Proenkephalin expression and enkephalin release are widely observed in non-neuronal tissues.

 

Peptides. 2007 Nov 17 [Epub ahead of print]

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Proenkephalin expression and enkephalin release are widely observed in non-neuronal tissues.

Denning GM, Ackermann LW, Barna TJ, Armstrong JG, Stoll LL, Weintraub NL, Dickson EW.

Department of Emergency Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, C-43 GH, Iowa City, IA 52242-1009, United States.

Enkephalins are opioid peptides that are found at high levels in the brain and endocrine tissues. Studies have shown that enkephalins play an important role in behavior, pain, cardiac function, cellular growth, immunity, and ischemic tolerance. Our global hypothesis is that enkephalins are released from non-neuronal tissues in response to brief ischemia or exercise, and that this release contributes to cardioprotection. To identify tissues that could serve as potential sources of enkephalins, we used real-time PCR, Western blot analysis, ELISA, immunofluorescence microscopy, and ex vivo models of enkephalin release. We found widespread expression of preproenkephalin (pPENK) mRNA and production of the enkephalin precursor protein proenkephalin (PENK) in rat and mouse tissues, as well as in tissues and cells from humans and pigs. Immunofluorescence microscopy with anti-enkephalin antisera demonstrated immunoreactivity in rat tissues, including heart and skeletal muscle myocytes, intestinal and kidney epithelium, and intestinal smooth muscle cells. Finally, isolated tissue studies showed that heart, skeletal muscle, and intestine released enkephalins ex vivo. Together our studies indicate that multiple non-neuronal tissues produce PENK and release enkephalins. These data support the hypothesis that non-neuronal tissues could play a role in both local and systemic enkephalin-mediated effects.

PMID: 18082911 [PubMed - as supplied by publisher]

Psychiatric Symptoms in Children and Adolescents With Cyclic Vomiting Syndrome and their Parents.

Another form of separation anxiety... MP

 

 

Headache. 2007 Dec 12 [Epub ahead of print]

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Psychiatric Symptoms in Children and Adolescents With Cyclic Vomiting Syndrome and their Parents.

Tarbell S, Li BU.

Department of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Objective.- To conduct a pilot study to evaluate the prevalence of psychiatric symptoms in children and adolescents with cyclic vomiting syndrome and to assess family history of psychiatric disorder. Background.- Little is known about psychiatric comorbidity in youth with cyclic vomiting syndrome, a periodic syndrome. Methods.- Eighty-five parents, of children aged 3-18 years with cyclic vomiting syndrome confirmed in a multidisciplinary clinic, completed the age-appropriate Children's Symptom Inventory, a questionnaire that screens for psychiatric symptoms in pediatric patients. Twenty-one adolescents aged 13-18 years completed the Youth's Report, a self-report form of this questionnaire. Sixty-two parents completed a family psychiatric history checklist. Results.- These children and their parents evidenced a high prevalence of anxiety and mood symptoms compared to norms of the Children's Symptom Inventory and population norms for internalizing psychiatric disorders. On the age-appropriate Children's Symptom Inventory, 47% of subjects (40/85) met diagnostic cut-off for an anxiety disorder, and 14% (12/85) for an affective disorder. Discrepancies were found in parent and adolescent reports for symptoms of panic disorder (chi-square = 4.83, df = 1, P = .028), posttraumatic stress disorder (chi-square = 6.87, df = 1, P = .009), and somatization disorder (chi-square = 6.41, df = 1, P = .01), with parents reporting significantly more symptoms than the adolescents. Internalizing disorders were also prevalent in the parents with 59% (36/62) endorsing either an anxiety and/or an affective disorder. Mothers reported a significantly higher prevalence of anxiety disorders (35%) than did fathers (13%) (chi-square = 8.43, df = 1, P < .004). Conclusion.- Children and adolescents with cyclic vomiting syndrome appear to be at increased risk for internalizing psychiatric disorders, especially anxiety disorders. Further research using standardized psychiatric interviews and a control group are indicated to further assess psychiatric disorders in children and adolescents with cyclic vomiting syndrome.

PMID: 18081819 [PubMed - as supplied by publisher]

Comorbidity of Migraine and Psychiatric Disorders-A National Population-Based Study.

Headache. 2007 Dec 7 [Epub ahead of print]

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Comorbidity of Migraine and Psychiatric Disorders-A National Population-Based Study.

Jette N, Patten S, Williams J, Becker W, Wiebe S.

Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.

Background.- Migraine is common, with an estimated lifetime prevalence of 7-17%. Population-based studies have reported an association between various psychiatric conditions and migraine. This is a population-based study exploring the association between migraine and psychiatric disorders in a large cohort and assessing various health-related outcomes. Objective.- (1) Determine the prevalence of various psychiatric conditions in association with migraine; (2) describe the patterns of association of these comorbidities with a variety of health-related outcomes. Methods.- Data from the 2002 Canadian Community Health Survey were used. This is a national health survey which included administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Health-related outcomes included 2-week disability, restriction of activities, quality-of-life, and mental health care utilization. Results.- The prevalence of physician-diagnosed migraine (n = 36,984) was 15.2% for females and 6.1% for males. Migraine was most common in those between ages 25 and 44 years and in those of lower income. Migraine was associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia, all occurring more than twice as often in those with migraines compared with those without. Migraine was not associated with drug, alcohol, or substance dependence. The higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographic variables. Psychiatric disorders were less common in those over 65 years, in those who were in a relationship, and in those of higher income whether migraine was present or not. Health-related outcomes were worst in those with both migraines and a psychiatric disorder and intermediate in those with either condition alone. Conclusion.- Migraine is associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia. Migraine in association with various mental health disorders results in poorer health-related outcomes compared with migraine or a psychiatric condition alone. Understanding the psychiatric correlates of migraine is important in order to adequately manage this patient population and to guide public health policies regarding health services utilization and health-care costs.

