Impairment and quality of life in individuals with generalized anxiety disorder

Improving the quality of life is an important goal in the treatment of psychiatric disorders. The current study described subjective quality of life, or life satisfaction, in a sample of older adults with generalized anxiety disorder (GAD). Patients with GAD were compared to other anxious and nonpsychiatric samples on measures of life satisfaction. Older adults with GAD reported lower quality of life than did nonpsychiatric samples; levels of life satisfaction were comparable between older adults with GAD and younger adults with social phobia. Predictors of quality of life for the GAD sample were examined. Severity of depression predicted decreased life satisfaction as measured by both the Quality of Life Inventory (QOLI) and the Life Satisfaction Index (LSI-Z). Severity of anxiety predicted poorer quality of life as measured by the QOLI, and optimism predicted better life satisfaction as measured by the LSI-Z. The findings suggest that quality of life is diminished in older adults with GAD, and that additional factors also affect quality of life for these patients.

The study by Devoe et al. presents a large systematic review and meta-analysis that includes 35 studies and a total of 9,646 individuals with a clinically diagnosed ED, and examined the prevalence rates of impulse control disorders and behavioral addictions. The authors found a 22% prevalence for any impulse control disorder, especially for pathological/compulsive buying, predominantly in individuals with EDs of the binge-purge phenotype. This study supports the need for screening and monitoring of comorbid impulse control disorders and behavioral addictions in individuals with EDs. Riquin et al. investigated psychiatric comorbidities in adults with anorexia nervosa (AN) and found that more than half of the cohort had experienced major depressive disorder (MDD) over their lifetime, almost a third had had generalized anxiety disorder (GAD) or social phobia (SP), and more than a quarter had OCD. Interestingly, the study showed that individuals with AN had more severe symptoms when comorbid MDD and GAD were diagnosed prior the diagnosis of the AN. The authors also reported that the greatest clinical severity (i.e., ED-related symptoms), general clinical condition, and quality of life in individuals with AN was associated with lifetime comorbidity for MDD, GAD, or SP.Li et al. evaluated treatment outcomes based on self-reported assessment of autistic traits -high autistic traits (HAT) vs. low autistic traits (LAT)-in individuals with AN in either an inpatient or day treatment program. In individuals with AN, HAT was a positive predictor for clinical improvement of the ED symptoms in an inpatient treatment program, but a negative predictor for those in a day treatment program. The authors argued that the individualized and structured routine care in an inpatient setting may be more suitable for the treatment of individuals with comorbid AN and HAT.While research in this area is growing, these findings suggest that treatment adaptations for individuals with comorbid AN and autistic traits are needed.Nobile et al. examined cognitive functions including attention, decision making, set shifting, and central coherence in women with bulimia nervosa (BN) who were receiving hormonal contraceptives (HC) compared to those who were not. The authors adjusted their analyses for a variety of variables that might influence cognitive performance and found that women with BN on HC (all types) showed better selection abilities and global sustained attention, and better understood the rules of the Iowa gambling task for decision making, while no differences between the groups were found for set shifting and central coherence. The authors argued that by limiting sex hormone changes by means of HC, cognitive functions might appear less prone to fluctuations. This Special Issue highlights recent literature on the implications of psychiatric and medical comorbidities reported in individuals with EDs. Individuals with EDs have a higher mortality rate compared to the general population and death is often due to the medical and/or psychiatric comorbidity -suicide or severe medical complications. The studies in the issue illustrate that comorbidities, some that precede the ED and others that are the consequence of the ED, can impact the clinical presentation, diagnosis, and treatment. Further, the comorbidity associated with EDs makes treatment a challenging task. This issue adds to the existing knowledge and provides stimuli to improve early diagnosis and treatment interventions to reduce the burden of suffering in individuals with EDs and comorbid conditions.

