Anxiety Disorders: University of Minnesota

Adityanjee, Schulz SC. · Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minn 55454-1495, USA. · J Clin Psychiatry. · Pubmed #12562145 No free full text.

Abstract: Although quetiapine was introduced as an atypical antipsychotic drug with clinical efficacy in schizophrenia patients, it has been used in a variety of disease states over the last 5 years. The most common conditions have included mood and anxiety disorders, obsessive-compulsive disorder, aggression, hostility, posttraumatic stress disorder, borderline personality disorder, delirium, and comorbid substance abuse. Considering its efficacy in a wide variety of neuropsychiatric conditions and its excellent tolerability profile, quetiapine could emerge as a broad-spectrum psychotropic medication that may be helpful in psychiatry across various diagnostic categories. Traditionally, studies on the predictive validity of psychiatric disorders help with nosologic issues and controversies. Assessing quetiapine's tolerability and its overall treatment response might help tease out the predictive validity of various psychiatric syndromes (based currently on an atheoretical descriptive approach) and may shape psychiatric nosology in the future. Quetiapine's low affinity and fast dissociation from postsynaptic dopamine-2 receptors give the least risk of producing acute extrapyramidal side effects, tardive dyskinesia, and neuroleptic malignant syndrome. These factors suggest that the clinical utility of quetiapine in psychiatric conditions other than schizophrenia has not been fully exploited thus far.

Mantyh PW. · Department of Preventive Sciences, Psychiatry, and Neuroscience, University of Minnesota, Minneapolis, USA. · J Clin Psychiatry. · Pubmed #12562137 No free full text.

Abstract: Substance P belongs to a group of neurokinins (NKs), small peptides that are broadly distributed in the central nervous system (CNS) and peripheral nervous system (PNS). The biological effects of substance P in the CNS, namely regulation of affective behavior and emesis in the brain and nociception in the spinal cord, are mediated by its binding to the NK1 receptor. The substance P-NK1 (SP-NK1) receptor system is the most extensively studied NK pathway, and in contrast to receptors for other neurotransmitters, such as glutamate, which have high expression throughout the CNS, only a minority of neurons (5% to 7%) in certain CNS areas express the NK1 receptor. The NK1 receptor is distributed in the plasma membrane of cell bodies and dendrites of unstimulated neurons, but upon substance P binding, the NK1 receptor undergoes rapid internalization, followed by rapid recycling to the plasma membrane. Release of substance P is induced by stressful stimuli, and the magnitude of its release is proportional to the intensity and frequency of stimulation. More potent and more frequent stimuli allow diffusion of substance P farther from the site of release, allowing activation of an approximately 3- to 5-times greater number of NK1 receptor-expressing neurons. Recent studies employing pharmacologic or genetic inactivation of NK1 receptors demonstrate the important role of the SP-NK1 receptor system in the regulation of affective behavior and suggest that inhibition of this pathway may be a useful approach to treatment of depression and associated anxiety.

Rassovsky Y, Kushner MG. · Department of Psychology, University of Minnesota, Fairview-University Hospital, F-282-2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA. · J Anxiety Disord. · Pubmed #12464286 No free full text.

Abstract: The carbon dioxide (CO(2)) challenge paradigm has been useful for modeling panic in the laboratory. While showing promise as a technique able to promote a better understanding of the etiology of panic disorder (PD), this goal has been impeded by the lack of standardization of the challenge methodology and by uncertainty concerning the optimal definition and assessment of laboratory panic. The purpose of this paper is to highlight the impact of method variance on laboratory findings and to present recommendations for future challenge research. We begin by reviewing studies that have employed CO(2) as a stimulus for panic provocation focusing on the status of key methodological parameters between the studies and the relationship of these parameters to findings. We then make pragmatic and theoretically-based recommendations concerning approaches to methodological standardization, the establishment of a valid laboratory panic definition and the desirability of using of additional outcome measures. We conclude that although further work is needed to improve the CO(2) challenge laboratory model of panic, this paradigm can play an important role in understanding the psychopathology of PD.

Overmier JB. · Center for Cognitive Sciences, University of Minnesota, Minneapolis, USA. · Integr Physiol Behav Sci. · Pubmed #12069364 No free full text.

