The relationship between the severity of asthma and comorbidites with anxiety and depressive disorders

Abstract

The relationship between the severity of asthma and comorbidites with anxiety and depressive disorders Relação entre a gravidade da asma e comorbidade com transtornos de ansiedade e depressão A b s t r a c t Objective: There is evidence that asthma is associated with increased frequency of psychiatric symptoms and mental disorders. Our aim was to assess the frequency of anxiety and depressive disorders in a sample of asthmatic outpatients and observe if there is any relationship between this comorbidity and the severity of asthma. Method: Sixty-two consecutive patients of two outpatient asthma clinics located in university hospitals were evaluated. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview 4.4 Version. Results: Twenty-seven patients (43.5%) met criteria for at least one psychiatric diagnosis. The most frequent diagnoses were major depression (24%), generalized anxiety disorder (20.9%) and panic disorder/agoraphobia spectrum disorders (17.7%). We found no significant differences in the prevalence of anxiety disorders and depression between the groups with mild/ moderate and severe asthma. Despite the high frequency of depression and anxiety disorders, only 4 (6.5%) patients were under psychiatric treatment and 13 (20.9%) patients were taking benzodiazepines. Twelve of 15 (80%) patients who reported present use of psychotropic medication were not under psychiatric treatment at the moment of the study. Conclusions: Our results support the high morbidity of anxiety and depressive disorders in asthmatic patients, independent of the severity of asthma. Keywords: Respiratory tract diseases; Respiratory insufficiency; Pulmonary disease (Specialty); Anxiety; Panic disorderResumo Objetivo: Existem evidências de que a asma está associada a um aumento da presença de sintomas psiquiátricos e de transtornos mentais. O objetivo do presente estudo é o de averiguar a freqüência de transtornos de ansiedade e depressão em uma amostra de pacientes asmáticos ambulatoriais e observar se há relação deste tipo de comorbidade com a gravidade da asma. Método: Sessenta e dois pacientes consecutivos de dois ambulatórios universitários especializados em asma foram examinados. Os diagnósticos psiquiátricos foram obtidos em entrevista com a utilização do Mini-International Neuropsychiatric Interview 4.4 Version. Resultados: Vinte e sete (43,5%) pacientes preencheram os critérios para ao menos um diagnóstico psiquiátrico. Os diagnósticos mais freqüentes foram depressão maior (24,0%), transtorno de ansiedade generalizada (20,9%) e transtornos do espectro pânico/agorafobia (17,7%). Não encontramos diferenças significativas na prevalência de transtornos de ansiedade e depressão entre os grupos com asma leve/moderada e com asma grave. Apesar da alta freqüência de depressão e transtornos de ansiedade, apenas 4 (6,5%) pacientes estavam em tratamento psiquiátrico e 13 (20,9%) estavam usando benzodiazepínicos. Doze dos 15 (80,0%) pacientes em uso de medicação psicotrópica não estavam em tratamento psiqu...

Anxiety and the management of asthma in an adult outpatient population

“…Anxiety itself may lead to hyperventilation, irrespective of the degree of objective pulmonary impairment, and in the presence of some form of airways obstruction, it may result in increased breathlessness [Carr, 1998]. As in the general population, the majority of the patients with clinically significant anxiety (79%) were undiagnosed and untreated, a finding also supported by other studies [Valenca et al 2006;Goodwin, 2003]. Various barriers have been cited with regards to the diagnosis and treatment of anxiety, such as the stigma perceived by patients, who would tend to exaggerate their somatic complaints, to health care professionals lacking interest and time to make the appropriate diagnosis [Kunik et al 2005].…”

“…Higher rates of asthma were found among adolescent psychiatric inpatients with post-traumatic stress disorder (PTSD) [Koltek et al 1998] and similar findings were reported in primary care patients [Weisberg et al 2002]. The association between asthma and anxiety appears to exist independently of the degree of severity of asthma [Valenca et al 2006;Brinke et al 2001].…”

Lifelong Opioidergic Vulnerability Through Early Life Separation: A Recent Extension of the False Suffocation Alarm Theory of Panic Disorder

“…Further, panic, in this group, was frequently precipitated by bereavement, or separation [...] (Preter and Klein, 2008). This was also noted by others, e.g., Faravelli and Pallanti (1989), Kaunonen et al (2000), Milrod et al 2004. We noted that "[p]atients highly comorbid for multiple anxiety disorders are particularly likely to recall childhood SAD (Lipsitz et al, 1994)", and that " [c]laims that separation anxiety equivalently antecedes other anxious states (Van der Molen et al, 1989) may be due to diagnostically ambiguous limited symptom attacks and the unreliability of the questionnaire method". We concluded that "in the only controlled, long-term, direct, blind, clinical interview follow-up of separation-anxious, school-phobic children, the only significant finding was an increased PD rate" (Preter and Klein, 2008) .…”

Tracheal occlusion modulates the gene expression profile of the medial thalamus in anesthetized rats

“…Of 62 asthmatic patients from an outpatient clinic in Brazil, 24.1% had major depression disorder and 33.8% had an anxiety disorder as diagnosed by the Mini-International Neuropsychiatric Interview (51). However, there was no association between the severity of asthma and the prevalence of anxiety and depression (51). In a study on Veteran's Affairs patients with chronic breathing disorders, 50.1% showed moderate to severe depression, and 64.2% had moderate to severe anxiety symptoms (38).…”

“…Airway obstruction in disease and association with anxiety and depression. Asthma is a respiratory disease characterized by reversible airways obstruction, airway inflammation, and hyperreactive airways (51). Our animal model of reversible tracheal obstructions, ITTO, thus mimics one component of asthma.…”