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Although Parkinson’s disease (PD) is most associated with and diagnosed by the presence of motor symptoms, non-motor symptoms (NMS) can often be the most debilitating for patients. Highly prevalent among non-motor features are neuropsychiatric symptoms (NPS), including depression, anxiety, psychosis, impulse control disorders, apathy and cognitive impairment, the latter being particularly burdensome and occurring in the majority of PD patients long term. The neurobiological underpinnings of NPS are a mix of disease-related, other neurodegenerative disease processes, PD treatment effects and psychosocial factors. NPS can be difficult to recognize and diagnose in PD patients; therefore, PD-specific assessments have been developed to better identify and treat them. Treatment strategies are a mix of those used in the general population for these conditions and those specific to PD, and are a combination of pharmacologic and non-pharmacologic interventions. Although significant advances have been made in our understanding and management of NPS in PD, etiology or biologically informed management strategies are needed to further advance the field.
There have been inconsistent findings for an association between assisted reproductive technology (ART) and poorer perinatal emotional wellbeing. This study is to explore whether ART is associated with increased depression and depressive symptoms, anxiety symptoms and parenting stress, and poorer antenatal attachment, over the perinatal period from pregnancy to 12 months postpartum.
Methods
This study drew on data collected within an ongoing cohort from 806 women including 42 who had conceived using ART, and all recruited in early pregnancy and followed to 12 months postpartum. Measures included the Structured Clinical Interview for the DSM, Edinburgh Postnatal Depression Scale, State and Trait Anxiety Inventory, Maternal Antenatal Attachment Scale and Parenting Stress Index.
Results
Women who conceived with ART were no more likely to be depressed. They had lower depressive and anxiety symptoms in early pregnancy, higher antenatal attachment and lower parenting stress. However, women who conceived with ART had a significant increase in depressive and anxiety symptoms in late pregnancy which reduced in the postpartum and showed a distinct pattern compared to those who conceived naturally.
Conclusions
This study found that women who conceived with ART did not have poorer emotional wellbeing across the perinatal period. However, in late pregnancy depressive and anxiety symptoms did rise and consideration of this clinically and in future research is warranted.
Depressive symptoms remaining after antidepressant treatment increase the risk of relapse and recurrence. We aimed to analyze the distribution and main drivers of remaining symptoms in patients with a major depressive episode.
Methods
Two independent samples of 8,229 and 5,926 patients from two large naturalistic studies were retrospectively analyzed. DSM-IV criteria for major depressive episodes were assessed during two face-to-face visits with clinicians: before the prescription of a new antidepressant, and after 6 weeks of treatment. The Hospital Anxiety and Depression Scale (HADS) was used to assess baseline severity of anxiety and depression.
Results
In both samples, two clusters of remaining symptoms were observed. The first cluster encompassed symptoms related to a negative emotional and cognitive bias and was specifically driven by the baseline severity of depression. The second cluster encompassed neurovegetative symptoms and was specifically driven by the baseline severity of anxiety.
Conclusions
The baseline anxiety-depressive balance of patients could be considered to adapt the treatment, focusing on emotional and cognitive symptoms with patients with high baseline severity of depression, and neurovegetative symptoms with patients with high baseline anxiety severity.
The school–vacation cycle may have impacts on the psychological states of adolescents. However, little evidence illustrates how transition from school to vacation impacts students’ psychological states (e.g. depression and anxiety).
Aims
To explore the changing patterns of depression and anxiety symptoms among adolescent students within a school–vacation transition and to provide insights for prevention or intervention targets.
Method
Social demographic data and depression and anxiety symptoms were measured from 1380 adolescent students during the school year (age: 13.8 ± 0.88) and 1100 students during the summer vacation (age: 14.2 ± 0.93) in China. Multilevel mixed-effect models were used to examine the changes in depression and anxiety levels and the associated influencing factors. Network analysis was used to explore the symptom network structures of depression and anxiety during school and vacation.
Results
Depression and anxiety symptoms significantly decreased during the vacation compared to the school period. Being female, higher age and with lower mother's educational level were identified as longitudinal risk factors. Interaction effects were found between group (school versus vacation) and the father's educational level as well as grade. Network analyses demonstrated that the anxiety symptoms, including ‘Nervous’, ‘Control worry’ and ‘Relax’ were the most central symptoms at both times. Psychomotor disturbance, including ‘Restless’, ‘Nervous’ and ‘Motor’, bridged depression and anxiety symptoms. The central and bridge symptoms showed variation across the school vacation.