Abstract: "Learned helplessness" and its Pavlovian analog, learned irrelevance, are phenomena thought integral to understanding depression, PTSD, psychosomatic vulnerability, and a variety of diseases and immune disorders. The origin and development of research on learned helplessness is briefly overviewed with attention to the reasons for the controversy that surrounds the study of learned helplessness and derived physiological, psychological, and behavioral phenomena. The need to remedy past focus on American research and English language journals in this area is noted. The heuristic value as well as the wide ranging empirical value of the research domain is lauded. The meretricious emerging social and legal barriers to this research are noted to be unrealistic and unfortunate.

Kushner MG, Abrams K, Borchardt C. · Department of Psychiatry, University of Minnesota, Minneapolis 55454, USA. · Clin Psychol Rev. · Pubmed #10721495 No free full text.

Abstract: It is generally agreed that problems related to alcohol use and anxiety tend to occur within the same individual ("comorbidity"); however, the cause of this association remains controversial. Three prominent perspectives are that anxiety disorder promotes pathological alcohol use, that pathological alcohol use promotes anxiety disorder and that a third factor promotes both conditions. We review laboratory, clinical, family, and prospective studies bearing on the validity of these explanatory models. Findings converge on the conclusion that anxiety disorder and alcohol disorder can both serve to initiate the other, especially in cases of alcohol dependence versus alcohol abuse alone. Further, evidence from clinical studies suggests that anxiety disorder can contribute to the maintenance of and relapse to pathological alcohol use. Relying heavily on pharmacological and behavioral laboratory findings, we tentatively propose that short-term anxiety reduction from alcohol use, in concert with longer-term anxiety induction from chronic drinking and withdrawal, can initiate a vicious feed-forward cycle of increasing anxiety symptoms and alcohol use that results in comorbidity.

Sullivan JE, Chang P. · University of Minnesota, USA. · J Pediatr Psychol. · Pubmed #10379143 links to  free full text

Abstract: OBJECTIVE: To examine 17 studies of the psychological sequelae of early-treated phenylketonuria (PKU) with emphasis on the impact of dietary control on functioning. Two questions are addressed: (1) What is the typical psychological profile associated with PKU? (2) Is emotional and behavioral disturbance more prevalent in PKU-affected individuals compared to appropriate controls? METHOD: Computerized searches of PsycINFO identified studies using behavioral, personality, and diagnostic measures. RESULTS: Findings converge upon a profile including attentional difficulties, depression, anxiety, and low self-esteem. Methodological constraints limit conclusions regarding the nature and severity of observed difficulties. A single study has used comparison groups appropriate for the simultaneous examination of the questions posed (Waisbren and Levy, 1991). CONCLUSIONS: We discuss results using a biopsychosocial framework, addressing the factors and processes that may influence emotional and behavioral functioning in this neurodevelopmental disorder. We outline potential lines of new investigation that address critical methodological factors.

Carey JR, Evans CD, Anderson DC, Bhatt E, Nagpal A, Kimberley TJ, Pascual-Leone A. · Program in Physical Therapy, University of Minnesota, Minneapolis 55455, USA. · Neurorehabil Neural Repair. · Pubmed #17876070 No free full text.

Abstract: BACKGROUND: Suppression of activity in the contralesional motor cortex may promote recovery of function after stroke. Furthermore, the known depressant effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) can be increased and prolonged by preceding it with 6-Hz priming stimulation. OBJECTIVE: The authors explored the safety of 6-Hz primed low-frequency rTMS in 10 patients with ischemic stroke. METHODS: Priming consisted of 10 minutes of 6-Hz rTMS applied to the contralesional hemisphere at 90% of resting motor threshold delivered in 2 trains/min with 5 s/train and 25-second intervals between trains. Low-frequency rTMS consisted of an additional 10 minutes of 1-Hz rTMS at 90% of resting motor threshold without interruption. Possible adverse effects were assessed with the National Institutes of Health Stroke Scale (NIHSS), the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), the Hopkins Verbal Learning Test-Revised (HVLT-R), the Beck Depression Inventory-Second Edition (BDI-II), a finger movement tracking test, and individual self-assessments. Pretest, treatment, and posttest occurred on the first day with follow-up tests on the next 5 weekdays. RESULTS: There were no seizures and no impairment of NIHSS, WAIS-III, or BDI-II scores. Transient impairment occurred on the HVLT-R. Transient tiredness was common. Occasional reports of headache, neck pain, increased sleep, reduced sleep, nausea, and anxiety occurred. CONCLUSION: Because there were no major adverse effects, the authors concluded that the treatment was safe for the individuals in this study and that further investigation is now warranted to examine efficacy and safety of serial treatments of 6-Hz primed low-frequency rTMS.

