Impact of a brochure and empathetic physician communication on patients' perception of breast biopsies.

PURPOSE: This study investigated the effect of an intervention designed to reduce patients' emotional distress associated with breast biopsy. METHODS: 125 breast biopsy patients receiving standard of care (control group, CG) were compared to 125 patients (intervention group, IG) who received a brochure with information prior to the biopsy and were biopsied by physicians trained in empathic communication. Anxiety was assessed by the State-Anxiety Inventory (STAI-S) at four time points (pre- and post-procedural, pre- and post-histology). All participants completed pre- and post-procedural questionnaires addressing worries, pain and comprehension. We evaluated the impact of the intervention on STAI-S levels using a log-transformed linear mixed effects model and explored patients' and physicians' perceptions of the procedure descriptively. RESULTS: Post-procedural and post-histology timepoints were associated with 13% and17% lower with STAI-S levels than at the pre-procedural timepoint on average. The histologic result had the strongest association with STAI-S: malignancy was associated with 28% higher STAI-S scores than a benign finding on average. Across all time points, the intervention did not affect patient anxiety. Nevertheless, IG participants perceived less pain during the biopsy. Nearly all patients agreed that the brochure should be handed out prior to breast biopsy. CONCLUSION: While the distribution of an informative brochure and a physician trained in empathic communication did not reduce patient anxiety overall, we observed lower levels of worry and perceived pain regarding breast biopsy in the intervention group. The intervention seemed to improve patient's understanding of the procedure. Moreover, professional training could increase physicians' empathic communication skills. TRIAL REGISTRATION NUMBER: NCT02796612 (March 19, 2014).

Anxiety in Brief: Assessment of the Five-Item Trait Scale of the State-Trait Anxiety Inventory in South Africa.

The current study examined the psychometric properties of a short form of the trait scale of the Spielberger State-Trait Anxiety Inventory. Participants consisted of a convenience sample of students (n = 322) who completed the five-item version of the trait scale of the State-Trait Anxiety Inventory, the Perceived Stress Scale, the nine-item version of the Beck Hopelessness Scale, the 10-item version of the Center for Epidemiological Studies Depression Scale, and the Post-Traumatic Stress Disorder Checklist. We used classical test theory and item response theory (Rasch and Mokken analyses) to examine the psychometric properties of a previously proposed five-item version of this scale. These approaches confirmed that the five-item measure of anxiety had satisfactory reliability and validity, and also confirmed that the five items comprised a unidimensional scale.

Caffeine Intake and Its Sex-Specific Association with General Anxiety: A Cross-Sectional Analysis among General Population Adults.

(1) Background: Caffeine is one of the most consumed psychoactive stimulants worldwide. It has been suggested that caffeine intake at large doses can induce anxiety, whereas evidence of the role of low to moderate caffeine intake is scarce and inconsistent. Therefore, we aimed to assess the association between caffeine intake and general anxiety in adults recruited from the general population. (2) Methods: Participants from the French NutriNet-Santé web cohort with data on caffeine intake and general anxiety (assessed during 2013−2016 through the trait subscale of Spielberger's State-Trait Anxiety Inventory Form Y; STAI-T, sex-specific top quartile = high trait anxiety) were included in this cross-sectional analysis (n = 24,197; 74.1% women; mean age = 53.7 ± 13.9 years). Mean dietary intake was estimated using ≥2 self-reported 24-h dietary records. Sex-specific tertiles of caffeine intake and low/high trait anxiety were calculated. Multivariable logistic regression models were fitted to assess the odds ratio (OR) and 95% confidence interval (CI) for the association between caffeine intake and general anxiety by sex. (3) Results: In the total sample, the mean caffeine intake (mg/day) from all dietary sources combined was 220.6 ± 165.0 (women = 212.4 ± 159.6; men = 243.8 ± 177.7, p < 0.01). Women in the highest tertile of caffeine intake showed significantly higher odds for high trait anxiety compared to those in the lowest tertile (reference), even after adjustment for potential confounders (OR: 1.13; 95% CI: 1.03−1.23). No significant associations were detected among men. Sensitivity analyses according to perceived stress level and sugar intake, respectively, showed similar results. (4) Conclusions: The results suggest that higher caffeine intake is associated with higher odds of general anxiety among women but not among men. Further research is needed to confirm the sex-specific findings and elucidate the potential causal relationship between caffeine intake and anxiety status.

