Anxiety Disorder Research

 1: Clin J Pain. 2009 May;25(4):307-12.  Pain in persons living with HIV and comorbid psychologic and substance use disorders.  Tsao JC, Soto T.  Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. jtsao@mednet.ucla.edu  OBJECTIVES: There is a dearth of information on the experience of pain in persons living with human immunodeficiency virus (HIV) and cooccurring psychologic and substance use problems. This study examined the prevalence and correlates of pain in 162 HIV-positive persons diagnosed with mood and/or anxiety disorders and substance use disorders. METHODS: Bodily pain scores in the current sample were compared with pain scores in the United States general population and HIV-positive persons who screened negative for psychologic and substance use problems. Bivariate analyses were used to identify significant correlates of pain scores in the current sample, which were then subjected to multiple regression analysis. RESULTS: Pain scores in the current sample were significantly lower (indicating more pain) than the general population and HIV-positive persons who screened negative for psychologic and substance use problems. Multivariate analysis indicated that the presence of mood disorder, older age, and lower CD4 cell counts (below 200) were associated with increased pain. Presence of mood disorder accounted for the largest amount of unique variance in pain scores. DISCUSSION: HIV-positive persons with diagnosed mood/anxiety and substance use disorders reported substantially higher levels of pain than the general population and HIV-positive persons without these comorbid conditions. The presence of mood disorder emerged as an important marker for pain in the current  sample. Given that individuals living with HIV and comorbid psychologic and substance use disorders are at increased risk for pain, concerted efforts should  be directed at identifying and treating pain in this population.  Publication Types:      Research Support, N.I.H., Extramural  PMID: 19590479 [PubMed - in process]  2: Biol Psychiatry. 2009 Jul 7. [Epub ahead of print]  Bcl-2 Polymorphism Influences Gray Matter Volume in the Ventral Striatum in Healthy Humans.  Salvadore G, Nugent AC, Chen G, Akula N, Yuan P, Cannon DM, Zarate CA Jr, McMahon FJ, Manji HK, Drevets WC.  Mood and Anxiety Disorders Program, National Institute of Mental Health, Department of Health and Human Services, Bethesda, Maryland.  BACKGROUND: Bcl-2 is a major regulator of neural plasticity and cellular resilience. A single nucleotide polymorphism (SNP) in the Bcl-2 gene, Bcl-2 rs956572, significantly modulates the expression of Bcl-2 protein and cellular vulnerability to apoptosis. We tested the hypothesis that this SNP would modulate gray matter (GM) volume in the limbic-cortical-striatal-pallidal-thalamic circuitry that plays major roles in mood regulation. METHODS: Forty-seven healthy subjects participated in this study (30 A carriers, 17 G homozygotes). Neuromorphometric differences between G homozygotes and A carriers were investigated using optimized voxel-based morphometry (VBM). Statistical significance was set at p < .05, corrected for multiple comparisons. RESULTS: A carriers showed less GM volume than G homozygotes in the left ventral striatum (p(corrected) < .05). CONCLUSIONS: Genetic variation in the Bcl-2 gene modulates  GM volume in areas known to play key roles in the neurobiology of reward processes and emotion regulation and in the pathophysiology of mood disorders. Thus, the findings from the current study are noteworthy insofar as they converge with preclinical findings that Bcl-2 functions to enhance neuronal viability and  might indirectly extend this evidence to humans.  PMID: 19589501 [PubMed - as supplied by publisher]  3: Neuropharmacology. 2009 Jul 6. [Epub ahead of print]  Chronic icv oxytocin attenuates the pathological high anxiety state in female high anxiety-related behaviour rats.  Slattery DA, Neumann ID.  Department of Molecular and Behavioural Neuroendocrinology, University of Regensburg, Regensburg, Germany.  Central oxytocin (OXT) has been shown to promote numerous social behaviours, to attenuate hormonal stress responsiveness of the HPA axis and to decrease anxiety. Wistar rats selectively bred for high (HAB) and low (LAB) anxiety-related behaviour, respectively, have been shown to represent a suitable animal model to  study the underlying aetiology of psychopathologies like anxiety- and depression-related disorders. The goal of the present studies was to assess the effects of central OXT on anxiety and depression-related behaviour in male and female HAB and LAB rats. Acute icv OXT (1 mug) or OXT receptor antagonist (OXT-A; 0.75 mug) administration did not affect anxiety-related behaviour in male or female HAB and LAB rats as assessed in the light-dark box. In contrast, chronic icv OXT infusion (10 ng/h; 7d) attenuated the high level of anxiety-related behaviour in female, but not male, HAB rats, whereas chronic OXT-A infusion (7.5  ng/h; 7d) increased anxiety-related behaviour in female, but not male, LAB rats.  Neither acute nor chronic manipulation of the OXT system altered depression-related behaviour in the forced swim test. Combined, these results suggest that pharmacological manipulation of the brain OXT system is effective to attenuate extremes in trait anxiety in an animal model of psychopathological anxiety. Moreover, the data indicate that differences in the activity of the brain OXT systems between HAB and LAB rats may, at least partially, contribute to the opposing anxiety but not depression-related behaviour.  PMID: 19589349 [PubMed - as supplied by publisher]  4: Expert Rev Neurother. 2009 Jul;9(7):1021-34.  sigma-1 receptors in major depression and anxiety.  Kulkarni SK, Dhir A.  Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160 014, India. skpu@yahoo.com  Major depression and anxiety are two of the major psychiatric disorders that have some overlapping pathophysiologies, the most significant being the dysfunction in the monoaminergic, GABAergic and glutamatergic systems. A large number of drugs that alter these neurotransmitter levels/systems are effective in the treatment of major depression and anxiety. However, full remission of the clinical symptoms has not been achieved, perhaps owing to the complex pathophysiology of the diseases. Thus, the search for newer targets and target-specific drugs continues. Recently, the role of sigma-receptors, particularly the sigma-1 receptor subtype, has been identified as a target for the pathophysiology of neuropsychiatric disorders, and sigma-1 receptor modulators are considered to be the drugs of the  future for the treatment of major depression and anxiety. The present review attempts to discuss the role of sigma-1 receptors in the pathophysiology of major depression and anxiety and also tries to position the use of its receptor modulators in the treatment of these two major disorders. The role of sigma-1 receptors in the mechanism of antidepressant action of venlafaxine, bupropion, neurosteroids and one of the herbal antidepressants, berberine, is reviewed. Although, sigma-1 receptor modulators may be future therapeutic options, either as individual agents or adjuvants in the treatment of mental disorders, the topic needs further preclinical and clinical exploration.  PMID: 19589051 [PubMed - in process]  5: Expert Rev Neurother. 2009 Jul;9(7):957-66.  Clinical implications of a staging model for bipolar disorders.  Kapczinski F, Dias VV, Kauer-Sant'Anna M, Frey BN, Grassi-Oliveira R, Colom F, Berk M.  Bipolar Disorders Program, Laboratory of Molecular Psychiatry and INCT Translational Medicine, Hospital de Clinicas de Porto Alegre, Avenida Ramiro Barcelos 2350, 90035-903 PortoAlegre RS, Brazil. kapcz@terra.com.br  A model of staging in the field of bipolar disorder (BD) should offer a means for clinicians to predict response to treatment and more general outcome measures, such as the level of functioning and autonomy. The present staging model emphasizes the assessment of patients in the interepisodic period and includes: latent phase: individuals who present mood and anxiety symptoms and increased risk for developing threshold BD; Stage I--patients with BD who present well established periods of euthymia and absence of overt psychiatric morbidity between episodes; Stage II--patients who present rapid cycling or current axis I  or II comorbidities; Stage III--patients who present a clinically relevant pattern of cognitive and functioning deterioration, as well as altered biomarkers; and Stage IV--patients who are unable to live autonomously and present altered brain scans and biomarkers. Such a model implies a longitudinal appraisal of clinical variables, as well as assessment of neurocognition and biomarkers in the interepisodic period. Staging facilitates understanding of the  mechanisms underlying progression of the disorder, assists in treatment planning  and prognosis and, finally, underscores the imperative for early intervention.  PMID: 19589046 [PubMed - in process] 