PMID: 18070059 [PubMed - as supplied by publisher]

Electromagnetic millimeter wave induced hypoalgesia: Frequency dependence and involvement of endogenous opioids.

Bioelectromagnetics. 2007 Dec 6 [Epub ahead of print]

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Electromagnetic millimeter wave induced hypoalgesia: Frequency dependence and involvement of endogenous opioids.

Radzievsky AA, Gordiienko OV, Alekseev S, Szabo I, Cowan A, Ziskin MC.

Center for Biomedical Physics, Temple University Medical School, Philadelphia, Pennsylvania.

Millimeter wave treatment (MMWT) is based on the systemic biological effects that develop following local skin exposure to low power electromagnetic waves in the millimeter range. In the present set of experiments, the hypoalgesic effect of this treatment was analyzed in mice. The murine nose area was exposed to MMW of "therapeutic" frequencies: 42.25, 53.57, and 61.22 GHz. MMWT-induced hypoalgesia was shown to be frequency dependent in two experimental models: (1) the cold water tail-flick test (chronic non-neuropathic pain), and (2) the wire surface test (chronic neuropathic pain following unilateral constriction injury to the sciatic nerve). Maximum hypoalgesic effect was obtained when the frequency was 61.22 GHz. Other exposure parameters were: incident power density = 13.3 mW/cm(2), duration of each exposure = 15 min. Involvement of delta and kappa endogenous opioids in the MMWT-induced hypoalgesia was demonstrated using selective blockers of delta- and kappa-opioid receptors and the direct ELISA measurement of endogenous opioids in CNS tissue. Possible mechanisms of the effect and the perspectives of the clinical application of MMWT are discussed. Bioelectromagnetics. (c) 2007 Wiley-Liss, Inc.

PMID: 18064600 [PubMed - as supplied by publisher]

Psychiatric disorders and family functioning in children and adolescents with functional abdominal pain syndrome.

J Gastroenterol Hepatol. 2007 Nov 14 [Epub ahead of print] Links

Psychiatric disorders and family functioning in children and adolescents with functional abdominal pain syndrome.

Ghanizadeh A, Moaiedy F, Imanieh MH, Askani H, Haghighat M, Dehbozorgi G, Dehghani SM.

Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran.

Background and Aim: Functional abdominal pain syndrome (FAPS) is a functional gastrointestinal disorder. There is a heightened risk when conducting potentially dangerous and unnecessary medical investigations and procedures in children with FAPS. The aim of this study was to survey the rate of the psychiatric disorders and family functioning in children and adolescents with FAPS. Methods: The subjects were a consecutive new sample of 45 children and adolescents with FAPS, 45 with an organic abdominal pain, and 45 pain-free comparison subjects aged 5-18 years that were interviewed using the Farsi version of K-SADS. Family functioning and the severity of pain were also studied. Results: About 51.1% of patients with FAPS suffered from at least one psychiatric disorder. Psychiatric disorders in the FAPS patients studied included general anxiety disorder (8.9%), obsessive-compulsive disorder (11.1%), attention deficit hyperactivity disorder (15.6%), separation anxiety disorder (24.4%), and major depressive disorder (15.6%). Except for generalized anxiety disorder and tic disorder, the other disorders were significantly more common in the FAPS group than in the two other control groups. Family functioning scores were not significantly different between groups. Discussion: There is a high rate of psychiatric disorders in children and adolescents with FAPS in Iran, but our study found fewer incidences of disorders than previous reports have indicated. Family dysfunction difficulties in FAPS children are not more common than those in the control groups.

PMID: 18005012 [PubMed - as supplied by publisher]

Oral naltrexone to enhance analgesia in patients receiving continuous intrathecal morphine for chronic pain: a randomized, double-blind, prospective pilot study.

J Opioid Manag. 2007 May-Jun;3(3):137-44.

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Oral naltrexone to enhance analgesia in patients receiving continuous intrathecal morphine for chronic pain: a randomized, double-blind, prospective pilot study.

Hamann S, Sloan P.

Department of Anesthesiology, University of Kentucky Medical Center, Lexington, USA.