Conclusions
The school–vacation transition had an impact on students’ depression and anxiety symptoms. Prevention and intervention strategies for adolescents’ depression and anxiety during school and vacation periods should be differentially developed.
This chapter provides a review for post-traumatic stress disorder (PTSD). It starts by presenting the epidemiological data as well as the risk factors in the development of PTSD. It then defines the diagnosis of PTSD, by using both DSM-5 and ICD-11 criteria, and provides a clinical approach on how to clarify differential diagnoses and comorbidities. It then reviews the pathophysiology and pathogenesis of PTSD by looking at neuroanatomic, neuroendocrine, neurochemical, and genetic changes in brain neural networks. It concludes by presenting the current evidence-based options for the treatment and management of PTSD that include psychotherapy and pharmacotherapy.
Anxiety disorders are the most common form of mental disorders, especially in young adults and children. They are typically characterized by extreme or excessive fear and anxiety or avoidance of perceived threats. Anxiety disorders encompass a range of conditions including, social anxiety disorder, selective mutism, panic disorder (or attacks), separation anxiety disorder, generalized anxiety disorder, and specific phobias. The risk for anxiety disorders is multifactorial, composed of genetic and environmental factors. While the specific neurobiological pathophysiology of anxiety disorders is yet to be undetermined, dysfunction in the fronto-limbic system is consistently related to these disorders. Additionally, comorbidity with other mental disorders, especially depression and substance abuse, is common with anxiety disorders. Anxiety disorders have a major public health relevance and remain highly underdiagnosed. They carry a high burden, as these disorders are often chronic, recurrent, and disabling throughout life. Treatment of anxiety disorders consists of various psychotherapies and pharmacological treatments. Although treatment methods are effective in mitigating the symptoms, more research is critically needed to personalize treatment approaches and provide long-term relief.
In this chapter, we discuss late-life psychiatric disorders highlighting their unique biological, clinical, and therapeutic features compared to presentations earlier in life. They are frequently overlapping and associated with dementia and other neurodegenerative diseases. The three D’s – delirium, dementia, and depression – represent common geriatric psychiatry syndromes that can pose diagnostic and therapeutic challenges. Clinical suspicion of delirium must prompt careful investigation of the underlying cause. Dementia is an umbrella term that describes progressive cognitive decline and related behavioral and functional impairments. Behavioral symptoms of dementia are a frequent reason for psychiatry referral. They have a more irregular course than the cognitive decline, and can be categorized in distinct dimensions. Late-life depression has unique features, such as the focus on somatic complaints instead of mood changes.
Transcranial direct current stimulation (tDCS) is a promising treatment for major depressive disorder (MDD). This study evaluated its antidepressant and cognitive effects as a safe, effective, home-based therapy for MDD.
Methods
This double-blind, sham-controlled, randomized trial divided participants into low-intensity (1 mA, n = 47), high-intensity (2 mA, n = 49), and sham (n = 45) groups, receiving 42 daily tDCS sessions, including weekends and holidays, targeting the dorsolateral prefrontal cortex for 30 minutes. Assessments were conducted at baseline and weeks 2, 4, and 6. The primary outcome was cognitive improvement assessed by changes in total accuracy on the 2-back test from baseline to week 6. Secondary outcomes included changes in depressive symptoms (HAM-D), anxiety (HAM-A), and quality of life (QLES). Adverse events were monitored. This trial was registered with ClinicalTrials.gov (NCT04709952).
Results
In the tDCS study, of 141 participants (102 [72.3%] women; mean age 35.7 years, standard deviation 12.7), 95 completed the trial. Mean changes in the total accuracy scores from baseline to week 6 were compared across the three groups using an F-test. Linear mixed-effects models examined the interaction of group and time. Results showed no significant differences among groups in cognitive or depressive outcomes at week 6. Active groups experienced more mild adverse events compared to sham but had similar rates of severe adverse events and dropout.
Conclusions
Home-based tDCS for MDD demonstrated no evidence of effectiveness but was safe and well-tolerated. Further research is needed to address the technical limitations, evaluate broader cognitive functions, and extend durations to evaluate its therapeutic potential.
