Can a Novel Algorithmic Approach Operationalise the Management of Depression & Anxiety for Primary Care?

Research Paper Title

Effects of Brief Depression and Anxiety Management Training on a US Army Division’s Primary Care Providers.

Background

There is a nation-wide gap between the prevalence of mental illness and the availability of psychiatrists. This places reliance on primary care providers (PCPs) to help meet some of these mental health needs.

Similarly, the US Army expects its PCPs to be able to manage common mental illnesses such as anxiety and depression. Therefore, PCPs must be able to close their psychiatric skills gaps via lifelong learning.

Methods

Following needs assessment of PCPs in a US Army division, the curriculum was developed. Objectives targeted pharmacological management of depression and anxiety. Behavioural intervention skills were also taught to treat insomnia.

Didactics and case-based small groups were used. A novel psychotropic decisional tool was developed and provided to learners to assist and influence their future psychiatric practice. Pre-training, immediate post-training, and 6-month assessments were done via survey to evaluate confidence and perceived changes in practice.

The curriculum was executed as a quality improvement project using the Plan, Do, Study, Act framework.

Results

Among 35 learners, immediate confidence in selecting optimal psychotropic and perceived knowledge, skill to change the dose or type of medication, and confidence in prescribing behavioural sleep improved significantly with large effect sizes.

At 6-month follow-up, learners reported that they were more likely to adjust medications for anxiety or depression and were more likely to start a new medication for anxiety or depression because of the training with moderate effect sizes. Use and satisfaction with the psychotropic decisional tool are also reported.

Conclusions

The psychotropic decisional tool illustrates a novel algorithmic approach for operationalising the management of depression and anxiety.

Similar approaches can improve the skills of a variety of PCPs in the management of psychiatric disorders.

Further studies in the military operational setting are needed to assess the effects of similar educational interventions on access to behavioural health care, suicidal behaviours, and unit medical readiness.

Reference

Amin, R. & Thomas, M.A. (2020) Effects of Brief Depression and Anxiety Management Training on a US Army Division’s Primary Care Providers. Military Medicine. doi: 10.1093/milmed/usz443. Online ahead of print.

Book: Understanding Motivation and Emotion

Book Title:

Understanding Motivation and Emotion.

Author(s): Johnmarshall Reeve.

Year: 2018.

Edition: Seventh (7th).

Publisher: John Wiley and Sons.

Type(s): Paperback and Kindle.

Synopsis:

Understanding Motivation and Emotion helps readers understand motivation; where it comes from, how and why it changes over time, and how motivation can be increased. The book also shows how to apply the principles of motivation in applied settings, such as in schools, in the workplace, on the athletic field, in counselling, and in one’s own personal life.

Reeve’s engaging writing captures the excitement of recent advances in the field to show the reader what contemporary motivation psychologists are excited about. He also uses effective examples and explains how motivation study can be applied to readers’ daily lives.

By combining a strong theoretical foundation with current research and practical applications, Reeve provides readers with a valuable tool for understanding why people do what they do and why people feel what they feel.

Book: The Age of Anxiety

Book Title:

Time Special Edition: The Age of Anxiety.

Author(s): The Editors of TIME.

Year: 2020.

Edition: First (1st).

Publisher: Time.

Type(s): Magazine and Kindle.

Synopsis:

Anxiety disorders are one of the most common mental illness in the US, affecting 40 million adults.

But what exactly is anxiety?

In this special edition from TIME, anxiety is examined in all of its complexity.

Is it a physiological ailment, or a psychological impairment or both? Is it a simple fight-or-flight response to everyday stress and how best to manage it in our lives?

This special edition includes:

  • What anxiety does to your brain and body;
  • The upside of anxiety;
  • How the stress can fuel you;
  • How social media and our digital lives can make us anxious; and
  • The unique pressures upon children and teens and how to address them.

Also included are natural remedies for anxiety, tips on mindful meditation and more.

Gaming Disorders & their Association with Mental Disorders for African Countries

Research Paper Title

Insomnia, Sleepiness, Anxiety and Depression Among Different Types of Gamers in African Countries.

Background

Gaming has increasingly become a part of life in Africa. Currently, no data on gaming disorders or their association with mental disorders exist for African countries.

This study for the first time investigated:

  1. The prevalence of insomnia, excessive daytime sleepiness, anxiety and depression among African gamers;
  2. The association between these conditions and gamer types (i.e. non-problematic, engaged, problematic and addicted); and
  3. The predictive power of socioeconomic markers (education, age, income, marital status, employment status) on these conditions.

