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BACKGROUND: Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease (COPD) patients and reduce the quality of life of patients, but also affect the treatment effect and long-term prognosis. Therefore, it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression. AIM: To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents. METHODS: In this retrospective study, 60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group. The control group was given routine nursing, and the observation group was given comprehensive assessment. Clinical symptoms, quality of life [COPD assessment test (CAT) score], anxiety and depression Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) were compared between the two groups. RESULTS: CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge, and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge. The average score was 22.1 (P < 0.05). In the observation group, HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge, and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge. The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge, and from an average of 14.1 at admission to an average of 11.8 at discharge. CONCLUSION: The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients' clinical symptoms and quality of life, and can effectively reduce patients' anxiety and depression.

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Background: Anxiety is common in patients with chronic obstructive pulmonary disease (COPD), especially in older patients with the definition of age over 60 years old. Few studies have focused on anxiety in older COPD patients. This study aimed to analyze the risk factors of anxiety in older COPD patients and the impacts of anxiety on future acute exacerbation. Methods: The general information, questionnaire data, previous acute exacerbation and pulmonary function were collected. Hamilton Anxiety Rating Scale (HAMA) was used to evaluate the anxiety of older COPD patients. The patients were followed up for one year, the number and the degrees of acute exacerbations of COPD were recorded. Results: A total of 424 older COPD patients were included in the analysis. 19.81% (N = 84) had anxiety symptoms, and 80.19% (N = 340) had no anxiety symptoms. There were increased pack-years, more comorbidities, and more previous acute exacerbations in older COPD patients with anxiety compared to those without anxiety (P < 0.05). Meanwhile, a higher modified Medical Research Council (mMRC), a higher COPD assessment test (CAT) score and a shorter six-minute walking distance (6MWD) were found in older COPD patients with anxiety (P < 0.05). The BODE index, mMRC, CAT score, comorbidities and acute exacerbations were associated with anxiety. Eventually, anxiety will increase the risk of future acute exacerbation in older COPD patients (OR = 4.250, 95% CI: 2.369-7.626). Conclusion: Older COPD patients with anxiety had worsening symptoms, more comorbidities and frequent acute exacerbation. Meanwhile, anxiety may increase the risk of acute exacerbation in the future. Therefore, interventions should be provided to reduce the risk of anxiety in older COPD patients at an early stage.

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BACKGROUND: Individuals wrestling with panic disorder (PD) know all too well its debilitating impact. Sudden, intense fear episodes disrupt lives and erode well-being. Fortunately, integrating complementary therapies like yoga with standard treatment offers a glimmer of hope for improved outcomes. Yoga's unique blend of physical postures (asanas), breathing exercises (pranayama), and meditative practices holds promise for mitigating anxiety and fostering a sense of inner peace, potentially making it a valuable tool in the fight against panic disorder. METHODS AND MATERIALS: This study investigated the effect of yoga as an adjuvant to standard care for panic disorder. Sixty-four panic disorder patients of both genders previously diagnosed with panic disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were randomly assigned to the yoga group (n = 32) and the control group. The yoga group participated in integrated yoga sessions lasting 60 minutes, five days a week, for 12 weeks. Both groups received standard care. Pre- and post-intervention data were collected for HAM-A and WHOQOL-BREF. RESULTS: The yoga group exhibited a significant reduction in HAM-A scores (Pre: 49.13 ± 4.55, Post: 13.53 ± 5.54, p < 0.001) with a substantial effect size of 7.02. Quality of life significantly improved across all domains (physical, psychological, social, and environmental) in the yoga group (p < 0.001), demonstrating effect sizes ranging from 4.11 to 4.57. Control group participants also experienced improvements, though less pronounced. Between-group comparisons revealed significant differences in anxiety reduction (p = 0.042) and quality of life enhancement (p < 0.001), favouring the yoga group. CONCLUSION: The results suggest that yoga can be a valuable complementary or alternative approach to traditional treatments for anxiety disorders.

