Escala de ansiedad generalizada GAD-7 en profesionales médicos colombianos durante pandemia de COVID-19: validez de constructo y confiabilidad

Introducción: La detección de síntomas de ansiedad entre el personal sanitario que atiende a pacientes contagiados de COVID-19 es una prioridad actual. Se requieren instrumentos rápidos y válidos para esta población. El objetivo es establecer la validez de constructo y la confiabilidad de la Escala de Ansiedad Generalizada (GAD-7) en médicos colombianos durante la cuarentena por la COVID-19. Métodos: Estudio eSalud, en el que se recopilaron datos transversales en línea (n = 1.030) de 610 médicos de COVID y 420 no de COVID durante la cuarentena colombiana, entre el 20 de abril y el 10 de agosto de 2020. Se contactó con cada sujeto, que confirmó participación, identidad y función profesional. Resultados: Se encontró una estructura factorial de 1 solo factor, conformado por los 7 ítems del instrumento, que logró explicar el 70% de la varianza. Los índices de bondad de ajuste (RMSEA = 0,080; CFI = 0,995; SRMR = 0,053; p 0,07. Por último, la consistencia interna del instrumento fue buena, con alfa de Cronbach = 0,920 (IC95%,8,80-9,71). Conclusiones: El GAD-7 es un instrumento que presenta indicadores adecuados de validez y confiabilidad. Es un excelente instrumento, confiable, fácil y rápido de usar para la detección de los síntomas de ansiedad generalizada en personal médico, atienda o no a pacientes contagiados de COVID-19.

Introduction: The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalized Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown. Methods: E-health study, in which cross-sectional data were collected online (n = 1,030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role. Results: A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p 0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71). Conclusions:The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

The evaluation of pancreas β-cell autoantibodies in non-diabetic COVID-19 patients

ABSTRACT Objective: This study aims to evaluate potential pancreas endocrine damage due to SARS-CoV-2 by measuring β-cell autoantibodies in COVID-19 patients. Subjects and methods: Between June and July 2020, 95 inpatients with a positive COVID-19 test result after polymerase-chain-reaction (PCR) and who met the inclusion criteria were enrolled in our study. Laboratory parameters that belong to glucose metabolism and β-cell autoantibodies, including anti-islet, anti-glutamic acid decarboxylase, and anti-insulin autoantibodies, were measured. β-cell autoantibodies levels of the patients were measured during COVID-19 diagnosis. Positive results were reevaluated in the 3rd month of control. Results: In the initial evaluation, 4 (4.2%) patients were positive for anti-islet autoantibody. Only one (1.1%) patient was positive for anti-glutamic acid decarboxylase autoantibody. No patient had positive results for anti-insulin autoantibody. FPG, HbA1c, and C-peptide levels were similar in patients who were split into groups regarding the initial positive or negative status of anti-islet and anti-GAD autoantibodies (p>0.05). In the 3rd month after the initial measurements, anti-islet autoantibody positivity of 2 (50%) of 4 patients and anti-glutamic acid decarboxylase positivity of 1 (100%) patient were persistent. Finally, 3 (3.1%) patients in the whole group were positive for anti-islet autoantibody in the 3rd month of control. No difference was determined between the initial and the 3rd month of parameters of glucose metabolism. Conclusion: Following an ongoing autoantibody positivity in the present study brings the mind that SARS-CoV-2 may be responsible for the diabetogenic effect. Clinicians should be aware of autoantibody-positive DM as a potential autoimmune complication in patients with SARS-CoV-2.

Sintomas de ansiedade generalizada entre estudantes de graduação: prevalência, fatores associados e possíveis consequências / Symptoms of generalized anxiety among undergraduate students: prevalence, associated factors and possible consequences