Methods

10,566 people from 2 low- (Rwanda, Gabon), 6 lower-middle (Cameroon, Nigeria, Morocco, Tunisia, Senegal, Ivory Coast) and 1 upper-middle income countries (South Africa) completed online questionnaires containing validated measures on insomnia, sleepiness, anxiety, depression and gaming addiction.

Results

Results showed the sample of gamers (24 ± 2.8 yrs; 88.64% Male), 30% were addicted, 30% were problematic, 8% were engaged and 32% were non-problematic.

Gaming significantly contributed to 86.9% of the variance in insomnia, 82.7% of the variance in daytime sleepiness and 82.3% of the variance in anxiety [p < 0.001].

Conclusions

This study establishes the prevalence of gaming, mood and sleep disorders, in a large African sample.

The results corroborate previous studies, reporting problematic and addicted gamers show poorer health outcomes compared with non-problematic gamers.

Reference

Sosso, F.A.E, Kuss, D.J., Vandelanotte, C., Jasso-Medrano, J.L., Husain, M.E., Curcio, G., Papadopoulos, D., Aseem, A., Bhati, P., Lopez-Rosales, F., Becerra, J.R., D’Aurizio, G., Mansouri, H., Khoury, T., Campbell, M. & Toth, A.J. (2020) Insomnia, Sleepiness, Anxiety and Depression Among Different Types of Gamers in African Countries. Scientific Reports. 10(1):1937. doi: 10.1038/s41598-020-58462-0.

Book: Overcoming Anxiety

Book Title:

Overcoming Anxiety: Reassuring ways to break free from stress and worry and lead a calmer life.

Author(s): Gill Hasson and Tania Rodrigues.

Year: 2016.

Edition: First (1st).

Publisher: Audible Studios.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Understand, overcome, and break free from worry and anxiety.

Best-selling personal development author Gill Hasson is back, and this time she is here to help with something that affects all people at some point in their lives: anxiety.

Worries and anxieties are familiar to us all. Worrying can be helpful when it prompts you to take action and solve a problem, but unrelenting doubts, fears, and negative possibilities can dominate your mind, affecting your ability to manage your everyday life and well-being, your sleep and appetite, your social life, and your ability to concentrate.

But it does not need to be like this; there are ways that you can manage this spiral of unhelpful thoughts and difficult feelings. Overcoming Anxiety explains how to manage anxiety and stop it from taking over; it teaches you the skills you need to lead a more peaceful, stress-free life.

Overcoming Anxiety:

  • Provides practical strategies and techniques to manage your anxiety.
  • Discusses how to break free from negative cycles and move forward in a positive way.
  • Contains real-life examples from anxiety sufferers.
  • Explores what it takes to handle immediate anxiety events and longer term, low-level background anxiety and worry.

Is Early Improvement within the First 2 Weeks of Receiving Antidepressant Treatment a Predictor of Outcome in Patients with MDD and a High Level of Anxiety?

Research Paper Title

Antidepressant treatment strategy with an early onset of action improves the clinical outcome in patients with major depressive disorder and high anxiety: a multicenter and 6-week follow-up study.

Background

Major depressive disorder (MDD) is a prevalent, often chronic, and highly disabling multidimensional psychiatric illness. Moreover, co-occurring anxiety symptoms are extremely common among patients with MDD; up to 90% of patients present with anxiety symptoms. Notably, high levels of anxiety symptoms may predict worse clinical outcomes because of poor response to pharmacotherapy for MDD. So use of augmentation or combination strategies during early course of treatment could be necessary, but ensuring the accurate and timely change is difficult because of the lack of consensus to assess the early improvement of initial treatment. To date, replicated evidence indicates that the lack of early improvement (eg, <20% reduction in a depression scale score) in 2 weeks can be an accurate predictor to identify eventual non-responders. This study aimed to evaluate the early onset of antidepressant action and clinical outcomes in patients with MDD and high anxiety, and to explore the potential influencing factors of early onset improvement.

