Anxiety Disorders: University of California San Francisco

Marmar CR, Neylan TC, Schoenfeld FB. · Department of Psychiatry, University of California, Department of Veterans Affairs Medical Center, San Francisco, California, USA. · Psychiatr Q. · Pubmed #12418356 No free full text.

Abstract: Advances in psychopharmacology of PTSD are presented, focusing on antidepressants, adrenergic agents, antianxiety agents, and mood stabilizers. Treatment recommendations are related to recent advances in the understanding of the biology of PTSD. Pharmacotherapy of PTSD in children and adolescents is discussed, including recommended dose ranges. Recommendations are specified for pharmacotherapy of trauma survivors in the immediate aftermath of traumatic exposure, and for those with acute and chronic posttraumatic stress disorders.

Rose CS, Ress B. · Pacific AIDS Education and Training Center, University of California, San Francisco, USA. · J Assoc Nurses AIDS Care. · Pubmed #12369386 No free full text.

Abstract: Using case studies, this article discusses a nursing approach for working with HIV-positive clients who have experienced stress as the result of the 9/11 attack on the United States. The stress and coping framework developed by Lazarus and Folkman is used to guide nursing care.

Shusterman D. · Division of Occupational and Environmental Medicine, University of California-San Francisco, San Francisco, California, USA. · Environ Health Perspect. · Pubmed #12194901 links to  free full text

Abstract: The upper airway serves as air conditioner, filter, and warning device. Two neurological modalities, olfaction and trigeminal chemoreception, inform us of the chemical qualities of the air we breathe. A number of poorly understood conditions, including nonallergic rhinitis, irritant-induced rhinitis, odor-triggered asthma, odor-triggered panic attacks, chemical-induced olfactory dysfunction, and irritant-associated vocal cord dysfunction, involve induction of symptoms by odorant and/or irritant chemicals in the upper airway. This article is a summary of the knowledge and theories about these various conditions, and highlights those aspects of nasal anatomy, physiology, and pathophysiology relevant to their understanding.

Taylor M. · Department of Reproductive Science, Obstetrics and Gynecology, University of California, San Francisco, School of Medicine, USA. · J Reprod Med. · Pubmed #11304879 No free full text.

Abstract: More than 250,000 women have a bilateral oophorectomy every year. With surgical menopause, the onset of menopausal symptoms is abrupt and often dramatic. Oophorectomy offers relief from physical conditions for many women; however, those with preexisting psychological and some physical problems tend to experience postsurgical exacerbation of those problems. Loss of estrogenic and androgenic underpinnings may destabilize women with unstable psychiatric axes. Surgically menopausal women may also experience a decline in sexual interest and activity. The relation of surgical menopause to physiologic and sexual well-being is described in this article. The link between hormonal levels and psychological well-being has been well documented. Depression seems to be increased at times of changing hormone levels in women, possibly a result of the effect of estrogen levels on serotonergic activity and its impact on other neurotransmitters. In addition, a sex-specific association with specific psychological disorders has been described in the literature and will be reviewed in this article. The potential benefits of estrogen or estrogen/androgen therapy on libido and mood are discussed, as are findings that estrogen-androgen therapy correlated with less anxiety and hostility and with increased positive feelings when compared with estrogen-only treatment.

Tsao MN, Wara WM, Larson DA. · Department of Radiation Oncology, University of California San Francisco, San Francisco, California 94143, USA. · Semin Radiat Oncol. · Pubmed #10092704 No free full text.

Abstract: The most common indication for the use of radiation therapy in the treatment of benign central nervous system disease is for the treatment of benign brain tumors, such as meningioma, pituitary adenoma, acoustic neuroma, arteriovenous malformation, and craniopharyngioma. Other less common benign intracranial tumors treated with radiation include chordoma, pilocytic astrocytoma, pineocytoma, choroid-plexus papilloma, hemangioblastoma, and temporal bone chemodectomas. Benign conditions, such as histiocytosis X, trigeminal neuralgia, and epilepsy, are also amenable to radiation treatment. There have also been reports of radiosurgery being used for the treatment of movement disorders and psychiatric disturbances, such as obsessive-compulsive and anxiety disorders. For benign brain tumors, radiation therapy as either primary or adjuvant therapy plays an integral role in improving local control. In the treatment of trigeminal neuralgia, epilepsy, tremor, and some psychiatric disturbances, radiosurgery may help ameliorate or eliminate some symptoms. Patients with benign central nervous system disease are expected to live a long time. As such, treatment should be highly conformal and based on three-dimensional planning using magnetic resonance imaging, computed tomography, or both. It is critical that damage to normal brain be minimized.

