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      Anxiety and depression in patients with alpha-1 antitrypsin deficiency: current insights and impact on quality of life

      1 , 1

      Therapeutics and Clinical Risk Management

      Dove

      anxiety, depression, alpha-1 antitrypsin deficiency

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          Abstract

          Chronic physical illness is associated with significant vulnerability for emotional disorders. Some studies suggest anxiety and depression are common comorbidities in individuals with alpha-1 antitrypsin deficiency (AATD). Many aspects of AATD contribute to quality of life impairment. Delays in diagnosis, high costs of disease treatment, and inherited genetic risk add to the symptom burden of lung or liver disease to alter quality of life. Whether anxiety and depression independently contribute to quality of life impairment remains unproven. In this article, we aim to review current literature examining the impact of anxiety and depression on the quality of life of AATD-affected individuals. Multifaceted approaches may best meet the needs of a heterogeneous population and are the best future strategies to minimize these emotional impacts and assure highest quality of life possible. More research studies are needed to achieve this ambitious goal and make life of AATD-affected individuals better by minimizing the effects of anxiety and depression.

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          Most cited references 29

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          Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression.

          The aim of the present study was to analyse the risk of rehospitalisation in patients with chronic obstructive pulmonary disease and associated risk factors. This prospective study included 416 patients from a university hospital in each of the five Nordic countries. Data included demographic information, spirometry, comorbidity and 12 month follow-up for 406 patients. The hospital anxiety and depression scale and St. George's Respiratory Questionnaire (SGRQ) were applied to all patients. The number of patients that had a re-admission within 12 months was 246 (60.6%). Patients that had a re-admission had lower lung function and health status. A low forced expiratory volume in one second (FEV1) and health status were independent predictors for re-admission. Hazard ratio (HR; 95% CI) was 0.82 (0.74-0.90) per 10% increase of the predicted FEV1 and 1.06 (1.02-1.10) per 4 units increase in total SGRQ score. The risk of rehospitalisation was also increased in subjects with anxiety (HR 1.76 (1.16-2.68)) and in subjects with low health status (total SGRQ score >60 units). When comparing the different subscales in the SGRQ, the closest relation between the risk of rehospitalisation was seen with the activity scale (HR 1.07 (1.03-1.11) per 4 unit increase). In patients with low health status, anxiety is an important risk factor for rehospitalisation. This may be important for patient treatment and warrants further studies.
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            Associations of depression and anxiety with gender, age, health-related quality of life and symptoms in primary care COPD patients.

            Under-diagnosis of anxiety and depression in Chronic Obstructive Pulmonary Disease (COPD) patients may have a negative impact on patient quality of life and result in disparity between prevalence and the recognition and treatment of these symptoms. To reveal associations of depression and anxiety with demographic, health-related quality of life and clinical characteristics of COPD patients seen in UK primary care. Cross-sectional population-based postal survey of COPD patients comprising the EQ-5D visual analogue scale (EQ-5D(VAS)), the COPD symptom control questionnaire, the Hospital Anxiety and Depression Scale, the Medical Research Council dyspnea index. Demographic and spirometric data were collected from general practice records. A total of 170 (57%) patients consented to take part. Data are reported on 110 of these patients for whom up-to-date spirometry was available. Approximately one in five participants reported 'caseness' for depression (20.8%) and one in three reported anxiety (32.7%). Age and high levels of symptoms were independent predictors of anxiety and depression, as was the EQ-5D(VAS) of depression. These data suggest that in UK primary care, depressive and anxious symptoms in COPD are related to age and high levels of symptoms. Depression is also associated with lower patient-reported generic health status. The data suggest that assessment and treatment for depression and anxiety should be considered for all COPD patients, not just those with more severe clinical levels of disease. The potential of the EQ-5D(VAS) as a screening tool for anxiety and depression in primary care COPD patients also merits study.
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              Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease.

              To investigate whether psychological factors predict outcome after emergency treatment for obstructive pulmonary disease. Emergency department at a university hospital. Forty-three patients presenting with exacerbation of asthma or COPD. The patients received emergency treatment and were followed up for 4 weeks. Spirometry, blood sampling, pulse oximetry, breathing rate, pulse rate, and dyspnea score was measured before and during emergency treatment. The psychological status was assessed using the hospital anxiety and depression (HAD) scale questionnaire at the end of the follow-up period. Anxiety and/or depression was found in 17 patients (40%). Of these patients, nine patients (53%) were admitted to hospital or had a relapse within 1 month, compared with five patients (19%) in the group without anxiety and/or depression (p < 0.05). Among patients who relapsed within 1 month (n = 14), the HAD total score was 12.4 +/- 5.9 compared with 8.6 +/- 5.1 (mean +/- SD) among the patients without a relapse (p < 0.05). After making adjustments for age, gender, atopic status, treatment, and pack-years, the significant association between treatment failure and anxiety and/or depression still remained. Our study indicates that anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Further studies should be conducted evaluating the effect of treatment of anxiety and depression in patients with recurrent exacerbations of asthma and COPD.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                TCRM
                tcriskman
                Therapeutics and Clinical Risk Management
                Dove
                1176-6336
                1178-203X
                31 July 2019
                2019
                : 15
                : 959-964
                Affiliations
                [1 ] Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina , Charleston, SC, USA
                Author notes
                Correspondence: Tatsiana BeikoDivision of Pulmonary and Critical Care Medicine, Medical University of South Carolina , 96 Jonathan Lucas St, CSB 816 MSC 630, Charleston, SC26425, USAEmail beiko@ 123456musc.edu
                Article
                175369
                10.2147/TCRM.S175369
                6682319
                © 2019 Beiko and Strange.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 1, References: 33, Pages: 6
                Categories
                Review

                Medicine

                alpha-1 antitrypsin deficiency, depression, anxiety

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