Effectiveness of Low-Dose Naltrexone in the Post-Detoxification Treatment of Opioid Dependence.

J Clin Psychopharmacol. 2007 Oct;27(5):468-474.

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Effectiveness of Low-Dose Naltrexone in the Post-Detoxification Treatment of Opioid Dependence.

Mannelli P, Patkar AA, Peindl K, Murray HW, Wu LT, Hubbard R.

*Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; †Brown University, Providence, RI.

BACKGROUND:: The clinical use of naltrexone (NTX) in the treatment of opioid dependence has been limited because of poor compliance and inconsistent outcomes. In particular, the therapeutic benefit of extended treatment with NTX after opioid detoxification is unclear. The present study evaluated whether the augmentation with low-dose NTX during the post-detoxification treatment of opioid dependence would improve outcomes. METHODS:: In an open-label naturalistic design, 435 opioid-dependent patients who had completed inpatient detoxification were offered the choice of entering 1 of the 2 outpatient treatment arms: clonidine extended treatment (CET) (clonidine + psychosocial treatment), or enhanced extended treatment (EET) (oral NTX [1-10 mg/d] + CET) for 21 days. The primary outcome measure was retention in treatment. Secondary outcomes included abstinence from opioids, dropouts, and adherence to postdischarge care. RESULTS:: One hundred sixty-two patients (37.2%) accepted EET. Subjects receiving EET stayed longer in the program (F = 64.4; P = 0.000), were less likely to drop out, used less opioids, and followed through with referral to long-term outpatient treatment in a higher number, compared with patients in the CET arm (P = 0.000 in each case). The NTX + clonidine combination was safe and well tolerated. CONCLUSIONS:: This preliminary study indicates the potential benefit of augmentation with low-dose NTX to improve outcomes after opioid detoxification for a preferred group of patients. Randomized controlled trials are necessary to further evaluate the role of low-dose NTX in the outpatient treatment of opioid dependence.

PMID: 17873678 [PubMed - as supplied by publisher]

Turning back the clock: adopting a healthy lifestyle in middle age.

Am J Med. 2007 Jul;120(7):598-603. Epub 2007 Apr 19.

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Turning back the clock: adopting a healthy lifestyle in middle age.

King DE, Mainous AG 3rd, Geesey ME.

Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. kingde@musc.edu

PURPOSE: To determine the frequency of adopting a healthy lifestyle (5 or more fruits and vegetables daily, regular exercise, BMI 18.5-29.9 kg/m2, no current smoking) in a middle-aged cohort, and determine the subsequent rates of cardiovascular disease (CVD) and mortality among those who adopt a healthy lifestyle. METHODS: We conducted a cohort study in a diverse sample of adults age 45-64 in the Atherosclerosis Risk in Communities survey. Outcomes are all-cause mortality and fatal or non-fatal cardiovascular disease. RESULTS: Of 15,708 participants, 1344 (8.5%) had 4 healthy lifestyle habits at the first visit, and 970 (8.4%) of the remainder had newly adopted a healthy lifestyle 6 years later. Men, African Americans, individuals with lower socioeconomic status, or a history of hypertension or diabetes were less likely to newly adopt a healthy lifestyle (all P <.05). During the following 4 years, total mortality and cardiovascular disease events were lower for new adopters (2.5% vs 4.2%, chi2P <.01, and 11.7% vs 16.5%, chi2P <.01 respectively) compared to individuals who did not adopt a healthy lifestyle. After adjustment, new adopters had lower all-cause mortality (OR 0.60, 95% Confidence Interval [CI], 0.39-0.92) and fewer cardiovascular disease events (OR 0.65, 95% CI, 0.39-0.92) in the next 4 years. CONCLUSIONS: People who newly adopt a healthy lifestyle in middle-age experience a prompt benefit of lower rates of cardiovascular disease and mortality. Strategies to encourage adopting healthy lifestyles should be implemented, especially among people with hypertension, diabetes, or low socioeconomic status.

Publication Types:

• Research Support, N.I.H., Extramural

PMID: 17602933 [PubMed - indexed for MEDLINE]

Depressive Symptoms Predict Mucosal Wound Healing.

Psychosom Med. 2007 Aug 31; [Epub ahead of print]

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Depressive Symptoms Predict Mucosal Wound Healing.

Bosch JA, Engeland CG, Cacioppo JT, Marucha PT.

College of Dentistry (J.A.B., C.G.E., P.T.M.), University of Illinois at Chicago, Chicago, Illinois; School of Sport and Exercise Sciences (J.A.B.), University of Birmingham, Birmingham, UK; Department of Psychology (J.T.C.), University of Chicago, Chicago, Illinois; and Institute for Behavioral Medicine Research (J.A.B., C.G.E., P.T.M.), Ohio State University, Columbus, Ohio.