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Objective: : Insomnia is associated with elevated high-frequency electroencephalogram power in the waking state. Although affective symptoms (e.g., depression and anxiety) are commonly comorbid with insomnia, few reports distinguished objective sleep disturbance from affective symptoms. In this study, we investigated whether daytime electroencephalographic activity explains insomnia, even after controlling for the effects of affective symptoms. Methods: : A total of 107 participants were divided into the insomnia disorder (n = 58) and healthy control (n = 49) groups using the Mini-International Neuropsychiatric Interview and diagnostic criteria for insomnia disorder. The participants underwent daytime resting-state electroencephalography sessions (64 channels, eye-closed). Results: : The insomnia group showed higher levels of anxiety, depression, and insomnia than the healthy group, as well as increased beta [t(105) = -2.56, p = 0.012] and gamma [t(105) = -2.44, p = 0.016] spectra. Among all participants, insomnia symptoms positively correlated with the intensity of beta (r = 0.28, p ＜ 0.01) and gamma (r = 0.25, p ＜ 0.05) spectra. Through hierarchical multiple regression, the beta power showed the additional ability to predict insomnia symptoms beyond the effect of anxiety (ΔR2 = 0.041, p = 0.018). Conclusion: : Our results showed a significant relationship between beta electroencephalographic activity and insomnia symptoms, after adjusting for other clinical correlates, and serve as further evidence for the hyperarousal theory of insomnia. Moreover, resting-state quantitative electroencephalography may be a supplementary tool to assess insomnia.

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BACKGROUND: Anxiety scale based on Ayurveda would help Ayurveda physicians to measure and initiate appropriate treatment strategies. OBJECTIVES: The objective of the study was to develop a clinical assessment scale for anxiety based on Ayurveda science. MATERIALS AND METHODS: Ayurveda assessment scale for anxiety (AAA) was developed and subjected to various psychometric evaluations. Patients of generalized anxiety disorder with social phobia (GAD with SP) (n = 31) meeting DSM-IV-TR criteria and age, sex-matched healthy subjects (n = 31) were enrolled from NIMHANS Psychiatry OPD. Two independent Ayurveda experts evaluated both patients and healthy subjects using AAA, Hamilton Anxiety Rating Scale (HARS), and Beck Anxiety Inventory (BAI). Reliability and validity assessments were carried out. The sensitivity to treatment-induced change was evaluated in a randomized controlled clinical trial. 72 patients of GAD with SP meeting DSM-IV-TR criteria, aged between 20 and 55 years, and either sex participated in the study. The duration of intervention was 30 days. The assessments were done through HARS, BAI, Beck Depression Inventory (BDI), AAA and Clinical Global Impression scales (Severity, Improvement, and Efficacy). RESULTS: The Interrater reliability was between - good to very good score. Validity of AAA with HARS and BAI was significant (p < 0.001). Scales recorded significant differences when compared between patients and healthy subjects (p < 0.001). AAA also recorded the sensitivity to treatment-induced changes in a randomized controlled study and noted a large effect size (>0.60). CONCLUSIONS: The psychometric properties such as interrater reliability, validity (criteria, convergent, divergent, face) and sensitivity to change of AAA were promising.

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BACKGROUND: Mitigating rating inconsistency can improve measurement fidelity and detection of treatment response. METHODS: The International Society for CNS Clinical Trials and Methodology convened an expert Working Group that developed consistency checks for ratings of the Hamilton Anxiety Rating Scale (HAM-A) and Clinical Global Impression of Severity of anxiety (CGIS) that are widely used in studies of mood and anxiety disorders. Flags were applied to 40,349 HAM-A administrations from 15 clinical trials and to Monte Carlo-simulated data as a proxy for applying flags under conditions of inconsistency. RESULTS: Thirty-three flags were derived these included logical consistency checks and statistical outlier-response pattern checks. Twenty-percent of the HAM-A administrations had at least one logical scoring inconsistency flag, 4 % had two or more. Twenty-six percent of the administrations had at least one statistical outlier flag and 11 % had two or more. Overall, 35 % of administrations had at least one flag of any type, 19 % had one and 16 % had 2 or more. Most of administrations in the Monte Carlo- simulated data raised multiple flags. LIMITATIONS: Flagged ratings may represent less-common presentations of administrations done correctly. Conclusions-Application of flags to clinical ratings may aid in detecting imprecise measurement. Flags can be used for monitoring of raters during an ongoing trial and as part of post-trial evaluation. Appling flags may improve reliability and validity of trial data.