Personal and Psychological Traits Influencing the Willingness to Pay for Food with Nutritional Claims: A Comparison between Vice and Virtue Food Products.

Several studies have demonstrated the usefulness of nutritional claims (NCs) to help consumers make more informed food decisions. However, fewer studies have investigated the effect of personal and psychological consumer characteristics on their food purchase decision. Hence, the main aim of this study is to examine the impact of body image, emotional eating style, anxiety traits, and body mass index on consumer preferences for multiple NCs on the front of the package (FOP) of hedonic (potato chips) and utilitarian (toasted bread) products carrying the same NCs. Therefore, a real choice experiment (RCE) has been used and the willingness-to-pay-space model was estimated to analyse the interaction between personal and psychological characteristics and consumer preferences. The main finding suggests differences in purchase behaviour between potato chips and toasted bread. In particular, consumers are willing to pay more for toasted bread with one NC than potato chips with one NC. Moreover, personal and psychological consumer characteristics influence the purchase behaviour regarding food products with nutritional claims. However, only the anxiety trait appears to explain the differences between the selection of both types of food products. In line with this new evidence, we proposed some behavioural, political, and managerial implications.

The relevant psychological burden of having a benign brain tumor: a prospective study of patients undergoing surgical treatment of cranial meningiomas.

OBJECTIVE: Meningiomas are the most common intracranial neoplasm. Evidence concerning surgical management and outcome is abundant, while the implications for the quality of life (QOL) of a patient confronted with the diagnosis and undergoing surgery are unclear. The authors conducted a prospective study to evaluate QOL in relation to psychological comorbidities comorbidities. METHODS: A prospective study of patients undergoing elective surgery for the removal of an intracranial meningioma was performed. The authors evaluated depression (Allgemeine Depressionsskala K score) and anxiety (Post-Traumatic Stress Scale-10 [PTSS-10]; State Trait Anxiety Inventory-State Anxiety and -Trait Anxiety [STAI-S and STAI-T]; and Anxiety Sensitivity Index-3 [ASI-3]) scores before surgery and at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative QOL as measured by the 36-Item Short Form Health Survey and EQ-5L questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined. RESULTS: A total of 78 patients undergoing resection of a meningioma between January 2013 and September 2017 participated in the preoperative psychological screening and 71 patients fully completed postoperative follow-up examination after 1 year of follow-up. At presentation, 48 patients (67.7%) had abnormal anxiety scores, which decreased to 29.6% (p = 0.003). On follow-up at 12 months, mean EQ-5L visual analog scale scores were significantly lower in patients with pathological scores on the PTSS-10 (0.84 vs 0.69; p = 0.004), STAI-S (0.86 vs 0.68; p = 0.001), and STAI-T (0.85 vs 0.71; p = 0.011). Neurological status (modified Rankin Scale) improved slightly and showed some correlation with psychological comorbidities QOL scores (p = 0.167). There was a nonsignificant increase of EQ-5L scores over the period of follow-up (p = 0.174) in the repeated-measures analysis. In the regression analysis, impaired QOL and physical disability on follow-up correlated with elevated preoperative anxiety and depression levels. CONCLUSIONS: The QOL and physical disability of patients undergoing resection of an intracranial meningioma highly depend on preoperative anxiety and depression levels. Stress and anxiety scores generally decrease after the resection, which leads us to conclude that there is a tremendous emotional burden caused by an upcoming surgery, necessitating close psychooncological support in order to uphold functional outcome and health-related QOL in the postoperative course.