Rice DP. · Institute for Health & Aging, University of California at San Francisco, 94118, USA. · J Clin Psychiatry. · Pubmed #10037163 No free full text.

Abstract: Although schizophrenia afflicts 1.1% of the U.S. population, it imposes a disproportionately large economic burden due to expenditures for hospitalization, treatment and rehabilitation, and lost productivity. Cost-of-illness studies, using a variety of methodologies to calculate direct and indirect costs, have estimated that in 1990 the total economic burden of schizophrenia was $32.5 billion. Of this total, $17.3 billion was attributable to direct medical costs. By comparison, in the same year the total and direct medical costs for anxiety disorders, which are more than 10 times more prevalent than schizophrenia, were $46.6 billion and $10.7 billion, respectively. For affective disorders, almost 10 times more prevalent than schizophrenia, the total and direct costs were $30.4 billion and $19.2 billion, respectively. Effective treatments used early in the course of schizophrenia can help reduce the costs associated with this illness.

Ming ME, Bhawan J, Stefanato CM, McCalmont TH, Cohen LM. · Department of Dermatology and Pathology, University of California, San Francisco, USA. · J Am Acad Dermatol. · Pubmed #10025739 No free full text.

Abstract: BACKGROUND: Hyperpigmentation is a side effect of several medications, including amiodarone, bleomycin, chlorpromazine, and minocycline. OBJECTIVE: The purpose of this study is to describe the clinical and light microscopic findings in 4 patients with imipramine-induced hyperpigmentation and to better understand its origin. METHODS: All 4 patients underwent a skin biopsy for light microscopy. In 1 patient, a biopsy specimen was obtained for electron microscopy. Tissue from patient 1 was analyzed with a mass spectrophotometer, and energy-dispersive x-ray analysis was performed on tissue from patients 1 and 2. RESULTS: All 4 women had been taking imipramine for at least 2 years. Hyperpigmentation occurred in a photodistribution on the face, arms, and backs of the hands. Light microscopy in all cases demonstrated golden-brown granules in the superficial dermis, which were strongly positive for Fontana-Masson stain. Electron microscopy demonstrated areas of electron-dense inclusion bodies within macrophages, which were distinct from melanosomes. Mass spectrophotometric and energy-dispersive x-ray analysis of the electron-dense bodies showed the presence of sulfur atoms, and no peak corresponding to that expected for imipramine was found. A peak closely corresponding to phaeomelanin, a sulfur-containing compound, was found. CONCLUSION: Hyperpigmentation is a side effect of long-term imipramine use. It may result from the deposition of melanin in an unusual form. The melanin pigment is possibly complexed with a metabolite of imipramine, and does not represent the deposition of imipramine in its native form.

Otte C, Lenoci M, Metzler T, Yehuda R, Marmar CR, Neylan TC. · Department of Psychiatry, University of California, San Francisco, California, USA. · Biol Psychiatry. · Pubmed #17336940 No free full text.

