How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review [The role of regular physical activity in the prevention and intervention of symptoms of anxiety and anxiety disorders]. Does Acute Propranolol Treatment Prevent Posttraumatic Stress Disorder, Anxiety, and Depression in Children with Burns? Efficacy of vitamin D supplementation in depression in adults: a systematic review protocol The Effectiveness of Psychosocial Interventions as Adjuncts to Orthopaedic Surgery: A Systematic Review Protocol A comparison of propranolol and diazepam for preoperative anxiolysis Alprazolam, Propranolol, and Placebo in the Treatment of Panic Disorder and Agoraphobia with Panic Attacks A systematic review of anxiety interventions in stroke and acquired brain injury: Efficacy and trial design Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review Propranolol in chronic anxiety disorders. A controlled study. Comparative efficacy of propranolol, chlordiazepoxide, and placebo in the treatment of anxiety: a double-blind trial. Effects of yoga on depression and anxiety of women. Oxprenolol and propranolol in anxiety states. A double-blind comparative study. Effect of a serotonin precursor and uptake inhibitor in anxiety disorders; a double-blind comparison of 5-hydroxytryptophan, clomipramine and placebo. Combined cognitive bias modification treatment for social anxiety disorder: a pilot trial. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Comparative effects of propranolol and chlordiazepoxide in anxiety states. Propranolol reduces the anxiety associated with day case surgery. A Randomized Dose-Ranging Study of Neuropeptide Y in Patients with Posttraumatic Stress Disorder Propranolol does not reduce risk for acute stress disorder in pediatric burn trauma. The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials Pharmacotherapy of impaired affect in recovering schizophrenic patients.
We conducted a review of systematic review s ( SRs ) and r and omized-controlled trials ( RCTs ) to analyze efficacy and safety of cannabis-based medication in patients with mental disorders . Five data bases were systematic ally search ed ( 2006—August 2018 ) ; 4 SRs ( of 11 RCTs ) and 14 RCTs ( 1629 participants ) were included . Diagnoses were : dementia , cannabis and opioid dependence , psychoses/schizophrenia , general social anxiety , posttraumatic stress disorder , anorexia nervosa , attention-deficit hyperactivity disorder , and Tourette`s disorder . Outcome variables were too heterogeneous to conduct a meta- analysis . A narrative synthesis method was applied . The study quality was assessed using the risk-of-bias tool and SIGN-checklists . THC- and CBD-based medicines , given as adjunct to pharmaco- and psychotherapy , were associated with improvements of several symptoms of mental disorders , but not with remission . Side effects occurred , but severe adverse effects were mentioned in single cases only . In order to provide reliable treatment recommendations , more and larger RCTs with follow-up assessment s , consistent outcome measures and active comparisons are needed Anxiety disorders are the most common mental illness , but are not uniform , many clinical diagnoses include the symptoms of anxiety . That is the reason why there are relatively small numbers of population surveys and r and omized-controlled trials which have examined the relationship between exercise and the various anxiety symptoms/ disorders . In our review we summarize meta-analytic studies , epidemiological surveys and r and omized controlled studies which examine the role of regular physical activity in the prevention and treatment of sub clinical anxiety/anxiety symptoms and anxiety disorders .  The meta-analytic studies and r and omized-controlled trials examining the relationship between sub clinical anxiety disorders and anxiety symptoms demonstrated small to moderate effect of exercise in the decrease of anxiety symptoms , especially for moderate-intensity exercise . This relationship was confirmed for both acute and chronic exercise , for state and trait anxiety in different sex , age and state of health groups . In the case of the anxiety disorders based on review ed studies , we can conclude that there is a potential association between decreased symptoms of anxiety and exercise .  