***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract The purpose of this study was to determine prevalence rates of psychiatric morbidity in the elderly , distinguishing different levels of psychiatric caseness as compared to the diagnoses of the DSM-III-R. In a cross-sectional population -based study in Berlin ( West ) , Germany , 516 people aged 70 to 95 + were r and omly selected from the obligatory city registry ( 1990 - 1993 ) and stratified by age and gender ( N = 43 men and N = 43 women in each of six 5-year age groups ) .  Psychiatric and physical examinations  were carried out in an extensive st and ardized assessment . Distinct psychopathological syndromes occurred in 72.7 % of the elderly ( 54.6 % of the men , 79.1 % of the women ) . A clinical ly defined psychiatric disorder was found in 49.4 % of the elderly ( 95 % confidence interval 43.9 % – 54.9 % ; 36.4 % of the men , 54.0 % of the women ) . Excluding insomnia , the overall psychiatric morbidity was 40.4 % ( 30.9 % m , 43.8 % w ) . Excluding clinical diagnoses that were not otherwise specified in the DSM-III-R , the overall prevalence of specified DSM-III-R diagnoses was 23.5 % ( 16.3 % m , 26.0 % w ) . Excluding dementia , which is known to be age-related , the prevalence was 11.3 % ( 8.5 % m , 12.2 % w ) and no significant effect between the age groups was seen . A considerable proportion of clinical ly relevant psychiatric morbidity in the elderly does not meet the criteria of specified DSM-III-R diagnoses , although these cases are in need of care . The data show that the threshold and severity of caseness accounts for important differences when overall psychiatric morbidity is assessed Patients with chronic obstructive pulmonary disease ( COPD ) often report anxiety , depression and poor health status , not least if they experience repeated hospitalisations due to acute exacerbations . The aim of this study was to analyse the interrelationships between health status , anxiety , depression and physical status in COPD patients being discharged after hospitalisation . This was a prospect i ve study of 416 patients in five university hospitals in each of the Nordic countries . Data included demographic information , lung function and co-morbidity . The  Hospital Anxiety and Depression Scale and St. George 's Respiratory Question naire ( SGRQ )  were applied to all patients . Both anxiety and depression were common among these patients . Anxiety was more common in women than in men ( 47 % vs. 34 % , P=0.009 ) and current smokers had a higher prevalence of both anxiety ( 54 % vs. 37 % ) and depression ( 43 % vs. 23 % ) than non-smokers ( P<0.01 ) . In general , the studied COPD patients had poor health status , especially those with anxiety , depression or both . Psychological status was independently related to all dimensions of SGRQ . Higher GOLD stages were significantly associated with increasing impairment in health status . In conclusion this multicentre study showed that anxiety and depression are common in patients with COPD , and , furthermore , that patients with psychological disorders have poor health status . Screening for depression and anxiety may help to identify patients with poor quality of life and an urgent need for intervention in order to improve their health status AIMS We examined the management of depression by general practitioners ( GPs ) , through the use of case vignettes , in patients with chronic obstructive pulmonary disease ( COPD ) , severe osteoarthritis and depressive symptoms alone . BACKGROUND Depression is common in patients with COPD . Untreated depression leads to poor compliance with medical treatment and increases health-care utilisation . METHODS We surveyed a r and om sample of GPs ( n = 3956 ) in Engl and using a postal question naire . The question naire explored how GPs would approach the management of emotional distress in patients with and without a chronic condition and gauged their views of and experiences with depression in patients with COPD . FINDINGS A total of 864 completed responses were received ( 22 % ) . In the vignettes , a significantly greater percentage of GPs reported that they would explore or offer the diagnosis of depression in a patient with COPD ( 95.4 % ) compared with patients with either severe osteoarthritis ( 88.3 % ) or depressive symptoms alone ( 86.3 % ) . In each case , the vast majority of GPs reported that they would explore a diagnosis of depression using a clinical diagnostic tool . The preferred method of treatment , if offered , in all three cases was a combination of anti-depressant drugs and psychological therapy . GPs endorsed the importance of routinely screening for depression in patients who have COPD and acknowledged that depression impairs patient self-management of COPD .In conclusion , GPs in Engl and were able to diagnose depression from the vignettes and plan appropriate treatment strategies in patients with chronic diseases . This should be complemented with thorough physical examination by GPs to rule out other factors such as the impact of physical illness . GPs believe depression interferes with patient self-management of COPD OBJECTIVE Screening for mental illness in primary care is widely recommended , but little is known about the evaluation , treatment , and long-term management processes that follow screening . The aim of this study was to examine and describe the quality of mental health care for persons with chronic obstructive pulmonary disease ( COPD ) and anxiety/depressive disorders , as measured by adherence to practice guidelines . METHOD This retrospective chart review examined data for 102 primary care and mental health care patients with COPD who were diagnosed , using Structured Clinical Interview for DSM-IV criteria , with major depressive disorder , dysthymia , depression not otherwise specified , generalized anxiety disorder , or anxiety not otherwise specified . Data were gathered from primary care progress notes from the year prior to enrollment in a r and omized controlled trial ( enrollment was from July 2002 to April 2004 ) . We compared the care received by these patients over 1 year with that recommended by practice guidelines . Charts were abstract ed using a checklist of recommended practice guidelines for diagnostic evaluation , acute treatment , and long-term management of anxiety and depressive disorders . RESULTS Fifty ( 49 % ) of the 102 patients were recognized during the review year as having an anxiety or depressive disorder .  