RESUMO Objetivo Medir a prevalência de sintomatologia ansiosa entre estudantes de graduação de uma universidade pública no Sul do Brasil, seus fatores associados e possíveis consequências. Métodos Trata-se de um estudo transversal com uma amostra aleatória de graduandos, realizado em 2019. Foi utilizado um questionário com questões sociodemográficas, acadêmicas e de saúde mental e física. Sintomas de ansiedade generalizada foram avaliados por meio do Generalized Anxiety Disorder - 7 (GAD-7). Fatores associados e possíveis consequências foram analisados por meio da regressão de Poisson com ajuste robusto da variância. Resultados Entre os 994 participantes, a prevalência de sintomas de ansiedade generalizada severa foi de 30,9% (IC 95%: 27,9%-33,9%). As variáveis independentemente associadas a sintomas de ansiedade generalizada foram: sexo feminino, orientação não heterossexual, sentir muito/muitíssimo medo de violência no bairro e perceber como difícil o acesso a serviço psicológico. Possuir alto nível de suporte social e apresentar algum nível de atividade física foi considerado fator de proteção para o desfecho. Possíveis consequências dos sintomas de ansiedade generalizada foram: pior qualidade de sono, utilizar algum medicamento sem prescrição nos últimos 30 dias e ser classificado como risco de suicídio moderado/severo. Conclusões Esses resultados demonstram a necessidade de um olhar mais atento para alguns subgrupos populacionais. Recomenda-se a implementação de intervenções psicológicas que incluam um número maior de indivíduos simultaneamente (como a criação de grupos terapêuticos), com o intuito de reduzir a carga de ansiedade no contexto universitário. O fortalecimento do setor de assistência estudantil da universidade também se torna uma importante possibilidade de melhora para esse cenário.

ABSTRACT Objective To measure the anxious symptoms of undergraduate students at a public university in southern Brazil, the factors associated with it and the possible consequences. Methods This was a cross-sectional study with a random sample of undergraduate students in 2019. A questionnaire that evaluated sociodemographic, academic, mental and physical health aspects was used. Symptoms of generalized anxiety were evaluated through the Generalized Anxiety Disorder - 7 (GAD-7). Associated factors and possible consequences were analyzed using the Poisson regression, with robust variance adjustment. Results Among the 994 participants, the prevalence of symptoms of severe generalized anxiety was 30.9% (95% CI: 27,9%-33,9%). The variables independently associated with symptoms of generalized anxiety were: female gender, non-heterosexual orientation, feeling very afraid of violence in the neighborhood, perceiving access to psychological service as difficult. Having a high level of social support, and with any level of physical activity were considered protective factors for the outcome. Possible consequences of symptoms of generalized anxiety were: worse sleep quality, non-medical use of prescription drugs in the last 30 days, and being classified with moderate or severe suicide risk. Conclusions These results indicate the need to a closer attention to subgroups within this population. Implementation of psychological interventions that includes a broader range of individuals simultaneously are recommended (such as therapeutic groups) to reduce the burden of anxiety in the university context. The strengthening of the university's student assistance sector is also important to improve this situation.

Impacto de la presencia de depresión y ansiedad en pacientes con artritis psoriásica / Impact of depression and anxiety in patients with psoriatic arthritis

Introducción: un tercio de los pacientes con artritis psoriásica (APs) sufre ansiedad y/o depresión, lo que podría impactar negativamente en la actividad de la enfermedad. Los objetivos de este estudio fueron: evaluar la prevalencia de depresión y ansiedad en pacientes con APs, estudiar su asociación con diferentes factores sociodemográficos y clínicos, y determinar el efecto sobre los diferentes componentes de los índices compuestos de la actividad de la APs. Materiales y métodos: se incluyeron pacientes con APs que cumplían criterios de la Classification criteria of psoriatic arthritis (CASPAR). La depresión se definió según el Patient Health Questionnaire-9 (PHQ-9) y la ansiedad según el cuestionario General Anxiety Disorder-7 (GAD-7). Se realizó regresión logística múltiple para identificar variables asociadas a ansiedad y depresión. Resultados: se incluyeron 100 pacientes con APs, de los cuales el 26% y el 59% presentaron depresión mayor y ansiedad respectivamente. Los pacientes con depresión mayor tuvieron mayor actividad de la enfermedad, dolor, fatiga, ansiedad, y menor educación formal y peor calidad de vida. Aquellos con ansiedad manifestaron mayor actividad de la enfermedad, dolor y fatiga, y peor calidad de vida y capacidad funcional. La alta actividad de la enfermedad y la menor educación formal se asociaron independientemente con depresión mayor. Conclusiones: la presencia de depresión mayor y ansiedad se asoció con mayor actividad de la enfermedad en pacientes con APs.

