We aimed to study the prevalence of anxiety disorders with the comorbidity of depressive disorders and the effects of risk factors among the patients attending the general Geriatric Psychiatry Outpatient Unit.

Subjects were evaluated in terms of Anxiety Disorders on the basis of DSM criteria, SCID. Each patient was asked to fill out Spielberger State-Trait Anxiety Scale, Beck Anxiety and Depression Scale. Sociodemographic features and risk factors were assesed the prepared questionnaire.

In a number of total 1209 applicants in 12 months, we found the prevalance of anxiety disorders was %9,48 with a number of 115 patients in outpatient department applications and the prevalence of Generalized Anxiety Disorder was found out to be %4,63(n:56), Panic Disorder with Agoraphobia %1,98(n:24), without Agoraphobia %0,90(n:11), the prevalence of OCD was %0,82(n:10), PTSD %0,49(n:6) and other anxiety disorders (SAD, SP, NOS) was %0,66(n:8).

In the patients with anxiety disorders, the prevalence of depression comorbidity was found out to be %73,05(n:84), with the prevalence of the comorbid major depressive disorder %26,1(n:31), and the dysthymic/minor depressive disorder was %46,95(n:53). As a result of statistical analysis,we found that the risk factors associated with STAI-I and II scores were total years spent on education, but in reverse manners, as the education level increased, the STAI-I and II scores decreased.

Anxiety disorders with comorbid depression might be frequent disorders among Turkish secondary care attenders. There is a need for further studies on the epidemiology of anxiety disorders and their comorbidity with depression among elderly in Turkey.

The safety and efficacy of pregabalin in Generalized Anxiety Disorder (GAD) has been confirmed based on the results of 7 large, placebo-controlled trials. We report data on different patient populations from an open-label non-interventional observational trial under naturalistic conditions.

331 physicians (mainly psychiatrists) recruited 578 adult GAD patients and documented treatment with pregabalin over 4 weeks. GAD severity was rated by the patients using Hospital Anxiety and Depression Scale (HADS) and a 100mm daily Visual Analogue Scale (VAS-anxiety). Spontaneous Adverse Events (AEs) were collected.

Most patients received an initial dose of 150mg pregabalin per day, which was then increased to 300mg per day. Mean HADS-A Baseline Score (15.5 vs. 14.6) and Improvement (-5.9 vs. -6.1) was similar in younger (≤65 years, n=484) and older (>65 years, n=71) patients. Treatment naive patients had a lower HADS-A-Score (mean 14.2) than patients who got pregabalin add-on to their current medication (mean 15.8); both groups showed a similar improvement by 5.9 points over 4 weeks. A total of 26 AEs occured during this study, most of them rated mild to moderate in severity with no treatment related serious events. The pattern of events resembled the one known from clinical trials and post-marketing experience. 1.2% of subjects discontinued treatment due to adverse events.

Data from this non-interventional study in GAD show that pregabalin demonstrates similar effectiveness in adults and older (≤65 years) patients, regardless of whether used as mono- or adjunctive therapy.

In the past few decades, new and more efficient techniques to help solve fertility problems have become widely available throughout the developed world. The aim of this study was to determine whether there were differences on psychopathology factors between women who had conceived after in vitro fertilization (IVF) and women who had conceived naturally.

The sample was composed of 41 pregnant women of whom 28 women had conceived through assisted reproductive technology (IVF) and 13 had conceived naturally. Women were evaluated by week 20 of pregnancy at the Infanta Cristina University Hospital Obstetrics and Gynecology Service, in Badajoz. Women consented to complete the Symptom Checklist-90-Revised (SCL-90-R).

IVF women were characterized by higher scores on Anxiety Scale (t = 3.90; p = 0.045) and lower scores on Hostility Scale (t = 4.35; p = 0.041) than women who had conceived naturally. There were no differences in the others scales.

IVF women appear to present a temperamental profile characterized by a tendency to anxiety. Further research is needed to firstly, confirm these preliminary findings, and secondly, to longitudinally explore its impact on pregnancy outcome and mother-infant attachment.

