Anxiety Disorders: Duke University

Koenig HG. · Duke University Medical Center, Durham, North Carolina 27710, USA. · Can J Psychiatry. · Pubmed #19497160 No free full text.

Abstract: Religious and spiritual factors are increasingly being examined in psychiatric research. Religious beliefs and practices have long been linked to hysteria, neurosis, and psychotic delusions. However, recent studies have identified another side of religion that may serve as a psychological and social resource for coping with stress. After defining the terms religion and spirituality, this paper reviews research on the relation between religion and (or) spirituality, and mental health, focusing on depression, suicide, anxiety, psychosis, and substance abuse. The results of an earlier systematic review are discussed, and more recent studies in the United States, Canada, Europe, and other countries are described. While religious beliefs and practices can represent powerful sources of comfort, hope, and meaning, they are often intricately entangled with neurotic and psychotic disorders, sometimes making it difficult to determine whether they are a resource or a liability.

Schaefer FC, Blazer DG, Koenig HG. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. · Int J Psychiatry Med. · Pubmed #19480362 No free full text.

Abstract: OBJECTIVE: An increasing body of literature examines the association of religious factors with posttraumatic stress as well as posttraumatic growth. This review of selected empirical studies describes religious and spiritual factors that have been examined in their association with the consequences of trauma. A comprehensive model is proposed to explain the complex interrelationship. METHOD: We performed a qualitative review of empirical research in August 2006, updated in February 2008, using Medline (1950-present), PsychInfo (1806-present), Web of Science (1900-present), and PILOTS (1960-present). We searched the terms posttraumatic, posttraumatic stress, posttraumatic growth, and religion, religious, spirituality, spiritual, meditation, and forgiveness. Based on supporting data from reviewed literature, we then developed a model for key religious factors derived from this review predictive of the response to trauma over time. RESULTS: Twenty-three studies were identified that describe religious pre-trauma characteristics, religious trauma-appraisal and post-trauma adjustment factors. The association of these factors with posttraumatic stress and growth is described. CONCLUSIONS: Intrinsic religious orientation, in particular, appears to be a useful construct in measuring religiosity in the association with the consequences of trauma. There are preliminary indications that the association between intrinsic religiosity and the consequences of trauma may change depending on the time after the event. Future studies should stratify outcome by the time after trauma or use longitudinal designs.

Davidson JR. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. · J Clin Psychiatry. · Pubmed #19371504 No free full text.

Abstract: Many patients with generalized anxiety disorder (GAD) do not receive adequate treatment. Several classes of drugs, including benzodiazepines, azapirones, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, antihistamines, alpha(2)delta Ca++ channel modulators, and atypical antipsychotics are consistently beneficial in patients with GAD. Cognitive therapy is also effective as a first-line treatment. When individualizing treatment, drug dose ranges and side effect profiles need to be considered, as well as the patient's comorbid conditions. Doses may need to be reduced for elderly or medically ill patients or those taking other medications. Doses may need to be increased for refractory cases. Common comorbid conditions with GAD include depression, alcohol or drug abuse, social anxiety disorder, and panic disorder. In patients with significant depression, an antidepressant is more likely to succeed than a benzodiazepine. Generalized anxiety disorder is a chronic illness that requires long-term treatment. Remission is attainable but can take several months, and stopping medication increases the risk of relapse within the first year of initiating treatment.

Marks DM, Park MH, Ham BJ, Han C, Patkar AA, Masand PS, Pae CU. · Duke University Medical Center, Department of Psychiatry and Behavioural Sciences, 2218 Elder Street, Durham 27705, USA. · Expert Opin Drug Saf. · Pubmed #18983224 No free full text.

