Relationship between two anxiety instruments in patients receiving mechanical ventilatory support

Serotonergic antidepressants are first-line medication therapies for obsessive-compulsive disorder, however it is not known if synaptic serotonin availability is important for selective serotonin reuptake inhibitor efficacy. The present study tested the hypothesis that temporary reduction in central serotonin transmission, through acute tryptophan depletion, would result in an increase in anxiety in selective serotonin reuptake inhibitor-remitted obsessive-compulsive disorder patients. Eight patients (four males) with obsessive-compulsive disorder who showed sustained clinical improvement with selective serotonin reuptake inhibitor treatment underwent acute tryptophan depletion in a randomized, double-blind, placebo-controlled, within-subjects design, over two days one week apart. Five hours after consumption of the depleting/sham drink the participants performed a personalized obsessive-compulsive disorder symptom exposure task. Psychological responses were measured using the Spielberger State Anxiety Inventory, Yale-Brown Obsessive Compulsive Scale and Visual Analogue Scales. Free plasma tryptophan to large neutral amino acid ratio decreased by 93% on the depletion day and decreased by 1% on the sham day, as anticipated. Psychological rating scores as measured by Visual Analogue Scale showed a significant decrease in perceived control and increase in interfering thoughts at the time of provocation on the depletion day but not on the sham day. A measure of convergent validity, namely Visual Analogue Scale Similar to past, was significantly higher at the time of provocation on both the depletion and sham days. Both the depletion and time of provocation scores for Visual Analogue Scale Anxiety, Spielberger State Anxiety Inventory, Yale-Brown Obsessive Compulsive Scale and blood pressure were not significant. Acute tryptophan depletion caused a significant decrease in perceived control and increase in interfering thoughts at the time of provocation. Acute tryptophan depletion had no effect on the Spielberger State Anxiety Inventory or Visual Analogue Scale Anxiety measures, which suggests that the mechanism of action of selective serotonin reuptake inhibitors may be different to that seen in panic, social anxiety and post-traumatic stress disorder. Successful selective serotonin reuptake inhibitor treatment of obsessive-compulsive disorder may involve the ability of serotonin to switch habitual responding to goal-directed behaviour.

Purpose: To evaluate the correlation between pain during cataract surgery and preoperative anxiety. Methods: This prospective observational masked study included 103 eyes of 103 consecutive patients who underwent routine clear corneal incision phacoemulsification surgery at the Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel. Patients were interviewed prior to surgery and 5 min following surgery by two separate independent interviewers. Anxiety level was measured by the Visual Analog Scale for Anxiety (VASA) and pain by the Visual Analog Scale (VAS). The main outcome measure was the maximum amount of pain endured during the procedure using VAS. Results: The mean participant age was 68.9 ± 8.9 years, and 46.6% were male. Severe anxiety (VASA ≥ 7) and pain (VAS ≥ 7) were documented in 18.5 and 17.5% of patients, respectively. There was a statistically significant positive correlation between VAS and VASA (r = 0.62, p < .001) as well as between VAS and duration of surgery (r = 0.20, p = .04). There was no association between VAS and all other investigated parameters in the univariate analysis. In backward regression analysis, VASA was the only parameter that was significantly associated with VAS (R2 = 36.61%, p < .001). Patients with severe anxiety were >10 times more likely to experience severe pain, and a VASA > 4 predicted severe pain with a sensitivity of 88.9% and a specificity of 69.4%. Conclusions: One-fifth of patients experienced severe anxiety and pain. Preoperative anxiety levels were the only significant predictor of pain. Reducing preoperative anxiety in cataract patients is warranted.