The regular , moderate-intensity exercise can reduce and alleviate the symptoms of anxiety - at least in panic , agoraphobia and generalized anxiety disorders . The review ed studies have been highlighted the fact , that exercise can be effective in psychiatric practice as an alternative or adjuvant therapy . Physically healthy people with anxiety symptoms , or patients with anxiety disorders can perform exercise , there are no contraindications . Although based on previous studies , we can not assume that the relationship is causal , but we can not ignore the evidence s that are already available OBJECTIVE This study examined whether acute propranolol treatment prevented posttraumatic stress disorder ( PTSD ) , anxiety , and depression in children hospitalized in the pediatric intensive care unit for large burns . We hypothesized that the prevalence of PTSD , anxiety , and depression would be significantly less in the  propranolol  than nonpropranolol groups . METHODS Children who had previously participated in a r and omized controlled clinical trial of acute propranolol and nonpropranolol controls were invited to participate in long-term follow-up interviews . Eligible participants from 1997 to 2008 were identified from the electronic medical records , and data were collected in 2010 - 2011 . Measures included the Missouri Assessment of Genetics Interview for Children to assess lifetime PTSD , Revised Children 's Manifest Anxiety Scale to assess anxiety , and two depression inventories Children 's Depression Inventory and Beck Depression Inventory-II . RESULTS Of 202 participants , 89 were in the propranolol group and 113 were nonpropranolol controls . Children were an average of 7 years postburn . The average total body surface area burned was 56.4 + 15.1 % ( range = 24%-99 % ) . The mean dose of propranolol was 3.64 ± 3.19 mg/kg per day ( range = 0.36 - 12.12 ) . The duration of propranolol inpatient treatment days varied , mean days 26.5 ± 19.8 . The prevalence of lifetime PTSD in the propranolol group was 3.5 % and controls 7.2 % , but this difference was not statistically significant . We controlled for administration of pain medications , anxiolytics , and antidepressants overall and no significant differences were detected in the rates of PTSD , anxiety , or depression . CONCLUSIONS The prevalence of PTSD , anxiety , and depression was similar in children who received propranolol acutely and those who did not . This may be influenced by the st and ard of care that all children received timely pharmacotherapy for pain and anxiety management and psychotherapy beginning in their acute phase of treatment Background The role of vitamin D in management of depression is unclear . Results from observational and emerging r and omized controlled trials ( RCTs ) investigating the efficacy of vitamin D in depression lack consistency - with some suggesting a positive association while others show a negative or inconclusive association . Methods / Design The primary aim of this study is to conduct a systematic review of RCTs to assess the effect of oral vitamin D supplementation versus placebo on depression symptoms measured by scales and the proportion of patients with symptomatic improvement according to the authors ’ original definition . Secondary aims include assessing the change in quality of life , adverse events and treatment discontinuation . We will conduct the systematic review and meta- analysis according to the recommendations of the Cochrane H and book for Systematic Review s of Interventions . We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ) , MEDLINE ( 1966 to present ) , EMBASE ( 1980 to present ) , CINAHL ( 1982 to present ) , PsychINFO ( 1967 to present ) and Clinical Trials.gov . Unpublished work will be identified by search ing two major conferences : the International Vitamin Conference , the Anxiety Disorders and Depression Conference , while grey literature will be acquired by contacting authors of included studies . We will use the r and om-effects meta- analysis to synthesize the data by pooling the results of included studies . Discussion The results of this systematic review will be helpful in clarifying the efficacy of vitamin D supplementation and providing evidence to establish guidelines for implementation of vitamin D for depression in general practice and other relevant setting s. Study registration Unique identifier : CRD42013003849 AIMS Pain and anxiety are commonly reported among those undergoing orthopaedic surgery . Improvement in anxiety and pain control might be achieved by supplementing st and ard care with psychological interventions . However , the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic review s in orthopaedic surgeries . The present study aim ed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery , to identify the most effective intervention types and to evaluate potential moderators . METHODS We will perform a systematic review and meta- analysis to address the study aims . PubMed , PsycINFO , CINAHL and ProQuest Dissertations & Theses will be