 1: Arch Suicide Res. 2009;13(3):247-56.  Are high-lethality suicide attempters with bipolar disorder a distinct phenotype?  Oquendo MA, Carballo JJ, Rajouria N, Currier D, Tin A, Merville J, Galfalvy HC, Sher L, Grunebaum MF, Burke AK, Mann JJ.  Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY 10032, USA. mao4@columbia.edu  Because Bipolar Disorder (BD) individuals making highly lethal suicide attempts have greater injury burden and risk for suicide, early identification is critical. BD patients were classified as high- or low-lethality attempters. High-lethality attempts required inpatient medical treatment. Mixed effects logistic regression models and permutation analyses examined correlations between lethality, number, and order of attempts. High-lethality attempters reported greater suicidal intent and more previous attempts. Multiple attempters showed no pattern of incremental lethality increase with subsequent attempts, but individuals with early high-lethality attempts more often made high-lethality attempts later. A subset of high-lethality attempters make only high-lethality attempts. However, presence of previous low-lethality attempts does not indicate  that risk for more lethal, possibly successful, attempts is reduced.  Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't  PMID: 19590998 [PubMed - in process]  2: Med Hypotheses. 2009 Jul 7. [Epub ahead of print]  Is 'bipolar disorder' the brain's autopoietic response to schizophrenia?  Llewellyn S.  Faculty of Humanities, The University of Manchester, Booth Street West, Manchester M15 6PB, UK.  Evidence is accumulating that schizophrenia and bipolar disorder are related conditions. This paper proposes a particular form of relatedness. If 'schizophrenia' is a mind/brain 'trapped' between waking and dreaming, in a disordered in-between state, then bipolar 'disorder' could actually be an attempt to restore order. The mind/brain is a self-producing, self-organizing system. Autopoiesis applies to such systems. Neuromodulation accomplishes self-organization in the mind/brain. If schizophrenia is a state in-between waking and dreaming, characterized by aminergic/cholinergic interpenetration and  dopaminergic imbalance then bipolar 'disorder' could be a modulatory response. This autopoietic reaction may take the form of either aminergic hyperactivity aimed at producing a purer waking state, (precipitating mania in the waking state), or cholinergic hyperactivity aimed at producing a purer dreaming state, (producing depression in the waking state), or both, resulting in rapid cycling bipolar disorder. Thus bipolar activity may be an autopoietic response aimed at restoring differentiation to the in-between state of schizophrenia.  PMID: 19589644 [PubMed - as supplied by publisher]  3: Expert Rev Neurother. 2009 Jul;9(7):1045-58.  Olanzapine dosing above the licensed range is more efficacious than lower doses:  fact or fiction?  Citrome L, Kantrowitz JT.  Nathan S Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA. citrome@nki.rfmh.org  A substantial number of patients with schizophrenia or bipolar disorder receive olanzapine in amounts that are greater than what is recommended in the product labeling approved by drug regulatory agencies. The purpose of this review is to describe the evidence supporting the use of olanzapine in excess of 20 mg/day. PubMed was queried using the keywords 'olanzapine' and 'dose' or 'dosing' for all English-language articles published between 1990 and December 2008, inclusive of  articles that describe utilization of olanzapine at doses in excess of 20 mg/day. Also queried was clinicaltrials.gov for studies involving 'olanzapine'. Efficacy  and safety data were extracted from case reports, case series, observational studies and double-blind, randomized clinical trials. We found that the use of olanzapine at doses greater than 20 mg/day appears to be increasing. Among patients hospitalized for intermediate and long-term care in New York State psychiatric centers in the period from 1997 to 2003, the average dose of olanzapine increased from 17.4 to 22.5 mg/day. The percentage of patients receiving olanzapine at a dose exceeding 20 mg/day increased from 16.2 to over 50% from 1997 to 2006. Case reports of patients receiving doses up to 60 mg/day describe a favorable benefit-risk ratio. Double-blind clinical trials that have examined doses of olanzapine greater than 20 mg/day are limited in number, but suggest that these doses may be helpful in selected patients who are treatment resistant, have high levels of psychopathology or who are acutely agitated. This  must be balanced by an increased risk of weight gain and elevated prolactin that  was observed among those receiving 40 mg/day in a large randomized clinical trial comparing doses of 40 versus 20 versus 10 mg/day. In conclusion, dosing of olanzapine in clinical practice is higher than what has been established in the registration program for schizophrenia or bipolar disorder. This is somewhat supported by double-blind, controlled clinical trial evidence, but only for selected patients with severe and/or persistent symptoms.  PMID: 19589053 [PubMed - in process]  4: Expert Rev Neurother. 2009 Jul;9(7):957-66.  Clinical implications of a staging model for bipolar disorders.  Kapczinski F, Dias VV, Kauer-Sant'Anna M, Frey BN, Grassi-Oliveira R, Colom F, Berk M.  Bipolar Disorders Program, Laboratory of Molecular Psychiatry and INCT Translational Medicine, Hospital de Clinicas de Porto Alegre, Avenida Ramiro Barcelos 2350, 90035-903 PortoAlegre RS, Brazil. kapcz@terra.com.br  A model of staging in the field of bipolar disorder (BD) should offer a means for clinicians to predict response to treatment and more general outcome measures, such as the level of functioning and autonomy. The present staging model emphasizes the assessment of patients in the interepisodic period and includes: latent phase: individuals who present mood and anxiety symptoms and increased risk for developing threshold BD; Stage I--patients with BD who present well established periods of euthymia and absence of overt psychiatric morbidity between episodes; Stage II--patients who present rapid cycling or current axis I  or II comorbidities; Stage III--patients who present a clinically relevant pattern of cognitive and functioning deterioration, as well as altered biomarkers; and Stage IV--patients who are unable to live autonomously and present altered brain scans and biomarkers. Such a model implies a longitudinal appraisal of clinical variables, as well as assessment of neurocognition and biomarkers in the interepisodic period. Staging facilitates understanding of the  mechanisms underlying progression of the disorder, assists in treatment planning  and prognosis and, finally, underscores the imperative for early intervention.  PMID: 19589046 [PubMed - in process]  5: Expert Rev Neurother. 2009 Jul;9(7):949-55.  Corpus callosum abnormalities in pediatric bipolar disorder.  Baloch HA, Brambilla P, Soares JC.  Department of Psychiatry, 10616 Neuroscience Hospital CB#7160, UNC School of Medicine, Chapel Hill, NC 27599-7160, USA. baloch@med.unc.edu  The corpus callosum (CC) is a midline white matter brain region that is important in interhemispheric communication and coordination. CC abnormalities are associated with a variety of psychiatric conditions, including increased vulnerability for psychotic illness, stressful early-life experiences, marijuana  use, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, borderline personality disorder, dementia, schizophrenia and bipolar disorder. CC abnormalities in bipolar disorder have been identified in both pediatric and adult populations. In adults, a consistent finding has been a reduction in CC size, as well as abnormal axonal orientation or structure. Axonal abnormalities have also been noted in pediatric populations, but overall CC size reductions have not thus far been demonstrated. Furthermore, there are unique gender differences in the expression of CC abnormalities in pediatric populations, possibly related to androgen changes during puberty. The protean number of conditions in which the CC is involved is reflective of its central role in normal brain function and its potential as an early marker of neuropathology in psychiatric illness. Specifically, in bipolar disorder it has the potential to be useful as an early preclinical marker of disease or disease risk.  PMID: 19589045 [PubMed - in process] 

