RxPG News : Anxiety

Does Dad's stress affect his unborn children?

Sat, 03 Sep 2011 23:00:00 PST

( from http://www.rxpgnews.com ) According to the results of a new study in Elsevier's Biological Psychiatry, it seems the answer may be "yes, but it's complicated".

The risk of developing depression, which is significantly increased by exposure to chronic stress, is influenced by both environment and genetics. The interplay of these two factors is quite complex, but in fact, there is even a third factor that most of us know nothing about – epigenetics. Epigenetics is the science of changes in genetic expression that are not caused by actual changes in DNA sequencing. It is these mechanisms that have been the recent focus of intergenerational investigations into the transmission of stress vulnerability.

Inheritance is complex. We've all known that mothers and fathers have tremendous influence on their children, but "this study highlights how complicated the relationship between genetic, epigenetic, and environmental contributions can be with regards to the inheritance of important behavioural traits," commented Dr. John Krystal, editor of Biological Psychiatry.

Most work to date has focused on maternal effects. In this fascinating new study, researchers investigated paternal effects instead, and found that male mice exposed to chronic stress pass those stress behaviours along to their offspring. Both their male and female offspring showed increased depression and anxiety-like behaviours, although the effects were stronger in males. Importantly, these behavioural changes were only present in offspring produced through natural reproduction, and not in those offspring that were produced via in vitro fertilization. That interesting twist suggests that most stress-related vulnerabilities are transmitted to subsequent generations behaviourally, rather than epigenetically.

"This type of translational animal work is important to help scientists focus their work in humans", explained lead author Dr. Eric Nestler, from Mount Sinai School of Medicine in New York. "These findings in mice raise the possibility that part of an individual's risk for clinical depression or other stress-related disorders may be determined by his or her father's life exposure to stress, a provocative suggestion that now requires direct study in humans."

Online CBT is Effective in Depression & Panic Disorders: RCT

Wed, 14 Apr 2010 11:58:28 PST

( from http://www.rxpgnews.com ) The online Cognitive Behaviour Therapy is as effective in treating panic disorder and depression as the traditional group-based method, a new study has found.

'Internet-based CBT is also more cost-effective than group therapy,' said Jan Bergstrom, a researcher with the Center for Psychiatry Research at the Swedish medical university Karolinska Institute.

'The results therefore support the introduction of internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety,' Bergstrom said.

It is estimated that depression affects some 15 percent and panic disorder 4 percent of all people during their lifetime.

Depression can include symptoms such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life.

It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.

In the internet-based CBT, the patient undergoes an online self-help counselling programme and can contact a therapist via email.

The new research is based on a random clinical trial of 104 patients with panic disorder and comparison of the effectiveness of internet-based CBT and group CBT within a regular healthcare service.

Both treatments worked very well and there was no significant difference between them, either immediately after treatment or at a six-month follow-up, the research said.

Anxious women more likely to have smaller babies

Wed, 04 Nov 2009 12:13:43 PST

( from http://www.rxpgnews.com ) Women with severe and chronic anxiety during pregnancy are more likely to have smaller babies, says a new study.

The study authors demonstrated that the mother's anxiety during pregnancy impacts birth outcomes, including smaller babies, over and beyond factors such as drug use, education, and race.

Low to moderate levels of anxiety in women during either the first or second trimester did not significantly affect the birth outcomes, but women who are severely anxious during much of their pregnancy should be considered for anxiety-reducing interventions.

Shahla M. Hosseini of the University of Pittsburgh Medical Centre, co-authored the study with Minhnoi W. Biglan, Cynthia Larkby, Maria M. Brooks, Michael B. Gorin, and Nancy L. Day.

'One way to prevent health problems in children and adults is to focus care on the prenatal period,' the authors note.

'It is key to pursue further research which addresses interventions to ameliorate the effects that a woman's trait anxiety has on the development of foetuses,' they said.

The study was published in Paediatric and Perinatal Epidemiology.

High Risk of Disordered Eating in OCD

Mon, 08 Jun 2009 10:56:15 PST

( from http://www.rxpgnews.com ) Doctors and other health workers should be more aware of the high risk of eating disorders among people with obsessive compulsive disorder (OCD) and other anxiety disorders.

According to new research presented at the recently concluded Royal College of Psychiatrists’ 2009 Annual Meeting, as many as one in five people with OCD could also have some form of disordered eating. In addition, disordered eating may occur in as many as one in three patients with other anxiety disorders.

OCD is a serious anxiety-related condition that affects 2-3% of the adult population. People with severe OCD may find it difficult to work regularly, or even take part in their family or social life.

Dr Lynne Drummond, a consultant psychiatrist at South West London and St George's NHS Mental Health Trust, collected data from a sample of patients with severe OCD who were referred to a specialist unit for treatment. A control group of patients with other anxiety disorders referred for treatment to the same unit was also studied.

The study found that a fifth of the patients with OCD also had signs of disordered eating. The prevalence for those with other anxiety disorders was a one in three.

Dr Drummond said: “Although these have been several studies examining the prevalence of OCD and obsessive symptoms in patients with eating disorders, there is a dearth of studies where patients with OCD and other anxiety disorders are examined for eating disorders.

“This study suggests that clinicians should be made aware of the high prevalence of disordered eating in patients with all anxiety disorders as well as OCD.”

Deep brain mapping to isolate evidence of Gulf War syndrome

Fri, 21 Nov 2008 10:32:06 PST

( from http://www.rxpgnews.com ) Washington, Nov 20 - Researchers are pioneering use of spatial statistical modelling to analyse brain scan data from military veterans, aiming to pinpoint brain areas affected by Gulf War Syndrome.

Richard Gunst, Wayne Woodward and William Schucany, professors in Southern Methodist University -, are collaborating with imaging specialists at University of Texas Southwestern Medical Centre - to compare brain scans of people suffering from the syndrome with those of a healthy control group.

Gulf War Veterans - are being tested at UTSW using a type of brain imaging called functional Magnetic Resonance Imaging - while they perform tasks intended to activate specific regions of the brain.

The SMU team is analysing brain activation signals reflected from the multiple images taken of each subject's brain to determine which variations are naturally occurring and which are due to the syndrome. Previous analyses have been unable to separate real distinctions from 'noise'.

The SMU team's primary challenge is in identifying differences in brain activation from locations deep within the brain using measured brain signals that are weak and vary from location to location, according to an SMU release.

Spatial modelling uses information from neighbouring locations to strengthen the weak signals in active brain locations so the signal can be detected as real.

'Spatial modelling in brain imaging is new,' Gunst said. 'This has not been done the way we are doing it.'

Rapid technological advances in medical imaging of the human brain are imposing demands for new statistical methods that can be used to detect small differences between normal and dysfunctional brain activity, Gunst said.

Chronic anxiety may cause heart attack

Thu, 10 Jan 2008 16:50:30 PST

( from http://www.rxpgnews.com ) New York, Jan 10 - Chronic anxiety may trigger heart attack, says a new study, suggesting highly anxious individuals to stay careful.

While earlier studies have linked stress to an increased risk of heart problems, this is the first time that chronic anxiety has been identified as a risk factor also.

A team of researchers led by Biing-Jiun Shen, an assistant professor of psychology at the University of Southern California in Los Angeles, collected data on 735 men who participated in the Normative Aging Study, which assesses medical and psychological changes associated with aging.

The findings of the new study, which appeared in the Jan 15 issue of the Journal of the American College of Cardiology, said that the risk of getting heart attack was more among people who are suffering from chronic anxiety.

All the men whose data were used for the study had completed psychological testing in 1986 and had no heart problems at the time. The men were followed for an average of 12 years.

During follow up, the researchers found men who had chronic anxiety had a 30-40 percent increased risk of heart attack. Those with the highest levels of anxiety had an even higher risk of heart attack, health portal HealthDay reported.

The risk posed by anxiety remained even after the researchers adjusted their data to account for standard cardiovascular risk factors, health habits and negative psychological and personality traits, Shen said.

Whether treating anxiety reduces the risk of heart attack is not yet known, Shen said. 'But the implication is there,' he added. 'It is something that doctors can look out for.'

Highly anxious individuals should be aware they might face an increased risk of a heart attack, the researchers said.

'They should take proactive steps under physician supervision to control heart attack risk factors which are modifiable including blood pressure, lipid levels, activity level and weight,'

However, the researchers said they were not sure whether women with same anxiety conditions also face the similar risk.

New insights into the neural basis of anxiety

Tue, 05 Jun 2007 04:00:00 PST

( from http://www.rxpgnews.com ) People who suffer from anxiety tend to interpret ambiguous situations, situations that could potentially be dangerous but not necessarily so, as threatening. Researchers from the Mouse Biology Unit of the European Molecular Biology Laboratory (EMBL) in Italy have now uncovered the neural basis for such anxiety behaviour in mice. In the current issue of Nature Neuroscience they report that a receptor for the messenger serotonin and a neural circuit involving a brain region called the hippocampus play crucial roles in mediating fear responses in ambiguous situations.

A mouse that has learned that a certain cue, for example a tone, is always followed by an electrical shock comes to associate the two and freezes with fear whenever it hears the tone even if the shock is not delivered. But in real life the situation is not always so clear; a stimulus will only sometimes be followed by a threat while other times nothing might happen. Normal mice show less fear towards such ambiguous cues than to clearly threatening stimuli.

A team of researchers led by Cornelius Gross at the EMBL Mouse Biology Unit now discovered that this response to ambiguous stimuli requires a specific receptor molecule for serotonin, a signal many brain cells use to communicate. Mice that lack the serotonin receptor 1A have problems processing ambiguous stimuli and react to them with full-fledged fear responses. The cause is wrongly connected cells in their brains. Serotonin signalling is very important for brain development and if the receptor 1A is missing, defects arise in the wiring of the brain that affect the behaviour of mice later on in life.