Objective: There is mounting evidence that psychosocial stress can delay wound healing, but this literature almost exclusively pertains to dermal wound healing. Many surgical procedures involve damage to mucosal tissues and the time course and the role of repair processes, such as inflammation, in the healing of these tissues are markedly different from those in dermal healing. Feelings of depression and social isolation are common among surgical patients, and the present study therefore investigated if these factors predict the rate of mucosal wound healing. Methods: Undergraduate students were invited to participate in the study if they reported high or low levels of loneliness or depressive symptoms, corresponding to the upper or lower quintile of their peer group. The UCLA loneliness scale and the Beck Depression Inventory [short form] were used for this screening. A sample of 193 healthy young adults (age range 18-31 years) received a 3.5-mm circular wound on the oral hard palate, under local anesthesia. Healing was monitored by daily videographs of the wound. Results: The median healing rate was 7 days. High dysphoric participants were, however, more likely to heal slower than this median healing rate (odds ratio 3.57 (1.58-8.07); p < .001). This association remained robust after correction for a broad range of demographic and behavioral variables, including gender, age, ethnicity, and health behaviors. High dysphoric individuals also exhibited significantly larger average wound sizes from day 2 post wounding onward. Loneliness and diurnal cortisol secretion (measured over 5 days) were unrelated to healing. Conclusion: Depressive symptoms predict the rate of mucosal wound healing in healthy young adults. We discuss potential pathways that warrant further investigation.

PMID: 17766687 [PubMed - as supplied by publisher]

Association between reduced sleep and weight gain in women.

Am J Epidemiol. 2006 Nov 15;164(10):947-54. Epub 2006 Aug 16.

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Association between reduced sleep and weight gain in women.

Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB.

Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA. srp20@case.edu

Physiologic studies suggest that sleep restriction has metabolic effects that predispose to weight gain. The authors investigated the association between self-reported usual sleep duration and subsequent weight gain in the Nurses' Health Study. The 68,183 women who reported habitual sleep duration in 1986 were followed for 16 years. In analyses adjusted for age and body mass index, women sleeping 5 hours or less gained 1.14 kg (95% confidence interval (CI): 0.49, 1.79) more than did those sleeping 7 hours over 16 years, and women sleeping 6 hours gained 0.71 kg (95% CI: 0.41, 1.00) more. The relative risks of a 15-kg weight gain were 1.32 (95% CI: 1.19, 1.47) and 1.12 (95% CI: 1.06, 1.19) for those sleeping 5 and 6 hours, respectively. The relative risks for incident obesity (body mass index: >30 kg/m(2)) were 1.15 (95% CI: 1.04, 1.26) and 1.06 (95% CI: 1.01, 1.11). These associations remained significant after inclusion of important covariates and were not affected by adjustment for physical activity or dietary consumption. These data suggest that short sleep duration is associated with a modest increase in future weight gain and incident obesity. Further research is needed to understand the mechanisms by which sleep duration may affect weight.

Publication Types:

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

PMID: 16914506 [PubMed - indexed for MEDLINE]

DSM Biases Evident in Clinical Training and Courtroom Testimony

An important article by Gopal and Bursztajn on the limitations of manual-driven diagnosis (and treatment). It starts:

>>The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM),1 which was most recently revised in 2000 with DSM, fourth edition, text revision (DSM-IV- TR), has been helpful in promoting inter-rater reliability or agreement among clinicians. This reliability has been achieved by moving from a causation-heavy, narrative-rich system to a causation-free, narrative- and context-empty system of diagnostic categories. However, as helpful as an increased degree of agreement among clinicians may be, this measure of the reliability of a diagnosis does not indicate if the diagnosis is valid. A challenge for those involved in the construction of the DSM, fifth edition (DSM-V) is how to retain the strength of reliability and increase diagnostic validity. When decisions need to be made quickly, heuristic processes are more likely to be used,2 reacting to the need for speed with simplifying strategies for diagnostic decision-making. However, when clinicians lack the time to check if the processes they used have led to a fundamentally misleading diagnosis,errors are more likely to go unnoticed. With insufficient time to learn about individual patients, and to observe them, there is a growing tendency to make premature cognitive commitments to diagnoses that fit the menu or bulletpoint layout of the DSM.3 Heuristic approaches are routinely employed to limit potential information overload in diagnostic decision-making.4 Unfortunately, reliance on simplifying procedures may introduce unintended biases, which are magnified by the categorical structure of the DSM.In this context, recent work on Holocaust survivors has shown that posttraumatic stress disorder (PTSD) combined with psychosis presents a diagnostic and clinical challenge.5 Throughout the course of repeated diagnostic interviews, PTSD symptoms decreased for some of these survivors; however, this does not mean that PTSD disappeared from their lives.

