The Mind Brain Medicine Forum

Quality psychiatric care is needed

2010-07-05T19:15:00.000-04:00

Quality psychiatric care is needed

China Daily article mirrored on Xinhua

China Daily Op-ed: Quality psychiatric care is needed - not only in China

2010-07-04T23:22:00.004-04:00

Cross-posted from Chinadaily.com July 5, 2010:

http://www.chinadaily.com.cn/opinion/2010-07/05/content_10056660.htm

Quality psychiatric care is needed
Op-Ed By Dr. Maurice Preter (China Daily)
Updated: 2010-07-05 08:00

The recent spate of attacks on schoolchildren and the workers' suicides at the Foxconn factory in Shenzhen have again highlighted China's urgent need to balance economic progress with care for those left behind, and unable to cope with, the lightning speed of development.

Sustainable development is an avowed goal of Chinese government policy, and from a medical-psychological perspective, accessible, quality general medical and psychiatric care is a fundamental part of long-term, ecologically minded, peaceful societal progress.

However, it is an open secret that the medical profession in China is in disarray and rather ill-equipped to contribute to the solution of China's larger societal problems. Chinese physicians are overworked. They routinely see several dozen, if not a hundred patients a day, including those in urgent need of expert mental health treatment.

They are forced to accept absurdly low salaries and are consequently, generally disrespected. Pharmaceutical sales productivity incentives imposed by hospital administrations and by the wish to supplement meager earnings lead to a medical assembly line mentality that short-changes patients and frustrates doctors.

It comes as no surprise that, according to data cited in this newspaper (China Daily, March 25, 2010: "Doctors at receiving end in medical reform"), there are high levels of stress and depression among Chinese doctors.

Coincidentally or not, this year's most murderous school attack was perpetrated by a supposedly mentally ill physician.

This situation is unlikely to attract the needed numbers of highly intelligent and motivated students to the practice of medicine. This in turn stymies the development of quality medical care, and the future acquisition and transmission of clinical knowledge. However, the recent violent events are a cruel reminder that China must make the rational delivery of compassionate, sophisticated medical-psychiatric care an absolute priority.

Keeping in mind that for the foreseeable future, the majority of mentally ill and emotionally distressed patients in China will continue to receive their care from general (non-specialist) doctors, what is the current situation in my own field of practice?

Chinese patients seeking expert help for mental distress will often receive care from physicians educated without any knowledge of available non-drug based treatment options, such as psychodynamic psychotherapy, group therapy and other types of behavioral interventions.

While in the West the set ways of medicine, and especially psychiatric medicine, are increasingly coming under critical scrutiny, most Chinese psychiatrists limit themselves to simplistic, obsolete interpretations of Western biomedical models that de-emphasize empathic listening.However, quality medical care, and especially mental health care, begins with a well-trained and experienced physician who is able to create a therapeutic alliance with a suffering and often frightened, and ashamed patient.

By contrast, the lack of time spent with an individual patient (when there are countless individuals waiting to be seen), combined with the economic reality of multiplying one's salary by writing huge numbers of prescriptions puts Chinese doctors under undue and undeclared influence from extraneous forces, namely the pharmaceutical industry.

In turn, patients are at risk of receiving sub-optimal diagnosis and care and are put in harm's way by medication overuse.

On a positive note, the Chinese government is taking steps to alleviate the existing income and infrastructure discrepancies between the Eastern coastal areas and the countryside, which will improve general medical, and one hopes, mental health care.

Equally important, a whole generation of sophisticated, highly motivated psychiatric physicians and non-medical psychotherapists is coming of age (in the big cities), educated in part thanks to outside efforts by not-for-profit organizations such as the Chinese American Psychoanalytic Alliance (CAPA).

Regarding the proposed health care reform, China might conclude that there is little synergy between corporate business models and her huge population's need for accessible medical care.

The conflicts of interest that have come to shake US academia will need to be addressed here as well. At the same time, doctors' working conditions must be improved. Eventually, consideration should be given to the establishment of a rational tort system that does not simply copy the excesses of the US system. There is much reason for hope and much work to be done. Chinese society, patients and doctors will be better off for it.

The author is a US educated neurologist and psychiatrist based in New York City, and a faculty member of Columbia University and the Chinese American Psychoanalytic Alliance.

(China Daily 07/05/2010 page8)

Scientists Spot Gene Variants That Predict Longevity Grouping determined whether person lived to 100 with 77% accuracy

2010-07-02T08:25:00.000-04:00

http://consumer.healthday.com/Article.asp?AID=640714

A significant increase in polypharmacy involving antidepressant and antipsychotic medications.

2010-06-17T12:51:00.000-04:00

Arch Gen Psychiatry. 2010 Jan;67(1):26-36.

National trends in psychotropic medication polypharmacy in office-based psychiatry.

Mojtabai R, Olfson M.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 797, Baltimore, MD 21205, USA. rmojtaba@jhsph.edu

Abstract

CONTEXT: Psychotropic medication polypharmacy is common in psychiatric outpatient settings and, in some patient groups, may have increased in recent years. OBJECTIVE: To examine patterns and recent trends in psychotropic polypharmacy among visits to office-based psychiatrists. DESIGN: Annual data from the 1996-2006 cross-sectional National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in psychotropic polypharmacy within nationally representative samples of 13 079 visits to office-based psychiatrists. SETTING: Office-based psychiatry practices in the United States. PARTICIPANTS: Outpatients with mental disorder diagnoses visiting office-based psychiatrists. MAIN OUTCOME MEASURE: Number of medications prescribed in each visit and specific medication combinations. RESULTS: There was an increase in the number of psychotropic medications prescribed across years; visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006; visits with 3 or more medications increased from 16.9% to 33.2% (both P < .001). The median number of medications prescribed in each visit increased from 1 in 1996-1997 to 2 in 2005-2006 (mean increase: 40.1%). The increasing trend of psychotropic polypharmacy was mostly similar across visits by different patient groups and persisted after controlling for background characteristics. Prescription for 2 or more antidepressants, antipsychotics, sedative-hypnotics, and antidepressant-antipsychotic combinations, but not other combinations, significantly increased across survey years. There was no increase in prescription of mood stabilizer combinations. In multivariate analyses, the odds of receiving 2 or more antidepressants were significantly associated with a diagnosis of major depression (odds ratio [OR], 3.44; 99% confidence interval [CI], 2.58-4.58); 2 or more antipsychotics, with schizophrenia (OR, 6.75; 99% CI, 3.52-12.92); 2 or more mood stabilizers, with bipolar disorder (OR, 15.46; 99% CI, 6.77-35.31); and 2 or more sedative-hypnotics, with anxiety disorders (OR, 2.13; 99% CI, 1.41-3.22). CONCLUSIONS: There has been a recent significant increase in polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.

PMID: 20048220 [PubMed - indexed for MEDLINE]

An Occupational Neurosis: A Psychoanalytic Case History of a Rabbi

2010-06-13T14:14:00.002-04:00

An Occupational Neurosis: A Psychoanalytic Case History of a Rabbi

Maya Balakirsky Katz (2010).
AJS Review, Volume 34, Issue 01, Apr 2010 pp 1-31 http://journals.cambridge.org/action/displayAbstract?aid=7629776

Vers une meilleure intégration d’Internet à la relation médecins-patients | Conseil National de l'Ordre des Médecins

2010-05-07T09:42:00.000-04:00

Vers une meilleure intégration d’Internet à la relation médecins-patients | Conseil National de l'Ordre des Médecins: "Vers une meilleure intégration d’Internet à la relation médecins-patients
06/05/2010

Sept Français sur dix consultent aujourd’hui Internet pour obtenir des informations en matière de santé . Devant l’essor de cette pratique, le Conseil National de l’Ordre des Médecins a convié le 4 mai dernier, experts, institutionnels et journalistes pour débattre de l’évolution de l’information santé en ligne et de son incidence dans la relation des Français avec leurs praticiens."

