Challenges and Opportunities in Anxiety Disorders

Challenges and Opportunities in Anxiety Disorders

Dr. Caitlin Powell and Dr. Kaitlin Vollet Martin


The following study explores the potential impact of COVID-19 on Social Anxiety and Rejection Sensitivity among college students. Over 300 college students completed a survey asking about whether they had contracted COVID-19, and, if they had, additional characteristics (i.e., when they contracted the disease, whether they were symptomatic, whether their symptoms were neurological, how many times they had contracted COVID-19). In addition, they indicated their current levels of Social Anxiety and Rejection Sensitivity, as well as general classroom anxiety. Lastly, participants indicated whether they had been formally diagnosed with related psychological disorders (autism, ADHD, anxiety disorders, mood disorders, rejection sensitivity dysphoria), as well as roughly when they had been diagnosed. Approximately half of the sample reported that they had contracted COVID-19 at least once, and approximately one third of the total sample had been previously diagnosed with anxiety. Results indicated that about one third of those who contracted COVID-19 indicated increases in anxiety or depression post-COVID-19. In addition, females in reported higher Social Anxiety and general classroom anxiety. Results did find that there were higher amounts of Social Anxiety and classroom anxiety among those who had been diagnosed with COVID-19 more recently, these results were no longer significant after controlling for previously diagnosed mental illness. There were otherwise no significant relationships between any aspects of contracting COVID-19 and Social Anxiety, rejection sensitivity, or classroom anxiety. This indicates that while students are reporting increased anxiety and depression, and while recently diagnosed COVID-19 does contribute to Social Anxiety and classroom anxiety, that these increases are likely due to the stress of being ill rather than the virus itself.

Robert D Friedberg, Callie Goodman, Ellison Choate, Hannah Zelcer, Eunice Mendez, Yasaman Movahedi, Sandra Trafalis, Isabella Xie, Megan Neelly, and Joee Zucker


The search for transdiagnostic pathways and processes to emotional disorders in youth is an emerging and compelling field. In this mini-review, intolerance of uncertainty is posed as a transdiagnostic pathway. The theoretical foundation of intolerance of uncertainty is discussed. Subtypes of intolerance of uncertainty are explained, a behavioral typology is reviewed, neuropsychological correlates are briefly discussed, and age differences are addressed. The role of the Coronavirus-19 pandemic as a critical incident is examined. Subsequently, the research supporting the association between intolerance of uncertainty and anxiety, obsessive-compulsive,, depression, autism, as well as eating disorders is reviewed. The findings are then integrated into a parsimonious theoretical synthesis. Limitations of the research are delineated and clinical implications are presented

Gilbert Seda, MD, PhD and Sharonya Shrivastava, MD


Purpose of Review: Obstructive sleep apnea and chronic insomnia are the most common sleep disorders in adults. Both sleep disorders can adversely affect physical and mental well-being. Cognitive function has been extensively studied in relation to chronic insomnia and obstructive sleep apnea. This paper reviews the recent studies investigating the cognitive effects of insomnia and obstructive sleep apnea as well as the potential benefits of treatment.

Recent Findings: Recent studies indicate that insomnia is associated with impairments in attention, memory, and executive function.  Chronic insomnia may have a moderating role in mild cognitive impairment and Alzheimer’s dementia. Mood and anxiety disorders may moderate the effects of insomnia on cognitive function. Hyperarousal and short sleep time associated with insomnia are risk factors for cognitive impairment. Cognitive behavior therapy for insomnia may improve cognitive function but more studies are needed. Nonbenzodiazepine receptor agonists improve insomnia without causing cognitive impairment.  Benzodiazepine use is associated with cognitive impairment.

Obstructive sleep apnea is associated with impairments in attention, concentration, memory, and executive function with apnea severity as measured by the apnea hypopnea index and severity of nocturnal hypoxemia being the largest risk factors.  Untreated obstructive sleep apnea may have a significant impact on the progression of mild cognitive impairment and Alzheimer’s dementia.  The impact of obstructive sleep apnea treatment, particularly with continuous positive airway pressure, appears to mitigate and slow the rate of cognitive decline but more randomized controlled studies are needed. 

Summary: Standardized cognitive assessments and larger, long-term controlled prospective studies with diverse populations are needed to further elucidate the cognitive impairments associated with chronic insomnia and obstructive sleep apnea. More studies are needed on the benefits of various treatments for obstructive sleep apnea and insomnia.

Sermin Kesebir and Rüştü Murat Demirer


Background: Current classification systems ignore the family histories of patients and psychiatric and medical comorbidity.
Methods: We study a new approach of applying spectral clustering to determine distinct bipolar disorder subtypes, which is data whose clusters are of various sizes and densities. We discovered clusters by processing a SRB (Sinai-Ruelle-Bowen) similarity matrix that reflects the proximity of Von Bertalanffy’s functions fitted to phase growth dynamics of EEG (electroencephalography) within a new pipeline architecture. For this purpose, 109 patients diagnosed with bipolar disorder according to DSM-V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) were evaluated in remission period cross-sectionally.
Results: We found three distinct bipolar disorder subtypes with the p-values < 0.001. We exhibit mixing sub-shifts of EEG phase gradients such that there are chaotic phase transitions but higher order phase gradients in a cone basin is always strictly convex. More surprisingly, we show that the SRB entropy measures on some time interval although there exist several equilibrium states each corresponds to equilibrium state.
Conclusion: It seems subtypes of the bipolar spectrum were shaped according to seasonality, comorbidity for anxiety disorder and presence of psychotic symptom.