In humans serotonin signalling has been implicated in disorders including depression and anxiety and like our mice patients suffering from these conditions also overreact to ambiguous situations, Gross says. The next step was to identify the brain regions that are responsible for such complex fear behaviour and the processing of ambiguous cues.

Using a new technique to switch off neural activity in selective brain cells in living mice, Gross and his colleagues discovered that a specific part of the hippocampus is required for correct processing of ambiguous stimuli.

Shutting down a specific circuit in the hippocampus abolished fear reactions only to ambiguous cues, says Theodoros Tsetsenis who carried out the research in Gross' lab. The pathway must be involved in processing and assessing the value of stimuli. It seems to bias mice to interpret situations as threatening.

The hippocampus is mainly known as a region important for learning and memory, but the results reveal a more general role in evaluating information and assessing contingencies.

Neural circuits that govern fundamental behaviours like fear are often often conserved between species and patient studies suggest a role for the hippocampus in anxiety also in humans.

The new insights gained into serotonin signalling via the receptor 1A and the role of the hippocampus in fear behaviour in mice promise to shed light on the neural basis of anxiety disorders and open up new avenues for therapies.

Guanfacine in PTSD is no more effective than placebo

Mon, 04 Dec 2006 12:39:58 PST

( from http://www.rxpgnews.com ) Guanfacine, a medication commonly prescribed to alleviate symptoms of post-traumatic stress disorder, is no more effective than a placebo, according to a study led by researchers at the San Francisco VA Medical Center.

“There was no benefit at all, and there were several adverse side effects,” says lead author Thomas Neylan, MD, medical director of the PTSD treatment program at SFVAMC. “People with symptoms of PTSD should probably stay away from this drug and others of its type.”

Guanfacine belongs to a class of medications known as alpha-2 agonists, which lower the brain’s supply of the neurotransmitter norepinephrine. Neurotransmitters are chemicals that transmit electrical signals between nerve cells. They are responsible for many aspects of behavior.

“Norepinephrine is released in the brain during states of excited arousal, and PTSD is associated with that state – patients startle easily, have trouble sleeping, and are hypervigilant and anxious,” explains Neylan, who is also an associate professor of psychiatry at the University of California, San Francisco.

Guanfacine and clonidine, another alpha-2 agonist, are commonly prescribed for PTSD symptoms. “There are at least 20 peer-reviewed articles published in the field of PTSD that recommend drugs which lower norepinephrine,” Neylan says. “However, ours was the first randomized, controlled study of alpha-2 agonists for symptoms of PTSD.”

The double-blind study compared the effects of guanfacine and an identical looking placebo pill on 63 male and female veterans at four VA medical centers in California and Hawaii. Twenty-nine participants were randomly assigned to take weekly doses of the drug, and 34 were assigned the placebo, for eight weeks.

At the end of the study, the effect of guanfacine on PTSD symptoms was “zero,” and there were no differences between men and women or older versus younger veterans. In addition, the subjects who took guanfacine had significantly more somnolence, lightheadedness, and dry mouth than those who took placebo.

The study authors conclude, “These results do not support the use of alpha 2 agonists in veterans with chronic PTSD.”

Neylan speculates that instead of lowering the overall level of norepinephrine, a more effective approach might be to inhibit the ability of brain cells to respond to the neurotransmitter. He notes that this is the action of prazosin, a blood pressure medication that has been found by other researchers to decrease the incidence of nightmares in combat veterans with PTSD.

Men, women respond to trauma differently

Tue, 21 Nov 2006 18:24:09 PST

( from http://www.rxpgnews.com ) New York, Nov 21 (IANS) Men and women may respond to trauma differently with the latter more prone to stress and anxiety disorders, says a new study.

Men may experience more traumatic events than women, but women are more likely to develop post-traumatic stress disorder (PTSD) - an anxiety disorder developed after experiencing a traumatic event, reported the online edition of health magazine WebMD.

Symptoms of PTSD may include flashbacks or re-experiencing the trauma, sleep problems, nightmares, panic attacks and depression, said researchers who reviewed 290 studies conducted between 1980 and 2005.

David Tolin of University of Connecticut School of Medicine and Edna Foa of University of Pennsylvania School of Medicine conducted the study to determine who is more at risk for potentially traumatic events and PTSD - men or women.

The results showed men have a higher risk of experiencing traumatic events but women have higher rates of the disorder.

The researchers found that women are more likely to have experienced sexual assault and child sexual abuse, but less likely to have experienced accidents, non-sexual assaults, disasters, war, or witness death or injury.

The results suggest that sexual trauma may cause more emotional suffering, leading to PTSD. But the study also showed that women still had higher PTSD rates than men when both sexes were compared on the same type of trauma.

For example, female survivors of motor vehicle accidents were more likely to report symptoms of PTSD than male survivors.

Researchers said experiencing more than one type of trauma may make women more prone to PTSD than men.

Panic attacks are linked to poor outcomes for diabetic patients

Tue, 21 Nov 2006 12:55:22 PST

( from http://www.rxpgnews.com ) There is a strong link between panic episodes and increased complications from diabetes, according to a study conducted at Group Health Cooperative, a Seattle-based nonprofit health care system that coordinates care and coverage. The work appears in the November issue of General Hospital Psychiatry,

The researchers surveyed patients with diabetes about their symptoms, disability, social and emotional function, and quality of life. They also collected data on the patients' blood sugar levels, diabetic complications, and other illnesses.

The team had previously reported a strong link between diabetes and depression, which often goes along with panic disorders. They were interested in examining panic independently, however, to see whether patients who have panic without depression would also have poor diabetic outcomes.

"Panic attacks can mimic episodes of hypoglycemia (low blood sugar), so we need a better understanding of how the two conditions are related," explained Evette Ludman, PhD, lead author of the article and a research associate at Group Health. "We don't want people adjusting their blood sugar thinking they are having hypoglycemia when their symptoms are actually caused by a panic disorder."

Of the 4,385 patients surveyed, 193 reported experiencing recent episodes of panic or fear that caused them to change their immediate behavior. After accounting for the effect of depression, panic episodes were associated with higher blood sugar levels, increased diabetic complications and symptoms, greater disability, and lower self-rated health and functioning.

About half of the patients with panic also reported having major depression. By contrast, only 10 percent of patients without panic episodes had major depression.

Panic episodes may be a consequence of the diabetes itself, the researchers explain. Also, panic may interfere with patients' self-care and ability to follow their treatment plans.

If you have diabetes and you know that anxiety is an issue for you, you should talk to your doctor about possible treatment for your anxiety," advised Ludman. And doctors should carefully assess their patients with diabetes, looking for signs of depression or panic disorders, she added.

Anxiety sensitivity linked to future psychological disorders

Tue, 07 Nov 2006 14:18:00 PST

( from http://www.rxpgnews.com ) People who get scared when they experience a pounding heart, sweaty palms or dizziness -- even if the cause is something as mundane as stress, exercise or caffeine -- are more likely to develop a clinical case of anxiety or panic disorder, according to a Florida State University researcher in Tallahassee, Fla.

While other researchers have proposed a connection between this so-called "anxiety sensitivity" and a range of anxiety problems, the study by FSU psychology professors N. Brad Schmidt and Jon Maner and University of Vermont Professor Michael Zvolensky provides the first evidence that anxiety sensitivity is a risk factor in the development of anxiety disorders. The study will be published in the December issue of the Journal of Psychiatric Research.

"The findings offer an exciting possibility for prevention of anxiety and panic reactions among high-risk individuals," Schmidt said, explaining that the key is to teach people cognitive and behavioral skills to reduce their anxiety sensitivity so that it does not lead to a serious problem.

People with anxiety sensitivity perceive their physical responses to certain triggers as a sign of imminent personal harm. They not only fear their reactions, they also fear that other people will detect their anxiety, which only serves to increase their anxiety and puts them at risk for a panic attack, according to Schmidt.

While a single panic attack does not indicate development of a psychological disorder -- in fact, some estimates indicate that about 20 percent of people will experience a spontaneous panic attack at some point in their lives -- repeated occurrences do, he said.

"When people start having repeated panic attacks, plus a lot of what we call panic-related worry -- they worry when the next attack will occur and they start avoiding things due to worry -- this is when someone has panic disorder," Schmidt said.

People with panic disorder suffer attacks of intense feelings of terror that strike suddenly with no warning. Some sufferers have a feeling of being out of control or even on the verge of death. They soon develop a "fear of fear" and may begin to restrict their activities in an attempt to prevent more attacks.

The study followed 404 young adults over a two-year period as part of an anxiety prevention study. After completing interviews and a battery of self-report measures, including the Anxiety Sensitivity Index (ASI), eligible participants then were randomly assigned to either a treatment or control group.

The researchers found that those who scored high on the ASI during the initial assessment -- whether they were assigned to the prevention or the control group -- were nearly twice as likely to have suffered spontaneous panic attacks and to have been diagnosed with an anxiety disorder by the time of the follow-up two years later.

Anxiety Disorders and Physical Illness

Mon, 23 Oct 2006 17:42:00 PST

( from http://www.rxpgnews.com ) Anxiety disorders appear to be independently associated with several physical conditions, including thyroid disease, respiratory disease, arthritis and migraine headaches, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. This co-occurrence of disorders may significantly increase the risk of disability and negatively affect quality of life.

Although depression has long been linked to physical illness, evidence supporting an association between anxiety disorders and physical health problems is more recent, according to background information in the article. Anxiety disorders include panic disorder, agoraphobia (fear of being in a situation where panic or anxiety may occur and escape from the situation might be difficult), social phobia and obsessive-compulsive disorder. Studies have found that those with phobic (fearful) anxiety may be more likely to experience sudden cardiac death, and rates of anxiety disorders are higher than expected in patients with thyroid disease, cancer, hypertension and several other conditions.