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Objective: One of the most prevalent psychiatric conditions that affect a person's quality of life, ability to function and productivity, and consequently the loss of national income, are anxiety disorders. Rajyoga meditation (RM) is a form of meditation that is performed without rituals or mantras and can be practiced anywhere at any time. In this study, we attempted to evaluate the modulation of psycho-physiological parameters in panic disorder patients by a technique of short-term on RM. Methods: In this prospective randomized control study, 110 patients with panic disorder were randomized into two groups, Group A (standard treatment + RM) and Group B (Standard treatment). The participants of both group participants were subjected to sleep quality score, Physical Health Questionnaire-9 score, Panic Disorder Severity Scale (PDSS), and Hamilton Anxiety Rating Scale (HAM-A) questionnaires before starting the study (baseline) and at the end of the 8th week. Study groups were compared at baseline and at the end of 8 weeks. Results: We found that the PDSS/HAM-A was not statistically different among the study groups at baseline (P > 0.05); however, there was a statistically significant difference in mean z-scores of PDSS and post-HAM-A scores among the study groups at 8 weeks (P < 0.001). The composite score was created by adding the z-scores of pre- and post-PDSS and HAM-A. We found a statistically significant difference in postcomposite scores between the study groups (P < 0.001). Analysis of co-variance for PDSS and HAM-A among study groups showed statistical significance (P < 0.001). Conclusion: When used in conjunction with pharmaceutical treatments for the treatment of panic disorder, RM is a successful therapy. The key factors are adherence and motivation while being supervised by a licensed therapist.

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Introduction Tuberculosis-associated obstructive pulmonary disease (TOPD), anxiety, and depression are significant public health problems worldwide and their prevalence is common. These diseases interfere with physical, psychosocial, and economic well-being, resulting in unemployment, prolonged hospitalization, abstinence from working, and isolation. Subjects and methods This is a single-center, cross-sectional cohort, observational study conducted in a tertiary care hospital over six years to understand spirometry, laboratory profiles, as well as the impact on overall health, daily life, and perceived well-being in patients with TOPD. Result The sample size of the study was 73 patients. A total of 43 (58.5%) patients had depression with an average St. George's Respiratory Questionnaire for chronic obstructive pulmonary disease (SGRQ-C) score of 67.5, and 16 (21.9%) patients had anxiety with an average SGRQ-C score of 78.9. In the patients who scored higher on the Hamilton Depression Rating Scale (HAM-D), there was a significant correlation between Hamilton Anxiety Rating Scale (HAM-A) and HAM-D scores, as well as C-reactive protein (CRP) levels and WBC counts. In 16 (21.9%) of the patients with moderate to severe anxiety, there was a statistically significant negative correlation between higher HAM-A scores and lower WBC counts. Anxiety, depression, CRP level, WBC count, and serum fibrinogen did not show a significant correlation with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups-based assessment of TOPD severity. A high serum fibrinogen level did not correlate with a high HAM-D score, nor did a high CRP level correlate with a high HAM-A score. Conclusion Psychiatric comorbidities like depression are associated with increased inflammation in chronic diseases like TOPD, but no definitive biomarker has been identified and further studies are required to identify suitable biomarkers.

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Background: Considering the huge population in China, the available mental health resources are inadequate. Thus, our study aimed to evaluate whether mental questionnaires, serving as auxiliary diagnostic tools, have efficient diagnostic ability in outpatient psychiatric services. Methods: We conducted a retrospective study of Chinese psychiatric outpatients. Altogether 1,182, 5,069, and 4,958 records of Symptom Checklist-90 (SCL-90), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), respectively, were collected from March 2021 to July 2022. The Mann-Whitney U test was applied to subscale scores and total scores of SCL-90, HAM-A, and HAM-D between the two sexes (male and female groups), different age groups, and four diagnostic groups (anxiety disorder, depressive disorder, bipolar disorder, and schizophrenia). Kendall's tau coefficient analysis and machine learning were also conducted in the diagnostic groups. Results: We found significant differences in most subscale scores for both age and gender groups. Using the Mann-Whitney U test and Kendall's tau coefficient analysis, we found that there were no statistically significant differences in diseases in total scale scores and nearly all subscale scores. The results of machine learning (ML) showed that for HAM-A, anxiety had a small degree of differentiation with an AUC of 0.56, while other diseases had an AUC close to 0.50. As for HAM-D, bipolar disorder was slightly distinguishable with an AUC of 0.60, while the AUC of other diseases was lower than 0.50. In SCL-90, all diseases had a similar AUC; among them, bipolar disorder had the lowest score, schizophrenia had the highest score, while anxiety and depression both had an AUC of approximately 0.56. Conclusion: This study is the first to conduct wide and comprehensive analyses on the use of these three scales in Chinese outpatient clinics with both traditional statistical approaches and novel machine learning methods. Our results indicated that the univariate subscale scores did not have statistical significance among our four diagnostic groups, which highlights the limit of their practical use by doctors in identifying different mental diseases in Chinese outpatient psychiatric services.

