Predictors of anxiety recurrence in the Coordinated Anxiety Learning and Management (CALM) trial

Abstract

Few studies have examined anxiety recurrence after symptom remission in the primary care setting. We examined anxiety recurrence in the Coordinated Anxiety Learning and Management (CALM) trial. From 2006-2009, CALM randomized adults with anxiety disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder) in primary care clinics to usual care (UC) or a collaborative care (CC) intervention of pharmacotherapy and/or cognitive behavioral therapy. We examined 274 patients who met criteria for anxiety remission (Brief Symptom Inventory for anxiety and somatization (BSI-12) < 6) after 6 months of randomized treatment and completed a follow-up of 18 months. Logistic regression and receiver operating characteristics (ROC) were used to identify predictors of anxiety recurrence (BSI-12 ≥ 6 and 50% increase from 6-month ratings) during the year following remission. Recurrence was lower in CC (29%) compared to UC (41%) (p = 0.04). Patients with comorbid depression or lower self-perceived socioeconomic status particularly benefited (in terms of reduced recurrence) if assigned to CC instead of UC. In the multivariable logistic regression model, smoking, being single, Anxiety Sensitivity Index score, functional impairment at month 6 due to residual anxiety (measured with the Sheehan Disability Scale), and treatment with benzodiazepines were associated with subsequent anxiety recurrence. ROC identified prognostic subgroups based on the risk of recurrence. Our study was exploratory, and our findings require replication. Future studies should also examine the effectiveness of relapse prevention programs in patients at highest risk for recurrence.

Ketamine Effects on EEG during Therapy of Treatment-Resistant Generalized Anxiety and Social Anxiety

“…SAD, in particular, has high economic burden, because it causes social impairment, poor academic achievement, reduced work productivity, and increased financial dependence on the government ( Lipsitz and Schneier, 2000 ). Conventional treatments can take weeks to produce their full effects and, worse, one-third of SAD patients are treatment resistant ( Kelly et al, 2015 ; Taylor et al, 2015 , 2018 ), which increases outpatient costs, doubles hospitalizations, and produces substantial morbidity ( Liebowitz et al, 2003 ). We urgently need novel pharmaceutical agents that are both more effective and act quickly ( Liebowitz et al, 2003 ; Taylor et al, 2018 ).…”

Where There is Smoke There is Fear—Impaired Contextual Inhibition of Conditioned Fear in Smokers

“…In patients suffering from post-traumatic stress disorder (PTSD), the odds-ratio for smoking is between 2 and 4 (Fu et al, 2007) and related to symptom severity in high-risk groups, such as combat veterans (Kirby et al, 2008). Moreover, smoking compromises therapeutic efficiency and enhances relapse risk in PTSD and anxiety disorders after treatment (Taylor et al, 2015). Although several studies observed associations between smoking and categorical diagnoses of PTSD (Breslau et al, 2004;Fu et al, 2007) and other anxietyrelated disorders (Isensee et al, 2003;Lasser et al, 2000), it is unclear if associations between smoking and basic dimensional phenotypes of fear exist.…”

Predictors and Moderators of Antipsychotic-Related Weight Gain in the Treatment of Early-Onset Schizophrenia Spectrum Disorders Study

“…ANCOVA analysis, the interaction term was removed from the ANCOVA and regression model. The significance threshold was two-tailed p < 0.05 for all analyses, and we did not correct for multiple comparisons to minimize Type II Error (false negatives), similar to prior studies (Taylor et al 2015(Taylor et al , 2018. We prioritized minimizing Type II Error so that if previously identified predictors were not significant in this analysis, our negative findings would have increased validity.…”

“…The same procedure is repeated systematically in each subsample. Like other investigations using ROC, our methods were determined a priori (Taylor et al 2015(Taylor et al , 2018Gabriel et al 2017). Table 1 displays a list of pretreatment participant clinical variables and demographics for the 69 treatment completers with weight assessments.…”