We report a case of a 27-year-old Iraq War veteran with no previous psychiatric history who sustained severe traumatic brain injury (TBI) following a blast injury from an improvised explosive device. The patient subsequently suffered severe anxiety symptoms controlled only with combined therapy with benzodiazepines and venlafaxine. Even more disabling, the patient also experienced intractable headache and shoulder pain unresponsive to non-steroidal anti-inflammatory agents, tramadol, gabapentin, or NMDA-receptor antagonists. Given the risk of respiratory depression with his current medications, opioid analgesics were not favored for the management of his pain. The patient was started on sublingual buprenorphine at a dose of 8mg three times daily with significant improvement. This dose was maintained and the patient was able to function relatively pain-free.

Chronic pain is a significant complication in patients with TBI and is reported by a majority of patients with TBI, regardless of the severity of the injury. The treatment of chronic pain among individuals can be challenging. Patients with TBI may be on other medications for impulse control, such as anticonvulsants and benzodiazepines. Further treatment with narcotic analgesics may therefore increase the risk of respiratory depression. Buprenorphine is a partial mu agonist whose effects plateau at higher doses, at which time it begins to act like an antagonist. It is this property at higher doses that limits its dose-dependent respiratory depression. Buprenorphine thus has the advantage of effective analgesia with minimal sedation and may be useful to treat chronic pain among TBI patients already taking benzodiazepines.

The examined group consisted of 59 women at the age between 17 and 64 years, the average age 35,9 years. Perpetrators used psychical violence (humiliating, menacing, deriding, setting financial limits, cheating victims out of money) or physical violence (beating and spanking, strangling, tieing together, sexual intercourse forcing, locking in a house).

To assess the level and symptoms of anxiety Hamilton Anxiety Scale (HAS) was used. To assess the level of anxiety as state and as trait the State Trait Anxiety Inventory (STAI) self-evaluation questionnaire was used. To assess the level of social anxiety self-report Liebowitz Social Anxiety Scale (LSAS) was used.

The average level of intensity of anxiety according to HAS was 16, 5 points. In 28,8 % of women the medium intensity anxiety were found, in 8,4 % - hard intensity anxiety. In the studied group the low level of anxiety as a trait and as a state was noted. Social anxiety was reported among 57,1% of women who have experienced domestic violence. 38% was noted with a subtype of isolated social anxiety, whereas 19% had a generalized subtype of social phobia. Moderate intensity of social anxiety was presented by 9,5% of women, quite significant by 6,4% and severe and very severe by 9,4% of respondents.

Traumatic events caused by home bullying can be a source of anxiety in victims. Victims of domestic violence are inherently at risk of social anxiety.

Substantial literature supports clinically important associations between anxiety and chronic medical conditions. Diabetes is among the most psychologically and behaviorally demanding chronic medical illnesses. Anxiety has been associated with poor glycemic control, regimen adherence, and with accelerated rates of coronary heart disease in diabetic patients.

The aim of this study is to provide an overview of the role of clinically significant anxiety in patients with diabetes mellitus.

MEDLINE, EMBASE and PSYCINFO databases were searched using the combined search terms diabetes, diabetes mellitus, anxiety symptoms and anxiety disorders. Published reference lists were also examined. In total 25 studies were identified that fulfilled the inclusion criteria.

Anxiety was present in 41.7% of diabetic patients. There was no significant difference between those with Types 1 and types 2 diabetes. The rate of elevated symptoms was significantly higher in diabetic women than in diabetic men. General anxiety disorder was the most prevalent of the clinical disorders and was found in 13.2% of the diabetic patients. The rates of the other anxiety disorders were within the range of those reported in community studies. Treatment of anxiety was associated with improved glycemic control, particularly in the subgroup of patients with severe anxiety.

Emerging data offer a strong argument for the role of anxiety in diabetes. Psychological interventions and/ or pharmacological treatments in patients with diabetes are needed, in order to increase treatment adherence and control of the disease and improve patients’ functioning and quality of life.