This article makes a twofold contribution on the relationship between self/other securitisation, ambiguous threat constructions, and anxiety at the intersection of Securitisation Theory (ST) and Ontological Security Studies (OSS). First, we develop the concept topos of threat (TT) as a potent linguistic anchor in securitisation processes. TTs depict an entire self/other threat situation that warrants escape, serving identity needs while staying flexible and ambiguous. However, their frequent rhetorical deployment can blur the threat construction and increase anxiety: this challenges the classical scholarly assumption that antagonism necessarily alleviates anxiety. Second, we theorise metapolitics as an anxiety mediation strategy. Metapolitics is a mode of interpretation – a relentless analysis of surface clues to expose a deceptive, powerful adversary – which in the final event fails to alleviate anxiety. The dual practice of nurturing topoi of threat and metapolitics drives conflict because it sets in motion a vicious securitisation spiral that entrenches rigid patterns of self/other representation and fosters a bias of anticipating hostility. We employ abductive theorising: working with established theory alongside empirical discovery through a discourse analysis of Russia’s official rhetoric on NATO and the use of the TT ‘colour revolution’ since the conflict in Ukraine began in 2014.
Crowd crush disasters result in psychological risks such as anxiety, depression, and post-traumatic stress disorder (PTSD). This descriptive research study identified the mental health status of Koreans after the Itaewon crowd crush disaster and explored related factors.
Methods
Data were collected May 2-9, 2023 using an online survey. Participants included 205 adults aged 19-69 years recruited through South Korean local and online university communities. Their mental health and related factors were measured at 6 months post-disaster. Data were analyzed using IBM® SPSS® Statistics 26.0. and R 3.4.2.
Results
Significant differences in anxiety, depression, and PTSD among participants who experienced the disaster as victims; changes in drinking frequency and alcohol consumption; and differences in anxiety and PTSD according to family type were observed. Comparing the 3 and 6 month surveys, there were no significant changes in anxiety, depression, PTSD, general mental health, or mental well-being. When mental health severity was divided according to victimization, a significant difference in the severity of anxiety, depression, and PTSD was observed.
Conclusions
Participants’ levels of anxiety, depression, and PTSD varied according to their direct and indirect experience of the disaster, with higher levels of PTSD even without direct experience with the disaster.
The ability to detect and monitor errors enables us to maintain optimal performance across tasks. One neurophysiological index of error monitoring is the error-related negativity (ERN), a fronto-central negative deflection peaking between 0 and 150 ms following an erroneous response. While the developmental literature has illustrated age-related differences in the ERN and its association with anxiety, the literature has mainly focused on the between-person differences of the ERN. Our study examined the within-person variations of the ERN in 115 community-dwelling 9- to 12-year-olds (66 girls; mean age/SD = 11.00/1.16 years). Participants completed an EEG Go/No-Go task and reported their anxiety symptoms. Multilevel growth analyses yielded significant within-person, curvilinear changes in the ERN throughout the task. Youths’ trial-level ERN increased (i.e., became more negative) with early errors, but decreased with subsequent errors. This curvilinear pattern was evident in older, but not younger, youths. Age also interacted with anxiety symptoms: younger youths with higher anxiety showed a continuous increase in the ERN throughout the task, whereas older youths with higher anxiety showed an initial increase followed by a decline in the ERN. Our study contributed novel evidence for the development of the ERN and the underlying mechanisms of the ERN-anxiety relationship that cannot be captured by between-person approaches.
Anxiety disorders and treatment-resistant major depressive disorder (TRD) are often comorbid. Studies suggest ketamine has anxiolytic and antidepressant properties.
Aims
To investigate if subcutaneous racemic ketamine, delivered twice weekly for 4 weeks, reduces anxiety in people with TRD.
Method
The Ketamine for Adult Depression Study was a multisite 4-week randomised, double-blind, active (midazolam)-controlled trial. The study initially used fixed low dose ketamine (0.5 mg/kg, cohort 1), before protocol revision to flexible, response-guided dosing (0.5–0.9 mg/kg, cohort 2). This secondary analysis assessed anxiety using the Hamilton Anxiety (HAM-A) scale (primary measure) and ‘inner tension’ item 3 of the Montgomery–Åsberg Depression Rating Scale (MADRS), at baseline, 4 weeks (end treatment) and 4 weeks after treatment end. Analyses of change in anxiety between ketamine and midazolam groups included all participants who received at least one treatment (n = 174), with a mixed effects repeated measures model used to assess the primary anxiety measure. The trial was registered at www.anzctr.org.au (ACTRN12616001096448).