Abstract: BACKGROUND: Metyrapone blocks cortisol synthesis which results in removal of negative feedback, a stimulation of hypothalamic corticotropin releasing factor (CRF) and a reduction in delta sleep. We previously reported a diminished delta sleep and hypothalamic-pituitary-adrenal (HPA) response to metyrapone in men with post-traumatic stress disorder (PTSD). In this study, we aimed to extend these findings to women. METHODS: Three nights of polysomnography were obtained in 17 women with PTSD and 16 controls. On day 3, metyrapone was administered throughout the day up until bedtime. Plasma adrenocorticotropic hormone (ACTH), cortisol, and 11-deoxycortisol were obtained the morning following sleep recordings the day before and after metyrapone administration. RESULTS: There were no significant between-group differences in hormone concentration and delta sleep at baseline. Relative to controls, women with PTSD had decreased ACTH and delta sleep responses to metyrapone. Decline in delta sleep was associated with the magnitude of increase in ACTH across groups. CONCLUSIONS: Similar to our previous findings in men, the ACTH and sleep electroencephalogram response to metyrapone is attenuated in women with PTSD. These results are consistent with a model of downregulation of CRF receptors in an environment of chronically increased CRF activity or with enhanced negative feedback regulation in PTSD.

Warwick TC, Griffith J, Reyes B, Legesse B, Evans M. · Department of Internal Medicine, University of California, San Francisco,University Medical Center, 445 South CedarAvenue, Fresno, CA 93702, USA. · Epilepsy Behav. · Pubmed #17300990 No free full text.

Abstract: Seizures are a common comorbidity of autism and occur in as many as 30% of patients. This case report describes a 23-year-old man diagnosed with both Asperger syndrome and bitemporal epilepsy. The patient had behavioral regression that correlated with worsening of his intractable seizures. He subsequently underwent implantation of a vagus nerve stimulation therapy device for his refractory epilepsy. Both his seizures and his behavior were monitored for 6 months. We describe the efficacy of vagus nerve stimulation therapy in reducing seizure severity as well as improving the behavioral components of his Asperger syndrome. We also review the current literature regarding epilepsy in autistic spectrum disorders.

Zelman DC, Brandenburg NA, Gore M. · California School of Professional Psychology, Alliant International University, One Beach Street, San Francisco, CA 94133-122, USA. · Clin J Pain. · Pubmed #16988563 No free full text.

Abstract: OBJECTIVE: This study evaluated sleep impairment associated with painful diabetic peripheral neuropathy (DPN), a neuropathic pain condition. Sleep is of critical concern for DPN because sleep impairment and its comorbidities may influence type 2 diabetes progression. METHODS: This is a supplemental analysis of sleep data from a burden of illness study of patients with painful DPN (N=255, 61+/-12.8 y old, 51.4% women). Sleep was evaluated using the Medical Outcomes Study Sleep measure (MOS-Sleep). MOS-Sleep scores were compared with general population norms (N=1011), the MOS chronic disease sample (N=3445), and patients with postherpetic neuralgia (N=89). The MOS-Sleep Sleep Adequacy score was compared with data from the MOS diabetes subsample (N=590). RESULTS: Patients with painful DPN reported impaired sleep relative to the general population (P<0.001), the chronic disease sample (P<0.001), and postherpetic neuralgia patients (P<0.05). Self-rated MOS-Sleep Sleep Adequacy was significantly less for the painful DPN than for the diabetes sample (P<0.001), although self-reported hours of sleep were not significantly different. Multiple regression indicated that age, average daily pain, and anxiety and depression symptom levels were each significantly (P<0.01) associated with, and collectively accounted for, 47% of variance in the MOS-Sleep Sleep Problems Index. DISCUSSION: Painful DPN is associated with considerable sleep impairment. Given the recognized association between sleep impairment, type 2 diabetes and metabolic and affective disturbance, and the known adverse impact of affective disturbance on diabetes self-care, addressing these features-pain, sleep, and affective disturbance-is an important aspect of care for patients with painful DPN.

Jacobs BP, Bent S, Tice JA, Blackwell T, Cummings SR. · Department of Medicine, Osher Center for Integrative Medicine, University of California-San Francisco, California, USA. · Medicine (Baltimore). · Pubmed #16010204 No free full text.