ObjectiveTo investigate factors influencing somatic symptom disorder (SSD) in epilepsy patients and construct a cut-off point prediction model.MethodsUsing structured interviews and based on DSM-5 diagnostic criteria, the 206 epilepsy patients included in this study were categorized into SSD and non-SSD (n-SSD) groups. Demographic and clinical data were collected, and assessments were conducted using the Quality of Life in Epilepsy (QOLIE-31), Generalized Anxiety Disorder-7 (GAD-7), Neuropsychiatric Disease and Disability Inventory-Extended (NDDI-E), and Pittsburgh Sleep Quality Index (PSQI). Age, negative life events, seizure anxiety, energy/fatigue, GAD-7, NDDI-E, and PSQI scores were identified as independent risk factors for SSD comorbidity in epilepsy. The constructed cut-off model demonstrated good predictive performance. External validation in an independent multicenter cohort is required prior to clinical implementation.ResultsCompared with the n-SSD group, the SSD group exhibited statistically significant differences in age, age at onset, years of education, place of residence, number of comorbid physical illnesses, and adverse life events (all p < 0.05). The SSD group also showed significantly higher scores on GAD-7, NDDI-E, and PSQI, but lower total QOLIE-31 score and lower subscale scores for seizure worry, medication effects, energy/fatigue, life satisfaction, social functioning, and emotional well-being (all p < 0.05). Multivariate logistic regression analysis revealed that age (OR = 1.076, 95% CI: 1.015–1.141), negative life events(OR = 6.624, 95% CI: 2.130–20.606), seizure anxiety (OR = 0.945, 95% CI: 0.895–0.999), energy/fatigue (OR = 0.923, 95% CI: 0.872–0.977), and GAD-7 (OR = 1.274, 95% CI: 1.015–1.274) were independently associated with higher QOLIE-31 total scores. Fatigue (OR = 0.923, 95% CI: 0.872–0.977), GAD-7 (OR = 1.274, 95% CI: 1.037–1.565), NDDI-E (OR = 1.233, 95% CI: 1.038–1.442), and PSQI (OR = 1.375, 95% CI: 1.097–1.723) were independent predictors of SSD. The AUC of the nomogram model constructed based on the aforementioned factors was 0.939 (95% CI: 0.904–0.975), with an AUC of 0.907 following internal validation. The optimal risk probability cutoff value was 0.200 (based on the Yorden index), yielding a sensitivity of 84.7% and specificity of 95.3%. Calibration curve and decision curve analyses demonstrated good model calibration and clinical net benefit.ConclusionOlder age, exposure to negative life events, higher GAD-7, NDDI-E, and PSQI scores, and lower scores on the seizure worry and energy/fatigue dimensions of QOLIE-31 are independent risk factors for SSD in epilepsy patients. The constructed nomogram model demonstrates favorable predictive performance. External validation within an independent multicenter cohort is required prior to clinical implementation.

Quality-of-life indices have been used in medical practice to estimate the impact of different diseases on functioning and well-being and to compare outcomes between different treatment modalities. An integrated view of the issue of quality of life in patients with anxiety disorders can provide important information regarding the nature and extent of the burden associated with these disorders and may be useful in the development of strategies to deal with it. A review of epidemiological and clinical studies that have investigated quality of life (broadly conceptualized) in patients with panic disorder, social phobia, posttraumatic stress disorder, generalized anxiety disorder, and obsessive-compulsive disorder was conducted by searching MEDLINE and PsycLIT citations from 1984 to 1999. A summary of the key articles published in this area is presented. The studies reviewed portray an almost uniform picture of anxiety disorders as illnesses that markedly compromise quality of life and psychosocial functioning. Significant impairment can also be found in individuals with subthreshold forms of anxiety disorders. Effective pharmacological or psychotherapeutic treatment has been shown to improve the quality of life for patients with panic disorder, social phobia, and posttraumatic stress disorder. Limitations in current knowledge in this area are identified, and suggestions for needed future research are provided. It is expected that a more thorough understanding of the impact on quality of life will lead to increased public awareness of anxiety disorders as serious mental disorders worthy of further investment in research, prevention, and treatment.

While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs. Forty-one individuals (mean age: 46.93years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive-developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS-QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained. The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices. Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large.

