Anxiety Disorders: University of Pennsylvania

Silver J, Dicker S. · Starting Young Program, Department of Psychology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. · Child Welfare. · Pubmed #18422047 No free full text.

Abstract: Infants placed in foster care are at high risk for emotional and behavioral problems. Assessment of their mental health must account for their often-adverse life experiences prior to placement and the involvement of multiple systems that shape their lives in lieu of parents' authority. This article presents practice guidelines for infant mental health evaluations with consideration of legal requirements and the unique issues conferred by foster care.

Foa EB, Cahill SP, Boscarino JA, Hobfoll SE, Lahad M, McNally RJ, Solomon Z. · Department of Psychiatry, University of Pennsylvania, 3535 Market Street 6th Floor, Philadelphia, PA 19104, USA. · Neuropsychopharmacology. · Pubmed #16012536 links to  free full text

Abstract: The terrorist attacks of September 11, 2001, and the constant threat of imminent terrorist activity have brought into the forefront the urgent need to prepare for the consequences of such attacks. Such preparation entails utilization of existing knowledge, identification of crucial gaps in our scientific knowledge, and taking steps to acquire this knowledge. At present, there is little empirical knowledge about interventions following terrorism and absolutely no available empirical knowledge about interventions following bioterrorism. Therefore, this paper reviews knowledge about (1) reactions following the September 11 terrorist attacks in New York City and other places, (2) the practical experiences accumulated in recent years in countries (eg, Israel) that have had to cope with the threat of bioterrorism and the reality of terrorism, and (3) interventions for acute and chronic stress reactions following other types of traumatic events (eg, rape, war, accidents). Our review found several treatments efficacious in treating individuals for acute and chronic post-traumatic stress disorder (PTSD) related to other traumatic events that will likely be efficacious in treating PTSD related to terrorist attacks. However, there were significant gaps in our knowledge about how to prepare populations and individuals for the possibility of a terrorist attack and what interventions to apply in the immediate aftermath of such an attack. Accordingly, we conclude the paper with several questions designed to guide future research.

Jolin EM, Weller RA, Weller EB. · Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA. · Curr Psychiatry Rep. · Pubmed #19302762 No free full text.

Abstract: Velocardiofacial syndrome, now known as 22q11.2 deletion syndrome (22qDS), is estimated to affect more than 700 children born in the United States each year. Some clinical studies have found increased rates of schizophrenia in adults with 22qDS. However, these studies have been limited by small sample size and possible ascertainment bias. The psychiatric disorders most commonly reported in children and adolescents with 22qDS have been attention-deficit/hyperactivity disorder, oppositional defiant disorder, anxiety disorders, and major depression. Psychotic symptoms have been observed in 14% to 28% of children with 22qDS, but their clinical significance remains uncertain. A 5-year follow-up study of 22qDS children who reported psychotic symptoms at baseline found they had an increased risk for a subsequent psychotic disorder. Thus, a broad differential diagnosis should be considered when 22qDS children present with psychotic symptoms. Longitudinal studies are needed to better understand the full extent of the psychopathology associated with 22qDS.

Kim DR, Connolly KR, Cristancho P, Zappone M, Weinrieb RM. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. · Arch Womens Ment Health. · Pubmed #19263196 No free full text.

Abstract: The request for a psychiatric examination of patients with hyperemesis gravidarum (HG) is a unique challenge for the psychiatric consultant. Unfortunately, there are little data in the psychosomatic medicine literature to guide diagnostic evaluations and treatment of patients with HG. In this article, we summarize the existing literature and propose a practical approach to such patients based on the literature and our clinical experience.

Ruckenstein MJ, Staab JP. · Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, 3400 Spruce Street, 5 Silverstein, Philadelphia, PA 19104, USA. · Otolaryngol Clin North Am. · Pubmed #19134491 No free full text.