Current psychiatric classiﬁcation and diagnostic scales - Are they sensitive enough to detect the lasting effects of early childhood adversity?

2010-05-06T09:54:00.003-04:00

Original Articles

Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions; respiratory and subjective responses: relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss

M. Preter, S. H. Lee, E. Petkova, M. Vannucci, S. Kim and D. F. Klein

Psychological Medicine, First View Articles article

doi:10.1017/S0033291710000838 (About doi), Published Online by Cambridge University Press 06 May 2010

From the results:

"Normal subjects, usually relatively insensitive to the TV effects of lactate infusion, in this study, given
opioid antagonist pretreatment, developed TV and RR increments resembling those occurring in both spon-
taneous clinical panic attacks and in panic patients who panic during lactate infusions (Gorman et al.
1984 ; Liebowitz et al. 1984 a ; Papp et al. 1993). The hypothesis that a functioning endogenous opioid sys-
tem buﬀers normal subjects from the behavioral and physiological eﬀects of lactate is consonant with these
results.
To our knowledge, this is the ﬁrst time that the prolonged physiological eﬀects of actual separations
and losses during childhood (i.e. parental death, parental separation or divorce) on the endogenous opioid
system of healthy adults have been objectively shown in an experimental setting. The presence or absence
of CPL antecedents determined the response to the naloxone–lactate probe. A history of CPL decreased..." [read more].

Click here for complete PDF version

Click here for Journal website

"Oedipe est le meilleur site français sur la psychanalyse"

2010-05-04T19:14:00.000-04:00

- Le Monde interactif, supplément du 19 mai 2002.

Ouverture

Il y a un peu plus d'un siècle, un jeune médecin juif, intelligent, ambitieux, peu fortuné se posait quelques questions dont les réponses allaient avoir des répercussions nombreuses sur ses contemporains . Son premier objectif était de gagner sa vie , d'ouvrir un cabinet et de trouver une clientèle pour enfin pouvoir se marier. Comme tout homme jeune versé dans le domaine de la recherche, il rêvait de gloire, de grandes découvertes. Son travail dans le domaine de la neurobiologie, intéressant et novateur ne lui avait pas ouvert autant de portes qu'il avait pu l'espérer. La question de la correspondance anatomo-clinique qui avait nourri ses recherches se heurtait aux questions soulevées par les patients pour lesquels cette correspondance n'existait pas.

En France deux "écoles" interrogeaient, notamment grace à l'hypnose, cette difficulté épistémologique. L'école de Nancy prenait le risque de questionner des hypnotiseurs, non-médecins . A Paris, le professeur Jean-Martin Charcot, dont la célébrité reposait sur plusieurs découvertes importantes dans le champ de la neurologie, s'intéressait lui aussi aux manifestations provoquées chez certaines malades hospitalisées à la Salpêtrière et cataloguées " hystériques ". Ces malades présentaient des symptomes-notamment des paralysies- qui ne correspondaient pas à ce que l'on connaissait de l'anatomie et de la physiologie.Elles revivaient sous hypnose des scènes à caractère sexuel. C'est en faisant le saut qui passe du " bras " en tant qu'il peut être décrit en termes anatomiques, au bras en tant qu'il est une représentation imaginaire inscrite dans le langage, que Freud sans abandonner la question de la correspondance anatomo-clinique, s'aventure alors dans une autre voie celle d'une parole qu'il s'agit non seulement d'écouter mais d'entendre. Consciemment ou non, Freud cherche aussi à se connaître lui-même et se confronte aux énigmes de sa propre histoire. Cette démarche prendra toute sa dimension au cours des échanges épistolaires et lors de ses rencontres avec un autre médecin juif, son ami Wilhem Fliess, et plus tard, quand il entreprendra l'analyse de ses propres rêves. Pour écouter parler toute au long de la journée des patients, il était sans doute utile, pour le confort des deux protagonistes, d'inventer un dispositif. Freud ne supportait pas le regard de ses patients au cours des longues heures d'entretiens qu'il avait avec eux. En les allongeant sur un divan et en se plaçant derrière eux, il privilégie l'écoute sur le regard, il invente un dispositif congruant avec sa méthode. Il énonce la règle fondamentale qui invite ses patients à dire ce qui vient.

Très rapidement il rencontre un certain nombre de questions :
- la question de la réalité des faits racontés et parmi les récits qu'il entend, le problème lié à la véracité et à l'impact des actes de séduction sexuelle commis, selon le récit de ses patientes, dans leur petite enfance par un adulte, souvent un membre de la famille proche,en particulier le père. Freud élabore alors une série d'avancées qui problématisent cette question du traumatisme et débouche sur la théorie du fantasme qui met en avant l'importance du désir du sujet dans la mémorisation de son histoire infantile .
- la question du lien qui se noue entre l'analyste et l'analysant au cours de la cure . Il nomme transfert ce lien , précisant que le transfert doit se comprendre en référence aux images archaïques infantiles et s'interpréter en fonction des données propres à la cure.
- La question de la résistance et de la censure. L'interprétation donnée au patient ne conduit pas d'emblée à une adhésion de celui-ci. L'analysant tient à son symptôme, le défend en quelque sorte et peine à y renoncer.

Freud tout au long de sa vie et grâce à son travail a construit : Une méthode pour explorer le psychisme grâce à laquelle il lui a été possible d'élaborer une nouvelle théorie de l'appareil psychique ainsi que le dispositif de la cure dont il est avéré qu'elle entraîne pour les patients qui s'y prêtent des effets thérapeutiques. Après Freud, de nombreux psychanalystes ont contribués à affiner , modifier, élargir les champs ouverts par lui ,qu'il s'agisse de la théorie des groupes,de la pédagogie,de l'anthropologie etc.. où à l'intérieur même du champ analytique qui n'a cessé de s'étendre: enfants, nourrissons, psychosomatique etc... Des hommes et des femmes venus du monde entier ont commencé à pratiquer la psychanalyse , posant le problème de savoir qui pouvait se dire psychanalyste? Était-ce seulement l'adhésion à une théorie qui qualifiait le psychanalyste? Dans un premier temps deux principes furent retenus: Le psychanalyste doit avoir fait une analyse et en avoir sur lui-même éprouvé les effets, notamment en ce qui concerne le transfert et la résistance. Il doit avoir reçu une formation complémentaire et avoir pendant un certain nombre d'années pu exposer ses difficultés à un ou plusieurs analyste plus expérimentés que lui. La communauté analytique, s'est progressivement dotée d'associations locales regroupées au niveau international, d'instituts de formation, de revues nationales et internationales, de bibliothèques et à présent de sites internet... Depuis Freud, un nombre incalculable de patients par le monde ont fait une cure psychanalytique. La théorie psychanalytique a progressé et s'est enrichie d'apports multiples .Elle s'est aussi complexifiée au point que personne n'est aujourd'hui capables de faire le bilan de toutes les pistes explorées, de toutes les hypothèses avancées