 1: Afr J Psychiatry (Johannesbg). 2008 Aug;11(3):191-8.  A longitudinal comparative analysis of economic and family caregiver burden due to bipolar disorder.  Zergaw A, Hailemariam D, Alem A, Kebede D.  School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.  Objective: to explain comparatively how economic and family caregiver burden in families with bipolar disorder patients change overtime. Method: one year follow-up of economic and family caregiver burden was carried out on family caregivers of 190 bipolar, 55 diabetes, hypertension and asthma patients and 659  sick controls in the community. Population average generalized estimating equation was used to make longitudinal comparative analysis. Results: bipolar patient family caregivers were found to be more burdened, for about 8 to 10 months of the year of study, than family caregivers of diabetes, hypertension and asthma and sick controls in the community. The average difference in family caregiver burden score between bipolar and diabetes, hypertension and asthma patient family caregivers was 4.36 (z = -8.75, P>|z|= 0.001); while the difference due to time between the two groups was 3.42 (z= -4.27, P>|z|= 0.001).  Similarly, the average difference in family caregiver burden score between family caregivers of bipolar patient and sick controls in the community was 3.7 (z= -4.88, P>|z| 0.001). In terms of longitudinal caregiver burden difference, bipolar patients family caregivers were found to be more burdened than family caregivers of sick controls in the community with a burden score difference of 2.97 (z= -5.17, P>|z|= 0.001). Conclusion: more should be done to lessen the economic and family caregiver burden due to bipolar disorder.  PMID: 19588042 [PubMed - in process]  2: Clin Trials. 2009 Jul 8. [Epub ahead of print]  Increasing minority research participation through collaboration with community outpatient clinics: the STEP-BD community partners experience.  Kogan JN, Bauer MS, Dennehy EB, Miklowitz DJ, Gonzalez JM, Thompson PM, Sachs GS.  University of Pittsburgh School of Medicine.  BACKGROUND: Minority populations have been under-represented in mental health research studies. The systematic treatment enhancement program for bipolar disorder developed the Community Partners Program (CPP) to address this issue in  a large, prospective treatment study of persons with bipolar disorder. PURPOSE: The primary goal of CPP was to develop a community-based infrastructure for studying bipolar disorder that would enhance the ethnic/racial and socioeconomic  diversity of participants. METHODS: Selected academic sites partnered with local  clinics (n = 6 partnerships in five cities). This report describes the conceptualization, implementation, and qualitative evaluation of CPP, as well as  quantitative analysis of clinical and sociodemographic differences between the samples recruited at academic versus community sites. RESULTS: Quantitative analysis of the 155 participants from the six partnerships revealed enrollment of 45% from minority populations (vs. 15% in academic sites). Significant sociodemographic differences were evident not only between academic and community sites, but within minority and non-minority groups across site types. Notably, clinical differences were not evident between participants from academic and community sites. Review of qualitative data suggests that certain factors around  implementation of research protocols may enhance community participation. CONCLUSIONS: Moving research recruitment and participation into community sites was more successful in increasing minority enrollment than efforts to attract such individuals to academic sites. Recommendations for creating and maintaining  academic/community partnerships are given. LIMITATIONS: Several important variables were not considered including mood severity, hospitalization, or treatment differences. Minority participants were grouped by combining African American and Hispanics, which may have obscured subgroup differences. A derivation of standard qualitative methods was used in this study.  PMID: 19587069 [PubMed - as supplied by publisher]  3: Behav Brain Funct. 2009 Jul 8;5(1):28. [Epub ahead of print]  Evidence for the association of the DAOA (G72) gene with schizophrenia and bipolar disorder but not for the association of the DAO gene with schizophrenia.  Bass NJ, Datta SR, McQuillin A, Puri V, Choudhury K, Thirumalai S, Lawrence J, Quested D, Pimm J, Curtis D, Gurling HM.  ABSTRACT: BACKGROUND: Previous linkage and association studies have implicated the D-amino acid oxidase activator gene (DAOA)/G30 locus or neighbouring region of chromosome 13q33.2 in the genetic susceptibility to both schizophrenia and bipolar disorder. Four single nucleotide polymorphisms (SNPs) within the D-amino  acid oxidase (DAO) gene located at 12q24.11 have also been found to show allelic  association with schizophrenia. Methods: We used the case control method to test  for genetic association with variants at these loci in a sample of 450 patients with schizophrenia, 300 patients with bipolar disorder and 450 ancestrally matched supernormal controls all selected from the UK population. Results: Ten SNPs spanning the DAOA locus were genotyped in these samples. In addition three SNPs were genotyped at the DAO locus in the schizophrenia sample. Allelic association was detected between the marker rs3918342 (M23), 3' to the DAOA gene  and both schizophrenia (p=0.016) and bipolar disorder (p=0.038). A trend towards  association with schizophrenia was observed for two other DAOA markers rs3916967  (M14,p=0.055) and rs1421292 (M24,p=0.062). A test of association between a three  marker haplotype comprising of the SNPs rs778293 (M22), rs3918342 (M23) and rs1421292 (M24) and schizophrenia gave a global empirical significance of p=0.015. No evidence was found to confirm the association of genetic markers at the DAO gene with schizophrenia. Conclusions: Our results provide some support for a role for DAOA in susceptibility to schizophrenia and bipolar disorder.  PMID: 19586533 [PubMed - as supplied by publisher]  4: Clin Toxicol (Phila). 2009 Jul;47(6):517-24.  Chronic toxicology of cannabis.  Reece AS.  Medical School, University of Queensland, Highgate Hill, Brisbane, QLD, Australia. sreece@bigpond.net.au  INTRODUCTION: Cannabis is the most widely used illicit drug worldwide. As societies reconsider the legal status of cannabis, policy makers and clinicians require sound knowledge of the acute and chronic effects of cannabis. This review focuses on the latter. METHODS: A systematic review of Medline, PubMed, PsychInfo, and Google Scholar using the search terms "cannabis," "marijuana," "marihuana," "toxicity," "complications," and "mechanisms" identified 5,198 papers. This list was screened by hand, and papers describing mechanisms and those published in more recent years were chosen preferentially for inclusion in  this review. FINDINGS: There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use. Cannabis  has now been implicated in the etiology of many major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder, and an amotivational state. Respiratory conditions linked with cannabis include reduced  lung density, lung cysts, and chronic bronchitis. Cannabis has been linked in a dose-dependent manner with elevated rates of myocardial infarction and cardiac arrythmias. It is known to affect bone metabolism and also has teratogenic effects on the developing brain following perinatal exposure. Cannabis has been linked to cancers at eight sites, including children after in utero maternal exposure, and multiple molecular pathways to oncogenesis exist. CONCLUSION: Chronic cannabis use is associated with psychiatric, respiratory, cardiovascular, and bone effects. It also has oncogenic, teratogenic, and mutagenic effects all of which depend upon dose and duration of use.  PMID: 19586351 [PubMed - in process]  5: Pac Health Dialog. 2009 Feb;15(1):79-88.  Twelve-month prevalences of mental disorders and treatment contact among Cook Islanders resident in New Zealand.  Kokaua J, Wells JE.  