Abstract: This article reviews the authors' work, which expands on previous studies to confirm that anxiety-related processes cause or maintain symptoms of dizziness. Discussed are interventions directed at patients' underlying psychologic disorders, including current methods of pharmacotherapy and psychotherapy. Patients with chronic complaints of nonspecific dizziness can present frustrating diagnostic and therapeutic challenges, but can be offered definitive and palliative care. The authors emphasize the importance of eliciting a precise description of the dizziness sensation from the patient as the critical factor in delineating the specific diagnosis and guiding treatment.

Cuellar NG. · School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. · AAOHN J. · Pubmed #18717302 No free full text.

Abstract: Mindfulness meditation (MfM) is a mind-body therapy identified by the National Center for Complementary and Alternative Medicine. Initially taught in a formal classroom setting, MfM is a sustainable intervention with minimal costs that can be used over time. For veterans, after mastery, this technique shows promise in improving health outcomes and quality of life. This article describes MfM, discusses the conceptual framework and evidence-based research for MfM, and identifies the implications of MfM use by health care providers who are caring for war veterans.

Lohoff FW, Rickels K. · University of Pennsylvania School of Medicine Mood and Anxiety Disorders Section, Department of Psychiatry, Center for Neurobiology and Behavior, Translational Research Laboratories, Philadelphia, PA 19104, USA. · Expert Opin Pharmacother. · Pubmed #18671467 No free full text.

Abstract: Major depressive disorder (MDD) remains one of the most common psychiatric disorders with high morbidity and mortality. Effective treatment is limited and response/remission to antidepressant pharmacotherapy remains poor and unpredictable. The development of new antidepressants is thus of great importance to the field. Desvenlafaxine succinate (DVS) is the active metabolite of the serotonin and noradrenaline re-uptake inhibitor venlafaxine and was recently FDA approved for the treatment of MDD. DVS showed efficacy in clinical trials in MDD with doses ranging from 50 - 400 mg. Advantages compared to other antidepressants include once daily dosing at effective doses, no CYP450 metabolism and low drug-drug interactions. Concerns include side effect profile and moderate efficacy. DVS might be a useful addition to the arsenal of antidepressants available to the clinician. Additional studies, in particular head-to-head comparison to other antidepressants and long-term treatment studies, will be necessary to comprehensively evaluate DVS safety and efficacy for clinical practice.

O'Brien CP, McLellan AT, Childress AR, Woody GE. · University of Pennsylvania, Treatment Research Center, 3900 Chestnut Street, Philadelphia, PA 19104-6178, USA. · Neuropharmacology. · Pubmed #18625251 No free full text.

Abstract: The Penn/VA Center was founded in 1971 because of great concern over the number of Vietnam veterans returning home addicted to heroin. At that time little was known about the science of addiction, so our program from the very beginning was designed to gather data about the nature of addiction and measure the effects of available treatments. In other words, the goals were always a combination of treatment and research. This combination has continued to the present day. A human laboratory for the study of addiction phenomena such as conditioned responses was also founded in 1971. The key clinician investigators in this group have remained in the Center since the 1970s with most of the research staff continuing to work together. Important new investigators have been added over the years. Treatment was empirically based with randomized, controlled clinical trials as the gold standard for determining evidence-based treatment. The patients coming to treatment do not distinguish between abuse of alcohol and other drugs, so the treatment and research programs have always focused on all drugs including ethyl alcohol and the combination of ethyl alcohol with other drugs such as cocaine and opioids. Most of the patients coming for treatment also suffered from additional psychiatric disorders such as depression, anxiety, bipolar disorder or schizophrenia. Thus, the addiction treatment program in 1980 absorbed the rest of the VA Psychiatry Service into the Substance Abuse Program forming a new Behavioral Health Service with responsibility for over 9000 patients. The integration of substance abuse treatment with overall mental health care was the most efficient way to handle patients with complicated combinations of disorders. While this continues to be the best way to treat patients, it has proven difficult in practice. The main reason for this difficulty is that most mental health therapists whether they are psychiatrists, psychologists or social workers feel very inadequate to handle substance abuse problems. Unless they have had specialized training in addictive disorders, therapists are likely to be uncomfortable if substance abuse is one of the diagnoses while they may be quite comfortable treating other complex disorders such as schizophrenia. This lack of education of clinicians remains a major problem for our field. Some of the findings that came out of both the Penn/VA laboratory and clinical studies are now widely accepted and form the basis of standard clinical practice. These concepts and evidence will be briefly reviewed below.