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BACKGROUND: Anxiety disorders such as generalized anxiety disorder (GAD) impact 10% of the US population, and many patients do not completely respond to first-line treatments (e.g., selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and psychotherapy). Given the dearth of evidence for non-pharmacologic, non-psychotherapeutic interventions, we performed a systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) in adults with GAD. METHODS: A systematic literature review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted. Pre- and post-treatment anxiety scores were extracted, and a random-effects meta-analysis was conducted to determine the magnitude of improvement (standardized mean difference). Standard assessments of heterogeneity (e.g., Q-statistic, I2, and τ 2) and publication bias were performed. RESULTS: The initial search resulted in 3194 citations, of which 6 studies were included in the meta-analysis. In total, 152 patients were studied, including 97 patients who received active treatment and 55 who received sham treatment, and heterogeneity was modest (I2 13.32, Q = 5.77). In patients with GAD, rTMS produced a standardized mean difference of -1.857 (confidence interval: -2.219 to -1.494; P < .001) with a prediction interval of -2.55 to -1.16. CONCLUSIONS: The results suggest a robust effect of rTMS in GAD in the context of limited, heterogenous studies. Rigorously designed, randomized controlled trials of rTMS for GAD and related anxiety disorders are urgently needed. These studies will provide opportunities for biomarker development and integration of concurrent evidence-based psychotherapy to maximize results.

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The relationship between the skin and the brain is based on their origin from the same ectodermal structure, as well as being affected by similar hormones and neurotransmitters. At this point, psychodermatology forms a common field of study based on the relationship and interaction between psychiatry and dermatology. Cosmetology is a special group within dermatology, and the psychosocial needs of this group differ. In this study, it was aimed to examine the moods such as anxiety, fear and depression experienced by the patients during their application to the cosmetology unit during the COVID-19 pandemic process and to compare them with the control group. A total of 162 cases, 80 cases from the cosmetology unit meeting the specified conditions and 82 cases as the control group, were retrospectively evaluated. In all participants, the Coronavirus Anxiety Scale (CAS) scores decreased significantly compared to the beginning of the pandemic (P = .001). In the study, while depression (HAM-D) and general anxiety (HAM-A) were higher in the cosmetology group compared to the control group (P = .049 and P = .001, respectively), there was no difference in coronavirus anxiety scores (CAS) (P = .24). It should be known that patients who underwent cosmetological procedures during the pandemic period may have anxiety and depression. In this patient group, which requires a special psychodermatological approach, pandemic effects should also be considered. In patients who apply to cosmetology units during the pandemic period, attention should be paid to the relationship between surreal cosmetological process requests and their anxiety and depression state.

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Objective: The Hamilton Depression Rating Scale (HDRS-17) and the Hamilton Anxiety Rating Scale (HARS-14) have been acknowledged as gold standards in evaluating the severity of depression and anxiety. The specificity and sensitivity of these scales in predicting somatic complaints of depression and anxiety are issues in both clinical and research areas. The present study proposes a new model to enhance the sensitivity and specificity of HDRS-17 and HARS-14 for predicting symptoms of insomnia, inappetence, and loss of libido in psychiatric patients. Methods: This study included 1507 patients diagnosed withbipolar disorder, depression, panic disorder, obsessive-compulsive disorder, and generalized anxiety disorder. The HDRS-17 and the HARS-14 were utilized as predictive scales for the prediction of patients' sleep, appetite, and libido. The sensitivity and specificity were computed using the receiver operating characteristic (ROC). Logistic regression was performed to enhance the predictive values. The predictive value of the logistic regression model was not satisfactory, and a conversion table was therefore designed for each symptom-diagnosis subgroup. The new joint ROC model was then used to recalculate the sensitivity and specificity of the 2 scales for each symptom-diagnosis subgroup. The outcome is a prediction table, presented for use by clinicians. Results: It was observed that the new statistical model, the joint ROC, increased the sensitivity and specificity of the HDRS-17 and the HARS-14. Conclusion: : Based on the results of the evaluations with the HDRS and the HARS, the joint ROC method was developed to better predict the presence of symptoms.

