Cognitive functioning in chronic fatigue syndrome and the role of depression, anxiety and fatigue

Objective: This study was designed to investigate the role of depression, anxiety, and fatigue in Chronic Fatigue Syndrome (CFS) sufferers' objective and subjective cognitive performance. Methods: Twenty-three CFS sufferers and 23 healthy control participants were compared on objective and subjective assessments of cognitive performance. Depression, anxiety, and fatigue were also evaluated. Results: CFS sufferers did not demonstrate any impairment in objective cognitive functioning compared to the control group, and objective performance was not related to their higher levels of depression or their level of fatigue. Depression scores only accounted for a small amount of the variance in CFS sufferers' lower subjective assessment of their cognitive performance compared to control participants. There were no differences between the groups on anxiety scores. Conclusion: The results are discussed in terms of the heterogeneity of the CFS population and the complex interaction of symptomatological factors that characterise CFS.

The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety

A diagnosis of cancer is a very stressful event for the patients and their families. Patients, partners and other family members can suffer from clinical levels of depression and severe levels of anxiety and stress reactions. The similarity in levels of distress between patients and partners and patients and offspring suggests that there are common factors that impact on families' distress levels. The current study examined levels of depression and anxiety in newly diagnosed adult patients (n = 48) and their adult relatives (n = 99). Family functioning and patients' illness characteristics were identified as factors that might impact on families' depression and anxiety. Results from multilevel models indicated that family functioning was important. Families that were able to act openly, express feelings directly, and solve problems effectively had lower levels of depression. Direct communication of information within the family was associated with lower levels of anxiety. Aside from differences anxiety due to cancer type, patients' illness characteristics appear to be risk factors in patients' but not relatives' depression and anxiety. The results from the current study suggest that researchers and clinicians need to be family-focused as cancer affects the whole family, not just the patient.

Depression, anxiety and stress in women following acute coronary syndrome: implications for secondary prevention

Objective
To document incidence of depression, anxiety, and stress in women more than 6 months following an acute coronary syndrome.

Design
Participants were identified from a coronary care unit database. The Depression Anxiety Stress Scales 21 (DASS 21) was sent to potential participants via postal survey.

Setting
A metropolitan teaching hospital in Melbourne, Australia.

Participants
The cohort of women was aged between 55 and 70 years. They had been admitted to hospital with a diagnosis of acute coronary syndrome (ACS) between 6 and 14 months prior to participating in this study.

Main outcome measures
Scores on Depression, Anxiety, and Stress Scale (DASS 21).

Results
Of the 117 posted questionnaires, 39 women with a mean age of 63 (S.D. 4.97) responded to the survey, representing a response rate of 33.3%. Most participants scored within normal levels of depression (66.7%), anxiety (60.5%), and stress (70.3%), however, mild to extremely severe levels of each construct (33.4%, 39.6%, and 29.7%, respectively) were found.

Conclusions
The reporting of elevated levels of depression, anxiety and stress in a subset of women more than 6 months following an ACS event underscores the importance of ongoing screening for risk factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in both the inpatient and outpatient settings. Based on these pilot data, consideration of a screening system in the immediate post discharge period for women at risk and an education or support service are recommended.

Identifying the health and mental health information needs of people with coronary heart disease, with and without depression

Objective:
To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression.

Design and setting:
A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients.

Participants:
14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing).

Results:
Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect.

Conclusion:
This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.

Parrot interpreter : representation, extinction and the electronic information environment

Carter discusses insights and ideas on and about parrots, based on his book of the same name. Parrot understanding is an understanding of the critical role noise plays in binding man together, and in relating to the external world whose resistance to translation is not a source of anxiety but a phenomenon respectfully to embrace. Moreover, the most remarkable thing about parrot is not perhaps that it speaks but that it listens.

Same information, different behaviour

Over the last three decades the literature on ethical decision-making has burgeoned. Despite this, a number of recent corporate collapses have been attributed to unethical business practices. Through an online simulation study, the research found that an individual's cognitive predispositions, anxiety and moral identity are key contributors to unethical behaviour.

An application of RST in understanding social anxiety and alcohol use

By employing revised-Reinforcement Sensitivity Theory (r-RST) this thesis was the first study to provide important information beyond that afforded by current motivational models in both the social anxiety and alcohol use literature. Specifically, the Fight Flight Freeze system was the most important variable in understanding social anxiety and o-BAS in understanding co-morbid hazardous alcohol use.

