Distinct neurostructural signatures of anxiety-, fear-related and depressive disorders: a comparative voxel-based meta-analysis

Internalizing disorders encompass anxiety, fear and depressive disorders. While the DSM-5 nosology conceptualizes anxiety and fear-related disorders as an entity, dimensional psychopathology models suggest that generalized anxiety disorders (GAD) and major depression originate from an overarching "anxious-misery" factor whereas fear-related disorders originate from the "fear" factor. Given that a neurobiological evaluation is lacking, we conducted a comparative neuroimaging meta-analysis of gray matter volume alterations to determine common and disorder-specific brain structural signatures in these disorders. The PubMed, Web of Knowledge, and Scopus databases were searched for case-control voxel-based morphometric studies through December, 2020 in GAD, fear-related anxiety disorders (FAD, i.e., social anxiety disorders, SAD; specific phobias, SP; panic disorders, PD; and agoraphobia, AG) and major depressive disorder (MDD). Neurostructural abnormalities were assessed within each disorder group followed by quantitative comparison and conjunction analyses using Seed-based d-Mapping (SDM-PSI). GAD (9 studies, 226 patients) showed disorder-specific decreased volumes in left insula (z=-2.98, pFWE-corrected <0.05) and lateral/medial prefrontal cortex (z=-2.10, pFWE-corrected<0.05,) as well as increased right putamen volume (z=1.86, pFWE-corrected<0.05) relative to FAD (10 SAD, 11 PD, 2 SP studies, 918 patients). Both GAD and MDD (46 studies, 2,575 patients) exhibited decreased prefrontal volumes compared to controls and FAD. While FAD showed less robust alterations in lingual gyrus (p < 0.0025, uncorrected), this group presented intact frontal integrity. No shared structural abnormalities were found. Unique clinical features characterizing anxiety-, fear-related and depressive disorders are reflected by disorder-specific neuroanatomical abnormalities. Targeting the disorder-specific neurostructural signatures could improve therapeutic efficacy.

Does Online Counseling Reduce Anxiety in Parents of Children with Autism Spectrum Disorders During Coronavirus Disease 2019 Pandemic?

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has made governments in a number of countries to issue and implement a regulation of social and physical restriction. It leaves a serious impact, one of which is anxiety experienced by parents of children with autism spectrum disorder (ASD) as the only access to therapy and education for their children has to be done online. AIM: The purpose of this study was to determine the optimization of online counseling on the anxiety in parents of children with ASD during COVID-19 pandemic. MATERIALS AND METHODS: The design of this study used pre-test-post-test design without control. The sampling technique used purposive sampling with 46 respondents. The instrument used online counseling design and Generalized Anxiety Disorders-7 which has been tested for validity and reliability. This study used marginal homogeneity test. RESULTS: The result showed that the majority of respondents’ anxiety before and after online counseling had severe and minimal anxiety (16 respondents, 34.8% and 15 respondents, 32.6%, respectively) with p = 0.012. CONCLUSIONS: There was an effect of online counseling on anxiety in parents of children with ASD during COVID-19 pandemic. This can serve as a recommendation in providing online counseling to reduce anxiety in parents of children with ASD during COVID-19 pandemic.

FREQUENCY OF GENERALIZED ANXIETY DISORDERS IN PATIENTS WITH POLYCYSTIC OVARIAN SYNDROME

Objective: To determine the factors associated with generalized anxiety disorders in patients presenting with polycystic ovarian syndrome. Study Design: Cross-sectional study. Place and Duration of Study: Gynecology and Psychiatric outpatient department of Pakistan Institute of Medical Sciences, SZABMU, Islamabad, from Jan to Jul 2016. Methodology: Patients presenting with polycystic ovarian syndrome were enrolled. Patients were selected from the gynaecological and Medicine department. Patient’s history was taken and diagnosis of generalized anxiety disorder was made utilising Generalized Anxiety Disorder-7. Patients having diabetes mellitus, hypertension, Cushing’s syndrome, hypoglycaemia, co-morbid psychiatric illnesses, history of psychiatric illness in past and family history of psychiatric illness were excluded from the study. Results: Among 105 patients with polycystic ovarian syndrome, 79 (75%) patients had no generalized anxiety disorders while, 26 (25%) had generalized anxiety disorders. 2 out of 12 (16.6%) patients of age range of 15-20 year had generalized anxiety disorders, 9 out of 63 14.2% patients having age 21-30 years had generalized anxiety disorders and 15 out of 30 (50%) patients having age 31-40 years age had generalized anxiety disorders. Chi-square test revealed age, education level and socioeconomic status has a significant association with presence of generalized anxiety disorder among patients of polycystic ovarian disorder (with p-value <0.05). Conclusion: Generalized anxiety disorder was common in patients with polycystic ovarian syndrome. Age, low education level and low socioeconomic status had a significant relationship with generalized anxiety disorder in polycystic ovarian syndrome patients.

