[Prevalence of persistent physical symptoms and association with depression, anxiety and health anxiety in Iceland].

INTRODUCTION: Persistent physical symptoms that are medically unexplained can result in significant functional impairment. The aim of this study was to estimate the prevalence of persistent physical symptoms among people seeking primary healthcare in Reykjavík, Iceland, how they relate to functional impairment, symptoms of depression, general anxiety and health anxiety, and estimate the proportion of people with such symptoms who would likely benefit from psychological treatment. MATERIALS AND METHODS: Questionnaires measuring persistent physical symptoms, functional impairment, and symptoms of depression, general anxiety and health anxiety were administered to 106 patients attending two primary healthcare clinics. RESULTS: The prevalence of persistent physical symptoms was 27.4% among the primary care patients and they had a strong relationship to symptoms of mental disorders. Participants with persistent physical symptoms were 8 times more likely to have clinical levels of depression and general anxiety than participants without such symptoms, 4 times more likely to have clinical levels of health anxiety and 13 times more likely to have clinical levels of functional impairment. At least two-thirds of participants with persistent physical symptoms would likely benefit from psychological treatment. CONCLUSION: The prevalence of persistent physical symptoms among health care patients in the capital area of Iceland is in line with previous studies. Similarly, the strong relationship between persistent physical symptoms and symptoms of depression and anxiety corresponds to previous studies. It is likely that at least two out of three patients with persistent physical symptoms would benefit from psychological treatment. Transdiagnostic cognitive behavioural therapy for persistent physical symptoms might be particularly useful as is focuses on the interplay between physical and mental symptoms.

Transdiagnostic cognitive behavioural treatment and the impact of co-morbidity: An open trial in a cohort of primary care patients.

BACKGROUND: The development of initiatives to improve access to psychological therapies has been driven by the realization that untreated anxiety and depression are both very common and costly to individuals as well as society. Effective and efficient treatments, mostly in the form of cognitive behavioural therapies (CBT), can be used in ways which enhance their acceptability and accessibility. To date, numbers of group therapies have been developed to improve cost efficiency, but in spite of growing interest in transdiagnostic approaches, group therapies have so far mostly been diagnosis specific. AIMS: This study is aimed at evaluating a brief transdiagnostic cognitive behavioural group therapy (TCBGT) designed to treat both anxiety and depression among patients in primary care. METHOD: The participants were 287 adult patients in primary care with diagnoses of depression and/or anxiety disorders. They underwent a 5-week TCBGT. A mixed design ANOVA was used to evaluate differential effects of treatment according to diagnostic groups (anxiety versus depression) and number of diagnoses (co-morbidity). RESULTS: Pre-post differences were significant and the treatment was equally effective for both anxiety disorders and depression. Number of diagnoses did not affect the outcome. CONCLUSIONS: The study indicates feasibility of the brief transdiagnostic group therapy for a wide range of mood and anxiety disorders in primary care. The results indicate that low intensity, brief transdiagnostic group therapies may be a feasible way to improve access to psychological therapies for a large number of patients.

[The effect of antidepressants and sedatives on the efficacy of transdiagnostic cognitive behavioral therapy in groups in primary care]. / Ahrif thunglyndislyfja og roandi lyfja a arangur af osertaekri hugraenni atferlismedferd hopa i heilsugaeslu.

BACKGROUND: Cognitive behavioral therapy (CBT) and SSRI/SNRI antidepressants have proven to be effective treatments for anxiety and depression. The gain from combined CBT and antidepressant therapy has in some studies been greater than from monotherapy. Benzodiazepines may interfere with the efficacy of individual CBT-treatment. We examined the effects of SSRI/SNRI antidepressants and the effects of benzodiazepines/z-drugs on the efficacy of group CBT (gCBT) in primary care. MATERIAL AND METHODS: Primary outcome measures were the Beck's Depression Inventory II (BDI-II) and the Beck's Anxiety Inventory (BAI) scores before treatment and after the last session. The last observed score was carried forward and compared to the initial score for each individual, irrespective of the timing of the last score (LOCF). Mean change of scores was compared between groups of individuals on or not on SSRI/SNRI antidepressants and/or benzodiazepines/z-drugs. RESULTS: Over three years 557 subjects participated in a 5 week-long gCBT. Of these 355 returned BDI-II and 350 returned BAI at least twice. The mean score on SSRI/SNRI or benzo/z-drugs fell significantly both for those on combined treatment (medication and gCBT) and those who only received gCBT. Combined treatment with SSRI/SNRI and gCBT led to a greater fall in depressive symptoms compared to gCBT monotherapy. The efficacy of such combined treatment was less for those who also were prescribed benzodiazepines and/or z-drugs. CONCLUSIONS: Group CBT significantly improved symptoms of anxiety and depression in primary care. The improvement was not reduced by concomitant use of SSRI/SNRI antidepressants nor of benzodiazepines/z-hypnotics. The use of such medication is therefore not contraindicated for gCBT participants, at least not short term. Adding SSRIs or SNRIs to gCBT led to greater efficacy in reducing depressive symptom though the efficacy of such combined treatment was less for those who were also prescribed benzodiazepines and/or z-hypnotics.