search ed between 1980 and 2015 . Prospect i ve controlled clinical trials completed in adults , contrasting st and ard care and st and ard care supplemented with psychosocial methods  , will be eligible for inclusion . Effectiveness will be assessed through the outcomes of postoperative pain intensity , analgesic requirement , perioperative anxiety , quality of life and postoperative recovery . The results of a r and om-effect meta- analysis will be reported . To aid implementation of best practice , moderating effects of the type and timing of psychosocial intervention , type of surgical intervention and type of anaesthesia will be evaluated through meta-regression . Sensitivity analyses and subgroup contrasts will follow as necessary . DISCUSSION Recommendations will be made to improve medical care in orthopaedic procedures . The quality of evidence will be rated using GRADE criteria . Copyright © 2016 John Wiley & Sons , The effectiveness of propranolol , a nonsedating anxiolytic premedication , was studied by monitoring preoperative anxiety and postoperative recovery of cognitive function in 92 healthy ASA physical status 1 females aged 15–42 yr undergoing outpatient dilatation and curretage (D&C)for therapeutic abortion . In a r and omized double-blind design , patients received one of the following oral medications 1–1.5 hr preoperatively : ( 1 ) diazepam 10 mg ( n = 31 ) ; ( 2 ) propranolol 80 mg ( n = 31 ) ; ( 3 ) placebo ( n = 30 ) . Anxiety throughout the hospital stay was monitored using the State-Trait Anxiety Inventory ( STAI ) . Postoperative cognitive recovery was assessed using the digit span and Trieger tests . STAI anxiety levels were recorded on admission to hospital , immediately before entering the operating room , and two hours postoperatively . There was no difference among the anxiolytic properties of the three medications and all three patient groups showed a significant decrease in anxiety levels after administration of the medication . Tests of cognitive function after anaesthesia showed the fastest return to baseline status in patients receiving propranolol , possibly because beta adrenergic blockade blunted the autonomic signs of light anaesthesia and less anaesthetic was administered . None of the study premedications was demonstrated to have an anxiolytic advantage , but propranolol did offer a faster return of cognitive function in the postoperative period . RésuméNous avons voulu évaluer l’efficacité du propranolol à litre de prémédication anxiolytique non-sédative en mesurant le degré d’anxiété préopératoire et la rapidité de la récupération postopératoire des fonctions cognitives . Quatre-vingt douze femmes de 15 à 42 ans de classe ASA I , c and i date s à une dilatation cervicale et curetage pour avortement en externe , se sont prêtées à notre étude . Après r and omisation à double-insu , elles prenaient par la bouche soit 10 mg de diazépam ( n = 31 ) , soit 80 mg de propranolol ( n = 31 ) , soit un placebo ( n = 30 ) et ce , de 60 à 90 minutes avant l’intervention . Nous mesurions le niveau d’anxiété à l’admission , juste avant d’entrer en salle d’opération et deux heures après l’intervention en utilisant le  « State-Trait Anxiety Inventory ( STAI ) » . Le « digit span » , test mnémonique numérique et le test de Trieger nous servaient à mesurer les fonctions cognitives avant et après l’opération . Les trois médications utilisés n’ont pas démontré de propriétés anxiolytiques différentes , les niveaux d’anxiété allant décroissant dans les trois groupes à partir de l’admission à l’hôpital . Par contre , après l’opération , les fonctions cognitives retournaient plus vite à la normale chez les patientes du groupe propranolol , peut-être parce que le blocage β-adrénergique avait permis de surestimer la profondeur de l’anesthésie pendant l’intervention entraînant l’utilisation de moindres doses d’anesthésique Fifty-five patients completed a 5-week double-blind study comparing alprazolam , propranolol , and placebo in the treatment of panic disorder and agoraphobia with panic attacks . There was no concomitant behavioral treatment . Patient and therapist rating scales included Sheehan 's Panic and Anxiety Attack Scales , the Marks-Sheehan Phobia Scale , the Hamilton Anxiety Scale , the Hamilton Depression Scale , and the Side Effects Checklist . The results generally support the efficacy of alprazolam , but not propranolol , in the treatment of panic disorder and agoraphobia with panic attacks . The significance of the results are discussed , as well as a number of the unique aspects of our procedures and patient population Objective There is little r and omized controlled trial ( RCT ) evidence to guide