Innovations In Clinical Neuroscience

MAR-APR 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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41 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE March-April 2018 • Volume 15 • Number 3–4 O R I G I N A L R E S E A R C H coexisting depressive symptoms, obfuscating the diagnosis and making it difficult to clarify the need for psychotropic medication. 6,10,23–25 A sizable number of patients with GAD in this study (33%) reported experiencing a previous MDE. Patients with a history of MDE had significantly more depressive symptoms at the screening visit than patients without a history of MDE, although their anxiety symptom scores on the CAS, GAD-7, and total SIGH-A were not significantly different (Table 3). One study identified different risk factors for GAD and MDE and argued that these two disorders are not merely different manifestations of a single underlying condition or that GAD is merely a prodrome or severity marker of MDE. 23 Our screening data do not allow us to speculate whether patients with GAD, with or without concomitant depressive symptoms, are different from each other or whether a history of MDE alternating with GAD actually matters in the course of the illness. The widely used DSM classification system has evolved since the third edition of the DSM and now describes GAD as a disorder characterized by excessive worry that is hard to control. It includes a relatively short checklist of six associated anxious/arousal symptoms, of which only three are required to qualify the diagnosis as GAD. 1,2,24 Many "normally" anxious but reasonably well- functioning people could potentially have worries that are hard to control and might also endorse many, but not all, of the associated symptoms. TABLE 3. Clinical metric comparisons of GAD patients with or without a previous history of MDEs METRIC HISTORY OF MDEs NO HISTORY OF MDEs t p n=30 n=60 CAS 11.30±1.44* 10.98±1.43 0.99 ns RDS 5.73±1.05 4.95±1.08 3.27 0.0015 CGI-S 4.85±0.61 4.71±0.56 0.96 ns GAD-7 16.40±3.63 16.45±4.02 -0.06 ns Total SIGH-A 26.8±3.63 27.2±3.73 -0.48 ns SIGH-A item 1 2.83±0.38 2.85±0.36 -0.20 ns SIGH-A item 2 2.83±0.38 2.83±0.38 0.00 ns SIGH-A item 3 1.77±1.07 1.78±0.94 -0.08 ns SIGH-A item 4 2.67±0.61 2.65±0.52 0.14 ns SIGH-A item 5 2.40±0.62 2.20±0.82 1.18 ns SIGH-A item 6** 1.50±0.86 1.15±0.73 2.01 0.047 SIGH-A item 7** 2.03±0.93 2.42±0.70 -2.20 0.031 SIGH-A item 8 1.47±1.07 1.35±1.12 0.47 ns SIGH-A item 9 1.30±1.02 1.37±0.94 -0.31 ns SIGH-A item 10 1.33±1.03 1.53±0.87 -0.96 ns SIGH-A item 11 1.50±0.94 1.60±0.99 -0.46 ns SIGH-A item 12 1.27±1.01 1.45±1.16 -0.74 ns SIGH-A item 13 1.83±0.91 1.97±0.82 -0.70 ns SIGH-A item 14 2.07±0.37 2.05±0.59 0.14 ns *Mean score±standard deviation (SD) at the screen visit **SIGH-A item 6 assesses depressed mood; SIGH-A item 7 assesses muscular tension. GAD: generalized anxiety disorder; MDE: major depressive episode; CAS: Covi Anxiety Scale; ns: not significant; RDS: Raskin Depression Scale; CGI-S: Clinical Global Impression of Severity; SIGH-A: Structured Interview Guide for the Hamilton Anxiety Rating Scale FIGURE 1. Comparison of individual Hamilton Rating Scale for Anxiety (HAM-A) items: site-based and site-independent "dual" scores TABLE 2. Primary treatments given in the current GAD episode MEDICATIONS PATIENTS, %* Citalopram 11.4 Duloxetine 8.0 Escitalopram 29.6 Paroxetine 23.9 Sertraline 9.1 Venlafaxine 18.2 * Eligible patients needed to be taking citalopram, escitalopram, paroxetine, sertraline, duloxetine, or venlafaxine at a stable, approved dose for at least two consecutive months in the current episode immediately prior to the screening visit. GAD: generalized anxiety disorder

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