Results of Gamma Knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a severe psychiatric condition. The authors present their experience with Gamma Knife radiosurgery (GKRS) in the treatment of patients with OCD resistant to any medical therapy. METHODS: Patients with severe OCD resistant to all pharmacological and psychiatric treatments who were treated with anterior GKRS capsulotomy were retrospectively reviewed. These patients were submitted to a physical, neurological, and neuropsychological examination together with structural and functional MRI before and after GKRS treatment. Strict study inclusion criteria were applied. Radiosurgical capsulotomy was performed using two 4-mm isocenters targeted at the midputaminal point of the anterior limb of the capsule. A maximal dose of 120 Gy was prescribed for each side. Clinical global changes were assessed using the Clinical Global Impression (CGI) scale, Global Assessment of Functioning (GAF) scale, EQ-5D, Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). OCD symptoms were determined by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS: Ten patients with medically refractory OCD (5 women and 5 men) treated between 2006 and 2015 were included in this study. Median age at diagnosis was 22 years, median duration of illness at the time of radiosurgery was 14.5 years, and median age at treatment was 38.8 years. Before GKRS, the median Y-BOCS score was 34.5 with a median obsession score of 18 and compulsion score of 17. Seven (70%) of 10 patients achieved a full response at their last follow-up, 2 patients were nonresponders, and 1 patient was a partial responder. Evaluation of the Y-BOCS, BDI, STAI-Trait, STAI-State, GAF, and EQ-5D showed statistically significant improvement at the last follow-up after GKRS. Neurological examinations were normal in all patients at each visit. At last follow-up, none of the patients had experienced any significant adverse neuropsychological effects or personality changes. CONCLUSIONS: GKRS anterior capsulotomy is effective and well tolerated with a maximal dose of 120 Gy. It reduces both obsessions and compulsions, improves quality of life, and diminishes depression and anxiety.

Frequency-dependent changes in local intrinsic oscillations in chronic primary insomnia: A study of the amplitude of low-frequency fluctuations in the resting state.

New neuroimaging techniques have led to significant advancements in our understanding of cerebral mechanisms of primary insomnia. However, the neuronal low-frequency oscillation remains largely uncharacterized in chronic primary insomnia (CPI). In this study, the amplitude of low-frequency fluctuation (ALFF), a data-driven method based on resting-state functional MRI, was used to examine local intrinsic activity in 27 patients with CPI and 27 age-, sex-, and education-matched healthy controls. We examined neural activity in two frequency bands, slow-4 (between 0.027 and 0.073 Hz) and slow-5 (0.010-0.027 Hz), because blood-oxygen level dependent (BOLD) fluctuations in different low-frequency bands may present different neurophysiological manifestations that pertain to a spatiotemporal organization. The ALFF associated with the primary disease effect was widely distributed in the cerebellum posterior lobe (CPL), dorsal and ventral prefrontal cortex, anterior cingulate cortex, precuneus, somatosensory cortex, and several default-mode sub-regions. Several brain regions (i.e., the right cerebellum, anterior lobe, and left putamen) exhibited an interaction between the frequency band and patient group. In the slow-5 band, increased ALFF of the right postcentral gyrus/inferior parietal lobule (PoCG/IPL) was enhanced in association with the sleep quality (ρ = 0.414, P = 0.044) and anxiety index (ρ = 0.406, P = 0.049) of the CPI patients. These findings suggest that during chronic insomnia, the intrinsic functional plasticity primarily responds to the hyperarousal state, which is the loss of inhibition in sensory-informational processing. Our findings regarding an abnormal sensory input and intrinsic processing mechanism might provide novel insight into the pathophysiology of CPI. Furthermore, the frequency factor should be taken into consideration when exploring ALFF-related clinical manifestations.

Gradients of fear: How perception influences fear generalization.