The Schoolteachers' Version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Stress and Anxiety During the COVID-19 Pandemic

This study aimed to validate the schoolteachers' version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale. This scale assessed the work-related stress and anxiety response of schoolteachers to the COVID-19 pandemic. A total of 400 schoolteachers participated in an online survey between March 4 and 15, 2021. The survey questionnaire included the schoolteachers' version of the SAVE-9, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorders-7 (GAD-7) scales. A scree test and parallel analysis suggested a single-factor structure model for the schoolteachers' version of the SAVE-9 scale (real-data eigenvalue = 68.89, 95th percentile of the random eigenvalues = 27.56). The SAVE-9 scale showed good internal consistency (Cronbach's alpha = 0.853) and good convergent validity with GAD-7 (rho = 0.545, p &lt; 0.001) and PHQ-9 (rho = 0.434, p &lt; 0.001) scale scores. This, schoolteachers' version of the SAVE-9 scale is a reliable and valid rating scale that can be applied to teachers in a pandemic situation.

Impact of COVID 19 pandemic on psychological wellbeing of oncology clinicians in MENA (Middle East and North Africa) region.

e24105 Background: Cancer care has been severely affected by covid 19 pandemic leading to medical, ethical and organizational issues. Oncology healthcare professionals face challenges due to reorganization of cancer services and increasing health care requirements resulting in uncertainty and psychological stress. Aim of this study is to evaluate the impact of covid 19 pandemic on psychological well being of oncology clinicians in the MENA region. Methods: We randomly invited 1500 oncology clinicians including medical oncologists, clinical oncologists, radiation oncologists and surgical oncologists from 17 countries in the MENA region to complete a web based survey to determine the level of psychological stress during covid 19 pandemic from October 2020 to January 2021. The questionnaire was based on Perceived Stress Scale (PSS), Generalized Anxiety Disorders Scale (GAD-7) and WHO Well-being Index (WHO-5). The data was analyzed using SPSS version 21 and difference between groups was measured by T-test and ANOVA. Results: Overall 520 (35%) oncology clinicians including 368 (71%) males and 152 (29%) females participated in the survey. Most of the participants were medical oncologists (38%) from teaching institutions (76%) and the public sector (84%). 46% (n = 242) participants were 35-45 years of age. Majority of clinicians reported moderate (45.6%) to severe (42.3%) anxiety on GAD-7 scale. Females had statistically higher levels of anxiety (average score;15.46 ±4.87, p = 0.04). On PSS, the majority of participants reported higher stress with average scores (29.64 ±3.83) for males and (30.23 ±4.62) for females. Average score for WHO wellbeing index was 62.95 (±20.52) for males and 74.3 (±20.87) for females denoting a preservation of general well being, even in a higher stress and anxiety situation. Female gender was significantly associated with anxiety level on GAD-7 scale (p = 0.04), but this difference in stress level and well being was not observed on PSS (p = 0.134) and WHO well being index (p = 0.709). Clinicians of ages 25-35 years had significantly higher anxiety levels on GAD-7 scale (p = 0.004) and higher stress on PSS (p = 0.000). Age over 55 years was associated with lower levels of anxiety and stress on GAD-7 and PSS. Oncology clinicians working in public sector experienced significantly lower stress as compared to private sector on PSS scale (p = 0.041) Conclusions: Covid 19 pandemic has significantly increased the anxiety and stress levels among oncology clinicians in the MENA region. Anxiety and stress were higher in females and young clinicians. Clinicians over 55 years of age and oncologists working in the public sector reported less stress and anxiety. General well being of clinicians was well preserved even in a highly stressful and anxious situation.