Methods

This study was a post-hoc analysis of a multi-centre, randomised, parallel-controlled, open-label study. The study protocol was approved by the independent ethics committee in each research centre or the ethics committee of the Peking University Sixth Hospital. All the participants provided written informed consent before the study. A total of 245 patients (aged 18–65 years) were diagnosed with MDD based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. They were required to have a current major depressive episode with a total score ≥17 on the Hamilton Depression Rating Scale 17-item (HAMD-17), and also have a high level of anxiety symptoms with a total score ≥14 on the Hamilton Anxiety Rating Scale (HAMA) at the baseline visit.

All eligible patients were assigned to receive at least 6 weeks of follow-up and antidepressant treatment, including selective serotonin reuptake inhibitors (SSRIs) alone or coupled with a flexible dose of tandospirone. The involved SSRIs were fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, and escitalopram. Notably, not all the patients were naive to any antidepressants at the first visit, but they were not treated with adequate dose of antidepressants for more than 2 weeks in the current episode. Treatment with several sedative-hypnotic drugs for short-term use was permitted as needed for sleep disorders, including zopiclone, lorazepam, alprazolam, clonazepam, midazolam, zaleplon, and zolpidem.

The efficacy measurements were evaluated at different visit points, including week 2, week 4, and week 6. The evaluation tools included HAMD-17 total scores, HAMA total scores, and Clinical Global Impressions Severity Subscale (CGI-S) score. Moreover, short form-12 (SF-12) physical component score (PCS) and mental component score (MCS) were used to assess the quality of life of these patients. Remission assessment was defined as showing an HAMD-17 total score ≤7 points.

At the end of week 2,240 patients remained and were divided into two groups based on the reduction rate of HAMD-17 total score compared with the baseline: early-improvement group (≥20% decrease in HAMD-17 total score, n = 134) and early-unimproved group (<20% decrease in HAMD-17 total score, n = 106). Finally, 230 patients completed the 6-week follow-up, including 128 patients with early-improvement and 102 early-unimproved patients. The comparison of the remission rate between the two groups was conducted in week 6. In addition, the potential influencing factors of early improvement in week 2 were also analysed.

The data analysis was based on the full analysis set. The data collected at each visit point were analysed using the mixed-effects repeated-measures model. The influencing factors of early improvement were analysed by logistic regression. All the statistical analyses were performed using the Statistical Package for the Social Sciences for Windows, version 24.0 (SPSS, Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant.

Results

The baseline demographic data were similar between the two groups (P > 0.05), except for the number of patients taking sedative-hypnotic drugs. The patients in the early-improvement group showed more combination of sedative-hypnotic drugs compared with the patients in the early-unimproved group (12.7% [17/134] vs. 1.9% [2/106], χ2 = 11.979, P = 0.002).

At baseline, the total scores of HAMD-17 (24.76 vs. 23.11, P = 0.007) and CGI-S (4.89 vs. 4.54, P = 0.002) in the early-improvement group were significantly higher, and SF-12 (PCS) (38.77 vs. 41.65, P = 0.022) and SF-12 (MCS) (26.01 vs. 28.05, P = 0.035) scores were significantly lower than those in the early-unimproved group. The statistical superiority was observed for the early-improvement group in the HAMD-17 total score, HAMA total score, and CGI-S total score during weeks 2 to 6, SF-12 (PCS) score in week 6 and SF-12 (MCS) score between weeks 2 and 6.

Notably, the patients in the early-improvement group showed greater improvements in several important rating scales compared with the patients in the early-unimproved group at the endpoint visit. The least-squares (LS) mean in the HAMD-17 total score was statistically lower for the early-improvement group than the early-unimproved group (6.48 vs. 12.17, P < 0.001). The LS means in both HAMA total score (7.19 vs. 11.8, P < 0.001) and CGI-S total score (1.91 vs. 2.65, P < 0.001) were also significantly lower in the early-improvement group than in the early-unimproved patients. The greater improvements were observed in both SF-12 (PCS) score (48.26 vs. 45.36, P = 0.014) and SF-12 (MCS) score (44.21 vs. 36.36, P < 0.001) for the early-improvement group than for the early-unimproved group. In addition, the early-improvement group showed a significant difference in the remission rate in week 6 compared with the early-unimproved group (62.8% [80/128] vs. 29.4% [30/102], χ2 = 25.424, P < 0.001).