Abstract: Paroxetine is a selective serotonin re-uptake inhibitor (SSRI) available in immediate release and controlled release (CR) formulations. Paroxetine is the most potent inhibitor of serotonin re-uptake among the now available SSRIs. Paroxetine has been approved for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder (PD), generalised anxiety disorder, post traumatic stress disorder (PTSD), and social anxiety disorder (SAD) in adults, whereas paroxetine CR is approved for the treatment of MDD, SAD, PD and premenstrual dysphoric disorder in adults. The overall efficacy of paroxetine seems to be comparable to other SSRIs in the treatment of approved indications, although paroxetine treatment induces more sedation, constipation, sexual dysfunction, discontinuation syndrome and weight gain than other SSRIs. Recent data suggest that paroxetine treatment leads to increased rates of congenital malformations, although this evidence is not conclusive. Paroxetine and paroxetine CR are not indicated for use in the paediatric population and are categorised as Pregnancy Class D. In conclusion, whether the tolerability profile of paroxetine differs substantially from other new antidepressants (including other SSRIs) needs to be determined in adequately powered well-designed randomised controlled comparative clinical trials.

Rubin DC, Berntsen D, Bohni MK. · Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA. · Psychol Rev. · Pubmed #18954211 No free full text.

Abstract: In the mnemonic model of posttraumatic stress disorder (PTSD), the current memory of a negative event, not the event itself, determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-important-aspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD.

Whetten K, Reif S, Whetten R, Murphy-McMillan LK. · Center for Health Policy, Law, and Management, Department of Public Policy, Duke University, Durham NC 27708, USA. · Psychosom Med. · Pubmed #18541904 No free full text.

Abstract: Individuals living with HIV often have complicated histories, including negative experiences such as traumatic events, mental illness, and stigma. As the medical community in the United States adapts to managing HIV as a chronic disease, understanding factors such as these negative experiences that may be associated with poorer adherence to treatment regimens, greater HIV risk behavior, and lower patient quality of life becomes critical to HIV care and prevention. In less wealthy nations, these issues are also critical for addressing quality of life as well as medication adherence in the areas where antiretroviral therapies are being made available. This article presents a review of the literature regarding the following psychosocial factors as they relate to HIV/AIDS in the US and globally: traumatic events; mental illness, including depression, anxiety, and posttraumatic stress disorder; lack of trust in the healthcare system and government; and experiences of stigma among individuals with HIV disease. These factors have been found to be prevalent among individuals with HIV/AIDS, regardless of gender or race/ethnicity. Traumatic events, mental illness, distrust, and stigma have also been linked with poorer adherence to medication regimens and HIV risk behavior.

Beyer JL. · Duke Mood and Anxiety Disorder Clinic, Duke University Medical Center, Durham, NC 27710, USA. · J Clin Psychiatry. · Pubmed #18533760 No free full text.

Abstract: Controlled trials have demonstrated the efficacy of several classes of drugs for achieving acute response in bipolar mania and depression. For many years, clinical response has been the primary outcome in the majority of short-term efficacy studies. However, there is a growing consensus that the optimal goal in the long-term management of bipolar disorder is remission. The purpose of this article is to briefly summarize the clinical importance of remission in bipolar disorder and to review data on the effectiveness of available treatments for achieving and sustaining remission.

Jackson GL, Hamilton NS, Tupler LA. · Center for Health Services Research in Primary Care, Durham Veteran Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA. · N C Med J. · Pubmed #18429566 No free full text.

This publication has no abstract.

Dew RE, Daniel SS, Armstrong TD, Goldston DB, Triplett MF, Koenig HG. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. · Child Psychiatry Hum Dev. · Pubmed #18219572 No free full text.

Abstract: The aim of the current article is to review the literature on religion and spirituality as it pertains to adolescent psychiatric symptoms. One hundred and fifteen articles were reviewed that examined relationships between religion/spirituality and adolescent substance use, delinquency, depression, suicidality, and anxiety. Ninety-two percent of articles reviewed found at least one significant (p < .05) relationship between religiousness and better mental health. Evidence for relationships between greater religiousness and less psychopathology was strongest in the area of teenage substance use. Methods of measuring religion/spirituality were highly heterogeneous. Further research on the relationship of religion/spirituality to delinquency, depression, suicidality, and anxiety is warranted. Measurement recommendations, research priorities, and clinical implications are discussed.

Cassidy F, Yatham LN, Berk M, Grof P. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. · Bipolar Disord. · Pubmed #18199232 No free full text.

