Tinnitus and anxiety disorders: A review Pattyn, T.; Van Den Eede, F.; Vanneste, S. ...
Hearing research,
March 2016, 2016-Mar, 2016-03-00, 20160301, Letnik:
333
Journal Article
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The most common form of tinnitus is a subjective, auditory, and distressing phantom phenomenon. Comorbidity with depression is high but other important psychiatric disorders such as anxiety disorders ...have received less attention. The current paper reviews the literature on the associations between tinnitus and anxiety disorders and the underlying pathophysiology, and discusses the clinical implications.
PubMed and Web of Science were searched for all articles published up until October 2014 using combinations of the following search strings “Tinnitus”, ”Anxiety disorder”, “Panic Disorder”, “Generalized Anxiety Disorder”, “Post traumatic stress disorder”, “PTSD” “Social Phobia”, “Phobia Disorder”, “Obsessive Compulsive Disorder”, “Agoraphobia”.
A total of 117 relevant papers were included. A 45% lifetime prevalence of anxiety disorders is reported in tinnitus populations, while an important overlap in associated (sub)cortical brain areas and cortico-subcortical networks involved in attention, distress, and memory functions is suggested. A disturbed hypothalamic-pituitary-adrenal axis function can be found in tinnitus and in anxiety disorders but, in comorbidity, the direction of the dysfunction is unclear.
Comorbidity is high and screening for and treatment of anxiety disorders is recommended in moderate to severe tinnitus, as, given the overlap in the structural and functional brain circuitries involved, theoretically, their management could improve (subjective) levels of tinnitus although further empirical research on this topic is required.
•A 45% lifetime prevalence of comorbid anxiety disorder in tinnitus.•Subcortical overlaps in and links between known tinnitus and anxiety networks.•Direction of causality or possibility of a common vulnerability remains undefined.•Ambiguous involvement of HPA axis; possible by different, acute/chronic, settings.•To screen and treat anxiety could potentially improve perceived levels of tinnitus.
Cognitive insight: A systematic review Van Camp, L.S.C.; Sabbe, B.G.C.; Oldenburg, J.F.E.
Clinical psychology review,
July 2017, 2017-Jul, 2017-07-00, 20170701, Letnik:
55
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Cognitive insight is the ability to re-evaluate thoughts and beliefs in order to make thoughtful conclusions. It differs from clinical insight, as it focuses on more general metacognitive processes. ...Therefore, it could be relevant to diverse disorders and non-clinical subjects. There is a growing body of research on cognitive insight in individuals with and without psychosis. This review has summarised the current state of the art regarding this topic. We conclude that while cognitive insight in its current form seems valid for use in individuals with psychosis, it is less so for individuals without psychosis. Additionally, higher cognitive insight not always leads to better psychological functioning. For instance, higher levels of self-reflection are often associated with depressive mood. We therefore recommend the sub-components of cognitive insight to be studied separately. Also, it is unclear what position cognitive insight takes within the spectrum of metacognitive processes and how it relates to other self-related concepts that have been defined previously in literature. Combining future and past research on cognitive insight and its analogue concepts will help in the formation of a uniform definition that fits all subjects discussed here.
•There is a growth in research on cognitive insight in a variety of subjects.•In individuals without psychosis, studies on cognitive insight show mixed results.•Higher cognitive insight is not always psychologically more healthy.•Sub-components of cognitive insight should be studied separately.•Analogue concepts should be included when re-considering this concept.
Metacognition is an important factor in the development and persistence of bipolar disorder. One of the most striking examples of impairment in metacognitive functioning in bipolar disorder is the ...lack of insight these patients have in their disorder. Despite its importance, research regarding metacognition in bipolar disorder is scarce. Furthermore, the neurocognitive basis of metacognitive functioning is unknown.
The current study included 29 patients with bipolar disorder and 29 age, educational level and gender matched healthy controls. All the participants filled in a metacognition questionnaire that examined their metacognitive beliefs. In addition, it was tested how well they estimated their performance on a neurocognitive test-battery beforehand (metacognitive knowledge) and afterwards (metacognitive experience).
Bipolar disorder patients showed maladaptive metacognitive beliefs in comparison with the healthy controls. They also showed impaired metacognitive knowledge and experience. That is, they overestimated their own cognitive performance. However, the latter result was also true for the healthy controls. In addition, metacognition had neurocognitive correlates. However, for the bipolar patients, depressive symptomatology had an important effect on this relationship and on metacognition in general.
Maladaptive metacognitive skills are related to depression in bipolar disorder. A more healthy metacognitive thinking should be promoted. An effective training for this could be a therapy that includes various elements, from basic cognitive- to higher order metacognitive training.