The purpose of this single-blinded randomized clinical trial was to determine whether therapeutic touch (TT) versus sham TT could produce greater pain relief as an adjunct to narcotic analgesia, a greater reduction in anxiety, and alterations in plasma T-lymphocyte concentrations among burn patients. Therapeutic touch is an intervention in which human energies are therapeutically manipulated, a practice conceptually supported by Rogers' (1970) theory of unitary human beings. Data were collected at a university burn centre in the south-eastern United States. The subjects were 99 men and women between the ages of 15 and 68 hospitalized for severe burns, and they received either TT or sham TT once a day for 5 days. Baseline data were collected on day 1, data were collected before and after treatment on day 3, and post-intervention data were collected on day 6. Instruments included the McGill Pain Questionnaire, Visual Analogue Scales for Pain, Anxiety and Satisfaction with Therapy, and an Effectiveness of Therapy Form. Blood was drawn on days 1 and 6 for lymphocyte subset analysis. Medication usage for pain in mean morphine equivalents, and mean doses per day of sleep, anxiety and antidepressant medications were recorded. Subjects who received TT reported significantly greater reduction in pain on the McGill Pain Questionnaire Pain Rating Index and Number of Words Chosen and greater reduction in anxiety on the Visual Analogue Scale for Anxiety than did those who received sham TT. Lymphocyte subset analyses on blood from 11 subjects showed a decreasing total CD8 + lymphocyte concentration for the TT group. There was no statistically significant difference between groups on medication usage.

Preoperative anxiety, which can affect postoperative recovery, is often present in patients undergoing surgery under loco-regional anaesthesia (LRA). Minimising preoperative anxiety with premedication can be effective but results in drug-related side effects. Therefore, the use of non-pharmacological techniques should be encouraged. We evaluated whether a virtual reality (VR) incorporating music and a hypnosis session, provided during the performance of LRA, can reduce preoperative anxiety. Fifty patients scheduled for elective hand surgery under an axillary plexus block were enrolled (March-June 2019). The primary outcome measure was the change in the Amsterdam Anxiety and Preoperative Information Scale (APAIS) questionnaire 5min after the VR session as compared to before the VR session. The secondary outcome measures were the visual analog scale (VAS) for anxiety before and 2h after the surgery and the Evaluation du Vécu de l'ANesthésie-LocoRégionale (EVAN-LR) satisfaction score. Data from 48 patients were analysed. The APAIS score as well as VAS for anxiety were significantly reduced after a VR session (p<.001 for both scores). Patients were very satisfied (EVAN-LR: 92 (88, 94)). The use of VR incorporating music and a hypnosis session could be an effective tool in the management of a patient's preoperative anxiety during the performance of an axillary plexus block.

Women with breast cancer are prone to moderate to severe preoperative anxiety. Effective measures for preventing and managing preoperative anxiety include drug therapy and non-drug intervention. The main evaluation method is scale assessment, which has certain limitations and may involve human concealment or evaluation errors. In this study, resting-state electroencephalography (EEG) was used to explore changes in power spectrum during the alleviation of preoperative anxiety in breast cancer patients, which is of great significance for objectively identifying and evaluating preoperative anxiety in patients. 40 breast cancer patients were randomly divided into two groups (20 patients per group), receiving either psychological intervention (PI) or intravenous midazolam (MID) before surgery. Visual Analog Scale for Anxiety (VAS-A) and Observer's assessment alert/Sedation (OAA/S) scores, clinical monitoring indexes and EEG data were measured before and after intervention. VAS-A scores significantly decreased in both groups (p < 0.05), the power in the theta band of the frontal parietal regions decreased (p < 0.05) and was positively correlated with VAS-A scores (p < 0.001). Network analysis revealed that the three highest centrality measures in the PI group were located in the alpha band frontal parietal region, frontal central region, and gamma band parietal region, while the OAA/S scores showed the highest centrality for all three measures in the MID group. Both PI and intravenous MID can effectively alleviate preoperative anxiety in breast cancer patients, but their neuroelectrophysiological mechanisms were not entirely the same. Regarding the relationship between brain region power and monitoring indexes, the power of three specific regions in certain frequency bands was the primary factor in the PI group, while the level of sedation was the determining factor in the MID group.