Adson DE, Kushner MG, Fahnhorst TA. · Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Ave., Minneapolis, MN 55454-1495, USA. · J Affect Disord. · Pubmed #15820277 No free full text.

Abstract: BACKGROUND: Depression and anxiety are common disorders and have substantially overlapping symptom complexes. Not surprisingly, treatment approaches are similar for both conditions with the selective serotonin reuptake inhibitors (SSRIs) as the initial therapy of choice. However, after first line treatments have been deployed, residual symptoms are often problematic. Augmentation strategies to address these difficulties are an area of active investigation. This study assessed aripiprazole as adjunctive therapy to SSRIs for patients with persistent anxiety symptoms complicating a depression or anxiety disorder. METHODS: Ten patients who had been receiving SSRIs for at least 6 weeks, but still had clinically significant anxiety symptoms, were enrolled in an open label, flexibly-dosed study of adjunctive aripiprazole. Clinical status was assessed with the Hamilton Anxiety Rating Scale (HAM-A), Montgomery Asberg Rating Scale (MADRS), and Sheehan Disability Scale (SDS). RESULTS: Eighty percent of the subjects had a greater than 50% reduction of symptoms on these outcome measures by week 2 of therapy, and continued with further decrements in symptoms throughout the course of the study. CONCLUSIONS: The results of this trial provide preliminary evidence that aripiprazole may be an effective adjunctive treatment in individuals on SSRIs with residual symptoms of anxiety or depression. More rigorous double-blind studies are warranted to confirm and elucidate the potential role of aripiprazole in these conditions.

Abrams K, Kushner MG. · Department of Psychiatry, University of Minnesota, Fairview-Riverside Hospital, F-282-2A West, 2450 Riverside Avenue, Minneapolis 55455, USA. · Addict Behav. · Pubmed #15236826 No free full text.

Abstract: We conjectured that individual differences in tension-reduction alcohol outcome expectancies (TR-AOEs) could produce widely varying responses to manipulations in alcohol-placebo studies and tested this idea by having individuals with social phobia give speeches in front of a group. One speech occurred before and one after participants consumed either a placebo beverage or a control beverage (i.e., a nonalcoholic drink described as containing no alcohol). Study results indicate that the placebo manipulation reduced cognitive and affective symptoms of anxiety to a greater extent for males with high TR-AOEs than for males with low TR-AOEs. This pattern was not found for women in the placebo group or for individuals in the control group. These findings demonstrate a moderating effect of TR-AOEs on the association between the consumption of a placebo beverage and response to an anxiety challenge and highlight the importance of accounting for gender and outcome expectancies when evaluating psychoactive substances.

Adson DE, Kushner MG, Eiben KM, Schulz SC. · Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota 55454-1495, USA. · Depress Anxiety. · Pubmed #15022147 No free full text.

Abstract: Treatment of depression and anxiety disorders with selective serotonin reuptake inhibitors (SSRIs) has been shown by numerous studies to be generally effective. Less well understood is how clinically to address the residual anxiety symptoms a significant minority of such patients treated with SSRIs continue to experience. We assessed quetiapine as adjunctive therapy to SSRIs for patients with anxiety symptoms complicating a depressive or anxiety disorder. Patients receiving a stable dosage of an SSRI for at least 6 weeks who also had persistent anxiety symptoms (Hamilton Anxiety scale [HAM-A] > or =16), were enrolled in a 9-week, open-label, variable dose study. Changes in clinical status were assessed with the Hamilton Depression Rating Scale (HAM-D), HAM-A, and State Anxiety Inventory (SAI). Statistically and clinically significant reductions of > or =50% in the HAM-D and HAM-A occurred by the second week of treatment in 10 of the 11 patients. These improvements continued throughout the study along with a significant improvement on the SAI scale. The most frequent side effects reported were mild dry mouth, constipation, and transient drowsiness with dose escalation. The results provide evidence that quetiapine may be an effective adjunctive treatment for recalcitrant anxiety symptoms in individuals treated with SSRIs for either anxiety or depressive disorders. Given the open-label design of the trial, more rigorous studies are clearly indicated.