treatment for anxiety after stroke . We systematic ally review ed RCTs of anxiety interventions in acquired brain injury ( ABI ) conditions including stroke and traumatic brain injury ( TBI ) in order to summarize efficacy and key aspects of trial design to help guide future RCTs . Methods We search ed the Cochrane trial register , Medline , Embase , PsychInfo and CINAHL systematic ally up to August 2017 . Two independent review ers systematic ally selected studies and extracted data . We summarized the effect size , key study characteristics and sources of potential bias in trial design . Results 14 studies ( 12 stroke ; one stroke & TBI ; one TBI ) with 928 participants were included . Meta- analysis of five psychotherapy comparisons favoured intervention over control ( st and ardized mean difference ( SMD ) : − 0.41 [ − 0.79 , − 0.03 ] , I2 = 28 % ) ; Overall effect size of pharmacotherapy comparisons favoured intervention over control ( SMD : − 2.12 [ − 3.05 , − 1.18 ] , I2 = 89 % ) . One comparison of mixed pharmacotherapy and psychotherapy favoured intervention over usual care ( SMD : − 4.79 [ − 5.87 , − 3.71 ] ) . One comparison favoured  forest therapy versus urban control ( SMD : − 2.00 [ − 2.59 , − 1.41 ] ) . All positive studies carried high or unclear risk of bias . Sample sizes were small in all included studies . Conclusions There is low quality evidence to suggest that psychotherapy and pharmacotherapy may be effective interventions in the treatment of anxiety after stroke based on underpowered studies that carried high risk of bias . Large-scale well- design ed definitive trials are needed to establish whether pharmacological or psychotherapy works . Our review highlighted key considerations for investigators wishing to design high quality trials to evaluate treatments for anxiety after stroke Background To systematic ally review in- and outpatient costs in patients with coronary artery disease ( CAD ) and comorbid mental disorders . Methods A comprehensive data base search was conducted for studies investigating persons with CAD and comorbid mental disorders ( Medline , EMBASE , PsycINFO , Psyndex , EconLit , IBSS ) . All studies were included which allowed a comparison of in- and outpatient health care costs ( assessed either monetarily or in terms of health care utilization ) of CAD patients with comorbid mental disorders ( mood , anxiety , alcohol , eating , somatoform and personality disorders ) and those without . R and om effects meta-analyses were conducted and results reported using forest plots . Results The literature search result ed in 7,275 potentially relevant studies , of which 52 met inclusion criteria . Hospital readmission rates were increased in CAD patients with any mental disorder ( pooled st and ardized mean difference ( SMD ) = 0.34 [ 0.17;0.51 ] ) . Results for depression , anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from −0.44 to 1.26 . Length of hospital stay was not increased in anxiety and any mental disorder , while studies on depression reported heterogeneous SMDs ranging from −0.08 to 0.82 . Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders . Results for invasive procedures were non-significant respectively inconclusive . Conclusions Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs . From a health care point of view , it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs In a double-blind crossover study the beta-adrenergic blocking drug propranolol hydrochloride reduced symptoms in 17 of 26 patients with chronic anxiety disorders . Both somatic and psychic symptoms improved as judged by patient and observer ratings . The most frequent side effects ( dizziness , fatigue , and insomnia ) were difficult to distinguish from anxiety symptoms and were , for the most part , mild . The therapeutic and side effects observed suggested CNS activity of the drug . Although propranolol is of benefit to patients with anxiety , its efficacy , compared with that of other antianxiety drugs , has not been established The efficacy and safety of propranolol in the treatment of anxiety was compared with those of chlordiazepoxide and placebo in a 3-week , double-blind study of 212 patients . After a 1-week , single-blind placebo-washout period , patients were r and omized to receive either propranolol ( 80 , 160 , or 320 mg/day ) , chlordiazepoxide ( 30 , 45 , or 75 mg/day ) , or placebo . Patients were evaluated by three physician-rated scales -- Hamilton Rating Scale for Anxiety ( HAM-A ) , Covi Anxiety Scale ( CAS ) , and Clinical Global Impressions scale-- and two patient-rated scales -- Symptoms Checklist 90 and Profile of Mood States . Patients in all groups demonstrated