[The full text is here: http://www.psychiatricannalsonline.com/showPdf.asp?rID=23800]

Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

J Affect Disord. 2007 Aug 27; [Epub ahead of print]

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Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

Esquivel G, Díaz-Galvis J, Schruers K, Berlanga C, Lara-Muñoz C, Griez E.

Academic Anxiety Center, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.

BACKGROUND: Chronic exercise has been shown to have therapeutic effects in panic disorder (PD). The mechanism of these effects is unknown. Acute exercise reduces the effect of a panic challenge in healthy volunteers. Such an effect has not yet been demonstrated in PD patients. The present study aimed at exploring the antipanic effects of acute exercise on a 35% CO(2) panic provocation in treatment-naïve PD patients to further elucidate the mechanisms of the beneficial effects of exercise on panic. METHODS: Eighteen PD patients performed either moderate/hard exercise or very-light exercise before a 35% CO(2) challenge in a randomized, between-group design. The reactivity to CO(2) was assessed with the Visual Analogue Anxiety Scale and the DSM-IV Panic Symptom List. RESULTS: Panic reactions to CO(2) were smaller in patients that performed moderate/hard exercise in contrast to those that performed very-light exercise. Increments in both measurements and panic rates were consistently reduced by intense exercise. LIMITATIONS: Since this study focuses on the acute effects of exercise on CO(2) sensitivity in patients with PD, the results of repetitive exercise sessions on the rate of spontaneous panic attacks and overall symptoms are warranted. The small sample size and other limitations are addressed. CONCLUSIONS: Exercise reduced the panicogenic effects of a CO(2) challenge. In addition to its therapeutic potential, exercise may also be useful as a laboratory maneuver with heuristic value in experimental research into the mechanisms of antipanic treatment.

PMID: 17727960 [PubMed - as supplied by publisher]

Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Progress in Neuro-Psychopharmacology and Biological Psychiatry Article in Press, Accepted Manuscript - Note to users

PDF (127 K)

doi:10.1016/j.pnpbp.2007.07.029
Copyright © 2007 Elsevier Inc. All rights reserved.

Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Maurice Preter^{a, ,} and Donald F. Klein^{b, 1,
a}New York State Psychiatric Institute Columbia University College of Physicians and Surgeons, 1160 Fifth Avenue, Suite 112 New York, NY 10029, USA
^bNew York State Psychiatric Institute Columbia University College of Physicians and Surgeons 1051 Riverside Drive, New York, NY 10032, USA
Received 23 February 2007; revised 24 July 2007; accepted 24 July 2007. Available online 9 August 2007.

Corresponding author. Tel.: +1 212 713 5336; fax: +1 212 713 5336.
¹ Tel.: +1 212 543 6249.

Review article

Panic, suffocation false alarms, separation anxiety and endogenous opioids

Maurice Preter a,⁎, Donald F. Klein b,1

a New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1160 Fifth Avenue, Suite 112, New York, NY 10029, USA

b New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1051 Riverside Drive, New York, NY 10032, USA

Received 23 February 2007; received in revised form 24 July 2007; accepted 24 July 2007

Abstract

This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic [Klein DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry; 50:306-17.]. SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively
occur when the alarm is erroneously triggered. That panic is distinct from Cannon's emergency fear response and Selye's General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic–pituitary–adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO2 and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of "spontaneous" panic requires an integrative explanation. Because of the opioid system's central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.

© 2007 Elsevier Inc. All rights reserved.

Keywords: Affective neuroscience; Endogenous opioids; Panic disorder; Respiratory physiology; Separation anxiety

Headache as a sole manifestation in nonconvulsive status epilepticus.

J Child Neurol. 2007 May;22(5):660-2.

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Headache as a sole manifestation in nonconvulsive status epilepticus.

Ghofrani M, Mahvelati F, Tonekaboni H.

Child Neurology Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. fmshamsa@yahoo.com.

Nonconvulsive status epilepticus may present with several manifestations, and many of them may not be obvious. The most important for the diagnosis of nonconvulsive status epilepticus is the electroencephalogram pattern. This is a case report of a 9-year-old boy with severe and continuous headache. He received chemotherapy for histiocytosis that was diagnosed when he was 3 years, 6 months years old. He had no evidence of central nervous system histiocytosis involvement or drug toxicity. He was diagnosed with nonconvulsive status epilepticus. The headache and electroencephalogram anomaly disappeared completely when anticonvulsant therapy began. Headache and seizure disorder may coexist, but this may be the first report of nonconvulsive status epilepticus with headache as a sole manifestation.

PMID: 17690080 [PubMed - in process]

Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.

