Anxiety Disorders: University of California San Francisco

Hall SM, Prochaska JJ. · Psychiatry Department, University of California-San Francisco, CA 94143, USA. · Annu Rev Clin Psychol. · Pubmed #19327035 links to  free full text

Abstract: This article reviews the research on the treatment of cigarette smoking in individuals who have comorbid mental illnesses or non-nicotinic addictions. The prevalence of smoking in mentally ill and substance-abusing populations is presented, as well as reasons for this high prevalence. The historical role of cigarettes and tobacco in mental illness and addiction is reviewed to help the reader better understand the pervasiveness of smoking in these disorders and the relative absence of intervention efforts in mental heath and addiction treatment settings. The article then discusses the several reasons for integrating smoking treatment into mental health and addiction settings. The outcome research for adult and adolescent comorbid smokers is reviewed, and barriers to treatment are discussed. The review closes with a brief discussion of models of integration and thoughts about prevention.

Miaskowski C. · Department of Physiological Nursing, University of California, San Francisco, California 94143-0610, USA. · Pain Manag Nurs. · Pubmed #19264278 No free full text.

Abstract: Chronic/persistent pain places a significant burden on patients, the health care system, and society, because it is associated with substantial personal suffering, lost productivity, and health care costs. Along with its significant socioeconomic impact, chronic/persistent pain can also alter normal sleep patterns in patients, which in turn may affect multiple aspects of daily life, such as interference with social relationships, diminished cognitive functions, interference with daily activities, and increased levels of anxiety and depression. Therefore, a clinical understanding of the relationship between chronic pain, pain relief, and pain-related sleep disturbances is essential for creating an effective pain management regimen. As an example, if sleep assessments are performed consistently over time (i.e., before the initiation of analgesic therapy and during treatment), changes in sleep patterns may signal the need for a change in treatment. An optimal treatment for the management of chronic/persistent pain should provide continuous around-the-clock pain control and subsequently improve sleep, thereby improving health-related quality of life in many patients. This article focuses on the disruptions in sleep that are commonly seen in patients with chronic/persistent pain, and their utility as a measure of effective pain management in clinical studies evaluating pharmacologic approaches to chronic pain management.

Reich J. · Department of Psychiatry, University of California at San Francisco Medical School, 2255 North Point Street, Suite 102, San Francisco, CA 94123, USA. · Curr Psychiatry Rep. · Pubmed #19187715 No free full text.

Abstract: This review summarizes past and recent findings in the empiric literature and the evolution of the concepts of avoidant personality disorder (APD) and social phobia (SP). APD is an internally consistent dimensional personality pathology that causes dysfunction that appears to be dimensional rather than a sudden jump in impairment after a certain number of criteria have been met. It has state and trait personality components. Evidence indicates that symptoms are at least partially treatable with psychological or pharmacologic interventions. APD and SP have similar symptoms and treatment response and identical genetics. We can conclude from the empiric evidence that no dividing line exists between APD and SP, with APD merely being the more severe form of the disorder. The best conceptualization is that APD is a dimensional personality pathology that in its attenuated form (SP) resembles an anxiety disorder.

Peltier B. · University of the Pacific, San Francisco, California, USA. · Spec Care Dentist. · Pubmed #19152568 No free full text.

Abstract: Dental fears and phobias trouble patients with and without special needs, and they are a problem for dentists, as well. This article reviews current research and literature related to methods used to alleviate dental fear and concludes that while some important psychological methods are available, much work is left to be done in this area. It is clear that there is an important role for psychological and behavioral input to the dentist-patient interaction. While dental phobia represents a class of special needs itself, patients with other important disabilities (e.g., physical or cognitive impairments) are sometimes comorbidly phobic, a condition often missed or misdiagnosed by treating practitioners. Office-based techniques that focus on relaxation, breathing, imagery, hypnosis, and effective use of operatory language are described. The methods advocated here can be used with patients having mild or moderate cognitive impairments. Readings are recommended for the dentist or auxiliary practitioner interested in learning these techniques.

