Pain as a risk factor of depression and anxiety symptoms with multiple myeloma during maintenance therapy
Hui ShiHonglin RenYing TianZhe ChenCuiping XuLu LuXiaoyu MaXiaoyan LiWen-Ming ChenTong GuoC N FanLu Wen
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Objective To investigate the prevalence of depression or anxiety in patient with multiple myeloma (MM) in China during maintenance treatment and its associated influencing factors. Methods Patients with MM ( n = 160) received maintenance therapy, and control subjects (without MM, n = 160) matched on age, sex, and BMI were recruited. Patients completed questionnaires, including the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Verbal Pain Rating Scale (VPRS). Data on the Clinical characteristics, biochemical indicators of de novo MM were from the database of the Hematology Department of Beijing Chao-yang Hospital. Multiple linear regression model analysis was used to compare the differences in PHQ-9 and GAD-7 scale scores between the control group and the case group after correction for relevant variables. Multiple logistic regression models were subsequently used to analyze the correlation between the presence or absence of anxiety and depression and clinical indicators in the MM groups. Results Depression symptoms was present in 33.33% and anxiety symptoms in 24.68% of first-episode MM in the maintenance phase of treatment, and depression symptoms in the index-corrected MM group was significantly different from that in the control group ( t = 2.54, P < 0.05). Analyses of multiple logistic regressions: biochemical indicators and clinical typing were not significantly associated with anxiety and depression. Compared to the pain rating 1, the risk of depressive mood was greater in the case group with the pain rating 2 (OR = 2.38) and the pain rating ≥ 3 (OR = 4.32). The risk of anxiety was greater in the case group with the pain rating ≥ 3 than the pain rating 1 (OR = 2.89). Conclusion Despite being in clinical remission, depressive mood problems in patients with MM remain prominent. Clinicians should enhance mood assessment and management in patients with concomitant pain.Keywords:
Depression
Poststroke anxiety affects rehabilitation outcomes. This study aimed to investigate the prevalence of and factors associated with anxiety among patients with stroke at the 1 year after rehabilitation from 9 tertiary centers. Anxiety, functional score, and quality of life were evaluated by the Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A), modified Barthel Index, and World Health Organization Quality of Life-BREF (WHOQoL-BREF), respectively. This study reveals 20 (11.7%) patients with stroke who developed anxiety, and 18 from 171 patients (10.5%) were new cases of anxiety, which was more than double the rate at discharge (4.7%). Factors related to anxiety were depression (adjusted odds ratio [aOR]: 30.7) and having complications (aOR: 12.48).
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全般不安症（GAD）はもともと残遺カテゴリーから出発し，“心配”を中心とする独立カテゴリーとして再構築された。しかし“心配”は他の精神疾患や身体疾患でもよくみられる症状であり，疾患の中心症状としての特異性がない。また，GADは他の精神疾患とのcomorbidity率が極めて高く，そのdistinct entityとしての存在に疑問を生じずにいられない。そもそも，この40年間，GADの診断基準自体が大きく揺らいでおり，DSMとICDでも大きく異なっていた。GADはうつ病の前駆症状，残遺症状，増悪因子，あるいは重症度指標にすぎないのではないかとの指摘もある。特にわが国においては，GADは積極的に付けられる診断ではない。たとえ，GADの患者だとしても，うつ病や他の不安症，あるいは身体表現性障害などの診断で，治療されているのであろう。中には，多剤併用となって場合もあるかもしれない。このような状況を脱するためには，わが国において，さらなるGADの啓発，GADの適応をもつ抗うつ薬の導入，GADの診療ガイドラインの作成が必要と考えられる。
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Discriminant validity
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Generalized anxiety
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ResultsOur review disclosed that, in last years, several screening tools with the objective of assessing anxiety symptoms in different sub-populations have been proposed.Some examples are: HAM (Hamilton Anxiety Rating Scale) [6], HADS-A (Hospital Anxiety and Depression Scale) [7], GAD-2 (Generalized Anxiety Disorder -2 Scale) [8] and GAD-7 (Generalized Anxiety Disorder -7 Scale) [9].The GAD-7 is an evaluation instrument elaborated by Spitzer et al. [9] and validated by Kroenke and Spitzer et al.[10], in United States of America.Based on the 4 th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Generalized Anxiety Disorder (GAD) criteria, seven items aiming a self-report measure of anxiety symptoms were developed to compound a brief questionnaire [11].It takes a few minutes to complete GAD-7.Each item is scored from 0 to 3 (total score of 21 points).As proposed in the original validation article, a total
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Generalized anxiety disorder (GAD) is a chronic, impairing and highly comorbid psychiatric condition. A small but sufficient group of empirically supported instruments to assess the severity of GAD are now available.
Generalized anxiety
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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.
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Generalized anxiety disorder; 7-items Generalized Anxiety Disorder Scale(GAD-7)
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In the past Generalized anxiety disorder (GAD)--previously classified as anxiety neurosis--was regarded as not being a separate diagnostic entity. On the basis of new explicit criteria for GAD in the 90ies, GAD-specific pharmacological (i.e. SNRI) and psychological treatments with improved efficacy have become available. The Generalized Anxiety and Depression in Primary care study (GAD-P) investigates the prevalence of GAD in primary care settings and evaluates the patterns of care provided. Aims, methods and findings of the GAD-P study are described in this supplement.
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Abstract Generalized anxiety disorder (GAD) is a relatively new concept. Worry is the main characteristic of GAD, which can be a highly debilitating illness, with profound effects on a person's career, relationships, and overall wellbeing. About 3% of people suffer from generalized anxiety disorder, and women are twice as likely to be affected as men. There are four main theories of worry: the metacognitive model; the cognitive avoidance theory; intolerance of uncertainty; and the mood-as-input theory.
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