Abstract: OBJECTIVE: To review issues surrounding the diagnosis and validity of bipolar manic states. METHODS: Studies of the manic syndrome and its diagnostic subtypes were reviewed emphasizing historical development, conceptualizations, formal diagnostic proposals, and validation. RESULTS: Definitions delineating mixed and pure manic states derive some validity from external measures. DSM-IV and ICD-10 diagnosis of bipolar mixed states are too rigid and less restrictive definitions can be validated. Anxiety is a symptom often overlooked in diagnosis of manic subtypes and may be relevant to the mixed manic state. The boundary for separation of mixed mania and depression remains unclear. A 'pure' non-psychotic manic state similar to Kraepelin's 'hypomania' has been observed in several independent studies. CONCLUSIONS: Issues surrounding diagnostic subtyping of manic states remain complex and the debates surrounding categorical versus dimensional approaches continue. To the extent that categorical approaches for mixed mania diagnosis are adopted, both DSM-IV and ICD-10 are too rigid. Inclusion of non-specific symptoms in definitions of mixed mania, such as psychomotor agitation, does not facilitate and may hinder the diagnostic separation of pure and mixed mania. The inclusion of a diagnostic seasonal specifier for DSM-IV, which is currently based on seasonal patterns for depression might be expanded to include seasonal patterns for mania. Boundaries between subtypes may be 'fuzzy' rather than crisp, and graded approaches could be considered. With the continued development of new tools, such as imaging and genetics, alternative approaches to diagnosis other than the purely symptom-centric paradigms might be considered.

Barbour KA, Edenfield TM, Blumenthal JA. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. · J Cardiopulm Rehabil Prev. · Pubmed #18197069 No free full text.

Abstract: This article reviews evidence supporting exercise as a treatment for psychiatric disorders. Although data from randomized trials are limited, results of studies included in this review generally support use of exercise as an alternative or adjunctive treatment. Discussion of practical issues regarding exercise, potential mechanisms for the beneficial effects of exercise, and recommendations for future research are provided.

Compton SN, Kratochvil CJ, March JS. · Pediatric Psychiatry, Duke University Medical Center, DUMC Box 3527, Durham, NC 27710, USA. · Pediatr Ann. · Pubmed #17910206 No free full text.

This publication has no abstract.

Amaya-Jackson L, Derosa RR. · National Center for Child Traumatic Stress & Center for Child and Family Health, Durham, NC 27710, USA. · J Trauma Stress. · Pubmed #17823959 No free full text.

Abstract: Professionals in the child trauma field, eager to bring best practices to children and their families who have suffered from traumatic life events, have developed a number of evidence-based treatments (EBTs) and promising practices available for adoption and implementation into community practice. Clinicians and researchers alike have raised questions about "if, when, and how" these EBTs can be applied to some of the more complex trauma presentations seen in real world practice. The authors take an evidence-based practice approach, including critical appraisal of clients' unique needs and preferences, utilizing applicable trauma treatment core components and current EBTs, and emphasizing monitoring strategies of client progress, particularly when needing to adapt EBTs for select clients.

Zhang W, Davidson JR. · Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, USA. · Expert Opin Pharmacother. · Pubmed #17696789 No free full text.

Abstract: Post-traumatic stress disorder (PTSD) is often a chronic and disabling anxiety disorder that develops after exposure to a traumatic event. Researchers have demonstrated efficacy for both pharmacologic and psychosocial interventions in the treatment of PTSD. First-line pharmacotherapeutic options are the selective serotonin re-uptake inhibitors and serotonin noradrenaline re-uptake inhibitors. Older antidepressant agents, such as the tricyclic antidepressants and the monoamine oxidase inhibitor, phenelzine, have also proven efficacy in PTSD among more established agents. However, concerns for side effects have limited frequent use of these. Existing pharmacologic agents produce meaningful results and bear the advantage of treating depression and other co-morbid disorders, yet still fall short of being ideal due to limited response and remission rates and tolerability issues. The need for improving pharmacotherapy of PTSD remains compelling and directions for further research are discussed.