Rien ne va plus

La psychanalyse est constamment prise dans des débats contradictoires. Elle est dénoncée par ceux qui en contestent le bien fondé sans toujours que leur propos apparaisse instruit de façon suffisante et pertinente. Elle est aussi l'objet de multiples débats au sein de ce qu'il est convenu d'appeler peut être improprement, la communauté analytique. Il en résulte des conflits ou la question du pouvoir n'est pas absente, des scissions et des rivalités plus ou moins importantes . Chaque scission a entraîné la création de nouvelles associations et de nouvelles structures qui se séparent, se regroupent, se combattent etc... Les clivages sont tels aujourd'hui qu'ils conduisent à se poser la question de l'existence de cette " communauté analytique " dont les contours semblent bien difficiles à tracer. Le plus souvent , il n'est même plus possible de renouer le dialogue. Les mots employés par les tribus voisines ont trouvé un sens différent et d'autres mots au contenu énigmatique sont venus au fil des ans s'ajouter à ceux de la langue commune au point pour l'analyste quittant sa tribu, d'éprouver parfois le sentiment étrange de se trouver en une terre étrangère et pourtant familière. Notre objectif n'est pourtant pas d'élaborer une plate-forme consensuelle entre tous les analystes, non plus qu'un illusoire " esperanto ". Nous souhaitons par contre aider ceux qui nous rejoindront à procéder à une lecture raisonnée des sites qui fleurissent désormais un peu partout à l'enseigne de la psychanalyse, participant à notre manière à la circulation de la parole et à la réaffirmation de l'importance de la psychanalyse dans le monde d'aujourd'hui. Ils y trouveront également un lieu ou ils pourront s'exprimer s'ils le souhaitent. S'il revient bien à chaque analyste pris un par un, de répondre du présent et de l'avenir de la psychanalyse, ceux qui voudront participer à la construction du site oedipe trouveront, nous l'espérons dans celui-ci, un moyen utile pour cette tâche.

Laurent Le Vaguerèse, Responsable du site Oedipe

Les sources juives de la psychanalyse Lacan lecteur de la Bible (28 mn) Gérard Haddad, Psychanalyste Centre Communautaire - Paris, novembre 2004

2010-05-04T19:06:00.001-04:00

http://www.akadem.org/sommaire/themes/philosophie/4/1/module_466.php

Foreign accent syndrome(FAS)

2010-05-04T18:52:00.003-04:00

Medicine Through Time Foreign accent syndrome(FAS) "When my voice have been changed"

FAS is a rare medical condition involving speech production that usually occurs as a side effect of severe brain injury, such as a stroke or a head injury. Two cases have been reported of individuals with the condition as a development problem and one assoc...iated with severe migraine. Between 1941 and 2009, there have been sixty recorded cases. Its symptoms result from distorted articulatory planning and coordination processes. It must be emphasized that the speaker does not suddenly gain a foreign language (vocabulary, syntax, grammar, etc); they merely pronounce their native language with a foreign or dialectical accent. Despite a recent unconfirmed news report that a Croatian speaker has gained the ability to speak fluent German after emergence from a coma, there has been no verified case where a patient's foreign language skills have improved after a brain injury (and in fact in the case of the Croatian girl, she lost her ability to speak Croatian).

Cross-posted from Medicine Through Time (Facebook)
http://www.facebook.com/permalink.php?story_fbid=121012817915007&id=348794679530

Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia -- Chernyshev et al. 74 (17): 1340 -- Neurology

2010-04-30T20:03:00.001-04:00

Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia -- Chernyshev et al. 74 (17): 1340 -- Neurology

Antibodies in patients with neuropsychiatric systemic lupus erythematosus -- Kimura et al. 74 (17): 1372 -- Neurology

2010-04-30T20:03:00.000-04:00

Antibodies in patients with neuropsychiatric systemic lupus erythematosus -- Kimura et al. 74 (17): 1372 -- Neurology

Daily headache: What have we learned? -- Karceski 74 (17): e73 -- Neurology

2010-04-30T19:54:00.000-04:00

Daily headache: What have we learned? -- Karceski 74 (17): e73 -- Neurology

UPDATE: Justice Dept Confirms Settlement In Seroquel Probe - WSJ.com

2010-04-28T16:52:00.000-04:00

UPDATE: Justice Dept Confirms Settlement In Seroquel Probe - WSJ.com

Nanotech and medicine « David Kirkpatrick

2010-04-21T12:51:00.000-04:00

Nanotech and medicine « David Kirkpatrick

Surviving Long-Term Unemployment - Forbes.com

2010-04-21T12:25:00.000-04:00

Surviving Long-Term Unemployment - Forbes.com

The Coming Merging of Mind and Machine: Scientific American

2010-04-21T11:51:00.000-04:00

The Coming Merging of Mind and Machine: Scientific American

Nano-Risks: A Big Need for a Little Testing: Scientific American

2010-04-21T11:45:00.000-04:00

Nano-Risks: A Big Need for a Little Testing: Scientific American

Letters - Perception and Distortion - NYTimes.com NYT Review of Books April 18, 2010

2010-04-17T15:19:00.001-04:00

Letters - Perception and Distortion - NYTimes.com

Letters
Perception and Distortion

Published: April 15, 2010

To the Editor:

'The Shaking Woman,' by Siri Hustvedt: Seized (April 4, 2010)

As is the case in most presentations of “unexplainable” neurological-psychiatric symptoms, there are unspeakables in Siri Hustvedt’s book “The Shaking Woman” (April 4): the horror of a vague, transgenerationally transmitted memory of a witnessed wartime atrocity; the pain and fear of cumulative loss. Any attempt to put the unspeakable on paper will necessarily fall short, but Hustvedt’s sustained argument in the book is precisely that all categories — medical and philosophical — are in themselves subject to ambiguity.

Criticizing it for its failure to address the pain of caregivers is a non sequitur. The reviewer, I am afraid, fell into the same fallacy she accuses Hustvedt of: seeing and hearing only what she wanted to see and hear. In my work as a clinical and forensic neurologist-psychiatrist, I am used to seeing unspeakable emotional pain causing perceptual distortions. Neither literary creation nor its criticism are exempt from this fundamental observation.

MAURICE PRETER
New York
The writer is an assistant professor of clinical psychiatry at Columbia University and an adjunct associate professor of neurology at SUNY Downstate Medical Center.

The Brain Is Not Modular: What fMRI Really Tells Us: Scientific American

2010-04-16T19:08:00.000-04:00

The Brain Is Not Modular: What fMRI Really Tells Us: Scientific American

A conversation between Siri Hustvedt and Maurice Preter MD

2010-04-16T09:52:00.010-04:00

In 2006, the novelist and essayist Siri Hustvedt suffered an inexplicable seizure while speaking at a memorial service for her father. The seizures continued to occur, and the condition remains undiagnosed. Her most recent book The Shaking Woman or A History of My Nerves tells the story of her condition and explores her symptoms through the lenses of several disciplines: medical history, psychiatry, psychoanalysis, contemporary neuroscience, philosophy, and literature. Hustvedt has a PhD in English literature from Columbia and has worked as a writing teacher with psychiatric patients at the Payne Whitney Psychiatric Clinic in New York. Her web site is www.sirihustvedt.

Maurice Preter, MD is a practicing neurologist, psychiatrist, and psychotherapist. Dr. Preter received his training in neurology and psychiatry at the Albert Einstein College of Medicine, and is board certified in both specialties. He has done neuropsychiatric research in stress, anxiety, panic disorder, and psychological trauma. A member of the psychiatry faculty of Columbia University’s College of Physician’s and Surgeons, his particular interest is in the treatment of conditions that cross the conventional and limiting borders of psychiatry, neurology, and general medicine. His web site is www.psychiatryneurology.net.

Please join us for a discussion between Siri Hustvedt and Dr. Maurice Preter on unexplained medical symptoms, their meanings for patients and for doctors, and the vital importance of viewing illness, no matter how mysterious, in a narrative context.

Hosted by Dr. Rita Charon and the Program in Narrative Medicine.

Wednesday May 12th at 5:00 PM in the Faculty Club in the Physicians & Surgeons Building, 4th floor, Room #446.