Layne AE, Bernstein GA, Egan EA, Kushner MG. · Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12595785 No free full text.

Abstract: OBJECTIVE: To identify predictors of treatment response to 8 weeks of cognitive-behavioral therapy (CBT) among anxious-depressed adolescents with school refusal, half of whom received imipramine plus CBT and half of whom received placebo plus CBT. METHOD: A hierarchical multiple regression analysis was used to evaluate the following variables as potential predictors of treatment response as measured by school attendance at the end of treatment: baseline severity (school attendance at baseline), drug group (imipramine versus placebo), presence of separation anxiety disorder (SAD), and presence of avoidant disorder (AD). RESULTS: Baseline attendance, CBT plus imipramine, SAD, and AD were significant predictors of treatment response and accounted for 51% of the variance in outcome. Specifically, a higher rate of attendance at baseline and receiving imipramine predicted a better response to treatment whereas the presence of SAD and AD predicted a poorer response to treatment. The relationship between sociodemographic variables and treatment outcome was also evaluated. Age and socioeconomic status were unrelated to school attendance after treatment. Males had significantly higher rates of attendance after treatment than females. CONCLUSIONS: Adolescents with school refusal are a heterogeneous population and require individualized treatment planning. Variables such as diagnosis and severity at the start of treatment should be taken into consideration when planning treatment.

Kim SW, Grant JE. · Department of Psychiatry, University of Minnesota School of Medicine, F256/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454-1495, USA. · Psychiatry Res. · Pubmed #11728609 No free full text.

Abstract: This study was conducted to investigate the similarities and differences in the personality dimensions of patients with pathological gambling disorder (PGD) and obsessive-compulsive disorder (OCD). Thirty-three subjects with PGD, 41 with OCD and 40 normal controls were assessed with the Tridimensional Personality Questionnaire (TPQ), which assesses three personality dimensions: novelty seeking, reward dependence, and harm avoidance. Compared with OCD subjects, PGD subjects expressed significantly greater novelty seeking, impulsiveness, and extravagance. The PGD subjects also reported significantly less anticipatory worry, fear of uncertainty, and harm avoidance than the OCD subjects. Compared with controls, the PGD subjects expressed significantly greater novelty seeking, impulsiveness, and extravagance. These results suggest that the personality dimensions of pathological gamblers may differ significantly from both those of OCD patients and normal controls.

Abrams K, Kushner M, Medina KL, Voight A. · Department of Psychiatry, University of Minnesota, Fairview-Riverside Hospital, F-282-2A West, 2450 Riverside Ave., Minneapolis, MN 55455, USA. · Drug Alcohol Depend. · Pubmed #11543992 No free full text.

Abstract: Individuals with social phobia are at an increased risk for alcohol problems. Individuals with social phobia could increase their risk for pathological alcohol use if they drink as a means of coping with anxiety-provoking social situations. Providing a circumscribed test of this view, we evaluate the effect of alcohol on the intensity of social phobia anxiety responses. Sixty-one individuals with social phobia gave two speech challenges in front of a group ('social anxiety challenge'), one occurring before and one after they consumed either: (a) an alcoholic drink they were told contained alcohol ('alcohol group'), (b) a non-alcoholic drink they were told contained alcohol ('placebo group'), or, (c) a non-alcoholic drink they were told contained no alcohol ('control group'). Both the alcohol group and the placebo group showed greater reduction in performance anxiety from the first to the second speech challenge than did the control group. Further, there was a strong trend in the data for the alcohol group to show greater reduction in performance anxiety from the first to the second speech challenge than did the placebo group. We concluded from these findings that the pharmacologic effects of alcohol and the belief that one consumed alcohol decrease social performance anxiety in an additive fashion. These results provide direct support for the negatively reinforcing properties of alcohol and are consistent with the view that symptom reduction may motivate alcohol use among socially phobic individuals.