To evaluate the differential effect of pregabalin and venlafaxine-XR versus placebo on sleep outcomes in non-depressed outpatients with generalized anxiety disorder (GAD).

This secondary analysis was based on data from a double-blind trial in which adults who met DSM-IV criteria for GAD were randomized to 8-weeks of flexible-dose treatment with pregabalin (300-600 mg/d; N=121; baseline HAM-A=27.6), venlafaxine-XR (75-225 mg/d: N=125; HAM-A=27.4), or placebo (PBO; N=128; HAM-A=26.8). Sleep was evaluated at baseline, weeks 4, 8, and endpoint using the Medical Outcomes Study (MOS) Sleep Scale, including an overall sleep problems index (SPI), as well as subscale scores such as sleep disturbance.

At baseline, 64% of patients with GAD met MOS-Sleep scale criteria for insomnia. Treatment with pregabalin was associated with significant endpoint improvement in the MOS-SPI compared to both placebo (-18.1 vs. -10.5; P< 0.01) and venlafaxine-XR (-10.1: P< 0.01). Treatment with pregabalin was associated with significant endpoint improvement in the MOS-sleep disturbance score compared to both placebo (-22.2 vs. -12.0; P< 0.001) and venlafaxine-XR (-11.6: P< 0.001). While somnolence as a treatment-emergent adverse event occurred more frequently on pregabalin (9.1%) compared to venlafaxine-XR (4.8%) and placebo (2.3%), overall, patients treated with pregabalin reported greater reduction in daytime sleepiness compared to venlafaxine-XR on the MOS-daytime sleepiness sub-scale (-9.7 vs. -5.8).

Treatment of moderate-to-severe GAD with pregabalin was associated with significantly better sleep outcomes compared to both placebo and venlafaxine-XR. Improvement in anxiety on pregabalin was associated with reduction in daytime sleepiness.

There appears to be no dose-response effect for pregabalin at doses of 300-600 mg, and a modest dose-response effect in the range of 150-300 mg. The goal of the current investigation was to determine the effect of the starting dose on the speed of onset of anxiolytic efficacy.

Data were analyzed from 7 trials of outpatients with DSM-IV GAD and a HAM-A total score ≥18. Starting doses of pregabalin ranged from 100 mg (N=301) or 150 mg (N=104), to 200 mg (N=167) and 300 mg (N=388). Assessment of early improvement included the HAM-A total score and CGI-Severity and Improvement scores.

The mean Week 1 HAM-A change score was similar for a starting dose of 200 mg/d with no titration (-8.24) when compared to patients who started on 200 mg/d and then titrated up to 400 mg/d on Day 4 (-8.64). The mean Week 1 HAM-A change score was somewhat higher for patients started on 300 mg/d, and then titrated to 450 mg/d on Day 4/5 (-8.84) when compared to patients started on a lower (100/150 mg/d) dose and titrated on Day 5 to 400/450 mg/d (-7.32). Starting on a dose of 300 mg/d with no titration resulted in an intermediate Week 1 change score (-7.87). The interaction of starting dose and titration schedule with baseline anxiety severity will be summarized in detail.

The initial dose of pregabalin appears to have only a weak effect on the speed of onset of anxiolytic improvement.

The frequency of organ somatization in multimedical network was the object of study.

Study of 2181 patients (average age-54 ± 0.8) are presented.inventory for clinical-anamnestic behavior sign of adaptation form of disease of patients with comorbid phenomenon and standard scales for value of anxiety and depressions were used.

The organ somatization have been often among patients with highly education, higher job-qualification and more favorable indexes of job-performance: scientific workers (5,6% over 2,6% in the general selection, p< 0,05), leading workers (9,3% over 3,8% in the general selection, p< 0,05), employers (14,5% over 9,9% in the general selection, p< 0,5). At the same time, the workers with lower qualificated job and manual labour (3,6% over 5,9% in general selection, p< 0,05) and also without working activity by any reason (6,0% over 42,8% in general selection, p< 0,0001).