Maninger N, Wolkowitz OM, Reus VI, Epel ES, Mellon SH. · Department of Psychiatry, University of California San Francisco, School of Medicine, San Francisco 94143, USA. · Front Neuroendocrinol. · Pubmed #19063914 No free full text.

Abstract: DHEA and DHEAS are steroids synthesized in human adrenals, but their function is unclear. In addition to adrenal synthesis, evidence also indicates that DHEA and DHEAS are synthesized in the brain, further suggesting a role of these hormones in brain function and development. Despite intensifying research into the biology of DHEA and DHEAS, many questions concerning their mechanisms of action and their potential involvement in neuropsychiatric illnesses remain unanswered. We review and distill the preclinical and clinical data on DHEA and DHEAS, focusing on (i) biological actions and putative mechanisms of action, (ii) differences in endogenous circulating concentrations in normal subjects and patients with neuropsychiatric diseases, and (iii) the therapeutic potential of DHEA in treating these conditions. Biological actions of DHEA and DHEAS include neuroprotection, neurite growth, and antagonistic effects on oxidants and glucocorticoids. Accumulating data suggest abnormal DHEA and/or DHEAS concentrations in several neuropsychiatric conditions. The evidence that DHEA and DHEAS may be fruitful targets for pharmacotherapy in some conditions is reviewed.

Palacios JF, Portillo CJ. · University of California, San Francisco. · J Transcult Nurs. · Pubmed #18840885 No free full text.

Abstract: PURPOSE: Theoretical underpinnings of two theories are examined for their applicability in guiding practice and research when understanding Native American women's health outcomes. Method: Published studies testing two independent theories, historical trauma and weathering, are reviewed. Key theoretical concepts that are applicable in the study of Native women and understanding their intergenerational heritage of injustice and cultural context are discussed. RESULTS: The authors infer underlying assumptions and definitions of both theories and present a hypothetical diagram blending both theories. CONCLUSION: By understanding historical legacies and the surrounding context, researchers and clinicians can develop knowledge to improve and enhance optimal health outcomes and life opportunities for Native women.

Lustig SL, Tennakoon L. · Department of Psychiatry, University of California San Francisco, 401 Parnassus Avenue, Box 0984F, San Francisco, CA, 94143, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #18558313 No free full text.

Abstract: An estimated 80% of the world's war victims are women and children, a significant proportion of whom suffer from social and psychiatric sequelae of traumatic experiences. Various treatments for psychiatric symptoms related to trauma among refugees have been studied. This article summarizes the literature on therapies involving the creation of stories, such as narrative therapy and testimonial therapies, and other storytelling techniques described on the World Wide Web in the absence of an academic literature. At this point, longer and larger studies of the efficacy of all these approaches are warranted.

Larson PS. · Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA. · Neurotherapeutics. · Pubmed #18164483 No free full text.

Abstract: Surgery for psychiatric disorders first began in the early part of the last century when the therapeutic options for these patients were limited. The introduction of deep brain stimulation (DBS) has caused a new interest in the surgical treatment of these disorders. DBS may have some advantage over lesioning procedures used in the past. A critical review of the major DBS targets under investigation for Tourette's syndrome, obsessive-compulsive disorder, and major depression is presented. Current and future challenges for the use of DBS in psychiatric disorders are discussed, as well as a rationale for referring to this subspecialty as limbic disorders surgery based on the parallels with movement disorders surgery.

Maguen S, Papa A, Litz BT. · San Francisco VA Medical Center, University of California at San Francisco, CA, USA. · Anxiety Stress Coping. · Pubmed #18027122 No free full text.

Abstract: Terrorism creates a ripple of fear and uncertainty. Although most individuals are resilient and recover over time, a minority remains functionally and psychologically impaired. In this paper, we examine research on coping strategies employed in the aftermath of terrorist events, theories and empirical findings related to appraisal processes that influence individuals' primary attributions of risk, and normative processes that shape secondary appraisals, which predict specific coping behaviors. We also describe individual diatheses and factors promoting resilience that may influence coping and functioning in the face of terrorism. Finally, we offer suggestions for future research.