Introduction: nearly one-third of psoriatic arthritis (PsA) patients suffer from anxiety and/or depression. The objectives of this study were to estimate the prevalence of depression and anxiety in patients with PsA, establish the relationship with different socio-demographic and clinical factors, and determine the effect of depression and anxiety on various components of disease activity scores. Materials and methods: patients with PsA who met the Classification criteria of psoriatic arthritis (CASPAR) criteria were included. Depression was defined according to the Patient Health Questionnaire-9 (PHQ-9) and anxiety according to the General Anxiety Disorder-7 (GAD-7) questionnaire. Multiple logistic regression was performed to identify variables associated with anxiety and depression. Results: 100 patients were included. The prevalence of major depression and anxiety was 26% and 59%, respectively. Patients with major depression had higher disease activity, pain, fatigue and anxiety, less formal education and worse quality of life. In comparison those patients with anxiety showed higher disease activity, pain and fatigue and worse quality of life and functional capacity. High disease activity and low formal education were independently associated with the existence of major depression. Conclusions: patients with PsA who suffer from major depression and anxiety show higher disease activity levels.

Cross sectional study of depression, anxiety and quality of life in glaucoma patients at a tertiary centre in North Kerala

Purpose: To determine the magnitude and direction of association of anxiety and depression and the quality of life (QoL) in persons with glaucoma. Methods: This prospective cross?sectional study in conducted in a tertiary eye center in north Kerala included glaucoma patients and normal subjects aged 40–80 years. The Patient Health Questionnaire?9 (PHQ?9), the Generalized Anxiety Disorder?7 (GAD?7), Glaucoma Quality of Life (GQOL), and glaucoma evaluation were performed for all participants. One?way analysis of variance was used for statistical analysis. Results: The study included 148 subjects with glaucoma and 150 subjects without glaucoma. The prevalence of depression (35.81%) and anxiety (25.0%) was significantly higher in glaucoma patients. In a multivariate regression model, PHQ?9 (adjusted OR: 2.39, 95% CI: 1.31–4.38, P < 0.001), GAD?7 (adjusted OR: 2.06, 95% CI: 1.01–4.19, P = 0.01) and GQOL (coefficient: 6.92, 95% CI: 4.52–9.31, P = < 0.001) was significantly associated with glaucoma. The GAD?7 score was significantly higher (P = 0.02) in PACG compared to POAG in moderate and severe anxiety. ADL scores (one?way ANOVA, P = 0.001) and GQOL scores (one?way ANOVA, P < 0.001) were significantly associated with vision impairment and blindness. Conclusion: Depression and anxiety are common in glaucoma patients, indicating the need for screening protocols using PHQ and GAD scales to identify persons at risk. The lack of ophthalmic risk factors associated with depression and anxiety emphasizes the importance of psychological evaluation and combined management with a psychiatrist in glaucoma management.

Prevalence of Latent Autoimmune Diabetes in Adult Based on the Presence of GAD 65 Antibodies in North-Eastern Uttar Pradesh, India

Objective:The objective of this paper was (1) to study the prevalence of latent autoimmune diabetes in adult (LADA) in the region of north-eastern Uttar Pradesh, India, based on the positivity for glutamic acid decarboxylase 65 (GAD65) antibodies and (2) to compare the glycemic profile between GAD65-positive and GAD65-negative subjects. Materials and Methods?The subjects were of more than 30 years of age, with either recently diagnosed pre-diabetes/diabetes presenting with the hemoglobin A1c (HbA1c) level of ?5.7% or already diagnosed cases of type 2 diabetes mellitus (T2DM) who had no requirement of insulin therapy for at least 6 months from the time of their diagnosis. All the patients were natives of north-eastern Uttar Pradesh. The GAD65 test was done by the enzyme-linked immunosorbent assay. Further, the glycemic status of GAD-positive and GAD-negative subjects were compared on the basis of fasting blood sugar (FBS), fasting insulin (FI), and homeostatic model assessment for insulin resistance (HOMA-IR). The “unpaired t-test” was used to compare and assess the significance of differences between the glycemic profile of GAD65-positive and GAD65-negative subjects using the GraphPad Prism Scientific Software, San Diego, CA, United States. The p-value of <0.05 was considered to be significant. Results?A total of 77 patients were included in the study, with the age group ranging from 30 to 75 years (47.81?±?12.9 years) with the male–female ratio of 1:2.6. The prevalence of LADA was found to be 51.95%. On comparing GAD65-positive and GAD65-negative groups, a higher value of HbA1c levels and FBS were found in the former, whereas FI and HOMA-IR were found to be higher in the latter. On testing for significance of difference, only FI and HbA1c values were significant (p-value <0.0001). Conclusion?LADA can no longer be considered a rare type of diabetes mellitus, with the present study showing a high prevalence of LADA in this north eastern region of Uttar Pradesh. Identification of adult-onset diabetics accurately as LADA or true T2DM is very crucial for the appropriate treatment, as LADA patients require insulin inevitably and much earlier than true T2DM patients, who can be managed mostly on oral hypoglycemic agents with seldom requirement of insulin