Abstract: The herbal extracts kava and valerian are the leading dietary supplements used in the self-management of anxiety and insomnia, respectively. There is limited evidence to support their effectiveness for these common symptoms. The Internet has been used to a limited extent for research, but it is not known whether randomized controlled trials can be conducted entirely using Internet technology. We performed a randomized, double-blind, placebo-controlled trial using a novel Internet-based design to determine if kava is effective for reducing anxiety and if valerian is effective for improving sleep quality. E-mail recruitment letters and banner advertisements on websites were used to recruit a large pool of interested participants (1551) from 45 states over an 8-week period. Participants were first asked to read study information, complete an online informed consent process, and undergo electronic identity verification. In order to be eligible for the study, participants were required to have 1) anxiety as documented by scores of at least 0.5 standard deviations above the mean on the State-Trait Anxiety Inventory State subtest (STAI-State) on 2 separate occasions, and 2) insomnia, defined as a "problem getting to sleep or staying asleep over the past 2 weeks." We randomly assigned 391 eligible participants to 1 of the following 3 groups, and mailed 28 days' supply: kava with valerian placebo (n = 121), valerian with kava placebo (n = 135), or double placebo (n = 135). The primary outcome measures were changes from baseline in anxiety (STAI-State questionnaire) and insomnia (Insomnia Severity Index [ISI]) compared with placebo. Participants receiving placebo had a 14.4 point decrease in anxiety symptoms on the STAI-State score and an 8.3 point decrease in insomnia symptoms on the ISI. Those receiving kava had similar reductions in STAI-State score (2.7 point greater reduction in placebo compared with kava; 95% confidence interval [CI], -0.8 to +6.2). Those receiving valerian and placebo had similar improvements in sleep (0.4 point greater reduction in the placebo than the valerian group; 95% CI, -1.3 to +2.1). Results were similar when limited to the 83% of participants who adhered to study compounds for all 4 weeks. Neither kava nor valerian relieved anxiety or insomnia more than placebo. This trial demonstrates the feasibility of conducting randomized, blinded trials entirely via the Internet.

Mohr DC, Cox D, Merluzzi N. · University of California, San Francisco, CA, USA. · Mult Scler. · Pubmed #15794392 No free full text.

Abstract: Anxiety and phobia frequently prevent patients with multiple sclerosis (MS) from self-injecting their injectable disease-modifying medications. This small, randomized, controlled trial tested the efficacy of a six-session nurse-administered programme to teach self-injection to patients with MS, who, due to anxiety or phobia, were unable to self-inject their injectable medications. Participants were 30 patients with MS who were prescribed interferon beta-1a (IFNbeta-1a) administered via weekly intramuscular injection. All patients were unable to self-inject due to anxiety or phobia. Patients were randomized to either the six-session Self-Injection Anxiety Therapy (SIAT) or a control telephone support condition modelled on the support programme offered by the manufacturer of IFNbeta-1a. Four patients dropped out of SIAT while three dropped out of the control condition. Eight patients receiving SLAT compared to three control patients, were able to self-inject after six weeks of treatment. SIAT patients were significantly more likely to achieve self-injection at treatment cessation, compared to telephone control patients, in completer analyses (p =0.022), however, this only reached a trend in intent-to-treat analyses (p =0.058). These findings suggest that SIAT is a potentially valuable intervention to teach self-injection skills to injection phobic and anxious patients, and should be investigated more thoroughly in a larger clinical trial.

Otte C, Lenoci M, Metzler T, Yehuda R, Marmar CR, Neylan TC. · Department of Psychiatry, University of California, San Francisco, CA, USA. · Neuropsychopharmacology. · Pubmed #15714228 links to  free full text

Abstract: Alterations of the hypothalamic-pituitary-adrenal (HPA) axis and sleep disturbances have been described separately in post-traumatic stress disorder (PTSD). It is not known if HPA alterations and sleep disturbances are associated in PTSD. This study examined sleep and HPA activity in 20 male medication-free subjects with PTSD and 16 matched healthy controls. Two nights of polysomnography were obtained and 24-h urinary cortisol was collected during day 2. Subjects self-administered a low-dose (0.5 mg) salivary dexamethasone test at home. Compared with controls, PTSD subjects had higher 24-h urinary microg cortisol/g creatinine (mean+/-SD 40+/-17 vs 28+/-12, p=0.03) but not significantly higher 24-h urinary cortisol (mean+/-SD 52+/-15 microg/day vs 43+/-23, p=0.19). PTSD subjects showed a trend towards less cortisol suppression after dexamethasone (73%+/-18 vs 83%+/-10, p=0.06). In the combined sample, delta sleep was significantly and negatively correlated with 24-h urinary cortisol (r=-0.36, p=0.04), and with 24-h urinary cortisol/g creatinine on a trend level (r=-0.34, p=0.06). Our results suggest that increased cortisol is negatively associated with delta sleep. This may contribute to sleep abnormalities in conditions associated with elevated cortisol, possibly including PTSD. Future studies should explore the temporal relationship between HPA activity, sleep disturbances, and psychopathology after a traumatic event.