Factors associated with suicide risk among Chinese adults: A prospective cohort study of 0.5 million individuals

Background Suicide is a leading cause of death in China and accounts for about one-sixth of all suicides worldwide. The objective of this study was to examine the recent distribution of suicide and risk factors for death by suicide. Identifying underlying risk factors could benefit development of evidence-based prevention and intervention programs. Methods and findings We conducted a prospective study, the China Kadoorie Biobank, of 512,715 individuals (41% men, mean age 52 years) from 10 (5 urban, 5 rural) areas which are diverse across China in geographic locations, social economic developmental stages, and prevalence of disease patterns. After the baseline measurements of risk factors during 2004 to 2008, participants were followed up for suicide outcomes including suicide and possible suicide deaths. Risk factors, such as sociodemographic factors and physical and mental health status, were assessed by semistructured interviews and self-report questionnaires. Suicide and possible suicide deaths were identified through linkage to the local death registries using ICD-10 codes. We conducted Cox regression to calculate hazard ratios (HRs) for suicide and for possible suicide in sensitivity analyses. During an average follow-up period of 9.9 years, 520 (101 per 100,000) people died from suicide (51.3% male), and 79.8% of them lived in rural areas. Sociodemographic factors associated with increased suicide risk were male gender (adjusted hazard ratios [aHR] = 1.6 [95% CI 1.4 to 2.0], p < 0.001), older age (1.3 [1.2 to 1.5] by each 10-yr increase, p < 0.001), rural residence (2.6 [2.1 to 3.3], p < 0.001), and single status (1.7 [1.4 to 2.2], p < 0.001). Increased hazards were found for family-related stressful life events (aHR = 1.8 [1.2 to 1.9], p < 0.001) and for major physical illnesses (1.5 [1.3 to 1.9], p < 0.001). There were strong associations of suicide with a history of lifetime mental disorders (aHR = 9.6 [5.9 to 15.6], p < 0.001) and lifetime schizophrenia-spectrum disorders (11.0 [7.1 to 17.0], p < 0.001). Links between suicide risk and depressive disorders (aHR = 2.6 [1.4 to 4.8], p = 0.002) and generalized anxiety disorders (2.6 [1.0 to 7.1], p = 0.056) in the last 12 months, and sleep disorders (1.4 [1.2 to 1.7], p < 0.001) in the past month were also found. All HRs were adjusted for sociodemographic factors including gender, age, residence, single status, education, and income. The associations with possible suicide deaths were mostly similar to those with suicide deaths, although there was no clear link between possible suicide deaths and psychiatric factors such as depression and generalized anxiety disorders. A limitation of the study is that there is likely underreporting of mental disorders due to the use of self-report information for some diagnostic categories. Conclusions In this study, we observed that a range of sociodemographic, lifestyle, stressful life events, physical, and mental health factors were associated with suicide in China. High-risk groups identified were elderly men in rural settings and individuals with mental disorders. These findings could form the basis of targeted approaches to reduce suicide mortality in China.

Clinical correlation between Migraine and Generalized Anxiety Disorders: a literature review

Background: Migraine and anxiety are common neuro-psychiatric disorders in clinical practice, sharing symptoms and epidemiological factors among themselves. The presence of both pathologies in the same individual is frequently reported in the literature. Objectives: To report the clinical and epidemiological correlations established between generalized anxiety disorder and migraine. Methodology: Systematic review of studies published between 2016 and 2021, exploring the association between generalized anxiety disorders and Migraine. The descriptors “association”, “Migraines” and “Generalized Anxiety Disorder” were used in the LILACS, SCIELO and PUBMED databases. Fourteen articles were selected, mostly dealing with epidemiological studies. Results: Evidence suggests that these pathologies are associated and share common symptoms, pathophysiology and epidemiological factors. Studies corroborate that anxiety and painful sensation are more strongly associated with migraine than with other psychiatric illnesses. It has also demonstrated some characteristics of patients who are predisposed to develop both comorbidities such as smoke, low income and a history of other previous diseases. Common triggering factors such as pain, sleep disorders and stress can also contribute to the association between pathologies. Conclusions: Based on the studies analyzed in full, the high prevalence of both diseases in the same individual highlights the importance of research on the cause and consequence relationship between Anxiety and Migraine, since this is not yet clarified in the medical literature. In addition, paying attention to migraine correlation to generalized anxiety disorder increases the quality of life of the patient in the short and long term, as well as help in the choice of better treatments.