Prevalence and influencing factors of anxiety status among elderly hypertensive patients in a district of Shanghai / 四川精神卫生

ObjectiveTo analyze the anxiety status among elderly hypertensive patients in Hongkou district of Shanghai city， and to screen the influencing factors. MethodsConvenience sampling method was adopted to enroll 265 hypertensive patients aged 60 years or above from 8 communities in Hongkou district of Shanghai city， and Generalized Anxiety Disorder-7 item （GAD-7） was used to assess their anxiety status， then Logistic regression analysis was applied to explore the influencing factors. ResultsAmong 265 patients with hypertension， 45 patients （17.0%） had anxiety symptoms. Multivariate Logistic regression analysis showed that non-hypertensive chronic disease comorbidity in recent six months （OR=3.093， 95% CI： 1.075~8.898， P<0.05）， excessive alcohol consumption （OR=5.203， 95% CI： 1.407~19.234， P<0.05）， living with spouse （OR=0.061， 95% CI： 0.005~0.699， P<0.05） and regular exercise （OR=0.360， 95% CI： 0.167~0.775， P<0.01） were the factors affecting anxiety in hypertensive patients. ConclusionAnxiety symptoms are quite common among elderly hypertensive patients in community，among which comorbidities and excessive alcohol consumption are risk factors， while living with spouse and regular exercise are protective factors.

The effect of COVID-19 pandemic on anxiety disorders among workers in a hospital in Balikpapan, East Kalimantan

INTRODUCTION@#During the global COVID-19 pandemic, health workers were found to have a higher prevalence of anxiety disorder compared to non-health workers. Anxiety disorder that occurs chronically have a 25% chance to become a major depression disorder.@*OBJECTIVE@#The aim of this study is to understand the anxiety condition and related risk factors among workers in a Balikpapan hospital during the COVID-19 pandemic.@*METHOD@#The design of this research used a cross sectional method that involved 279 respondents who are workers in a Balikpapan hospital. The study used SPSS version 20.0, using the chi square and Fisher’s Exact test for the bivariate analysis, and the logistic regression with enter method for the multivariate analysis.@*RESULTS@#The study shows that using the General Anxiety Disorder 7 (GAD-7) questionnaire from 279 hospital workers, there were 10.8% with mild-, 1.45% with moderate-, and 0.4% with severe anxiety disorder. A significant relation was found between anxiety disorder and risk factors such as being a health worker with p=0.001 and a 4.8 OR adj (95% CI: 1.9-12.3), working in areas with high risk of transmitting COVID-19 with p=0.04 and a 5.1 OR adj (95% CI: 1.0-24.2), and workers who are being quarantined with p=0.001 a 10.5 OR adj (2.6-42.3) after being adjusted by age and gender variables.@*CONCLUSION@#Significant relations were found between anxiety disorder among hospital workers with risk factors such as being health workers, working in areas with high risk of transmitting COVID-19, and workers who are being quarantined. Researchers strongly advise health providers to do regular monitoring and seek moral support especially for workers who have higher risk of anxiety disorder.

Prevalencia mensual de trastorno de ansiedad generalizada durante la pandemia por Covid-19 en México / Monthly prevalence of generalized anxiety disorder during the Covid-19 pandemic in Mexico

Resumen: Objetivo: Estimar la prevalencia de ansiedad generalizada (GAD, por sus siglas en inglés) entre abril y junio de 2020. Material y métodos: Diseño transversal repetido basado en la Encovid-19, una serie de encuestas telefónicas mensuales con muestras representativas de México (N= 833-1 674). El cuestionario incluye la escala GAD-2 y en julio se añadió la GAD-7; se examinó su validez interna con análisis factorial confirmatorio y su validez concurrente con variables sociodemográficas. Con la GAD-7 como criterio, se calculó la validez predictiva de la GAD-2. Se estimó la prevalencia mensual con la GAD-2. Resultados: La GAD-7 y la GAD-2 son confiables y válidas. La GAD-2 tiene una sensibilidad de 0.87 y una especificidad de 0.90. La prevalencia mensual se mantuvo alta y estable, entre 30.7 y 32.6%. El GAD se concentró en mujeres, personas desocupadas y de bajo nivel socioeconómico. Conclusiones: El GAD es un problema de salud pública que se agravó con la pandemia por Covid-19.

