Anxiety Disorders: UCLA

Eisenman D, Weine S, Green B, de Jong J, Rayburn N, Ventevogel P, Keller A, Agani F. · RAND, Santa Monica, California and David Geffen School of Medicine, UCLA, USA. · J Trauma Stress. · Pubmed #16568460 No free full text.

Abstract: Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations.

Rapkin AJ, Mikacich JA. · Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1740, USA. · Curr Opin Obstet Gynecol. · Pubmed #18797268 No free full text.

Abstract: PURPOSE OF REVIEW: To review the current knowledge about the prevalence, diagnosis, and management of premenstrual syndromes in adolescents. RECENT FINDINGS: Large epidemiologic studies addressing adolescent premenstrual disorders, clinical presentation, and comorbidity with other disorders have yet to be performed. Randomized controlled treatment trials for teens with moderate-to-severe premenstrual syndrome or the more severe affective predominant, premenstrual dysphoric disorder still are sorely lacking. This review will present an updated review of the published studies with respect to premenstrual syndrome and premenstrual dysphoric disorder in adolescents in the context of the large body of literature regarding presentation, diagnosis, and treatment in adult women. SUMMARY: Premenstrual disorders likely start in the teen years. At least 20% of adolescents may experience moderate-to-severe premenstrual symptoms associated with functional impairment. Current treatment includes lifestyle recommendations and pharmacologic agents that suppress the rise and fall of ovarian steroids or augment serotonin.

Mendez MF, Lauterbach EC, Sampson SM, Anonymous00067. · Department of Neurology and Psychiatry, UCLA, USA. · J Neuropsychiatry Clin Neurosci. · Pubmed #18451185 links to  free full text

Abstract: The Committee on Research of the American Neuropsychiatric Association conducted a review of the noncognitive neuropsychiatric manifestations of frontotemporal dementia. The Committee on Research searched reviews and several online databases for all pertinent publications. Single case reports without pathology were excluded, except for psychosis, where single cases made up much of the literature. The strongest evidence supports an association of frontotemporal dementia with the following behaviors: apathy-abulia; disinhibition-impulsivity; loss of insight and self-referential behavior; decreased emotion and empathy; violation of social and moral norms; changes in dietary or eating behavior; and repetitive behaviors. Frontotemporal dementia is less frequently associated with anxiety and mood disorders, which may be a prodrome or risk factor, and rarely presents with delusions or hallucinations. The results of this review highlight the distinct neuropsychiatric manifestations of frontotemporal dementia and the need to reconsider the current diagnostic criteria for this disorder.

Rapkin AJ, Winer SA. · Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California 90095-1740, USA. · Expert Opin Pharmacother. · Pubmed #18220493 No free full text.

Abstract: Premenstrual dysphoric disorder (PMDD) is characterized by physical, affective and behavioral symptoms that are linked to the luteal phase of the menstrual cycle and relieved soon after the onset of menses. The disorder is chronic and exerts a major impact on personal relationships and occupational productivity for the estimated 6% of reproductive-aged women who fulfill strict PMDD criteria and the almost 20% of women who nearly meet these criteria. There are now various pharmacologic options that have demonstrated efficacy for PMDD and two of these approaches have an approved indication for treatment from the US FDA: three selective serotonin re-uptake inhibitors; and for women who also desire hormonal contraception, a low dose oral contraceptive pill containing the progestin drospirenone, in a new dosing regimen. Due to the unique pathophysiology of the disorder, the selective serotonin re-uptake inhibitors can be effectively administered intermittently, with dosing limited to the luteal phase of the cycle (2 weeks prior to menses). In the future, new pharmacotherapy will likely evolve from research evaluating other hormonal formulations that inhibit ovulation, without simulating PMDD-like symptoms, or novel pharmacologic agents that modulate the central neurotransmission.

Apostolova LG, Cummings JL. · Department of Neurology, David Geffen School of Medicine, UCLA, USA. · Dement Geriatr Cogn Disord. · Pubmed #18087152 No free full text.