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Depression is prevalence in patients with laryngeal cancer. In this study, we aim to investigate whether psychological intervention could reduce the depression of patients receiving cancer treatment. In this study, 258 patients with laryngeal cancer were assigned into two groups with or without psychological intervention. The depression symptoms of all patients were assessed using Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA). Europe Organization for research and Treatment of cancer Quality of life Questionnaire (EORTC QLQ-C30) was used to measure the life quality of the participants. Other measurements including general attitudes towards psychology services, hospitalization duration and expenses were analyzed. We found that patients with intervention showed more positive attitudes towards psychology services compared to those in control group. Hospitalization duration and expenses were significantly less in intervention group compared to control group. In addition, the intervention group showed a significantly lower HAMD and HAMA scores and improved life quality than control group. Patients aged lower than 40 years showed more obvious reductions in HAMD and HAMA scores and better life quality compared to older patients. In conclusion, our study demonstrated that psychological intervention was necessary and effective in patients with laryngeal cancer during treatment.

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Obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) are in terms of nosography different pathologies, however they share a stress-related physio-pathogenetic component, not yet explored in depth. Therefore, the aim of the present study was to ascertain whether OSA and CSC share a common profile, specifically in cortisol production focusing on the cortisol awake response (CAR), the area under curve (AUCCAR) and the SLOPECAR compared with healthy matched controls. Furthermore, standardized self-administered questionnaires were used to identify mental health status related to depression, anxiety and subjective stress perception levels in the study populations. The results showed hypothalamus-pituitary-adrenal (HPA) axis activity anomalies, represented by a flattening CAR in the OSA group and a statistically significant increase in cortisol production in CSC patients at awakening. This disarrangement of the HPA axis activity associated with elevated distress and mental health scores, and its presence in both patients with OSA and patients with CSC, might represent the shared path explaining the stress-related component in these diseases. Further research is needed to investigate the psycho-neuro-endocrinological aspects of OSA and CSC to determine whether psychoeducation on effective stress coping strategies might be of value in improving the quality of life of OSA and CSC patients.

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BACKGROUND: Tension-type headache (TTH) is one of the most common reasons patients seek medical treatment. Psychiatric co-morbidities such as anxiety and depression have been commonly observed in patients with TTH. OBJECTIVE: The objective was to study the prevalence and severity of co-morbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) in patients with TTH. MATERIALS AND METHODS: The present cross-sectional study was conducted in the Tertiary Health Care Centre in Central Rural India, with a sample size of 85. Data were recorded in the predesigned, semi-structured questionnaire. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS) were used to categorise the co-morbid anxiety and depression. RESULTS: About 48.2% of the study participants were in the age group of 31-40 years with a mean age of 36.8 ± 7.1 years. Higher proportions of female study participants (64.7%) were observed. Majority of the study participants were literate (76.5%), employed (57.7%), married (78.8%) and had rural residence (54.1%). The prevalence of co-morbid GAD was 70.6%, whereas the prevalence of co-morbid MDD was 54.1%. According to HAM-A, 31.8% had mild, 21.2% had moderate, while 17.6% had severe anxiety levels. According to HDRS, 34.1% had mild, 16.5% had moderate and 3.5% had severe co-morbid depression. CONCLUSION: TTH is frequently associated with co-morbid GAD and MDD.

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OBJECTIVES: To evaluate and compare efficacy and tolerability of Vilazodone with Escitalopram and Amitriptyline in patients of major depressive disorder(MDD). METHODS: This was a randomized, prospective, parallel-group, open label clinical study in which newly diagnosed patients of MDD were randomized to receive Tab Vilazodone 20 mg daily or Tab Escitalopram 20mg daily or Tab Amitriptyline 75mg daily for 12 weeks. Antidepressant activity was assessed by change in score from baseline to week 12 on HAMD-17 and MADRS scales while change in score on HAM-A scale was used to assess antianxiety effect. Change in scores on the three scales was also compared between the three treatment groups. Severity and causality of adverse events were assessed by the modified Hartwig & Siegel scale and Naranjo scale respectively. Data was analyzed in accordance with per protocol analysis. RESULTS: Reduction in HAMD-17 and MADRS scores was significantly more in vilazodone group compared to the other two drugs indicating that vilazodone is more efficacious antidepressant. Number of remitters were also significantly more in the vilazodone group (n=11) compared to escitalopram (n=4) (p<0.05) and amitriptyline (n=0) (p<0.001) at 12 weeks. Similar results were also obtained with HAM-A score. Number of patients showing MADRS sustained response at 12 weeks was statistically significantly more in vilazodone (n=12) and escitalopram (n=12) groups compared to amitriptyline (n=01) (p<0.001). Reported adverse events were constipation and sedation(amitriptyline group); nausea and headache(escitalopram and vilazodone groups). These adverse events were of mild severity. Most adverse events belonged to probable category. CONCLUSION: Vilazodone is more efficacious and well tolerated antidepressant compared to escitalopram and amitriptyline.