Abstract: Objective: Estimate the prevalence of generalized anxiety disorder (GAD) from April to June 2020. Materials and methods: Repeated cross-sections design based in the Encovid-19, a series of monthly mobile surveys with representative samples of Mexico (N= 833-1 674). The questionnaire includes the GAD-2 scale, and, in July, the GAD-7 scale was added; we examined its internal validity with confirmatory factor analysis and its concurrent validity with sociodemographic variables. Using GAD-7 as criterion, we analyzed the predictive validity of the GAD-2. We estimated the monthly prevalence with the GAD-2. Results: The GAD-7 and the GAD-2 are reliable and valid. The GAD-2 has a sensitivity of 0.87 and a specificity of 0.90. The monthly prevalence remains high and stable, between 30.7 and 32.6%. GAD concentrated in women, unemployed and persons with low socioeconomic status. Conclusions: GAD is a public health problem that worsened during the Covid-19 pandemic.

A review on anxiety disorders during covid-19 pandemic-homoeopathic perspective

The unprecedented Covid-19 pandemic has created havoc in most areas of human lives. Anxiety disorders are the most prevalent psychiatric disorders, and the incidence increased in recent times. Homoeopathy is an alternative system of medicine with evidence-based effectiveness in mental health issues. There is a dearth of literature concerning the potential utility of Homoeopathy in the management of psychological issues during this pandemic.Objectives:This overview aims to assess the commonly prevalent anxiety disorders during Covid-19 and assess the usefulness of homoeopathic medicines in managing anxiety.Materials and methods:Selective literature in PubMed search engine to identify most prevalent anxiety disorders during Covid-19 using terms "Covid-19" and "Anxiety" and available research studies in homoeopathy on anxiety have been put forward in this narrative review.Results:The identified anxiety disorders during Covid-19 and the role of Homoeopathy in managing anxiety disorders have been summarized in the article. The homoeopathic perspective of anxiety and the rubrics related to anxiety disorders in different repertories are discussed.Conclusion:mental health is a critical concern in the pandemic's scenario, and Homoeopathy can be a safe and effective alternative or adjunctive to the conventional system in the management of anxiety disorders during this chaotic situation

Tratamento do TAG nas terapias cognitivas de terceira geração / GAD treatment third generation cognitive therapies

Esta rápida revisão tem como objetivo levantara literatura sobre o tratamento do transtorno de ansiedade generalizada (TAG) pelas terapias cognitivas de terceira geração e, com isso, estimular o entendimento de clínicos e pacientes sobre essa abordagem recente de tratamento. Os estudos, em sua maioria, demonstram que as preocupações e ruminações são o processamento principal do TAG. É uma condição multifacetada em nível cognitivo, físico e emocional. O tratamento apresentado por essas técnicas integrativas mostrou-se relevante, tendo como consequência a diminuição dos sintomas. Já os efeitos do tratamento foram mantidos após o seu término por um período maior em comparação à TCC. Apenas a terapia do esquema e a terapia comportamental dialética não retornaram dados suficientes. As evidências fornecem, portanto, um arcabouço teórico para os clínicos utilizarem de intervenções sistematizadas quanto ao TAG, com técnicas cognitivas, meditativas e emocionais.(AU)

This brief review aims to review the literature on the treatment of generalized anxiety disorder (GAD) by third generation cognitive therapies and thereby stimulate the understanding of clinicians and patients about this recent approach to treatment. Studies generally showed that concerns and ruminations are GAD's main processes. It is a multifaceted condition on the cognitive, physical and emotional level. The treatment presented by these integrative techniques was relevant, with a decrease in symptoms and the treatment effects were maintained after the treatment ended for a longer period compared to CBT. Only schema therapy and dialectical behavior therapy did not show sufficient data. Therefore, the evidence provides a theoretical enough for clinicians to use systematic GAD interventions with cognitive, meditative and emotional techniques.(AU)

La presente breve revisión tiene por objetivo revisar la literatura sobre el tratamiento del Trastorno de Ansiedad Generalizada (TAG) por terapias cognitivas de tercera generación y, con ello, estimular el entendimiento de clínicos y pacientes sobre dicho abordaje reciente del tratamiento. En su mayoría, los estudios demuestran que las preocupaciones y reflexiones son el procesamiento principal del TAG. Es una condición multifacética a nivel cognitivo, físico y emocional. El tratamiento presentado por estas técnicas integrativas se mostró relevante, y su consecuencia trajo una disminución de síntomas. Por otro lado, los efectos del tratamiento se sostuvieron luego del término del tratamiento por un periodo mayor comparado al de la TCC. La Terapia de Esquema y la Terapia Dialéctico-Conductual fueron las únicas a no ofrecer datos suficientes. Así, las evidencias proveen un marco teórico para que clínicos utilicen intervenciones sistémicas para el TAG, con técnicas cognitivas, mediáticas y emocionales.(AU)