Osman Sinanovic, Muhamed Lepuzanović, Edin Bašagić, Mirsad Muftić, and Sedjad Kahrić


Background: Corona infection is primarily a respiratory disease, but the SARS-CoV-2 virus also penetrates other organs, causing various symptoms, including olfactory and gustatory dysfunction, which is why we can consider COVID-19 as a multisystem disease.

Aim: To present review of some aspects of the olfactory and gustatory dysfunction in SARS-CoV- infection.

Methods: The article has an analytical character and review of the literature.

Results and Discussion: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a high similarity with SARS-CoV-1 and uses the same receptors to enter the human body (angiotensin-converting enzyme 2/ACE2). COVID-19 is primarily a disease of the respiratory system, but SARS-CoV-2 also penetrates the other organs including central nervous system (CNS). Patients with SARS-CoV-2 infection can experience a range of clinical manifestations, from no symptoms to critical illness. The entry of the virus into the brain can lead to different neurological and psychiatric manifestations, including loss of smell (anosmia) and the loss of taste (ageusia). The frequency of anosmia and ageusia in patients with COVID-19 varies widely, from 10 to 65%, being the primary symptom in about 12% of patients. For now, the etiopathogenesis of anosmia and ageusia in SARS-CoV-2 infection is still unknown. Most of the analyzed subjects reported olfactory recovery. However, anosmia and ageusia can last several months or even longer. While most patients are expected to recover their sense of smell or taste within the first three months, a major subpopulation of patients might develop long lasting dysfunction. Although a substantial proportion of patients with Covid-19 might develop long lasting of diferent level of ansomia and ageusia it is uncertain what proportion of patients develop persistent dysfunction. Anosmia/ageusia can be as an important risk factor for fog, anxiety, and depression that may show a prolonged and/or delayed impact. However, we do not yet know what long-term effects these disorders may have on the central nervous system and mental health in general.

Conclusion: The COVID-19 is primarily a disease of the respiratory system, but SARS-CoV-2 also penetrates other organs (multisystem disease), causing various symptoms, including olfactory and gustatory dysfunction. The frequency of anosmia and ageusia in patients with COVID-19 is common but according to different papaers varies widely, from 10 to 65%, being the primary symptom in about 12% of patients. Most of the analyzed subjects reported olfactory recovery. However, anosmia and ageusia can last several months or even longer. We do not yet know what long-term consequences these disorders may have on the central nervous system and mental health in general.

Vasiliki S. Raidou, Stilliani Andreadou, Anna Christakou, and Eleni A. Kortianou


The coronavirus disease 2019 pandemic increased the need for alternative disease monitoring, medication management, and rehabilitation approaches. During this period, significant adjustments were made to integrate telemedicine into various aspects of healthcare.

This critical review describes the use and effectiveness of digital health approaches adopted for the care of people with chronic respiratory diseases during and beyond the COVID-19 pandemic. A thorough search was conducted in the PubMed database from January 2020 up to December 2022. A total of thirty studies were retrieved and reviewed for the utilization of telehealth services for education, monitoring, assessment, self-management, and rehabilitation in comparison to standard care or not.

During the lockdown patients with chronic obstructive pulmonary disease, asthma, cystic fibrosis, interstitial lung diseases, lung cancer, and neuromuscular disorders indicated positive perception towards remote healthcare delivery. They expressed high levels of satisfaction and achieved self-management in chronic obstructive pulmonary disease and asthma. Remote visits decreased exacerbations of asthma and reinforced smoke cessation in patients with chronic obstructive pulmonary disease. Teleassessment and monitoring increased the percentage of cystic fibrosis and Duchenne Muscular Dystrophy patients seen via telemedicine. Web platforms and mobile applications supported telehealth interventions to reduce stress, depression, and anxiety in patients with cystic fibrosis, assessed the quality of life and physical activity of patients with sarcoidosis, and pursued health education in adolescents with asthma. A few studies carried out telerehabilitation programs in patients with chronic obstructive pulmonary disease, cystic fibrosis, Duchenne Muscular Dystrophy, and sarcoidosis. Findings advocate the feasibility of online exercises, the improvement of exercise capacity, muscle strength, respiratory muscle strength, and the reduction of dyspnea and fatigue.

Rima Dada, Surabhi Gautam, Tanuj Dada, Prabhakar Tiwari, and Manoj Kumar


Complex and chronic lifestyle disorders have become the leading cause of death and disability worldwide. They involve multiple morbidities necessitating the attention of numerous healthcare facilities as well as community-based care too. Stress and anxiety brought on by the fast-paced life, unhealthy eating habits, sedentary lifestyle, poor quality of life, polypharmacy, and high medical costs have significantly influenced the development of such multimorbid conditions. Most chronic complex diseases share a similar underlying pathology including high levels of stress, inflammatory immune response, persistent activation of the hypothalamo-pituitary-adrenal axis, oxidative stress, accelerated immune-aging, dysregulated blood flow, enhanced apoptosis and accelerated aging with shorter telomeres and DNA damage. These are modifiable factors which can impact disease progression and no single treatment modality in modern medicine can alone impact all these factors. As a result, the treatment must involve an integrated approach that targets both mind and body and each of these factors which form an architectural framework which supports the onset of these complex lifestyle disease and thus though we may enjoy longer lifespan, but it is accompanied by shorter health span. Yoga, a mind-body intervention with Indian roots, strives to bring about the synchronization of physical and mental health by unraveling and switching on the internal pharmacy and maintenance of homeostasis at cellular and molecular level.

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