Arch Phys Med Rehabil. 2004 Jul;85(7):1183-7.

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Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.

Hoffman MD, Shepanski MA, Ruble SB, Valic Z, Buckwalter JB, Clifford PS.

Department of Physical Medicine and Rehabilitation, Veterans Affairs Medical Center and Medical College of Wisconsin, WI, USA. martin.hoffman@med.va.gov

OBJECTIVE: To examine how exercise-induced analgesia is affected by the duration and intensity of aerobic exercise. DESIGN: Repeated-measures design. SETTING: Exercise science laboratory. PARTICIPANTS: Convenience sample of 12 healthy male and female volunteers (mean age +/- standard deviation, 32+/-9 y). INTERVENTIONS: Pain ratings were assessed before and at 5 and 30 minutes after treadmill exercise of 10 minutes at 75% maximal oxygen uptake (Vo(2)max), 30 minutes at 50% Vo(2)max, and 30 minutes at 75% Vo(2)max (randomized order and no less than 48 h between each bout). MAIN OUTCOME MEASURES: Pain ratings were measured on a visual analog scale at 10-second intervals during a 2-minute pressure-pain stimulus to the nondominant index finger. RESULTS: Pain ratings were significantly decreased (P<.05) from pre-exercise values 5 minutes after 30 minutes of exercise at 75% Vo(2)max but returned toward baseline by 30 minutes after exercise. There were no significant changes in pain ratings after 10 minutes of exercise or after exercise at 50% Vo(2)max. CONCLUSIONS: There are thresholds for both the intensity (>50% Vo(2)max) and duration (>10 min) of exercise required to elicit exercise analgesia.

Publication Types:

• Clinical Trial
• Randomized Controlled Trial
• Research Support, Non-U.S. Gov't
• Research Support, U.S. Gov't, Non-P.H.S.

PMID: 15241771 [PubMed - indexed for MEDLINE]

A pilot study of a yoga and meditation intervention for dementia caregiver stress.

J Clin Psychol. 2004 Jun;60(6):677-87.

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A pilot study of a yoga and meditation intervention for dementia caregiver stress.

Waelde LC, Thompson L, Gallagher-Thompson D.

Pacific Graduate School of Psychology, Palo Alto, CA 94303, USA. lwaelde@pgsp.edu

Twelve older female dementia patient family caregivers (eight Latinas and four Caucasians) participated in a six-session manualized yoga-meditation program (called Inner Resources) designed to help caregivers cope with stress. Pre/post comparisons revealed statistically significant reductions in depression and anxiety and improvements in perceived self-efficacy. Average minutes of weekly yoga-meditation practice were significantly associated with improvements in depression. The majority of caregivers found the intervention useful and reported subjective improvements in physical and emotional functioning. These findings suggest that Inner Resources may be a feasible and effective intervention for family caregivers and may improve affect, coping, physical well-being, and stress management. Copyright 2004 Wiley Periodicals, Inc.

Publication Types:

• Comparative Study

PMID: 15141399 [PubMed - indexed for MEDLINE]

Yoga Asana sessions increase brain GABA levels: a pilot study.

J Altern Complement Med. 2007 May;13(4):419-26.

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Yoga Asana sessions increase brain GABA levels: a pilot study.

Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF.

Division of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA. streeter@bu.edu

OBJECTIVES: The aim of this study was to compare changes in brain gamma-aminobutyric (GABA) levels associated with an acute yoga session versus a reading session. It was hypothesized that an individual yoga session would be associated with an increase in brain GABA levels. DESIGN: This is a parallel-groups design. SETTINGS/LOCATION: Screenings, scan acquisitions, and interventions took place at medical school-affiliated centers. SUBJECTS: The sample comprised 8 yoga practitioners and 11 comparison subjects. INTERVENTIONS: Yoga practitioners completed a 60-minute yoga session and comparison subjects completed a 60-minute reading session. OUTCOME MEASURES: GABA-to-creatine ratios were measured in a 2-cm axial slab using magnetic resonance spectroscopic imaging immediately prior to and immediately after interventions. RESULTS: There was a 27% increase in GABA levels in the yoga practitioner group after the yoga session (0.20 mmol/kg) but no change in the comparison subject group after the reading session ( -0.001 mmol/kg) (t = -2.99, df = 7.87, p = 0.018). CONCLUSIONS:These findings demonstrate that in experienced yoga practitioners, brain GABA levels increase after a session of yoga. This suggests that the practice of yoga should be explored as a treatment for disorders with low GABA levels such as depression and anxiety disorders. Future studies should compare yoga to other forms of exercise to help determine whether yoga or exercise alone can alter GABA levels.

Publication Types:

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

PMID: 17532734 [PubMed - indexed for MEDLINE]