Intradetrusor chemodenervation with onabotulinumtoxinA (BOTOX) injections, a common office-based procedure for overactive bladder (OAB), is associated with patient anxiety and discomfort. Aromatherapy and music have been shown to decrease procedure-related anxiety and pain with improved satisfaction. The objectives of this study were to determine whether a relaxing environment consisting of lavender aromatherapy, calming music, and dim lighting compared with a typical office environment decreases patients' anxiety level before undergoing intradetrusor chemodenervation. We hypothesized that a relaxing environment would decrease patients' anxiety level before the procedure as measured by the Visual Analog Scale (VAS). Secondary outcomes included the VAS for pain, satisfaction, and staff energy level. This was a single-center randomized trial of women receiving office intradetrusor chemodenervation for overactive bladder. Participants were randomized to receive their procedures in a relaxing versus typical office environment. Eighty patients were needed to detect a clinically significant 12mm difference on the anxiety VAS. Staff completed a preclinic and postclinic Burnout Battery VAS to measure change in their energy level during the day. Patients in the relaxing environment reported a clinically significant reduction in anxiety (-13.8 ± 18.1 vs -4.7 ± 14.7, P = 0.015). Pain was lower for the relaxing environment group, although it did not reach statistical significance (21.9 vs 28.9, P = 0.261). Satisfaction scores were high in both groups (91.4 vs 89.3, P = 0.599) and not significantly different. The procedure room environment did not affect staff energy levels. A relaxing environment of lavender aromatherapy, calming music, and dim lighting is a noninvasive, easily implemented technique to decrease patients' anxiety before office intradetrusor chemodenervation.

This study aimed to investigate patients' expectative pain of spinal anesthesia puncture and anxiety pre-anesthesia, and to examine the effect of lidocaine-prilocaine cream and remimazolam prior to spinal anesthesia puncture on pain relief and anxiety release. Patients undergoing spinal anesthesia were divided into control, lidocaine-prilocaine cream, and lidocaine-prilocaine cream with remimazolam groups. A questionnaire consisting of The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and patient's concerns and Visual Analog Scale (VAS) was used to evaluate patient's anxiety and pain. The primary outcomes were differences in VAS and anxiety scores. Patient's spinal anesthesia-related concerns, advent events and hemodynamic index were also recorded. The expected spinal anesthesia puncture pain was 5.34±0.27 and anxiety scores before spinal anesthesia was 10.88 ± 0.64. A statistically significant positive correlation of 31.3% was detected between VAS and APAIS scores (r = 0.313; P=0.003). The VAS score at the time of puncture decreased by 29.7% (3.78±0.40, P=0.001) in lidocaine-prilocaine cream group and 29.2% (3.75±0.39, P=0.001) in lidocaine-prilocaine cream with remimazolam group compared with the expected VAS score. Lidocaine-prilocaine cream combined with or without remimazolam reduced the percentage of moderate pain (21.4% and 31.3% vs 50.0%, P=0.0001) and increased mild pain (60.7% vs 59.4% vs 22.7%, P=0.03). Anxiety score in lidocaine-prilocaine cream group was reduced by 2.84 (8.04±0.76 vs 10.88 ± 0.46, P=0.05) when compared with pre-anesthesia. Concerns about postoperative pain (P=0.03) and fear of the needle or intervention (P=0.000) both decreased post-anesthesia among groups. Approximately half of the patients scheduled for spinal anesthesia experienced a moderate level of preoperative anxiety. The patient's pain expectation from the spinal anesthesia puncture was moderate, which was higher than the actual pain. Lidocaine-prilocaine cream with or without remimazolam sedative before spinal anesthesia puncture reduced the patient's pain and anxiety scores after surgery.

The Effect of Music Therapy on Pain, Anxiety, Agitation and Sedation in Cardiac Intensive Care Patients: Randomized Controlled Study.

BackgroundAnxiety among patients undergoing joint replacement increases the risk of post-surgery complications and mental health problems, and impairs health-related quality of life (HRQoL). Since clinical procedures require adequate, but possibly simple and cost-saving tools, an augmenting application of a one-item visual analogue scale for anxiety (VAS-A) has been observed. The purpose of the present study is to validate the VAS-A using the State-Trait Anxiety Inventory (STAI) and consider both as HRQoL predictors among patients waiting for total joint replacement.Participants and procedurePatients (n = 68, 34% male), hospitalized for total hip or knee replacement, participated before surgery in this cross-sectional study. They completed the Nottingham Health Profile (NHP) to assess their HRQoL, the VAS-A and STAI for anxiety, and the Visual Analogue Scale for pain as a control variable.ResultsAlthough the VAS-A correlated with the STAI score (r = .29, p = .019 for the state anxiety subscale), this conven-ient measure did not relate to the NHP results (NHP total score β = –0.03, p = .799), while the STAI results did, especially the trait subscale (β = 1.29, p &lt; .001, CI 0.82 to 1.75).ConclusionsThe value of the VAS-A regarding HRQoL is limited while trait anxiety seems a disregarded factor significantly referring to HRQoL. Its assessment, in addition to the evaluation of temporary emotional states, might provide benefits in the clinical management of patients within surgery, orthopedic and rehabilitation care. Intervention possibilities for those with altered trait anxiety are discussed.

