Mind-Body Therapies May Reduce Anxiety in Teens

Anxiety affects approximately one in three American teens, with more than eight percent experiencing severe impairment in daily functioning. But according to a new review published in The Nurse Practitioner, mind-body therapies, such as mindfulness, yoga and hypnosis, can play a vital role in reducing the very common problem of adolescent anxiety.

“Mind-body therapies encompass self-regulation and positive thinking…to help promote self-control, physical health, and emotional well-being,” write Bernadette Fulweiler RN, MSN, CPNP-PC, and Rita Marie John DNP, EdD, CPNP-PC, DCC, of Columbia University School of Nursing, New York.

“A growing body of evidence supports the implementation of mind-body therapy as a low-risk and cost-effective strategy in the management of anxious teenagers.”

The researchers also emphasize the role of pediatric nurse practitioners (NPs) in integrating screening and treatment for adolescents with anxiety. NPs can screen young patients for anxiety at every health visit and help create a personalized plan to treat it.

And while NPs are often highly supportive of alternative medicine practices, they need ongoing education regarding the benefits and methods of integrating mind-body medicine into patient care, according to the researchers.

“Whereas anxiety and fear are typical reactions to the academic, social, and developmental challenges common during the adolescent years, clinical or pathological anxiety is excessive, persistent, and disruptive,” according to the authors.

So while anxiety is often situational and temporary, many teens develop chronic anxiety lasting six months or longer.

But the recommended treatments for adolescent anxiety — cognitive behavioral therapy and/or antidepressant medications — have important limitations. They are expensive, often difficult to obtain, and in the case of antidepressants, can have side effects. In fact, research shows that most teens with mental health disorders, especially anxiety, do not receive any form of mental health care.

For the study, the researchers reviewed and analyzed published research on mind-body therapy for anxiety in teens, focusing on four approaches: mindfulness, yoga, hypnosis and biofeedback.

Mindfulness techniques involve aspects of meditation, body scanning, and mindful breathing to help focus attention on the present moment and separate from negative thoughts. Six studies showed positive effects of mindfulness approaches for teens with anxiety, including school-based programs in high-risk populations.

Yoga is one of the most popular mind-body therapies, with positive physical and mental effects including reduced anxiety. The researchers cite five studies, including four randomized trials, reporting positive effects of yoga in school settings.

Hypnosis involves using imagery and relaxation techniques to help control stress responses. The review identified three studies of hypnosis techniques to lower stress in adolescents, including a tele-hypnosis intervention to reduce anxiety-related absences in high school students.

Biofeedback involves becoming mindful of your body’s involuntary reactions (such as the feeling of anxiety arising in the body) through electrodes attached to the skin. Then through the power of your mind, you can gain more control over such reactions. The review identified four studies of biofeedback approaches, showing significant reductions in anxiety and stress in teens receiving heart-rate variability (HRV) monitoring and video game-based biofeedback.

The researchers conclude by saying that mind-body therapies can help to meet the “dire need” for affordable and accessible mental health strategies in pediatric primary care.

Source: Wolters Kluwer Health

Depression, Anxiety Tied to Worse Outcomes in Heart Failure Patients

Heart failure patients who suffer from depression and anxiety are at greater risk of progressive heart disease and other adverse outcomes, according to a new study published in the Harvard Review of Psychiatry. In addition, healthy individuals with depression are more likely to develop heart failure.

Heart failure is a chronic, progressive condition in which the heart can’t pump enough blood, leading to symptoms such as fatigue and shortness of breath. This condition affects more than five million Americans and leads to death within five years in about 50 percent of patients.

Although symptoms of depression and anxiety are present in about one-third of patients with heart failure, these mental health disorders remain underrecognized and undertreated in heart patients, say the researchers.

“Diagnosing a psychiatric illness can be challenging in view of the significant overlap” between psychiatric symptoms and those related to heart failure, said Christopher Celano, M.D., of Massachusetts General Hospital. Nevertheless, “making the effort can help to identify those who are at higher risk for poor cardiac outcomes and to implement the treatment of these disorders.”

Earlier studies have linked psychiatric disorders to worse outcomes in patients with heart failure. To clarify these associations, Celano and colleagues performed a targeted review of research on the links between heart failure, depression, and anxiety.

Their findings confirm “markedly higher” rates of depression and anxiety disorders among patients with heart failure, compared to the general population. Research has shown that one-third of heart failure patients report elevated symptoms of depression on standard questionnaires, while 19 percent meet diagnostic criteria for major depression or other depressive disorders.

“Depression has been linked to the development and progression of heart failure and other cardiovascular diseases,” write the researchers. Studies suggest not only that heart failure patients with depression are at increased risk of death or cardiac events, but also that otherwise healthy adults with depression are more likely to develop heart failure.