Association analysis of single nucleotide polymorphisms in the promoter region of GAD1 and GABRB3 with schizophrenia in Chinese Han population / 上海交通大学学报（医学版）

Objective: To investigate the correlation between the polymorphisms of locus in the promoter region of glutamate decarboxylase 1 (GAD1) gene and γ-aminobutyric acid (GABA)A receptor β-3 gene (GABRB3) and schizophrenia (SZ) in Chinese Han population. Methods: SNaPshot genotyping technique was used to detect the polymorphisms of rs3791878 and rs3749034 in the promoter region of GAD1 and rs4906902 in the promoter region of GABRB3 in 545 SZ patients (case group) and 624 healthy controls (control group). The distribution of alleles and genotypes under different genetic models between the case group and the control group in all samples were compared by SNPstats online software. The above analysis was also performed after the subjects were stratified according to gender. The correlation of G/T risk genotype of rs3791878 with the age of the first onset of male SZ was investigated by survival analysis. Results: Under over-dominant genetic model, the distribution of G/T risk genotype of rs3791878 showed statistically difference between the male SZ cases and male controls (P=0.000), and the difference was still statistically significant after Bonferroni correction (P=0.000). However, there was no significant difference in the distribution of alleles and genotypes under different genetic models of rs3749034 and rs4906902 between the case group and the control group in all samples (P>0.05), and there was also no significant difference in the distribution of alleles between the case group and the control group after them being stratified according to gender (P>0.05). Kaplan-Meier analysis showed that there was no significant difference between the age of onset of male SZ who carried G/T genotype in rs3791878 locus and that of male SZ who did not carry it (P=0.603). Conclusion: The polymorphism of rs3791878 in the promoter region of GAD1 is significantly associated with the incidence of male SZ in Chinese Han population.

Effect of simplified cognitive behavioral therapy on generalized anxiety disorder / 上海交通大学学报（医学版）

Objective • To explore the effect of simplified cognitive behavioral therapy (SCBT) on generalized anxiety disorder (GAD). Methods • GAD patients were recruited from Shanghai Hongkou Mental Health Center, Shanghai Putuo Mental Health Center, Tenth People's Hospital of Tongji University, The Affiliated Brain Hospital of Nanjing Medical University and Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, who were divided into SCBT group, SCBT+medication group and medication group. The Generalized Anxiety Disorder Scale-7(GAD-7) was used to assess the patients' generalized anxiety symptoms, Hamilton Anxiety Scale-14(HAMA-14) to assess the patients' anxiety level, and Hamilton Depression Scale-17(HAMD-17) to assess the patients' depression level. SCBT and/or medication were used. Three groups of patients were evaluated by single blind method. Variance analysis and χ2 test were used to compare the cure rate and the severity of anxiety and depression at different time points. Results • A total of 134 cases were included in the statistical analysis, 39 cases in SCBT group, 53 cases in SCBT+medication group, and 42 cases in medication group. There was no significant difference in gender, education level and marital status among the three groups, and there was significant difference in age (P=0.033). The cure rate of SCBT group was higher than those of SCBT+medication group and medication group (P=0.005). The scores of anxiety and depression of the three groups decreased with the prolongation of treatment time. Conclusion • SCBT can effectively alleviate the anxiety and depression symptoms of GAD patients, and has a better prognosis for GAD patients.

