Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression.

J Anxiety Disord. 2008 Aug 27. [Epub ahead of print]

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Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression.

Gros DF, Antony MM, McCabe RE, Swinson RP.

Mental Health Service, Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada.

High rates of irritable bowel syndrome (IBS) symptoms have been reported in individuals diagnosed with anxiety and depressive disorders. However, most studies have investigated these relations in a single disorder, rather than a heterogeneous group of patients, thereby not allowing for comparisons across anxiety disorders and depression, or for considering the effects of comorbidity. Thus, the present study investigated the symptoms of IBS in a diverse group of patients (N=357) by administering questionnaires and a diagnostic interview. A high frequency of IBS symptoms was found in patients with panic disorder, generalized anxiety disorder, and major depressive disorder. However, the frequency of IBS symptoms in patients with social anxiety disorder, specific phobia, and obsessive-compulsive disorder was comparable to rates found in community samples. In addition, anxiety sensitivity and illness attitudes and intrusiveness were predictive of elevated IBS symptomatology. Together, these findings emphasize the role physiological symptoms of anxiety and worry in the co-occurrence of the anxiety disorders and IBS.

PMID: 18819774 [PubMed - as supplied by publisher]

Psychiatric disturbances in CADASIL: a brief review.

Acta Neurol Scand. 2008 Mar 31 [Epub ahead of print]

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Psychiatric disturbances in CADASIL: a brief review.

Valenti R, Poggesi A, Pescini F, Inzitari D, Pantoni L.

Department of Neurological and Psychiatric Sciences, University of Florence, Italy.

Background - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease, clinically characterized by a variable combination of migraine, recurrent transient ischemic attack (TIA) or lacunar strokes, cognitive decline, and mood disturbances. However, the assessment of psychiatric disturbances in this disease has never been carried out systematically. Methods - This paper presents a brief review of the literature regarding the occurrence of psychiatric disorders in CADASIL patients. Results - The prevalence of psychiatric disorders in CADASIL patients is reported to range from 20% to 41%. The psychiatric disturbances reported with the highest frequency are mood disturbances (9-41%). Pooling together the studies and considering a total of 454 CADASIL patients reported in the literature, 106 of these were affected by mood disturbances (24%). The majority of studies however did not use any defined criteria to assess the presence of psychiatric disorders and diagnoses were mainly based on history or review of clinical records. Conclusions - The review of CADASIL literature suggests the need for a more structured approach to the investigation of these disturbances that are highly prevalent and may greatly impact quality of life in these patients.

PMID: 18384453 [PubMed - as supplied by publisher]

Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth

Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth

Geeta K. Swamy, MD; Truls Østbye, MD, PhD; Rolv Skjærven, PhD

JAMA. 2008;299(12):1429-1436.

Context Preterm birth is a major cause of infant morbidity and mortality. Less is known about long-term health among persons born preterm.

Objective To determine the long-term effects of preterm birth on survival, reproduction, and next-generation preterm birth.

Design, Setting, and Participants Population-based, observational, longitudinal study using registry data from 1 167 506 singleton births in the Medical Birth Registry of Norway in 1967-1988. The cohort was followed up through 2002 for survival. The cohort was truncated to births from 1967-1976 for assessment of educational achievement and reproductive outcomes through 2004.

Main Outcome Measures In relation to sex and gestational age at birth, absolute mortality, risk of fetal, infant, child, and adolescent mortality, and incidence and risk of reproduction and next-generation preterm birth. Singleton term (37-42 weeks) fetal deaths and live births, stratified by sex, served as the reference group for all analyses.

Results The percentage who were born preterm was higher among boys (5.6%) than among girls (4.7%). Preterm participants had an increased risk of mortality throughout childhood. For boys born at 22 to 27 weeks, mortality rates were 1.33% and 1.01% for early and late childhood death, with relative risks (RRs) of 5.3 (95% confidence interval [CI], 2.0-14.2) and 7.0 (95% CI, 2.3-22.0), respectively. The mortality rate for girls born at 22 to 27 weeks was 1.71% for early childhood death, with an RR of 9.7 (95% CI, 4.0-23.7); there were no late childhood deaths. For 28 to 32 weeks, the early and late childhood mortality rates among boys were 0.73% and 0.37%, with RRs of 2.5 (95% CI, 1.6-3.7) and 2.3 (95% CI, 1.3-4.1), respectively. Girls born at 28 to 32 weeks did not have a significantly increased risk of childhood mortality. Reproduction was diminished for index participants born preterm. For men and women born at 22 to 27 weeks, absolute reproduction was 13.9% and 25%, with RRs of 0.24 (95% CI, 0.17-0.32) and 0.33 (95% CI, 0.26-0.42), respectively. For 28 to 32 weeks, absolute reproduction was 38.6% and 59.2% for men and women, with RRs of 0.7 (95% CI, 0.66-0.74) and 0.81 (95% CI, 0.78-0.85), respectively. Preterm women but not men were at increased risk of having preterm offspring.