Cross-posted from http://www.psychiatryneurology.net/News.html

PDF: http://psychiatryneurology.com/SiriHustvedt_MauricePreter_flyer.pdf

Click here to listen

Siri Hustvedt – Works by Siri Hustvedt – Official Website

2010-04-11T13:59:00.000-04:00

Siri Hustvedt – Works by Siri Hustvedt – Official Website

Les dépêches - Le Monde.fr

2010-04-08T18:53:00.000-04:00

Les dépêches - Le Monde.fr

Effects of sleep deprivation on dissociated compon... [Sleep. 2010] - PubMed result

2010-04-08T12:31:00.000-04:00

Effects of sleep deprivation on dissociated compon... [Sleep. 2010] - PubMed result

Multivitamins Linked to Breast Cancer Risk

2010-04-01T14:59:00.000-04:00

Multivitamins Linked to Breast Cancer Risk

Too Good to Be True? - Psychiatric Times

2010-04-01T14:40:00.000-04:00

Too Good to Be True? - Psychiatric Times

PARK AVENUE - Medical Weight & Wellness - Blog - Too Sleep-Deprived to Have Sex? May Be Sign of a Larger Problem

2010-03-31T12:30:00.000-04:00

PARK AVENUE - Medical Weight & Wellness - Blog - Too Sleep-Deprived to Have Sex? May Be Sign of a Larger Problem

Thin Brains and Depression | ScienCentral | Science Videos | Science News

2010-03-31T10:18:00.000-04:00

Thin Brains and Depression | ScienCentral | Science Videos | Science News

Report of two Chinese families and a review of Mai... [J Neurol Sci. 2009] - PubMed result

2010-03-28T14:41:00.000-04:00

Report of two Chinese families and a review of Mai... [J Neurol Sci. 2009] - PubMed result: "and a"

Sleep-disordered breathing: impact on functional o... [Sleep Med. 2009] - PubMed result

2010-03-28T13:33:00.000-04:00

Sleep-disordered breathing: impact on functional o... [Sleep Med. 2009] - PubMed result

Tea Consumption and Ischemic Stroke Risk: A Case-Control Study in Southern China -- Liang et al. 40 (7): 2480 -- Stroke

2010-03-28T13:32:00.000-04:00

Tea Consumption and Ischemic Stroke Risk: A Case-Control Study in Southern China -- Liang et al. 40 (7): 2480 -- Stroke

Neuropsychiatric Effects of Traumatic Brain Injury - Psychiatric Times

2010-03-26T23:14:00.000-04:00

Neuropsychiatric Effects of Traumatic Brain Injury - Psychiatric Times

Should I Resign From the American Psychiatric Association? - Psychiatric Times

2010-03-26T23:13:00.000-04:00

Should I Resign From the American Psychiatric Association? - Psychiatric Times

News in anxiety research

2010-03-25T17:59:00.003-04:00

Panic disorder study just accepted for publication in Psychological Medicine

[http://journals.cambridge.org/action/displayJournal?jid=PSM]

TITLE: Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions;

respiratory and subjective responses: Relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss (CPL)

Short Title: Controlled study of naloxone-lactate infusions in normals.

Maurice Preter¹, MD, Sang Han Lee², PhD, Eva Petkova³, PhD, Marina Vannucci⁴, PhD, Sinae Kim⁵, PhD, Donald F. Klein⁶, MD, DSc

¹ Corresponding Author. Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, and Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NY.

Mailing address: 1160 Fifth Avenue, 112. New York, NY 10029, USA.

² The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962.

³ Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, U.S.A.

⁴ Department of Statistics, Rice University, Houston, Texas 77251-1892.

⁵ Department of Biostatistics, University of Michigan, Ann Harbor, MI 48109.

⁶ Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Department of Child and Adolescent Psychiatry, New York University Langone Medical Center; Nathan S. Kline Institute for Psychiatric Research; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York.

ABSTRACT:

Background: The expanded suffocation false alarm theory (SFA; Preter and Klein, 2008) hypothesizes that dysfunction in endogenous opioidergic regulation increases sensitivity to CO2, separation distress and panic attacks. In panic disorder patients, both spontaneous clinical panics and lactate-induced panics markedly increase tidal volume, while normals have a lesser effect, perhaps due to their intact endogenous opioid system. We hypothesized that impairing the opioidergic system by naloxone could make normal controls parallel panic disorder patients’ response when lactate challenged.

Whether actual separations and losses during childhood (Childhood Parental Loss, CPL) affected naloxone-induced respiratory contrasts was explored. Subjective panic-like symptoms were analyzed although pilot work indicated that the subjective aspect of anxious panic was not well modeled by this specific protocol.

Methods: Randomized cross-over sequences of intravenous naloxone (2mg/kg) followed by lactate (10mg/kg), or saline followed by lactate were given to 25 volunteers. Respiratory physiology was objectively recorded by the LifeShirt. Subjective symptomatology was recorded.

Results: Impairing of the endogenous opioid system by naloxone accentuates tidal volume and symptomatic response to lactate. This interaction is substantially lessened by CPL.

Conclusions: Opioidergic dysregulation may underlie respiratory pathophysiology and suffocation sensitivity in panic disorder. Comparing specific anti-panic medications with ineffective anti-panic agents (e.g., propranolol) can test the specificity of the naloxone+lactate model. A screen for putative anti-panic agents and a new pharmacotherapeutic approach is suggested. Heuristically, the experimental unveiling of the endogenous opioid system impairing effects of childhood parental loss and separation in normal adults opens a new experimental, investigatory area.

2010-03-25T17:49:00.001-04:00

Characteristics of young rural Chinese suicides: a psychological autopsy study

J Zhang, W Wieczorek, Y Conwell, X-M Tu, et al. Psychological Medicine. Cambridge: Apr 2010. Vol. 40, Iss. 4; pg. 581, 9 pgs

Abstract (Summary)

Background: Patterns of suicide rates in China differ in many ways from those in the West. This study aimed to identify the risk factors characteristic for young rural Chinese suicides.

Method: This was a case-control psychological autopsy (PA) study. The samples were suicides and living controls (both aged 15-34 years) from 16 rural counties of China. We interviewed two informants for each suicide and each control with pretested and validated instruments to estimate psychosocial, psychiatric and other risk factors for suicides.

Results: The prevalence of mental disorders was higher among the young Chinese who died by suicide than among the living controls, but was lower than among suicides in the West. Marriage was not a protecting factor for suicide among young rural Chinese women, and never-married women who were involved in relationships were about three times more likely to commit suicide than single women who were unattached. Religion/religiosity was not a protecting factor in Chinese suicide, as it tended to be stronger for suicides than for controls. Impulsivity was significantly higher for suicides than for controls. Psychological strain, resulting from conflicting social values between communist gender equalitarianism and Confucian gender discrimination, was associated significantly with suicide in young rural Chinese women, even after accounting for the role of psychiatric illness.

Conclusions: Risk factors for suicide in rural China are different from those in the West. Psychological strain plays a role in suicide. Suicide prevention programs in China should incorporate culture-specific considerations. [PUBLICATION ABSTRACT]

A comparison of chronic pain patients and controls on traumatic events in childhood.

2009-10-04T21:38:00.001-04:00

Disabil Rehabil. 2000 Nov 20;22(17):756-63.Links

A comparison of chronic pain patients and controls on traumatic events in childhood.

Goldberg RT, Goldstein R.

Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Boston, USA. THAYER9378@aol.com

PURPOSE: The purpose was to examine the incidence of traumatic events in childhood, such as sexual and physical abuse, in a chronic pain group and a control group of hospital employees without chronic pain. METHOD: Ninety two patients with chronic pain, age range 20-62, were consecutively recruited from the outpatient clinics of a rehabilitation hospital and a general hospital. Ninety eight hospital employees, age range 20-62, were consecutively recruited from the employee health office of a rehabilitation hospital. All participants responded to nine questions related to sexual, physical and verbal abuse in childhood and completed the Childhood Traumatic Events Scale. A logistic regression with age, gender, sexual, physical, and verbal abuse, death of a family member, childhood illness, major upheaval before age 17, as independent variables were used to predict membership in the pain group contrasted with the control group. RESULTS: Child abuse was reported in the childhood history by 54.4% of the chronic pain group, compared with 21.4% of the control group. A logistic regression showed that after adjusting for gender and age, sexual and verbal abuse were statistically significant predictors of being a member of the pain group. Odds ratios were sexual abuse: 2.67, p < 0.05, CI 1.00-7.14. Verbal abuse: 4.39, p < 0.001, CI 1.93-9.97. A logistic regression was modelled to predict child abuse when gender was taken into account. The results of the logistic regression showed that pain was a significant predictor for sexual abuse after adjusting for gender and age: odds ratio 4.37, p < 0.001, CI 1.80-10.60. Gender was not a statistically significant predictor for sexual abuse, after adjusting for pain and age: odds ratio 2.92, p < 0.072, CI 0.91-9.42. CONCLUSIONS: A history of physical, sexual and verbal abuse is more likely to occur in a chronic pain group than in a control group of hospital employees. Although child abuse is reported to be as high as 25% in the general American population, the statistics for chronic pain patients are twice as high as in the general population. The mechanisms for abuse include age, gender, and early family environment.

Work stress precipitates depression and anxiety in young, working women and men.

2009-10-04T21:37:00.001-04:00

Psychol Med. 2007 Aug;37(8):1119-29. Epub 2007 Apr 4. Links

Comment in:: Psychol Med. 2007 Aug;37(8):1073-4.

Work stress precipitates depression and anxiety in young, working women and men.

Melchior M, Caspi A, Milne BJ, Danese A, Poulton R, Moffitt TE.

MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London, UK.

BACKGROUND: Rates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults. METHOD: Participants were enrolled in the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria. RESULTS: Participants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1.90 [95% confidence interval (CI) 1.22-2.98] in women, and 2.00 (95% CI 1.13-3.56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members' socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder. CONCLUSIONS: Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.

PMID: 17407618 [PubMed - indexed for MEDLINE]

Relationship between traumatic events in childhood and chronic pain.

2009-10-04T21:24:00.001-04:00

Disabil Rehabil. 1999 Jan;21(1):23-30.Cited in PMC, LinkOut

Relationship between traumatic events in childhood and chronic pain.

Goldberg RT, Pachas WN, Keith D.

Department of Psychiatry, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA.

PURPOSE: The purpose was to examine the relationships between traumatic events in childhood, such as sexual and physical abuse, alcoholism, and drug addiction, and three types of chronic pain: facial pain, myofascial pain, and fibromyalgia. A fourth group, a heterogeneous group of other pain, was used as a comparison group. METHOD: Ninety one patients with chronic pain, age range 20-60, were consecutively recruited from the outpatient clinics of a rehabilitation hospital and a general hospital. Patients were given four measures for completion at evaluation: Childhood History Questionnaire; Childhood Traumatic Events Scale; McGill Melzack Pain Questionnaire; Pain Disability Index. Chi-square was used to test significant differences among four pain groups on sexual, physical, and verbal abuse; alcoholism; drug dependence; medications; major upheaval, childhood illness, death of a family member or friend, and separation or divorce of parents. Logistic regression was used to predict membership in the four pain groups. RESULTS: All pain groups had a history of abuse exceeding 48%: fibromyalgia, 64.7%; myofascial, 61.9%; facial, 50%; other pain, 48.3%. All groups had a history of family alcohol dependence exceeding 38%, and a history of drug dependence ranging from 5.8 to 19.1%. A combined history of pain, child physical abuse, and alcoholism was prevalent in 12.9 to 35.3%. Logistic regression showed patients who were female, with an alcoholic parent, using non-narcotic drugs were more likely to be members of the facial, myofascial, and fibromyalgia groups. CONCLUSIONS: Child traumatic events are significantly related to chronic pain. Since the problem of child abuse is broader than physical and sexual abuse, health and rehabilitation agencies must shift from individualized treatment to interdisciplinary treatment of the family and patient.

PMID: 10070600 [PubMed - indexed for MEDLINE]

Tension-type headache as the unique pain experience of a patient with congenital insensitivity to pain.

2009-10-04T21:18:00.000-04:00

Pain. 2005 Oct;117(3):478-83. Links

Tension-type headache as the unique pain experience of a patient with congenital insensitivity to pain.

Danziger N, Willer JC.

Département de Neurophysiologie Clinique, Centre Hospitalo-Universitaire, Pitié-Salpêtrière, Paris, France. ndanziger@hotmail.com

Congenital insensitivity to pain (CIP) is a rare clinical syndrome characterized by dramatic impairment of pain perception since birth and is generally caused by a hereditary sensory and autonomic neuropathy (HSAN) with loss of the small-calibre, nociceptive nerve fibres. We report the case of a 32-year-old woman with CIP and a presumptive diagnosis of HSAN type V, who experienced physical pain for the first and unique time in her life shortly after the sudden loss of her brother. This patient had sustained innumerable painless injuries during childhood, including bone fractures and severe burns. The only pain she ever felt consisted in an intense headache, which took place in a context of strong emotional overload and anxiety, 3 weeks after her younger brother died suddenly in a car accident. The description of this inaugural episode of headache fulfilled the diagnostic criteria of episodic tension-type headache. This case strongly suggests that the transcription of the grief of bereavement into physical pain may sometimes occur independently of the peripheral mechanisms of nociception and despite the lack of previous pain experience. In the light of recent experimental data showing that the same neural mechanisms that regulate physical pain may also control the expression of separation distress and the feeling of social exclusion, this unique case helps to better understand why some patients may feel physically hurt after the loss of someone they love.

PMID: 16154693 [PubMed - indexed for MEDLINE]

Review[Congenital insensitivity to pain]
Rev Neurol (Paris). 2009 Feb; 165(2):129-36. Epub 2008 Jul 9.
[Rev Neurol (Paris). 2009]
Is pain the price of empathy? The perception of others' pain in patients with congenital insensitivity to pain.
Brain. 2006 Sep; 129(Pt 9):2494-507. Epub 2006 Jun 24.
[Brain. 2006]
ReviewAssessment and evaluation of hereditary sensory and autonomic neuropathies with autonomic and neurophysiological examinations.
Clin Auton Res. 2002 May; 12 Suppl 1:I33-43.
[Clin Auton Res. 2002]
Congenital insensitivity to pain (hereditary sensory and autonomic neuropathy type V): a rare case report.
J Dent Child (Chic). 2008 May-Aug; 75(2):207-11.
[J Dent Child (Chic). 2008]
Congenital insensitivity to pain in four related Saudi families.
Pediatr Dermatol. 2002 Jul-Aug; 19(4):333-5.
[Pediatr Dermatol. 2002]
» See reviews... | » See all...

Recent Activity

Socially isolated children 20 years later: risk of cardiovascular disease.

2009-10-04T20:51:00.002-04:00

Arch Pediatr Adolesc Med. 2006 Aug;160(8):805-11. Cited in PMC, LinkOut

Socially isolated children 20 years later: risk of cardiovascular disease.

Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R.

