Article

Duration of untreated illness as a predictor of treatment response and clinical course in generalized anxiety disorder

Department of Psychiatry, University of Milan, Milan, Italy.
CNS spectrums (Impact Factor: 1.3). 05/2008; 13(5):415-22.
Source: PubMed

ABSTRACT The aim of the present study was to investigate the impact of the duration of untreated illness (DUI)-defined as the time elapsing between the onset of generalized anxiety disorder (GAD) and the first adequate pharmacologic treatment-on treatment response and clinical course in a sample of subjects with GAD.
One hundred patients with GAD, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria, were enrolled and their main demographic and clinical features collected. Patients were then treated with selective serotonin reuptake inhibitors or venlafaxine for 8 weeks in open-label conditions. Treatment response and other clinical variables were analyzed after dividing the sample into two groups according to DUI (DUI <or=12 months and DUI >12 months).
When the DUI was computed with respect to the first antidepressant treatment (DUI-AD), a higher improvement (Clinical Global Impressions-Severity of Illness scale) after the pharmacologic treatment was found in the group with a shorter DUI (analysis of variance with repeated measures: time effect F=654.975, P<.001; group effect: F=4.369, P=.039). When computed with respect to the first treatment with benzodiazepines (DUI-BDZ), the two groups did not show any significant difference in treatment response (time effect: F=652.183, P<.001; group effect: F=0.009, P=.924). In addition, patients with a longer DUI (DUI-BDZ or DUI-AD) showed an earlier age at onset, a longer duration of illness and a higher rate of comorbid psychiatric disorders with onset later than GAD.
Results from this preliminary study seem to suggest that a shorter DUI-AD may determine a better response to pharmacologic treatment in patients with GAD, and that a longer DUI (DUI-BDZ and DUI-AD) may be associated to a worse clinical course. Further investigation on the relationship between DUI and GAD is needed.

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    • "On the other hand, other studies showed the opposite. A longer duration of untreated GAD was associated to a worse clinical course [17]. Similarly, if PD is left untreated, patients could develop other psychiatric conditions (such as agoraphobia or depression), which may complicate PD outcome [18] [19]. "
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    ABSTRACT: The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors. An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed. GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased. GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.
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    • "He has accepted paid speaking engagements in from Bristol Myers, Eli Lilly, GSK, and Wyeth. Stefano initiating treatment is not ideal, as patients with a longer duration of untreated GAD (more than 12 months) have generally worse clinical outcomes and increased psychiatric co-morbidity, when compared to patients with a shorter duration of untreated illness (Altamura et al. 2008). Over 80% of respondents indicated that referred patients had undergone treatment with benzodiazepines before referral to secondary care services. "
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    ABSTRACT: Abstract Objective. To gain insight into the experience and practice of psychiatrists in the pharmacological management of patients with generalized anxiety disorder (GAD). Methods. Multiple-choice questionnaire completed by 501 psychiatrists (representing a 45% response rate) from 18 countries, selected by pharmaceutical company representatives to attend a scientific meeting, through having an interest in anxiety disorders. Results. Use of screening tools, routine structured diagnostic interviews, and practice guidelines was infrequent. Over one-third of patients did not receive their initial psychiatric consultation within a month after referral. A total of 45% of patients had symptoms for 2 years or longer before being diagnosed and treated. Most patients had been treated with benzodiazepines before referral. 80% of respondents always or often prescribed selective serotonin reuptake inhibitors (SSRIs), 43% serotonin-norepinephrine reuptake inhibitors (SNRIs), or pregabalin (35%) as first-line treatments. The most frequently recommended second-line treatments were SNRIs (41%) and pregabalin (36%). Concentration difficulties, fatigue, excessive worrying and pain were reported as the symptoms most difficult to manage. Conclusions. Patients with GAD have frequently been treated with benzodiazepines before referral to a psychiatrist. SSRIs were the preferred first-line treatment, and SNRIs and pregabalin preferred second-line treatments. Reported practice in this sample appears largely consistent with recent evidence-based treatment guidelines.
    The World Journal of Biological Psychiatry 11/2011; 13(7):510-6. DOI:10.3109/15622975.2011.624548 · 4.23 Impact Factor
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    • "I en studie av behandling av GAD fann man ett negativt samband mellan duration av symtom och behandlingsutfall (Angst & Vollrath, 1991). Vid farmakologisk behandling av GAD har man studerat hur tiden från debut av GAD till adekvat farmakologisk behandling påverkade utfallet (Altamura et al., 2008). Vid antidepressiv medicinering fann man att de med kortast duration av symtom fick ett bättre resultat. "
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