significant improvement in their level of anxiety at all time points compared with their baseline level . At Week 1 propranolol and chlordiazepoxide patients were significantly better than placebo patients , as measured by the HAM-A and CAS . At Week 2 only propranolol was superior to placebo , based on HAM-A and CAS scores . Fifteen patients prematurely terminated because of adverse reactions ( 4 taking propranolol , 4 taking placebo , and 7 taking chlordiazepoxide ) . The incidence of side effects was similar for the two active drugs ; fatigue , drowsiness , and change in libido were significantly more frequent with chlordiazepoxide and drowsiness and indigestion were more frequent with propranolol compared with placebo UNLABELLED Yoga has often been perceived as a method of stress management tool that can assist in alleviating depression and anxiety disorders . This study sought to evaluate the influence of yoga in relieving symptoms of depression and anxiety in women who were referred to a yoga clinic . METHODS The study involved a convenience sample of women who were referred to a yoga clinic from July 2006 to July 2007 . All new cases were evaluated on admission using a personal information question naire well as Beck and Spielberger tests . Participants were r and omly assigned into an experimental and a control group . The experimental group ( n=34 ) participated in twice weekly yoga classes of 90 min duration for two months . The control group ( n=31 ) was assigned to a waiting list and did not receive yoga . Both groups were evaluated again after the two-month study period . RESULTS The average prevalence of depression in the experimental group pre and post Yoga intervention was 12.82+/-7.9 and 10.79+/-6.04 respectively , a statistically insignificant decrease ( p=0.13 ) . However , when the experimental group was compared to the control group , women who participated in yoga classes showed a significant decrease in state anxiety ( p=0.03 ) and trait anxiety ( p<0.001 ) . CONCLUSIONS Participation in a two-month yoga class can lead to significant reduction in perceived levels of anxiety in women who suffer from anxiety disorders . This study suggests that yoga can be considered as a complementary therapy or an alternative method for medical therapy in the treatment of anxiety disorders The efficacy of oxprenolol ( Trasicor ) and propranolol in controlling anxiety was compared in a double-blind study of patients with anxiety and tension .  Efficacy was assessed by the investigator with the aid of a psychiatric rating scale consisting of 19 items , bythe patients using visual analogue scales , and by the investigator 's and the patients ' over-all assessment s. Tolerance to the drugs was evaluated by over-all assessment and by means of a checklist of signs and symptoms which emerged during treatment . Little difference in the efficacy of the two drugs was observed . Both were effective in the treatment of anxiety and tension . In general , oxprenolol was significantly better tolerated than propranolol . Evidence of the intrinsic sympathomimetic activity of oxprenolol emerged during the course of the study or , alternatively , evidence that propranolol had a greater cardiac-depressant effect A double-blind placebo-controlled study of 5-HTP and clomipramine was carried out on 45 patients suffering from anxiety disorders ( DSM-III ) .  Clomipramine has shown to be effective in that it induced significant improvement on all rating scales as compared to placebo . 5-HTP showed a moderate reduction of the symptomatology on the 90-item symptoms checklist ( SCL-90 ) and the State Scale of the Spielberger State-Trait Anxiety Inventory .  Clomipramine and 5-HTP differed in their efficacy in that 5-HTP did not affect the associated depressive symptomatology . The results support the hypothesis that brain serotonergic pathways are involved in the pathogenesis of anxiety disorders , particularly in agoraphobia and panic disorders BACKGROUND Cognitive Bias Modification ( CBM ) is a promising treatment for Social Anxiety Disorder ( SAD ) . However , previous r and omized trials have not systematic ally examined the combination of CBM for attention ( CBM-A ) and interpretation ( CBM-I ) or the credibility and acceptability of these protocol s. METHODS We conducted a r and omized , double-blind placebo-controlled  trial ( N = 32 ) to examine the efficacy of a CBM treatment called Attention and Interpretation Modification ( AIM ) for SAD . AIM comprised eight , twice weekly computer sessions with no therapist contact . During AIM , participants ( 1 ) completed a dot probe task in which probes always followed neutral faces when paired with a