Krystal AD. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. · J Clin Sleep Med. · Pubmed #17557457 No free full text.

Abstract: STUDY OBJECTIVES: Impairments in health, function, and quality of life (QOL) are a central feature of insomnia, yet insomnia treatment is targeted solely to improving problems falling and staying asleep. It is not even known if the nonsleep deficits improve with current treatment. We hypothesized that therapy that improves sleep also improves these nonsleep difficulties and carried out this review to test that hypothesis. METHODS: A literature search identified the health, function, and QOL deficits of insomnia patients. A second search determined the effect of insomnia treatments on those problems, capturing randomized controlled treatment trials in insomnia patients that included relevant measures. RESULTS: Insomnia patients report a variety of symptoms, including daytime sleepiness, fatigue, cognitive impairment, symptoms of depression, anxiety, health decrements, and impairment in social and occupational function. However, the reported deficits are generally not paralleled by objective evidence of impairment. Nineteen treatment studies reported measures related to these deficits. At least one treatment (eszopiclone [5 studies], zopiclone [2 studies], progressive muscle relaxation [2], zolpidem [2], multi-component cognitive-behavioral therapy [1], doxepin [1], valerian/hops [1], and stimulus control [1]) led to a significant improvement compared with placebo in at least one of these measures in 14/20 studies. CONCLUSIONS: Treatment can improve the perceived health, function, and QOL of insomnia patients. This potential improvement signals the need to shift the attention of research and clinical practice to include aspects other than sleep difficulties and move towards defining successful therapy as not only improving sleep but also eliminating deficits in health, function, and QOL.

Pae CU, Patkar AA. · Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA. · Expert Rev Neurother. · Pubmed #17286545 No free full text.

Abstract: Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with antidepressant and anxiolytic properties. It is commercially available in both an immediate-release (paroxetine) and a controlled-release formulation (paroxetine CR). The latter product was developed to improve gastrointestinal tolerability. Paroxetine is the most potent inhibitor of the reuptake of serotonin among the available SSRIs. It has approved indications for the treatment of major depression, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic stress disorder and social phobia in adults. Paroxetine CR is approved for the treatment of major depression, social anxiety disorder, panic disorder and premenstrual dysphoric disorder in adults. While the overall efficacy of paroxetine appears to be comparable with other SSRIs in the treatment of major depression, it is approved for use in a wider variety of anxiety disorders than any other antidepressant. Long-term data suggest that paroxetine is effective in preventing relapse or recurrence of depression for up to 1 year. Limited data show that paroxetine maintains a therapeutic response over 1 year in obsessive-compulsive disorder and up to 6 months in panic disorder. The side-effect profile of paroxetine is largely similar to that of the other SSRIs, although paroxetine tends to be more sedating and constipating in some patients, perhaps due to its anticholinergic activity. The potential for discontinuation syndrome and weight gain appears to be slightly higher with paroxetine than with other SSRIs. This review focuses on the immediate release and controlled-release formulations of paroxetine. It summarizes the efficacy and tolerability data for both formulations, with a particular emphasis on paroxetine CR which was introduced in 2002. It also discusses emerging evidence in other clinical areas and recent data that have led to modifications in the safety profile of paroxetine.

Davidson JR. · Department of Psychiatry and Behavioral Science and the Anxiety and Traumatic Stress Program, Duke University Medical Center, Durham, NC 27710, USA. · J Clin Psychiatry. · Pubmed #17092192 No free full text.