Han WT, Collie K, Koopman C, Azarow J, Classen C, Morrow GR, Michel B, Brennan-O'Neill E, Spiegel D. · University of California, San Francisco, USA. · Psychooncology. · Pubmed #15386762 No free full text.

Abstract: This investigation examined relationships between breast cancer patients' psychosocial characteristics (impact of the illness, traumatic stress symptoms, emotional self-efficacy, and social support) and problems they perceived in their medical interactions and their satisfaction with their physicians. Participants were 352 women enrolled in a multicenter trial of the effects of group therapy for women with recently diagnosed primary breast cancer. The findings reported here are from a cross-sectional analysis of baseline data gathered prior to randomization. Problems interacting with physicians and nurses were associated with greater levels of cancer-related traumatic stress (p < 0.01), less emotional self-efficacy for cancer (p < 0.05), less satisfaction with informational support from family, friends, and spouse, and a tendency to perceive those sources of support as more aversive (p < 0.05). Women who were less satisfied with emotional support from their family, friends and spouse were less likely to feel satisfied with their physicians (p < 0.05). These patient characteristics identify women with primary breast cancer who are likely to experience difficulty in their interactions with nurses and physicians and to be less satisfied with their physicians.

Zweben JE, Cohen JB, Christian D, Galloway GP, Salinardi M, Parent D, Iguchi M, Anonymous00308. · East Bay Community Recovery Project, Oakland, CA, USA. · Am J Addict. · Pubmed #15204668 No free full text.

Abstract: The Methamphetamine Treatment Project (MTP) offers the opportunity to examine co-occurring psychiatric conditions in a sample of 1016 methamphetamine users participating in a multisite outpatient treatment study between 1999-2001. Participants reported high levels of psychiatric symptoms, particularly depression and attempted suicide, but also anxiety and psychotic symptoms. They also reported high levels of problems controlling anger and violent behavior, with a correspondingly high frequency of assault and weapons charges. Findings continue to support the value of integrated treatment for co-occurring conditions, especially the importance of training counseling staff to handle psychotic symptoms when needed.

Neylan TC, Lenoci M, Maglione ML, Rosenlicht NZ, Leykin Y, Metzler TJ, Schoenfeld FB, Marmar CR. · Department of Psychiatry, University of California, and the Psychiatry Service, San Francisco Veterans Affairs Medical Center, 94121, USA. · J Clin Psychiatry. · Pubmed #12716248 No free full text.

Abstract: BACKGROUND: This study assesses the efficacy of nefazodone treatment (target dose of 400-600 mg/day) on objective and subjective sleep quality in Vietnam combat veterans with chronic DSM-IV posttraumatic stress disorder (PTSD). METHOD: Medically healthy male Vietnam theater combat veterans with DSM-IV PTSD (N = 10) completed a 12-week open-label trial. Two nights of ambulatory polysomnography were obtained at baseline and at the end of the trial. PTSD and depressive symptoms and subjective sleep quality were assessed at baseline and after 12 weeks. Data were collected in 1999 and 2000. RESULTS: Nefazodone treatment led to a significant decrease in PTSD and depressive symptoms (p <.05), an improvement in global subjective sleep quality, and a reduction in nightmares. Nefazodone also resulted in a substantial improvement in objective measures of sleep quality, particularly increased total sleep time, sleep maintenance, and delta sleep as measured by period amplitude analysis. CONCLUSION: Nefazodone therapy results in an improvement of both subjective and objective sleep quality in subjects with combat-related PTSD.