Abstract: BACKGROUND: Mild cognitive impairment (MCI) is an etiologically heterogeneous condition that is characterized by cognitive changes without impairment of activities of daily living and insufficient to represent dementia. MCI is an important risk state for dementia. Neuropsychiatric symptoms may be present in MCI. METHODS: We executed a PubMed search for articles on the neuropsychiatric manifestations in MCI and reviewed their findings. RESULTS: Behavioral abnormalities are reported in 35-75% of MCI patients with the most common being depression, apathy, anxiety and irritability. The observed variability in symptom prevalence can be explained by the different sampling methods, MCI diagnostic criteria and behavioral instruments used. There is a compelling body of evidence that MCI patients with behavioral features are more prone to develop Alzheimer's disease (AD) than patients without these features. CONCLUSIONS: Neuropsychiatric symptoms are common features of MCI. The behavioral changes observed in MCI are similar to those of AD and may help identify the subgroup of MCI patients with prodromal AD. Large prospective longitudinal studies would greatly contribute to our understanding of the epidemiology, diagnostic and prognostic value of the neuropsychiatric features in MCI.

Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A. · Department of Psychology, Los Angeles, CA 90095-1563, USA. · Behav Res Ther. · Pubmed #18005936 No free full text.

Abstract: Prevailing models of exposure therapy for phobias and anxiety disorders construe level of fear throughout exposure trials as an index of corrective learning. However, the evidence, reviewed herein, indicates that neither the degree by which fear reduces nor the ending fear level predict therapeutic outcome. Developments in the theory and science of fear extinction, and learning and memory, indicate that 'performance during training' is not commensurate with learning at the process level. Inhibitory learning is recognized as being central to extinction and access to secondary inhibitory associations is subject to influences such as context and time, rather than fear during extinction training. Strategies for enhancing inhibitory learning, and its retrieval over time and context, are reviewed along with their clinical implications for exposure therapy and directions for future research.

Craske MG, Waters AM. · Department of Psychology, University of California, Los Angeles, California 90095, USA. · Annu Rev Clin Psychol. · Pubmed #17716087 No free full text.

Abstract: This chapter provides a review of recent empirical developments, current controversies, and areas in need of further research in relation to factors that are common as well as specific to the etiology and maintenance of panic disorder, phobias, and generalized anxiety disorder. The relative contribution of broad risk factors to these disorders is discussed, including temperament, genetics, biological influences, cognition, and familial variables. In addition, the role that specific learning experiences play in relation to each disorder is reviewed. In an overarching hierarchical model, it is proposed that generalized anxiety disorder, and to some extent panic disorder, loads most heavily on broad underlying factors, whereas specific life history contributes most strongly to circumscribed phobias.

Mayer EA, Tillisch K, Bradesi S. · Department of Medicine, Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA. · Aliment Pharmacol Ther. · Pubmed #16948804 No free full text.

Abstract: BACKGROUND: The importance of bi-directional brain-gut interactions in gastrointestinal illness is increasingly being recognized, most prominently in the area of functional gastrointestinal disorders. Numerous current and emerging therapies aimed at normalizing brain-gut interactions are a focus of interest, particularly for irritable bowel syndrome and functional dyspepsia. METHODS: A literature search was completed for preclinical and clinical studies related to central modulation of gastrointestinal functions and published in English between 1980 and 2006. RESULTS: Existing data, while sparse, support the use of different classes of antidepressant drugs, including tricyclics, and selective and non-selective serotonin reuptake inhibitors in irritable bowel syndrome. Serotonin receptor agonists and antagonists with peripheral and possibly central effects are effective in treating specific subtypes of irritable bowel syndrome. Based largely on theoretical and preclinical evidence, several novel compounds that selectively target receptors at multiple levels within the brain-gut axis such as neurokinin, somatostatin and corticotropin-releasing factor receptor antagonists are promising. CONCLUSIONS: This review discusses the rationale for modulation of the brain-gut axis in the treatment of functional gastrointestinal disorders and highlights the most promising current and future therapeutic strategies.