Purpose: To determine if quality of life is reduced in individuals with patellofemoral osteoarthritis, whether it can be improved with treatment, and potential factors associated with quality of life in individuals with patellofemoral osteoarthritis.Materials and methods: Published articles were identified by using electronic and manual searches. Studies reporting quality of life in individuals with patellofemoral osteoarthritis relative to a comparator group (e.g., no osteoarthritis) and intervention studies reporting quality of life in patellofemoral osteoarthritis following treatment relative to baseline/control group were included.Results: Seventeen studies (seven cross-sectional, 10 intervention) were included in this systematic review. Relative to those without osteoarthritis, individuals with patellofemoral osteoarthritis had worse knee-related quality of life (five studies) and health-related quality of life (two studies). Non-surgical treatments appear to improve knee-related quality of life compared to pre-treatment (three studies) but not control (three studies). Surgical-treatments also improved knee-related quality of life compared to pre-treatment (five studies). Worse knee-related quality of life was associated with younger age, worse pain, symptoms, function in activities of daily living, and function in sport and recreation.Conclusions: Individuals with patellofemoral osteoarthritis had worse knee-related and health-related quality of life compared to those without knee osteoarthritis. Non-surgical and surgical interventions may be effective in improving knee-related quality of life in individuals with patellofemoral osteoarthritis, but the intervention results are based on limited studies, and further research is needed to determine optimal strategies.Implications for rehabilitationClinicians and researchers should consider knee-related and health-related quality of life when developing treatment strategies for patellofemoral osteoarthritis.Researchers investigating the effectiveness of a treatment should compare intervention to a control group.Addressing knee pain and functional limitations may aid in improving knee-related quality of life in individuals with patellofemoral osteoarthritis.

PurposeTo assess the effects of virtual reality using the NintendoTM Wii Fit on balance, gait, and quality of life in ambulatory individuals with incomplete spinal cord injury (iSCI).RelevanceThere is a need for continued research to support effective treatment techniques in individuals with iSCI to maximize each individual's potential functional performance.SubjectsFive males with a mean age of 58.6 years who had an iSCI and were greater than one-year post injury.MethodsAn interrupted time series design with three pre-tests over three weeks, a post-test within one week of the intervention, and a four-week follow up. Outcome measures: gait speed, timed up and go (TUG), forward functional reach test (FFRT) and lateral functional reach test (LFRT), RAND SF-36. Intervention consisted of one-hour sessions with varied games using the Nintendo Wii Fit twice per week for seven weeks. Survey data was also collected at post-test.ResultsThere were statistically significant changes found in gait speed and functional reach. The changes were also maintained at the four-week follow up post-test. Survey reports suggested improvements in balance, endurance, and mobility with daily tasks at home.ConclusionAll subjects who participated in training with the NintendoTM Wii Fit demonstrated statistically significant improvements in gait speed and functional reach after seven weeks of training. Given the potential positive impact that the NintendoTM Wii Fit has on functional reach and gait speed in patients with iSCI, physical therapists may want to incorporate these activities as part of a rehabilitation program.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

BackgroundWe evaluated the effects of once-daily extended-release quetiapine fumarate (quetiapine XR) on patient-reported outcomes in generalized anxiety disorder (GAD).MethodsThis is a report of a pooled analysis from three acute 8-week, randomized, placebocontrolled, fixed-dose (50, 150, 300 mg/day) studies and a 52-week maintenance flexible dose (50–300 mg/day) study of quetiapine XR monotherapy in patients with GAD. Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) percent maximum total scores (items 1–14), item 15 (“satisfaction with medication”), item 16 (“overall life satisfaction”), and Pittsburgh Sleep Quality Index (PSQI) global scores are reported. Sheehan Disability Scale (SDS) total scores were also assessed (maintenance study only).ResultsThe acute studies showed significant improvements at week 8 in Q-LES-Q-SF percent maximum total score with quetiapine XR 150 mg/day (P < 0.001) and item 16 with quetiapine XR 50 (P < 0.05) and 150 mg/day (P < 0.001) versus placebo; PSQI global scores significantly improved with quetiapine XR 50, 150, and 300 mg/day versus placebo (P < 0.001). The maintenance study showed significant benefits versus placebo with quetiapine XR 50–300 mg/day in Q-LES-Q-SF percent total score, item 15 and item 16 scores, PSQI global score, and SDS total score.ConclusionQuetiapine XR 150 mg/day (acute studies) and 50–300 mg/day (maintenance study) improved quality of life, overall functioning, and sleep quality in patients with GAD.

Objective: To examine and predict the relationship among social appearance anxiety, emotional regulation and quality of life in individuals with premature canities. Methods: The correlational study was conducted from September 2019 to February 2020 in Lahore, Pakistan, after approval from the Riphah International University, Lahore, and comprised individuals of either gender aged 15-25 years with premature canities. Social Appearance Anxiety Scale, Emotional Regulation Questionnaire and the Quality of Life Scale were used to measure the study variables. Data was analysed using SPSS 21. Results: Of the 100 subjects, 50(50%) each were males and females. The overall mean age was 19.80±3.33 years. Individuals with premature canities had significant social appearance anxiety which was positively correlated with emotional suppression. As social appearance anxiety increased, the quality of life decreased (p&lt;0.05). Lower level of cognitive reappraisal and higher expressive suppression were linked with improved quality of life in individuals with premature canities (p&lt;0.05). Conclusion: Social appearance anxiety, emotional regulation along with age were together found to be the predictors of quality of life. Key Words: Social appearance anxiety, Emotional regulation, Quality of life, Premature canities.