Abstract: The treatment goals for social anxiety disorder (SAD) are to reduce fear, avoidance, physical distress, disability, and comorbidity. This review illustrates some of the primary studies used to evaluate efficacy of treatments for SAD. The selective serotonin reuptake inhibitors (SSRIs) paroxetine, sertraline, fluoxetine, fluvoxamine, and escitalopram and the serotonin-norepinephrine reuptake inhibitor venlafaxine are effective treatments. They have the additional benefit of being able to treat comorbid conditions. For people who do not respond to serotonin reuptake inhibitors, treatment options include benzodiazepines (clonazepam, alprazolam, and bromazepam), alpha2delta calcium-channel blockers (gabapentin and pregabalin), reversible inhibitors of monoamine oxidase A (moclobemide, although agents in this class are not available in the United States), antiepileptics (levetiracetam), and atypical antipsychotics (olanzapine). The irreversible monoamine oxidase inhibitor phenelzine can be considered an effective third-line therapy. Combination treatments may be beneficial, but more research is needed. Benefits of beta-blockers (propranolol and atenolol) are limited to performance anxiety. Botulinum toxin A may be an effective augmentation treatment option for severe axillary hyperhidrosis in patients with SAD. Studies show that patients with SAD who are maintained on paroxetine, sertraline, or clonazepam have a low relapse rate.

Connor KM, Zhang W. · Anxiety and Traumatic Stress Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. · CNS Spectr. · Pubmed #17008825 links to  free full text

Abstract: In human terms, resilience is an ability to cope with stress and varies with context, time, age, gender, and cultural origin. Resilience shifts the focus of psychological investigation onto increasing the positive rather than reducing the negative. Inquiry into resilience has evolved from descriptions of resilient qualities, to discovery of the process to attain resilience, to uncovering the motivation to reintegrate in a resilient manner. Much of the research on resilience has focused on children in settings such as family violence, extreme poverty, war, and natural disasters. A coherent pattern of characteristics associated with successful adaptation has emerged. Salient characteristics include commitment, dynamism, humor in the face of adversity, patience, optimism, faith, and altruism. As such, resilience may represent an important target of treatment in anxiety, depression, and stress reactions. Resilience can be quantified, but available measures need to be validated transculturally. There exist many possible determinants of resilience, including neurobiologic, genetic, temperament, and environmental influences. Resilience is modifiable on individual and cultural levels. Posttraumatic stress disorder is an example of a serious disorder associated with impaired stress coping that can improve with treatment.

Connor KM. · Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC 27710, · J Clin Psychiatry. · Pubmed #16602815 No free full text.

Abstract: Resilience is a crucial component in determining the way in which individuals react to and deal with stress. A broad range of features is associated with resilience; these features relate to the strengths and positive aspects of an individual's mental state. In patients with posttraumatic stress disorder, resilience can be used as a measure of treatment outcome, with improved resilience increasing the likelihood of a favorable outcome. Resilience can be monitored using the Connor-Davidson Resilience Scale, and perceived vulnerability to the effects of stress can be monitored with the Sheehan Stress Vulnerability Scale. Both scales are well validated, self-rated, easy to use, and easily translatable. Within a short period of time, nonspecialists can be taught to use these in the field.

Davidson JR. · Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC 27710, USA. · J Clin Psychiatry. · Pubmed #16602813 No free full text.

Abstract: This article reviews pharmacologic treatment options for posttraumatic stress disorder (PTSD), focusing on goals of pharmacotherapy and the clinical trial evidence for drug treatments available for PTSD. The selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line therapy for PTSD; the roles of these and other drug classes including anticonvulsants, mood enhancers, atypical antipsychotic agents, benzodiazepines, alpha1-adrenergic antagonists, and beta-blockers in achieving improvement in PTSD symptom and outcome scores, achieving remission, and avoiding relapse are discussed. Treatment of PTSD in association with other comorbid conditions is addressed, and the role of pharmacotherapy in treating early PTSD and acute stress disorder is examined. Dosing strategies for the SSRIs sertraline and paroxetine are provided, and an algorithm for PTSD pharmacotherapy is discussed.

Connor KM, Foa EB, Davidson JR. · Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC 27710, USA. · J Clin Psychiatry. · Pubmed #16602812 No free full text.