The current experiment investigated whether overgeneralization of fear could be due to an inability to perceptually discriminate the initial fear-evoking stimulus from similar stimuli, as fear learning-induced perceptual impairments have been reported but their influence on generalization gradients remain to be elucidated. Three hundred and sixty-eight healthy volunteers participated in a differential fear conditioning paradigm with circles of different sizes as conditioned stimuli (CS), of which one was paired to an aversive IAPS picture. During generalization, each subject was presented with one of 10 different sized circles including the CSs, and were asked to categorize the stimulus as either a CS or as novel after fear responses were recorded. Linear mixed models were used to investigate differences in fear generalization gradients depending on the participant's perception of the test stimulus. We found that the incorrect perception of a novel stimulus as the initial fear-evoking stimulus strongly boosted fear responses. The current findings demonstrate that a significant number of novel stimuli used to assess generalization are incorrectly identified as the initial fear-evoking stimulus, providing a perceptual account for the observed overgeneralization in panic and anxiety disorders. Accordingly, enhancing perceptual processing may be a promising treatment for targeting excessive fear generalization.

Análisis de la estructura factorial del STAI-T en una muestra de deportistas brasileros / STAI-T factor structure analysis in a sample of Brazilian athletes / Análise da estrutura fatorial do STAI-T em uma mostra de esportistas brasileiros

Este estudio tuvo como objetivo investigar la estructura interna del State-Trait Anxiety Inventory (STAI-T) en una muestra de deportistas de Brasil. Participaron 179 sujetos que practicaban cinco deportes diferentes, con edades entre 14 y 58 años (M=21,04; DT=4,21). El inventario evalúa la ansiedad como estado y como rasgo, pero en este estudio fue utilizada apenas la escala referente a los rasgos, compuesta por 20 ítems dispuestos en una escala Likert de cuatro puntos. Los resultados del análisis factorial confirmatorio indicaron que los ítems no se ajustaron adecuadamente al modelo originalmente establecido por el instrumento y, considerando ese resultado, se optó por realizar un análisis factorial exploratorio, el cual mostró la existencia de dos factores que explicaron el 33% de la variancia. Esos factores fueron denominados de ansiedad presente y ansiedad ausente, con coeficientes de precisión con valores de 0,82 y 0,72 respectivamente.

This study aimed to examine the internal structure of the State-Trait Anxiety Inventory (STAI-T) in a sample of Brazilian athletes. Participants were 179 subjects practicing five different sports modalities, aged between 14 and 58 years (M = 21.04; SD = 4.21). The inventory assesses anxiety as state and trait, but in this study only the trait anxiety scale was used which is composed of 20 items arranged in a four-point Likert scale. Results of the confirmatory factor analysis indicated the items were not properly adjusted to the instrument's original model. This exploratory factor analysis indicated the existence of two factors that explained 33% of the variance. These factors were called present anxiety and absent anxiety, with reliability coefficients of 0.82 and 0.72 respectively.

Este estudo teve como objetivo pesquisar a estrutura interna do State-Trait Anxiety Inventory (STAI-T) em uma mostra de esportistas do Brasil. Participaram 179 sujeitos que praticavam cinco esportes diferentes, com idades entre 14 e 58 anos (M=21,04; DT=4,21). O inventario avalia a ansiedade como estado e como rasgo, mas neste estudo foi utilizada apenas a escala referente aos rasgos, composta por 20 itens dispostos em uma escala Likert de quatro pontos. Os resultados da análise fatorial confirmatoria indicaram que os itens não se ajustaram adequadamente ao modelo originalmente estabelecido pelo instrumento e, considerando esse resultado, se optou por realizar uma análise fatorial exploratória, que mostrou a existência de dois fatores que explicaram a variância de 33%. Esses fatores foram denominados de ansiedade presente e ansiedade ausente, com coeficientes de precisão com valores de 0,82 e 0,72 respectivamente.