Jitender Sareen, B.Sc., M.D., F.R.C.P.C., University of Manitoba, Winnipeg, Canada, and colleagues further explored the association between anxiety disorders and physical conditions in 4,181 adults who were part of the German Health Survey (GHS), conducted between 1997 and 1999. The survey assessed whether participants had any physical illnesses through a questionnaire asking about 44 particular conditions, a medical interview conducted by a primary care physician, blood pressure measurements and blood and urine samples. Psychiatric interviews were conducted by a psychologist or physician, who used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to detect anxiety disorders. A quality of life surveywhich measured factors such as physical functioning, pain and general healthwas also administered, and to determine disability levels participants reported how many days of the past 30 they were unable to perform their usual daily activities.

Among the 1,913 men and 2,268 women in the study, 429 (8.4 percent) had an anxiety disorder within the past month and 2,610 (60.8 percent) had a physical condition within the past month. Having an anxiety disorder was associated with having any type of physical condition, and specifically with respiratory diseases, gastrointestinal diseases, arthritis, allergies, thyroid diseases and migraine headaches. Most individuals with both an anxiety disorder and physical illness developed the anxiety disorder first, and tended to have a poorer quality of life than those with anxiety disorders or physical conditions alone. Those who had both types of disorders also were more likely to have one or more days of disability than those with physical illnesses alone.

The mechanisms of association between anxiety disorders and physical conditions remain unknown, although several possibilities should be considered, the authors write. For example, the presence of an illness may cause worry and anxiety that eventually becomes serious enough to qualify as an anxiety disorder, the presence of an anxiety disorders could trigger biological processes that contribute to illness or a third condition, such as a substance abuse disorder, could be linked to both.

These findings extend previous work in clinical and community samples that noted an association between anxiety disorders and physical illnesses but also demonstrate the unique association of this comorbidity with poor quality of life and disability, the authors write. Although there have been increased efforts to recognize and treat depression in the medically ill, our findings underscore the need to create similar programs to recognize and treat anxiety disorders in the medically ill.

Men, women have similar rates of compulsive buying

Mon, 02 Oct 2006 01:32:00 PST

( from http://www.rxpgnews.com ) Contrary to popular opinion, nearly as many men as women experience compulsive buying disorder, a condition marked by binge buying and subsequent financial hardship, according to new research from the Stanford University School of Medicine.

"The widespread opinion that most compulsive buyers are women may be wrong," the researchers wrote in their paper, which will be published in the October issue of the American Journal of Psychiatry.

Senior author Lorrin Koran, MD, emeritus professor of psychiatry and behavioral sciences, said the study is the first large, nationwide effort to assess the prevalence of the disorder. The study found that more than one in 20 adults in the United States suffers from the condition.

People who have compulsive buying disorder - sometimes called compulsive shopping disorder - are often struck with an irresistible, intrusive and often senseless impulse to buy. It is common for sufferers to go on frequent shopping binges and to accumulate large quantities of unnecessary, unwanted items. Sufferers often rack up thousands of dollars in debt and lie to their loved ones about their purchases. The consequences can be bankruptcy, divorce, embezzlement and even suicide attempts.

Koran emphasized that this type of shopping and buying is not the same as occasional impulse buying, which many people engage in.

"Compulsive buying leads to serious psychological, financial and family problems including depression, overwhelming debt and the breakup of relationships," Koran explained. "People don't realize the extent of damage it does to the sufferer."

Prior to this study, researchers estimated that compulsive buying disorder affected between 2 and 16 percent of the U.S. population and that 90 percent of sufferers were women. Koran launched this study to get a more definitive estimate of how many people were affected by the disorder.

For the study, the researchers conducted a national, random-sample household telephone survey and interviewed 2,513 adults. The researchers asked respondents about buying attitudes and behaviors, and their financial and demographic data. The team used a screening instrument, the Compulsive Buying Scale, to determine whether respondents were compulsive buyers.

The researchers found that 6 percent of women and 5.5 percent of men had symptoms consistent with compulsive buying disorder. The gender-adjusted prevalence rate was 5.8 percent.

Koran said the fact that men and women have similar rates of compulsive shopping tendencies was surprising. "The difference that we observed between the prevalence in women and men is quite small and contrasts with the marked difference reported in clinical trials, in which women constituted 80 to 95 percent of the participants," the authors noted.

The researchers also discovered interesting tidbits about compulsive buyers. Compared with other respondents, compulsive buyers were younger and more likely to have reported incomes under $50,000. In addition, more of their credit cards were within a few hundred dollars of the credit limit, and compulsive buyers were more than four times as likely as other respondents to make only the minimum payment on credit card balances.

Koran said the latter finding is one that merits more investigation. "Many U.S. adults are laboring under their debt burden," he and his colleagues wrote. "The extent to which compulsive buying plays a role in [this] deserves investigation."

Koran said studies are also needed to explore the apparent link between compulsive buying and younger age and to clarify potential gender differences. As for Koran, he plans to seek federal funding for a study looking at the prevalence of so-called "behavioral addictions" - including pathological gambling, compulsive buying and skin picking - and whether these conditions are associated with other mental disorders.

Mental illnesses double up in Katrina survivors

Tue, 29 Aug 2006 21:19:00 PST

( from http://www.rxpgnews.com )

The researchers concluded that despite the doubling of mental illness after Hurricane Katrina, these positive cognitions appear to have prevented increased suicidal thoughts, plans, and attempts.

According to the most comprehensive survey yet completed of mental health among Hurricane Katrina survivors from Alabama, Louisiana, and Mississippi, the proportion of people with a serious mental illness doubled in the months after the hurricane compared to a survey carried out several years before the hurricane. The study also found that thoughts of suicide did not increase despite the dramatic increase in mental illness. The authors suggest that this low rate of suicide thoughts is due to optimistic beliefs about the success of future recovery efforts. The research, which was published today in a special online edition of the Bulletin of the World Health Organization, was led by researchers from Harvard Medical School (HMS).

"The increase in mental illness among Katrina survivors is not surprising, but the low suicidality is a surprise," says Ronald Kessler, PhD, professor of health care policy at HMS and lead author of the study. "Our concern, though, is that this lowering of suicidal tendencies appears to be strongly associated with expectations for recovery efforts that might not be realistic."

This report is the first in a planned series based on the Hurricane Katrina Community Advisory Group, a statistically representative sample of hurricane survivors participating in ongoing tracking surveys to monitor the pace and mental health effects of hurricane recovery efforts. The project is funded by the National Institute of Mental Health and the Office of the Assistant Secretary of Health and Human Services for Planning and Evaluation.

To estimate the influence of Hurricane Katrina on the mental health of survivors, the researchers compared results of the post-Katrina survey with a survey carried out several years earlier that used the same assessment of mental illness. The earlier survey was the 2001-03 National Comorbidity Survey Replication (NCS-R), taken every 10 years to assess the mental health of the country. The NCS-R, although carried out throughout the entire country, included 826 respondents in the area subsequently affected by hurricane Katrina. The NCS-R, which is managed by the same HMS research team overseeing the Katrina project, was administered face-to-face, and had a 70 percent response, or cooperation, rate.

The post-Katrina survey included a completely separate sample of 1,043 individuals who agreed to participate in the ongoing project. Interviewers reached participants by random-digit dialing of phones working in the eligible counties and parishes prior to the hurricane (if survivors relocated, calls were forwarded to their new locations), and from telephone numbers provided by the American Red Cross from individuals requesting assistance.

The post-Katrina survey was carried out between January 19 and March 31, 2006 and had a response rate of 41.9 percent. Although this is a relatively low response rate in comparison to typical one-shot surveys, it is considerably higher than the response rates obtained in more conventional consumer panel surveys. A weight was applied to the survey to adjust for observed differences between respondents and non-respondents, as non-respondents tended to have somewhat higher levels of trauma exposure and hurricane-related psychological distress. Other weights were added to account for the household participant selection and any discrepancies between the sample and the population based on data obtained from the US Bureau of the Census.

In addition to identically worded questions asked of the pre- and post-Katrina respondents, the post-Katrina survey also assessed "cognitions" found in previous research to predict adjustment to disasters. Mental illness was assessed with a widely accepted screening scale that can distinguish between serious and less serious cases. To validate the estimates of mental illness, trained clinical interviewers carried out follow-up assessments of depression, post-traumatic stress, panic, anxiety and other mental disorders in a random sub-sample of survey respondents. Suicide thoughts, plans, and attempts were assessed with a standard battery of questions about these outcomes.

Kessler and his team found that post-Katrina survey respondents were significantly more likely than respondents in the earlier survey to have either serious mental illness (11.3 percent versus 6.1 percent) or mild to moderate mental illness (19.9 percent versus 9.7 percent). They also found that the prevalence of suicidal thoughts given mental illness was significantly lower in the post-Katrina survey than the NCS-R.

The team discovered a strong relationship between the comparatively low rate of suicide thoughts and the existence of positive cognitions among Katrina survivors, especially with cognitions regarding increased sense of meaning and purpose in life and increased realization of inner strengths. For mentally ill post-Katrina survey respondents who did not endorse these cognitions, the prevalence of suicide thoughts was comparable to the prevalence in the NCS-R.

The researchers concluded that despite the doubling of mental illness after Hurricane Katrina, these positive cognitions appear to have prevented increased suicidal thoughts, plans, and attempts. However, they also concluded that because the positive cognitions were tied to expectations about a better future, the results might only be a temporary reprieve.

Kessler notes that although previous studies have suggested a connection between positive cognitions and lowered suicidality, this is the first study that offers quantitative evidence of these psychological processes in a sample of disaster victims.

Kessler and his team believe that their findings suggest a systematic investigation of positive cognitions might be useful in guiding public health mass media efforts in the aftermath of future disasters, given that previous research has shown that public health messages play an important role in psychological reactions to disasters.

