Anxiety Disorders: Dennerstein L

Alexander JL, Dennerstein L, Woods NF, McEwen BS, Halbreich U, Kotz K, Richardson G. · Psychiatry Women's Health Program, Kaiser Permanente Northern California, Oakland, CA, USA. · Expert Rev Neurother. · Pubmed #18039072 No free full text.

Abstract: Stress plays an essential role in the development, continuation and exacerbation of mood problems throughout a woman's life. It exacerbates somatic symptoms of menopause, increasing the risk of recurrence of mood disorders, as well as of a mood disorder de novo throughout the lifespan and specifically in the menopausal transition. Chronic stress affects the hypothalamic-pituitary axis, hypothalamic-pituitary-ovarian axis, the proinflammatory cytokines and cardiovascular risk. The current evidence for the potential interactions between acute stress, chronic stress, childhood stress and victimization, and individual susceptibility to the development of depression and/or anxiety in response to stressful life events, are reviewed in the context of the increasing data on the association of these and a symptomatic menopausal transition. Strategies for the optimal approach for clinicians to evaluate and treat the symptomatic perimenopausal patient with stressful life events and comorbid mood disorders are presented.

Alexander JL, Dennerstein L, Kotz K, Richardson G. · Kaiser Permanente Northern California, Psychiatry Women's Health Program, Oakland, CA, USA. · Expert Rev Neurother. · Pubmed #18039068 No free full text.

Abstract: Women experience a high prevalence of mood and anxiety disorders, and comorbidity of mood and anxiety disorders is highly prevalent. Both mood and anxiety disorders disturb sleep, attention and, thereby, cognitive function. They result in a variety of somatic complaints. The mood disorder continuum includes minor depression, dysthymia, major depression and bipolar disorder. Chronobiological disorders, such as seasonal affective disorder as well as premenstrual dysphoric disorder, occur in some women, with comorbid seasonal affective disorder and premenstrual dysphoric disorder in just under half of these individuals [1] . Early life experience, heritability, gender, other psychiatric illness, stress and trauma all interact dynamically in the development of mood and anxiety disorders. The epidemiology, nomenclature and clinical diagnostic issues of these illnesses in midlife woman are reviewed.

Woods NF, Alexander JL, Dennerstein L, Richardson G. · University of Washington, School of Nursing, Seattle, WA, USA. · Expert Rev Neurother. · Pubmed #18039065 No free full text.

Abstract: Culture, individual health beliefs and distressing symptoms frequently determine women's perceptions of their menopausal transitions. Women's perceptions of mental health problems and the acceptability of different interventions greatly affect if and what a woman is willing to try as a treatment option and whether or not she will accept the possibility that her menopausal symptoms represent a comorbidity with a diagnosis, such as depression or anxiety. These perceptions have a significant impact on women's choices with regard to health practices, as well as on whether or not they will seek out medical care for their distressing symptom(s). Working with a woman's beliefs, sharing decision making, and empowering her through health education are all critical aspects of the treatment of the patient with comorbid perimenopausal symptoms, regardless of their etiology.

Alexander JL, Sommer BR, Dennerstein L, Grigorova M, Neylan T, Kotz K, Richardson G, Rosenbaum R. · Kaiser Permanente Northern California, Psychiatry Women's Health Program, Oakland, CA, USA. · Expert Rev Neurother. · Pubmed #18039064 No free full text.

Abstract: While cognitive complaints are common during the menopausal transition, measurable cognitive decline occurs infrequently, often due to underlying psychiatric or neurological disease. To clarify the nature, etiology and evidence for cognitive and memory complaints during midlife, at the time of the menopausal transition, we have critically reviewed the evidence for impairments in memory and cognition associated with common comorbid psychiatric conditions, focusing on mood and anxiety disorders, attention-deficit disorder, prolonged stress and decreased quantity or quality of sleep. Both the evidence for a primary effect of menopause on cognitive function and contrarily the effect of cognition on the menopausal transition are examined. Impairment in specific aspects of executive function is explored. Evaluation and treatment strategies for the symptomatic menopausal woman distressed by changes in her day-to-day cognitive function with or without psychiatric comorbidity are presented.