BACKGROUND: Years' worth of observations suggest that morphine has both inhibitory and excitatory actions, and that selective blockade of excitatory effects by low doses of opioid antagonists (e.g., naltrexone) may paradoxically enhance morphine analgesia. The purpose of this pilot study was to evaluate and compare the analgesic efficacy and safety of two different low doses of oral naltrexone given in addition to chronic intrathecal morphine infusions in patients with chronic nonmalignant pain (CNMP). METHODS: After institutional review board approval, 15 patients with CNMP receiving continuous intrathecal morphine were admitted into a prospective, randomized, double-blind, placebo-controlled, seven-day pilot study. Patients were randomized into three treatment groups based on oral naltrexone dose: 100 microg (Group A, n = 3), 10 microg (Group B, n = 7), or placebo (Group C, n = 5). All patients continued with their constant intrathecal morphine infusion, and in addition they received one capsule of study medication every 12 hours for seven days. Other analgesics or coanalgesics were kept at a constant dose level throughout the study. Patients rated pain scores (visual analogue score [VAS]; 0 = no pain, 10 = worst pain imaginable) and side effects three times daily throughout the study period. Efficacy measures included pain intensity difference (PID) scores, constructed so that positive scores indicate a reduction in pain intensity and negative scores indicate a worsening of pain. RESULTS: Fifteen patients (six male, nine female) with a mean (SD) age of 55 (10) years and weight of 81 (21) kg completed the study. The mean (SD) baseline VAS pain intensity rating was similar in all three groups (6.8 [1.5]). Baseline pain VAS score minus the lowest daily pain VAS score yielded the peak PID score. The peak PID score from Day 1 was statistically (p < 0.05) highest (median PID score: 5.9) in Group A compared with Group C. There was a trend in PID scores across Days 2 through 7, with median PID scores higher (i.e., greater pain relief p = 0.07) in Group A. In the daily global pain assessments, the pain scores across Days 2 through 7 approached significance (least pain) in Group A compared to Group C (p = 0.07) or B (p = 0.08). Side effects were common (93 percent of patients), minor (headache, nausea, sedation, dry mouth), and similar across treatment groups. No serious adverse events were observed, and no evidence of opioid withdrawal was seen. CONCLUSIONS: 1) Patients with chronic pain who received oral naltrexone 100 microg BID in addition to their chronic intrathecal morphine infusions demonstrated the greatest improvement (p = 0.07) in their daily pain scores. Because of the small sample size, the results did not reach traditional levels of significance. 2) Side effects were common, minor, and similar across treatment groups. 3) No serious adverse events were recorded. 4) No evidence of opioid antagonist toxicity or opioid withdrawal was observed.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 18027539 [PubMed - in process]

Leukocyte-derived opioid peptides and inhibition of pain.

J Neuroimmune Pharmacol. 2006 Mar;1(1):90-7.

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Leukocyte-derived opioid peptides and inhibition of pain.

Machelska H, Stein C.

Klinik für Anaesthesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany. halina.machelska@charite.de

In peripheral inflamed tissue interactions between leukocyte-derived opioid peptides and opioid receptors on sensory neurons lead to potent, clinically relevant inhibition of pain. Opioid receptors are present on peripheral terminals of sensory neurons and are upregulated in inflammation. Their endogenous ligands, opioid peptides, are synthesized in circulating immune cells, which migrate to injured tissues directed by chemokines and adhesion molecules. Under stressful stimuli or in response to releasing agents (e.g., corticotropin-releasing factor, cytokines, catecholamines) leukocytes can secrete opioids. These peptides activate peripheral opioid receptors and produce analgesia by inhibiting the excitability of sensory nerves and/or the release of excitatory neuropeptides. These effects occur without central opioid side effects such as depression of breathing, clouding of consciousness, or addiction. Future research should elucidate the selective targeting of opioid peptide-containing immune cells to sites of painful tissue injury and the augmentation of opioid peptide and receptor synthesis.

Publication Types:

• Research Support, Non-U.S. Gov't
• Review

PMID: 18040794 [PubMed - in process]

Depression and panic disorder as predictors of health outcomes for patients with asthma in primary care.

Respir Med. 2007 Nov 29 [Epub ahead of print]

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Depression and panic disorder as predictors of health outcomes for patients with asthma in primary care.

Schneider A, Löwe B, Meyer FJ, Biessecker K, Joos S, Szecsenyi J.

Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany.

INTRODUCTION: Depression and panic disorder are widely acknowledged as complicating factors in asthma patients. However, their impact on health outcomes in primary care patients is less well examined. This study prospectively evaluated the impact of depression and panic disorder on outcomes of primary care patients with asthma over 1 year. METHODS: At baseline, 256 asthma patients from 43 primary care practices completed self-report questionnaires including the Patient Health Questionnaire (PHQ), the Asthma Quality of Life Questionnaire (AQLQ), and a structured questionnaire evaluating asthma severity, hospitalisation and emergency visits. One year later, 185 (72.3%) patients completed the same questionnaire. RESULTS: At baseline, 3.9% of patients suffered from major depressive disorder, 22.7% from minor depressive disorder, and 7.8% from panic disorder. In the year under evaluation, 17 patients (9.2%) received emergency home visits and 10 patients (5.4%) were admitted to a hospital. Depression at baseline predicted hospitalisation within the subsequent year (OR 6.1; 95% CI 1.5-24.6) and panic disorder predicted unscheduled emergency home visits (OR 4.8; 95% CI 1.3-17.7). Depression but not panic disorder predicted the AQLQ scales activity (p=0.001), symptoms (p=0.001), emotions (p=0.001) and environment (p=0.001) at follow-up. CONCLUSIONS: Although rates of hospitalisation and emergency visits in primary care are low, the impact of psychiatric comorbidity on health outcomes for patients with asthma is substantial. It might be helpful to identify patients with psychiatric comorbidity by analysing reasons for hospitalisation and emergency visits. For these patients, intensifying care with psychiatric interventions might help to reduce inappropriate healthcare utilisation and avoid adverse outcomes.

PMID: 18061424 [PubMed - as supplied by publisher]

History of childhood maltreatment is associated with comorbid depression in women with migraine.

 

Neurology. 2007 Sep 4;69(10):959-68.

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History of childhood maltreatment is associated with comorbid depression in women with migraine.

Tietjen GE, Brandes JL, Digre KB, Baggaley S, Martin VT, Recober A, Geweke LO, Hafeez F, Aurora SK, Herial NA, Utley C, Khuder SA.