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BACKGROUND: Meta-analyses support the efficacy of cognitive behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in Western cultures. However, there are no adequately powered multicentre studies in China. This study aimed to compare the effectiveness of treatment with CBT combined with medication and medication alone in OCD patients in China. METHODS: OCD patients (N = 167) were recruited from outpatient clinics at three large tertiary psychiatric hospitals and one general hospital in China. Participants were randomly allocated to receive either CBT combined with medication (n = 92) or medication alone (n = 75) for a 24-week treatment period. Participants' symptoms and social functioning were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF) and Clinical Global Impression Scale for Severity (CGI-S) at 0, 4, 8, 12 and 24 weeks, and the effectiveness of the two treatments compared using linear mixed-effects models. RESULTS: At 24 weeks, both groups showed large within-group effects in all measures. Significantly more patients receiving combined therapy than medication alone had a decrease in symptom severity of at least 35% (based on Y-BOCS total score). The CGI-S and GAF scores decreased in both groups, and significant differences were found between the groups. LIMITATIONS: Study limitations included lack of consideration of medication types and dosages, and the absence of a CBT-only arm. CONCLUSIONS: CBT combined with medication may be effective in alleviating symptoms and social functioning impairment associated with OCD, and is more effective than medication alone in China, particularly for the treatment of compulsive behaviours.

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OBJECTIVE: Anxiety disorders (ADs) are frequent comorbid disorder in patients with epilepsy (PWE). The availability of validated screening instruments to detect AD in PWE is limited. The aim of the present study was to validate the Polish version of the Hamilton Anxiety Rating Scale (HARS) in adult PWE for the detection of AD. METHODS: A total of 96 outpatient PWE completed the self-report symptom scale, the HARS, and were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HARS. RESULTS: Receiver operating characteristic analyses showed areas under the curve at 81.2%. For diagnoses of AD, the HARS demonstrated the best psychometric properties for a cutoff score ≥17 with sensitivity of 68.8%, specificity of 87.5%, positive predictive value of 52.4%, and negative predictive value of 93.3%. CONCLUSIONS: The Polish version of the HARS performed moderately well as a screening instrument for ADs in PWE. In the epilepsy setting, the HARS maintains moderate sensitivity, high specificity, and excellent Negative perdictive value (NPV) but low Positive perdictive value (PPV) for diagnosing ADs with an optimum cutoff score ≥17. These results suggest that the HARS performed better to rule out anxiety, however, because of moderate sensitivity, some cases of anxiety might be missed.

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BACKGROUND: Despite its high prevalence and associated disability, the neural correlates of emotion processing in patients with functional (psychogenic) tremor (FT), the most common functional movement disorder, remain poorly understood. METHODS: In this cross sectional functional magnetic resonance imaging (fMRI) study at 4T, 27 subjects with FT, 16 with essential tremor (ET), and 25 healthy controls (HCs) underwent a finger-tapping motor task, a basic-emotion task, and an intense-emotion task to probe motor and emotion circuitries. Anatomical and functional MRI data were processed with FSL (FMRIB Software Library) and AFNI (Analysis of Functional Neuroimages), followed by seed-to-seed connectivity analyses using anatomical regions defined from the Harvard-Oxford subcortical atlas; all analyses were corrected for multiple comparisons. RESULTS: After controlling for depression scores and correcting for multiple comparisons, the FT group showed increased activation in the right cerebellum compared to ET during the motor task; and increased activation in the paracingulate gyrus and left Heschl's gyrus compared with HC with decreased activation in the right precentral gyrus compared with ET during the basic-emotion task. No significant differences were found after adjusting for multiple comparisons during the intense-emotion task but increase in connectivity between the left amygdala and left middle frontal gyrus survived corrections in the FT subjects during this task, compared to HC. CONCLUSIONS: In response to emotional stimuli, functional tremor is associated with alterations in activation and functional connectivity in networks involved in emotion processing and theory of mind. These findings may be relevant to the pathophysiology of functional movement disorders.

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