"The immediate take-home message for disaster recovery and policy makers is that communications with survivors can sometimes build on the temporary reprieve from suicidal tendencies afforded by these protective cognitions. Efforts on the part of public officials to control expectations as practical recovery moves forward without destroying the positive cognitions related to these expectations could prove crucial in the process of continued psychological recovery," says Kessler.

Kids with OCD bullied more than others

Tue, 15 Aug 2006 02:43:00 PST

( from http://www.rxpgnews.com ) Children with obsessive-compulsive disorder are three times more likely to be bullied than other children, and the name-slinging could cause symptoms of OCD to worsen, University of Florida researchers have found.

"One of the things we have noticed working with many kids with OCD is that peer relations are extremely impaired," said Eric Storch, Ph.D, a UF assistant professor of psychiatry and pediatrics and lead author of the study. "Kids target kids who are different. Kids with OCD sometimes exhibit behaviors that peers simply don't understand."

More than one-quarter of the children with OCD who researchers studied reported chronic bullying as a problem, according to findings described in the September issue of the Journal of Clinical Child and Adolescent Psychology.

By comparison, only 9 percent of kids in the two other groups researchers studied - healthy kids without medical or mental conditions and children with type 1 diabetes - reported serious problems with bullies.

Nearly all children are bullied at least once in their lives. But chronic bullying equates to about one taunt per day, ranging from kicking or hitting to name-calling or excluding children from activities in school.

"The kids with OCD are really experiencing higher rates of peer problems than other kids," Storch said. "We're not saying one causes the other, but there is a positive relationship between (OCD and bullying)."

About one in 100 children struggle with OCD, an anxiety disorder that leads people to engage in rituals such as hand washing to drive away obsessive thoughts about germs or other worries. Rituals often become so involved that they interfere with a person's ability to function, according to the National Institute of Mental Health.

"Their day becomes filled with repeating behaviors," Storch said. "For a lot of kids, peers don't understand what is going on. They are isolated. They are ostracized because it doesn't make sense why they are washing their hands. Why they keep repeating questions."

The researchers also found links between bullying and other problems, namely loneliness and depression, in children with OCD, Storch said. Kids were also apt to internalize bullies' negative comments, telling themselves, "No one will ever love me," or "Maybe I am a loser," Storch said.

Having OCD and conditions such as depression is linked to worsening obsessive-compulsive symptoms, potentially explaining why researchers also found a link between bullying and more serious symptoms.

"It could be that the peers are attacking because they are doing things that are so different," he said. "Or it might be that bullying is in some way contributing to OCD."

Compulsive behaviors such as repeating questions, recounting and rechecking information can draw attention to kids with OCD in school, as can vocal or physical tics, common among children with OCD, said Phoebe Moore, Ph.D., an assistant clinical professor of child psychiatry at Duke University.

"That kind of behavior can draw fire," Moore said. "I definitely see that clinically."

Treating OCD either with approved drugs or behavior modification techniques will help patients control their obsessions and compulsions, Storch said. But he emphasizes that doctors need to examine the whole child and not just treat OCD symptoms.

"When one focuses solely on the obsessions and compulsions you experience a resolution of those problems, but problems like depression or anxiety and loneliness may still exist," he said. "If you address the OCD without addressing the peer problems, that depression and loneliness may not go away."

Storch suggests parents help children learn how to handle aggressive peers, either at home or by finding a counselor who can help them develop social skills. Parents should also take their concerns to their child's school if teachers or administrators are not stopping the bullying before it becomes a problem.

"Bullying is one of the largest challenges kids, with OCD and in general, have to face," he said. "One of the main clinical implications is considering the child as an entire person, one who has OCD but who also has other impairments."

Psychological debriefing after trauma does not reduce PTSD

Wed, 09 Aug 2006 12:44:00 PST

( from http://www.rxpgnews.com ) Individual psychological debriefing does not reduce the symptoms of post-traumatic stress disorder (PTSD), anxiety or depression after psychological trauma, a new study from The Netherlands has found.

People who are highly aroused after a trauma may actually be made worse by single-session emotion-focused psychological debriefing.

Recent research has shown that individual single-session psychological debriefing does not prevent, and can even aggravate, symptoms of PTSD.

The aims of this randomised controlled trial, published in the August issue of the British Journal of Psychiatry, were to assess the effects of emotional debriefing alone, or educational debriefing alone, compared with no debriefing, on symptoms of PTSD, anxiety and depression.

236 adult survivors of a recent traumatic event were randomised to receive either the emotional debriefing, psychoeducational debriefing, or no debriefing (control group) approximately 2 weeks, 6 weeks and 6 months after the event.

Both types of debriefing lasted between 45 minutes and 1 hour and were individually administered.

It was found that psychiatric symptoms decreased significantly in all 3 groups over time, with no significant differences between them in PTSD symptoms.

Participants with more than two of the five early symptoms of high arousal actually had higher PTSD scores 6 weeks after an emotional debriefing session than similar participants in the control group.

The authors of the study hypothesise that encouraging highly aroused trauma survivors to express their feelings might activate the sympathetic nervous system to such a degree that the successful encoding of the traumatic memory is disrupted.

People receiving an emotional debriefing may also feel disempowered, which may keep them in a high state of arousal, causing PTSD symptoms to get worse rather than better.

The researchers comment that their findings are in line with recent expert statements that do not recommend single-session interventions (National Institute of Mental Health, 2002; National Collaborating Centre for Mental Health, 2005). There are all too many reasons, they say, for discontinuing this practice.

On the basis of current evidence, more benefits can be expected from early treatment only of those patients with acute stress disorder or acute PTSD with 4 or 5 sessions of cognitive behavioural therapy, or 12 sessions of cognitive therapy, in order to prevent a chronic course of PTSD.

Tsunami Survivors Face Increased Risk of Mental Disorders

Thu, 03 Aug 2006 14:52:00 PST

( from http://www.rxpgnews.com ) Adult and children in the tsunami-affected areas in Thailand have elevated rates of mental health problems such as symptoms of posttraumatic stress disorder and depression up to 9 months after the disaster, according to two studies in the August 2 issue of JAMA, a theme issue on violence and human rights.

On December 26, 2004, a massive undersea earthquake northwest of Sumatra, Indonesia, caused a giant ocean shockwave or tsunami that devastated the shorelines of Indonesia, Sri Lanka, India, Thailand, and many other countries. More than 200,000 individuals are estimated to have died from the tsunami, making it one of the deadliest natural disasters in history. In Thailand, the tsunami severely affected all 6 southwestern provinces, where 5,395 individuals died, 2,991 were unaccounted for, and 8,457 were injured, according to background information in the article.

Previous assessments among survivors of natural disasters have shown that posttraumatic stress disorder (PTSD) and other mental health problems are common. Thailand does not have a history of natural disasters and the prevalence of PTSD among individuals exposed to traumatic events has not been assessed previously. Understanding post-tsunami mental health indicators is essential for identifying vulnerable populations and developing culturally specific mental health interventions.

Frits van Griensven, Ph.D., of the Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand, and colleagues with the Thailand Post-Tsunami Mental Health Study Group, assessed the prevalence of symptoms of PTSD, anxiety, and depression and associated factors among random samples of displaced and nondisplaced persons in the three Thai provinces of Phang Nga, Krabi, and Phuket, which were the most severely affected by the tsunami. The population-based mental health survey was conducted from February 15 to 22, 2005, of displaced (n = 371) and nondisplaced persons in Phang Nga province (n = 322) and nondisplaced persons in the provinces of Krabi and Phuket (n = 368). Data were collected using an interviewer-administered questionnaire on handheld computers. Participation rates for displaced and nondisplaced in the survey were 69 percent and 58 percent, respectively. A follow-up survey was conducted in September 2005.

The researchers found that symptoms of PTSD were reported by 12 percent of displaced and 7 percent of nondisplaced persons in Phang Nga and 3 percent of nondisplaced persons in Krabi and Phuket. Anxiety symptoms were reported by 37 percent of displaced and 30 percent of nondisplaced persons in Phang Nga and 22 percent of nondisplaced persons in Krabi and Phuket. Symptoms of depression were reported by 30 percent of displaced and 21 percent of nondisplaced persons in Phang Nga and 10 percent of nondisplaced persons in Krabi and Phuket. Loss of livelihood was independently and significantly associated with symptoms of all 3 mental health outcomes (PTSD, anxiety, and depression).

Restoration of persons livelihoods to prevent and diminish mental morbidity among populations affected by natural disasters is therefore of utmost importance, the authors write.

In the 9-month follow-up survey of 73 percent of displaced participants and 80 percent of nondisplaced participants in Phang Nga, prevalence rates of symptoms of PTSD, anxiety, and depression decreased among displaced and nondisplaced persons, but remain elevated.

This decrease may be due to spontaneous recovery under improved social and environmental conditions, such as more permanent housing for displaced persons, continued mental health support and occupational training, and restoration of livelihood programs, which were implemented in Phang Nga province by multiple governmental and nongovernmental organizations, the researcher add.

Substantial burden of PTSD among people after disasters

Fri, 09 Jun 2006 18:12:00 PST

( from http://www.rxpgnews.com ) In the year after a hurricane, tornado, terrorist attack or other natural or man-made disaster, 30 to 40 percent of adults who were directly affected may suffer from post-traumatic stress disorder, according to a University of Michigan researcher.

In addition, approximately 10-to-20 percent of rescue workers and 5-to-10 percent of the general population may experience PTSD symptoms, including flashbacks, recurrent dreams of the event, survival guilt and hyper-vigilance.

"Our review of studies conducted in the aftermath of disasters during the past 40 years shows that there is a substantial burden of PTSD among people who experience a disaster," said Sandro Galea, lead author of an article on the topic appearing in the current issue of Epidemiologic Reviews.

"Our analysis also shows that the most important risk factors for the development of PTSD are the extent of exposure to the disaster and the scope of the disaster."