Phoenix BJ. · University of California, San Francisco, School of Nursing, San Francisco, CA, USA. · Perspect Psychiatr Care. · Pubmed #17576305 No free full text.

Abstract: PURPOSE: Education about the persistent effects of trauma helps survivors better understand their own stress responses, and knowledge of coping strategies provides a sense of control over these responses. Trauma education for providers can minimize negative countertransference and prevent vicarious traumatization. CONCLUSIONS: This article discusses content areas to be covered in psychoeducation with survivors of acute traumatic events and prolonged trauma and abuse, and reviews resources for trauma psychoeducation with clients and healthcare providers. PRACTICE IMPLICATIONS: Advanced practice psychiatric nurses may provide psychoeducation to people who suffer from complex psychological and behavioral disturbances related to severe and persistent abuse or trauma, especially early in life.

Weiss SJ. · Department of Community Health Systems, School of Nursing at the University of California, San Francisco, CA, USA. · Perspect Psychiatr Care. · Pubmed #17576304 No free full text.

Abstract: PURPOSE: The purpose of this article is to describe the effects of traumatic stress on brain structure and function, and the relationship of these neurobiological changes to symptoms experienced after trauma. CONCLUSIONS: Exposure to traumatic stress is associated with changes in the limbic system, the hypothalamic-pituitary-adrenal axis, and key monoamine neurotransmitters. Different neurobiological alterations can be linked to specific symptoms of hyperarousal, dissociation/numbing, and reexperiencing of the trauma. PRACTICE IMPLICATIONS: Understanding what is happening in the brain can inform more targeted treatment for various symptoms that the individual may be experiencing.

Newton PM, Ron D. · Ernest Gallo Clinic and Research Center, 5858 Horton Street, Suite 200, Emeryville, CA 94608, USA. · Pharmacol Res. · Pubmed #17566760 No free full text.

Abstract: Alcohol abuse and addiction are serious global health problems. Tackling these disorders requires an understanding of how ethanol produces its effects. Early cell culture studies implicated the protein kinase C (PKC) family of serine-threonine kinases in mediating both acute and chronic responses to ethanol exposure. More recent studies using transgenic mice have identified two isozymes, PKCgamma and PKCepsilon, that have opposing roles in mediating the behavioral effects of ethanol. Genetic deletion of PKCgamma produces mice with a high ethanol drinking phenotype which are impulsive and require high levels of ethanol to reach intoxication, perhaps modeling the human condition of individuals who are at risk for developing alcoholism. In contrast, deletion of PKCepsilon produces a low ethanol drinking animal that is more sensitive to the acute effects of ethanol and displays less anxiety-like behavior, perhaps modeling human individuals with decreased risk for developing alcoholism. These findings suggest that drugs targeting PKCgamma and PKCepsilon may be useful to curb excessive drinking, the key symptom of alcohol use disorders.

Summer GJ, Puntillo KA, Miaskowski C, Green PG, Levine JD. · Department of Physiological Nursing, School of Nursing, University of California-San Francisco, San Francisco, California 94143, USA. · J Pain. · Pubmed #17434800 No free full text.

Abstract: The development of more effective methods of relieving pain associated with burn injury is a major unmet medical need. Not only is acute burn injury pain a source of immense suffering, but it has been linked to debilitating chronic pain and stress-related disorders. Although pain management guidelines and protocols have been developed and implemented, unrelieved moderate-to-severe pain continues to be reported after burn injury. One reason for this is that the intensity of pain associated with wound care and rehabilitation therapy, the major source of severe pain in this patient population, varies widely over the 3 phases of burn recovery, making it difficult to estimate analgesic requirements. The effects of opioids, the most commonly administered analgesics for burn injury procedural pain, are difficult to gauge over the course of burn recovery because the need for an opioid may change rapidly, resulting in the overmedication or undermedication of burn-injured patients. Understanding the mechanisms that contribute to the intensity and variability of burn injury pain over time is crucial to its proper management. We provide an overview of the types of pain associated with a burn injury, describe how these different types of pain interfere with the phases of burn recovery, and summarize pharmacologic pain management strategies across the continuum of burn care. We conclude with a discussion and suggestions for improvement. Rational management, based on the underlying mechanisms that contribute to the intensity and variability of burn injury pain, is in its infancy. The paucity of information highlights the need for research that explores and advances the identification of mechanisms of acute and chronic burn injury pain. PERSPECTIVE: Researchers continue to report that burn pain is undertreated. This review examines burn injury pain management across the phases of burn recovery, emphasizing 3 types of pain that require separate assessment and management. It provides insights and suggestions for future research directions to address this significant clinical problem.