Evan EE, Zeltzer LK. · Department of Pediatrics, David Geffen School of Medicine at the University of California, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California, USA. · Cancer. · Pubmed #16921479 links to  free full text

Abstract: Psychosocial research examining the impact of cancer on adolescents and young adults has focused mostly on domains relating to family, psychological/emotional impact and social effects. An overview of the evidence-based literature available in each of these domains is presented to highlight the trends and provide a basis for clinical application. A review of the research literature was conducted to summarize what is known regarding the psychosocial dimensions of cancer in adolescents and young adults. Key elements critical to the psychosocial adaptation of the adolescents and young adults with cancer, as well as later effects of the cancer experience, are discussed in terms of clinical implications. A case example is utilized to demonstrate the application of what has been investigated empirically in regard to psychosocial dimensions of cancer in young adults and adolescents. Studies have identified various psychosocial challenges that adolescents and young adults experience when faced with cancer. Further research, incorporating the effects of treatment stage and developmental level of the patient on specific psychosocial dimensions of the cancer experience, is needed. Evidence-based information regarding the influence and interaction of family, psychological and emotional state, and social status of adolescents and young adults with cancer can aid clinicians when developing psychosocial assessment and treatment approaches for these patients.

Demertzis KH, Craske MG. · UCLA Department of Psychology, 405 Hilgard Avenue, Box 951563, Los Angeles, CA 90095-1563, USA. · Curr Psychiatry Rep. · Pubmed #16879793 No free full text.

Abstract: Anxiety disorders are common within primary care (PC) settings and are associated with patient functional impairment, distress, and high utilization of medical care services. Data from PC settings indicate that detection of anxiety disorders is low. Furthermore, adequate psychosocial and pharmacologic treatment of anxiety disorders in accordance with empirically validated guidelines remains low in PC. When patients do receive treatment or referrals from their PC providers, a bias exists for pharmacologic over psychological interventions despite theoretical strengths, empirical evidence, and long-term cost efficiency supporting the use of psychotherapeutic interventions such as cognitive-behavioral therapy (CBT). Objectives of this article include increasing awareness of the prevalence of anxiety disorders in PC, impairment associated with anxiety disorders, issues of detection of anxiety in PC, treatment model and components of CBT, and data supporting the application of CBT to PC to improve patient functioning.

Rapkin AJ, Biggio G, Concas A. · Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States. · Pharmacol Biochem Behav. · Pubmed #16854457 No free full text.

Abstract: A deregulation in the peripheral and brain concentrations of neuroactive steroids has been found in certain pathological conditions characterized by emotional or affective disturbances, including major depression and anxiety disorders. In this article we summarize data pertaining to the modulatory effects of oral contraceptive treatment on neuroactive steroids in women and rats. Given that the neuroactive steroids concentrations are reduced by oral contraceptives, together with the evidence that a subset of women taking oral contraceptives experience negative mood symptoms, we propose the use of this pharmacological treatment as a putative model to study the role of neuroactive steroids in the etiopathology of mood disorders. Moreover, since neuroactive steroids are potent modulators of GABA(A) receptor function and plasticity, the treatment with oral contraceptives might also represent a useful experimental model to further investigate the physiological role of these steroids in the modulation of GABAergic transmission.

Bystritsky A. · UCLA, Department of Psychiatry, Los Angeles, CA 90095-6968, USA. · Mol Psychiatry. · Pubmed #16847460 No free full text.

Abstract: Several epidemiological studies confirmed that Anxiety Disorders as a group are the most prevalent psychiatric conditions in the United States. The importance of these conditions is underlined by the fact that they cause significant disability, poor quality of life, alcohol and drug abuse. Anxiety disorders are treatable conditions and respond to the front-line interventions such as serotonin reuptake inhibitors and cognitive behavioral therapy. However, only about 60% of patients respond to those treatments to any significant degree. Many still have residual symptoms or stay treatment refractory. The group of anxiety patients that is resistant to the treatment has been shown to have very poor quality of life and have highest rate of suicidal attempts than any other disorders. Many biological, treatment specific and social factors are affecting treatment resistance. In this paper, we are attempting to review reasons for the treatment resistance. In addition, we would like to review current strategies that could be helpful in reducing treatment resistance and aiding people chronically suffering from these severe and disabling conditions.

Tsao JC, Dobalian A, Wiens BA, Gylys JA, Evans GD. · Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. · J Rural Health. · Pubmed #16441340 No free full text.

Abstract: CONTEXT: Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE: Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS: We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS: Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.

Barad M. · Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, 635 Charles Young Drive South, Los Angeles, CA 90095, USA. · Curr Opin Neurobiol. · Pubmed #16260129 No free full text.