Funded in part by the National Institutes of Health, the study considered the evidence from peer-reviewed studies conducted between 1980, when PTSD was first included as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and 2003.

The earliest disaster included in the review was a 1963 landslide and flood that took place in northeastern Italy. The most recent was the September 11 terrorist attack in New York City.

Although the prevalence of PTSD has previously been found to be higher after human-made and technological disasters than after natural disasters, Galea notes that this difference is largely due to differences in sampling.

"Most studies conducted after human-made and technological disasters have focused on direct victims, while studies of natural disasters typically include samples of people in the overall community who probably had substantially lower exposure to the disaster," he said.

In addition to exposure to a disaster, a number of other risk factors for PTSD were found to be important across multiple studies.

Women consistently have a higher prevalence of PTSID after disasters than men, as do persons with pre-existing or concurrent psychiatric disorders and those who have previously experienced traumatic events or substantial stress.

Galea, an M.D. who is an associate professor at the U-M School of Public Health and a research affiliate at the U-M Institute for Social Research, is involved in several other ongoing research projects related to the mental health consequences of disasters.

One is a study of mental health service use among uniformed service providers in New York City in the first five years after the September 11 attacks. Another is a study of how social context, including income inequality, influences an individual's underlying strengths and vulnerabilities in the aftermath of a disaster.

OCD has multiple genetic associations

Thu, 08 Jun 2006 05:30:00 PST

( from http://www.rxpgnews.com ) A federally funded team of researchers including several from Johns Hopkins have identified six regions of the human genome that might play a role in susceptibility to obsessive compulsive disorder, or OCD. The study was published online June 6 in Molecular Psychiatry.

"OCD once was thought to be primarily psychological in origin," says Yin Yao Shugart, Ph.D., statistical geneticist and associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. "But now there is growing evidence that there is a genetic basis behind OCD, which will help us better understand the condition," she says.

OCD is characterized by intrusive and senseless thoughts and impulses that together are defined as obsessions, as well as repetitive and intentional behaviors, referred to as compulsions. OCD is estimated to affect up to 3 percent of the American population.

In what the research team describes as the first whole-genome scan to look for genetic "markers" or similarities in the genomes of people with OCD, results identified six potentially significant regions in the genome, which lie on five different chromosomes that appear "linked" to OCD. It's likely that any genes directly associated OCD are to be found in these regions.

"We've long suspected that, rather than being caused by a single gene, OCD has multiple genetic associations," says Jack Samuels, Ph.D., an epidemiologist and assistant professor of psychiatry at the Johns Hopkins School of Medicine.

To conduct the study, the researchers collected blood samples from 1,008 individuals from a total of 219 families in which at least two siblings were clinically diagnosed with OCD.

DNA from each sample was analyzed by the Hopkins Center for Inherited Disease Research (CIDR) using both molecular biology and statistical analysis computer programs. Specific DNA sequences known as genetic markers on chromosomes 1, 7, 6, and 15 and two markers on chromosome 3 appear more frequently in the patients with OCD than in those without it. The researchers want to further analyze the genetic regions they identified in this report and use more markers to possibly narrow down these regions to identify OCD risk genes.

The researchers suggest that whatever genes are found don't directly cause OCD but increase risk for it in conjunction with other genes or environmental factors.

"OCD is a relative newcomer to these genetic linkage studies," says Shugart, "so it's extremely important to follow up these findings by looking at more families and using more markers to assess the role of gene-environment interactions in OCD. "We are also very interested in finding genes underlying the different subtypes of OCD," she says.

Careful genetic analysis of different clinical categories of OCD has been limited by currently existing computer programs used in analyzing this type of data. The vast amount of data used in whole-genome analysis requires fine-tuned statistical calculations. The research team is eager to develop new methods in this area. "We predict that such findings may have immediate clinical implications for OCD patients," says Shugart.

Intermittent Explosive Disorder could be behind cases of road rage and spousal abuse

Thu, 08 Jun 2006 03:16:00 PST

( from http://www.rxpgnews.com ) A seldom-studied mental illness called Intermittent Explosive Disorder, characterized by recurrent episodes of angry and potentially violent outbursts--seen in cases of road rage or spousal abuse--has been found to be much more common than previously thought. Depending upon how broadly it is defined, this disorder affects as many as 7.3 percent of adults, or 16 million Americans, in their lifetimes. In a year, Intermittent Explosive Disorder affects nearly 4 percent of Americans, or 8.6 million adults, reports Ronald Kessler, PhD, professor of health care policy at Harvard Medical School (HMS), and colleagues. The study also found that Intermittent Explosive Disorder may predispose people to other mental illnesses and substance abuse. Intermittent Explosive Disorder attacks are out of proportion to the social stressors triggering them and are not due to another mental disorder or the effects of drugs or alcohol, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). People with this disorder overreact to situations with uncontrollable rage, feel a sense of relief during the angry outburst, and then feel remorseful about their actions.

"Intermittent Explosive Disorder is not a clinical term well-known in society, but the weight of these numbers should help patients and physicians come to recognize the pervasiveness of this disorder and develop appropriate treatment strategies," says Kessler, senior author of the study. The study is based on data from the National Comorbidity Survey Replication (NCS-R), a nationally representative face-to-face household survey of 9,282 American adults, conducted from 2001 to 2003. The NCS-R is carried out in conjunction with the World Health Organization World Mental Health Survey Initiative.

"If people think these explosive outbursts are just bad behavior, they are not thinking of this problem as a serious biomedical problem that can be treated."

Among people with this disorder, 81.8 percent also were diagnosed with depression, anxiety, and alcohol or drug abuse disorders, although the age of onset of Intermittent Explosive Disorder was usually much earlier than that of these other disorders. "This suggests that people with this disorder may be more susceptible to other disorders because of increased stressful life experiences as a result of their disorder, such as financial difficulties or divorce," says Kessler. This raises the possibility that Intermittent Explosive Disorder may be a risk factor for other mental disorders.

A narrow definition of Intermittent Explosive Disorder includes three or more of these attacks in one year. In the study, people with narrow Intermittent Explosive Disorder had a more persistent and severe illness, particularly if they attacked both people and property, causing 3.5 times more property damage than other violent Intermittent Explosive Disorder subgroups.

The study shows that for both broad and narrowly-defined Intermittent Explosive Disorder, the first episode of rage occurred in early adolescence, around age 13 for males and age 19 for females. "Given its age of onset, identifying Intermittent Explosive Disorder early, determining its causes, and providing treatment might prevent some of the associated secondary disorders, such as anxiety or alcohol abuse," says Kessler.

Although most study respondents with the disorder had seen a professional for emotional problems at some time in their lives, only 11.7 percent had been treated for their anger in the 12 months prior to the study interview.

Shame or embarrassment about these violent reactions may prevent people from discussing this disorder with their doctors, says coauthor Maurizio Fava, MD, professor of psychiatry at HMS and Massachusetts General Hospital (MGH). Effective treatment for Intermittent Explosive Disorder includes both behavioral and pharmacological interventions (selective serotonin reuptake inhibitors [SSRIs] and mood stabilizers), says Coccaro. "Ideally, people should be treated with both medicine and cognitive-behavioral therapy. Medicines increase the threshold at which people will explode, and cognitive-behavior therapy teaches people how to handle feelings of frustration or threat thath often lead to explosive episodes."

A form of cognitive-behavioral therapy involving cognitive restructuring, coping skills training, and relaxation training--a combination known as CRCST--has proven to be effective in treating Intermittent Explosive Disorder, says Coccaro, who is also director of the University of Chicago's Clinical Neuroscience and Psychopharmacology Research Unit. Interventions like CRCST are also helpful because they work to teach people to identify triggers that set off attacks of rage, says Fava, who is also the associate chief of psychiatry for clinical research at MGH and director of the MGH Depression Clinical and Research Program. These programs can teach people to identify triggers that set off attacks of rage.

Pregabalin Receives a Positive Opinion from CHMP for the Treatment of Generalized Anxiety Disorder in Adults

Sat, 28 Jan 2006 12:37:00 PST

( from http://www.rxpgnews.com ) Pfizer Inc said that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency issued a positive opinion recommending marketing authorization of Lyrica® (pregabalin), a novel mechanism for the treatment of generalized anxiety disorder (GAD) in adults.

The CHMP's positive recommendation will be reviewed by the European Commission, which has authority to approve medicines for the European Union. Pfizer anticipates a final decision from the Commission in the coming months.

"Though GAD has been formally recognized by the medical community and is frequently associated with high levels of distress and impairment, the condition often goes undetected and untreated," said Dr. Joseph Feczko, Pfizer's chief medical officer. "It is estimated that only one-third of those who suffer from this condition seek treatment despite the significant impact on patient quality of life. We are pleased that the CHMP has recognized the potential therapeutic benefits of Lyrica in treating this serious medical condition."

GAD, which affects an estimated five percent of people at some point in their lives, is a psychiatric disorder characterized by excessive worry as well as physical symptoms such as poor sleep, fatigue, difficulty concentrating, irritability and restlessness. GAD affects slightly more women than men, and symptoms are often chronic and worsen during times of stress. GAD occurs more frequently in patients with chronic medical illnesses, particularly in connection with pain syndromes. The direct annual healthcare costs associated with GAD in Europe are approximately $1.5 billion.

"Despite frequent visits to their doctor, GAD patients are still very poorly treated." said Dr. Stuart Montgomery, Professor of Psychiatry, Imperial College School of Medicine, University of London. "The psychological and physical effects of GAD disrupt work and personal relationships and make it difficult to carry on with everyday activities. Accurate diagnosis of GAD is important since prolonged anxiety increases impairment and worsens the outcome of co-existing physical illnesses."