Jolin EM, Weller EB, Weller RA. · Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, 3440 Market Street, Philadelphia, PA 19104, USA. · Curr Psychiatry Rep. · Pubmed #18474202 No free full text.

Abstract: Anxiety disorders are relatively common in children and adolescents with bipolar disorder. Research to date indicates they may impact the onset, course, and treatment response of bipolar illness in children. Anxiety disorders often precede the onset of pediatric bipolar disorder. Family studies suggest first-degree relatives of bipolar patients are at increased risk for developing mood and anxiety disorders compared with relatives of individuals without mood disorders. Childhood adversity has been associated with higher rates of comorbid anxiety disorders and more severe illness course in bipolar patients. Preliminary study of the neurobiology of bipolar disorder with comorbid anxiety disorders suggests it may be neurophysiologically distinct from bipolar disorder without comorbid anxiety. Bipolar disorder with comorbid anxiety disorders has been associated with greater functional impairment and slower recovery. Prospective, longitudinal studies are needed to help us better understand the relationship between bipolar disorder and comorbid anxiety disorders so that opportunities for early intervention and effective treatment can be realized.

Pak VM, O'Hara M, McCauley LA. · University of Pennsylvania, Philadelphia, PA , USA. · AAOHN J. · Pubmed #18444404 No free full text.

Abstract: The attacks on the World Trade Center in 2001 resulted in hazardous environmental exposures of enormous magnitude, bringing about persistent respiratory and psychological problems among survivors. Approximately 40,000 men and women worked at Ground Zero, the former site of the World Trade Center in New York City, and at the Staten Island landfill, the main wreckage depository, in the days, weeks, and months following 9/11. First responders such as firefighters and police, construction workers, and utility and public sector workers were involved. These individuals were at high risk for injury, respiratory complications, and psychological distress from the traumatic event. This article highlights the controversy surrounding 9/11 research and reports, identifies populations at high risk for exposure, and examines the health effects. Occupational health nurses should not only be empowered to provide the best care for workers affiliated with 9/11, but also contribute to research to protect worker health in future disaster responses.

Hersh EV, Balasubramaniam R, Pinto A. · Department of Oral Surgery and Pharmacology, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104-6030, USA. · Oral Maxillofac Surg Clin North Am. · Pubmed #18343325 No free full text.

Abstract: Although there are theoretically numerous pharmacologic targets for relieving temporomandibular disorder (TMD)-associated pains, evidence-based literature clearly establishing the efficacy and safety of drugs in the TMD population is limited at best. This article reviews the pharmacology, toxicology, and research supporting the use of a host of pharmacologic agents that have been used in patients who have TMD, including nonsteroidal anti-inflammatory drugs, corticosteroids, benzodiazepines, nonbenzodiazepine sedative hypnotics, opioids, skeletal muscle relaxants, capsaicin, transdermal lidocaine, antidepressants, and anticonvulsants. Recommendations regarding the proper use of each drug class are also made.

Hanisch LJ, Hantsoo L, Freeman EW, Sullivan GM, Coyne JC. · Department of Psychiatry, University of Pennsylvania, USA. · Psychol Bull. · Pubmed #18298271 No free full text.

