Anxiety Disorders: Allen K

Dennis CL, Allen K. · Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, Canada, M5T 1P8. · Cochrane Database Syst Rev. · Pubmed #18843730 No free full text.

Abstract: BACKGROUND: Although pregnancy was once thought of as a time of emotional well-being for many women, conferring 'protection' against psychiatric disorders, a recent meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester to a high of 12.8% in the second trimester. Due to maternal treatment preferences and potential concerns about fetal and infant health outcomes, non-pharmacological treatment options are needed. OBJECTIVES: To assess the effects, on mothers and their families, of non-pharmacological/psychosocial/psychological interventions compared with usual antepartum care in the treatment of antenatal depression. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007), the Cochrane Collaboration Depression Anxiety and Neurosis Group's Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (January 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 3), MEDLINE (1966 to January 2007), EMBASE (1980 to January 2007) and CINAHL (1982 to January 2007). We scanned secondary references and contacted experts in the field to identify other published or unpublished trials. SELECTION CRITERIA: All published, unpublished and ongoing randomised controlled trials of non-pharmacological/psychosocial/psychological interventions to treat antenatal depression. DATA COLLECTION AND ANALYSIS: All review authors independently participated in the evaluation of methodological quality and data extraction. . MAIN RESULTS: We included one US three-armed randomised controlled trial in this review, incorporating 61 outpatient antenatal women who met Diagnostic and Statistical Manual for Mental Disorders-IV criteria for major depression. Maternal massage, compared to non-specific acupuncture (control group), did not significantly decrease the number of women diagnosed with clinical depression immediately post-treatment (one trial, n = 38; risk ratio (RR) 0.80, 95% confidence interval (CI) 0.25 to 2.53) or at final assessment at 10 weeks' postpartum (one trial, n = 32; RR 1.93, 95% CI 0.37 to 10.01). Acupuncture specifically treating symptoms of depression, compared to non-specific acupuncture, did not significantly decrease the number of women diagnosed with clinical depression immediately post-treatment (one trial, n = 35; RR 0.48, 95% CI 0.11 to 2.13) or at final assessment at 10 weeks' postpartum (one trial, n = 32; RR 0.64, 95% CI 0.06 to 6.39). AUTHORS' CONCLUSIONS: The evidence is inconclusive to allow us to make any recommendations for massage therapy or depression-specific acupuncture for the treatment of antenatal depression. The included trial was too small with a non-generalisable sample, to make any recommendations.

Tang ML, Osborne N, Allen K. · Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia. · Curr Opin Allergy Clin Immunol. · Pubmed #19506470 No free full text.

Abstract: PURPOSE OF REVIEW: The prevalence of allergic disorders has more than doubled in the last two decades leading to increased community concern and anxiety, and unprecedented demand for allergy-specialist services. However, although allergic reactions are common, anaphylaxis is uncommon and fatal anaphylaxis is rare. This review examines recent developments in the epidemiology of anaphylaxis, focusing on new information that may assist in identifying those at increased risk of severe reactions and adverse outcomes. RECENT FINDINGS: Recent studies suggest an increase in prevalence of anaphylaxis in industrialized countries. Examination of the demographic characteristics of anaphylaxis has revealed potential approaches to better recognize those at greatest risk. Novel laboratory approaches to identify patients at increased risk of severe reactions have been suggested. SUMMARY: Increased knowledge of the epidemiology of anaphylaxis has provided insights into the characteristics of those patient groups most at risk of adverse outcomes. However, these characteristics have poor specificity and limited applicability for detection of at-risk individuals in the clinical setting. Further research is required to facilitate more accurate assessment of an individual's risk for anaphylaxis or fatal outcome. This would represent a major advance in clinical management and enable better allocation of existing healthcare resources.

Sharpe M, Strong V, Allen K, Rush R, Postma K, Tulloh A, Maguire P, House A, Ramirez A, Cull A. · Division of Psychiatry, School of Molecular and Clinical Medicine, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, UK. · Br J Cancer. · Pubmed #14735170 links to  free full text

Abstract: A screening programme designed to identify cases of Major Depressive Disorder (MDD) in patients attending a Regional Cancer Centre outpatient department was established. It comprised two stages: (1) The Hospital Anxiety and Depression Scale (HADS) self-rating questionnaire administered by a touch-screen computer; (2) we interviewed patients with high scores on the HADS (15 or more total score) over the telephone using the depression section of the Structured Clinical Interview for DSMIV (SCID). A large consecutive sample (5613) of oncology clinic attenders was screened, and practical difficulties in the screening process were identified. The estimated prevalence of major depressive disorder (MDD) in the sample surveyed was approximately 8% (7.8%; 95% confidence intervals 6.9-8.5%). We assessed a consecutive series of 150 patients identified as having MDD to determine how many had received evidence-based treatment for MDD. Only half had discussed their low mood with their general practitioner, only one-third had been prescribed any antidepressant medication, and very few had taken a therapeutic dose for an adequate period. Very few had received psychological treatment or had been referred to mental health services. Most were receiving no potentially effective therapy.