***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: Study objective : To determine the association between a clinician assessment of temperament in early adulthood and cause specific mortality . Design : Prospect i ve observational study . Setting : Glasgow University . Participants : 9239 male former students aged 16–30 ( mean 20.5 ) years who participated in an ongoing health survey from 1948–68 . A physician recorded free text assessment of temperament , which seemed to capture aspects of personality ( trait ) and mental health ( state ) , was coded into : stable , anxious , schizoid , hypomanic , odd , depressed , immature , hypochondriacal , unstable , and obsessive . Associations between temperament and mortality were investigated using Cox proportional hazards models . Main results : There were 878 deaths . Most students—8342 (90.3%)—were assessed as stable , the remaining 897 ( 9.7 % ) having at least one , and 103 ( 1.1 % ) having more than one , temperament type . The second most common temperament was anxiety , recorded in 520 ( 5.6 % ) students . In multivariable analyses , having at least one temperament type was associated with increased all cause and stroke mortality , hazard ratios ( 95 % confidence intervals ) : 1.23 ( 1.01 to 1.50 ) and 1.95 ( 1.06 to 3.59 ) respectively , compared with stable students . Students with more than one temperament type had higher risk of death from : all causes , 2.05 ( 1.36 to 3.09 ) ; stroke , 3.26 ( 1.01 to 10.56 ) ; and cancer , 2.90 ( 1.62 to 5.20 ) . Anxiety was positively associated with all cause and cancer mortality , respective hazard ratios : 1.36 ( 1.07 to 1.72 ) and 1.51 ( 1.04 to 2.20 ) . Men labelled hypomanic had increased cardiovascular mortality risk , 1.90 ( 1.05 to 3.44 ) . Conclusions : Markers of early adult psychological distress are associated with increased mortality . Mechanisms underlying these associations require investigation Background : Social anxiety disorder ( SAD ) is characterized by distorted self-views . The goal of this study was to examine whether mindfulness-based stress reduction ( MBSR ) alters behavioral and brain measures of negative and positive self-views . Methods : Fifty-six adult patients with generalized SAD were r and omly assigned to MBSR or a comparison aerobic exercise ( AE ) program . A self-referential encoding task was administered at baseline and post-intervention to examine changes in behavioral and neural responses in the self-referential brain network during functional magnetic resonance imaging . Patients were cued to decide whether positive and negative social trait adjectives were self-descriptive or in upper case font . Results : Behaviorally , compared to AE , MBSR produced greater decreases in negative self-views , and equivalent increases in positive self-views . Neurally , during negative self versus case , compared to AE , MBSR led to increased brain responses in the posterior cingulate cortex ( PCC ) . There were no differential changes for positive self versus case . Secondary analyses showed that changes in endorsement of negative and positive self-views were associated with decreased social anxiety symptom severity for MBSR , but not AE . Additionally , MBSR-related increases in dorsomedial prefrontal cortex ( DMPFC ) activity during negative self-view versus case were associated with decreased social anxiety related disability and increased mindfulness . Analysis of neural temporal dynamics revealed MBSR-related changes in the timing of neural responses in the DMPFC and PCC for negative self-view versus case . Conclusion : These findings suggest that MBSR attenuates maladaptive habitual self-views by facilitating automatic ( i.e. , uninstructed ) recruitment of cognitive and attention regulation neural networks . This highlights potentially important links between self-referential and cognitive-attention regulation systems and suggests that MBSR may enhance more adaptive social self-referential processes in patients with SAD BACKGROUND Escitalopram , the therapeutically active isomer of the racemic selective serotonin reuptake inhibitor antidepressant citalopram , has shown significant anxiolytic effects in placebo-controlled clinical trials of social anxiety disorder , generalized anxiety disorder , and anxiety symptoms associated with major depression . This study evaluated the safety and efficacy of escitalopram in out patients diagnosed with panic disorder . METHOD Male and female out patients between 18 and 80 years of age meeting DSM-IV