Department of Neurology, College of Medicine, The University of Toledo-Health Science Campus, Toledo, OH 43614, USA. gretchen.tietjen@utoledo.edu

BACKGROUND: A bidirectional relationship between migraine and depression suggests a neurobiological link. Adverse experiences, particularly childhood maltreatment, may alter neurobiological systems, and predispose to a multiplicity of adult chronic disorders. Our objective is to determine, within a headache clinic population of women, if depression moderates the abuse-migraine relationship. METHODS: At six headache specialty clinics, women with migraine were diagnosed using ICHD-II criteria, and frequency was recorded. A questionnaire regarding maltreatment history, headache characteristics, current depression, and somatic symptoms was completed. RESULTS: A total of 949 women with migraine completed the survey: 40% had chronic headache (> or =15 headache days/month) and 72% had "very severe" headache-related disability. Major depression was recorded in 18%. Physical or sexual abuse was reported in 38%, and 12% reported both physical and sexual abuse in the past. Migraineurs with current major depression reported physical (p < 0.001) and sexual (p < 0.001) abuse in higher frequencies compared to those without depression. Women with major depression were more likely to report sexual abuse occurring before age 12 years (OR = 2.30, 95% CI: 1.14 to 4.77), and the relationship was stronger when abuse occurred both before and after age 12 years (OR = 5.08, 95% CI: 2.15 to 11.99). Women with major depression were also twice as likely to report multiple types of maltreatment (OR = 2.07, 95% CI: 1.27 to 3.35) compared to those without depression. CONCLUSIONS: Childhood maltreatment was more common in women with migraine and concomitant major depression than in those with migraine alone. The association of childhood sexual abuse with migraine and depression is amplified if abuse also occurs at a later age.

Publication Types:

• Comparative Study
• Multicenter Study
• Research Support, Non-U.S. Gov't

PMID: 17785664 [PubMed - indexed for MEDLINE]

Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study.

Hypertension. 2007 Oct;50(4):693-700. Epub 2007 Sep 4.

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Erratum in:

• Hypertension. 2007 Nov;50(5):e170.

Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study.

Cappuccio FP, Stranges S, Kandala NB, Miller MA, Taggart FM, Kumari M, Ferrie JE, Shipley MJ, Brunner EJ, Marmot MG.

Clinical Sciences Research Institute, Warwick Medical School, Coventry, United Kingdom. sleepresearch@warwick.ac.uk

Sleep deprivation (<or=5 hour per night) was associated with a higher risk of hypertension in middle-aged American adults but not among older individuals. However, the outcome was based on self-reported diagnosis of incident hypertension, and no gender-specific analyses were included. We examined cross-sectional and prospective associations of sleep duration with prevalent and incident hypertension in a cohort of 10,308 British civil servants aged 35 to 55 years at baseline (phase 1: 1985-1988). Data were gathered from phase 5 (1997-1999) and phase 7 (2003-2004). Sleep duration and other covariates were assessed at phase 5. At both examinations, hypertension was defined as blood pressure >or=140/90 mm Hg or regular use of antihypertensive medications. In cross-sectional analyses at phase 5 (n=5766), short duration of sleep (<or=5 hour per night) was associated with higher risk of hypertension compared with the group sleeping 7 hours, among women (odds ratio: 1.72[corrected]; 95% CI: 1.07[corrected] to 2.75[corrected]), independent of confounders, with an inverse linear trend across decreasing hours of sleep (P=0.037[corrected]). No association was detected in men. In prospective analyses (mean follow-up: 5 years), the cumulative incidence of hypertension was 20.0% (n=740) among 3691 normotensive individuals at phase 5. In women, short duration of sleep was associated with a higher risk of hypertension in a reduced model (age and employment) (6 hours per night: odds ratio: 1.56 [95% CI: 1.07 to 2.27]; <or=5 hour per night: odds ratio: 1.94 [95% CI: 1.08 to 3.50] versus 7 hours). The associations were attenuated after accounting for cardiovascular risk factors and psychiatric comorbidities (odds ratio: 1.42 [95% CI: 0.94 to 2.16]; odds ratio: 1.31 [95% CI: 0.65 to 2.63], respectively). Sleep deprivation may produce detrimental cardiovascular effects among women.

Publication Types:

• Research Support, N.I.H., Extramural
• Research Support, Non-U.S. Gov't
• Research Support, U.S. Gov't, P.H.S.

PMID: 17785629 [PubMed - indexed for MEDLINE]

Complicated Pain Management in a CYP450 2D6 Poor Metabolizer.

Pain Pract. 2007 Nov 6; [Epub ahead of print]

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Complicated Pain Management in a CYP450 2D6 Poor Metabolizer.

Foster A, Mobley E, Wang Z.

Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, Georgia, USA.

We describe the case of a patient with significant adverse effects from posttraumatic analgesic therapy with opioid analgesics who was found by microarray analysis to have a CYP2D6 genotype predictive of a poor metabolizer phenotype. In addition to her poor tolerance and limited response to opioid analgesics, she developed further discomfort when the antiemetic promethazine was administered to treat her gastrointestinal adverse effects. In our discussion we review the literature about the clinical impact of CYP450 2D6 polymorphisms in treatment with the commonly used opioid analgesics codeine, oxycodone, hydrocodone, hydromorphone, and morphine, as well as the antiemetic promethazine. The case we present, as well as the literature we review, demonstrates the clinical utility of CYP2D6 genotyping in patients with adverse effects from analgesia therapy.

PMID: 17986163 [PubMed - as supplied by publisher]

Rat brain opioid peptides-circadian rhythm is under control of melatonin.

Neuropeptides. 2007 Nov 5; [Epub ahead of print]

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Rat brain opioid peptides-circadian rhythm is under control of melatonin.