Eighteen patients were newly assessed for depressive or anxiety disorders  during the chart review year . Patients followed in primary care alone , compared with those who were comanaged by mental health care providers , were less likely to have guideline -adherent care . CONCLUSION Depressive and anxiety disorders are recognized in about half of patients ; however , guideline -supported diagnostic evaluation , acute treatment ( except for medications ) , and long-term management rarely occur in the primary care setting . To improve the treatment of depressive and anxiety disorders in primary care , the process of care delivery must be understood and changed The reliability of psychiatric diagnoses made remotely by telecommunication was examined . Two trained interviewers each interviewed the same 30 psychiatric in patients using the Structured Clinical Interview for DSM-III-R. Fifteen subjects had two in-person interviews , and 15 subjects had one in-person and one remote interview via telecommunication .  Interrater reliability was calculated for the four most common diagnoses : major depression , bipolar disorder , panic disorder , and alcohol dependence . For each diagnosis , interrater reliability ( kappa statistic ) was identical or almost identical for the patients who had two in-person interviews and those who had an in-person and a remote interview , suggesting that reliable psychiatric diagnoses can be made via telecommunication BACKGROUND We hypothesized that compared to an educational intervention , a single 2 h session of cognitive behavioural therapy ( CBT ) , with 6-week follow-up , would reduce anxiety and depression , improve physical and mental functioning , and lead to a better quality of life and greater satisfaction with treatment in older patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Fifty-six subjects were recruited from a large , urban , academically affiliated Veterans Affairs ( VA ) Hospital , a non-profit private hospital , and a local newspaper , for a single blind r and omized controlled clinical trial . One 2 h session of group CBT was design ed to reduce symptoms of anxiety , with specific components including relaxation training , cognitive interventions , and graduated practice , followed by homework and weekly calls for 6 weeks . This was compared to a group that received 2 h of COPD education , followed by weekly calls . Pre- and post-intervention subjects in both groups were administered SF-36 , Geriatric Depression Scale , Beck Anxiety Inventory , 6 min walk test , and the FEV-1 . Following the intervention , both groups completed the Client Satisfaction Question naire . RESULTS When compared with a group that received education about COPD , 2 h CBT group showed decreased depression and anxiety . Contrary to our hypothesis , despite the decrease in depression and anxiety , there was no change in the physical functioning of the patients . CONCLUSIONS Twenty to 40 % of patients with COPD have high levels of anxiety and depression . Our study finds that as little as 2 h of CBT administered in a group setting is able to reduce these anxious and depressive symptoms BACKGROUND Anxious depression , defined as Major Depressive Disorder ( MDD ) with high levels of anxiety symptoms , may represent a relatively common depressive subtype , with distinctive features . OBJECTIVE The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns . METHOD Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study . A baseline Hamilton Rating Scale for Depression ( HAM-D ) Anxiety/ Somatization factor score of > or = 7 was considered indicative of anxious depression . The types and degree of concurrent psychiatric symptoms were measured using the  Psychiatric Diagnostic Screening Question naire ( PDSQ ) , by recording the number of items endorsed by study participants for each diagnostic category . MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology ( IDS-C30 ) . RESULTS The prevalence of anxious depression in this population was 46 % . Patients with  anxious MDD were significantly more likely to be older , unemployed , less educated , more severely depressed , and to have suicidal ideation before and after adjustment for severity of depression . As far as concurrent psychiatric symptoms are concerned , patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety , obsessive compulsive , panic , post-traumatic stress , agoraphobia , hypochondriasis , and somatoform disorders before and after adjustment for severity of depression . Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features , and were significantly more likely to endorse items concerning melancholic/endogenous depression features . CONCLUSION This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety ( anxious depression ) 
    Output:
    
CONCLUSIONS : There is a high prevalence of clinical anxiety in patients with COPD .
Social phobia and specific phobia appear to be particularly prevalent , yet they have received little attention within existing literature .