Abstract: Fear extinction, the reduction of fear by repeated exposure to the object of fear, is a crucial paradigm of inhibitory learning and the acknowledged preclinical model for behavior therapy of human anxiety. Recent insights have clarified roles for infralimbic prefrontal cortex, hippocampus and periaqueductal gray in extinction learning, while maintaining a central role for the basolateral amygdaloid nucleus in the acquisition and storage of this learning. Simultaneously, molecular insights have implicated several neurotransmitter and second messenger systems in extinction learning, and revealed that extinction is surprisingly easy to improve, yielding the promise of a novel approach to improved psychiatric treatments for a variety of human anxiety disorders.

Roblek T, Piacentini J. · School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16171706 No free full text.

Abstract: Over the past decade, multiple controlled trials have demonstrated the efficacy of cognitive-behavior therapy (CBT) for the treatment of anxiety disorders in children and adolescents. Relying heavily on behavioral exposure, cognitive restructuring, and psychoeducation, CBT for child anxiety has been shown to be adaptable to a variety of implementation formats, including individual, family, and group treatment. This article describes the conceptual framework underlying CBT and the key elements of this treatment approach. Important developmental and family considerations in treatment are discussed, and the empirical literature is reviewed.

Craske MG, Tsao JC. · Department of Psychology, University of California, 405 Hilgard Ave., Los Angeles, CA 90095-1563, USA. · Sleep Med Rev. · Pubmed #15893248 No free full text.

Abstract: Nocturnal panic (NP), waking from sleep in a state of panic, is a common occurrence among patients with panic disorder, with 44-71% reporting at least one such attack. NP is a non-REM event that is distinct from sleep terrors, sleep apnea, nightmares or dream-induced arousals. This review outlines recent advances in the characterization of NP, as well as current approaches to the assessment and treatment of NP. In contrast to earlier work, more recent studies suggest that patients with NP do not differ from patients without NP on sleep architecture, sleep physiology, self-reported sleep quality and severity of panic disorder. However, more precise measurement of physiological precipitants and features is warranted. Assessment of NP focuses on ruling out other explanations for NP, with differential diagnosis based on interviews, sleep polysomnography and ambulatory recording of sleep. Psychological treatment (cognitive-behavioral therapy) targets misappraisals of anxiety sensations, hyperventilatory response, and conditioned reactions to internal, physical cues. Recent evidence supports the efficacy of this approach, however, controlled studies on pharmacological agents in the treatment of NP are lacking. Research is needed to examine the effects of combined cognitive-behavioral therapy and medications, compared to medication alone in the treatment of NP.

Wyatt GE, Myers HF, Loeb TB. · Neuropsychiatric Institute, University of California, Los Angeles, USA. · AIDS Behav. · Pubmed #15690113 No free full text.

This publication has no abstract.

Sankar R. · David Geffen School of Medicine and Mattel Children's Hospital at University of California Los Angeles, Room 22-474 MDCC, UCLA Medical Center, Los Angeles, CA 90095-1752, USA. · Neurology. · Pubmed #15557549 No free full text.

Abstract: The selection of an antiepileptic drug (AED) for initial treatment of epilepsy in infancy, childhood, and adolescence should ideally be made after a clear syndromic diagnosis of the patient's seizure disorder. A common cause of failure of the first AED is erroneous diagnosis. The availability of new-generation AEDs has expanded the choice of available agents with comparable efficacy for most syndromes. Efficacy data based on class I or II evidence are not available for many syndromes of childhood, and selection must therefore be based on the best data available. It is also important to assess the relative toxicity and tolerability of AEDs in making the selection. It is especially important to appreciate age-specific organ toxicities. Moreover, the use of AEDs in childhood requires an understanding of their neurobehavioral effects. Important neuropsychiatric co-morbidities in children with epilepsy include attention deficit/hyperactivity disorder, autistic spectrum disorders, depression and anxiety, and thought disorders. These problems can be exacerbated or ameliorated by specific AEDs. The effect of AEDs on body weight, insulin sensitivity, lipid profile, and bone health is becoming better appreciated. Newer AEDs may offer significant advantages in this regard. Co-morbid migraine in children with epilepsy may benefit from some AEDs. There remains a continuing need for the development of newer AEDs that are targeted for the developing brain to improve the efficacy and tolerability of treatment in childhood seizure disorders.