Miguel Asai MA, Lilian Mayagoitia LM, David García DG, Gilberto Matamoros-Trejo GM, Marcela Valdés-Tovar MV, Phillipe Leff PL.

Laboratorio de Análisis Químicos, Instituto Nacional de Psiquiatría, Calzada México-Xochimilco #101, Col. San Lorenzo Huipulco, C.P. 14370, México D.F., Mexico.

Several experiments have revealed an Endogenous Opioid System (EOS)-circadian rhythm. The brain-borne hormone, melatonin (MEL) has been shown to regulate the organism photoperiodic activity and may be implicated in the EOS-circadian rhythm. To explore this hypothesis, we studied the effect of functional pinealectomy on the EOS-circadian rhythm by measuring the immunoreactive content of Met-Enkephalin, Leu-Enkephalin and Synenkephalin in both hypothalamus and hippocampus of the rat brain, using standard radioimmunoassay procedures. Experimental animals exposed to white fluorescent light (WFL) for 15days (<50lux), displayed a disruption of the EOS-circadian rhythm, showing that absence of MEL induced a significant decrease of tissue content of enkephalin peptides at 01:00h during the dark-phase of the 24-h circadian rhythm, when compared to control rats. Functional pinealectomized rats exposed to 4 or 6h period of darkness (used to revert the effects induced by the absence of melatonin) significantly increased the tissue content of ME-IR and LE-IR, when compared to both controls and non-exposed WFL-treated rats. In addition, subcutaneous administration of exogenous melatonin (10, 100, 150, 300, 600mug/kg), in WFL-treated animals produced significant dose-dependent increases of ME-IR in both brain regions tested. Finally, luzindole (melatonin receptor antagonist) administration, was not able to prevent the enkephalin tissue increase, induced with the MEL administration (150mug/kg). This data suggest that MEL not only regulates the EOS-circadian rhythm, but also appears to modulate their synthesis in the rat brain from their respective neurons.

PMID: 17988732 [PubMed - as supplied by publisher]

Tinnitus and pain.

Prog Brain Res. 2007;166:47-53.

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Tinnitus and pain.

Møller AR.

School of Behavioral and Brain Sciences, University of Texas at Dallas, GR41, PO Box 830688, Richardson, TX 75083-0688, USA.

Tinnitus has many similarities with the symptoms of neurological disorders such as paresthesia and central neuropathic pain. There is considerable evidence that the symptoms and signs of some forms of tinnitus and central neuropathic pain are caused by functional changes in specific parts of the central nervous system and that these changes are caused by expression of neural plasticity. The changes in the auditory nervous system that cause tinnitus and the changes in the somatosensory systems that cause central neuropathic pain may have been initiated from the periphery, i.e. the ear or the auditory nerve for tinnitus and receptors and peripheral nerves in the body for pain. In the chronic condition of tinnitus and pain, abnormalities in the periphery may no longer play a role in the pathology, but the tinnitus is still referred to the ear and central neuropathic pain is still referred to the location on the body of the original pathology. In this chapter we will discuss specific similarities between tinnitus and pain, and compare tinnitus with other phantom disorders. Since much more is known about pain than about tinnitus, it is valuable to take advantage of the knowledge about pain in efforts to understand the pathophysiology of tinnitus and find treatments for tinnitus.

PMID: 17956770 [PubMed - in process]

Panic disorder among Vietnamese refugees attending a psychiatric clinic: prevalence and subtypes.

Gen Hosp Psychiatry. 2001 Nov-Dec;23(6):337-44.

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Panic disorder among Vietnamese refugees attending a psychiatric clinic: prevalence and subtypes.

Hinton D, Chau H, Nguyen L, Nguyen M, Pham T, Quinn S, Tran M.

Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. devon_hinton@hms.harvard.edu

This study surveys Vietnamese refugees attending two psychiatric clinics to determine both the prevalence of panic disorder (PD) as well as panic attack subtypes in those suffering PD. A culturally valid adaptation of the SCID-panic module (the Vietnamese Panic Disorder Survey or VPDS) was administered to 100 Vietnamese refugees attending two psychiatric clinics. Utilizing culturally sensitive panic probes, the VPDS provides information regarding both the presence of PD and panic attack subtypes during the month prior to interview. Of 100 patients surveyed, 50 (50%) currently suffered PD. Among the 50 patients suffering PD, the most common panic attack subtypes during the previous month were the following: "orthostatic dizziness" (74% of the 50 panic disorder patients [PDPs]), headache (50% of PDPs), wind-induced/temperature-shift-induced (24% of PDPs), effort-induced (18% of PDPs), gastro-intestinal (16% of PDPs), micturition-induced (8% of PDPs), out-of-the-blue palpitations (24% of PDPs), and out-of-the-blue shortness of breath (16% of PDPs). Five mechanisms are adduced to account for this high PD prevalence as well as the specific profile of subtypes: 1) a trauma-caused panic attack diathesis; 2) trauma-event cues; 3) ethnic differences in physiology; 4) catastrophic cognitions generated by cultural syndromes; and 5) a modification of Clark's spiral of panic.

Publication Types:

• Review

PMID: 11738465 [PubMed - indexed for MEDLINE]

Neck pain causes respiratory dysfunction.

See also the "Sore Neck Syndrome" described in Vietnamese refugees (reference posted on this blog). MP 

 

 

Med Hypotheses. 2007 Oct 22; [Epub ahead of print]

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Neck pain causes respiratory dysfunction.

