The Iraq-Iran war lasted for 8 years and ended approximately 20 years ago. It left many physically and mentally injured individuals. Many of these veteran have been suffering from chronic post-traumatic stress disorder (PTSD).. We observed a percentage of them, suddenly died which could be attributed to self over-medicated. In this research we evaluate tendency to suicide in them.

One hundred and four patients with chronic PTSD who referred to Beheshti psychiatric hospital in Kerman/Iran were included in the study. Subjects should met DSM-IV criteria for PTSD. After collecting demographic data, the risk of suicide was evaluated with California risk estimator for suicide. History of opium dependence and one to one fight were obtained from patients.

The mean±SD of age was 39.90±4.33 years and the mean duration of disease was 18.31±1.99 years.. Severity of suicide based on California test showed 15.4% had high and 63.5% and very high tendency to suicide. History of substance dependence (t=6.58, P<0.0001) and history of one to one fight (t=2.9111, P<0.01) were two factors which are contributed to high suicidal tendency.

Veterans with chronic PTSD are patients who are at risk for many consequent problems. One of these is suicidal tendency. Suicide is a matter which was not paid sufficient attention. Veterans who had specific problem such as drug dependence and whom which were involved in one to one fight are more at risk of suicide.

Yoga has been considered a stress decreasing method in treatment of depression and anxiety disorders whose prevalence is unfortunately increasing gradually.The goal of this study is to evaluate the influence of yoga on depression and anxiety in women referred to yoga clinic.

This is a clinical trial study on all persons who were referred to a yoga clinic for women, from July 2006 to July 2007. All new cases were evaluated on admission using a personal information questionnaire, Beck and Speilberger tests, and then divided into two groups of case and control randomly. The case group (n=34) participated in two weekly yoga classes of 90 min duration for two months. The control group (n=31) were assigned to a waiting list. Both groups were evaluated again after two months.

The average prevalence of depression in the case group before and after yoga course was 12.82 ±7.9 and 10.79 ±6.04 respectively, a statistically insignificant decrease (p=0.13).

However, compared with the control group, the women who participated in yoga classes showed a significant decrease in state anxiety (p=0.03)and trait anxiety (p<0.001).

Participation in a two month yoga class is very likely to lead to significant improvement in anxiety of women who suffer from anxiety disorders.

This study suggests that yoga can be considered as a complementary therapy or an alternative method for medical therapy in the treatment of anxiety disorders.

Presence of childhood abuse is considered a psychological factor in etiology of anxiety disorders. Our aim was to study the effects of childhood/adolescence abuse and suicidal/self-mutilative behaviour on sexual functions in patients diagnosed with panic disorder.

Subjects were 81 patients treated for panic disorder at the psychiatric outpatient clinic of Sisli Etfal Research and Training Hospital, Istanbul, whose diagnoses were established using the SCID-I. Childhood Trauma Questionnaire and Arizona Sexual Experiences Scale (ASEX) were administered to the subjects. A score of 1 is the most favorable score in ASEX while a score of 6 is the least.

71.6% (n=58)of the subjects were female, 28.4%(n=23) of the subjects were male and the average age was 35.8±11.6. Those with history of childhood and adolescence violence/neglect [48% (n=39)] had sexual desire, stimulation, orgasm, orgasm satisfaction and ASEX total points; those with a history of sexual harrasment/rape [9.9% (n=8)] had sexual arousel, orgasm and ASEX total points: and those with a history of attempted suicide/self mutiation [19.8% (n=18)] had sexual desire, orgasm and orgasm satisfaction points which differed to a stastistically significant degree.

This study revealed that a history of abuse and suicide/self mutilation effects phases of sexual function in panic disorder. It is important to question sexual function in panic disorder and to question childhood abuse in those cases where there is sexual disfunction. A history of attempted suicide and self mutilation adversely effects sexual functions in panic disorder.