Preoperative anxiety is a challenging concept in the preoperative care of patients. The hypothesis of this study was that the doctors are able to estimate their patients' preoperative anxiety. A prospective clinical trial was performed on 67 adult patients and 26 paired anaesthetists and surgeons. The patients filled out two separate visual analogue scales for anxiety for the planned anaesthesia and surgery. After that the 'anxiety subscale' of the Hospital Anxiety and Depression's Scale was completed and a list of fearsome items was presented as the patients were asked to choose two conditions they considered the most frightening. Finally the patients were asked to select one or more items from a list of things, which they considered likely to relieve their preoperative anxiety. Similarly, the participating doctors were asked to estimate their patients' anxiety, guess their fearful conditions and their anxiety-relieving requests. Median scores for anxiety as estimated with visual analogue scales by anaesthetists, surgeons and patients for anaesthesia were 34, 36 and 6, respectively; and for surgery 53, 47 and 9, respectively. The anxiety subscale of the Hospital Anxiety and Depression's Scale 8.9 +/- 4.2, 8.6 +/- 4.6 and 6.5 +/- 4.5 (mean +/- SD), respectively. Doctors' scores were significantly higher than the patients' scores (P < 0.05). Thus, the anaesthetists and the surgeons were unable to estimate their patients anxiety on any of the scales used (Kendall's tau < 0.25; P < 0.05). The proportion of correct estimation of the fearsome items was 20% for both the anaesthetists and the surgeons. Both anaesthetists and surgeons overestimated their patients' preoperative anxiety by a wide margin and poorly predicted their patients' feared conditions and their desire for relief of anxiety.

Background: Management of preoperative anxiety in surgical patients is usually required for better perioperative hemodynamics and patient management. Various pharmacological and nonpharmacological entities have been used for the management of anxiety. The aim of this study was to analyze the effect of oral melatonin on patient anxiety scores and dose requirement of propofol using bispectral index (BIS)-guided induction of general anesthesia. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical Status I and II between 18 and 45 years of age scheduled to undergo elective surgery of more than 30 min participated in this study. Patients were divided into control and melatonin groups, comprising 30 patients each. Group M patients received two melatonin tablets (3 mg each) and Group C patients received two placebo tablets 120 min before induction. Anxiety scores using visual analog scale-anxiety at baseline and 120 min, mean dose requirement of propofol, time to attain BIS value of 55 in seconds, and hemodynamic parameters were studied in-between the groups. Results: There were significant differences between two groups in anxiety scores 120 min after drug dosage (P = 0.0013) with Group M patients with reduced levels of anxiety, and mean requirement of propofol in Group C (104.67 ± 16.34 mg) was found to be statistically significantly higher than Group M (70.67 ± 16.39 mg), P Conclusion: 6 mg of melatonin 120 min before elective surgery can allay anxiety in patients along with reduced dose requirement for propofol for BIS-guided induction of general anesthesia without any adverse effects.

Effect of video-assisted information prior to intratympanic steroid injection on patient anxiety.