Conclusion In persons born in Norway in 1967-1988, preterm birth was associated with diminished long-term survival and reproduction.

Author Affiliations: Departments of Obstetrics and Gynecology (Dr Swamy) and Community and Family Medicine (Dr Østbye), Duke University Medical Center, Durham, North Carolina; Duke-NUS Graduate Medical School, Singapore (Dr Østbye); Section for Epidemiology and Medical Statistics, Department of Public Health and Primary Health Care, University of Bergen (Dr Skjærven), and Medical Birth Registry of Norway, Norwegian Institute of Public Health (Dr Skjærven), Bergen, Norway.

Childhood physical abuse in outpatients with psychosomatic symptoms.

Biopsychosoc Med. 2008 Mar 21;2(1):8 [Epub ahead of print]

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Childhood physical abuse in outpatients with psychosomatic symptoms.

Handa M, Nukina H, Hosoi M, Kubo C.

ABSTRACT: BACKGROUND: In Japan and Asia, few studies have been done of physical and sexual abuse. This study was aimed to determine whether a history of childhood physical abuse is associated with anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. METHODS: We divided 564 consecutive new outpatients at the Department of Psychosomatic Medicine of Kyushu University Hospital into two groups: a physically abused group and a non-abused group. Psychological test scores and the prevalence of self-injurious behavior were compared between the two groups. RESULTS: A history of childhood physical abuse was reported by patients with depressive disorders(12.7%), anxiety disorders(16.7%) , eating disorders (16.3%), pain disorders (10.8%), irritable bowel syndrome (12.5%), and functional dyspepsia(7.5%). In both the patients with depressive disorders and those with anxiety disorders, STAI-I (state anxiety) and STAI-II (trait anxiety) were higher in the abused group than in the non-abused group (p<0.05). In the patients with depressive disorders, the abused group was younger than the non-abused group (p<0.05). The prevalence of self-injurious behavior of the patients with depressive disorders, anxiety disorders and pain disorders was higher in the abused groups than in the non-abused groups (p<0.005). CONCLUSIONS: A history of childhood physical abuse is associated with psychological distress such as anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. It is important for physicians to consider the history of abuse in the primary care of these patients.

PMID: 18358076 [PubMed - as supplied by publisher]

Associations Between Vitamin D Status and Pain in Older Adults: The Invecchiare in Chianti Study.

J Am Geriatr Soc. 2008 Mar 5 [Epub ahead of print]

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Associations Between Vitamin D Status and Pain in Older Adults: The Invecchiare in Chianti Study.

Hicks GE, Shardell M, Miller RR, Bandinelli S, Guralnik J, Cherubini A, Lauretani F, Ferrucci L.

Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.

OBJECTIVES: To examine cross-sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex. DESIGN: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy). SETTING: Community. PARTICIPANTS: Nine hundred fifty-eight persons (aged >/=65) selected from city registries of Greve and Bagno a Ripoli. MEASUREMENTS: Pain was categorized as mild or no pain in the lower extremities and back; moderate to severe back pain, no lower extremity pain; moderate to severe lower extremity pain, no back pain; and moderate to severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L. RESULTS: The mean age+/-standard deviation was 75.1+/-7.3 for women and 73.9+/-6.8 for men. Fifty-eight percent of women had at least moderate pain in some location, compared with 27% of men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women (odds ratio=1.96, 95% confidence interval=1.01-3.59) but not in men. CONCLUSION: Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.

PMID: 18331295 [PubMed - as supplied by publisher]

Psychiatric comorbidity in different organic vertigo syndromes.

J Neurol. 2008 Mar 14 [Epub ahead of print]

Psychiatric comorbidity in different organic vertigo syndromes.

Eckhardt-Henn A, Best C, Bense S, Breuer P, Diener G, Tschan R, Dieterich M.

Dept. of Psychosomatic Medicine, Klinikum Stuttgart – Bürgerhospital, Tunzhoferstrasse 14–16, 70191, Stuttgart, Germany, A.Eckhardt@klinikum-stuttgart.de.

