disorder represents significant clinical entity with domination of the different groups of symptoms between the groups PTSD and PTSD-D on HAMD. Identification of aforementioned severity of illness and delineated group of symptoms lead the clinician to establish the diagnosis of depression, reduce the risk of diagnostic ommition of the depression and enable the clinician to chose the optimal treatment method for the delineated disorders.
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