Bernstein GA, Hektner JM, Borchardt CM, McMillan MH. · Division of Child and Adolescent Psychiatry, University of Minnesota, Minneapolis, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #11211369 No free full text.

Abstract: OBJECTIVE: To conduct a 1-year follow-up of anxious-depressed school-refusing adolescents who participated in an 8-week study of imipramine versus placebo, each in combination with cognitive-behavioral therapy. METHOD: Sixty-five percent (41 of 63) of the randomly assigned subjects returned for follow-up evaluation, which consisted of diagnostic interviews, clinician rating scales for anxiety and depression, family functioning measure, and a questionnaire regarding interim treatments and school programs. RESULTS: From the adolescent and/or parent perspective, 64.1% met criteria for an anxiety disorder and 33.3% met criteria for a depressive disorder. Remission rates and acquisition rates for specific anxiety and depressive disorders were determined. In the follow-up period, 67.5% received at least one psychotropic medication trial and 77.5% had outpatient therapy. Higher level of somatic complaints on the Anxiety Rating for Children-Revised Physiological subscale at baseline predicted more severe depression on the Children's Depression Rating Scale-Revised at follow-up (p = .029). CONCLUSIONS: In this naturalistic follow-up study, there was high utilization of mental health interventions. In addition, a substantial number of subjects met criteria for anxiety and/or depressive disorders 1 year after treatment. Investigation of duration of acute treatments and evaluation of maintenance treatments for school refusal is needed.

Coleman E, Gratzer T, Nesvacil L, Raymond NC. · Department of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis 55454, USA. · J Clin Psychiatry. · Pubmed #10830149 No free full text.

Abstract: BACKGROUND: Recent reports suggest that individuals with nonparaphilic compulsive sexual behavior can be treated pharmacologically with selective serotonin reuptake inhibitors (SSRIs) to control sexual obsessions and compulsions. However, these medications have produced sexual side effects that may limit long-term use, particularly as individuals strive to reestablish healthy sexual relationships. Nefazodone is an antidepressant that is not associated with the sexual side effects of other SSRIs. We examined retrospective data from our clinic to investigate whether nefazodone has utility in the treatment of nonparaphilic compulsive sexual behavior. METHOD: Fourteen subjects who met DSM-IV criteria for sexual disorder NOS as well as criteria used by our research group for nonparaphilic compulsive sexual behavior and who had been treated with nefazodone were selected from patient charts at our clinic. The treating physician abstracted information from the charts regarding comorbid psychiatric conditions, medication, dosage, treatment response, and side effects. RESULTS: In this study, the mean dosage of nefazodone was 200 mg/day. Of the subjects who remained on long-term nefazodone therapy, 6 (55%) reported good control of sexual obsessions and compulsions, and 5 (45%) reported a remission of sexual obsessions and compulsions. CONCLUSION: Results from this preliminary retrospective study suggest that nefazodone decreases the frequency of sexual obsessions and compulsions but does not produce the undesired sexual side effects caused by SSRI treatment.

Bernstein GA, Anderson LK, Hektner JM, Realmuto GM. · Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis 55454-1495, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #10714047 No free full text.