Diabetes-Associated Autoantibodies Among Young Diabetes Mellitus Patients in Malaysia

@#Introduction: Diabetes-associated autoantibodies (DAA) is the hallmark of T1DM and LADA which are frequently tested in young diabetes patients. It was noted that up to 10-15% of patients with initial diagnosis of T2DM also exhibit DAA. Regardless of the classification, the presence of DAA suggests an underlying islet autoimmunity which lead to progressive pancreatic β-cell failure. There is limited data reported on DAA in young diabetes patients in Malaysia. This study aims to determine the frequency of DAA positivity and its association with demographic and clinical characteristics among this cohort. Methods: A retrospective study using secondary data obtained from Allergy and Immunology Research Centre, Institute for Medical Research, Malaysia. This study included 194 diabetes patients who were diagnosed before the age of 40 years old and tested for GADA, ICA, IA2A and IAA. Results: From 194 patients, 91 (46.9%) were positive for least one of the following DAA: ICA (79, 40.7%), GADA (61, 31.4%), IA2A (37, 19.1%) and IAA (9, 4.6%). Multiple positivity was higher (73.6%) compared to single positivity. Highest combination of double positivity was ICA+GADA (54, 59.3%) and triple positivity was ICA+GADA+IA2A (25, 27.5%). Simultaneous positivity of four autoantibodies was seen in only one (1.1%) patient. ICA, GADA and IA2A were associated with age group and ethnicity (all p < 0.001). Only IA2A was associated with gender (p = 0.012). Conclusions: GADA, ICA ad IA2A are more significant in young Malaysian diabetes patients. IAA has a very low frequency in this studied population.

Stiff person syndrome: An unusual paraneoplastic neurological phenomenon in Carcinoid tumour

@#Stiff person syndrome is a rare neurologic disorder characterised by rigidity of the truncal and proximal limb muscles with intermittent superimposed spasms. It’s unique because it lacks similarity to any other neurologic disorder. Possibly tetanus is the closest related condition with both inhibiting central gamma-aminobutyric (GABA) systems. Stiff person syndrome is extremely rare with less than 20 cases reported from South Asia which has a population of nearly 2 billion. In its classic form, it is associated with the presence of high titres of glutamic acid decarboxylase (GAD) antibodies. Paraneoplastic stiff person syndrome comprising of around 5% of the patients has been reported with malignancies of the breast, colon, lung, thymus and Hodgkin’s lymphoma. Antibodies against amphiphysin and gephyrin are detected in paraneoplastic stiff person syndrome. We report a 58 year old Sri Lankan male with stiff person syndrome with a high GAD antibody titre and classical electromyographic changes, who was found to have an underlying carcinoid tumour. We postulate that stiff person syndrome was a paraneoplastic phenomenon secondary to the carcinoid in this case. Although neurological syndromes such as sensory neuropathy, limbic encephalitis and, myelopathy have been described as paraneoplastic features in carcinoid, we believe this is the first report of stiff person syndrome associated with carcinoid tumour.

Prevalencia de Trastorno de Ansiedad Generalizada según el Trimestre de Embarazo / Prevalence of Generalized Anxiety Disorder according to the Trimester of Pregnancy

Introducción: El trastorno de ansiedad generalizado (TAG) es una entidad clínica caracterizada por preocupación excesiva y no controlada que puede causar discapacidad funcional, durante un período mínimo de 6 meses. La prevalencia global de TAG en las pacientes en estado de gestación es de 8.5% a 10.5%, la cual es mayor en comparación a la población general (reportada de 1.2% a 6.4%). Entre los factores de riesgo se incluyen: bajo nivel educacional y socioeconómico, pobreza, desintegración familiar, etc. Se ha reportado como complicaciones de TAG durante el embarazo: incremento de consumo de alcohol, riesgo de parto pre término, bajo peso al nacer, etc. Objetivo: Determinar la prevalencia de trastorno de ansiedad generalizada según el trimestre de embarazo en mujeres gestantes de San Juan Sacatepéquez ya que no existen datos de dicha población. Metodología: Se empleó la escala GAD-7. Se escogió como población a pacientes que asistieron a la consulta externa del Centro de Salud Bárbara durante el mes de junio del 2018. Resultados: La prevalencia de TAG hallada fue: 7.40% en el primer trimestre, 8.82% en el segundo trimestre y 7.31% en el tercer trimestre. Palabras Clave: Ansiedad generalizada, embarazo GAD-7.

Introduction: Generalized anxiety disorder (GAD) is a clinical entity characterized by excessive and uncontrolled worry that can lead to functional disability, for a minimum period of 6 months. The global prevalence of GAD in pregnant patients is from 8.5% to 10.5%, which is higher compared to the general population (reported from 1.2% to 6.4%). Risk factors include: low educational and socioeconomic level, poverty, family disintegration, etc. It has been reported as complications of GAD during pregnancy: Increased consumption of alcohol, risk of preterm birth, low birth weight, etc. Objective: To determine the prevalence of generalized anxiety disorder according to the trimester of pregnancy in pregnant women from San Juan Sacatepéquez, since there are no data for this population. Methodology: the GAD-7 scale was used. Patients attending the outpatient clinic of the Barbara Health Center were selected as a population during the month of June 2018. Results: The prevalence of GAD found was: 7.40% in the first trimester, 8.82% in the second trimester and 7.31% in the third trimester. Keywords: General anxiety, pregnancy, GAD-7