Neylan TC, Otte C, Yehuda R, Marmar CR. · University of California, San Francisco, San Francisco DVAMC 116P, 4150 Clement Street, San Francisco, CA 94121, USA. · Ann N Y Acad Sci. · Pubmed #16891571 No free full text.

Abstract: Studies that have conducted quantitative analysis of the sleep electroencephalogram (EEG) have demonstrated decreased delta sleep in PTSD. Elevations in both hypothalamic (neurohormonal) and extrahypothalamic (neurotransmitter) corticotropin releasing factor (CRF) release is associated with decreased delta sleep activity. We present data from several studies examining the effect of metyrapone administration on the sleep EEG in PTSD and control subjects. Plasma ACTH, cortisol, and 11-deoxycorticol were obtained the morning following polysomnographic sleep recordings before and after metyrapone administration. Delta sleep was measured by period amplitude analysis. The results demonstrate: a) decreased delta sleep in male subjects with PTSD; b) metyrapone administration resulted in an activation of the sleep EEG and a robust decrease in quantitative delta sleep; c) the sleep and endocrine (increase in ACTH) responses to metyrapone were significantly decreased in PTSD in two different study samples; and d) the metyrapone-related disruption to sleep in both samples was predicted by the increase in ACTH measured the following morning. These findings strongly suggest that the delta sleep response to metyrapone is a measure of the brain response to a hypothalamic CRF challenge. The attenuated delta sleep and endocrine response to metyrapone challenge in PTSD is consistent with a model of enhanced negative feedback regulation or downregulation of CRF receptors in an environment of chronically increased CRF activity.

Schuff N, Meyerhoff DJ, Mueller S, Chao L, Sacrey DT, Laxer K, Weiner MW. · Magnetic Resonance Unit VA Medical Center, Department of Radiology, University of California, San Francisco, CA 94121, USA. · Adv Exp Med Biol. · Pubmed #16802717 links to  free full text

This publication has no abstract.

Eisendrath SJ, Shim JJ. · University of California, San Francisco, USA. · Am J Med. · Pubmed #16431178 No free full text.

Abstract: Critical care units have become essential elements in modern medicine. These units reflect the highest levels of scientific and technological advance in medicine. Within these units, however, lie significant psychiatric challenges for patients and staff. This article examines the identification and treatment of the most frequent psychiatric problems facing patients entering critical care units, including delirium, depression and anxiety. These conditions are important to address in order to decrease patient suffering and improve morbidity and mortality. The article also addresses some of the most common staff stressors encountered in working in these units. Managing these stressors makes the critical care unit a place where staff can flourish instead of burning out. Specific techniques may help the staff deal with the complex medical, psychological, and ethical issues found in these units in an empathic, compassionate, and well-balanced manner that allows ongoing work satisfaction.

Krishnan A, Koo J. · Department of Medicine, University of California, San Francisco (USCF), CA, USA. · Dermatol Ther. · Pubmed #16297003 No free full text.

Abstract: A patient's psychological condition can substantially affect the presence and severity of pruritus, a phenomenon thought to be mediated by the central nervous system's (CNS) opioid neurotransmitter system. Specific psychodermatologic disorders associated with psychogenic pruritus, including depression, anxiety, chronic tactile hallucinations, delusions of parasitosis, neurotic excoriations, and other cutaneous compulsions are likely controlled by this pathway. Therefore, in treating these conditions, medications specifically directed at the CNS can be the most effective therapies, whereas topical and supportive therapy may be important adjuncts in targeting the associated pruritus. Furthermore, the impact of an understanding clinician and a good physician-patient relationship cannot be underestimated in determining ultimate prognosis. This review will begin by discussing the relationship between the psyche and pruritus as well as the opioid neurotransmitter system. Following this, several disorders characterized by psychogenic pruritus will be described, and CNS-specific and adjunctive topical and supportive therapies for these conditions will be detailed.