Abstract: Almost all individuals who experience a severe trauma will develop symptoms of posttraumatic stress disorder (PTSD) shortly after the traumatic event. Although the natural history of PTSD varies according to the type of trauma, most people do not develop enduring PTSD, and, in many of those who do, it resolves within 1 year without treatment. To the extent that is possible, maintenance of normal daily activities is believed to help patients cope more successfully in the aftermath of major trauma. In the case of a disaster such as the Asian tsunami, the whole community is involved, and it is impossible to continue with normal daily activities. To improve overall outcome after trauma, it would be optimal to identify individuals at increased risk for developing PTSD. This article describes screening and assessment tools for posttrauma mental health problems, particularly PTSD, and examines in more detail instruments that can be used in rapid field assessment of individuals who may be affected or who have already been identified and require monitoring. Self-rated instruments are most appropriate, but the choice of instrument will depend on the local situation and availability of appropriately validated questionnaires. The article also addresses important aspects of training nonmedical personnel in screening and assessment.

Davidson JR, McFarlane AC. · Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC 27710, USA, and the University of Adelaide, Department of Psychiatry, Queen Elizabeth Hospital, Woodville, Australia. · J Clin Psychiatry. · Pubmed #16602810 No free full text.

Abstract: Disasters are events that challenge the individual's ability to adapt, which carries the risk of adverse mental health outcomes including serious posttraumatic psychopathologies. While risk is related to degree of exposure to psychological toxins, the unique vulnerabilities of special populations within the affected community as well as secondary stressors play an important role in determining the nature and amount of morbidity. Disasters in developing countries and those associated with substantial community destruction are associated with worse outcome. Although acute responses are ubiquitous, few disasters lead to posttraumatic psychopathology in the majority of people exposed. However, the shortage of human resources in psychiatry, particularly in developing countries, places a considerable burden on psychiatric services even without the additional constraints imposed by disaster. Hence, disasters are events that invite a public health approach to mental health that better serves the needs of the individual and the affected community. Such an approach considers all available human resources and is intended to mitigate the effects of disaster before serious psychopathologic sequelae arise. This community mental health strategy allows peripheral mental health workers to mediate between survivors and specialized mental health professionals while assisting in removing barriers to treatment. To be effective when disaster occurs, this approach requires careful planning in conjunction with community consultation before implementation of formal disaster mitigation policies.

Cotter G, Milo-Cotter O, Rubinstein D, Shemesh E. · Department of Medicine, Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina 27715, USA. · CNS Spectr. · Pubmed #16520690 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) symptoms may develop as a result of an acute, life-threatening traumatic event. Such acute events are quite common in patients with cardiovascular illnesses (ie, a myocardial infarction, acute exacerbations of heart failure or edema). Indeed, PTSD symptoms have been described in a substantial minority of patients who had such events (10% to 25%), and have been shown to be associated with medical morbidity and with non-adherence to medications. This review summarizes available information about these symptoms in patients with cardiovascular illnesses. It also describes the importance of recognizing PTSD as a distinct psychiatric disorder (that can be addressed by specific treatments) and as an important compounding factor in studies of psychopathology in cardiovascular patients. In particular, an argument is made that the understanding of depressive disorders in patients with cardiovascular illnesses should incorporate conceptual and treatment information from the emotional trauma literature if indeed depressive and anxiety disorders are to be successfully treated in these patients. The authors conclude with a description of the challenges and promise of an effort to implement a clinical program to screen for PTSD symptoms in patients with cardiovascular illnesses, and with recommendations for future efforts.

Egger HL, Angold A. · Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, USA. · J Child Psychol Psychiatry. · Pubmed #16492262 No free full text.

Abstract: We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.

Payne JK. · Duke University School of Nursing, DUMC, Durham, NC 27710, USA. · Semin Oncol Nurs. · Pubmed #16458180 No free full text.

Abstract: OBJECTIVES: To provide an overview of the trajectory of select biomarkers and their potential usefulness in symptom management in the older individual with cancer. DATA SOURCES: Empirical data and literature review. CONCLUSION: Biomarkers offer significant opportunities to understand the biological impact of cancer and its treatment on older adults whose response is likely different from their younger counterparts. Large well-designed multi-site clinical trials with adequate numbers and power are necessary to create evidenced-based practice changes. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to understand the science and implications of biomarkers to develop interventions in response to the mechanisms of symptoms experienced by older adults with cancer.