Lyrica has been approved for various neuropathic pain indications including peripheral neuropathic pain, diabetic and postherpetic neuropathic pain and adjunctive therapy for epilepsy in more than 50 countries outside of the United States. The most common adverse events in Lyrica's clinical development program were dizziness and somnolence. In the U.S., Lyrica® (pregabalin) capsules C-V is FDA approved for the management of diabetic peripheral neuropathy, postherpetic neuralgia and adjunctive treatment of partial onset seizures. Developed by Pfizer, Lyrica is an alpha-2-delta ligand that is believed to work by calming hyper-excited neurons.

Anxious fathers make caesarean ops more painful for mothers

Thu, 26 Jan 2006 23:45:00 PST

( from http://www.rxpgnews.com ) In a study involving 65 women scheduled for an elective caesarean, researchers found that the way their birth partners felt during the operation was related to the womans own levels of fear and anxiety about the operation.

This increased the amount of pain the woman felt immediately after the operation, which could affect her immediate recovery as well as potentially influence other related factors such as breast feeding and parent-child bonding.

The lead researchers from the University of Bath (Dr Keogh) and Imperial College London (Dr Holdcroft) suggest that helping prepare the birth partner for a caesarean, both at antenatal classes and before the operation, could help reduce the pain experienced by the mother and improve the birth experience.

One in four babies born in the UK is now delivered by caesarean section (CS), with many hospitals delivering almost 30 per cent in this way. Fear of pain during childbirth is often cited as one of the contributory factors for the increasing rate of CS delivery.

But despite the popular notion that caesarean deliveries are the easy option, with respect to overall pain experiences compared with labour pain, this may not be the case.

Caesarean sections involve major surgery and are often performed whilst the mother is awake under regional anaesthesia which numbs the lower part of the body, said Dr Ed Keogh from the University of Bath.

Whilst actual pain during a caesarean is usually more controlled than a vaginal delivery, the whole procedure is not painless.

Women who have had a caesarean tend to experience much longer periods of postnatal pain and recovery. They also have mobility restrictions placed on them whilst they recover from the surgery, such as picking up heavy items, reaching upwards and driving.

Whilst it has become a social expectation that birth partners accompany and support mothers during a caesarean delivery, it is unclear what part birth partners play in womens experience of childbirth.

Whilst some women say that birth partners improve birth experiences, others report less positive outcomes. It is not unreasonable for the birth partner to have some feelings of anxiety and fear about the operation they are about to witness.

The women involved in the study were recruited from the Chelsea and Westminster Hospital in London during regular ante-natal check ups.

Almost all of the women (61) had chosen their husband or partner to be their birth partner, with just four deciding on a female birth partner.

The women and their birth partners were questioned before, during and after the delivery about their fears, expectations and experiences. The women were also assessed for their pain levels at different stages of the procedure and immediately afterwards.

The study revealed that those women who had negative birth expectations before the operation had the most fear experiences during the delivery, which in turn was related to greater post-operative pain.

It also showed that women are most afraid during the application of the nerve block used to numb the lower part of the body, rather than the initial incision as the researchers expected.

Maternal fear fluctuates during a caesarean section but it can be influenced by the psychosocial factors around them, including their birth partner, said Dr Keogh.

Anecdotally a number of birth partners told us that they had little choice in attending the caesarean operation and felt ill prepared.

Birth partners can have potentially beneficial effects on maternal birth experiences. Rather than removing them from the operating theatre altogether, it would be better to target the emotional wellbeing of the birth partner to help reduce the anxiety and fear experienced by the mother.

Since anxiety can increase recovery times, it would be useful to study whether increased maternal fear during the procedure has an impact on mothers, such as longer-term recovery from surgery as well as other related factors such as breast feeding and parent-child bonding.

Chronic work stress could lead to heart disease, diabetes

Fri, 20 Jan 2006 13:27:00 PST

( from http://www.rxpgnews.com ) Chronic work stress could lead to heart disease and diabetes, but lifestyle changes can help tackle the situation, says a study.

Stress has long been linked to ill health. But the new study, led by Indian-origin researcher Tarani Chandola at University College London, discovered a link between stress and metabolic syndrome, which involves obesity and high blood pressure, reported the online edition of BBC News.

The researchers, in a study of 10,000 British civil servants, measured the level of work stress and the different aspects of metabolic syndrome - a cluster of factors that cause heart disease and diabetes - such as high blood pressure and high cholesterol levels.

They recorded factors such as social class, smoking, high alcohol consumption and lack of exercise. They found that there was a link between the amount of stress experienced in their job and the levels of metabolic syndrome symptoms, even when considering the other risk factors.

"Employees with chronic work stress have more than doubled the odds of the syndrome than those without work stress, after other risk factors are taken into account," Chandola said.

A possible explanation for the result may be that prolonged exposure to work stress affects the nervous system, they said.

However, the good news is that many of the features of the metabolic syndrome can be reversed or improved by lifestyle changes, he said.

Panic disorder shown to be the single best predictor of a relapse to alcohol dependence

Mon, 15 Aug 2005 20:32:00 PST

( from http://www.rxpgnews.com ) Anxiety disorders and alcohol dependence co-occur at an alarming rate. A study in the August issue of Alcoholism: Clinical & Experimental Research examines what effects a co-existing anxiety disorder may have on relapse following treatment for alcoholism. Results indicate that two of the most common anxiety disorders found among alcoholics social phobia and panic disorder are more strongly associated with alcohol relapse than other anxiety disorders.

"Researchers and clinicians have long observed that the rate of anxiety disorders among those suffering with alcohol dependence is two to four times greater than that found in the general population," said Matt G. Kushner, associate professor at the University of Minnesota and corresponding author for the study. "Anxiety disorders are fairly common to begin with, about 15 percent of all adults, but the rate of anxiety disorders among alcohol-disordered individuals can be as high as 50 percent. Our research asked: 'what does the presence of these co-occurring disorders imply about optimal clinical approaches and treatment outcomes?'"

"Although the high rate of co-occurrence of these two types of mental health disorders is very well established," added Sherry H. Stewart, professor of psychiatry, psychology, and community health and epidemiology at Dalhousie University, "relatively little is known about the 'clinical significance' of this co-morbidity. For example, does having a co-morbid anxiety disorder influence a person's response to alcoholism treatment? More specifically, do those with a co-occurring anxiety disorder at the outset of alcoholism treatment fare worse in terms of increased risk for relapse to problematic alcohol use over time?"

Kushner and his colleagues examined the diagnostic status and daily drinking patterns of 82 (53 males, 29 females) individuals one week after they entered treatment for alcoholism, and again 120 days later (n=53).

Results indicate that screening for co-existing anxiety disorders in an alcoholism-treatment setting is clearly warranted.

"The key finding from our study is that having an anxiety disorder when starting treatment for alcohol dependence marks individuals at a significantly greater risk for relapse to drinking within four months," said Kushner. "This finding suggests that clinicians ought to provide additional resources for these patients during this 'high risk' period."

"Another very interesting finding was that different anxiety disorders predicted different aspects of alcohol relapse at alcoholism-treatment follow-up," said Stewart. "Having 'social phobia' significant social fears and avoidance of social situations at the outset of alcoholism treatment was the best predictor of a return to any drinking at treatment follow-up. Having 'panic disorder' persistent 'panic attacks' or episodes of intense anxiety and arousal at the outset of alcoholism treatment was the best predictor of a relapse to dependence at treatment follow-up. This pattern suggests that panic disorder is a risk factor for a major relapse, and social phobia a risk factor for a minor relapse, following alcoholism treatment."

"At a practical level," said Kushner, "our study tells clinicians that they should screen for co-occurring anxiety disorders, which is not typically done at this time, and that identifying these disorders, especially social phobia and panic disorder, should serve as a red flag for heightened relapse risk. In the past, many clinicians assumed that co-occurring anxiety problems were simply a product of excessive drinking and would 'take care of themselves' as soon as the drinking stopped. Our study, on the other hand, suggests that the chances that drinking will stop for as little as four months after treatment is severely undermined by the presence of an active anxiety disorder."

Stewart added that Kushner's findings also suggest that traditional alcoholism treatment is not particularly effective for those with co-occurring anxiety disorders. "It appears that we must develop new treatments, or modify existing treatments, to better serve those with co-occurring anxiety and alcohol use disorders," she said. "For example, integrated treatments that simultaneously address the anxiety symptoms, the problem drinking, and their inter-relations that is, how the individual is using alcohol to self-medicate for their anxiety might prove particularly effective for this type of patient. However," she added, "we cannot simply assume that such integrated treatments would be superior to existing alcoholism treatments in improving alcohol outcomes in co-morbid patients. This assumption would need to be tested rigorously."

Kushner agreed. "While seeming very logical based on our findings," he said, "this conclusion is not directly demonstrated by our study. That is, while we show that anxiety disorders mark a heightened risk for relapse to drinking following alcoholism treatment, it does not necessarily follow that treating the anxiety disorder would partially or wholly eliminate that risk."

Both Kushner and Stewart noted that the debate continues as to whether anxiety disorders in alcoholics are "independent disorders" or a consequence of their alcohol abuse/dependence, or for that matter, which comes first.

"The 'self-medication' hypothesis," said Kushner, "holds that alcohol is used deliberately as a means of managing anxiety symptoms. From this perspective, anxiety tends to cause alcohol problems to develop. However, things may be more complicated than this. For example, nearly one-third of our study subjects with both anxiety and alcohol disorder reported that the alcohol problems began first. Perhaps alcohol dependence and withdrawal can, themselves, either imitate or cause anxiety disorders via the neuro-chemical and environmental disruptions associated with alcohol addiction. Once this process occurs, an individual could begin to use alcohol to self-medicate the very anxiety symptoms that were caused by pathological drinking in the first place. This creates a vicious cycle, in which more drinking leads to greater anxiety, which, in turn, leads to more drinking. Once this vicious cycle is firmly in place, which disorder is operating as the cause' and which as the 'effect' becomes murky."