Cigarette smoking, nicotine dependence and anxiety disorders : a systematic review of population-based, epidemiological studies

Background Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized.

Methods We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)) for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders.

Results In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder), although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified.

Conclusions Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as increasing the risk of panic disorder and generalized anxiety disorder. The literature assessing anxiety disorders increasing smoking and nicotine dependence is inconsistent. Potential issues with the current literature are discussed and directions for future research are suggested.

Predicting the acceptance of unit guide information systems

Information Systems can play an important role in ensuring and improving the quality of education provided. However, lack of acceptance of these information systems and resistance of technology innovations by the end users limit the expected benefits of the system. This research attempts to identify the key determinants for the acceptance of the Unit Guide Information Systems (UGIS) in the Australian higher education sector. The technology acceptance model (TAM), social cognitive theory (SCT) and model of PC utilization (MPCU) are combined to provide a new framework for this analysis. Results of the study are consistent with the technology acceptance factors for explaining the behavioural intention of the academics. The study also shows the effects of application specific self-efficacy, application specific anxiety and social influence on the acceptance of UGIS. Implications of the results are discussed within the context of unit guides and curriculum mapping.

Internet cognitive behavioural therapy for panic disorder : does the inclusion of stress management information improve end-state functioning?

Previous research has established Internet-based cognitive behavioural therapy (CBT) for panic disorder (PD) as effective in reducing panic severity and frequency. There is evidence, however, that such programs are less effective at improving overall end-state functioning, defined by a PD clinician severity rating of ≤2 and panic free. In order to test the effect on end-state functioning of the incorporation of stress management material within a CBT program for PD, 32 people with PD were randomised to either Internet-based CBT (PO1), Internet-based CBT plus stress management (PO2) or an Internet-based information-only control condition (IC). Both CBT treatments were more effective at posttreatment assessment than the control condition in reducing PD severity, panic and agoraphobia-related cognition, negative affect and self-ratings of health. PO2 was more effective than PO1 at posttreatment assessment on PD severity and general anxiety, although at 3-month follow-up these differences were no longer apparent. This study provides further support for the efficacy of Internet-based CBT for PD and suggests that although the incorporation of stress management material confers short-term advantages over a standard program, it is not associated with any longer term improvements on panic severity and related cognitions, negative affect, general wellbeing and end-state functioning.

Physical comorbidities in men with mood and anxiety disorders: a population-based study

Background : The mind-body nexus has been a topic of growing interest. Further data are however required to understand the specific relationship between mood and anxiety disorders and individual physical health conditions, and to verify whether these psychiatric disorders are linked to overall medical burden.
Methods : This study examined data collected from 942 men, 20 to 97 years old, participating in the Geelong Osteoporosis Study. A lifetime history of mood and anxiety disorders was identified using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID-I/NP). The presence of medical conditions (lifetime) was self-reported and confirmed by medical records, medication use or clinical data. Anthropometric measurements and socioeconomic status (SES) were determined and information on medication use and lifestyle was obtained via questionnaire. Logistic regression models were used to test the associations.
Results : After adjustment for age, socioeconomic status, and health risk factors (body mass index, physical activity and smoking), mood disorders were associated with gastro oesophageal reflux disease (GORD), recurrent headaches, blackouts and/or epilepsy, liver disorders and pulmonary disease in older people, whilst anxiety disorders were significantly associated with thyroid, GORD and other gastrointestinal disorders, and psoriasis. Increased odds of high medical burden were associated with both mood and anxiety disorders.
Conclusions : Our study provides further population-based evidence supporting the link between mental and physical illness in men. Understanding these associations is not only necessary for individual management, but also to inform the delivery of health promotion messages and health care.

Anxiety versus fundamental emotions as predictors of perceived functionality of pre-competitive emotional states, threat, and challenge in individual sports

The objectives of this study were to examine the contribution of anxiety and fundamental emotions to perceived emotion functionality and evaluate the informational value of anxiety measures used in sport versus measures of fundamental emotions in terms of appraisal. A battery of questionnaires comprising the somatic and cognitive subscale of the Competitive State Anxiety Inventory-2 (CSAI-2), the State Anxiety Inventory, the Differential Emotions Scale–IV, a perceived functionality of emotions single item, and two items assessing challenge and threat appraisals was administered to 202 athletes competing in individual sports in the United Kingdom. They were tested on recalled pre-competitive emotions experienced before their best and worst competition ever and momentary emotions experienced one hour before an actual competition. In general, measures of fundamental emotions with clear approach or avoidance action tendencies were better predictors of emotion functionality than anxiety measures. Results also suggested that the CSAI-2 does not convey clear information about an athlete’s appraisal of a competition. Measures of negative and positive fundamental emotions with clear action tendencies were better indicators of athletes’ appraisal patterns. It was concluded that assessment of athletes’ emotional state should not be exclusively based on anxiety measures but should encompass or be replaced with measures of emotions conveying unambiguous information about the athlete-competition relationship.