Clinical trials in psychiatry rely on subjective outcome measures, where poor inter-rater reliability can negatively impact signal detection and study results. One approach to this challenge is to limit the number of raters thereby decreasing expected variance. However, sample size requirements—even those based on high reliability— often necessitate many sites. The implementation of comprehensive rater training combined with validated assessment of inter-rater reliability at study initiation and throughout the study is critical to ensure high inter-rater reliability. This study examined the effect of rater training and assessment to reduce inter-rater variance in clinical studies.

After rigorous training on the administration and scoring guidelines of the HAM-A, 286 raters independently reviewed and assessed a videotaped HAM-A interview of a GAD patient. Measures of inter-rater agreement across the pool of raters, as well as for each individual rater relative to all other raters were calculated using kappa statistics modified for situations where multiple raters assess a single subject1.

The overall level of inter-rater agreement was excellent (kappa = .889), with levels of inter-rater agreement of each individual rater relative to all other raters ranging from .514 to .930. Of the 286 raters participating, more than 97.2% (278) achieved inter-rater agreement > 0.8.

This study demonstrates that robust rater training can result in high levels of agreement between large numbers of site raters on both an overall and individual rater basis and highlights the potential benefit of excluding raters from study participation with inter-rater agreement below 0.8.

Examine the evidence for a relationship between pregabalin effect on pain and baseline anxiety and depressive symptoms in patients with fibromyalgia (FM).

Chronic pain and concomitant anxiety and depressive symptoms are common in patients with FM, as well as in other chronic pain disorders. Pregabalin was effective for treating pain in FM patients in three parallel group RCTs (105, 1056, 1077) where data for anxiety and depressive symptom levels were collected.

Patients meeting ACR criteria for FM with a pain VAS score ≥40 mm were followed for 8-14 weeks in 3 randomized, double-blind, placebo-controlled trials. Patients (N=2022) received 150, 300, 450 or 600mg/d pregabalin or placebo. The primary efficacy parameter was change in endpoint Mean Pain Score (MPS) (range 0 [no pain]-10[worst possible pain]). Regression analyses evaluated whether changes in pain bore any relation to the baseline Hospital Anxiety and Depression Scales (HADS-A) and (HADS-D) levels.

Pregabalin 300, 450, and 600 mg/d, but not 150 mg/d, showed statistically significant improvements in pain compared with placebo (p<0.0001). For each pregabalin treatment group, improvements in pain at endpoint were not found to have a statistically significant association with baseline levels of anxiety or depressive symptoms. Adverse events (AEs) were consistent with known side effects of pregabalin; dizziness and somnolence, mild to moderate in intensity, were the most frequently reported AEs for pregabalin patients.

Pregabalin treatment demonstrated significant improvements in pain regardless of baseline anxiety or depressive symptom levels for patients with FM.

Study funded by Pfizer, Inc

To compare the anxiolytic efficacy and speed of onset of pregabalin (PGB) and venlafaxine-XR (VXR) in patients with GAD.

Adult outpatients with DSM-IV GAD and a HAM-A score >20 were randomized to 8-weeks of flexible-dose double-bind treatment with PGB 300-600mg/d (n=121), VXR 75-225mg/d (n=125), or placebo (PBO; n=128). Primary outcome: LOCF-endpoint change in HAM-A total score. Secondary outcomes included the Clinical Global Impression, Severity scale (CGI-S).

Study groups were similar at baseline, or PGB, VXR, and PBO, respectively, in terms of gender, mean age, and baseline HAM-A (27.6±0.4 vs. 27.4±0.4 vs. 26.8±0.4. Treatment with PGB was associated with significantly greater improvement than placebo at LOCF-endpoint, with onset of treatment effect beginning by day 4. HAM-A-total scores for PBO, PGB, and VXR at day 4 were: -3.4±0.5, -5.3±0.5 (P=.008), and -2.9±0.6 (P=.070), respectively; corresponding LOCF-endpoint HAM-A-total scores were: -11.7±0.9, -14.5±0.9 (P=.03), and -12.0±0.9 (P=.097). LOCF-endpoint CGI-S scores for PBO, PGB, and VXR were: -1.5±0.2, -2.0±0.2 (P=.02), and -1.7±0.2 (P=.36),

Severe AE rates were: PGB (9.1%), VXR (20.0%), and PBO (7.8%). Discontinuation due to AEs were: PGB (12.4%), VXR (17.6%), and PBO (5.5%).

