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This study aims to review the research progress on the effects of repetitive transcranial magnetic stimulation （rTMS） on cognitive function in generalized anxiety disorder （GAD） with the view of providing references for clinical application. As a common chronic mental disorder， GAD affects the cognitive function， the quality of life and social function of patients. Although first-line treatment is safe and effective for the majority of patients， its effect of improving cognitive function is unclear. As a non-invasive and safe physiotherapy technology， rTMS is expected to provide a new option for the clinical treatment of GAD patients. This review focuses on the characteristics of cognitive function of GAD， the current status of first-line therapy and the treatment of rTMS.
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RESUMO Objetivo Medir a prevalência de sintomatologia de transtorno de ansiedade generalizada (TAG) entre estudantes de um curso pré-vestibular do sul do Brasil e sua associação com fatores sociais, demográficos, acadêmicos e psicológicos. Métodos Este estudo teve delineamento transversal, tendo como participantes estudantes com idade igual ou superior a 18 anos de um curso pré-vestibular privado do sul do Brasil. Foi administrado um questionário autoaplicável que avaliava aspectos sociais, demográficos, acadêmicos, de ansiedade relacionada à prova e estresse percebido. O desfecho analisado foi a sintomatologia de TAG, por meio do instrumento General Anxiety Disorder-7 (GAD-7). Para análise multivariável, utilizou-se a regressão de Poisson com ajuste robusto da variância. Resultados Participaram 137 alunos (taxa de resposta de 90,7%) e a prevalência de sintomatologia de TAG foi de 41,4%. Após análise ajustada, ser do sexo feminino, ter estudado em escola privada, ter maiores escores de estresse percebido e de ansiedade relacionada à prova permaneceram como fatores de risco. Estar com 19 anos apresentou-se como fator de proteção. Conclusões A ansiedade relacionada à prova foi o fator mais fortemente associado com a sintomatologia de TAG, o que sugere que as emoções e preocupações específicas do contexto de avaliação podem predispor o indivíduo a maior risco de desenvolver esse transtorno. A partir desses resultados, sugere-se a inclusão de profissionais da saúde mental no contexto do pré-vestibular, assim como intervenções direcionadas ao desenvolvimento de uma relação saudável entre o aluno e suas demandas acadêmicas.
ABSTRACT Objective To measure prevalence of symptomatology of generalized anxiety disorder (GAD) among students from a university-entrance preparation course in southern Brazil and its association with social, demographic, academic and psychological factors. Methods This study had a cross-sectional design and participants were students aged 18 years or older from a private university-entrance preparation course in southern Brazil. A self-administered questionnaire that assessed social, demographic, and academic variables, as well as test-related anxiety and perceived stress was administered. The outcome analyzed was the symptomatology of GAD through the General Anxiety Disorder-7 (GAD-7) instrument. Poisson regression with robust adjustment of variance was used in multivariate analysis. Results 137 students participated (90.7% response rate) and the prevalence of GAD symptomatology was 41.4%. After adjusted analysis, being female, having studied in a private school, having higher perceived stress and test anxiety scores remained as risk factors. Being 19 years old was a protective factor. Conclusions Anxiety regarding the test was the factor most strongly associated with symptomatology of GAD, which suggests that the emotions and concerns specific to the context of evaluations may predispose the individual to a higher risk of developing this disorder. Based on these results, we suggest the inclusion of mental health professionals in the context of university-entrance preparation courses, as well as interventions aiming the development of a healthy relationship between the student and their academic demands.
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Objective: Escitalopram (ETP), an SSRI (selective serotonin reuptake inhibitor), and s-enantiomer of citalopram is exclusively used as an antidepressant. The drug shows extensive hepatic metabolism, reduced drug efficacy and potential side effects, which reduces its therapeutic index. The present study is focused on developing and characterizing chitosan based nanoparticles of Escitalopram oxalate (ETP). Materials and Methods: The nanoparticles were prepared by ionic gelation method using chitosan and tripolyphosphate (TPP). The formulated nanoparticles were optimized and further characterized by various techniques like particle size, zeta potential analysis, TEM, SEM, EDX, rheological parameters and FT-IR techniques. Also, in vitro drug diffusion was studied to evaluate its pattern of drug release. Result and Discussion: The optimized ETP loaded nanoparticles were made with chitosan: tripolyphosphate (1:1.5) ratio, showing particle size range of 60 – 115nm, with polydispersity index of 0.117, which was further confirmed by TEM analysis whereas; zeta potential was estimated to be -1.89mV. The SEM EDX scans showed almost smooth morphology of the same. The FT – IR results confirmed that there is no interaction between the polymers and drug molecules. The in vitro drug release study using dialysis membrane showed sustained drug release pattern of ETP nanoparticles. Conclusion: ETP loaded chitosan nanoparticles were prepared successfully from ionic gelation method, suggesting a comparatively suitable option for treatment of disease with fewer side effects and increased affinity of drug.