Weisz JR, Hawley KM, Doss AJ. · Department of Psychology, University of California-Los Angeles, Franz Hall, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #15380784 No free full text.

Abstract: This article is a review of specific psychotherapies that have been supported in clinical trials. Treatments that showed significant effects in studies published over a period of 4 decades were identified, with the goal of complementing the overall picture of treatment benefit provided in narrative reviews and meta-analyses with a detailing of the specific interventions that have shown significant effects. The article focuses on treatments for four broad clusters of problems and disorders that account for a very large proportion of youth mental health referrals: anxiety, depression, attention-deficit/hyperactivity, and conduct.

Bhidayasiri R, Truong DD. · Department of Neurology, UCLA Medical Center, David Geffen UCLA School of Medicine and Parkinson's Disease Research, Education and Clinical Center (PADRECC) of West Los Angeles Veterans Affairs Medical Center, USA. · Postgrad Med J. · Pubmed #15356354 links to  free full text

Abstract: Chorea refers to irregular, flowing, non-stereotyped, random, involuntary movements that often possess a writhing quality referred to as choreoathetosis. When mild, chorea can be difficult to differentiate from restlessness. When chorea is proximal and of large amplitude, it is called ballism. Chorea is usually worsened by anxiety and stress and subsides during sleep. Most patients attempt to disguise chorea by incorporating it into a purposeful activity. Whereas ballism is most often encountered as hemiballism due to contralateral structural lesions of the subthalamic nucleus and/or its afferent or efferent projections, chorea may be the expression of a wide range of disorders, including metabolic, infectious, inflammatory, vascular, and neurodegenerative, as well as drug induced syndromes. In clinical practice, Sydenham's chorea is the most common form of childhood chorea, whereas Huntington's disease and drug induced chorea account for the majority of adult onset cases. The aim of this review is to provide an up to date discussion of this disorder, as well as a practical approach to its management.

Burt VK. · Department of Psychiatry and Biobehavioral Sciences, the David Geffen School of Medicine at UCLA and Women's Life Center at UCLA, USA. · J Clin Psychiatry. · Pubmed #15315474 No free full text.

Abstract: Depression includes a wide range of symptoms that can impair a person's psychosocial and physical functioning. This impairment can lead to decreased productivity, increased health care utilization, alcohol and substance abuse, and an increased risk of suicide. While the treatment of depression has significantly advanced over the past 30 years, there is still room for improvement. Full remission of depressive symptoms is often elusive, and many patients never achieve full relief from their depression despite being regarded as responders to antidepressant treatment. Current treatments for depression tend to focus on emotional symptoms, not the physical and anxious symptoms also associated with depression. However, the physical and anxious symptoms of depression can be serious and sometimes more prominent than the emotional symptoms of depression, especially among special populations such as women. New treatment strategies, such as dual-acting agents and the combination of pharmacotherapy and psychotherapy, target the emotional and anxious symptoms of depression as well as symptoms associated with pain. In order to increase response and remission, depression should be seen as an illness comprising not only emotional symptoms but physical and anxious symptoms as well.

Taché Y, Martinez V, Wang L, Million M. · CURE/Digestive Diseases Research Center, and Center for Neurovisceral Sciences and Woman's Health, West Los Angeles VA Medical Center, University of California-Los Angeles, 1130 Wilshire Boulevard, Los Angeles, CA 90073, U.S.A. ytaché@ucla.edu · Br J Pharmacol. · Pubmed #15100165 links to  free full text