Ministry of Health, Dunedin, New Zealand. jesse_kokaua@moh.govt.nz  OBJECTIVE: To show the 12 month prevalences of mental disorders, 12-month treatment contact and use of mental health services among Cook islanders resident in New Zealand. DATA: (A) The New Zealand Mental Health Survey (NZMHS) is a nationally representative face-to-face household survey, carried out in 2003-2004. It surveyed 12,992 New Zealand adults aged 16 or more including 2374 Pacflc peoples (500 Cook Islands Maori) and 2457 New Zealand Maori. (B) An extract from the Mental Health Information National Collection (MHINC). This is a national dataset that is reported to by mental health services around New Zealand. METHOD: Multiple logistic regression models are used to produce estimates from both sets of data. In the case of A) the NZMHS the results are weighted to account for different probabilities of selection and analysis takes account of the complex survey design. RESULTS: A previous paper and this one confirm that Cook Islanders experience high prevalence of mental disorders. However the difference is more attributable to their population age and gender structure or being New Zealand-born than from ethnicity. The prevalence was higher among New Zealand-born Cook Islanders than those born in the Cook Islands. Those born in the Islands with a disorder were less likely to have used a health  service for their mental health compared with others and much less likely to have visited a specialist mental health service. From MHINC, twelve month data on use  of mental health services shows: high use of acute inpatient and Forensic mental  health services by Cook Island clients but similar levels of community mental health services. Cook Islands clients were more commonly diagnosed with bipolar psychotic or schizophrenic disorders. They were also more likely to be diagnosed  with a substance disorder. CONCLUSION: In spfte of high levels of disorder Cook Islanders have low use of specialist mental health services. The exception to this is an over-representation in inpatient and forensic services. This experience of mental health services at the extreme end implies delayed or avoided treatment that has resulted in more serious levels of disorder among those Cook Islanders who are eventually seen by mental health services.  Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't  PMID: 19585737 [PubMed - in process] 

 1: Cochrane Database Syst Rev. 2009 Jul 8;(3):CD005170.  Pharmacotherapy for anxiety disorders in children and adolescents.  Ipser JC, Stein DJ, Hawkridge S, Hoppe L.  MRC Research Unit for Anxiety and Stress Disorders, University of Stellenbosch, PO Box 19063, Tygerberg, Western Cape, South Africa, 7505.  BACKGROUND: Anxiety disorders are a potentially disabling group of disorders which are prevalent in childhood and adolescence. The recognition of the early onset of anxiety disorders, and their successful treatment with medication in adults, has led to the growing interest in using medication for paediatric anxiety disorders. OBJECTIVES: To assess the efficacy and tolerability of medication for treating paediatric anxiety disorders. SEARCH STRATEGY: We searched the Cochrane Depression, Anxiety & Neurosis Group specialised register (CCDANCTR-Studies), MEDLINE (via PubMed 1966 to August 2008), EMBASE (1966 to August 2008), and PsycINFO (1972 to August 2008). Various electronic registers were searched for unpublished studies. Reference lists of retrieved articles were searched for additional studies. SELECTION CRITERIA: All randomised controlled trials (RCTs) of pharmacotherapy in childhood/adolescent anxiety disorders. DATA  COLLECTION AND ANALYSIS: Two raters independently assessed RCTs for inclusion in  the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. MAIN RESULTS: 22 short-term (<= 16 weeks) RCTs were included in the analysis (2519 participants). The majority of the trials assessed the efficacy of the SSRIs (N = 15).Medication and placebo response occurred in 58.1% and 31.5% of patients, respectively (Number of studies (N) = 14, Number needed to treat (NNT) = 4). Medication was more effective than placebo in reducing overall symptom severity in OCD in a post-hoc comparison (N = 7, Weighted Mean Difference (WMD) = -4.45, 95%CI = -5.94, -2.97, n = 765). Medication was less well tolerated than placebo overall, though the absolute proportion of participants who withdrew due to drug-related adverse events was low (4.9%). AUTHORS' CONCLUSIONS: Medication treatments can be effective in paediatric anxiety disorders, acting to reduce core symptoms, and should be considered as part of the treatment of these disorders. The greatest number of trials showing efficacy to date have assessed the SSRIs in treating paediatric OCD.There is no clear evidence to show that any particular class of medication is more effective or better tolerated than any other. As quantitative data was only  available for the SSRIs and venlafaxine the routine use of benzodiazepines cannot be recommended, especially given concerns of dependency and treatment -related emergent adverse events associated with this class of drugs.Future RCTs could help identify potential clinical moderators of treatment efficacy. Studies of the long-term efficacy of medication treatment, optimal dosage, as well as direct comparisons of pharmacotherapy and psychotherapy are also warranted.  PMID: 19588367 [PubMed - in process]  2: Arch Womens Ment Health. 2009 Jul 9. [Epub ahead of print]  Population-specific functional variant of the TPH2 gene 2755C>A polymorphism contributes risk association to major depression and anxiety in Chinese peripartum women.  Lin YM, Ko HC, Chang FM, Yeh TL, Sun HS.  Institute of Molecular Medicine, National Cheng Kung University Medical College,  1 University Road, Tainan, 70101, Taiwan.  The rate-limiting enzyme of serotonin biosynthesis, tryptophan hydroxylase 2 (TPH2), is one of the most promising candidate genes for psychiatric disorders. Although evidence strongly suggests that the TPH2 is significant in the etiology  of major depression and anxiety disorder, whether it also contributes to the etiology of peripartum major depression and anxiety disorder, a specific subtype  influenced considerably by other environmental factors like hormones, is unclear. This study investigated the role of TPH2 in the etiology of peripartum major depression and anxiety disorder in a Han Chinese population in Taiwan. Six single nucleotide polymorphisms were selected from previously profiled genetic information of TPH2 in Han Chinese. A cohort of postpartum Chinese women that included 117 patients with major depression, anxiety disorder, or both and 83 healthy controls were genotyped with selected TPH2 markers. The TPH2 2755A allele was found only in women with peripartum major depression and anxiety disorder (p  = 0.043) and exhibited a dominant gene action (p = 0.038) with an estimated disease risk of 1.73. Although the sample size is small, results from this study  suggest that the TPH2 C2755A polymorphism may represent a population-specific risk factor for peripartum major depression and anxiety disorder, perhaps by interacting with hormones.  PMID: 19588223 [PubMed - as supplied by publisher]  3: Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Jun;34(6):504-9.  [PTSD-positive screening and factors influencing the mental state in victims evacuated/ not evacuated from Wenchuan earthquake area within 1 month.]  [Article in Chinese]  Gao X, Luo X.  Mental Health Institute, Second Xiangya Hospital,Central South University, Changsha 410011,China xuepinggao@hotmail.com.  Objective To explore posttraumatic stress disorder (PTSD) positive screening and  factors influencing the mental state in victims who were evacuated/were not evacuated from Wenchuan earthquake area within 1 month.Methods The 3 groups included 235 victims who were not evacuated from Shifang territory (the incident  scene, Group A), 44 victims who were evacuated to Second Xiangya Hospital (the wounded, Group B) and 36 relatives (the relatives, Group C). The mental state of  all subjects was evaluated by Impact of Event Scale-Revised(IES-R)and other tools.Results (1) One month after the disaster, and the positive rate of PTSD screening in these survivors was 35.56%, the positive rate in women was significantly higher than that in men(chi(2)=16.27,P<0.001). The positive rate of PTSD screening in Group A, Group B and Group C was 39.15%, 31.82%, and 16.67%, respectively, with significant difference(chi(2)(mh)=5.243,P<0.05). Among the three groups which met the diagnosis criterion of PTSD symptoms, the scores for "numbness/avoidance symptom"and "excessive arousing symptom"in Group A were significantly higher than those in Group B and C (P<0.01). (2) The scores for "anxiety"and "depression"and "psychosomatic"symptoms in Group A and Group B were  significantly higher than those in Group C (P<0.05). (3) Gender, place of residence and evacuating from the earthquake area or not were factors of PTSD symptoms.Conclusion One month after the earthquake, the victims suffered psychologically. PTSD symptoms, anxiety and depression symptoms were their major  mental problems, more attention to especially women victims. The protection factors include dispersing victims to the secure place as soon as possible, expanding and strengthening society support. Early psychological interventions will help victims to raise their psychological endurance and prevent PTSD effectively.  