Riluzole eases obsessive-compulsive symptoms

Sat, 30 Jul 2005 16:55:00 PST

( from http://www.rxpgnews.com ) A medication used to ease symptoms of amyotrophic lateral sclerosis, or Lou Gehrig's disease, also is helpful in treating people with treatment-resistant obsessive-compulsive disorder (OCD), according to a pilot study at Yale School of Medicine.

Although the study included only 13 patients, the preliminary results are promising for persons who have found no relief using other medications and cognitive behavioral therapy, said the first author, Vladimir Coric, M.D., assistant clinical professor in the Department of Psychiatry and director of the Yale OCD clinic.

"Riluzole appears to have significant antiobsessional, antidepressant, and antianxiety properties," said Coric, who will be presenting the data Friday at the Obsessive-Compulsive Foundation annual conference in San Diego.

OCD currently is treated with serotonin reuptake inhibitors, cognitive behavioral therapy and dopamine antagonists, which reduce symptoms in 40-60 percent of patients. "However, a number of patients remain dramatically symptomatic even with the combination of pharmacotherapy and cognitive behavioral therapy," Coric said.

OCD symptoms include obsessive checking, cleaning, washing, counting, hoarding, touching, tapping, ordering, arranging, rubbing, and other repetitive behaviors. Coric said treatment-resistant OCD is one of the few psychiatric indications for neurosurgical intervention. "Novel therapeutic strategies are urgently needed," he said.

Since recent neuroimaging studies suggest that individuals with OCD have abnormalities in corticostriatal glutamate function, Coric and his colleagues tested riluzole, a glutamate modulating agent, on patients with OCD. Glutamate is the most abundant excitatory neurotransmitter in the brain, but when in excess may cause neurotoxicity. Seven of the patients treated with riluzole experienced a 35 percent reduction in symptoms and five were categorized as responsive to the treatment. One patient left the study.

"The use of glutamate modulating agents, such as riluzole, may represent a novel treatment intervention for certain anxiety and mood disorders," Coric said.

Size of ventromedial prefrontal cortex could signal vulnerability to anxiety disorders

Tue, 12 Jul 2005 12:59:00 PST

( from http://www.rxpgnews.com ) The size of a particular structure in the brain may be associated with the ability to recover emotionally from traumatic events. A new study by researchers from Massachusetts General Hospital (MGH) finds that an area called the ventromedial prefrontal cortex is thicker in volunteers who appear better able to modify their anxious response to memories of discomfort. The report will appear in the Proceedings of the National Academy of Science and has received early online release on the PNAS website.

"We've always wondered why some people who are exposed to traumatic experiences go on to develop anxiety disorders like post-traumatic stress disorder and others do not," says Mohammed Milad, PhD, a research fellow in the MGH Department of Psychiatry, the study's lead author. "We think this study provides some potential answers."

In the classical model of conditioned fear, individuals respond with physical and emotional distress to situations that bring back memories of traumatic events. Such responses are normal and usually diminish over time, as those situations are repeated without unpleasant occurrences. But some people continue to respond with what can be overwhelming fear and may develop post-traumatic stress disorder (PTSD).

For example, it would not be unusual for a soldier who experienced a traumatic battlefield situation to become distressed when hearing noises that bring back those memories, such as the sound of a helicopter. Most commonly, repeated exposure to such sounds without additional trauma reduces or extinguishes the fearful response a phenomenon called "extinction memory." But some individuals continue to experience anxiety, along with other symptoms characteristic of PTSD, when hearing the sounds.

Prior studies in animals have suggested that the ventromedial prefrontal cortex (vmPFC) an area on the lower surface of the brain may be involved in extinction memory. The vmPFC may help to quell potential fears by inhibiting the activity of the amygdala, an area known to be involved with fear. The current study was designed to see if the structure of the vmPFC is related to the ability to modify response to an unpleasant memory.

Over a period of two days, 14 volunteer study participants viewed a series of digital photos of two different rooms. Each room contained a lamp that was turned on sometimes with a red light, sometimes a blue light. On the first day, participants viewed the photos several times, and then viewed them again with a mild electric shock described as annoying but not painful delivered to their hands right after a lamp with a blue light appeared. They then viewed a series of the photos with no shocks administered.

On the second day, measurements of skin conductance were taken while the volunteers once again viewed the photos with both colors of lights displayed but no shocks given. A measurement of anxiety level, skin conductance is determined by the amount of perspiration on the palm of the hand. After that part of the experiment, the volunteers had structural magnetic resonance (MR) images taken of their entire brains.

The MR studies showed that those participants who appeared to have less anxiety response upon viewing the blue lights the second day, as measured by skin conductance, also had a thicker vmPFC. "That was the only area of the brain that correlated with extinction memory," says Milad. "So, these results suggest that a bigger vmPFC may be protective against anxiety disorders or that a smaller one may be a predisposing factor. But exactly how that might work we just don't know."

Scott Rauch, MD, the senior author of the paper and director of the Psychiatric Neuroscience Research Division in MGH Psychiatry, notes that future research could look at genetic or environmental factors that may underlie these differences in brain structure and also investigate whether vmPFC size predicts the success of exposure-based therapies for anxiety disorders. Another factor to study would be whether vmPFC measurement should be used to screen those likely to be exposed to traumatic situations or to develop preventive strategies. Rauch is an associate professor of Psychiatry at Harvard Medical School.

Life events generate more symptoms of PTSD than traumatic events

Thu, 02 Jun 2005 16:24:00 PST

( from http://www.rxpgnews.com ) Life events (e.g. divorce, unemployment) can generate more symptoms of post-traumatic stress disorder (PTSD) than traumatic events (e.g. a road accident, war), according to a new study.

PTSD is the only psychiatric condition that requires a specific event to have occurred for its diagnosis. The aims of this study from The Netherlands, published in the June issue of the British Journal of Psychiatry, were to gather evidence from the general population on whether life events generate as many symptoms of PTSD as traumatic events.

Information on demographic characteristics and history of stressful events was collected through a written questionnaire sent to a random sample of 2997 adults aged 20 and over. Respondents also filled out a PTSD symptom checklist, keeping in mind the worst event that had ever happened to them. Half of the questionnaires were returned.

Of the 1498 respondents, 832 were eligible for inclusion in the study, which compared average PTSD scores after traumatic v. life events. Reasons for exclusion were not having experienced any event, not having specified one's worst event, or having chosen more than one worst event.

There were 299 respondents whose worst event could be classified as traumatic, and 533 whose worst event was a life event. Those whose worst event was traumatic experienced it 18 years ago on average, compared with 12 years ago for those whose worst event was a life event.

It was found that for events from the past 30 years, the PTSD scores were higher after life events than after traumatic events. For earlier events, the scores were similar for both types of event.

The authors of the study comment that this research is the first to show that people from the general population whose worst event is a life event, such as chronic illness, marital discord or unemployment, on average have more PTSD symptoms from this event than people whose worst event is traumatic, such as an accident or a disaster.

This finding holds true for events that occurred at some time in the past 30 years. It may be that in the very long run the impact of a life event 'wears out' in terms of PTSD, whereas that of a traumatic event is more persistent.

Further research is needed to explore the reasons for the unexpected findings of this study.

PTSD after Nairobi and Oklahoma terrorist bombings - Study

Thu, 02 Jun 2005 16:24:00 PST

( from http://www.rxpgnews.com ) There were many similarities in the psychological problems found among survivors in the two cultures, following the terrorist bombings in Nairobi and Oklahoma City. However, coping responses and treatment were quite different.

Africa is poorly represented in published world research on disaster mental health. This study from the June issue of the British Journal of Psychiatry breaks new ground in using consistent methodology to provide cross-cultural comparison of diagnostic findings after two separate bomb attacks on two continents, North America and Africa.

Structured diagnostic interviews were carried out with 227 people directly exposed to the bombing of the US embassy in Nairobi in 1998, and with 182 individuals who experienced the bomb attack on the Murrah Federal Building in Oklahoma City in 1995.

Despite their geographical separation by nearly half a world, the Nairobi and Oklahoma populations and their mental health responses to the experience of bombing were remarkably similar.

The injury rate in Oklahoma City was 87% and in Nairobi 88%. Post-traumatic functional impairment, defined as interference with family, friends or work, was 39% in Oklahoma City and 40% in Nairobi.

The only difference in rates of pre-existing diagnoses before the bombing was less alcohol misuse and dependence among both men and women in Nairobi.

After the disaster, a third of the men and half of the women in Nairobi had bombing-related post-traumatic stress disorder (PTSD), and these rates were similar to those of men and women in Oklahoma City. In both locations, women's post-bombing PTSD rates were higher than men's.

Major depression also showed similar consistency between the sites in both men and women both before and after the bombings.

However, the responses to the bombings revealed important differences between the two locations. Treatment by a psychiatrist was not obtained by any Nairobi survivors in this study, whereas psychiatric treatment was more easily available in Oklahoma City.

Support and debriefing groups, and religious counselling, were used by the majority of Nairobi survivors, but not by those in Oklahoma City.

Although the majority of people in both sites coped without alcohol and medication, and most turned to family and friends for support in both settings, coping with the help of alcohol and medication was more common in Oklahoma City, and coping through social and religious supports was more often seen in Nairobi.

9/11 Babies Have Markers of Post Traumatic Stress Disorder

Wed, 04 May 2005 18:38:00 PST

( from http://www.rxpgnews.com ) Pregnant women present during the September 11 World Trade Center collapse have passed on markers of Post Traumatic Stress Disorder (PTSD) to their unborn babies through transgenerational transmission. The findings strengthen the evidence for in utero or early life risk factors for the later development of adult mental or physical disorders. The study will be published online today in The Journal of Clinical Endocrinology & Metabolism, one of the four journals produced by The Endocrine Society.