Pregabalin was safe and effective, demonstrating significantly earlier onset of anxiolytic activity against GAD than venlafaxine-XR. Venlafaxine-XR did not demonstrate significant efficacy, possibly due to a relatively high placebo response.

Funded by Pfizer Inc

To assess the speed of onset of anxiolytic efficacy of a single-dose of pregabalin (PGB) in a dental-anxiety model.

Adult outpatients in this double-blind, parallel-group study received a single-dose PGB 150mg (n=27), alprazolam 0.5mg (n=31; ALP), or placebo (n=31; PBO) 4 hours before a dental procedure. Inclusion criteria included Dental Anxiety Total score ≥12 (moderate-to-severe) without presence of DSM-IV anxiety disorder. Efficacy and safety assessments (at 2, 2.5, 3, 3.5, and 4 hours post-dose) included: 100-mm Visual Analogue Scale for Anxiety (VAS-A; primary outcome); 100-mm VAS-Sedation (VAS-S); and Time-to-Onset of Action Scale (TOAS), which rates anti-anxiety drug benefit (0-10, no–full benefit).

VAS-A scores at baseline were higher on PGB (70.2) compared to ALP (57.4) or PBO (64.1). On a mixed-model analysis, VAS-A improvement slopes were greater for PGB (t= -2.47; P=0.014) and ALP (t= -2.39; P=0.018) vs PBO. Significant improvement on TOAS was seen at hour 2 and hour 3 through endpoint for ALP and PGB subjects, respectively (P≤0.05 vs PBO, both groups). VAS-S scores were significantly higher vs PBO for PGB at hours 2.5-4.0, and at hours 2 until endpoint for ALP (P≤0.05 both groups). Spearman analysis showed similar levels of correlation between the TOAS and VAS-S (r= +0.58) and VAS-A (r= -0.50), suggesting that the VAS-S may be measuring an efficacy outcome in this model. Both PGB and ALP were well-tolerated.

Clinically meaningful anxiolytic effect occurred within 3-4 hours after single-dose PGB in this dental-anxiety model.

were consistent with national studies but showed higher figures to neighbouring countries. It was consistent with figures in United Kingdom before 1950.

Patient's satisfaction is a vital part of the assessment of quality of health care. Patient's mental health situation may influence service satisfaction and vice versa. The aim of this study was to evaluate relationship between anxiety and depression and service satisfaction, in a group of patients that were admitted in a general hospital.

Four hundred patients who were admitted in Dr. Shariati Hospital were included in the study consecutively. Participants were recruited from medical and surgical wards. The Hospital Anxiety and Depression Scale (HADS) was used to determine depression and anxiety and 18 items Patient Satisfaction Questionnaire (PSQ-18) was used to measure service satisfaction. Other variables that were measured included: demographic variables, duration of disease, time passed from admission, ward of admission, pattern of referral to hospital, type of insurance and the way of payment.

Patient with anxiety and depression were less satisfied with services. Service satisfaction according to PSQ-18 scores had a reverse significant relation with anxiety score of HADS. There was no significant relationship between service satisfaction and age, sex, education, duration of disease, time passed from admission, ward of admission, pathway of referral, type of insurance and the way of payment.

Psychological profile of hospitalized patients may play important role in their satisfaction with services. Careful management of mental health problem may be necessary to improve service satisfaction of medical inpatients. On the other hand improvement in quality of care and increasing service satisfaction may reduce mental health problem of the patients.

Generalized Anxiety Disorder (GAD) is classified as an anxiety disorder. High co-morbidity with other anxiety and depressive disorders blurs boundaries between these disorders, clinically as in research. This is particularly relevant for genetic research into causes of these disorders.