Abstract: OBJECTIVE: To investigate side effects, medication compliance, and assumption of medication assignment in adolescents taking imipramine versus placebo in a clinical trial. METHOD: Sixty-three anxious-depressed adolescents in an 8-week double-blind study of imipramine versus placebo, each in combination with cognitive-behavioral therapy for school refusal, were evaluated. Measures of side effects, global improvement, family functioning, medication compliance based on pill counts, and guesses of drug assignment (imipramine versus placebo) were analyzed. RESULTS: Mean side effects ratings were significantly higher for the imipramine group compared with the placebo group (p = .001). Side effects were not associated with noncompliance or with dropping out. Oppositional defiant disorder (ODD) in the adolescents was significantly associated with medication noncompliance (p = .036). On the Family Adaptability and Cohesion Evaluation Scale II (FACES II), low family adaptability (i.e., rigidity), low family cohesion (i.e., disengagement), and extreme family type were significantly associated with greater noncompliance with medications. Accuracy rates for guessing medication assignment (imipramine versus placebo) were 66% for subjects, 62.5% for mothers, and 79.5% for the psychiatrist. Logistic regression demonstrated that side effects (p = .005) and global improvement scores (p = .06) predicted the psychiatrist's guesses of drug assignment. CONCLUSIONS: Side effects were not associated with noncompliance. Nonadherence with taking medications was associated with ODD in the adolescents and problematic family functioning on FACES II. The psychiatrist, who was blind to treatment condition, guessed the subjects' medication assignments with high accuracy. Thus, because of expectancy bias, the data support the use of blind independent evaluators for rating changes in medication trials.

Bernstein GA, Borchardt CM, Perwien AR, Crosby RD, Kushner MG, Thuras PD, Last CG. · Division of Child and Adolescent Psychiatry, University of Minnesota, Minneapolis, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #10714046 No free full text.

Abstract: OBJECTIVE: To investigate the efficacy of 8 weeks of imipramine versus placebo in combination with cognitive-behavioral therapy (CBT) for the treatment of school-refusing adolescents with comorbid anxiety and major depressive disorders. METHOD: This was a randomized, double-blind trial with 63 subjects entering the study and 47 completing. Outcome measures were weekly school attendance rates based on percentage of hours attended and anxiety and depression rating scales. RESULTS: Over the course of treatment, school attendance improved significantly for the imipramine group (z = 4.36, p < .001) but not for the placebo group (z = 1.26, not significant). School attendance of the imipramine group improved at a significantly faster rate than did that of the placebo group (z = 2.39, p = .017). Over the 8 weeks of treatment, there was a significant difference between groups on attendance after controlling for baseline attendance; mean attendance rate in the final week was 70.1% +/- 30.6% for the imipramine group and 27.6% +/- 36.1% for the placebo group (p < .001). Defining remission as 75% school attendance, 54.2% of the imipramine group met this criterion after treatment compared with only 16.7% from the placebo group (p = .007). Anxiety and depression rating scales decreased significantly across treatment for both groups, with depression on the Children's Depression Rating Scale-Revised decreasing at a significantly faster rate in the imipramine group compared with the placebo group (z = 2.08, p = .037). CONCLUSIONS: Imipramine plus CBT is significantly more efficacious than placebo plus CBT in improving school attendance and decreasing symptoms of depression in school-refusing adolescents with comorbid anxiety and depression.

Rieke EF, Anderson D. · Regions Hospital, St. Paul, MN, USA. · Am J Occup Ther. · Pubmed #19432051 No free full text.

Abstract: OBJECTIVE: We sought to describe how the sensory processing of adults with obsessive-compulsive disorder (OCD) differs from that of the general population within the context of Dunn's (1997) model of sensory processing and to evaluate the discriminant validity of the Adolescent/Adult Sensory Profile (AASP). METHOD: Using unequal variance ttests, the AASP results of 51 adults with OCD were compared with the means of the AASP standardization study's adult age group. RESULTS: Adults with OCD scored higher than the means of the AASP standardization study's adult age group on sensory sensitivity and sensation avoiding, consistent with predictions based on the OCD literature. Adults with OCD also scored higher on low registration and lower on sensation seeking. CONCLUSIONS: The results provide a preliminary description of how the sensory processing of adults with OCD differs from that of the general population and preliminary support for the AASP's discriminant validity.

Schwebke KE. · Department of Medicine, Division of Infectious Diseases, Hennepin County Medical Center Coinfection Clinic, Minneapolis, USA. · Am J Nurs. · Pubmed #19411903 No free full text.

This publication has no abstract.

Kushner MG, Sletten S, Donahue C, Thuras P, Maurer E, Schneider A, Frye B, Van Demark J. · University of Minnesota, Department of Psychiatry, Fairview-Riverside Hospital, F-282-2A West, 2450 Riverside Ave., Minneapolis, MN 55455, United States. · Addict Behav. · Pubmed #19349122 No free full text.