•Bipolar disorder patients have maladaptive metacognitive skills.•Bipolar disorder patients and controls overestimate their cognitive performance.•Metacognition has neurocognitive correlates in bipolar disorder.•Depressive symptomatology has an impact on metacognition.
Major depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom clusters and ...networks have mostly been studied using cross-sectional designs, temporal dynamics of symptoms within patients may yield information that facilitates personalized medicine. Here, we aim to cluster depressive symptom dynamics through dynamic time warping (DTW) analysis.
The 17-item Hamilton Rating Scale for Depression (HRSD-17) was administered every 2 weeks for a median of 11 weeks in 255 depressed inpatients. The DTW analysis modeled the temporal dynamics of each pair of individual HRSD-17 items within each patient (i.e., 69,360 calculated "DTW distances"). Subsequently, hierarchical clustering and network models were estimated based on similarities in symptom dynamics both within each patient and at the group level.
The sample had a mean age of 51 (SD 15.4), and 64.7% were female. Clusters and networks based on symptom dynamics markedly differed across patients. At the group level, five dynamic symptom clusters emerged, which differed from a previously published cross-sectional network. Patients who showed treatment response or remission had the shortest average DTW distance, indicating denser networks with more synchronous symptom trajectories.
Symptom dynamics over time can be clustered and visualized using DTW. DTW represents a promising new approach for studying symptom dynamics with the potential to facilitate personalized psychiatric care.
Rationale
Impulsivity and craving are both associated with higher relapse rates and a worse prognosis in patients with a substance use disorder, but the relationship between these two phenomena has ...been largely ignored in the field of alcohol use disorders.
Objectives
The primary aim of this study was to investigate the relationship between different dimensions of impulsivity and different forms of self-reported craving. Additionally, the influence of the severity of alcohol dependence on impulsivity, craving, and on their relationship was exploed.
Methods
Impulsivity and craving levels were investigated in 87 abstinent alcohol-dependent (AD) patients using a broad range of self-report questionnaires and behavioral impulsivity measures. Alcohol use was measured by means of the timeline followback method.
Results
Higher scores of emotional craving (Alcohol Urge Questionnaire—AUQ) were significantly related to higher self-reported impulsivity (Barratt Impulsiveness Scale, version 11) and to higher cognitive impulsivity (information sampling task). Additionally, exploratory analyses suggest that these relationships are more pronounced in severe AD patients compared to less severe AD patients. No significant relationships were found between emotional craving (AUQ) and motor impulsivity (stop signal task) or delay discounting and between obsessive-compulsive craving (Obsessive Compulsive Drinking Scale) and measures of impulsivity.
Conclusions
Emotional craving is related to self-reported impulsivity and to cognitive impulsivity. These relationships seem to be more pronounced in AD patients with severe alcohol dependence. Further research is needed to explore the effect of this relationship on treatment outcome and relapse.
•Cognitive insight is a stable characteristic over time in bipolar disorder.•Changes in depression or mania did not affect cognitive insight over time.•At baseline, depression was positively ...correlated with self-reflectiveness.•Self-reflectiveness was higher in patients than controls.•It could be that higher self-reflectiveness is a trait in bipolar disorder.
Cognitive insight or the ability to be self-reflective and to retain from being over-confident in own beliefs is an upcoming topic in research regarding psychiatric disorders. In bipolar disorder investigations are scarce and an important lacuna is the unexamined longitudinal relationship between cognitive insight and mood. Therefore, in this study the level of cognitive insight, mania and depression were assessed in a total of 56 patients with bipolar disorder at baseline, four months and eight months follow-up. In addition, the cognitive insight of 35 healthy controls was assessed at baseline and at four months follow-up. The current research shows that self-reflectiveness and self-certainty remained stable over time in bipolar disorder. The improvement of mood did not affect the course of cognitive insight. However, at baseline higher levels of depression were correlated with more self-reflectiveness. In addition, self-reflectiveness was higher for bipolar disorder patients in comparison with the healthy controls. Our results could imply that higher levels of self-reflectiveness are a specific characteristic in bipolar disorder that is independent from an improvement in mood.
•Presence of agitation was associated with elevated hair cortisol.•Patients with catatonia showed relatively high hair cortisol concentrations.•Baseline hair cortisol concentrations were not ...associated with ECT outcome.
There is substantial evidence showing changes in hypothalamic pituitary adrenal (HPA)-axis activity in patients with major depressive disorder (MDD). Also, there seem to be differences in HPA-axis functioning between MDD subgroups. It is however unclear whether hair cortisol concentrations (HCC), which are a stable marker of long-term cortisol levels, are suitable as a biomarker for identifying subgroups in MDD.