The prevalence of anxiety is also high among heart failure patients: nearly 30 percent of patients have clinically significant anxiety symptoms, while 13 percent meet diagnostic criteria for anxiety disorders (such as generalized anxiety disorder, posttraumatic stress disorder, or panic disorder). Some studies have associated anxiety with adverse heart failure outcomes, although the evidence is less consistent than for depression.

Both physiological and behavioral factors may contribute to poorer outcomes. Depression and anxiety may make it more difficult for patients with heart failure to follow recommendations for diet, exercise, and medication use. Studies have also linked depression to metabolic changes, including greater levels of inflammatory markers.

The researchers believe that formal diagnostic interviews can help in assessing the cause of overlapping symptoms between heart failure and depression or anxiety, such as problems with sleep, concentration, or energy.

For treatment of depression and anxiety in heart failure patients, psychotherapy may offer advantages over medications. In fact, cognitive-behavioral therapy is the only type of psychotherapy specifically shown to be effective in heart failure patients.

Despite a lack of specific evidence for their effectiveness in patients with heart failure, antidepressants such as selective serotonin reuptake inhibitors are often recommended, with close monitoring, given their known beneficial effects when treating depression and anxiety in other populations.

The researchers emphasize the need for further research on effective treatments for the large group of patients with heart failure complicated by depression and anxiety.

Source: Wolters Kluwer Health

Chronic Dizziness May Be Tied to Psychiatric Disorder

Chronic Dizziness May Be Tied to Psychiatric Disorder

Chronic Dizziness May be Tied to a Psychiatric Disorder

Some cases of chronic dizziness may be tied to a psychiatric disorder, according to a new study published in The Journal of the American Osteopathic Association. The cause-and effect relationship can go both ways, with a psychiatric disorder triggering dizziness or vice versa.

The researchers looked over published studies focusing on the link between mental disorders and dizziness. They found that psychiatric disorders (primarily anxiety-related conditions) may be present in up to 15 percent of patients experiencing dizziness.

In general, chronic dizziness can result from a variety of underlying health problems, most commonly involving neurologic, vestibular and cardiac diseases. For sufferers who have been to several specialty physicians without ever receiving a diagnosis, however, a psychiatric referral may help them find relief, researchers said.

In fact, psychiatric disorders appear to be the second most common cause of chronic dizziness. The first is vestibular disease, which affect parts of the inner ear and brain responsible for controlling balance.

“One of the reasons the underlying cause can be so difficult to diagnose is that the way dizziness is experienced can vary dramatically,” said Zak Kelm, D.O., psychiatry resident at Ohio State University and lead author of this study.

Dizziness can fall into a number of broad categories, including vertigo (spinning sensation), presyncope (near-fainting), and disequilibrium (imbalance). When a patient’s description of symptoms appears consistent with one of these categories, doctors are better able to make an accurate diagnosis.

“Patients who have a difficult time describing their symptoms, or seem to experience several different symptoms, are likely experiencing non-specific dizziness,” Kelm said. “When physicians see patients who report general or vague dizziness, it should be a cue to ask about the patient’s mental health.”

The link between dizziness and psychiatric disorders is complex. It is often quite difficult to determine which one is causing the other or whether the interplay is reciprocal.

In an attempt to better understand this relationship, researchers have introduced the term chronic subjective dizziness (CSD). This is a condition in which patients experience dizziness most days for more than three months.

People with CSD often describe feeling heavy-headed, light-headed or imbalanced. Some feel as if the floor is moving, while others feel disassociated or far away from their environment. Many say their symptoms worsen with complex stimuli, such as being in a crowded space.

In one of the studies, one-third of patients with CSD had a primary anxiety disorder and no history of vestibular disorder or another disease that could cause dizziness. Another one-third had no history of a psychiatric disorder but had a vestibular disease that triggered an onset of anxiety.

The last one-third had a history of an anxiety or other psychiatric disorder, then developed a medical condition that triggered dizziness. In those cases, the pre-existing psychiatric disorder had become worse and resulted in chronic dizziness.

In any of these cases, it is important that the underlying or resulting psychiatric disorder is addressed.

“One of the reasons psychiatric disorders are overlooked is because many physicians are uncomfortable suggesting to patients that they might have a mental illness,” Kelm said.

“I think asking the patient about their stress levels and whether they’ve experienced anxiety can make the conversation more approachable for both parties.”

Once referred to a psychiatrist, some patients find success with cognitive-behavioral therapy (CBT); however, pharmacotherapy appears to be most helpful. Selective serotonin reuptake inhibitors (SSRIs) have proven effective, with approximately 50 percent of patients given an SSRI experiencing complete remission of symptoms, and 70 percent reporting a significant decrease in symptoms.

The authors note that a whole-person treatment approach — taking into account the patient’s mental and emotional health as well as their physical health — can help physicians get to the root of the problem more quickly.

Source: American Osteopathic Association