Abstract: 1. The characterization of corticotropin releasing factor (CRF) and, more recently, the discovery of additional CRF-related ligands, urocortin 1, urocortin 2 and urocortin 3, the cloning of two distinct CRF receptor subtypes, 1 (CRF(1)) and 2 (CRF(2)), and the development of selective CRF receptor antagonists provided new insight to unravel the mechanisms of stress. Activation of brain CRF(1) receptor signaling pathways is implicated in stress-related endocrine response and the development of anxiety-like behaviors. 2. Compelling evidence in rodents showed also that both central and peripheral injection of CRF and urocortin 1 mimic acute stress-induced colonic response (stimulation of motility, transit, defecation, mucus and watery secretion, increased ionic permeability and occurrence of diarrhea) in rodents. Central CRF enhances colorectal distention-induced visceral pain in rats. Peripheral CRF reduced pain threshold to colonic distention and increased colonic motility in humans. 3. Nonselective CRF(1)/CRF(2) antagonists and selective CRF(1) antagonists inhibit exogenous (central or peripheral) CRF- and acute stress-induced activation of colonic myenteric neurons, stimulation of colonic motor function and visceral hyperalgesia while selective CRF(2) antagonists have no effect. None of the CRF antagonists influence basal or postprandial colonic function in nonstressed animals. 4. These findings implicate CRF(1) receptors in stress-related stimulation of colonic function and hypersensitivity to colorectal distention. Targeting CRF(1)-dependent pathways may have potential benefit against stress or anxiety-/depression-related functional bowel disorders.

Steinberg AM, Brymer MJ, Decker KB, Pynoos RS. · Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA 90064, USA. · Curr Psychiatry Rep. · Pubmed #15038911 No free full text.

Abstract: Over the past decade, the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index has been one of the most widely used instruments for the assessment of traumatized children and adolescents. This paper reviews its development and modifications that have been made as the diagnostic criteria for post-traumatic stress disorder have evolved. The paper also provides a description of standard methods of administration, procedures for scoring, and psychometric properties. The Reaction Index has been extensively used across a variety of trauma types, age ranges, settings, and cultures. It has been broadly used across the US and around the world after major disasters and catastrophic violence as an integral component of public mental health response and recovery programs. The Reaction Index forms part of a battery that can be efficiently used to conduct needs assessment, surveillance, screening, clinical evaluation, and treatment outcome evaluation after mass casualty events.

Freedman J. · University of California-Los Angeles Department of Psychiatry, Los Angeles, CA 90024, USA. · Psychiatr Clin North Am. · Pubmed #14711123 No free full text.

Abstract: Clinical Computing is a natural tool for evidence-based practice. Automated self-report produces accurate clinical assessments both in research and clinical settings, thus assuring that patients in each satisfy the same symptom criteria. The Electronic Medical Record (EMR) eventually will form a real-time Information bridge between research and clinical settings. Despite substantial literature demonstrating the efficacy of clinical computing in psychiatric care and research, however, psychiatrists have been slow to adopt computers, and research has dwindled. The steady emergence of system-wide EMRs, will spark a resurgence.

Sternbach H. · Department of Psychiatry, UCLA Neuropsychiatric Institute, University of California-Los Angeles, 2730 Wilshire Boulevard #325, Santa Monica, CA 90403, USA. · J Clin Psychiatry. · Pubmed #14658962 No free full text.

Abstract: BACKGROUND: Antidepressants are widely prescribed for mood and anxiety disorders, though reports in the oncology and epidemiology literature have suggested these agents may possess tumor initiating and/or promoting properties, raising questions about safe long-term use in patients. The author conducted a review of the preclinical and clinical literature on the connection between antidepressants and carcinogenesis. METHOD: A MEDLINE search was conducted for English-language articles published from 1966 to 2002 using the search terms antidepressants, tumors, carcinogenesis, and cancer, as well as specific antidepressant names. Additional studies were ascertained through cross-references. RESULTS: Preclinical studies found evidence for both tumor promotion and suppression, though the majority of studies predominantly examined tricyclic antidepressants (TCAs), with 1 report suggesting that TCAs with a nitrogen atom in the central ring are genotoxic. Of 13 clinical studies, 3 found a significant increase, 4 noted a trend increase, and 6 found no increase in risk for cancer with antidepressant (mostly TCA) use. Methodologic differences could account for some of the discrepancies found in the clinical studies, while questions about the validity for humans of the preclinical models raise doubt about the significance of those findings. CONCLUSION: While there is some suggestive evidence of an association between antidepressant use and cancer, the link is, at this time, questionable but deserving of further study, especially with newer agents. Clinicians should not withhold antidepressant medication when indicated, as the risks of untreated depressive and anxiety disorders exceed the as yet unsubstantiated risk of tumor formation in such patients.