We attempt to clarify where GAD belongs in the anxiety/depression spectrum disorders.

The cohort is based on a population-wide screening for anxiety and depression in Iceland as part of a genetic research project. Following the screening participants underwent the Composite International Diagnostic Interview (CIDI) for possible ICD-10 diagnoses. Odds ratios (OR) were calculated by logistic regression analysis for GAD and the other disorders. The phobias (simple, social and agoraphobia) were pooled together in the analysis.

A total of 3.150 participants underwent the CIDI. The OR between GAD and dysthymia was 2.99 (2.37-3,78), Panic disorder, PD, 2.03 (1.59-2.59); any phobia 1.15 (0.92-1.42) and Major Depressive Disorder, MDD, 1.07 (0.84-1.37). The OR between dysthymia, MDD and GAD is very high, . The OR, with co-morbidity accounted for by logistic regression analysis, is slightly lowered for all except dysthymia.

Our results show that GAD is significantly associated with dysthymia, followed by PD, but non-significant with the phobias and MDD. Dysthymia, on the other hand, has a robust relationship both to GAD and MDD, 2.97 and 2.91 respectively. Logistic regression confirms the strong link between GAD and dysthymia and gives these disorders the possible role of a genetic bridge between anxiety and depressive disorders.

To assess the impact of high levels of insomnia on response to pregabalin (PGB) in patients with GAD.

Pooled data were analyzed from 6 double-blind, placebo-controlled, 4- to 6-week trials of outpatients who met DSM-IV criteria for GAD with a minimum Hamilton rating scale for anxiety (HAM-A) score ≥18. Response was evaluated for 3 fixed-dose PGB groups: 150mg/d, 300-450mg/d, and 600mg/d. A "high-insomnia" subgroup was defined by a baseline HAM-D insomnia factor score ≥4 (maximum=6).

At baseline, 482 (31%) patients met criteria for the high-insomnia subgroup, and 1073 (69%) for the low-insomnia subgroup. Mean baseline HAM-A scores were non-significantly higher (approx. 1-point) in high-insomnia vs low-insomnia patients. In high-insomnia patients, PGB produced significantly greater improvement in HAM-A total scores at LOCF-endpoint vs placebo—PGB 150mg/d (-10.3±1.01), PGB 300-450mg/d (-12.4±0.88), PGB 600mg/d (-11.6±0.72), and placebo (-8.4±0.66) (P<0.0001, all comparisons). Effect sizes for endpoint HAM-A change were higher in high-insomnia than low-insomnia subgroups (0.47 vs 0.32). Endpoint HAM-A-score changes were the same (-12.0) on PGB in both insomnia subgroups; placebo response was higher in low-insomnia patients. Significantly more high-insomnia patients on PGB were insomnia responders (reduction to minimal-to-no insomnia) (75.2%, all doses combined) vs placebo (61.5%; P<0.005). Rates of treatment-emergent insomnia were 4.7% for all PGB doses combined vs 5.4% for placebo.

Pregabalin was well tolerated, and improved overall anxiety symptoms, while specifically improving insomnia in patients with GAD presenting with high levels of concurrent insomnia.

Panic attacks are psychopathological phenomena with a strong emotional component that often induce an adaptive response with anticipatory anxiety and phobic avoidance. There are evidences of the presence of biases in emotional processing in patients with panic disorder. The aims of this study were to compare Emotional Intelligence (EI) between patients with PD and control subjects and to investigate if this construct is related to the severity of agoraphobia.

Fifty-one patients with PD and 50 healthy controls were assessed for their EI with the Mayer-Salovey-Caruso Emotional Intelligence Scale and their phobic avoidance with the Mobility Inventory for Agoraphobia. Data were analysed by not parametric statics.