Managing post-discharge care at home: an analysis of patients' and their carers' perceptions of information received during their stay in hospital

This small-scale study carried out in a Melbourne metropolitan hospital explored patients’ and their carers’ perceptions of information, adequacy of information, and their utilization of information concerning post-discharge care received from health professionals during their stay in hospital. The research design consisted of two stages. Stage one involved a qualitative approach using focused interviews of five pairs of patients and their carers, 2 weeks after discharge from hospital. Five main themes emerged from the content analysis of the interview transcripts: information given by health professionals to patients and carers, patients’ and carers’ psychological well-being, activities of daily living, caring tasks of the patients, and community linkages. A quantitative approach was used for stage two involving two sets of questionnaires, one for the patient and one for the carer, developed from the themes identified in stage one. A pilot study was conducted on three pairs of patients and their carers, 2 weeks after discharge from hospital. The main study consisted of a convenience sample of 40 pairs of patients and their carers who completed the questionnaires 2 weeks post-discharge. Data analysis of stage two of the study consisted of descriptive statistics and cross-tabulations. The main findings suggested that carers received very little information from health professionals concerning their patients’ health problems and care at home. The carers’ health and employment states were often not considered in their patients’ discharge plan. Carers who were present with their patients when they received information concerning post-discharge care experienced a decrease in anxiety during their patients’ convalescence at home, greater satisfaction with the information they received, and their patients experienced fewer medical problems post-discharge. The implications for nursing practice and research include recommendations for a more effective system of discharge planning, and further research to include a larger population with a more varied group of participants.

Does gender matter? A one year follow-up of autistic, attention and anxiety symptoms in high-functioning children with autism spectrum disorder

Gender differences in autism spectrum disorder (ASD) symptoms and associated problem behaviours over development may provide clues regarding why more males than females are diagnosed with ASD. Fifty-six high-functioning children with ASD, and 44 typically developing controls, half of the participants female, were assessed at baseline (aged 7–12 years) and one-year later, collecting measures of autism, attention and anxiety symptoms, school placement and support information. Findings indicated no gender differences in autistic symptoms. Males were more hyperactive and received more integration-aide support in mainstream schools, and females were more socially anxious. Overall, similar gender profiles were present across two time points. Lower hyperactivity levels in females might contribute to their under-identification. Implications are discussed using a biopsychosocial model of gender difference.

The impact of maternal smoking during pregnancy on depressive and anxiety behaviors in children: the Norwegian Mother and Child Cohort Study.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is associated with multiple adverse childhood outcomes including externalizing behaviors. However, the association between MSDP and internalizing (anxiety and depressive) behaviors in offspring has received less investigation. We aimed to assess the association between MSDP and childhood internalizing (anxiety and depressive) behaviors in a very large, well-characterized cohort study. METHODS: We assessed the association between MSDP and internalizing behaviors in offspring utilizing information drawn from 90,040 mother-child pairs enrolled in the Norwegian Mother and Child Cohort Study. Mothers reported smoking information, including status and frequency of smoking, twice during pregnancy. Mothers also reported their child's internalizing behaviors at 18 months, 36 months, and 5 years. Associations between MSDP and childhood internalizing behaviors, including dose-response and timing of smoking in pregnancy, were assessed at each time point. RESULTS: MSDP was associated with increased internalizing behaviors when offspring were aged 18 months (B = 0.11, P <0.001) and 36 months (B = 0.06, P <0.01), adjusting for numerous potential confounders. Higher rates of smoking (e.g., >20 cigarettes per day) were associated with higher levels of internalizing behaviors. Maternal smoking during early pregnancy appeared to be the critical period for exposure. CONCLUSIONS: We found evidence supporting a potential role for MSDP in increasing internalizing (anxiety and depressive) behaviors in offspring. We also found evidence supportive of a possible causal relationship, including dose-dependency and support for a predominant role of early pregnancy exposure. Further investigation utilizing genetically informed designs are warranted to assess this association.