The analyze of receive clinical characteristics, that reflected the structure of comorbid organ somatization with psychic pathology disorders has been following regularities: The patients with functional disorders of intestinal organs have been the wide specter of psychopathological disorders, such as personality, anxiety-phobic, obsessive-compulsive and affective disorders, and also continuous sluggish schizophrenia. Pathology among all psychical diseases by patients with organ somatization for certain (p< 0,05) exceed analogical activities in general disorders.

To study personality traits associated with social anxiety in university students.

We designed a cross-sectional study at the Autonomous University of Barcelona. Student were recruited by an advertisement. All student signed the informed consent. We collected: Socio-demographic data, personal and family psychiatry history, and the Liebowitz Anxiety Scale (LSAS) and the Temperament and Character Inventory of Cloninger. We defined as a social anxiety group a LSAS ≥50 total score.

Five hundred ninety-one students enter in the study. Final sample after excluded those who did not filled the rating scales was 574 participants: 75% were women, mean age (SD): 22.7 (5.3), 156 (124 women/32 men), 26% had social anxiety. Eighteen percent had family and 22% personal psychiatry history. The personality profile of the social anxiety group was: high harm avoidance (HA) (p< .001), low novelty seeking (NS) (p< .001), and low self-directedness (SD) (p< .001).

By logistic regression, after corrected by sex, age, personal and family psychiatry history, HA (OR=1.118; 95%CI=1.081-1.155), NS (OR=0.954;95%CI=0.927-0.982) and SD (OR=0.957;95%CI=0.930-0.985) predicted social anxiety. R2Nagelkerke=0.442. Hosmer-Lemeshow test (p>.05).

A profile of high HA, low NS and SD personality dimensions may predict those university students with social anxiety.

To investigate the predictive role of any specific (DSM-IV) Anxiety Disorders (AD) on depressive symptoms and Major or Minor Depressive Disorder (MDD, mDD) during early postpartum period.

Women (at the 12th-15th gestational week, N=1066) were recruited in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)’. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), and Axis-I disorders (AD, MDD, mDD) were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I).

Any current AD at baseline (3rd month of pregnancy) was detected in 231 (21.7%). Having at least one current AD, was associated with a greater likelihood of having MDD or mDD during the early postpartum period, even after the adjustment for the confounding factor of having a lifetime history of MDD (RR=3.86 95%CI 1.58-9.42).

In particular, women affected by Obsessive Compulsive Disorder (N=17; 1.6%) or Panic Disorder (N=43; 4%) had at higher risk to develop depressive symptoms (EPDS≥13) during the postpartum period than women without these AD (RR=6.9 and 6.7 respectively). As for the risk of developing PPD, the strongest association was found for women with Panic Disorder (RR=7.6 95% CI 2.62-22.0).

AD are associated with a greater likelihood to develop depressive symptoms and MDD or mDD during the early postpartum period. Women with current PD have the strongest risk to develop both MDD or mDD and depressive symptoms during early postpartum period compared to other anxiety disorders.

To estimate the clinical benefit of pregabalin and venlafaxine-XR for the short-term treatment of generalized anxiety disorder (GAD) using the metric of symptom-free days (SFDs).

A post-hoc analysis of a clinical trial in which adults who met DSM-IV criteria for GAD, with a HAM-A total score ≥ 20, were randomized to 8-weeks of double-blind, flexible-dose treatment with pregabalin (300-600 mg/d), venlafaxine-XR (75-225 mg/d) or placebo. SFDs were estimated for each one-week period based on weekly HAM-A scores using a published algorithm. Differences were analyzed using pairwise comparisons from a GLM adjusting for baseline HAM-A and sites.

The sample consisted of 121 patients on pregabalin (female, 64%; mean age, 39.5 years; LS mean ± SE baseline HAM-A, 27.6 ± 0.5), 125 patients on venlafaxine-XR (female, 58%; mean age, 42.6 years; baseline HAM-A, 27.5 ± 0.5), and 128 patients on placebo (female, 61%; mean age, 40.2 years; baseline HAM-A, 26.8 ± 0.5). At endpoint, LS mean (± SE) number of SFDs was significantly higher for pregabalin (20.6 ± 1.4) compared with both venlafaxine-XR (16.5 ± 1.4; p=0.018) and placebo (15.5 ± 1.3; p=0.004). Values remained significant after adjusting for multiple comparisions (p=0.0447 and p=0.0107, respectively).