Screening Tool for Anxiety Disorders: Development and Validation of the Korean Anxiety Screening Assessment

OBJECTIVE: This study evaluated the psychometric properties of the Korean Anxiety Screening Assessment (K-ANX) developed for screening anxiety disorders. METHODS: Data from 613 participants were analyzed. The K-ANX was evaluated for reliability using Cronbach’s alpha, item-total correlation, and test information curve, and for validity using focus group interviews, factor analysis, correlational analysis, and item characteristics based on item response theory (IRT). The diagnostic sensitivity and specificity of the K-ANX were compared with those of the Beck Anxiety Inventory (BAI) and Generalized Anxiety Disorder 7-item scale (GAD-7). RESULTS: The K-ANX showed excellent internal consistency (α=0.97) and item-total coefficients (0.92–0.97), and a one-factor structure was suggested. All items were highly correlated with the total scores of the BAI, GAD-7, and Penn State Worry Questionnaire. IRT analysis indicated the K-ANX was most informative as a screening tool for anxiety disorders at the range between 0.8 and 1.6 (i.e., top 21.2 to 5.5 percentiles). Higher sensitivity (0.795) and specificity (0.937) for identifying anxiety disorders were observed in the K-ANX compared to the BAI and GAD-7. CONCLUSION: The K-ANX is a reliable and valid measure to screen anxiety disorders in a Korean sample, with greater sensitivity and specificity than current measures of anxiety symptoms.

Dendritic Cell Factor 1-Knockout Results in Visual Deficit Through the GABA System in Mouse Primary Visual Cortex / 神经科学通报·英文版

The visual system plays an important role in our daily life. In this study, we found that loss of dendritic cell factor 1 (DCF1) in the primary visual cortex (V1) caused a sight deficit in mice and induced an abnormal increase in glutamic acid decarboxylase 67, an enzyme that catalyzes the decarboxylation of glutamate to gamma aminobutyric acid and CO, particularly in layer 5. In vivo electrophysiological recordings confirmed a decrease in delta, theta, and beta oscillation power in DCF1-knockout mice. This study presents a previously unknown function of DCF1 in V1, suggests an unknown contact between DCF1 and GABA systems, and provides insight into the mechanism and treatment of visual deficits.

Gene-gene interactions of suicidal behavior by multifactor dimensionality reduction analysis :Do both 5-HT and GAD1 work? / 西安交通大学学报(医学版)

Objective To investigate gene-gene interactions of suicidal behavior with single-nucleotide-polymorphism (SNP) in MAOA ,GAD1 and 5-HTR2C by multifactor dimensionality reduction .Methods For this case-control study ,six SNPs were captured in related genes and detected in blood samples obtained from 21 patients with suicidal behavior and 50 healthy individuals .The genotype frequency and allele frequency as well as the Hardy-Weinberg equilibrium (HWE) ,tests were performed and compared by plink software .The gene-gene interactions models were built by the MDR software .Results The HWE test for case group showed that rs3813928 rs518147 of 5-HTR2C gene was not in line with HWE ( P< 0 .05) .However ,the additive model analysis after adjustment by gender indicated that the polymorphism had a positive correlation with suicidal behavior in case group .The case and control groups differed significantly only in genotype frequencies of 5-HTR2C gene (χ2 =6 .18 , P=0 .04) .There was no significant difference in allele and genotype frequencies of the other genes ( P>0 .05) .The best combination model of MDR was rs5953210-rs769391 OR=20 .19 ,95% CI 4 .19-97 .38 , P<0 .01 ,with significant interaction . Conclusion The 5-HTR2C gene rs3813928 and rs518147 polymorphisms may play an important role in the susceptibility to suicidal behavior .The combination of MAOA with GAD1 has a significant interaction which may increase the risk of suicidal behavior .

Application of GAD-7 in population screening for generalized anxiety disorder / 中华全科医师杂志

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders.However,the diagnosis of GAD is difficult,GAD has the lowest diagnostic reliability among anxiety disorders and is often neglected.This article reviews the application of the General Anxiety Disorder-7 (GAD-7) in population screening for GAD,focusing on its history of development and the scope of unilization.