Neylan TC, Metzler TJ, Schoenfeld FB, Weiss DS, Lenoci M, Best SR, Lipsey TL, Marmar CR. · Department of Psychiatry, University of California, and Veterans Affairs Medical Center, San Francisco 94121, USA. · J Trauma Stress. · Pubmed #11534878 No free full text.

Abstract: This study assesses the efficacy of fluvoxamine treatment on different domains of subjective sleep quality in Vietnam combat veterans with chronic posttraumatic stress disorder (PTSD). Medically healthy male Vietnam theater combat veterans (N = 21) completed a 10-week open label trial. Fluvoxamine treatment led to improvements in PTSD symptoms and all domains of subjective sleep quality. The largest effect was for dreams linked to the traumatic experience in combat. In contrast, generic unpleasant dreams showed only a modest response to treatment. Sleep maintenance insomnia and the item "troubled sleep" showed a large treatment response, whereas sleep onset insomnia improved less substantially. These therapeutic benefits contrast with published reports that have found activating effects of Selective Serotonin Reuptake Inhibitors on the sleep electroencephalogram.

Clark HW, Masson CL, Delucchi KL, Hall SM, Sees KL. · Department of Psychiatry, Langley Porter Psychiatric Institute, University of California-San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA. · J Subst Abuse Treat. · Pubmed #11306214 No free full text.

Abstract: We examined the occurrence of violent traumatic events, DSM-III-R diagnosis of posttraumatic stress disorder (PTSD), and PTSD symptoms, and the relationship of these variables to drug abuse severity. One-hundred fifty opioid-dependent drug abusers who were participants in a randomized trial of two methadone treatment interventions were interviewed using the Diagnostic Interview Schedule, the Addiction Severity Index, and the Beck Depression Inventory. Twenty-nine percent met diagnostic criteria for PTSD. With the exception of rape, no gender differences in the prevalence of violent traumatic events were observed. The occurrence of PTSD-related symptoms was associated with greater drug abuse severity after controlling for gender, depression, and lifetime diagnosis of PTSD. The high rate of PTSD among these methadone patients, the nature of the traumatic events to which they are exposed, and subsequent violence-related psychiatric sequelae have important implications for identification and treatment of PTSD among those seeking drug abuse treatment.

Karnik NS, Soller M, Redlich A, Silverman M, Kraemer HC, Haapanen R, Steiner H. · Department of Anthropology, History, and Social Medicine, University of California, San Francisco, 3333 California St., Suite 485, San Francisco, CA 94143, USA. · Psychiatr Serv. · Pubmed #19487357 No free full text.

Abstract: OBJECTIVE: This study examined prevalence rates of psychiatric disorders among young offenders after they were incarcerated for nine months. METHODS: A total of 790 youths were surveyed, including a significant proportion of females (N=140, 18%), nine months after incarceration. The Structured Clinical Interview for DSM-IV with portions of the Diagnostic Interview for Children and Adolescents and the Structured Interview for DSM-IV Personality were used. RESULTS: Even when conduct disorder and oppositional defiant disorder were excluded, 88% of males and 92% of females had a psychiatric disorder (including substance use disorder); more than 80% of offenders met criteria for some type of substance use disorder. Gender differences were found for anxiety disorders (males 26%, females 55%, p<.01), marijuana dependence (males 32%, females 24%, p=.04), marijuana abuse (males 19%, females 11%, p=.04), and stimulant dependence (males 25%, females 44%, p<.01). CONCLUSIONS: Despite nine months of incarceration, young offenders continued to show high levels of psychiatric and substance use disorders.

Newton PM, Messing RO. · Ernest Gallo Clinic and Research Center, Department of Neurology, University of California, San Francisco, Emeryville, CA 94608 , USA. · Channels (Austin). · Pubmed #19372737 No free full text.