disgust face , thereby directing attention away from threat and ( 2 ) completed a word-sentence association task in which they received positive feedback for making benign interpretations of word-sentence pairs and negative feedback for making negative interpretations . We also assessed participants ' perceived credibility of and satisfaction with AIM . RESULTS Participants receiving AIM reported significantly reduced self-reported ( Liebowitz Social Anxiety Scale ) symptoms of social anxiety relative to the placebo . These gains were also evident on a behavioral measure ( performance on an impromptu speech ) . AIM met our benchmarks for credibility and acceptability in this community sample , although credibility ratings were modest . Participants reported that CBM-I was more helpful than CBM-A. CONCLUSIONS A combined CBM treatment produced medium-to-large effects on social anxiety . Participants rated AIM as moderately credibly and acceptable . Should these findings be replicated in larger sample s , AIM has the potential to be a widely accessible and efficacious treatment for SAD The aim of the present study was to carry out a controlled pilot study on the putative anxiolytic effect of valepotriates .  Thirty-six out patients with generalized anxiety disorder ( DSM III-R ) , after a 2-week wash-out , were r and omized to one of the following three treatments for 4 weeks ( n = 12 per group ) : valepotriates ( mean daily dose : 81.3 mg ) , diazepam ( mean daily dose : 6.5 mg ) , or placebo . A parallel , double-blind , flexible-dose , placebo-controlled design was employed . No significant difference was observed among the three groups at baseline or in the change from baseline on the Hamilton anxiety scale ( HAM-A ) or in the trait part of the state-trait anxiety inventory ( STAI-trait ) . Moreover , the three groups presented a significant reduction in the total HAM-A scores . On the other h and , only the diazepam and valepotriates groups showed a significant reduction in the psychic factor of HAM-A. The diazepam group also presented a significant reduction of the STAI-trait . Although the principal analysis ( HAM-A between group comparison ) found negative results ( probably due to the small sample size in each group ) , the preliminary data obtained in the present study suggest that the valepotriates may have a potential anxiolytic effect on the psychic symptoms of anxiety . However , since the number of subjects per group was very small , the present results must be viewed as preliminary . Thus , further studies addressing this issue are warranted BACKGROUND There have been six r and omized controlled trials of psychological therapy with generalized anxiety disorder ( GAD ) using DSM-III-R and DSM-IV . All have used the Trait version of the Spielberger State-Trait Anxiety Inventory ( STAI-T ) as one of several outcome measures . Each study , however , employed different methods of calculating the clinical significance of outcomes making it difficult to reach a balanced appraisal of the efficacy of psychological treatment . METHODS Raw data on STAI-T scores at pre- , post- and follow-up were obtained for each of the six studies ( total N = 404 ) . Jacobson methodology for defining clinical ly significant change ( criterion c , reliable change index = 8 , cut-off point = 46 ) was used to allocate each patient to one of four outcomes : worse , unchanged , improved and recovered . The proportion of patients in each category was calculated for treatment conditions in each study and also for aggregate data across types of treatment . RESULTS A recovery rate of 40 % was found for the sample as a whole with 12 of the 20 treatment conditions obtaining very modest recovery rates of 30 % or less . Two treatment approaches -- individual cognitive behavioural therapy and applied relaxation -- do relatively well with overall recovery rates at 6-month follow-up of 50 - 60 % . CONCLUSIONS Jacobson methodology , in distinguishing between improvement and recovery on a st and ardized measure of general vulnerability to anxiety , provides a stringent but clinical ly more meaningful evaluation of the efficacy of psychological therapies with GAD than has been available hitherto . Systematic focus on either excessive worry or physiological arousal gives worthwhile results The trial showed propranolol to be as effective as  chlordiazepoxide overall in the treatment of these cases of anxiety states , but in  depression and sleep disturbance  chlordiazepoxide was better . Nevertheless , the new drug may have some part to play in the treatment of anxiety as an alternative to tranquillizers , and it may be possible in future to define more precise indications