Batniji R, Van Ommeren M, Saraceno B. · World Health Organization, Geneva, Switzerland. · Soc Sci Med. · Pubmed #16202495 No free full text.

Abstract: Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.

Schapiro NA. · Department of Family Health Care Nursing, University of California, San Francisco, CA, USA. · J Pediatr Health Care. · Pubmed #15867828 No free full text.

Abstract: In the past decade, 7 million children in the United States had a mental health problem, with higher rates of medication use, primary care visits, and specialty care visits than children without such problems. Children with bipolar disorders can present diagnostic and referral dilemmas for the primary care pediatric nurse practitioner, and frequently these children take multiple medications that interact with commonly used antibiotics, over-the-counter medications, and contraceptives. Diagnostic criteria for mania are controversial and coexisting attention deficit/hyperactivity disorder, conduct disorder, and anxiety disorders can complicate the diagnosis and treatment. The primary care pediatric nurse practitioner role includes referral, co-management, and advocacy for this vulnerable population.

Caughey AB. · Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, CA 94143, USA. · Gynecol Obstet Invest. · Pubmed #15692215 No free full text.

Abstract: With increasing concerns regarding rapidly expanding health care costs, cost-effectiveness analysis (CEA) provides a methodology to assess whether marginal gains from new technology are worth the increased costs. In the arena of prenatal diagnosis, particular methodological and ethical concerns include whether the effects of such testing on individuals other than the patient are included, how termination of pregnancy is included in the models, redundancy of screening and diagnostic methods, and how screening may reassure or cause anxiety in patients depending on their results. The existing literature has demonstrated cost-effectiveness of screening and diagnosis of neural tube defects, Down syndrome, and cystic fibrosis in the general population. Screening for genetic disorders which have a higher prevalence among particular groups has also been shown to be cost effective, including diseases such as hemoglobinopathies and Tay-Sachs disease. Understanding the methodology and salient issues of CEA is critical for researchers, editors and clinicians to accurately interpret results of the growing body of cost-effectiveness studies in prenatal diagnosis.

Song M, Messing RO. · Ernest Gallo Clinic and Research Center, Department of Neurology, Graduate Program in Neuroscience, University of California, San Francisco, 5858 Horton Street, Suite 200, Emeryville, California, 94608, USA. · Cell Mol Life Sci. · Pubmed #15666084 No free full text.

Abstract: Pharmacological studies with drugs that activate or inhibit several protein kinase C (PKC) isozymes have identified the PKC family of serine-threonine kinases as important in the regulation of gamma-aminobutyric acid type A (GABA(A)) receptor function. PKC modulates GABA(A) receptor surface density, chloride conductance and receptor sensitivity to positive allosteric modulators such as neurosteroids, ethanol, benzodiazepines and barbiturates. Recent studies using PKC isozyme-selective reagents and gene-targeted mice have begun to identify critical roles for three isozymes, PKCbetaII, PKCvarepsilon and PKCgamma, in various aspects of GABA(A) receptor regulation. Progress in this field touches upon therapeutic areas that are of great clinical importance such as anxiety and addiction. Increased understanding of how PKC regulates GABA(A) receptors and which PKC isozymes are involved holds promise for development of new treatments for diverse neuropsychiatric disorders.