Kapreli E, Vourazanis E, Strimpakos N.

Department of Physiotherapy, TEI Lamias, 3rd Km Old National Road Lamia, Athens, 35100 Lamia, Greece.

This paper describes a presumptive mechanism for the development of changes in respiratory function due to chronic neck pain. The patient with neck pain presents a number of factors that could constitute a predisposition of leading to a respiratory dysfunction: (a) the decreased strength of deep neck flexors and extensors, (b) the hyperactivity and increased fatigability of superficial neck flexors, (c) the limitation of range of motion, (d) the decrease in proprioception and disturbances in neuromuscular control, (e) the existence of pain and (f) the psychosocial influence of dysfunction. The possible connection of neck pain and respiratory function could have a great impact on various clinical aspects notably patient assessment, rehabilitation and pharmacological prescription.

PMID: 17959320 [PubMed - as supplied by publisher]

Antidepressants for neuropathic pain.

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005454.

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Antidepressants for neuropathic pain.

Saarto T, Wiffen P.

BACKGROUND: This is an updated version of the original Cochrane review published in Issue 3, 2005 of The Cochrane Library. For many years antidepressant drugs have been used to manage neuropathic pain, and are often the first choice treatment. It is not clear, however, which antidepressant is more effective, what role the newer antidepressants can play in treating neuropathic pain, and what adverse effects are experienced by patients. OBJECTIVES: To determine the analgesic effectiveness and safety of antidepressant drugs in neuropathic pain. SEARCH STRATEGY: Randomised controlled trials (RCTs) of antidepressants in neuropathic pain were identified in MEDLINE (1966 to Oct 2005); EMBASE (1980 to Oct 2005); the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Issue 3, 2005; and the Cochrane Pain, Palliative and Supportive Care Trials Register (May 2002). Additional reports were identified from the reference list of the retrieved papers, and by contacting investigators. SELECTION CRITERIA: RCTs reporting the analgesic effects of antidepressant drugs in adult patients, with subjective assessment of pain of neuropathic origin. Studies that included patients with chronic headache and migraine were excluded. DATA COLLECTION AND ANALYSIS: Two review authors agreed the included studies, extracted data, and assessed methodological quality independently. Sixty one trials of 20 antidepressants were considered eligible (3293 participants) for inclusion. Relative Risk (RR) and Number-Needed-to-Treat (NNTs) were calculated from dichotomous data for effectiveness and adverse effects.This update includes 11 additional studies (778 participants). MAIN RESULTS: Sixty one RCTs were included in total. Tricyclic antidepressants (TCAs) are effective and have an NNT of 3.6 (95% CI 3 to 4.5) RR 2.1 (95% CI 1.8 to 2.5) for the achievement of at least moderate pain relief. There is limited evidence for the effectiveness of the newer SSRIs but no studies of SNRIs were found. Venlafaxine (three studies) has an NNT of 3.1 (95% CI 2.2 to 5.1) RR 2.2 (95% CI 1.5 to 3.1). There were insufficient data to assess effectiveness for other antidepressants such as St Johns Wort and L-tryptophan. For diabetic neuropathy the NNT for effectiveness was 1.3 (95% CI 1.2 to 1.5) RR 12.4 (95% CI 5.2 to 29.2) (five studies); for postherpetic neuralgia 2.7 (95% CI 2 to 4.1), RR 2.2 (95% CI 1.6 to 3.1) (four studies). There was evidence that TCAs are not effective in HIV-related neuropathies. The number needed to harm (NNH) for major adverse effects defined as an event leading to withdrawal from a study was 28 (95% CI 17.6 to 68.9) for amitriptyline and 16.2 (95% CI 8 to 436) for venlafaxine. The NNH for minor adverse effects was 6 (95% CI 4.2 to 10.7) for amitriptyline and 9.6 (95% CI 3.5 to 13) for venlafaxine. AUTHORS' CONCLUSIONS: This update has provided additional confirmation on the effectiveness of antidepressants for neuropathic pain and has provided new information on another antidepressant - venlafaxine. There is still limited evidence for the role of SSRIs. Whether antidepressants prevent the development of neuropathic pain (pre-emptive use) is still unclear. Both TCAs and venlafaxine have NNTs of approximately three. This means that for approximately every three patients with neuropathic pain who are treated with either of these antidepressants, one will get at least moderate pain relief. There is evidence to suggest that other antidepressants may be effective but numbers of participants are insufficient to calculate robust NNTs. SSRIs are generally better tolerated by patients and more high quality studies are required.

PMID: 17943857 [PubMed - in process]

Role of acupuncture in the treatment of migraine.

Expert Rev Neurother. 2007 Sep;7(9):1121-34.

Related Articles, Links

Role of acupuncture in the treatment of migraine.

Endres HG, Diener HC, Molsberger A.

Ruhr University Bochum, Department of Medical Informatics, Statistics & Epidemiology, D-44801 Bochum, Germany. heinz.endres@ruhr-uni-bochum.de

Since the last Cochrane review of acupuncture and headache in 2001, which found methodological and/or reporting shortcomings in the majority of the studies, several large, randomized trials on the effectiveness of acupuncture as a treatment for headache have been published. Following a brief overview of the pathophysiology of migraine and possible action mechanisms of acupuncture, we look at current studies on acupuncture and migraine and discuss the results. From these results and our own studies on acupuncture and migraine, we conclude that a 6-week course of acupuncture is not inferior to a 6-month prophylactic drug treatment, but that specific Chinese point selection, point stimulation and needling depth are not as important as had been thought. The review suggests that acupuncture should be integrated into existing migraine therapy protocols.