for its use OBJECTIVE To find out if propranolol , a non-cardioselective beta-blocker , can reduce the anxiety associated with day case surgery . DESIGN Prospect i ve r and omized double blind trial . SETTING University hospital , Irel and . SUBJECTS An unselected group of 53 patients undergoing day case surgery . INTERVENTION Subjects r and omised to receive either propranolol ( 10 mg ) or placebo on the morning of operation . MAIN OUTCOME MEASURES Blood pressure ; pulse , anxiety , pain score and patient satisfaction . RESULTS Mean ( SD ) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group ( 2.5 ( 0.7 ) compared with 4.6 ( 0.7 ) , p < 0.0001 ) before discharge . CONCLUSION A low dose of propranolol given on the morning of day case surgery significantly reduced patients ' anxiety Abstract Background Anxiety and trauma-related disorders are among the most prevalent and disabling medical conditions in the United States , and posttraumatic stress disorder in particular exacts a tremendous public health toll . We examined the tolerability and anxiolytic efficacy of neuropeptide Y administered via an intranasal route in patients with posttraumatic stress disorder . Methods Twenty-six individuals were r and omized in a cross-over , single ascending dose study into 1 of 5 cohorts : 1.4 mg ( n=3 ) , 2.8 mg ( n=6 ) , 4.6 mg ( n=5 ) , 6.8 mg ( n=6 ) , and 9.6 mg ( n=6 ) . Each individual was dosed with neuropeptide Y or placebo on separate treatment days 1 week apart in r and om order under double-blind conditions . Assessment s were conducted at baseline and following a trauma script symptom provocation procedure subsequent to dosing . Occurrence of adverse events represented the primary tolerability outcome . The difference between treatment conditions on anxiety as measured by the Beck Anxiety Inventory and the State-Trait Anxiety Inventory immediately following the trauma script represented efficacy outcomes . Results Twenty-four individuals completed both treatment days . Neuropeptide Y was well tolerated up to and including the highest dose . There was a significant interaction between treatment and dose ; higher doses of neuropeptide Y were associated with a greater treatment effect , favoring neuropeptide Y over placebo on Beck Anxiety Inventory score ( F1,20=4.95 , P=.038 ) . There was no significant interaction for State-Trait Anxiety Inventory score . Conclusions Our study suggests that a single dose of neuropeptide Y is well tolerated up to 9.6 mg and may be associated with anxiolytic effects . Future studies exploring the safety and efficacy of neuropeptide Y in stress-related disorders are warranted . The reported study is registered at : http:// clinical trials.gov ( ID : NCT01533519 ) OBJECTIVE Acute stress disorder ( ASD ) can interfere with satisfactory recovery of children with severe burn injuries . Recent studies have found propranolol to be effective in reducing posttraumatic symptoms , but the benefits of this medication with ASD are unknown . Therefore , we hypothesized that individuals who were administered propranolol acutely would be less likely to develop ASD than those who were not . METHOD A review of electronic medical records was conducted on the children included in a previous blinded r and omized-control trial , in which the participants received propranolol or no propranolol during the acute phase of recovery ( first 30 days ) . These data were merged with electronic information regarding medication treatment for ASD . The psychologists and clinicians who had previously assessed for ASD for purpose s of treating the children 's distress were blinded to who received propranolol and who did not . RESULTS There were 363 participants ( 232 boys , 131 girls ) and the mean total body surface area was 56 % . Of this sample , 22 participants had been previously diagnosed and treated for ASD , and 341 were in a non-ASD group . Eight percent of those children who received propranolol required treatment for ASD , whereas 5 % of children who received no propranolol also required treatment for ASD . No statistically significant difference was noted . CONCLUSIONS Propranolol was not found to influence the risk for subsequent ASD . This finding is in contrast to the observed benefit of propranolol reported in other studies with different at risk population s. Further exploration is warranted to assess the possible long-term benefit on posttraumatic symptoms in pediatric burn survivor patients Background Conduct problems are common , disabling and costly . The prognosis for children with conduct problems is poor , with outcomes in adulthood including criminal behaviour , alcoholism , drug abuse , domestic violence , child abuse and a range of psychiatric disorders . There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems  in a number of countries over the past 10 years . Existing review s of parent training have method ological limitations such as inclusion of non-r and omised studies , the absence of investigation for heterogeneity prior to meta- analysis or failure to report confidence intervals . The objective of the current study was to systematic ally review r and omised controlled trials of parenting programmes for the treatment of children with conduct problems .  