Abstract: Anxiety disorders commonly co-occur with alcohol use disorders and reliably mark a poor response to substance abuse treatment. However, treating a co-occurring anxiety disorder does not reliably improve substance abuse treatment outcomes. Failure to account for individual differences in the functional dynamic between anxiety symptoms and drinking behavior might impede the progress and clarity of this research program. For example, while both theory and research point to the moderating role of tension-reduction alcohol outcome expectancies (TR-AOEs) in the association between anxiety symptoms and alcohol use, relevant treatment studies have not typically modeled TR-AOE effects. We examined the impact of a hybrid cognitive-behavioral therapy (H-CBT) treatment for panic disorder (independent variable) on response to a community-based alcohol dependence treatment program (dependent variable) in patients with higher vs. lower TR-AOEs (moderator). The H-CBT treatment was generally effective in relieving participants' panic symptoms relative to controls. However, TR-AOEs interacted with study cohort (H-CBT vs. control) in predicting response to substance abuse treatment. As expected, the H-CBT was most effective in improving alcohol use outcomes among those with the highest TR-AOEs. The study's primary methodological limitations are related to the quasi-experimental design employed.

Chlan L. · University of Minnesota, School of Nursing, 5-160 Weaver-Densford Hall, 308 Harvard St. SE, Minneapolis, MN 55455, USA. · Arch Psychiatr Nurs. · Pubmed #19327560 No free full text.

Abstract: Critically ill patients receiving mechanical ventilatory support experience profound anxiety with this common treatment modality. Music intervention is one adjunctive therapy that can be implemented to allay anxiety. This article reviews the evidence support music as an adjunctive intervention with mechanically ventilated patients.

Gross CR, Kreitzer MJ, Reilly-Spong M, Winbush NY, Schomaker EK, Thomas W. · Dept of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis 55455, USA. · Clin Trials. · Pubmed #19254938 No free full text.

Abstract: BACKGROUND: Solid organ transplant recipients must take immune suppressive medications that have side effects, cause complications, and lead to distressing symptoms that reduce health-related quality of life (QOL). Mindfulness meditation has been shown to reduce these symptoms in other patient populations, and it is unlikely to interfere with the immune suppressive medication regimen. PURPOSE: This article describes the design and rationale of a clinical trial to determine whether training in mindfulness meditation can reduce depression, anxiety and insomnia after transplantation, and summarizes baseline characteristics of the participants. METHODS: Transplant recipients were randomized in equal numbers to one of three arms: a Mindfulness-based Stress Reduction (MBSR) program consisting of 8 weeks of group instruction, home practice and telephone monitoring; a time and attention control Health Education program; or a waitlist arm. After serving 6 months as waitlist controls, these participants were re-randomized to MBSR or Health Education. Evaluations were obtained at baseline (prior to the active interventions), 8 weeks, 6 months, and 1 year (after randomization to MBSR or Health Education only). The primary analysis will compare composite symptom scores between MBSR and Health Education, initially or after serving in the waitlist. Subsequent analyses will compare these two groups on depression, anxiety, and insomnia symptom scales and secondary outcomes of health-related QOL, actigraphy, and health care utilization. A separate analysis, using only data collected before re-randomization, will compare short-term outcomes between the waitlist and active treatment arms. RESULTS: One hundred fifty recipients were randomized and 72% of waitlist participants (31/43) were recycled to an active intervention after 6 months. Patient characteristics were balanced across trial arms after initial and secondary randomizations. LIMITATIONS: Transplant recipients are a very select population. Their adherence to the intervention and willingness to serve as waitlist controls prior to re-randomization may be atypical. Participants were not blinded to treatment and primary outcomes are self-reports. CONCLUSION: The innovative design used in the trial enabled the waitlist group to directly contribute to the number in the primary analysis of active arms, and to also serve as an internal validation test. The trial may be a useful model for trials involving very small target populations.

Grant JE, Desai RA, Potenza MN. · Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454, USA. · J Clin Psychiatry. · Pubmed #19254518 No free full text.