Publication Types:      English Abstract  PMID: 19587432 [PubMed - in process]  4: J Neurosci. 2009 Jul 8;29(27):8798-804.  Role of calcitonin gene-related peptide in light-aversive behavior: implications  for migraine.  Recober A, Kuburas A, Zhang Z, Wemmie JA, Anderson MG, Russo AF.  Department of Neurology, University of Iowa, Iowa City, Iowa 52242, USA.  Migraine is a chronic neurological disorder characterized by recurrent episodes of severe unilateral throbbing head pain and associated symptoms, such as photophobia. Our current understanding of the mechanisms underlying migraine has  been hampered by limitations in ascertaining migraine symptoms in animal models.  Clinical studies have established the neuropeptide calcitonin gene-related peptide (CGRP) as a key player in migraine. Here, we establish a genetic model of photophobia by engineering increased sensitivity to CGRP in mice. These transgenic mice (nestin/hRAMP1) display light-aversive behavior that is greatly enhanced by intracerebroventricular injection of CGRP and blocked by coadministration of the CGRP receptor antagonist olcegepant. This behavior appears to be an indicator of photophobia and cannot be fully explained by gross  abnormality of ocular anatomy or differences in general anxiety or motor activity. Our findings demonstrate that a single gene, receptor activity-modifying protein 1 (RAMP1), can be a modifier of photophobia and, by extension, suggest that genetic or epigenetic modulation of RAMP1 levels may contribute to migraine susceptibility. Moreover, they validate CGRP hypersensitive mice as a tool for exploring the neurobiology and novel therapies  for migraine and other disorders involving photophobia.  Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't  PMID: 19587287 [PubMed - in process]  5: J Neurosci. 2009 Jul 8;29(27):8752-63.  A triplet repeat expansion genetic mouse model of infantile spasms syndrome, Arx(GCG)10+7, with Interneuronopathy, spasms in infancy, persistent seizures, and adult cognitive and behavioral impairment.  Price MG, Yoo JW, Burgess DL, Deng F, Hrachovy RA, Frost JD Jr, Noebels JL.  Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA.  Infantile spasms syndrome (ISS) is a catastrophic pediatric epilepsy with motor spasms, persistent seizures, mental retardation, and in some cases, autism. One of its monogenic causes is an insertion mutation [c.304ins (GCG)(7)] on the X chromosome, expanding the first polyalanine tract of the interneuron-specific transcription factor Aristaless-related homeobox (ARX) from 16 to 23 alanine codons. Null mutation of the Arx gene impairs GABA and cholinergic interneuronal  migration but results in a neonatal lethal phenotype. We developed the first viable genetic mouse model of ISS that spontaneously recapitulates salient phenotypic features of the human triplet repeat expansion mutation. Arx((GCG)10+7) ("Arx plus 7") pups display abnormal spasm-like myoclonus and other key EEG features, including multifocal spikes, electrodecremental episodes, and spontaneous seizures persisting into maturity. The neurobehavioral profile of Arx mutants was remarkable for lowered anxiety, impaired associative learning, and abnormal social interaction. Laminar decreases of Arx+ cortical interneurons  and a selective reduction of calbindin-, but not parvalbumin- or calretinin-expressing interneurons in neocortical layers and hippocampus indicate that specific classes of synaptic inhibition are missing from the adult forebrain, providing a basis for the seizures and cognitive disorder. A significant reduction of calbindin-, NPY (neuropeptide Y)-expressing, and cholinergic interneurons in the mutant striatum suggest that dysinhibition within this network may contribute to the dyskinetic motor spasms. This mouse model narrows the range of critical pathogenic elements within brain inhibitory networks essential to recreate this complex neurodevelopmental syndrome.  Publication Types:      Research Support, N.I.H., Extramural     Research Support, Non-U.S. Gov't  PMID: 19587282 [PubMed - in process] 

 1: Depress Anxiety. 2009 Jul 6. [Epub ahead of print]  Freezing reaction in panic disorder patients associated with anticipatory anxiety.  Lopes FL, Azevedo TM, Imbiriba LA, Freire RC, Valença AM, Caldirola D, Perna G, Volchan E, Nardi AE.  Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University  of Rio de Janeiro, INCT Translational Medicine, Rio de Janeiro, Brazil.  Background: Anticipatory anxiety can be described as a conditioned response with  a defensive posture of freezing and autonomic activation. The purpose of this study was to assess the postural control analysis and autonomic activation in panic disorder (PD) patients presented with visual stimuli. Methods: PD patients  (n=29) and healthy controls (n=27) stood on a force platform while viewing a series of anxiogenic, mutilation, and neutral pictures. Skin conductance responses and the displacements of the center of pressure were measured. Results: Overall, the PD patients demonstrated significantly reduced body sway, increased  mean power frequency, and increased skin conductance compared to control group throughout the experiment (P<.05). PD patients also showed a negative correlation between anticipatory anxiety and mean sway area throughout the experiment. However, there was no significant difference in body sway velocity compared to healthy controls while viewing the anxiogenic block of pictures or the neutral block. Conclusions: Our data shows that PD patients experiencing anticipatory anxiety may present with lower mobility, consistent with the freezing behavior of the defense cascade. The data also shows that PD patients do not have a postural  instability when confronted with specific anxiogenic context. The importance of this study is that it objectively demonstrates freezing-like behavior in PD patients. Depression and Anxiety 0:1-5, 2009. (c) 2009 Wiley-Liss, Inc.  PMID: 19582830 [PubMed - as supplied by publisher]  2: Depress Anxiety. 2009;26(7):622-33.  Income and attrition in the treatment of depression: a STAR*D report.  Warden D, Rush AJ, Wisniewski SR, Lesser IM, Thase ME, Balasubramani GK, Shores-Wilson K, Nierenberg AA, Trivedi MH.  Department of Psychiatry, The University of Texas Southwestern Medical Center at  Dallas, Dallas, Texas.  Background: Attrition, or dropping out of treatment, remains a major issue in the care of depressed outpatients. Whether different factors are associated with attrition for different socioeconomic groups is not known. This report assessed whether attrition rates and predictors of attrition differed among depressed outpatients with different income levels. Methods: Outpatients with nonpsychotic  major depressive disorder treated for up to 14 weeks with citalopram in the first step of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study were divided by household incomes of <$20,000, $20,000-<$40,000, and >/=$40,000.  Attrition rates and sociodemographic and clinical correlates of attrition were identified for each group. Results: Regardless of income level, remission rates were lower for participants who dropped out of treatment. Attrition rates increased as income decreased. For all income levels, younger age was independently associated with attrition. For the lowest income level, less education, better mental health functioning, being on public insurance, and having more concurrent Axis I conditions were associated with a greater likelihood of attrition. For the middle income group, less education, better mental health functioning, being Black or of another non-White race, and treatment in a psychiatric versus primary-care setting predicted greater attrition. For the highest income group, being Hispanic, having a family history  of drug abuse, and melancholic features predicted attrition. Atypical symptom features (middle income group) and recurrent depression (highest income group) were associated with retention. Conclusions: Efforts to retain patients in antidepressant treatment should focus especially on less educated patients with lower household incomes and younger patients. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc.  PMID: 19582825 [PubMed - in process]  3: Hum Psychopharmacol. 2009 Jul 6. [Epub ahead of print]  Subjective sleep, depression and anxiety: inter-relationships in a non-clinical sample.  Mayers AG, Grabau EA, Campbell C, Baldwin DS.  Department of Psychology, School of Design, Engineering & Computing, Bournemouth  University, Bournemouth, UK.  OBJECTIVES: Previous research confirms the interdependent relationship between poor sleep and depression, but has often focused on objective measures of sleep and overlooked the importance of subjective factors. Insomnia may be maintained by anxiety and perceptions of poor sleep timing, and depression is associated with poor sleep satisfaction, regardless of perceived sleep timing. METHODS: This study explored the contribution of current depression and anxiety to sleep perceptions. Participants (n = 98) completed the Hospital Anxiety and Depression  scale, and questionnaires were used to evaluate current and previous psychiatric  illness, sleep disorders and prescribed psychotropic medication. RESULTS: A series of ANOVAs and regression analyses indicated that variance in sleep timing  perceptions was more likely to be explained by symptoms of anxiety than depression; explained variance (adj. R(2)) 25%, t = 2.361; p = 0.023. The analyses also showed that sleep satisfaction perceptions (adj. R(2) = 20%, t = 3.085; p = 0.004), and those relating to overall quality of life (adj. R(2) = 37%, t = -2.763; p = 0.013), were more likely to be explained by symptoms of depression. CONCLUSIONS: These findings support the observation that anxiety appears related to poorer sleep timing perceptions, while depression appears associated with poor sleep satisfaction. Further research is needed to explore the factors that might maintain poor sleep satisfaction in depression. Copyright  (c) 2009 John Wiley & Sons, Ltd.  PMID: 19582759 [PubMed - as supplied by publisher]  4: Int J Geriatr Psychiatry. 2009 Jul 6. [Epub ahead of print]  Health status and suicide in the second half of life.  Conwell Y, Duberstein PR, Hirsch JK, Conner KR, Eberly S, Caine ED.  Department of Psychiatry, School of Medicine and Dentistry, University of Rochester (UR), USA.  OBJECTIVE: To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services. METHOD: A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence. RESULTS: Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical,  or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk. CONCLUSIONS: Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions. Copyright (c) 2009 John Wiley & Sons, Ltd.  PMID: 19582758 [PubMed - as supplied by publisher]  5: J Autism Dev Disord. 2009 Jul 7. [Epub ahead of print]  Association of COMT (Val158Met) and BDNF (Val66Met) Gene Polymorphisms with Anxiety, ADHD and Tics in Children with Autism Spectrum Disorder.  Gadow KD, Roohi J, Devincent CJ, Kirsch S, Hatchwell E.  Department of Psychiatry and Behavioral Science, State University of New York, Putnam Hall, South Campus, Stony Brook, NY, 11794-8790, USA, kenneth.gadow@stonybrook.edu.  The aim of the study is to examine rs4680 (COMT) and rs6265 (BDNF) as genetic markers of anxiety, ADHD, and tics. Parents and teachers completed a DSM-IV-referenced rating scale for a total sample of 67 children with autism spectrum disorder (ASD). Both COMT (p = 0.06) and BDNF (p = 0.07) genotypes were  marginally significant for teacher ratings of social phobia (etap (2) = 0.06). Analyses also indicated associations of BDNF genotype with parent-rated ADHD (p = 0.01, etap (2) = 0.10) and teacher-rated tics (p = 0.04; etap (2) = 0.07). There  was also evidence of a possible interaction (p = 0.02, etap (2) = 0.09) of BDNF genotype with DAT1 3' VNTR with tic severity. BDNF and COMT may be biomarkers for phenotypic variation in ASD, but these preliminary findings remain tentative pending replication with larger, independent samples.  PMID: 19582565 [PubMed - as supplied by publisher] 

 1: Rev Bras Psiquiatr. 2009 Jun;31(2):145-53.  The psychiatric side-effects of rimonabant.  Moreira FA, Crippa JA.  Department of Pharmacology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.  OBJECTIVE: Experimental evidence has suggested that drugs that enhance cannabinoid type-1 (CB1) receptor activity may induce anxiolytic and antidepressant effects, whilst the opposite has been reported with antagonists. Thus, the objective of the present review is to discuss the potential psychiatric side-effects of CB1 receptor antagonists, such as rimonabant, which has been recently marketed in several countries for the treatment of smoking cessation, obesity and associated metabolic disorders. METHOD: Literature searches were performed in PubMed and SciELO databases up to February 2009. The terms searched  were 'obesity', 'rimonabant', 'cannabinoids', 'unwanted effects', 'diabetes', 'smoking cessation' and 'side-effects'. RESULTS: Clinical trials have revealed that rimonabant may promote weight loss in obese patients, although it may also induce symptoms of anxiety and depression. DISCUSSION: Patients taking CB1 receptor antagonists should be carefully investigated for psychiatric side-effects. These drugs should not be prescribed for those already suffering from mental disorders. Nevertheless, the development of new compounds targeting the endocannabinoid system for the treatment of several conditions would be necessary and opportune.  PMID: 19578688 [PubMed - in process]  2: Georgian Med News. 2009 Jun;(171):47-53.  [Anxiety state in patients during postinsult period with old cerebral infarction]  [Article in Russian]  [No authors listed]  According to ICD-10 International Statistical Classification of Diseases anxiety  state is different combination of somatic and mental symptoms of anxiety of absence of real menace that is onset attack-like or permanently. Anxious disorder is observed in 5-10% of the population, twice more often at woman than at men. The lengthening of the postinsult period is observed more often in the structure  of the patient with old cerebral infarction that is complicated with anxious disorder. Diagnostics, treatment and prevention of anxious disorder in the postinsult period require elaboration of new approaches by the doctors. It is announced that anxious disorder in the postinsult period at such patient may reach 60-70%. Researches have been held on the basis of the clinic "Medina" in Batumi. The main group consisted of 30 out-patients (14 women and 16 men) between 41 and 73 years old who experienced cerebral infarction of 3-18 months prescription. Patients with pancreatic diabetes and unstable accompanying somatic diseases were excluded. Computer or magnetic - resonant tomography of the brain was performed to all patients during insult in order to verify the diagnosis; the clinical-and-psychological and neurological check up was also performed using neurological scale NIH NINDS in order to identify severity of insult as well as using the scale "Renkin" to assess the degree of impairment of vital functions. Depression was assessed with the help of HDRS (Hamilton depression ration scale). The level and presence of anxiety were determined by the scale that assesses the  level of reactive and personal - anxiety. The following initial data were received as a result of research from the patients of the comparing groups before treatment: an average age of patients was 55,1+/-1,9 years; prescription of cerebral infarction was 6,35+/-1,0 months; severity of cerebral infarction on scale NIH NINDS was 2,7+/-0,25 points; invalidation degree on "Renkin" scale was  1,95+/-0,25 points. Personal anxiety was 85,4+/-7,27 points according to self assessment scale, reactive anxiety equaled 86,3+/-7,1 points. Depression evidence in comparing groups turned out to be initially high and equaled 14,5+/-2,1 points. The study revealed cognitive functions according to MMSE at 4 men. Therefore, a long effecting social stress leads to development of depression. Unemployed people working under constant pressure, living in overpopulated areas  are the most subject to stress as well as those whose mutual relation with associates are broken and who more often gets in disputed situations. The first condition in treatment of the anxious disorders is detailed knowledge of the patient and his understanding the essence of illness. The necessary information and the elementary receptions of treatment for overcoming anxiety and panic attacks are given by the doctor. Frequently, the relief comes only that the patient realizes that it not illness that is unknown and dangerous to a life, but curable anxious disorder. Whenever possible the doctor will advise a relevant method of psychotherapy which will help to cope with the problems caused by prolonged panic disorder.  