Publication Types:

• Meta-Analysis
• Review

PMID: 17868011 [PubMed - indexed for MEDLINE]

ScienceNOW Daily News: Lungs to Brain: Don't Panic!

Lungs to Brain: Don't Panic!

By Elizabeth Quill
ScienceNOW Daily News
4 October 2007

Carbon dioxide may deserve blame for more than just the panic over global warming. New research involving healthy people inhaling the gas indicates that the brain's reaction to carbon dioxide helps explain panic attacks and other anxious feelings, independent of rising world temperatures. This new insight, reported 3 October in PLoS One, could help physicians prevent the development of depression and other anxiety disorders.

It's long been known that anxiety-prone individuals often experience panic attacks when they breathe in carbon dioxide. Psychiatrists have theorized that emotional distress reflects a built-in response to suffocation. The "false suffocation alarm theory" suggests that the brain has a carbon dioxide sensor and that it is oversensitive in some people, mistakenly spurring panic attacks. Such a sensor could have evolved to alert oxygen-breathing organisms of impending death.

Eric Griez, an experimental psychiatrist at the University of Maastricht, the Netherlands, came up with a test for the false-alarm theory. If it is valid, he surmised, healthy individuals should show some sensitivity to carbon dioxide as well. So he and his colleagues recently asked 64 volunteers to inhale two deep breaths of four mixtures of compressed air containing 9%, 17.5%, 35%, or no carbon dioxide. After inhaling each mixture, the volunteers continuously rated their level of fear and discomfort on a scale from 1 to 100 using a touch screen and rated their panic using a questionnaire that listed 13 common symptoms of panic attacks. As the dose of carbon dioxide increased, so did fear and discomfort. "Panic seems to be a very special kind of anxiety which truly can be called a suffocation alarm," says Griez. Volunteers also experienced a loss of touch with reality and a fear of going crazy, describing their experiences as "frightening," "panicky," and "scaring." Griez says the results show just how closely a person's emotions are linked to physical well-being. "Panic, which is the most dramatic form of acute anxiety, is the cry for life," he says.

The results suggest a new way to experimentally induce panic in the laboratory, which may allow easier and faster testing of new antianxiety drugs. However, Laszlo Papp, a psychiatrist at Columbia University, questions whether the reactions described by the healthy people are true panic attacks. He says the study simply shows that increasing the concentration of carbon dioxide inhaled results in more physical discomfort, such as shortness of breath and lightheadedness. Papp says he has conducted studies in which anxiety-prone individuals and healthy controls inhaled carbon dioxide, and only a small proportion of the latter panicked. "The discomfort rarely translated into the panic attack described by panic patients," he says.

Griez, however, believes the new finding will ultimately help physicians better treat patients with emphysema and asthma. When these patients cannot get enough oxygen, carbon dioxide builds up in their bodies, making them feel as though they are suffocating. They also face a higher risk of anxiety than the rest of the population.

Panic disorder with nocturnal panic attacks: Symptoms and comorbidities.

 

Eur Psychiatry. 2007 Oct 13; [Epub ahead of print]

Panic disorder with nocturnal panic attacks: Symptoms and comorbidities.

Sarísoy G, Böke O, Arík AC, Sahin AR.

Ondokuz Mayis University, Faculty of Medicine, Department of Psychiatry, 55139 Samsun, Turkey.

The aim of this study was to determine the relationship between nocturnal panic attacks and comorbidities, clinical variables and panic attack symptoms. One hundred and six consecutive patients with DSM-IV panic disorder were enrolled in the study. The patients were divided into two groups depending on the presence of nocturnal panic attacks. Comorbidities were diagnosed with the help of SCID-I and SCID-II. The groups were compared using the Beck Depression Inventory, State-Trait Anxiety Inventory and Symptom Checklist. Nocturnal panic attacks were not related to comorbidities or age at the onset of the disease. The scores from the Beck Depression Inventory, general scores from the Symptom Checklist, somatization, obsession-compulsion, interpersonal sensitivity and anger-hostility sub-scale scores were higher in the nocturnal panic attack group. Patients with nocturnal panic attacks experience more frequent respiratory symptoms, suggesting that nocturnal panic attacks may be related to respiratory symptoms. Our findings demonstrate that patients with nocturnal panic attacks have more respiratory symptoms of panic, depressive and other psychiatric symptoms than the no nocturnal panic group.

PMID: 17937981 [PubMed - as supplied by publisher]

Decreased central mu-opioid receptor availability in fibromyalgia.

J Neurosci. 2007 Sep 12;27(37):10000-6.

Related Articles, Links

Decreased central mu-opioid receptor availability in fibromyalgia.

Harris RE, Clauw DJ, Scott DJ, McLean SA, Gracely RH, Zubieta JK.

Department of Internal Medicine, The University of Michigan, Ann Arbor, Michigan 48109, USA. reharris@med.umich.edu

The underlying neurophysiology of acute pain is fairly well characterized, whereas the central mechanisms operative in chronic pain states are less well understood. Fibromyalgia (FM), a common chronic pain condition characterized by widespread pain, is thought to originate largely from altered central neurotransmission. We compare a sample of 17 FM patients and 17 age- and sex-matched healthy controls, using mu-opioid receptor (MOR) positron emission tomography. We demonstrate that FM patients display reduced MOR binding potential (BP) within several regions known to play a role in pain modulation, including the nucleus accumbens, the amygdala, and the dorsal cingulate. MOR BP in the accumbens of FM patients was negatively correlated with affective pain ratings. Moreover, MOR BP throughout the cingulate and the striatum was also negatively correlated with the relative amount of affective pain (McGill, affective score/sensory score) within these patients. These findings indicate altered endogenous opioid analgesic activity in FM and suggest a possible reason for why exogenous opiates appear to have reduced efficacy in this population.