The logistic regression model was used to analyse the influencing factors for early improvement. The dependent variable was a dichotomous variable, which was an early improvement vs. early un-improvement. The independent variables included in the model were treatment (SSRIs + tandospirone vs. SSRIs), combination with sedative-hypnotic drugs, age, body weight, sex, age of onset of psychiatric symptoms, course of recent episode, and baseline total scores of HAMD-17, HAMA, CGI-S, SF-12 (MCS), and SF-12 (PCS) scales. Of these variables, the combination with sedative-hypnotic drugs was statistically significant (odds ratio: 7.556, 95% confidence interval: 1.607–35.530, P = 0.010), indicating that the combination with sedative-hypnotic therapy was more helpful for early improvement.

Conclusions

The present study successfully replicated the findings of previous major studies, which demonstrated a significant relationship between early improvement within the first weeks of antidepressant treatment and later remission rate in patients with MDD. Specifically, a similar association was found in patients with MDD and high level of anxiety symptoms. The results showed that patients who achieved the early improvement of the depressive symptoms in week 2 after antidepressant treatment also obtained the sustained relief of symptoms and improved quality of life during weeks 2 to 6. Further, these patients with early improvement displayed more significant clinical remission of depressive symptoms in week 6.

According to the logistic regression analysis, the results revealed that the combination with sedative-hypnotic drugs was a significant predictor of early improvement in week 2. Benzodiazepines are primarily used as a sedative-hypnotics in patients with MDD to alleviate anxiety symptom and insomnia, and they might contribute to the response to antidepressants in the first two weeks because they produce a faster onset of effect on anxiety symptoms than antidepressants alone. Thus, it may be justifiable to combine benzodiazepines as a short-term treatment in patients with MDD and high-level anxiety.

In summary, the early improvement within the first 2 weeks of receiving antidepressant treatment is a powerful predictor of outcome in patients with MDD and a high level of anxiety. Notably, the short-term combination with sedative-hypnotic drugs within the first few weeks may augment the early-onset improvement of antidepressant therapy.

Reference

Liao, Xue-Mei., Su, Yun-Ai1., Wang, Ying.; Yu, Xin. & Si, Tian-Mei. (2020) Antidepressant treatment strategy with an early onset of action improves the clinical outcome in patients with major depressive disorder and high anxiety: a multicenter and 6-week follow-up study. Chinese Medical Journal. 6, pp.726-728. doi: 10.1097/CM9.0000000000000673.

What is the Role of Combat Exposure & Malevolent Environments in Mental Health?

Research Paper Title

Do different types of war stressors have independent relations with mental health? Findings from the Korean Vietnam Veterans Study.

Background

South Korea had the second largest contingent of soldiers in the Vietnam War, but little is known about their adaptation, especially in later life.

Previous work in a different sample found very high rates of post-traumatic stress disorder (PTSD; 41%) among Korean Vietnam veterans (KVVs; Kang, Kim, & Lee, 2014), compared to 19-31% for American Vietnam veterans.

The researchers explored possible reasons for this high rate of PTSD, as well as anxiety and depressive symptoms, utilising both vulnerability factors (e.g., war stressors) and protective factors (optimism, unit cohesion, and homecoming experiences).

Method

The sample included 367 male KVVs surveyed by mail (M age = 72, SD = 2.66).

Using hierarchical regressions controlling for demographics, the researchers examined the relative contributions of different types of war stressors and then the protective factors.

Results

Combat exposure was significantly associated with the three types of negative psychological symptoms, but their associations became non-significant when “subjective” war stressors (malevolent environments, perceived threat, and moral injury) were added.

In the final models, malevolent environments were the strongest predictor for all three outcomes.

In addition, moral injury was independently associated with PTSD symptoms, while perceived threat was marginally associated with depressive and anxiety symptoms.

Among psychosocial factors, only optimism was negatively associated with the mental health outcomes.

Conclusions

KVVs had very high rates of combat exposure, but malevolent environments played a more important role in their mental health in later life.

These findings suggest the importance of considering adverse environmental factors in understanding PTSD in future studies.

Reference

Lee, H., Aldwin, C.M. & Kang, S. (2020) Do different types of war stressors have independent relations with mental health? Findings from the Korean Vietnam Veterans Study. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/tra0000557. [Epub ahead of print].

Dosed (2019)

Introduction

An award-winning documentary film about treating anxiety, depression and addiction with psychedelic medicine.

Outline

After years of prescription medications failed her a suicidal woman, Adrianne, turns to underground healers to try and overcome her depression, anxiety, and opioid addiction with illegal psychedelic medicine like magic mushrooms and iboga.