Publication Types:      English Abstract  PMID: 19578214 [PubMed - in process]  3: Georgian Med News. 2009 Jun;(171):44-7.  [Relationship between serum blood serotonin and tension--type headache]  [Article in Russian]  [No authors listed]  Tension - type headache is one of the widely spread types of idiopathic headaches. The pathogenesis of the disease includes depression and change in brain serotonin level. The aim of the research is to study the characteristics of ache and the level of serotonin in blood serum in tension-type headache. The intensity of ache, complex psychometric parameters and the level of serotonin in  blood serum were investigated in 100 patients (75% females and 25% males from 17  to 55 years old) with tension-type headache. The average period of the illness was 6-5 years. The diagnosis has been determined according to MKGB (2003) criteria. According to the duration of anamnesis of ache the patients were divided into 3 groups: the first - 66 patients, the second - 24 patients, the third - 10 patients with tension-type headache and migraine. Ache status and its  impact on different spheres of activity were assessed according to international  150 millimeters visual analogous scale. The research showed that all patients with tension-type headache had moderate ache syndrome, depression and anxiety of  the middle or high rate which were in inverse dependence on serotonin rate in the blood. Intensity of episodic tension-type headache (n=24) was 52 mm according to  visual analogous scale, the high rate of anxiety (51,08+/-4,2 scores), moderate rate of depression (12,9 scores according to Bek scale) and tendency of serotonin decreasing in blood (205,72+/-6,74 ng ml) was noted. The research of 76 patients  with chronic tension-type headache with cephalgy intensity according to VASH 62 mm the high indicators of reactive (46,81+/-2,68 scores) and personal anxiety, the rate of depression (22,4+/-1,64 according to Bek scale) were associated with  the displayed decreasing of serotonin amount in blood (119,38+/-9,42 ng/ml). It was concluded that, tension-type headache and moderate ache syndrome leads to depression decreased self-control of pain and life quality. The quality of serotonin in blood decreases in patients with tension-type headache. The relationship between the intensity of pain syndrome, decrease of work capacity, life quality, and quantity of serotonin in patients with ageing was revealed. It  is concluded that serotonin level in blood serum may be considered as pain intensity, degree of depression and index of efficacy of depression treatment. Serotonin is an extremely important neurohormone and its metabolism further study will show new characteristic features of its activity in cerebral neurochemical processes. Scientists thought, that the increased activity caused the psychological disorder, changes in the mood and depression. But the results of the last studies show that the person with the abnormal activity of serotonin does not realize the sense of danger and accordingly the main instinct of self-preservation is broken.  Publication Types:      English Abstract  PMID: 19578213 [PubMed - in process]  4: J Pediatr Psychol. 2009 Jul 3. [Epub ahead of print]  The Psychosocial Impact of Completing Childhood Cancer Treatment: A Systematic Review of the Literature.  Wakefield CE, McLoone J, Goodenough B, Lenthen K, Cairns DR, Cohn RJ.  Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital,School of Women's and Children's Health, University of New South Wales,Prince of Wales Clinical School, University of New South Wales,School of Psychology, University of New South Wales and Department of Psychology, Macquarie University.  OBJECTIVE: To review the results of any published research study examining the psychosocial functioning of children who have recently completed cancer treatment. METHODS: Five electronic databases were searched (from 1978 to 2008).  Of 1,734 identified articles, 19 met all inclusion criteria. Four articles utilized a qualitative methodology, thirteen utilized a quantitative methodology, and two used mixed methods. RESULTS: Children may experience positive psychosocial outcomes on treatment completion, including high self-worth, good behavioral conduct, and improved mental health and social behavior. However, they may also experience significant negative outcomes, including lower levels of psychological well-being, mood, liveliness, self-esteem, and motor and physical functioning, as well as increased anxiety, problem behaviors, and sleeping difficulties. CONCLUSIONS: Completing treatment can be a psychologically complex  time for children as they wait to make the transition from "cancer patient" to long-term "cancer survivor." Further high-quality research targeting the needs of these children is warranted.  PMID: 19578137 [PubMed - as supplied by publisher]  5: J Affect Disord. 2009 Jul 3. [Epub ahead of print]  Who is MADD? Mixed anxiety depressive disorder in the general population.  Spijker J, Batelaan N, de Graaf R, Cuijpers P.  De Gelderse Roos, Mental Health Care, Ede, The Netherlands; Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.  BACKGROUND: Diagnostic criteria for (subthreshold) mixed anxiety depression (MADD) were proposed in DSM-IV. Yet the usefulness of this classification is questioned. We therefore assessed the prevalence of MADD, and investigated whether MADD adds to separate classifications of pure subthreshold depression and anxiety. METHOD: Data of the Netherlands Mental Health and Incidence Study were used. RESULTS: The 12-month prevalence of MADD was 0.6%. Between the three subthreshold categories few differences were found with regard to socio-demographic variables, care utilisation and functioning. Course in MADD seems more favourable and MADD is not a stable diagnosis over time. LIMITATIONS:  The MADD criteria used in the present study differed slightly from the proposed criteria in DSM-IV and sample sizes were small. CONCLUSIONS: Given these results, MADD is not a relevant diagnosis in terms of prevalence and consequences when classified according to the currently proposed criteria.  PMID: 19577307 [PubMed - as supplied by publisher] 

 1: Int J Geriatr Psychiatry. 2009 Jul 2. [Epub ahead of print]  fMRI activation in late-life anxious depression: a potential biomarker.  Andreescu C, Butters M, Lenze EJ, Venkatraman VK, Nable M, Reynolds CF 3rd, Aizenstein HJ.  Department of Psychiatry, The Advanced Center in Interventions and Services Research for Late-Life Mood Disorders, University of Pittsburgh School of Medicine and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh, PA, USA.  OBJECTIVE AND METHODS: The neurobiology of late-life anxious depression (LLAD) is poorly characterized despite evidence that this is a common and severe subtype of late-life depression. To identify the neuroanatomical substrate of LLAD, we examined event-related fMRI data collected in eight subjects with late-life depression, half of whom had high levels of comorbid anxiety. Subjects were trained on the Preparing to Overcome Prepotency (POP) task, which is an executive control task that reliably activates the lateral prefrontal cortex-anterior cingulate cortex (ACC) cognitive control circuit. RESULTS: Time series analysis showed that, when compared with elderly depressed subjects, elderly subjects with anxious depression performing the POP task produced a significantly greater and more sustained signal in three regions: BA24 (dorsal anterior cingulate), BA31 (posterior cingulate), and BA6 (prefrontal cortex). While elderly subjects with pure depression presented a bimodal activation curve in the dorsal anterior cingulate and the posterior cingulate, elderly subjects with anxious depression presented a sustained unimodal activation pattern. CONCLUSIONS: Our preliminary results suggest specific activation patterns unique to anxious depression that may suggest greater and more sustained efforts of the ACC to carry out cognitive  control tasks. Further research is needed to clarify the neuroanatomical basis of LLAD. Copyright (c) 2009 John Wiley & Sons, Ltd.  