OBJECTIVE : A high degree of psychiatric disorders has repeatedly been described among patients with organic vertigo syndromes and attributed to vestibular dysfunction. Yet almost no investigations exist which differentiate between various organic vertigo syndromes with regard to psychiatric comorbidity. The following prospective, interdisciplinary study was carried out to explore whether patients with different organic vertigo syndromes exhibit different psychological comorbidities. METHODS : 68 patients with organic vertigo syndromes (benign paroxysmal positioning vertigo (BPPV) n = 20, vestibular neuritis (VN) n = 18,Menière's disease (MD) n = 7, vestibular migraine (VM) n = 23) were compared with 30 healthy volunteers.All patients and control persons underwent structured neurological and neuro-otological testing. A structured diagnostic interview (-I) (SCID-I) and a battery of psychometric tests were used to evaluate comorbid psychiatric disorders. RESULTS : Patients with VM and MD showed significantly higher prevalence of psychiatric comorbidity (MD = 57%, VM = 65%) especially with anxiety and depressive disorders, than patients with VN (22%) and BPPV (15 %) compared to normal subjects (20 %). These elevated rates of comorbidities resulted in significantly elevated odds-ratios (OR) for the development of comorbid psychiatric disorders in general (for VM OR = 7.5, for MD OR = 5.3) and especially for anxiety disorders (for VM OR = 26.6, for MD OR = 38.7). CONCLUSION : As a consequence, a structured psychological and psychometric testing and an interdisciplinary therapy should be proceeded in cases with complex and prolonged vertigo courses, especially in patients with VM and MD. Possible reasons of these unexpected results in VM and MD are discussed.

PMID: 18338198 [PubMed - as supplied by publisher]

Our results suggest normal HPA responses to stress and ACTH stimulation in patients with CPP but reduced adrenal reactivity in patients with FMS, name

Psychosomatic Medicine 70:65-72 (2008)
© 2008 American Psychosomatic Society
ORIGINAL ARTICLES
HPA Axis Reactivity and Lymphocyte Glucocorticoid Sensitivity in
Fibromyalgia Syndrome and Chronic Pelvic Pain
Katja Wingenfeld, PhD, Christine Heim, PhD, Iris Schmidt, PhD, Dieter
Wagner, PhD, Gunther Meinlschmidt, PhD and Dirk H. Hellhammer, PhD

From the Department of Psychobiology, University of Trier, Trier,
Germany (K.W., C.H., I.S., D.W., G.M., D.H.H.); Department of
Psychiatry and Psychotherapy Bethel, Bielefeld, Germany (K.W.);
Department of Psychiatry and Behavioral Sciences, Emory University
School of Medicine, Atlanta, GA (C.H.); and Institute of Psychology,
University of Basel, Switzerland (G.M.).

Address correspondence and reprint requests to Katja Wingenfeld, PhD,
Department of Psychiatry and Psychotherapy, Bethel, Remterweg 69–71,
33617 Bielefeld, Germany. E-mail: katja.wingenfeld@evkb.de

Objective: Chronic pelvic pain (CPP) and fibromyalgia syndrome (FMS)
have been associated with hypothalamic-pituitary-adrenal (HPA) axis
alterations, i.e., mild hypocortisolism and enhanced feedback
sensitivity. We tested the hypothesis of reduced cortisol release in
response to a psychosocial stressor and pharmacological stimulation.
Furthermore, glucocorticoid (GC) sensitivity was evaluated.

Methods: Plasma total and salivary-free cortisol concentrations were
measured in response to a standardized social laboratory stressor, the
Trier Social Stress Test, and to adrenocorticotropin (ACTH)1–24
stimulation. In the Trier Social Stress Test, we additionally measured
ACTH. GC sensitivity was measured by dexamethasone inhibition of
lipopolysaccharide-induced interleukin-6 and tumor necrosis factor-
alpha production in whole blood.

Results: There were no HPA axis alterations in women with CPP (N = 18)
in these tests. Patients with FMS (N = 17) showed lower total cortisol
release in response to the social stressor and exogenous ACTH, but
normal free cortisol and ACTH levels compared with controls (N = 24).
GC sensitivity was similar in all groups.

Conclusions: Our results suggest normal HPA responses to stress and
ACTH stimulation in patients with CPP but reduced adrenal reactivity
in patients with FMS, namely in total cortisol release. Free cortisol
on the other hand was unaltered, possibly reflecting an adaptation to
reduced circulating total cortisol.

Key Words: chronic pelvic pain • fibromyalgia syndrome • hypothalamic-
pituitary-adrenal axis • cortisol • glucocorticoid sensitivity

Abbreviations: FMS = fibromyalgia syndrome; CPP = chronic pelvic pain;
HPA = hypothalamic-pituitary-adrenal; TSST = Trier Social Stress Test;
ACTH = adrenocorticotropin; GC = glucocorticoid; GR = glucocorticoid
receptor; BMI = body mass index; LPS = lipopolysaccharide; IL-6 =
interleukin-6; TNF-{alpha} = tumor necrosis factor-alpha.