Abstract: We recently validated the N-type calcium channel as a target for the treatment of alcoholism and anxiety. N-type calcium channels are neuronal presynaptic ion channels that regulate neurotransmitter release at many sites in the brain. Mice lacking N-type calcium channels exhibit reduced ethanol consumption and show resistance to the acute intoxicating effects of ethanol. In wild type rodents, pretreatment with a novel N- and T-type calcium channel blocker, NP078585, reduces the intoxicating and reinforcing effects of ethanol and abolishes stress-induced reinstatement of alcohol seeking. Here we discuss these findings and expand upon their implications for the N-type calcium channel as a target for drug development. An important consideration in the development of drugs to treat any addiction is that the medication itself not be addictive. We attempted, and failed, to generate a conditioned place preference for NP078585, suggesting that NP078585 is not rewarding.

Unick GJ, Snowden L, Hastings J. · Department of Psychiatry, University of California, San Francisco, California, USA. · J Nerv Ment Dis. · Pubmed #19363376 No free full text.

Abstract: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly comorbid and, as diagnoses, problematic because they are heterogeneous, may impair functioning even in subclinical manifestations, and may not predict important external criteria as well as empirically-derived classifications. The present study employed a latent class analysis using data from National Comorbidity Survey (1990-1992) and focused on respondents who endorsed at least 1 screening question for MDD and 1 for GAD (N = 1009). Results revealed 4 symptom domains (somatic anxiety, somatic depression, psychological anxiety, and psychological depression) reflecting the heterogeneity of MDD and GAD, and 7 respondent classes. Analysis revealed that people in classes with a high prevalence of either somatic anxiety or somatic depression symptoms presented with the highest levels of disability, distress, and service utilization. Evidence also was found for clinically meaningful subthreshold comorbid conditions. Anxiety-related and depression-related symptoms can be meaningfully differentiated, but differentiating between somatic and psychological symptoms has the greatest practical significance.

Rau V, Oh I, Laster M, Eger EI, Fanselow MS. · Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143-0464, USA. · Anesthesiology. · Pubmed #19212264 No free full text.

Abstract: BACKGROUND: A minority of patients who experience awareness and/or pain during surgery subsequently develop post-traumatic stress disorder. In a rodent model of post-traumatic stress disorder, stress-enhanced fear learning (SEFL), rats are preexposed to a stressor of 15 foot shocks. Subsequent exposure to a single foot shock produces an enhanced fear response. This effect is akin to sensitized reactions shown by some post-traumatic stress disorder patients to cues previously associated with the traumatic event. METHODS: The authors studied the effect of isoflurane and nitrous oxide on SEFL. Rats were exposed to the inhaled anesthetic during or after a 15-foot shock stressor. Then, rats were given a single foot shock in a different environment. Their fear response was quantified in response to the 15-foot shock and single-foot shock environments. SEFL longevity was tested by placing a 90-day period between the 15 foot shocks and the single foot shock. In addition, the intensity of the foot shock was increased to evaluate treatment effectiveness. RESULTS: Increasing isoflurane concentrations decreased SEFL when given during, but not after, the stressor. At 0.40 minimum alveolar concentration (MAC), isoflurane given during the stressor blocked SEFL 90 days later. A threefold increase in the stressor intensity increased the isoflurane concentration required to block SEFL to no more than 0.67 MAC. As with isoflurane, nitrous oxide suppressed SEFL at a similar MAC fraction. CONCLUSIONS: These results suggest that sufficient concentrations (perhaps 0.67 MAC or less) of an inhaled anesthetic may prevent SEFL.

Fisher L, Skaff MM, Mullan JT, Arean P, Glasgow R, Masharani U. · Department of Family & Community Medicine, School of Nursing, University of California, San Francisco, CA 94143, USA. · Diabet Med. · Pubmed #19183314 links to  free full text