Treatment with pregabalin resulted in more SFDs compared with venlafaxine-XR and placebo. The lack of difference in SFDs for groups treated with venlafaxine-XR compared to placebo contrasts with a previously reported study. Further studies are warranted to explore the application of the SFD metric.

To assess the impact of insomnia on quality of life (QoL) and functioning in patients with generalized anxiety disorder (GAD), and evaluate the efficacy of pregabalin and venlafaxine-XR in improving sleep and QoL.

A double-blind trial in adults who met DSM-IV criteria for GAD, with a HAM-A total score ≥20,randomized to 8-weeks of flexible-dose treatment with pregabalin (300-600 mg/d, N=121), venlafaxine-XR (75-225 mg/d, N=125), or placebo (N=128).

At baseline, 64% of all subjects had insomnia (according to the Medical Outcomes Study Sleep scale [MOS]-Sleep Problems Index [SPI] criteria).While HAM-A total scores (minus the insomnia item) were similar for patients with and without baseline insomnia (25.7 vs. 25.0) those with reported significantly more impairment on the Quality of Life, Enjoyment, and Satisfaction Questionnaire (Q-LES-Q; 45.4 vs. 53.6; p< 0.0001) and Sheehan Disability Scale (SDS; 17.5 vs.14.3; p< 0.0001) than those without. At endpoint, there was a significantly greater mean improvement in MOS-sleep disturbance factor and MOS-SPI with pregabalin (-29.0 and -21.1, respectively) than venlafaxine-XR (-14.7 and -11.0) or placebo (-15.2 and -12.5; all p< 0.05). In more pregabalin (64%) than venlafaxine-XR (51%) or placebo (52%) subjects, abnormal baseline sleep had normalized by endpoint. Endpoint change in MOS-SPI significantly correlated with improvement in both Q-LES-Q and SDS-total scores (Spearman r-values, -0.48 and 0.46, respectively; both p< 0.0001; all subjects).

Significantly greater impairment in QoL and functioning was observed in patients with high (vs. low) levels of insomnia. Pregabalin produced significantly greater improvement in insomnia than venlafaxine-XR or placebo.

To determine the incidence and clinical correlates of functional and quality of life (QoL) impairment in patients with generalized anxiety disorder (GAD), and to evaluate the efficacy of pregabalin and venlafaxine-XR in improving functional outcomes.

A double-blind trial in adults who met DSM-IV criteria for GAD, with a HAM-A total score ≥20, randomized to 8-weeks of flexible-dose treatment with pregabalin (300-600 mg/d, N=121), venlafaxine-XR(75-225 mg/d, N=125), or placebo (N=128). Anxiety-related impairment in QoL was evaluated using the Quality of Life, Enjoyment, and Satisfaction Questionnaire (Q-LES-Q) and impairment in functioning using the Sheehan Disability Scale (SDS).

At baseline, a similar proportion of patients in the 3 treatment groups met criteria for impairment on the Q-LES-Q (70.1%-77.6%) and SDS (74.1%-82.7%). For all groups combined, baseline impairment was more highly correlated with psychic than somatic anxiety on both the Q-LES-Q and SDS (Spearman r-values, -0.32 vs. -0.28 and 0.27 vs. 0.14,respectively). On the SDS but not on the Q-LES-Q, significantly more subjects in the pregabalin (67.2%) and venlafaxine-XR (59.5%) groups had improvement into the normative range compared with placebo (42.9%; p< 0.05) at endpoint. The mean HAM-A change score (all subjects) was significantly greater among patients whose Q-LES-Q returned to normal (“remitters” vs. non-remitters: -19.3 vs. -11.9; p< 0.05).