Author Affiliations: Department of Psychology, University of Wisconsin, Madison, USA. a.caspi@iop.kcl.ac.uk

OBJECTIVE: To test the hypothesis that children who occupy peripheral or isolated roles in their peer groups (isolated children) are at risk of poor adult health. DESIGN: Longitudinal study of an entire birth cohort. SETTING: Dunedin, New Zealand. PARTICIPANTS: A total of 1037 children who were followed up from birth to age 26 years. INTERVENTIONS: Measurement of social isolation in childhood, adolescence, and adulthood. MAIN OUTCOME MEASURES: When study members were 26 years old, we measured adult cardiovascular multifactorial risk status (overweight, elevated blood pressure, elevated total cholesterol level, low high-density lipoprotein level, elevated glycated hemoglobin concentration, and low maximum oxygen consumption). RESULTS: Socially isolated children were at significant risk of poor adult health compared with nonisolated children (risk ratio, 1.37; 95% confidence interval, 1.17-1.61). This association was independent of other well-established childhood risk factors for poor adult health (low childhood socioeconomic status, low childhood IQ, childhood overweight), was not accounted for by health-damaging behaviors (lack of exercise, smoking, alcohol misuse), and was not attributable to greater exposure to stressful life events. In addition, longitudinal findings showed that chronic social isolation across multiple developmental periods had a cumulative, dose-response relationship to poor adult health (risk ratio, 2.58; 95% confidence interval, 1.46-4.56). CONCLUSIONS: Longitudinal findings about children followed up to adulthood suggest that social isolation has persistent and cumulative detrimental effects on adult health. The findings underscore the usefulness of a life-course approach to health research, by focusing attention on the effect of the timing of psychosocial risk factors in relation to adult health.

PMID: 16894079 [PubMed - indexed for MEDLINE]

Family conflict in childhood: a predictor of later insomn

2009-10-04T20:51:00.001-04:00

Sleep. 2006 Aug 1;29(8):1063-7.Cited in PMC, LinkOut

Family conflict in childhood: a predictor of later insomnia.

Gregory AM, Caspi A, Moffitt TE, Poulton R.

Institute of Psychiatry, King's College London, United Kingdom. a.gregory@iop.kcl.ac.uk

STUDY OBJECTIVES: To examine the association between childhood exposure to family conflict and insomnia at 18 years of age. DESIGN: Longitudinal prospective data on an entire birth cohort were obtained. Parents completed the Conflict subscale of the Moos Family Environment Scale when the study members were 7, 9, 13, and 15 years of age. Insomnia was examined in a standardized interview when the participants were aged 18 years. SETTING: Participants were born in Dunedin, New Zealand, and were interviewed at this location. PATIENTS OR PARTICIPANTS: One thousand thirty-seven children born between April 1, 1972, and March 31, 1973, enrolled in the study (52% male). At age 18 years, 993 (97% of living cohort members) provided data. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The mean level of family conflict at age 7 to 15 years predicted insomnia at 18 years after controlling for sex, socioeconomic status, sleep problems at 9 years, and self-reported health (odds ratio [95% confidence interval] = 1.42 [1.17-1.73], p < .001). There was a dose-response relationship, whereby the more assessments at which families scored in the top 25% for conflict, the greater the young person's likelihood of developing insomnia at age 18 years. This association was present even after controlling for depression at 18 years. CONCLUSIONS: This study demonstrates a modest but robust longitudinal link between family conflict during childhood and insomnia experienced at 18 years of age. Future work needs to replicate this finding in different populations and to elucidate the mechanisms underlying this association.

PMID: 16944675 [PubMed - indexed for MEDLINE]

Increased prevalence of white matter hyperintensities in patients with panic disorder.

2009-10-04T20:32:00.001-04:00

J Psychopharmacol. 2008 Nov 21. [Epub ahead of print] Links

Increased prevalence of white matter hyperintensities in patients with panic disorder.

Bae S, Kim J, Hwang J, Lee Y, Lee H, Lee J, Lyoo I, Renshaw P, Yoon S.

Interdisciplinary Program in Brain Science and Department of Psychiatry, Seoul National University and Hospital, Seoul, South Korea.

AbstractThe aim of the current study is to compare the prevalence, severity and location of cerebral white matter hyperintensities (WMH) between patients with panic disorder (PD) and healthy control subjects. Patients with PD (n = 24) and matched healthy control subjects (n = 24) were scanned using a 3.0 Tesla whole-body magnetic resonance scanner. Axial T2-weighted and fluid-attenuated inversion recovery images were acquired and evaluated for the prevalence, severity and location of WMH using the modified composite scale of Fazekas and Coffey and coded separately for deep and periventricular WMH. Logistic regression analyses were used to assess the association between WMH and the diagnosis of PD. A greater severity of total WMH was associated with a diagnosis of PD in a dose-dependent pattern (odds ratio [OR] = 8.8, P = 0.005 for mild WMH; OR = 27.7, P = 0.007 for moderate to severe WMH). Deep WMH, where most group differences originated, were predominantly located in the frontal region of the brain (n = 16 in PD, n = 1 in control). The current report is the first study to report an increased prevalence of WMH in patients with PD.

Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study.

2009-10-04T20:18:00.000-04:00

Psychosom Med. 2009 Sep;71(7):798-804. Epub 2009 Jul 10. Links

Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study.

Chen YH, Tsai SY, Lee HC, Lin HC.

School of Public Health, Taipei Medical University, Taipei, Taiwan.

OBJECTIVE: To examine prospectively the relationship between a diagnosis of panic disorder and the risk of acute myocardial infarction within 1 year of follow-up. Panic disorder is associated prospectively with coronary artery disease, but the risk of acute myocardial infarction associated with panic disorder has not been specifically investigated. METHOD: This nationwide population-based study used data from the Taiwan National Health Insurance Research Database covering the years 2000 to 2005. A total of 9641 patients diagnosed with panic disorder in 2004 were included, together with 28,923 matched nonpanic disorder enrollees as a comparison cohort. Cox proportional hazard regressions were conducted to compute hazard ratios, after adjustment for comorbid medical disorders and sociodemographic characteristics. RESULTS: Results indicated that 4.77% of patients with panic disorder (approximately one in 21) experienced an acute myocardial infarction episode within a year, compared with 2.73% of patients in the comparison cohort. The adjusted hazard of acute myocardial infarction was significantly higher (1.75 times, 95% Confidence Interval = 1.55-1.97) for patients with panic disorder, relative to the comparison cohort. The association persisted in further analyses stratified by hypertension, coronary heart diseases, and age. CONCLUSION: Panic disorder was identified as an independent risk factor for subsequent acute myocardial infarction. Comprehensive multidisciplinary approaches are needed to optimize primary and secondary prevention of acute myocardial infarction among patients with panic disorder.

Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles.

2009-10-04T20:16:00.001-04:00

J Neurol Neurosurg Psychiatry. 2009 Oct;80(10):1176-9. Epub 2009 May 21. Links

Comment in:: J Neurol Neurosurg Psychiatry. 2009 Oct;80(10):1059.

Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles.

Lencer R, Steinlechner S, Stahlberg J, Rehling H, Orth M, Baeumer T, Rumpf HJ, Meyer C, Klein C, Muenchau A, Hagenah J.

Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany. rebekka.lencer@psychiatrie.uk-sh.de

BACKGROUND: Primary focal dystonia (PFD) is characterised by motor symptoms. Frequent co-occurrence of abnormal mental conditions has been mentioned for decades but is less well defined. In this study, prevalence rates of psychiatric disorders, personality disorders and traits in a large cohort of patients with PFD were evaluated. METHODS: Prevalence rates of clinical psychiatric diagnoses in 86 PFD patients were compared with a population based sample (n = 3943) using a multiple regression approach. Furthermore, participants were evaluated for personality traits with the 5 Factor Personality Inventory. RESULTS: Lifetime prevalence for any psychiatric or personality disorder was 70.9%. More specifically, axis I disorders occurred at a 4.5-fold increased chance. Highest odds ratios were found for social phobia (OR 21.6), agoraphobia (OR 16.7) and panic disorder (OR 11.5). Furthermore, an increased prevalence rate of 32.6% for anxious personality disorders comprising obsessive-compulsive (22.1%) and avoidant personality disorders (16.3%) were found. Except for social phobia, psychiatric disorders manifested prior to the occurrence of dystonia symptoms. In the self-rating of personality traits, PFD patients demonstrated pronounced agreeableness, conscientiousness and reduced openness. CONCLUSIONS: Patients with PFD show distinct neuropsychiatric and personality profiles of the anxiety spectrum. PFD should therefore be viewed as a neuropsychiatric disorder rather than a pure movement disorder.