criteria for panic disorder , with or without agoraphobia , were r and omly assigned to 10 weeks of double-blind treatment with escitalopram , citalopram , or placebo in a study conducted from September 1999 to July 2001 . The primary measure of efficacy was panic attack frequency at week 10 relative to baseline , as assessed by the Modified Sheehan Panic and Anticipatory Anxiety Scale . RESULTS A total of 366 subjects ( 128 escitalopram patients , 119 citalopram patients , and 119 placebo patients ) received at least 1 dose of double-blind treatment . The frequency of panic attacks was statistically significantly improved ( p = .04 ) , and the increase in percentage of patients with zero panic attacks reached borderline significance ( p = .051 ) , in the escitalopram-treated group relative to the placebo-treated group . Both escitalopram and citalopram statistically significantly reduced panic disorder symptoms and severity versus placebo at endpoint ( p < /=.05 ) , as measured by the Panic and Agoraphobia Scale total score , the Clinical Global Impressions scale , the Patient Global Evaluation , and the Quality of Life Enjoyment and Satisfaction Question naire . Treatment with escitalopram was safe and well tolerated , with a similar incidence of the most common adverse events for the escitalopram and placebo groups . The rate of discontinuation for adverse events was 6.3 % for escitalopram , 8.4 % for citalopram , and 7.6 % for placebo . CONCLUSION Escitalopram is efficacious , safe , and well tolerated in the treatment of panic disorder OBJECTIVES The aim of the study was to determine the status of the autonomic nervous system ( ANS ) in anxiety disorder patients and to evaluate possible exercise intervention in order to improve the ANS and overall psychiatric status of patients . PATIENTS AND METHODS The ANS function was monitored via means of heart rate variability ( HRV ) changes during a 6-week hospitalization at the Psychiatric Clinic of University Hospital in Olomouc . The status of ANS was monitored by the new evaluation method of spectral analysis ( SA ) of HRV . The research involved 43 anxiety patients ( 29 women and 14 men ) who underwent six weeks of intensive psychotherapy ;  part of the test group also participated in regular aerobic exercise . RESULTS In the sense of autonomic dysfunction we can not give clear-cut answers to the question whether the autonomic dysfunction could be one of the predictors of anxiety disorder , although our results suggest lower vagal representation in the spectra . Unlike in the healthy population the exercise had a positive impact only on a limited number of patients . Regular endurance exercise on a stationary bicycle had a positive impact on the ANS efficiency only in patients with primary ANS activity reduction . In patients with normal ANS efficiency the exercise intervention had no effect ; in some cases we even found activity reduction during the hospitalization period . However , the exercise had a positive effect on the course and outcome of the applied therapy in all patients . CONCLUSIONS ANS disturbances have not been exhibited in some patients suffering from anxiety disorder . Due to the positive impact of regular physical activity on cardiovascular , metabolic , neural , and psychological changes in organism , monitored exercise should be implemented into therapeutic programs for patients with anxiety disorders Background : Interrelations of exercise , mood , and weight reduction are unclear in the behavioral treatment of obesity . Methods : Obese women volunteers with high tension ( anxiety ) ( T ) , depression ( D ) , or total mood disturbance ( TMD ) scores , who were previously r and omized into conditions of ( 1 ) exercise supported by The Coach Approach : a protocol based on social cognitive and self-efficacy theory ( CA ; n = 53 , 66 , and 60 , respectively ) , ( 2 )  personal demonstration and follow up of exercise methods ( EX ; n = 27 , 27 , and 21 , respectively ) , and ( 3 ) exercise suggested through written information only ( INFO ; n = 24 , 28 , and 20 , respectively ) , were subjects . Identical nutrition information was provided to all subjects in a small group format . Results : Minutes of exercise over the 6-month study were greatest in the CA condition , with minutes in the EX condition greater than the INFO condition . T , D , and TMD scores were reduced to normal levels mostly in the CA condition , with the EX condition having significantly more normalized D scores than the INFO . Across