At baseline, approximately 75% of GAD patients reported moderate-to-severe impairment in QoL and functioning which was modestly correlated with severity of GAD symptomatology. Pregabalin produced improvement in QoL and functioning that was correlated with reduction in anxiety symptom severity.

In light of the ongoing debate whether agoraphobia [AG] should be viewed as a severe phobic disorder similar to specific phobia [SPE] or as a complication of panic disorder [PD] we aim to study the vulnerability structure of PD, AG and SPE.

3021 14-24 year-olds from the general population were followed-up over 10 years. DSM-IV syndromes were assessed via computerized M-CIDI interview and vulnerability factors via questionnaires. Associations were assessed with odds ratios from logistic regression. Latent class analysis (LCA) regressed on vulnerability factors was used to derive classes that underlie panic and phobic syndromes and to assess their associations with vulnerability factors.

1. 1. Vulnerability patterns were largely similar between PD, AG and SPE.

2. 2. The LCA resulted in a best fitting model with 4 classes: a healthy class, a class with moderate frequency of phobias without PD, a class characterized by PD and AG and moderate frequency of SPE (PDAG class) and one class characterized by high frequency of AG and SPE situational type and lower frequency of PD (AGSIT class).

3. 3. All classes showed different associations with multiple vulnerability measures. Subjects in the PDAG class reported less SPE in parents (OR=0.2; 95% CI=0.0-0.6) and older onset-age of any psychopathology (OR=2.0; 95% CI=1.07-3.6) than the AGSIT class.

We found indications for separate latent classes underlying PD and phobias that were characterized by different vulnerability factors. We interprete the different classes as different vulnerability clusters and evidence of multiple pathways leading to panic and phobias.

To carry out cultural adaptation and validation into Spanish of the 7-items self-administered GAD-7 scale; a tool to identify probable patients with Generalized Anxiety Disorder (GAD).

The adaptation, conducted by an eight-expert panel, was performed by means of a conceptual equivalence process, including forward and backward translations in duplicate to the original language. The content validity was assessed by inter-ratter-agreement (item-goal congruence index of Rovinelli-Hambleton). The adapted version was administered to patients with GAD according to DSM IV criteria and their respective controls, matched by age and sex, who were recruited at random in Mental Health and Primary Care centres to verify scale feasibility and potential understanding problems.

The inter-ratter reliability confirmed the correct inclusion of items in the corresponding dimension of GAD. The study sample consisted of 8 patients with GAD and 8 controls (62.5% male), mean age 50.38 years (SD=16.76). The average time to completion was 2’30”. No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. All the items, except item 5 (p=0,105), showed statistically significant differences among groups (p< 0.05).

After the adaptation process, a Spanish version of the GAD-7 scale was obtained, confirming its content validity, pertinence and adequacy of items in the Spanish cultural context. The brief time to completion precluded a fast and easy self-administration in the routine medical practice to promptly detect probable cases of GAD.

Since the end of 19th century, mental health professionals have noticed that individuals who have experienced traumatic situations often present dissociative symptoms, such as amnesia or fugue states. Dissociation is a defensive mechanism that allows an individual to separate from conscience the psychological distress produced by the trauma. Our aim was to remark the association between Post-traumatic Stress Disorder (PTSD) and long-term dissociative disorders through the study of a clinical case.

A clinical case was followed and reviewed to illustrate this relationship.

Ten years ago, a 49-year-old man was diagnosed of PTSD after having witnessed several colleagues burnt in a tragic accident at work and having helped the emergency fire brigade to rescue other victims. His symptoms required treatment with antidepressants and psychotherapy, and fully remitted after one year. Nevertheless, during the last year, he has presented two dissociative amnesia episodes lasting for three days each, which were examined by a neurology service. More recently, he has suffered a ten-day episode of dissociative fugue, which required psychiatric hospitalization. Although the patient has been asymptomatic during a decade, it is remarkable that he has presented three dissociative episodes in a short period of time. One of them, the fugue state, is interesting because of its long duration and its relatively low prevalence in the general population.

This clinical case allows us to appreciate the long-term relationships between psychological trauma and dissociation, in addition to the well-known short-term effects.