The Strategic Emotional Intelligence area showed lower scores in patients with PD compared to healthy controls (median 80 vs 84.9, z =-3.37, p<.0008). Among the subscales of this area, this difference was significant (median 80 vs 85.3, z =-2.61, p<.009) for the “Understanding emotions” branch. The severity of agoraphobia correlated with the “Facilitating thought with emotion” branch of Experiential EI area.

Patients with PD show a lower strategic EI. Some aspect of experiential EI seem to be related to the severity of agoraphobia. A training focused on the development of the strategic component of emotional intelligence might help patients with PD.

Mayer J., Caruso D., Salovey P. Emotional Intelligence Meets Traditional Standards for an Intelligence. Intelligence 2000; 27: 267–298.

Recent studies indicate that Adult Separation Anxiety Disorder (ASAD) may represent a discrete diagnostic entity worthy of attention. Adults with ASAD report estreme anxiety and fear about separations from major attachment figures. These symptoms lead to severe impairment in social relationships and are not better accounted for by the presence of agoraphobia. In a previous study, we found platelet expression reduction of the 18 kDa Translocator Protein (TSPO) in patients with panic disorder with associated ASAD.

To explore whether separation anxiety might be a factor differentiating TSPO expression in a sample of patients with major depression.

The equilibrium binding parameters of the specific TSPO ligand [3H]PK 11195 were estimated on platelet membranes from 40 adult outpatients with MDD, with or without separation anxiety symptoms, and 20 healthy controls. Patients were assessed by SCID-I, HAM-D, the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS) and the Adult Separation Anxiety Self-report Checklist (ASA-27).

A significant reduction of platelet TSPO density mean value was found in depressed patients with associated ASAD, while no significant differences were found between depressed patients without ASAD and the control group. Individual TSPO density values were significantly and negatively correlated with both SCI-SAS-A and ASA-27 total scores, but not with HAM-D total score or HAM-D anxiety/somatization factor score.

Reduction of platelet TSPO density in our sample of patients with depression was specifically related to the presence of ASAD. These data suggest that TSPO expression evaluation is a useful biological marker of ASAD.

Anxiety disorders are associated with impairment in social functioning and poor quality of life, with personal impairment affecting many areas. Instead of collapsing together symptoms and functioning, the Kennedy Axis V is designed to assess seven dimensions.

Thirty-five outpatients consecutively admitted to our Anxiety Disorders Unit were evaluated before starting treatment by a set of instruments including: Mobility Inventory for Agoraphobia (MIA), Self-rating Anxiety State (SAS), Anxiety Status Inventory (ASI), Penn State Worry Questionnaire (PSWQ), Symptom Check List 90 Revised (SCL-90-R), Brief-COPE, and Kennedy Axis V (K Axis).

Sample characteristics: age 38.5±10.9, males 36.1%, current substance use 14.3%, previous drug treatment 82.9%, previous psychotherapy 28.6%. Symptom scores (mean±SD): MIA 7.41±6.84, PSWQ 46.59±12.15, ASI 58.97±10.53, SAS 59.43±11.85; as for the SCL-90-R subscales and indexes: Somatization (SOM) 1.62±0.76, Obsessive-Compulsive (O-C) 1.48±0.70, Interpersonal Sensivity (I-S) 1.38±0.85, Depression (DEP) 2.02±0.90, Anxiety (ANX) 1.94±0.79, Hostility (HOS) 1.14±0.84, Phobic Anxiety (PHOB) 1.52±1.11, Paranoid Ideation (PAR) 1.33±0.87, Psychoticism (PSYC) 0.88±0.72; General Symptomatic Index (GSI) 1.55±0.59, Positive Symptom Total (PST) 58.84±15.42, Positive Symptom Distress Index (PSDI) 2.19±0.57. The results of the K Axis subscale for psychological functioning (PSY) was 54.00±4.97; all the remaining subscales scored 90 or more. Significant correlations between symptom scales and psychological functioning were (Spearman's Rho, α=.05): PSY vs. PSDI -0.526 (p=.002), PSY vs. PSYC -0.446 (p=.008), PSY vs. DEP -0.43 (p=.011), PSY vs. GSI -0.427 (p=.012), PSY vs. I-S -0.425 (p=.001).