PMID: 19575412 [PubMed - as supplied by publisher]  2: J Investig Med. 2009 Jun 1. [Epub ahead of print]  Fragile X-Associated Tremor/Ataxia Syndrome: Clinical Phenotype, Diagnosis, and Treatment.  Leehey MA.  From the Department of Neurology, University of Colorado Denver, Aurora, CO.  Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder caused by a CGG repeat expansion in the premutation range (55-200) in the fragile X mental retardation 1 gene. Onset is typically in the early seventh  decade, and men are principally affected. The major signs are cerebellar gait ataxia, intention tremor, frontal executive dysfunction, and global brain atrophy. Other frequent findings are parkinsonism (mild), peripheral neuropathy,  psychiatric symptoms (depression, anxiety, and agitation), and autonomic dysfunction. The clinical presentation is heterogeneous, with individuals presenting with varied dominating signs, such as tremor, dementia, or neuropathy. Magnetic resonance imaging shows atrophy and patchy white matter lesions in the cerebral hemispheres and middle cerebellar peduncles. The latter has been designated the middle cerebellar peduncle sign, which occurs in about 60% of affected men, and is relatively specific for FXTAS. Affected females generally have less severe disease, less cognitive decline, and some symptoms different from that of men, for example, muscle pain. Management of FXTAS is complex and includes assessment of the patient's neurological and medical deficits, treatment of symptoms, and provision of relevant referrals, especially genetic counseling.  Treatment is empirical, based on anecdotal experience and on knowledge of what works for symptoms of other disorders that also exist in FXTAS. Presently, the disorder is underrecognized because the first published report was only in 2001 and because the presentation is variable and mainly consists of a combination of  signs common in the elderly. However, accurate diagnosis is critical for the patient and for the family because they need education regarding their genetic and health risks.  PMID: 19574929 [PubMed - as supplied by publisher]  3: Acad Psychiatry. 2009 Summer;33(3):204-211.  Student Experiences with Competency Domains During a Psychiatry Clerkship.  West DA, Nierenberg DW.  Dartmouth Medical School, Psychiatry, DHMC -Psychiatry Level 2, # 1 Medical Center Dr., Lebanon, NH 03756; donald.west@dartmouth.edu.  OBJECTIVES: The authors reviewed medical student encounters during 3 years of a required psychiatry clerkship that were recorded on a web-based system of six broad competency domains (similar to ACGME-recommended domains). These were used  to determine diagnoses of patients seen, clinical skills practiced, and experiences in interpersonal and communications skills, professionalism, practice-based learning and improvement, and system-based practice. The authors aim to understand how students are learning and growing in these domains and to modify the clerkship in an ongoing manner. METHODS: Data were collected from the  Dartmouth Medical Encounter Documentation System (DMEDS) for all student encounters in required third-year psychiatry clerkships during academic years 2004-2007, in which students had intensive involvement in patient care. RESULTS:  One hundred seventy three students reported a total of 4,676 patient encounters,  averaging 27.2 encounters per student and 1.8 psychiatric diagnoses per patient.  Students met "learning targets" for anxiety disorder, bipolar affective disorder, depression, personality disorder (borderline), posttraumatic stress disorder, psychosis, schizophrenia, and substance abuse (alcohol), but not for disorders more likely seen in outpatient settings. For the 10 counseling skills learning targets, students only met those for family issues. In the four "newer" competency domains, students reported struggling with issues in 0.3% to 12.6% of  encounters. Students documented being challenged by professionalism issues most often and recorded examples of how these competencies played out for them during  the clerkship. CONCLUSION: Use of a required web-based medical encounter reporting system for student-patient-faculty encounters during a psychiatry clerkship can be of significant value in assessing what students are seeing, doing, and learning on this required third-year experience. The results provide helpful current information to the clerkship director and data that help the director modify the clerkship on an ongoing basis to better meet students' educational needs.  PMID: 19574516 [PubMed - as supplied by publisher]  4: J Psychiatr Res. 2009 Jun 30. [Epub ahead of print]  Social defeat stress produces prolonged alterations in acoustic startle and body  weight gain in male Long Evans rats.  Pulliam JV, Dawaghreh AM, Alema-Mensah E, Plotsky PM.  Neuroscience Institute, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, United States.  Individuals exposed to psychological stressors may experience a long-term resetting of behavioral and neuroendocrine aspects of their "stress response" so  that they either hyper or hypo-respond to subsequent stressors. These effects of  psychological or traumatic stressors may be mimicked in rats using the resident-intruder model of social defeat. The social defeat model has been characterized to model aspects of the physiology and behavior associated with anxiety and depression. The objective of this study was to determine if behaviors elicited following repeated social defeat can also reflect aspects of ethologically relevant stresses associated with existing post traumatic stress disorder (PTSD) models. Socially defeated rats displayed weight loss and an enhanced and prolonged response to acoustic startle which was displayed for up to 10days following repeated social defeat. These data indicate that the severe stress of social defeat can produce physiologic and behavioral outcomes which may reflect aspects of traumatic psychosocial stress.  PMID: 19573876 [PubMed - as supplied by publisher]  5: J Clin Psychiatry. 2009 Jun;70(6):817-828.  Pegylated interferon and ribavirin-induced depression in chronic hepatitis c: role of personality.  Castellvi P, Navinés R, Gutierrez F, Jiménez D, Márquez C, Subirà S, Solà R, Martín-Santos R.  Liver Section the Department of Adults, Adolescents and Child Psychopathology, Facultat de Psicologia, Institut Clínic de Neurociències, Hospital Clínic, IDIBAPS, Barcelona, Spain.  OBJECTIVE: Pegylated interferon (PegIFN) and ribavirin (RBV) treatment for the hepatitis C virus (HCV) infection can induce depressive episodes. Personality traits have been associated with mood disorders. The aim of this study was to evaluate the personality profile as a risk factor for induced depression by PegIFN and RBV treatment in patients with HCV. METHOD: In a prospective cohort study, 204 consecutive HCV outpatients who received PegIFN and RBV were assessed  using the Structured Clinical Interview for DSM-IV Axis I Disorders and the Temperament and Character Inventory-Revised (TCI-R). Moreover, the Patient Health Questionnaire and the Hospital Anxiety and Depression Scale were administered at  baseline and at 4, 12, 24, and/or 48 weeks of treatment. Patients were recruited  between September 2003 and December 2006. RESULTS: One hundred eighteen patients  (57.8%) were men. The mean (SD) age was 44.39 (10.4) years. The incidence of induced depression during the 48 weeks of antiviral treatment was 73 (42%). Low self-directedness dimension (HR = 0.63, 95% CI = 0.446 to 0.890, p = .009), baseline subclinical depression levels (HR = 1.113, 95% CI = 1.023 to 1.22, p = .013), and history of mood disorders (HR = 0.372, 95% CI = 0.220 to 0.629, p <.001) were independent predictive factors for induced depression during PegIFN and RBV treatment. Other predictive personality TCI-R subscales were enlightened  second nature (HR = 2.939, 95% CI = 1.423 to 6.071, p = .004), fatigability (HR = 0.421, 95% CI = 0.237 to 0.749, p = .01), and disorderliness (HR = 0.449, 95% CI  = 0.248 to 0.815, p = .008). CONCLUSION: Low self-directedness, depressive symptoms at baseline, and history of previous mood disorders may predict induced  depression by PegIFN and RBV in euthymic HCV patients. © Copyright 2009 Physicians Postgraduate Press, Inc.  PMID: 19573480 [PubMed - as supplied by publisher]