conditions , normalized mood scores generally predicted a greater reduction in waist circumference , with CA associated with additional benefits when D scores were considered . Conclusion : Properly accounting for exercise-induced mood change may be important in the behavioral treatment of obesity Background : Exercise training may be especially helpful for patients with generalized anxiety disorder ( GAD ) . We conducted a r and omized controlled trial to quantify the effects of 6 weeks of resistance ( RET ) or aerobic exercise training ( AET ) on remission and worry symptoms among sedentary patients with GAD . Methods : Thirty sedentary women aged 18–37 years , diagnosed by clinicians blinded to treatment allocation with a primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy , were r and omly allocated to RET , AET , or a wait list ( WL ) . RET involved 2 weekly sessions of lower-body weightlifting . AET involved 2 weekly sessions of leg cycling matched with RET for body region , positive work , time actively engaged in exercise , and load progression . Remission was measured by the number needed to treat ( NNT ) . Worry symptoms were measured by the Penn State Worry Question naire . Results : There were no adverse events . Remission rates were 60 % , 40 % , and 30 % for RET , AET , and WL , respectively . The NNT was 3 ( 95 % CI 2 to 56 ) for RET and 10 ( 95 % CI –7 to 3 ) for AET . A significant condition-by-time interaction was found for worry symptoms . A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL . Conclusions : Exercise training , including RET , is a feasible , low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an effective adjuvant , short-term treatment or augmentation for GAD . Preliminary findings warrant further investigation BACKGROUND Several studies have suggested an increased risk of fatal coronary heart disease ( CHD ) among patients with panic disorder , phobic anxiety , and other anxiety disorders . We prospect ively examined this association in the Normative Aging Study . METHODS AND RESULTS An anxiety symptoms scale was constructed out of five items from the Cornell Medical Index , which was administered to the cohort at baseline . During 32 years of follow-up , we observed 402 cases of incident coronary heart disease ( 137 cases of nonfatal myocardial infa rct ion , 134 cases of angina pectoris , and 131 cases of fatal CHD : made up of 26 cases of sudden cardiac death and 105 cases of nonsudden death ) . A nested case-control design ( involving 1869 control subjects who remained free of diagnosed CHD ) was used to assess the association between anxiety and risk of CHD . Compared with men reporting no symptoms of anxiety , men reporting two or more anxiety symptoms had elevated risks of fatal CHD ( age-adjusted odds ratio [ OR ] = 3.20 , 95 % confidence interval [ CI ] : 1.27 to 8.09 ) , and sudden death ( age-adjusted OR = 5.73 , 95 % CI : 1.26 to 26.1 ) . The multivariate OR after adjusting for a range of potential confounding variables was 1.94 ( 95 % CI : 0.70 - 5.41 ) for fatal CHD and 4.46 ( 95 % CI : 0.92 - 21.6 ) for sudden death . No excess risks were found for nonfatal myocardial infa rct ion or angina . CONCLUSIONS These data suggest an association between anxiety and fatal coronary heart disease , in particular , sudden cardiac death Background : Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder ( PD ) . The efficacy of this intervention has so far not been compared to an established psychotherapy , such as cognitive behaviour therapy ( CBT ) . Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking . Aim : To compare physical exercise to CBT as treatment for PD , and assess controlled long-term and clinical ly significant effects . Method : PD- patients were r and omized to either three weekly sessions of physical exercise ( n = 17 ) , or one weekly session of CBT ( n = 19 ) . Both treatments ran for 12 weeks , were manualized and administered in groups . Patients were assessed twice before the start of treatment , at post-treatment and at 6 and 12 months thereafter . Primary outcome - measures consisted of the Mobility Inventory ( MI ) , the Agoraphobia Cognitions Question naire ( ACQ ) and the Body Sensations Question naire ( BSQ ) . Results : A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time , F(16 , 
    Output:
    
Conclusions Exercise may be a useful treatment for anxiety , but lack of data from rigorous , method ologically sound RCTs precludes any definitive conclusions about its effectiveness