Background: Preoperative anxiety is a common challenge that can negatively impact surgical outcomes and patient well-being. Physiological symptoms of anxiety, such as increased heart rate, blood pressure, and sweating, highlight the need for effective management strategies. Murottal therapy, which involves listening to Qur'anic recitations, offers a non-pharmacological method for anxiety reduction. Purpose: Evaluate murottal therapy’s effectiveness in reducing preoperative anxiety. Methods: A cohort of 30 patients scheduled for spinal anesthesia was recruited for this community service initiative. Anxiety levels were measured using the Visual Analog Scale for Anxiety (VAS-A) before and after the intervention. Participants underwent murottal therapy, which involved listening to Qur'anic recitations for a designated period. Pre- and post-therapy anxiety levels were compared to evaluate the effectiveness of the intervention. Findings: Prior to murottal therapy, 60% of participants exhibited severe anxiety, and 40% had moderate anxiety. Post-therapy results showed a significant improvement: 90% of participants reported moderate anxiety, 6.7% continued to experience severe anxiety, and 3.3% reported mild anxiety. Additionally, a pocket book detailing the murottal therapy procedure was developed as a resource for implementation. Conclusions: Murottal therapy significantly reduced anxiety levels among preoperative patients, demonstrating its potential as an effective, non-invasive approach to anxiety management in surgical settings.

Discussing defaecating disorders is difficult for patients and many view anal physiology investigations (ultrasound, manometry, electromyography and pudendal nerve studies) as distasteful. This pilot study sought to assess whether present information sheets supplied to patients and the visit to the colorectal Pelvic Floor Clinic itself influenced patients' knowledge and anxiety. Thirty Pelvic Floor Clinic patients from Auckland City Hospital were included. Each patient filled in a questionnaire before and after the clinic. This included objective questions about their knowledge of the structure and function of the pelvic floor and satisfaction with and understanding of the information sheet. Both visual analogue scale (VAS) and multiple choice questions (MCQ) were used. Their subjective and objective knowledge were compared. Anxiety was assessed on a visual analogue anxiety scale (VAAS). Results were expressed as VAS scores or percentage correct and relationships were tested using Fisher's Exact test and paired T-test. Subjective knowledge increased in 93% of the patients. The doctor's explanation led to a greater increase in subjective knowledge than the information sheet (35/100 mm, P<0.001 and 10/100 mm, P=0.01, respectively). Subjective improvement in knowledge did not however, translate into an increase in objective knowledge (P=0.63). The information sheet was read by 87% of the patients. The information sheet had reduced anxiety only in 23% of the patients and increased in 10%. Anxiety levels were not significantly influenced by the information sheet, but reduced significantly by the clinic visit in 87% of patients (P<0.001). The mean anxiety level reduced from 44/100 to 12/100 after the clinic visit. Anxiety levels are high in those visiting the Pelvic Floor Clinic. It appears that it is the interaction with the doctor that has a profound influence on anxiety levels and subjective knowledge rather than written information.

Patients undergoing colonoscopy often experience anxiety related to bowel preparation, procedural pain, and fear of cancer, which can adversely affect their vital signs. This study aimed to evaluate the effect of virtual reality intervention on anxiety and cardiac vital signs (including systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate) of patients before the colonoscopy procedure. This study was designed as a randomised, controlled, and double-blind trial. The sample of this study consisted of 70 patients undergoing colonoscopy in the endoscopy unit of the general surgery service of a public hospital. Patients were randomly assigned to the groups (intervention group or control group) and were evaluated twice before the colonoscopy procedure. Patients in the intervention group watched a relaxing video via virtual reality glasses for 15 min between the first and second evaluation stages. The Visual Analog Scale for Anxiety was used to evaluate the patients' anxiety levels before colonoscopy, while cardiac vital signs were evaluated using a digital sphygmomanometer. In the intervention group, anxiety level of the patients significantly decreased during the second evaluation stage compared to the control group (p < 0.001). Additionally, systolic blood pressure, diastolic blood pressure, and mean arterial pressure scores showed significant reductions in the intervention group at the same stage (p < 0.05). Although patients in the intervention group had lower heart rate scores at the second evaluation stage, there was no statistically significant difference between groups (p > 0.05). Virtual reality intervention has an improving effect on patients' systolic blood pressure, diastolic blood pressure, and mean arterial pressure. It is also effective in reducing patients' anxiety levels. Virtual reality intervention can be used as a distraction method before colonoscopy procedure. In this study, patients actively participated in the process of evaluating their anxiety levels and vital signs. ClinicalTrials.gov identifier: NCT06407531.