Results
In cohort 1 (n = 68) the reduction in HAM-A score was not statistically significant: −1.4 (95% CI [−8.6, 3.2], P = 0.37), whereas a significant reduction was seen for cohort 2 (n = 106) of −4.0 (95% CI [−10.6, −1.9], P = 0.0058), favouring ketamine over midazolam. These effects were mediated by total MADRS and were not maintained at 4 weeks after treatment end. MADRS item 3 was also significantly reduced in cohort 2 (P = 0.026) but not cohort 1 (P = 0.96).
Conclusion
Ketamine reduces anxiety in people with TRD when administered subcutaneously in adequate doses.
Given the US population concentration near coastal areas and increased flooding due to climate change, public health professionals must recognize the psychological burden resulting from exposure to natural hazards.
Methods
We performed a systematic search of databases to identify articles with a clearly defined comparison group consisting of either pre-exposure measurements in a disaster-exposed population or disaster-unexposed controls, and assessment of mental health, including but not limited to, depression, post-traumatic stress (PTS), and anxiety.
Results
Twenty-five studies, with a combined total of n =616 657 people were included in a systematic review, and 11 studies with a total of 2012 people were included in a meta-analysis of 3 mental health outcomes. Meta-analytic findings included a positive association between disaster exposure and PTS (n = 5, g = 0.44, 95% CI 0.04, 0.85), as well as depression (n = 9, g = 0.28, 95% CI 0.04, 0.53), and no meaningful effect size in studies assessing anxiety (n = 6, g = 0.05 95% CI −0.30, 0.19).
Conclusions
Hurricanes and flooding were consistently associated with increased depression and PTS in studies with comparison groups representing individuals unaffected by hazards.
Chapter 2 explores Pentecostal ethics, and how urban Pentecostal churches in Rwanda attempted to Pentecostalise ubwenge, a traditional concept often translated as ‘intelligence’, ‘wisdom’, or even ‘cunning’. It traces discursive attempts on the part of Pentecostal pastors to show that the ‘spirit of intelligence’ (umwuka w’ubwenge) had divine origins. Moving from discourse to practice, the chapter also considers how young Pentecostals employed ubwenge in their own lives, using it to navigate relationships both within the church and with the state.
Motivated behaviors vary widely across individuals and are controlled by a range of environmental and intrinsic factors. However, due to a lack of objective measures, the role of intrinsic v. extrinsic control of motivation in psychiatric disorders remains poorly understood.
Methods
We developed a novel multi-factorial behavioral task that separates the distinct contributions of intrinsic v. extrinsic control, and determines their influence on motivation and outcome sensitivity in a range of contextual environments. We deployed this task in two independent cohorts (final in-person N = 181 and final online N = 258), including individuals with and without depression and anxiety disorders.
Results
There was a significant interaction between group (controls, depression, anxiety) and control-condition (extrinsic, intrinsic) on motivation where participants with depression showed lower extrinsic motivation and participants with anxiety showed higher extrinsic motivation compared to controls, while intrinsic motivation was broadly similar across the groups. There was also a significant group-by-valence (rewards, losses) interaction, where participants with major depressive disorder showed lower motivation to avoid losses, but participants with anxiety showed higher motivation to avoid losses. Finally, there was a double-dissociation with anhedonic symptoms whereby anticipatory anhedonia was associated with reduced extrinsic motivation, whereas consummatory anhedonia was associated with lower sensitivity to outcomes that modulated intrinsic behavior. These findings were robustly replicated in the second independent cohort.
Conclusions
Together this work demonstrates the effects of intrinsic and extrinsic control on altering motivation and outcome sensitivity, and shows how depression, anhedonia, and anxiety may influence these biases.
The purpose of the current study was to understand the prevalence and patterns of cannabinoid use among LTC residents across Canada. We gathered data on cannabinoid prescriptions among LTC residents for one year before and after recreational cannabis legalization. Multi-level modelling was used to examine the effects of demographic and diagnostic characteristics on rates of cannabinoid prescription over time. All prescriptions were for nabilone. There was a significant increase in the proportion of residents prescribed nabilone following the legalization of recreational cannabis in Canada. Residents with relatively more severe pain (based on the Minimum Data Set pain scale), a diagnosis of depression, or a diagnosis of an anxiety disorder were more likely to have received a nabilone prescription. Our results provide valuable information regarding the increasing use of synthetic cannabinoids in LTC. The implications for clinical practice and policy decision-makers are discussed.
Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained.
Aim:
The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program.
Method:
A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression.
Results:
The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up.
Conclusions:
Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.
The population of adult CHD patients is continuously increasing. The underlying CHD affects performance and prognosis, but also has a significant impact on quality of life, psychosocial behaviour, anxiety and emotional disturbances. This study analyzes these parameters of patients after one or more heart operations and the possible psychological effects of medical and psychosocial complications at the Department of Cardiology of the Kepler University Hospital Linz.
Methods and Results
A total of 81 subjects participated in the questionnaire survey of the Institute of Cardiology and Clinical Psychology during their annual cardiological check-up. Of these, 80 participants were included in the study and three showed a mild CHD, 49 a moderate one, and 28 a severe one. This study has an exploratory design to assess possible stress factors and limitations in quality of life. For this purpose, a self-administered sociodemographic questionnaire and three standardised questionnaires were used. In summary, the quality of life of adult CHD is considered depending on the severity of the symptoms and compared with the healthy population. Differences in this regard are observed in individuals with lower symptom severity, who report higher psychological well-being. Sex differences are observed in physical role function and physical functioning.
Conclusion:
Based on the results, regular repetitions of the study, as well as continuous psychological and psychosocial support, are necessary, since challenges are predictable with the increasing age of adult CHD patients and since the upholding of good quality of life and dealing with difficult life circumstances must be supported.
A growing number of studies among adolescents have reported early maladaptive schemas (EMS) to associate with anxiety and depression within non-clinical samples. However, there is a gap of knowledge concerning clinical populations.
Aims:
The current study’s aim was to explore the potential association between EMS domains and anxiety and depressive symptoms within clinical sample of adolescents.
Method:
The current study included 176 adolescent psychiatry out-patients. The EMS domains were measured with the Young Schema Questionnaire-Short Form 2-Extended (YSQ). Their association with anxiety symptoms (the Overall Anxiety Severity and Impairment Scale) and depressive symptoms (the Beck Depression Inventory II) were analysed with general linear models while controlling for significant confounding factors.
Results:
Depressive symptoms were associated with three of the four EMS domains: Disconnection and Rejection (η2p=0.047, p=0.005), Impaired Autonomy and Performance (η2p=0.074, p<0.001), and Impaired Limits (η2p=0.053, p=0.003). Anxiety symptoms were associated with two EMS domains: Impaired Autonomy and Performance (η2p=0.046, p=0.005) and Excessive Responsibility and Standards (η2p=0.054, p=0.002).
Conclusions:
Various EMS domains were associated with depressive and anxiety symptoms among adolescent out-patients. Further studies are needed on the effect of EMSs on the treatment outcomes for depression and anxiety.
Mounting evidence suggests that the Mediterranean diet has a beneficial effect on mental health. It has been hypothesised that this effect is mediated by a variety of foods, nutrients and constituents; however, there is a need for research elucidating which of these components contribute to the therapeutic effect. This scoping review sought to systematically search for and synthesise the research on olive oil and its constituents and their impact on mental health, including the presence or absence of a mental illness or the severity or progression of symptoms. PubMed and OVID MEDLINE databases were searched. The following article types were eligible for inclusion: human experimental and observational studies, animal and preclinical studies. Abstracts were screened in duplicate, and data were extracted using a piloted template. Data were analysed qualitatively to assess trends and gaps for further study. The PubMed and OVID MEDLINE search yielded 544 and 152 results, respectively. After full-text screening, forty-nine studies were eligible for inclusion, including seventeen human experimental, eighteen observational and fourteen animal studies. Of these, thirteen human and four animal studies used olive oil as a comparator. Observational studies reported inconsistent results, specifically five reporting higher rates of mental illness, eight reporting lower and five reporting no association with higher olive oil intake. All human experimental studies and nine of ten animal studies that assess olive oil as an intervention reported an improvement of anxiety or depression symptoms. Olive oil may benefit mental health outcomes. However, more experimental research is needed.