We were able to attain valid HCC from a scalp hair sample of sixty-two patients with a major depressive episode right before electroconvulsive therapy (ECT). HCC were our main biological outcome measure. We created subgroups using depression severity as defined by the Hamilton Depression Rating Scale, the presence/absence of psychotic symptoms, the presence of melancholia as defined by the CORE and catatonia as defined by the Bush-Francis Catatonia Rating Scale.
Our analyses of the total group showed a median HCC of 4.4 pg/mg. We found patients with catatonia (N = 10) to have substantially higher median HCC (8.3 pg/mg) than patients without catatonia (3.8 pg/mg). Although presence of melancholia and depression severity were not significantly associated with HCC, more severe psychomotor agitation was associated with higher HCC. Pre-treatment HCC was not associated with ECT outcome.
A complicating factor in interpretation of our results was the large variability in HCC. This could be related to potential confounders such as cardiometabolic and other comorbidities, that were however addressed to the extent possible.
HCC is a potential biomarker for MDD patients with severe agitation and/or catatonia.
Identifier: NCT02562846.
Docx L, Morrens M, Bervoets C, Hulstijn W, Fransen E, De Hert M, Baeken C, Audenaert K, Sabbe B. Parsing the components of the psychomotor syndrome in schizophrenia.
Objective: Catatonia, ...extrapyramidal signs, psychomotor slowing, and (motoric) neurological soft signs are well‐known psychomotor symptoms in schizophrenia. This study aims at investigating the interrelations between these symptoms. In addition, associations between psychomotor symptoms, clinical symptoms, and cognitive functioning will be studied.
Method: An extensive test battery containing psychomotor (Bush Francis Catatonia Rating Scale; St Hans Rating Scale; Salpêtrière Retardation Rating Scale; Neurological Evaluation Scale) and clinical (Positive and Negative Syndrome Scale; Calgary Depression Scale) rating scales as well as instrumental psychomotor tests (Line Copying Task; Finger Tapping Task) and cognitive tasks (Symbol Digit Substitution Test; Stroop Colour Word Test; Continuous Performance Test; Letter Number Sequencing) was administered to a sample of 124 patients with schizophrenia or schizoaffective disorder.
Results: Correlational analyses showed that two clusters emerge from our data: first, a psychomotor poverty cluster referring to the interrelations between catatonia, parkinsonism, psychomotor slowing, and negative symptoms; second, a cluster containing motoric neurological soft signs, which were found to be correlated with cognitive functioning.
Conclusion: Psychomotor abnormalities are highly prevalent phenomena in schizophrenia that have to be considered as a heterogeneous construct. However, longitudinal and neurobiological research is needed to further explore the precise nature of the interrelations found in this study.
Head-to-head comparisons of antipsychotics have predominantly included patients with chronic conditions. The aim of the present study was to compare the efficacy and tolerability of ziprasidone and ...olanzapine in patients with recent-onset schizophrenia.
The study was an 8-week, double-blind, parallel-group, randomized, controlled multicenter trial (NCT00145444). Seventy-six patients with schizophreniform disorder, schizophrenia or schizoaffective disorder (diagnosis < 5 y), and a maximum lifetime antipsychotic treatment < 16 weeks participated in the study. Efficacy of ziprasidone (80-160 mg/d) and olanzapine 10-20 mg was measured using the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression (CGI) Scale, the Calgary Depression Scale for Schizophrenia (CDSS), and the Heinrich Quality of Life Scale (HQLS); tolerability assessments included laboratory assessments, body weight, and electroencephalogram.
Olanzapine (n = 34) and ziprasidone (n = 39) showed equal efficacy as measured by the PANSS, CDSS, CGI, and HQLS. However, mean weight gain was significantly higher in the olanzapine group (6.8 vs 0.1 kg, P < .001). Ziprasidone was associated with decreasing levels of triglycerides, cholesterol, and transaminases, while these parameters increased in the olanzapine group (all P values < .05). There were no significant differences in fasting glucose and prolactin levels or in cardiac or sexual side effects. Patients on ziprasidone used biperiden for extrapyramidal side effects more frequently (P < .05).
The results of this study indicate that ziprasidone and olanzapine have comparable therapeutic efficacy but differ in their side effect profile. However, there is a risk of a type II error with this sample size. Clinically significant weight gain and laboratory abnormalities appear early after initiating treatment and are more prominent with olanzapine, while more patients on ziprasidone received anticholinergic drugs to treat extrapyramidal symptoms.
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