Production & Filming Details

  • Director(s): Tyler Chandler.
  • Producer(s): Robert J. Barnhart, Tyler Chandler, Jason Hodges, Kelley Hodges, Chris Mayerson, Nicholas Meyers, and Nick Soares.
  • Writer(s): Tyler Chandler, Nicholas Meyers, and Jessie Deeter (Story consultant).
  • Music: Jayme McDonald.
  • Cinematography: Nicholas Meyers.
  • Editor(s): Tyler Chandler and Nicholas Meyers.
  • Production: Golden Teacher Films.
  • Release Date: 20 March 2019 (US).
  • Running Time: 82 minutes.

A New Understanding: The Science of Psilocybin (2015)

Introduction

A New Understanding explores the treatment of end-of-life anxiety in terminally ill cancer patients using psilocybin, a psychoactive compound found in some mushrooms, to facilitate deeply spiritual experiences.

Outline

The documentary explores the confluence of science and spirituality in the first psychedelic research studies since the 1970’s with terminally ill patients.

As a society we devote a great deal of attention to treating cancer, but very little to treating the human being who is dying of cancer. The recent resurgence of psychedelic research is once again revealing the power of compounds like psilocybin to profoundly alter our understanding of both life and death. Through the eyes of patients, their loved ones, therapists, and researchers, A New Understanding examines the use of psilocybin in a controlled setting to reduce psychospiritual anxiety, depression, and physical pain.

The treatment aims to help the patient understand that a ‘good’ death is possible, and to help the patient’s family deal well with the dying process. A New Understanding shows patients and their families coming to terms with dying through the skillful treatment of the whole human being. If we can learn to work more skillfully with dying, we will also learn to take better care of life.

Production & Filming Details

  • Director(s): Roslyn Dauber.
  • Producer(s): Robert J Barnhart, Roslyn Dauber, Brady Dial, Matt Humble, Steve McDonald, Jeff Porter, and Mitch Schultz.
  • Music: Brian Satterwhite.
  • Editor(s): Jason Uson.
  • Studio: Red Phoenix Productions.
  • Production: Golden Teacher Films.
  • Release Date: March 2015 (US).
  • Running Time: 55 minutes.
  • Country: US.
  • Langauge: English.

Book: Overcome Anxiety

Book Title:

Overcome Anxiety: How to manage anxiety disorder, manage worry, stop panic attack for an happy life with joy and happiness.

Author(s): Jamie Peace.

Year: 2019.

Edition: First.

Publisher: Independently Published.

Type(s): Paperback.

Synopsis:

ANXIETY IN ONE SHOT: DON’T BELIEVE EVERYTHING YOU THINK.

Are you afraid of fear? Do you know that today there are new simple therapies? Did they ever talk to you about the diary of change?

We all feel anxious all the time. Without anxiety, we would have been eaten out of existence. It is what helps us determine the danger and get out of it in time. When your heart begins to race, you then know that you need to get your flight or fight on.

When one finds themselves on the cusps of anxiety and depression, it often feels like the world is coming to an end. You lose energy of what you want to do when depression sets in. When anxiety sets in, you almost feel as though the world is a raging enemy, charging at you in full speed. Desperately, you look round for a solution, or at least, guidelines for finding solutions. You find, them, but they are laded with medical jargon.

However, there is another situation where your body begins to act out anxiously even in the absence of a threat? So what do you do in this case? Well, you chose this book, and we are here to help you find a guide on how to live with it.

Well, guess what? This book is here to provide you with material that you won’t find around -easy to follow steps and guides to identify if you suffer from anxiety or depression, or a potent combination of both. You will then be run through a series of steps on what you can do to improve your condition, how to find the motivation to go through with exercises, medically proven remedies for anxiety and depression, the kind of exercises that will help you recover better.

YOU WILL LEARN:

  • What are the problem of Anxiety, Depression, Worry, Panic attack
  • How Identifying them in different situation
  • Simple helpful Exercise
  • Put the teachings into practice
  • What is a diary of change

This book is full of simple, easy to follow exercises, instructions, and guides written in a straightforward language. Instead of telling you that you have anxiety or depression, we give you concrete pointers on identifying the issue and then follow through with descriptive guideline that you can follow towards recovery. We have written this book in a way that even a child would pick it up and go through it and emerge at the back end of the page enlightened, bolder, more courageous and with a bigger desire to fight the monster that is depression and its deadly brother-in-crime anxiety. Trust us, these are bad conditions to live with, but in this book, you will learn how to manage them.