Effect of Social Support on Nocturnal Blood Pressure Dipping

Effect of Social Support on Nocturnal Blood Pressure Dipping
Carlos J. Rodriguez, MD, MPH, Matthew M. Burg, PhD, Joyce Meng, MD,
Thomas G. Pickering, MD, DPhil, Zhezhen Jin, PhD, Ralph L. Sacco, MD,
MS, Bernadette Boden-Albala, DrPH, Shunichi Homma, MD and Marco R. Di
Tullio, MD

From the Department of Medicine (C.J.R., M.M.B., J.M., T.G.P., S.H.,
M.R.D.T.), Columbia University, New York, New York; Department of
Neurology (R.L.S., B.B.-A.), Columbia University, New York, New York;
Department of Epidemiology (C.J.R., R.L.S.), Columbia University,
Mailman School of Public Health, New York, New York; Department of
Sociomedical Science (B.B.-A.), Columbia University, Mailman School of
Public Health, New York, New York; Department of Biostatistics (Z.J.),
Columbia University, Mailman School of Public Health, New York, New
York; Department of Neurology (R.L.S.), University of Miami, Miami,
Florida; and Section of Cardiovascular Medicine (M.W.B.), Yale
University, New Haven, Connecticut.

Address correspondence and reprint requests to Carlos J. Rodriguez,
Division of Cardiology, Columbia University, 622 W 168th street; PH
3-342, New York, NY 10032. E-mail: cjr10@columbia.edu

Objective: To determine if nocturnal blood pressure (BP) dipping among
non-Hispanic blacks is influenced by social support. Non-Hispanic
blacks have higher rates of cardiovascular morbidity and mortality
from hypertension and are more likely to have ambulatory blood
pressure (ABP) that remains high at night (nondipping).

Methods: A total of 68 non-Hispanic black normotensive and 13
untreated hypertensive participants (age 72 ± 10 years, 48% female)
free of clinical cardiovascular disease completed 24-hour ABP
monitoring and a questionnaire that included a modified version of the
CARDIA Study Social Support Scale (CSSS). Nondipping was defined as a
decrease of <10% in the ratio between average awake and average asleep
systolic BP. Analyses were adjusted for age, gender, and systolic BP.

Results: The prevalence of nondipping was 26.8% in subjects in the
highest CSSS tertile versus 41.1% in the lowest CSSS tertile (p = .
009). On adjusted analysis, CSSS was analyzed as a continuous variable
and remained independently and inversely associated with nondipping
(odds ratio 0.27, 95% Confidence Interval 0.08–0.94, p = .04).

Conclusions: Social support may be an important predictor of BP
dipping at night. These findings suggest that social support may have
positive health affects through physiologic (autonomic) pathways.

Key Words: ambulatory blood pressure monitoring • social support •
African-Americans • hypertension

Abbreviations: BP = blood pressure; ABP = ambulatory blood pressure;
NOMASS = Northern Manhattan Stroke Study; CSSS = CARDIA Social Support
Scale; BMI = body mass index; OR = odds ratio; SD = standard deviation.

Hypoxic changes in the central nervous system of noise-exposed mice.

Acta Otolaryngol Suppl. 2007 Oct;(558):73-7.
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Hypoxic changes in the central nervous system of noise-exposed
mice.

Kim YJ, Kang HH, Ahn JH, Chung JW.

Department of Otolaryngology, Pundang Jaesang Hospital, DaeJin
Medical Center, Seongnam City, Kyunggi Do, Korea.

CONCLUSION: After a noise-induced transient threshold shift,
hypoxia occurred in the central nervous system, especially in the
auditory cortex, the hippocampus, and the inferior colliculus.
OBJECTIVES: Noise-induced inner ear hypoxia was shown by measurement
of an increase in hypoxia-inducible factor-1 alpha, which is
expressed? in the nucleus under hypoxic conditions. This study uses
pimonidazole to localize site-specific hypoxic changes occurring in
the mouse central auditory pathway during noise-induced auditory
threshold shift. METHOD: BALB/c hybrid mice with normal hearing were
exposed to 122 dB SPL white noise for 3 h. Immediately after exposure
to the noise, and 7 d after noise exposure, the brains of mice were
collected. Brains were cryosectioned into slices 15 microm thick and
examined by immunofluorescence after staining with pimonidazole HCl.
RESULTS: After 3 h of exposure to 120 dB SPL noise, the hearing
thresholds of mice decreased to 51.1+/-8.6 dB SPL (n =14), but hearing
recovered in 7 d. After noise exposure, pimonidazole signal increased
in the auditory cortex, the hippocampus, and the inferior colliculus.
The pimonidazole signal remained elevated after 7 d. In control mice,
pimonidazole did not stain any brain region.

Publication Types:

* Research Support, Non-U.S. Gov't

PMID: 17882574 [PubMed - indexed for MEDLINE]

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]