Methods St and ard systematic review methods were followed including duplicate inclusion decisions , data extraction and quality assessment . Twenty electronic data bases from the fields of medicine , psychology , social science and education were comprehensively search ed for RCTs and systematic review s to February 2006 . Inclusion criteria were : r and omised controlled trial ; of structured , repeatable parenting programmes ; for parents/carers of children up to the age of 18 with a conduct problem ; and at least one measure of child behaviour . Meta- analysis and qualitative synthesis were used to summarise included studies . Results 57 RCTs were included . Studies were small with an average group size of 21 . Meta-analyses using both parent ( SMD -0.67 ; 95 % CI : -0.91 , -0.42 ) and independent ( SMD -0.44 ; 95 % CI : -0.66 , -0.23 ) reports of outcome showed significant differences favouring the intervention group . There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes . Conclusion Parenting programmes are an effective treatment for children with conduct problems . The relative effectiveness of different parenting programmes requires further research BACKGROUND Prominent and persistent anxiety , depression , and /or negative features characterize a substantial minority of recovered or residually psychotic schizophrenic out patients and contribute to poor outcome . Because extrapyramidal side effects of typical neuroleptic medications often resemble such features , we first systematic ally studied the contribution of extrapyramidal side effects to these problems and their treatment . For patients who remained distressed , controlled trials of supplemental thymoleptics were undertaken . METHODS In trial 1 , 92 distressed ( depressed and /or anxious ) patients and 36 patients in a defect state ( patients with negative symptoms ) participated in a double-blind , intramuscular challenge that compared central ly acting benztropine mesylate with peripherally acting glycopyrrolate . In trial 2 , 57 distressed patients and 22 patients in a defect state were r and omly assigned to a double-blind , neuroleptic medication dose-reduction group . In trial 3 , 57 chronically distressed patients who were maintained on a low dose of fluphenazine decanoate  were r and omly assigned to a supplemental desipramine hydrochloride , lithium carbonate , or placebo group under double-blind conditions for 12 weeks . RESULTS For patients who were already maintained on antiparkinsonian medication , impaired affect was not resolved by additional benztropine . Only distressed patients with a family history of severe mental disorder ( often affective ) showed improvement with neuroleptic medication dose reduction . Patients in the defect-state group reported less dysphoria on a reduced neuroleptic medication dose , but negative symptoms persisted . Desipramine improved diverse aspects of mood and residual psychoticism , possibly as a prophylaxis against minor affective exacerbations . Depression improved in women only . Lithium positively affected multiple indexes of anxiety and anxious depression . CONCLUSION Most often , persistent affective impairments are neither resistant extrapyramidal side effects nor characterological traits . Thymoleptics improve the nonphasic , chronic types of anxiety and depression in contrast to the acute , episodic forms , for which little support can be found in the literature
These meta-analyses found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia .
Also , no evidence was found for effects of propranolol on PTSD symptom severity through inhibition of memory reconsolidation .
In conclusion , the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders
The effects of propranolol in the treatment of anxiety disorders have not been systematic ally evaluated previously .
The aim was to conduct a systematic review and meta- analysis of r and omised controlled trials , addressing the efficacy of oral propranolol versus placebo or other medication as a treatment for alleviating either state or trait anxiety in patients suffering from anxiety disorders .