Prevalence of anxiety disorders and anxiety subtypes in patients with

2009-10-04T20:10:00.000-04:00

Mov Disord. 2009 Jul 15;24(9):1333-8. Links

Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease.

Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SA, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Rabins PV, Weiss HD, Marsh L.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

Anxiety disorders are common in Parkinson's disease (PD), but are not well characterized. This study determined the prevalence and clinical correlates of all DSM-IV-TR anxiety disorder diagnoses in a sample of 127 subjects with idiopathic PD who underwent comprehensive assessments administered by a psychiatrist and neurologist. A panel of six psychiatrists with expertise in geriatric psychiatry and/or movement disorders established by consensus all psychiatric diagnoses. Current and lifetime prevalence of at least one anxiety disorder diagnosis was 43% (n = 55) and 49% (n = 63), respectively. Anxiety disorder not otherwise specified, a DSM diagnosis used for anxiety disturbances not meeting criteria for defined subtypes, was the most common diagnosis (30% lifetime prevalence, n = 38). Compared with nonanxious subjects, panic disorder (n = 13) was associated with earlier age of PD onset [50.3 (12.2) vs. 61.0 (13.7) years, P < 0.01], higher rates of motor fluctuations [77% (10/13) vs. 39% (25/64), P = 0.01] and morning dystonia [38% (5/13) vs. 13% (8/62), P < 0.03]. This high prevalence of anxiety disorders, including disturbances often not meeting conventional diagnostic criteria, suggests that anxiety in PD is likely underdiagnosed and undertreated and refined characterization of anxiety disorders in PD is needed. In addition, certain anxiety subtypes may be clinically useful markers associated with disease impact in PD. 2009 Movement Disorder Society.

Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey.

2009-10-04T20:09:00.001-04:00

J Psychosom Res. 2009 May;66(5):417-24. Epub 2008 Dec 16. Links

Dizziness: anxiety, health care utilization and health behavior--results from a representative German community survey.

Wiltink J, Tschan R, Michal M, Subic-Wrana C, Eckhardt-Henn A, Dieterich M, Beutel ME.

Clinic of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg-University Mainz, Germany.

BACKGROUND: Due to the lack of epidemiological data on the relation of dizziness and anxiety, we investigated the prevalence of dizziness and anxiety in a representative sample of the German population. We explored the consequences of comorbid anxiety for emotional distress, functional impairment, health care utilization, and health behavior in dizziness. METHODS: By the end of 2006, we surveyed a total of 1287 persons between 14 and 90 years of age in their homes by trained interviewers with standardized self-rating questionnaires on anxiety (Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Mini-Social Phobia Inventory) and dizziness (Vertigo Symptom Scale). The sample was representative for the German population in terms of age, sex, and education. RESULTS: Symptoms of dizziness were reported by 15.8% of the participants. Of the participants with dizziness, 28.3% reported symptoms of at least one anxiety disorder (generalized anxiety, social phobia, panic). Persons with dizziness reported more somatic problems such as hypertension, migraine, diabetes, etc. Comorbid anxiety was associated with increased health care use and impairment. CONCLUSION: Dizziness is a highly prevalent symptom in the general population. A subgroup with comorbid anxiety is characterized by an increased subjective impairment and health care utilization due to their dizziness. Because treatment options for distinct neurotologic disorders are also known to reduce psychological symptoms, and in order to avoid unnecessary medical treatment, early neurologic and psychiatric/psychotherapeutic referral may be indicated.

Non-fearful panic disorder in gastroenterology.

2009-10-04T20:01:00.001-04:00

Psychosomatics. 2008 Nov-Dec;49(6):543-5. Links

Non-fearful panic disorder in gastroenterology.

Porcelli P, De Carne M.

Unità di Psicosomatica, IRCCS Ospedale De Bellis, Via della Resistenza, 70013 Castellana Grotte, Bari, Italy. porcellip@media.it

BACKGROUND: Nonfearful panic disorder (NFPD) is a panic condition masked under the appearance of somatic symptoms only, without the component of fear, and it represents a challenging diagnostic task. METHOD: This is the first case report of NFPD in a male patient with acute gastric pain and gastrointestinal disease (atrophic gastritis and H. pylori infection). RESULTS: The patient showed atypical panic symptoms and demoralization on the Diagnostic Criteria for Psychosomatic Research screening. He was successfully treated with anti-panic medication and cognitive-behavioral therapy. DISCUSSION: The case report shows that accurate psychosomatic assessment may help clinicians avoid diagnostic delay, prevent the administration of unnecessary medications, and give patients more appropriate treatment.

Pain interference impacts response to treatment for anxiety disorders.

2009-10-04T20:00:00.001-04:00

Depress Anxiety. 2009;26(3):222-8. Links

Pain interference impacts response to treatment for anxiety disorders.

Teh CF, Morone NE, Karp JF, Belnap BH, Zhu F, Weiner DK, Rollman BL.

Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. tehc@upmc.edu

BACKGROUND: Anxiety disorders and pain are commonly comorbid, though little is known about the effect of pain on the course and treatment of anxiety. METHODS: This is a secondary analysis of a randomized controlled trial for anxiety treatment in primary care. Participants with panic disorder (PD) and/or generalized anxiety disorder (GAD) (N=191; 81% female, mean age 44) were randomized to either their primary-care physician's usual care or a 12-month course of telephone-based collaborative care. Anxiety severity, pain interference, health-related quality of life, health services use, and employment status were assessed at baseline, and at 2-, 4-, 8-, and 12-month follow-up. We defined response to anxiety treatment as a 40% or greater improvement from baseline on anxiety severity scales at 12-month follow-up. RESULTS: The 39% who reported high pain interference at baseline had more severe anxiety (mean SIGH-A score: 21.8 versus 18.0, P<.001), greater limitations in activities of daily living, and more work days missed in the previous month (5.8 versus 4.0 days, P=.01) than those with low pain interference. At 12-month follow-up, high pain interference was associated with a lower likelihood of responding to anxiety treatment (OR=.28; 95% CI=.12-.63) and higher health services use (26.1% with >/=1 hospitalization versus 12.0%, P<.001). CONCLUSIONS: Pain that interferes with daily activities is prevalent among primary care patients with PD/GAD and associated with more severe anxiety, worse daily functioning, higher health services use, and a lower likelihood of responding to treatment for PD/GAD. (c) 2009 Wiley-Liss, Inc.

PMID: 19133701 [PubMed - indexed for MEDLINE

The relationship between migraine and mental disorders in a population-based sample.

2009-10-04T19:59:00.001-04:00

Gen Hosp Psychiatry. 2009 Jan-Feb;31(1):14-9. Epub 2008 Oct 9. Links

The relationship between migraine and mental disorders in a population-based sample.

Ratcliffe GE, Enns MW, Jacobi F, Belik SL, Sareen J.

Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada R3E 3N4.

OBJECTIVE: There is emerging evidence from clinical and community samples to suggest that migraines are associated with mental disorders. The present study utilized a large population-based sample to investigate the association between physician-diagnosed migraine and mental disorders. METHOD: Data were from the German Health Survey conducted between 1997 and 1999 (N=4181, response rate 61.4%, age 18-65 years). Lifetime and 12-month history of migraines were assessed by self-report and by a physician. Past 12-month DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview. RESULTS: After adjusting for sociodemographic factors, past-year migraine was significantly and positively associated with depression, dysthymia, bipolar disorder, panic attacks, panic disorder, agoraphobia and simple phobia [adjusted odds ratios (AOR) ranging from 1.74 to 3.21]. After additionally adjusting for other mental disorders, any anxiety disorder (AOR=1.82) and any mood disorder (AOR=1.61) remained significantly associated with past-year migraine. CONCLUSION: Although causal inferences cannot be made due to the cross-sectional nature of the data, the present study adds to a growing body of literature that suggests a strong association between migraines and mood and anxiety disorders.