Previous studies led researchers to believe that reduced cortisol levels observed in the adult children of Holocaust survivors could be attributed to mostly environmental factors, such as the stress of living with a parent who is depressed or anxious, or the experience of vicarious traumatization based on hearing stories of how parents suffered, rather than a 'transmitted' biological trait. "In the current study, reduced stress hormone levels were observed in infants, suggesting a larger role for very early environmental, genetic, or genetic-environmental interactions than previously thought," explains Rachel Yehuda, Ph.D., principal investigator of the study.

Scientists at Mount Sinai School of Medicine and the University of Edinburgh studied the relationship between maternal posttraumatic stress syndrome disorder (PTSD) symptoms and salivary cortisol levels in 38 women and their infants. Mothers who experienced symptoms of PTSD in response to 9/11 had lower cortisol levels compared to mothers who did not develop this condition. Moreover, approximately one year after birth, the babies of mothers who had developed PTSD symptoms had significantly lower cortisol levels compared to that in babies of mothers who developed only minimal symptoms. This decrease in cortisol levels among the infants was similar to their mothers' hormonal response to PTSD. Since lower cortisol levels in relation to maternal PTSD were most apparent in babies born to mothers who were in their third trimester on 9/11, the data implicate the possibility of in utero effects as contributors to a putative biological risk factor for PTSD.

"The findings suggest that mechanisms for transgenerational transmission of biologic effects of trauma may have to do with very early parent-child attachments," says Dr. Yehuda, "and possibly even in utero effects related to cortisol programming."

Increased mortality risk in men for anxiety disorders

Tue, 02 Nov 2004 15:26:00 PST

( from http://www.rxpgnews.com ) For men, but not for women, there is an increased mortality risk for anxiety disorders, according to a study from the Netherlands published in the November issue of the British Journal of Psychiatry.

Although the increased mortality risk for depression is well established, there are inconsistent reports as to whether people with anxiety disorders are at higher risk.

This study set out to determine whether anxiety disorders predict mortality in older men and women in the community.

Data were collected from the Longitudinal Ageing Study Amsterdam, which charts changes in well-being and autonomy among older people. This uses a large, community-based random sample of 3107 older men and women aged between 55 and 85, with a follow-up period of 7.5 years.

Anxiety disorders were assessed in a two-stage screening study. Stage one used a scale for measuring anxiety and depression. In stage two a diagnostic interview was held two to eight weeks after the first assessment with everyone who screened positive, and an equally large random sample of participants who screened negative.

659 people were interviewed (average age 70.6 years), of whom 332 were 'screen positives', and 327 'screen negatives'. In the study sample 17% were found to have an anxiety disorder. Older men with diagnosed anxiety disorders had an 87% higher risk of mortality than women over seven years of follow-up.

The associations between anxiety and mortality in men remained after taking into account depression, activity, smoking, drinking, body mass index, age, psychiatric treatment, functional limitations and chronic diseases, including heart disease and stroke. In women with anxiety disorders, no association was found with subsequent mortality.

The authors of the study comment that a possible explanation for the gender difference is that men have more cardiovascular disorders, the course of which could be affected more strongly by anxiety.

A psychological explanation could be that men are less capable of dealing with feelings of anxiety and hopelessness than women. Women are more inclined to discuss such feelings with others, are more open to accepting support, and may therefore be better able to cope with feelings of anxiety.

Further, men are less likely than women to report feelings of anxiety. If they do, their condition may be worse than that of their female counterparts, which can have a greater impact on their physical health and may lead to earlier death. Suicide did not explain the excess mortality among men.

A major implication of these findings is that it is important to treat anxiety in older people. In order to increase the number of treated patients, better recognition of anxiety, and patient empowerment, are key issues.

The next step for research should be to look into the causes of death associated with anxiety, and to explore further sociopsychological and pathophysiological differences between men and women.

Reference: Van Hout H P J, AartjaanT F B, De Beurs E et al (2004) Anxiety and the risk of death in older men and women. British Journal of Psychiatry, 185, 399-404.

More men than women admitted to psychiatric hospitals for depression and anxiety

Tue, 05 Oct 2004 16:12:00 PST

( from http://www.rxpgnews.com ) A study in the October issue of the British Journal of Psychiatry has found that, contrary to belief, and the findings of population morbidity surveys, psychiatric admissions are more common for men than for women, and for depression and anxiety than for psychosis.

This study was carried out by researchers at the University of Bristol and the South West Public Health Authority using the Department of Health's national Hospital Episode Statistics data on admissions to NHS hospitals in England between April 1999 and March 2000. The aim was to investigate admission rates of patients aged 16-64 by region, age, gender and diagnosis.

Although the number of in-patient psychiatric beds in England has fallen dramatically over the past 40 years, hospitalisation still accounts for about 75% of NHS spending on mental health. The assessment and reporting of national patterns of psychiatric hospital admissions is important for strategic service development and planning.

It was found that there were 102,980 admissions to psychiatric hospitals in England during the study period. The mental illness specialty of psychiatry accounted for 97.3% of all admissions. Rates for old age psychiatry were 0.9%, forensic psychiatry 0.8%, mental handicap 0.6%, child and adolescent psychiatry 0.4% and psychotherapy 0.04%.

The overall annual admission rate for England was 3.2 per 1000 population. Rates were highest in the North West region (3.8 per 1000) and lowest in the Eastern region (2.7 per 1000), a difference of about 30%.

Overall, the admission rates were higher for males (3.3 per 1000) than females (3.0 per 1000). The gender ratio was narrowest in the older age groups.

Depression and anxiety together were the most common reason for admission (29.6%). Schizophrenia and related psychoses accounted for 26%, substance misuse 19.1% and others 12.2%.

The proportion of admissions for schizophrenia and related psychoses was higher than for depression and anxiety in London only (34.5% v. 21.7%). The proportion of admissions for substance misuse was highest in the North West region, and for organic disorders in the Northern and Yorkshire region.

Although the London region had the second lowest admission rate, it had the highest proportion of long-stay patients. Length of stay was greatest for schizophrenia, almost twice that for depression and anxiety.

The authors comment that the findings of the study may point to variations in service delivery or availability. The impact on patient outcomes is uncertain.

Reference:
Thompson A, Shaw M, Harrison G, Verne J, Ho D and Gunnell D (2004) Patterns of hospital admission for adult psychiatric illness in England: analysis of Hospital Episode Statistics data, British Journal of Psychiatry, 185, 334-341.

Stress of caring affects immune system

Tue, 13 Jul 2004 23:13:00 PST

( from http://www.rxpgnews.com ) Two new studies have found that chronic stress in elderly caregivers is linked with impaired immunity to disease.
People who are informal caregivers report considerable psychological distress, which may have adverse effects on their immunity to disease. This distress may contribute to the development of new diseases, or hasten the progression of existing conditions.

These two studies examined the effects of chronic caregiver stress on the spouses of dementia patients. They set out to
§ examine the relationship between caregiving and levels of cortisol and immunity to influenza
§ examine the effects of cognitive-behavioural stress management (CBSM) on distress, cortisol and immunity to influenza.

In the first study, 50 caregiving spouses and 67 non-caregiving controls were recruited. Assessments of distress, cortisol and immune responses to influenza vaccination were undertaken.

Significantly raised levels of distress and cortisol were found in caregivers compared with non-caregivers. Immune responses to the vaccine revealed that significantly fewer carers (16%) showed the expected response, which is a four-fold increase in antibodies, compared with non-caregivers (39%).

In the second study, 43 caregiving spouses and 27 non-caregiving controls were recruited. 16 caregivers were allocated to an eight-week CBSM programme, and 27 to a non-intervention group. Assessments of distress and cortisol were undertaken during the intervention period, and immune responses to influenza vaccination were assessed after the intervention.

Raised levels of distress were found in both caregiver groups compared with controls throughout the CBSM period. However, there were no between-group differences in cortisol.

Immune responses to the vaccine revealed that 50% of carers who received CBSM, 7% of non-intervention carers and 29% of controls produced a clinically appropriate response to the vaccination.

The authors of the study conclude that the impaired immunity found among elderly caregivers can be improved through stress management.

Carers have high levels of stress and anxiety themselves

Wed, 14 Jan 2004 15:50:00 PST

( from http://www.rxpgnews.com ) Carers who are caring for people with mental health difficulties and dementia are more likely to say their own health is not very good or not at all good and have higher incidence of health and emotional problems, a survey released today by The Princess Royal Trust for Carers in UK has found.

The results of the survey of more than 1,000 carers, sponsored by GlaxoSmithKline and undertaken by Q2 Research, were released today as part of the launch of Partners in Care, a joint campaign between The Princess Royal Trust for Carers and The Royal College of Psychiatrists.

The results of this survey show that people caring for someone with a mental illness suffer from high levels of anxiety and stress and yet their main concern is would happen if they died or became too ill to look after the person they cared for, Alison Ryan Chief Executive of The Princess Royal Trust for Carers said.

The Partners in Care campaign is important because it aims to raise awareness about the issues carers face and encourage partnerships between carers, patients and professionals so that hopefully it will alleviate some of the burden for carers.

Key findings of the survey are that people who care for someone with a learning disability or a mental health problem, including dementia:
· care for longer (an average of 15.2 for those who care for someone with a learning disability and 10.5 years for those caring for someone with mental illness)
· care for more hours per week (83% of carers looking after someone with a learning disability care for more than 50 hours a week)
· feel they do not know enough about the illness of person they are caring for
· feel they do not know how to react in certain situations or how to deal with a mentally ill person
· worry about the person they care for harming themselves or committing suicide.

Getting up in the night was one of the main tasks that caused ill health for people caring for someone with dementia (40%) or a mental illness (39%). Also affecting carers health was coping with inconsistent or challenging behaviour (47% of those caring for someone with a mental illness; 36% of those caring for someone with dementia; 33% of those caring for someone with a learning disability) and dealing with verbal and mental abuse (41% of people caring for someone with mental illness).