Cognitive impairment in anxiety disorders

Introduction Processing of emotional stimuli is altered in patients with depression. The present feasibility study investigated the features of emotional information recognition in people with depressive disorders and how these differ from individuals without depression to determine whether response times could potentially be used as a diagnostic marker to identify individuals at high risk of depression and as an indicator of antidepressant medication response. Methods The study recruited 32 individuals, 16 with single or recurrent depressive episodes and 16 control subjects without depression. Patients with depression received 8 weeks of antidepressant therapy. The severity of depressive symptoms at baseline and their changes on prescribed therapy were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). The processing of emotional information was assessed using the computerized Penn Emotion Recognition Task (ER-40). Results The two groups were well matched in terms of age and gender. There was no difference between the groups in their ability to correctly recognize happy or sad emotional facial expressions, but the average time patients with depression took to recognize a happy face was significantly longer than controls. In addition, they were more likely to misinterpret facial expressions as non-emotional. In patients with depression, the mean MADRS total score decreased from 26.3 ± 4.4 at baseline to 11.1 ± 8.9 at 8 weeks, a reduction of 57.8%. The proportion of responders with greater than 50% reduction in their baseline MADRS total score was 64.3%. Antidepressive treatment was associated with a reduction in the mean time required for recognition of a happy face (P < 0.05). Conclusions Patients with depression are slower to identify positive emotions but have a similar time to recognition of negative emotions as patients without depression. The greater time required for recognition of happiness distinguished the patients with depression from control subjects, and was also the only parameter that showed an improvement with antidepressant therapy, suggesting a specific relationship of this parameter with the depressive state.

Anxiety disorders are widespread in the population and in general medical practice and have a pronounced negative impact on the quality of life and functioning of patients. Currently, the prerequisites for the diagnosis and treatment of anxiety disorders outside the psychiatric network are accumulating by therapists, general practitioners and other non-psychiatric doctors. A review of the most significant factors contributing to a wider diagnosis and treatment of anxiety disorders in general medical practice is given. This review presents modern ideas about the pathogenesis of anxiety disorders, substantiates the modern idea of their multifactorial nature, the contribution of genetic and epigenetic, psychological and social factors, outlines the concepts of the neurobiological basis of pathological anxiety based on neuroimaging studies. In the future, information is provided on the general manifestations of anxiety disorders, the main clusters of anxiety, the systematics of anxiety disorders according to ICD-10. Modern ideas about the diagnosis of anxiety disorders using both scales and a clinical approach are given, a detailed review of currently available diagnostic scales validated for clinical practice is presented. The main approaches to conducting a clinical conversation are also presented, recommendations are given for the most successful collection of information about the clinical condition of patients. At the end of the review, information is given on existing approaches to psychopharmacotherapy and psychotherapy of anxiety disorders. Taking into account pharmacological and clinical studies, the place of drugs tofisopam (an atypical allosteric modulator of GABA receptors) and buspirone (a partial agonist of serotonin 1A receptors) in the treatment of anxiety disorders in general medical practice has been argued.

Background: Chronic obstructive pulmonary disease (COPD) is a widespread, late-diagnosed, and difficult-to-treat disease that influences the quality of life. Despite the availability of a wide range of drugs for the treatment of COPD, none of them provides a complete cure, while the leading risk factors (primarily, smoking) persist. In this regard, illness perception and medical behavior play a key role. Methods: The study design was cross-sectional and included 143 stable outpatients (107 men, mean age 66 ± 7.5, FEV1 51.5 ± 16.5%) who attended the faculty therapy clinic of Sechenov University. The patients were examined pulmonologically and psychiatrically (Hamilton depression and anxiety rating scales). Illness perception was assessed by a brief version of the Illness perception questionnaire (brief IPQ). Results: There were no significant demographic differences and differences in the clinical severity of the disease between the selected groups. Patients in the distressed group had a longer duration of illness, a higher prevalence of anxiety and depression, and more severe dyspnea after a 6-minute walk test. In contrast, patients in the disregarding group had a significantly higher prevalence of smokers and a higher number of cigarettes smoked daily, and a lower prevalence of anxiety and depression. The harmonic had the most optimal profile with low severity of anxiety and depression, but with a healthier attitude to smoking. Conclusion: Perception of illness in COPD patients has a significant impact on medical behavior and levels of anxiety and depression. As such, the perception of illness deserves routine monitoring in clinical practice.

This review provides information on prospects for using the antidepressant agomelatine in neurological practice. The drug has a unique receptor profile, being a melatonin receptor type 1 and 2 agonist and a serotonin receptor subtype 2C antagonist. Due to this and in addition to antidepressant action, the drug has a number of other effects, such as analgesic, anti-apathetic, anti-asthenic, procognitive, anxiolytic, and sleep-normalizing ones, which are of great importance in the treatment of neurological diseases. There are clinical and experimental data that prove the high efficiency and safety of agomelatin in the follow-up of patients with post-stroke depression, Parkinson’s disease, Alzheimer’s disease, Pick’s disease, Huntington’s disease, chronic fatigue syndrome, and pain syndromes.

Depression is one of the most common mental disorders in neurological practice. Among other symptoms of depression, a symptom complex represented by apathy, anhedonia, and cognitive impairment plays an important role. This review presents the clinical characteristics of the symptoms described above and discusses modern neurochemical and neuroimaging concepts of their pathogenesis. The problem of pathogenetically substantiated therapy of depression with a predominance of apathy, anhedonia and cognitive impairment is discussed. Fundamental and clinical arguments are presented in favor of the high efficacy of vortioxetine in depression with a predominance of apathy, anhedonia, and cognitive impairment.