Publication Types:

• Comparative Study
• Research Support, N.I.H., Extramural
• Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17855614 [PubMed - indexed for MEDLINE]

Efficacy of Folic Acid in Children With Migraine, Hyperhomocysteinemia and MTHFR Polymorphisms.

Headache. 2007 Oct;47(9):1342-4.

Related Articles, Links

Efficacy of Folic Acid in Children With Migraine, Hyperhomocysteinemia and MTHFR Polymorphisms.

Di Rosa G, Attinà S, Spanò M, Ingegneri G, Sgrò DL, Pustorino G, Bonsignore M, Trapani-Lombardo V, Tortorella G.

Department of Medical and Surgical Pediatrics, Unit of Infantile Neuropsychiatry, University Hospital of Messina, Messina, Italy.

MTHFR gene variants C677T and A1298C seem to be related to an increased risk of migraine. Folates' metabolism could play a role in the pathophysiology of migraine. We supplemented 16 children with migraine, hyperhomocysteinemia, and MTHFR polymorphisms with folic acid and obtained a resolution/reduction of migraine attacks. Although the mechanism leading to these effects has been not made clear, we believe that the use of folic acid needs further investigations in migraineurs with hyperhomocysteinemia and MTHFR variants. A randomized, double-blind, placebo controlled crossover trial is needed to support these findings.

PMID: 17927652 [PubMed - in process]

[Dizziness associated with panic disorder and agoraphobia: case report and literature review.]

Rev Bras Otorrinolaringol (Engl Ed). 2007 Jul-Aug;73(4):569-72.

Related Articles

[Dizziness associated with panic disorder and agoraphobia: case report and literature review.]

[Article in Portuguese]

Gurgel JD, Costa KV, Cutini FN, Sarmento Júnior KM, Mezzasalma MA, Cavalcanti HV.

SBORL.

Dizziness is one of the most frequent complaints in both primary and specialized medical care facilities. Many dizzy patients, without a known organic cause, considered as having idiopathic dizziness, may have a psychiatric disorder. Besides, even organic dizziness may cause or exacerbate latent psychiatric alterations. One of the most common disorders associated with dizziness is Panic Disorder with or without Agoraphobia. The aim of this paper is to report a patients case and make a literature review on the subject.

Publication Types:

• English Abstract

PMID: 17923930 [PubMed - in process]

Emptiness in agoraphobia patients.

 

J Am Psychoanal Assoc. 2007 Summer;55(3):1007-26; discussion 1027-32.

Related Articles

Emptiness in agoraphobia patients.

Milrod B.

Weill Cornell College of Medicine, USA. bmilrod@mail.med.cornell.edu

In light of new research findings about the efficacy of psychodynamic treatment for panic disorder and agoraphobia, it seems a prudent time to carefully address psychoanalytic thinking about the treatment of agoraphobia. The literature has highlighted oedipal contributions to its genesis and clinical unraveling in psychoanalysis. While those contributions are indeed central to the disorder, structural deficits in the self-representation often become a central focus of treatment once symptomatic remission has been achieved in psychoanalytic treatment. This aspect of the clinical presentation of agoraphobia has not yet been specifically addressed in the psychiatric literature. Some aspects of the phenomenon have been described by psychoanalysts. It is more difficult to treat this "emptiness" than the overt symptoms of agoraphobia, as described in DSM-IV. Nonetheless, this phenomenon may be one of the contributors to the chronicity of the disorder. Two clinical cases illustrate these points.

Publication Types:

• Research Support, N.I.H., Extramural
• Research Support, Non-U.S. Gov't

PMID: 17915656 [PubMed - in process]

Art, Psychoanalysis, and Society Project: Film (Undzere Kinder)

Cross-posted from

http://internationalpsychoanalysis.net/2007/09/28/art-psychoanalysis-and-society-project/

 

Friday, September 28th, 2007 at 5:23 am

Art, Psychoanalysis, and Society Project: Film (Undzere Kinder)

Posted by Tamar Schwartz

INSTITUTE FOR PSYCHOANALYTIC TRAINING AND RESEARCH
 Art, Psychoanalysis, and Society Project
Co- sponsored by the Center for Jewish History and YIVO

Space is limited   Reservations required
Box office:  917 606-8200
Date: November 4, 2007                      
Time: 2 –5 PM

Location:  Center for Jewish History
                  15  West 16th  St.
                  New York City
Sunday 4, 2-5pm

Childhood Trauma In Film: Undzere Kinder (Our Children) Film and Workshop:  This last Yiddish-language film made in Poland features famous Yiddish comedians Szimon Dzigan and Yisroel Szumacher and a cast of Jewish orphans, survivors of the Holocaust. The film will be used as the basis of a workshop on psychological trauma and its representation in film. Introduced and moderated by Dr. Maurice Preter and Dr. Isaac Tylim with the participation of Dr. Harold J. Bursztajn, Harvard Medical School; Professor Shimon Redlich, Ben-Gurion University; Marek Web, YIVO Historian; Dr. Eva Weil, Paris Psychoanalytic Society; Dr. Eva Kantor, Institute for Psychoanalytic Training and Research, NYC.

Click Here to Read: More About the Movie Undzere Kinder.  

Click here to Read: More about Dr. Maurice Preter.

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