Scores on the self-rated symptomatic scales are inversely correlated with the clinician-attributed score of PSY, suggesting construct validity.

analyse the presence of comorbid symtoms as assessed by Hamilton Anxiety scale in outpatients followed in Psychiatric clinics.

Multicentre, cross-sectional study enrolling subjects above 18 years-old with GAD according with ICD-10. Participants were chosen at ramdon by quotes and weighted geographically, but patients were enrolled consecutively. HAM-A and CGI-S were administered to determine clinical status and comorbid symptoms (scoring > 3 in HAM-A). QoL was assessed by SF-36 questionnaire.

A total of 792 patients; 15.7% naives (GADn), 68.9% women, mean (SD) age of 40.0 (12.9) years were included. Symptoms of imsomnia were presented in 30.1% of subjects; 42.3% in GADn vs 27.8% on-treatment (GADt), p=0.001. Symptoms of cognitive function deterioration were showed in 21.1% (25.2% in GADn vs. 20.3% in GADt, p=0.220) and depressive symptoms in 15.5% (15.4% in GADn vs 15.5 in GADt, p=0.991). Moderate to excruciating pain was presented in 46.7% of subjects; 50.5% in GADn vs 46.1% in GADt, p=0.705. Overall, psychic and somatic anxiety symptoms scoring were higher in GADn than in GADt; 26.8 (7.3) vs 22.4 (9.6), p<0.0001, 14.2 (3.6) vs 12.0 (5.0), p<0.0001, and 12.6 (4.5) vs 10.4 (5.2), p<0.0001, respectively. No age or sex differences were found.

Pain, symptoms of depression and cognitive deterioration were comorbid conditions presented in a considerable proportion of GAD patients irrespective of time of evolution, age or sex. Frecuency of insomnia was also high, mainly in naïve patients. This study shows that more attention should be devoted to comorbid condition associated with GAD.

analyse the impact of comorbid depression on clinical and self-perceived health status in outpatients with GAD in Spain.

Multicentre, cross-sectional study enrolling subjects above 18 years-old with GAD according with ICD-10. Participants were chosen at ramdon by quotes and weighted geographically, but patients were enrolled consecutively. HAM-A and CGI-S were administered to determine clinical status and SF-36 and Sheehan disability scales for health status assessment.

Seven-hundred-ninety-two patients; 15.7% naives (GADn), 68.9% women, mean (SD) age of 40.0 (12.9) years were included. Ninety (11,4%) fulfilled criteria for comorbid depression with GAD. Depressive subjects were older [49.5 (11.3) vs. 43.7 (13.2) years, p=0.0001], female (78.7% vs 67.6%, p=0.034) and received lorazepan and lormetazepan more frequently (30.0% vs. 18.5%, p=0.015, and 15.6% vs. 5.0%, p=0.0002, respectively), but not antidepressatns, and received higher number of drugs; 2.3 (0.8) vs. 2.0 (0.8), p=0.011. Overall, psychic and somatic anxiety symptoms scoring (HAM-A) were higher in depressive; 26.4 (8.2) vs 22.7 (9.5), p=0.0003, 14.1 (4.1) vs 12.1 (4.9), p<0.0001, and 12.3 (4.7) vs 10.6 (5.2), p=0.0023, respectively. Depressive showed more severe symptoms of anxiety; 62.2% vs. 43.0%, p=0.0031, and scoring in CGI; 4.2 (0.9) vs 3.7 (1.1), p<0.0001. Depressives also showed higher scoring of disability; 19.7 (6.0) vs. 15.6 (7.0)%, p<0.0001, and lower values in physical and mental summary subscales of SF-36; 38,6 (7,9) vs 43.9 (9.0), p<0.0001, and 26.6 (9.5) vs. 30.4 (11.6), p=0.0008.

Comorbid depression enlarges deterioration in clinical status, level of functioning and quality of life of outpatients with GAD.