Abstract: OBJECTIVE: Nicotine dependence frequently co-occurs with subsyndromal and pathological levels of gambling. The relationship of nicotine dependence, levels of gambling pathology, and other psychiatric disorders, however, is incompletely understood. METHOD: To use nationally representative data from the National Epidemiologic Survey on Alcohol and Related Conditions to examine the influence of DSM-IV nicotine dependence on the association between pathological gambling severities and other psychiatric disorders. Face-to-face interviews were conducted with 43,093 adults living in households and group-quarters in the United States. The main outcome measure was the co-occurrence of current nicotine dependence and Axis I and II disorders and severity of gambling based on the 10 inclusionary diagnostic criteria for pathological gambling. The study was conducted from 2001 to 2002. RESULTS: Among non-nicotine-dependent respondents, increasing gambling severity was associated with greater psychopathology for the majority of Axis I and II disorders. This pattern was not uniformly observed among nicotine-dependent subjects. Significant nicotine-by-gambling-group interactions were observed for multiple Axis I and II disorders. All significant interactions involved stronger associations between gambling and psychopathology in the non-nicotine-dependent group. CONCLUSIONS: In a large national sample, nicotine dependence influences the associations between gambling and multiple psychiatric disorders. Subsyndromal levels of gambling are associated with significant psychopathology. Nicotine dependence accounts for some of the elevated risks for psychopathology associated with subsyndromal and problem/pathological levels of gambling. Additional research is needed to examine specific prevention and treatment for individuals with problem/pathological gambling with and without nicotine dependence.

Grant JE, Kim SW, Odlaug BL. · Department of Psychiatry, University of Minnesota School of Medicine, 2450 Riverside Avenue, Minneapolis, MN 55454, USA. · Biol Psychiatry. · Pubmed #19217077 No free full text.

Abstract: BACKGROUND: Kleptomania is a rare psychiatric disorder characterized by recurrent stealing and for which there exists no empirically validated treatments. This study examined the efficacy and tolerability of the opioid antagonist naltrexone in adults with kleptomania who have urges to steal. METHODS: An 8-week, double-blind, placebo-controlled trial was conducted to evaluate the safety and efficacy of oral naltrexone for kleptomania. Twenty-five individuals with DSM-IV kleptomania were randomized to naltrexone (dosing ranging from 50 mg/day to 150 mg/day) or placebo. Twenty-three subjects (92%) completed the study. Subjects were assessed every 2 weeks with the Yale Brown Obsessive Compulsive Scale Modified for Kleptomania (K-YBOCS), the urge and behavior subscales of the K-YBOCS, the Kleptomania Symptom Assessment Scale (K-SAS), the Clinical Global Impressions Scale (CGI), and measures of depression, anxiety, and psychosocial functioning. RESULTS: Subjects assigned to naltrexone had significantly greater reductions in K-YBOCS total scores (p = .001), stealing urges (p = .032), and stealing behavior (p < .001) compared with subjects on placebo. Subjects assigned to naltrexone also had greater improvement in overall kleptomania severity (reflected in the CGI scores) (p < .001). The mean effective dose of naltrexone was 116.7 (+/-44.4) mg/day. CONCLUSIONS: Naltrexone demonstrated statistically significant reductions in stealing urges and behavior in kleptomania. Naltrexone was well tolerated.

Kim SW, Grant JE, Potenza MN, Blanco C, Hollander E. · Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454, USA. · Psychiatry Res. · Pubmed #19200607 No free full text.

Abstract: Two hundred seven patients with DSM-IV Pathological Gambling Disorder completed both the Gambling Symptom Assessment Scale (G-SAS) and the Yale-Brown Obsessive-Compulsive Scale--modified for Pathological Gambling (PG-YBOCS) at baseline visit and weekly or biweekly thereafter during the 12-week study period. The week 1 to week 2 visit data were used to assess test-retest reliability. Weekly or biweekly data were used for the G-SAS validity. The PG-YBOCS reliability and validity data have been published previously. We used the PG-YBOCS as the established scale and compared the G-SAS performance with the PG-YBOCS. Test-retest reliability was statistically significant. The correlations between the G-SAS and the PG-YBOCS and Clinical Global Impression rating were excellent. Findings suggest that the G-SAS is reliable and valid in assessing changes in symptoms during a drug treatment study.