Abstract: AIMS: To report the prevalence and correlates of affective and anxiety disorders, depressive affect and diabetes distress over time. METHODS: In a non-interventional study, 506 patients with Type 2 diabetes were assessed three times over 18 months (9-month intervals) for: major depressive disorder (MDD), general anxiety disorder (GAD), panic disorder (PANIC), dysthymia (DYS) (Composite International Diagnostic Interview); depressive affect [Center for Epidemiological Studies-Depression (CES-D)]; Diabetes Distress Scale (DDS); HbA(1c); and demographic data. RESULTS: Diabetic patients displayed high rates of affective and anxiety disorders over time, relative to community adults: 60% higher for MDD, 123% for GAD, 85% for PANIC, 7% for DYS. The prevalence of depressive affect and distress was 60-737% higher than of affective and anxiety disorders. The prevalence of individual patients with an affective and anxiety disorder over 18 months was double the rate assessed at any single wave. The increase for CES-D and DDS was about 60%. Persistence of CES-D and DDS disorders over time was significantly greater than persistence of affective and anxiety disorders, which tended to be episodic. Younger age, female gender and high comorbidities were related to persistence of all conditions over time. HbA(1c) was positively related to CES-D and DDS, but not to affective and anxiety disorders over time. CONCLUSIONS: The high prevalence of comorbid disorders and the persistence of depressive affect and diabetes distress over time highlight the need for both repeated mental health and diabetes distress screening at each patient contact, not just periodically, particularly for younger adults, women and those with complications/comorbidities.

Spira AP, Stone K, Beaudreau SA, Ancoli-Israel S, Yaffe K. · Division of Geriatrics and Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA. · Am J Geriatr Psychiatry. · Pubmed #19155746 No free full text.

Abstract: OBJECTIVES: Few studies have examined the association between anxiety symptoms and objectively measured sleep quality in older adults. The authors determined this association in a large cohort of very old community-dwelling women. DESIGN: Cross-sectional. SETTING: Participants' homes, sites of the Study of Osteoporotic Fractures. PARTICIPANTS: Three thousand forty women (mean age: 83.6 years) enrolled in a prospective study of aging. MEASUREMENTS: Participants completed the Goldberg Anxiety Scale (ANX), the 15-item Geriatric Depression Scale (GDS), and > or = 3 nights of actigraphy--a method of measuring sleep by recording wrist movement with a device called an actigraph. Elevated anxiety symptoms were defined as ANX > or = 6. Elevated depressive symptoms were defined as GDS > or = 6. RESULTS: Participants' mean ANX score was 1.4 (standard deviation: 2.2); 9.2% (N = 280) had ANX > or = 6. Elevated anxiety symptoms were associated with greater odds of poor sleep efficiency (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.34, 2.23) and time awake after sleep onset (OR: 1.64, 95% CI: 1.27, 2.11). Associations remained after adjustment for GDS > or = 6, antianxiety medications, and other potential confounders (sleep efficiency OR: 1.50, 95% CI: 1.15, 1.97; time awake after sleep onset OR: 1.33, 95% CI: 1.01, 1.75). Anxiety symptoms were not associated with other sleep parameters. CONCLUSION: Findings suggest that elevated anxiety symptoms are independently associated with poor objectively measured sleep efficiency and elevated sleep fragmentation in very old women, after accounting for significant depressive symptoms, medical comorbidities, and use of antianxiety medications.

McCaslin SE, Inslicht SS, Metzler TJ, Henn-Haase C, Maguen S, Neylan TC, Choucroun G, Marmar CR. · Mental Health Service, San Francisco VA Medical Center, San Francisco, California 94121, USA. · J Nerv Ment Dis. · Pubmed #19077859 No free full text.

Abstract: The current study prospectively examines the predictive relationship of trait dissociation, assessed during academy training, to PTSD symptoms assessed at 12 months of active police duty in relatively young and healthy police academy recruits (N = 180). The roles of pre-academy trauma exposure, exposure to life-threatening critical incidents during police duty, and peritraumatic dissociation at the time of the officer's worst critical incident were also examined. Utilizing path analytic techniques, greater trait dissociation, assessed during academy training, was predictive of both peritraumatic dissociation, and PTSD symptoms assessed at 12 months of police service. Moreover, after accounting for trait dissociation and peritraumatic dissociation, the relationship of previous trauma to later PTSD symptoms was no longer significant, demonstrating that the effect of previous trauma on later vulnerability to PTSD symptoms in this sample may be mediated by both trait and peritraumatic dissociation.