Schoenfeld FB, Marmar CR, Neylan TC. · Department of Veterans Affairs Medical Center in San Francisco, San Francisco, California 94121, USA. · Psychiatr Serv. · Pubmed #15128960 links to  free full text

Abstract: OBJECTIVE: This article describes current approaches to the pharmacologic treatment of posttraumatic stress disorder (PTSD) and reviews the classes of pharmacologic agents used in the treatment of PTSD. Pharmacotherapy for PTSD that is comorbid with other psychiatric disorders is highlighted. METHODS: The primary-source literature was reviewed by using a MEDLINE search. Secondary-source review articles and chapters were also used. Results from studies of the psychophysiology of PTSD are outlined in the review to help inform treatment choices. The review gives more consideration to controlled studies than to open clinical trials. Recommendations for treatment are evidence based. RESULTS AND DISCUSSION: A growing body of evidence demonstrates the efficacy of pharmacologic treatment for PTSD. The effectiveness of the selective serotonin reuptake inhibitors sertraline and paroxetine in large-scale, well-designed, placebo-controlled trials resulted in their being the first medications to receive approval from the U.S. Food and Drug Administration for the treatment of PTSD. Observation of psychophysiologic alterations associated with PTSD has led to the study of adrenergic-inhibiting agents and mood stabilizers as therapeutic agents. Controlled clinical trials with these classes of medication are needed to determine their efficacy for treating PTSD. Finally, the choice of medication for treating PTSD is often determined by the prominence of specific PTSD symptoms and the pattern of comorbid psychiatric conditions.

Gum A, Areán PA. · Department of Psychiatry, University of California at San Francisco, 401 Parnassus Avenue, Box CPT, San Francisco, CA 94143, USA. · Curr Psychiatry Rep. · Pubmed #14738702 No free full text.

Abstract: Research on psychotherapy for older adults with psychiatric disorders has demonstrated its effectiveness, although the majority of research has been conducted on major depression. Recent advances in extending this research to additional diagnostic categories and treatment settings are reviewed. Psychotherapy appears promising in the treatment of minor depression, dysthymia, anxiety disorders, depression with comorbid personality disorders, depression with comorbid cognitive impairment, and as an adjunctive treatment in psychotic disorders. Psychotherapy also has been successfully transported to the primary care setting, and shows potential in long-term care and in-home settings. Many of these studies are preliminary, however; additional research is needed with larger, more diverse samples across a variety of psychiatric diagnoses and treatment settings.

Lee KC, Finley PR, Alldredge BK. · University of California, San Francisco, 521 Parnassus Avenue, C-152, Box 0622, San Francisco, CA 94143-0622, USA. · Expert Opin Drug Saf. · Pubmed #12904103 No free full text.

Abstract: Psychotropic medications in the classes of antidepressants, antipsychotics and mood stabilisers have been recognised in the literature and clinical settings as having high epileptogenic potential. Among these three classes, clozapine, tricyclic antidepressants (TCAs) and lithium are agents that clinicians have historically recognised as precipitants of drug-induced seizures. There are few reports that review the epileptogenic risk of newer psychotropic agents; in this qualitative review, the authors provide an update on the most recently published reports on seizures associated with antidepressants, antipsychotics, mood stabilisers, anxiolytics and sedative-hypnotics. In general, the epileptogenic risks of the newer psychotropic agents appear to be quite low as long as dosing strategies are consistent with recommended guidelines. Whilst newer psychotropic medications appear to be safe in patients with epilepsy, few studies have specifically addressed this population. In addition, the potential for drug interactions between antiepileptic drugs and psychotropics may be substantial with certain agents. For example, many psychotropes are both substrates and inhibitors of cytochrome P450 (CYP450) isoenzymes, whilst many antiepileptic drugs are both substrates and inducers of CYP450 activity. Every attempt should be made to minimise potential interactions when these agents are concomitantly administered.

Khouzam HR, Emes R, Gill T, Raroque R. · Chemical Dependency Treatment Program, VA Central California Health Care System (VACCHCS), University of California, San Francisco Medical School, Medical Education Program, Fresno, California, USA. · Compr Ther. · Pubmed #12701343 No free full text.

Abstract: Although sertraline was initially introduced as an antidepressant, it can be prescribed for a wide range of psychiatric and medical conditions. We review the pharmacology, the adverse effects, the dosing guidelines, as well as the indications of sertraline.