PMID: 19134504 [PubMed - indexed for MEDLINE]

Panic as a harbinger of pancreatic cancer.

2009-10-04T19:40:00.001-04:00

Psychosomatics. 2008 Nov-Dec;49(6):538-9. Links

Panic as a harbinger of pancreatic cancer.

Griffeth BT, Mehra A.

Salem VAMC, Mental Health, Code 116A7, 1970 Roanoke Blvd., Salem, VA 24153, USA. benjamin.griffeth@va.gov

BACKGROUND: Previous literature has discussed the diagnosis of cancer with psychiatric symptoms. There are noted associations made between pancreatic cancer and depression and anxiety symptoms both in literature and textbooks. METHOD: The authors discuss the case of a patient who presented with anxiety and panic attacks before his diagnosis of pancreatic cancer. CONCLUSION: There has been a previous association noted between depression and anxiety and pancreatic cancer; however, this work and another report have noted panic episodes preceding diagnosis, as well. These symptoms could prove to be an important marker for early detection.

When anxiety symptoms masquerade as medical symptoms: what medical specialists know about panic disorder and available psychological treatmen

2009-10-04T19:39:00.001-04:00

J Clin Psychol Med Settings. 2008 Dec;15(4):314-21. Epub 2008 Oct 15. Links

When anxiety symptoms masquerade as medical symptoms: what medical specialists know about panic disorder and available psychological treatments.

Teng EJ, Chaison AD, Bailey SD, Hamilton JD, Dunn NJ.

Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. ellen.teng@va.gov

Under-recognition of somatic symptoms associated with panic in primary care settings results in unnecessary and costly diagnostic procedures and inappropriate referrals to cardiologists, gastroenterologists, and neurologists. In the current study specialists' knowledge regarding the nature and treatment of panic were examined. One-hundred and fourteen specialists completed a questionnaire assessing their knowledge about panic attacks, including their perceptions of psychologists' role in treating panic. Respondents answered 51% of knowledge items correctly. Although most knew the definition of a panic attack, they knew less about clinical features of panic and its treatment. Specifically, whereas 97.4% believed medication effectively relieves panic symptoms, only 32.5% knew that cognitive-behavioral therapy (CBT) is a first-line treatment. Only 6% reported knowing how to implement CBT, and only 56.1% recognized that psychologists could effectively treat panic. These findings demonstrate significant gaps in specialists' knowledge about panic and the need to enhance physician knowledge about panic attacks and their treatment.

http://www.firsthospital.cn/content.aspx?id=1339#

2009-07-05T12:44:00.003-04:00

http://www.firsthospital.cn/content.aspx?id=1339#

Shanghai Jiao-Tong University/Neuroscience Bulletin

美哥伦比亚大学Preter 教授再次访问我院

近日，美哥伦比亚大学Preter 教授按计划再次访问了我院神经内科，访问期间Preter 教授会诊了本院IMCC一位德国患者。他还拜会中国科学院生命科学研究院Neuroscience Bulletin 编辑部，拜访中国科学院（上海）神经科学研究所并和段树民院士亲切交流。

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Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

2008-11-16T12:14:00.000-05:00

Environ Health Perspect. 2002 Aug;110 Suppl 4:669-71.

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Tarlo SM, Poonai N, Binkley K, Antony MM, Swinson RP.

Gage Occupational and Environmental Health Unit, University of Toronto, Toronto, Ontario, Canada. susan.tarlo@utoronto.ca

Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

Panic attacks in an individual with bilateral selective lesions of the amygdala.

2008-11-11T20:24:00.002-05:00

Arch Neurol. 2006 Dec;63(12):1798-801.

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Panic attacks in an individual with bilateral selective lesions of the amygdala.

Wiest G, Lehner-Baumgartner E, Baumgartner C.

Department of Neurology, Medical University of Vienna, Vienna, Austria. gerald.wiest@meduniwien.ac.at

OBJECTIVE: To describe the unique case of a patient with panic attacks and bilateral selective amygdala lesions due to Urbach-Wiethe disease. DESIGN: Case report. SETTING: Epilepsy Monitoring Unit, Medical University of Vienna. Patient A 38-year-old man with Urbach-Wiethe disease developed spontaneous panic attacks and depressive mood, which ceased after antidepressive treatment. INTERVENTIONS: Video electroencephalography monitoring, magnetic resonance imaging, and neuropsychological testing. RESULTS: Extended video electroencephalography monitoring excluded an epileptic etiology of the panic attacks. Results of cranial magnetic resonance imaging showed bilateral selective calcifications of the whole amygdaloid complex. Neuropsychological testing revealed selective memory impairment of autobiographic episodes with preserved memory for autobiographic facts. CONCLUSIONS: Our findings indicate that the occurrence of panic attacks does not critically depend on the integrity of the amygdala. Furthermore, the neuropsychological findings in our patient suggest that the amygdala represents an essential neural substrate for the processing of episodic autobiographic memories.

Publication Types:

Case Reports

PMID: 17172622 [PubMed - indexed for MEDLINE]

Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson's disease.

2008-11-10T22:22:00.045-05:00

Neurology. 2004 Oct 26;63(8 Suppl 3):S35-8.

Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson's disease.

Barone P, Amboni M, Vitale C, Bonavita V.

Department of Neurological Sciences, University of Napoli Federico II, Via Pansini 5, 80131 Naples, Italy.

Nocturnal disturbances are common in Parkinson's disease (PD) patients, with almost 70% of these patients reporting nocturnal disturbances. The etiology of sleep disturbances in patients with PD is still controversial. They might be dependent on dopaminergic drugs, on disease progression, or on a combination of these two factors. Nocturnal disturbances can be categorized in four groups: 1) PD-related motor symptoms, including nocturnal akinesia, early-morning dystonia, painful cramps, tremor, and difficulty turning in bed; 2) treatment-related nocturnal disturbances; 3) psychiatric symptoms, including hallucinations, vivid dreams, depression, dementia, insomnia, psychosis, and panic attacks; 4) other sleep disorders, including insomnia, REM behavioral disorder (RBD), restless legs syndrome (RLS), periodic leg movements (PLMS), and excessive daytime sleepiness (EDS). Specific treatment options are supplied for every group. A global evaluation of nocturnal disturbances would provide clinicians with a valuable tool to establish an optimal regimen that could positively influence all nocturnal disturbance categories and thus improve PD management on. However, it is important to consider that management of some nocturnal disturbances in a group may worsen nocturnal symptoms of another group or may increase EDS. PD-related symptoms can be treated with long-acting DA agonists to obtain continuous DA receptor stimulation during the night. Both treatment-related nocturnal disturbances and psychiatric symptoms may be related to drug treatment, and therefore, in both cases, drug reduction or discontinuance should be considered. Some sleep disorders, such as RLS and PLMS, may be controlled by DA agents, and others, such as insomnia and EDS, may be improved by reducing dopaminergic stimulation.

Publication Types:

Review

PMID: 15505142 [PubMed - indexed for MEDLINE]

Emptiness in agoraphobia patients.

2008-11-10T22:22:00.044-05:00

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

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M. Preter, S. H. Lee, E. Petkova, M. Vannucci, S. Kim and D. F. Klein

Psychological Medicine, First View Articles article

doi:10.1017/S0033291710000838 (About doi), Published Online by Cambridge University Press 06 May 2010

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