To examine and predict the relationship among social appearance anxiety, emotional regulation and quality of life in individuals with premature canities. The correlational study was conducted from September 2019 to February 2020 in Lahore, Pakistan, after approval from the Riphah International University, Lahore, and comprised individuals of either gender aged 15-25 years with premature canities. Social Appearance Anxiety Scale, Emotional Regulation Questionnaire and the Quality of Life Scale were used to measure the study variables. Data was analysed using SPSS 21. Of the 100 subjects, 50(50%) each were males and females. The overall mean age was 19.80±3.33 years. Individuals with premature canities had significant social appearance anxiety which was positively correlated with emotional suppression. As social appearance anxiety increased, the quality of life decreased (p<0.05). Lower level of cognitive reappraisal and higher expressive suppression were linked with improved quality of life in individuals with premature canities (p<0.05). Social appearance anxiety, emotional regulation along with age were together found to be the predictors of quality of life.

Purpose: This study aimed to investigate the effects of diaphragmatic mobilization and diaphragmatic breathing exercises on pain and quality of life in individuals with shoulder pain. Methods: A total of 72 individuals with shoulder pain were included in the study. The individuals included in the study were randomly divided into 3 groups as Diaphragmatic Mobilization Group (DMG) (n=24), Diaphragmatic Breathing Group (DBG) (n=24), and control group (n=24). In addition to classical physiotherapy treatment, diaphragmatic mobilization to mobilization group and diaphragmatic breathing exercises to breathing group were applied by the physiotherapist 3 days a week for 8 weeks. On the other hand, only classical physiotherapy treatments were applied to the control group. Individuals were evaluated in terms of pain and quality of life. Pain levels assessed with the Visual Analogue Scale (VAS) and quality of life assessed with Short Form-36 (SF-36). Results: In our study, it was observed that the pain level was reduced and the quality of life was improved in all groups (p&amp;lt;0.05). When DMG and DBG were compared with the control group, there was found a significant difference among groups in terms of reducing pain and improving quality of life in favor of DMG and DBG (p&amp;lt;0.05). When DMG and DBG were compared, no statistically significant difference was found between the groups (p&amp;gt;0.05). Conclusion: The study results demonstrated that diaphragmatic mobilization and diaphragmatic breathing exercises are found to be effective in reducing pain and improving quality of life in individuals with shoulder pain.

Effect of Aerobic Exercise on Fatigue and Quality of Life in Individuals With Fibromyalgia: A Systematic Review of Randomized Controlled Trials.

Gelotophobia can be defined as the fear of being laughed at or ridiculed. The aim of the current literature review is to present a synthesis of the literature on gelotophobia and the link between high-functioning autism spectrum disorder (hfASD) and gelotophobia. It will also give an overview of the literature regarding the variables hypothesised to be affected by the presence of gelotophobic symptoms in individuals with hfASD, namely social functioning, perceived social support and overall quality of life. Topics explored are defining the characteristics of gelotophobia, conceptualisation and measurement implications of gelotophobia, the aetiology and consequences of gelotophobia, analysing the social competence of gelotophobes and assessing the literature on the presence of gelotophobia in a hfASD sample. The characteristics of hfASD will be discussed. Research on hfASD and its relationship with other variables is also investigated, including comorbid psychopathology, perceived social support, social functioning, shame-bound emotions and overall quality of life. The current review will place an emphasis on research conducted on an adult population of individuals with hfASD. Given the limited research in the area, more research is needed to better understand the relationship between gelotophobia and bullying, social functioning, perceived social support, comorbid psychopathology and quality of life in individuals with hfASD. In conclusion, experts in the area of gelotophobia need to expand their research to include individuals with hfASD, and autism researchers need to be aware of gelotophobia and to incorporate gelotophobia as a potential comorbidity into their research.

BackgroundChronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL.MethodIndividuals with symptoms of ankle pain and stiffness (symptomatic individuals) and controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history.ResultsA total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm− 2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD > 1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2 = 0.66, p = 0.001).ConclusionIndividuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.