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Objective Repetitive transcranial magnetic stimulation (rTMS) has gradually been used in the treatment of generalized anxiety disorder (GAD).The efficacy and adverse reactions of repetitive transcranial magnetic stimulation on general anxiety disorder are assessed in the review.Methods Searched databases such as Pubmed,Cochrane library,OVID,CNKI,VIP by computer,and researched published randomized controlled trials (RCTs) focused on repetitive transcranial magnetic stimulation on general anxiety disorder.Meta-analysis was conducted by RevMan 5.3 software.Results A total of 10 RCTs were included,involving 732 general anxiety disorder patients.The were divided into two subgroups,one group is effect observation,the other group is the improvement of curative effect in the treatment process.The effectiveness of intervention of rTMS follow up is better than that of the control group (WMD =-5.02,95％ CI=-6.84--3.20,P＜0.01).The intervention of rTMS group can early ameliorate the symptom of anxiety.The results of low frequency and high frequency rTMS intervention is (WMD =-1.34,95％ CI=-1.97--0.71,P＜0.01;WMD =-2.65,95％ CI=-3.51--1.79,P＜0.01).The adverse reactious of the intervention of rTMS group is less than that of the control group(WMD =-7.04,95％ CI=-11.64--2.43,P＜0.01).Conclusion rTMS intervention in the treatment of GAD patients at the end of the treatment and short-term follow-up efficacy is better,rTMS intervention after the onset of rapid intervention,the intervention group adverse reactions are rare.
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Objective:To explore the traits of gray matter volume in general anxiety disorder (GAD)and ob-sessive compulsive disorder (OCD)by using magnetic resonance imaging (MRI)technique.Methods:Twenty-eight GAD,25 OCD and 39 normal controls were recruited.All patients were met the Diagnostic and Statistical Mannal of Mental Disorders,Fourth Edition,Text Revision (DSM-IV-TR)or the International Statistical Classifica-tion of Disease and Related Health Problems Tenth Revision (ICD-10)diagnostic criteria for GAD or OCD.All subjects underwent structural MRI scan.The severity of anxiety and OCD symptoms were rated in all patients with the Hamilton Anxiety Rating Scale (HAMA)and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).The gray matter volume (GMV)was compared between all groups by using the voxel-based morphometry (VBM)a- nalysis.The correlation analysis between GMV and total scores of HAMA and Y-BOCS was performed in GAD and OCD.Results:The GMV was increased in regions including left anterior cingulate cortex in GAD (P =0.016,small volume correction),while only decreased GMV was observed in OCD in bilateral orbitofrontal cortex (OFC)(P <0.001,uncorrected).GAD had larger GMV than OCD in several regions including bilateral OFC (P <0.001,un-corrected).The higher total score of HAMA was associated with increased GMV of right temporal cortex in GAD, and with the GMV of OFC in OCD (P <0.001,uncorrected).Conclusion:No sharing of GMV abnormalities in GAD and OCD was observed in the current study.The traits of brain structure and the potential neural substrate of anxiety symptom in GAD and OCD may be significantly different.
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Objective To explore the clinical features of female diagnosed recurrent major depression (MD) comorbidity with general anxiety disorder (GAD).Methods 301 females patients with recurrent major depression were interviewed by specially trained interviewers with using computer evaluation system and divided into comorbidity group and non-comorbidity group according to whether comorbid MD with GAD or without GAD.The comparison between the two groups included items of demographic,clinical data,assessment of psychopathology,Eysenck neuroticism questionnaire (EPQ),stressful life events,parental bonding instrument.Results 25.2％ of patients of MD coexistence GAD.There was no significant difference in sociodemographic data between the two groups.Significant differences among total number of depression symptoms(OR=1.439,95％ CI =1.049-1.975,P =0.024),duration of illness(OR=1.253,95％ CI =1.010-1.475,P=0.048),psychomotor agitation(OR=2.031,95％ CI =1.123-3.676,P=0.019),suicidal thought(OR=2.228,95％ CI =1.010-4.912,P=0.047),anxiety(OR =5.547,95％ CI =1.935-15.896,P=0.001),irritable(OR=1.956,95％ CI =1.081-3.542,P=0.027) were identified between the two group.In the comorbidity group,the score of nenroticism dimention derived from EPQ was also higher(OR=2.287,95％ CI =1.674-3.124,P=2.287× 10-7) than that of non-comorbidity group.There was no significant difference of stressful life events between two groups(OR=1.118,95％ CI =0.913-1.368,P=0.280).Conclusion This study suggests the phenomena that female patients of recurrent depression disorder comorbidity with general anxiety disorders is common in clinical.The patients comorbid MD and GAD have more symptoms,neuroticism and be worse in severity.
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Objective To study the condition of benzodiazepines use in generalized anxiety disorder (GAD) patients and the relationship with the first benzodiazepine(BZD) prescription.Methods 70 outpatients with GAD were investigated retrospectively and divided into either research group( n = 54, M21, F33; age (18 ～73)year) or control group( n= 16,M7,F9; age( 18 ～53)year) based on whether the first prescription included BZD or not.Results The duration and dose of BZD used in research group ( separately (9.7 ± 4.4) months, ( 1.6 ± 0.7 ) mg/d) were significantly higher than those in control group ( separately(2.3 ± 2.4) months, (0.9 ± 0.9 ) mg/d) (P＜0.01).The long-term use of BZD was positively related to whether the first prescription include BZD or not,patients' insomnia on first visit,the duration of follow-up and the dose of BZD,which showed significantly difference (P＜ 0.05 ).The standardized rates of long-term use of BZD and dependence in research group were significantly higher than those in control group (P ＜ 0.01 ).Conclusion Prescribing BZD on the first visit is partly responsible for the long-term use of BZD and doctors should better be very careful of prescribing BZD on first visit.