Abstract: Despite decades of research, the causal mechanisms of hot flashes are not adequately understood, and a biopsychosocial perspective on hot flashes remains underdeveloped. This article explores overlooked parallels between hot flashes and panic attacks within 5 areas: course and symptomatology, physiological indicators, neurocircuitry and biochemical mechanisms, pharmacotherapy, and psychological treatment, noting both similarities and important differences between the 2 events. An integrative conceptual model is presented that identifies key ways in which psychological factors may influence the experience of hot flashes, with clinical implications and areas of future research. This model yields readily testable hypotheses and may provide a template for exploring the role of cognition in the frequency and severity of hot flashes and, in turn, a basis for the development of nonpharmacological treatments.

Abel T, Zukin RS. · Department of Biology, University of Pennsylvania, 204G Lynch Laboratories, 433 South University Avenue, Philadelphia, PA 19104-6018, USA. · Curr Opin Pharmacol. · Pubmed #18206423 links to  free full text

Abstract: Epigenetic chromatin remodeling and modifications of DNA represent central mechanisms for regulation of gene expression during brain development and in memory formation. Emerging evidence implicates epigenetic modifications in disorders of synaptic plasticity and cognition. This review focuses on recent findings that HDAC inhibitors can ameliorate deficits in synaptic plasticity, cognition, and stress-related behaviors in a wide range of neurologic and psychiatric disorders including Huntington's disease, Parkinson's disease, anxiety and mood disorders, Rubinstein-Taybi syndrome, and Rett syndrome. These agents may prove useful in the clinic for the treatment of the cognitive impairments that are central elements of many neurodevelopmental, neurological, and psychiatric disorders.

Meltzer LJ, Moore M. · The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. · J Pediatr Psychol. · Pubmed #18084038 No free full text.

Abstract: OBJECTIVE: Provide a comprehensive review of the existing literature on the prevalence, causes, and consequences of sleep disruptions in parents of youth with chronic illnesses. METHODS: A comprehensive literature search of PsychInfo, MEDLINE, and CINAHL for articles related to sleep in parents of youth with chronic illnesses yielded 59 potential articles, with 19 meeting inclusion criteria. RESULTS: Parents of children with eczema were the most commonly studied group. The prevalence of sleep disruptions was 15-86%. Potential causes of parent sleep disruptions included nighttime caregiving, monitoring of the child's illness, and stress related to the child's illness. Consequences included poor sleep quality, depression, and anxiety. CONCLUSIONS: Parents of youth with chronic illnesses experience sleep disruptions, providing a potential mechanism to explain elevated rates of negative daytime functioning found in previous studies. To provide interventions and support for these parents, additional research is needed to address the limitations of the existing literature.

Kazak AE, Baxt C. · The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. · Pediatr Blood Cancer. · Pubmed #17943959 No free full text.

Abstract: Despite unique vulnerabilities in infants and young children, little research has been devoted to understanding the psychological impact of the diagnosis of cancer in this age group. We outline psychological factors affecting very young cancer patients and their families, using the broader literature on psychological adjustment of children and adolescents with cancer and their families, and a post-traumatic stress model for understanding likely reactions of children and families. Examples of evidence-based interventional approaches relevant to families of young children with cancer are presented.

Kersun LS, Shemesh E. · Division of Oncology, The Children's Hospital of Philadelphia, 4th Floor Wood Building, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA. · Pediatr Clin North Am. · Pubmed #17933618 No free full text.

Abstract: A significant component of palliative care is the prompt diagnosis and management of distress, anxiety, and depression. This article reviews the symptoms and treatment of anxiety and depressive disorders in children at the end of life. Distinguishing between symptoms and disorders, the importance of open communication, consideration of the child's understanding of death, diagnostic challenges in chronically ill children, and suicidality are discussed. Because treatment options are available, it is imperative that symptoms are recognized and addressed. Understanding the issues involved in screening and diagnosis and the risks and benefits of available treatments can lead to an informed approach to the management of these disorders in the palliative care setting.

Huppert JD, Siev J, Kushner ES. · University of Pennsylvania School of Medicine, Pennsylvania, USA. · J Clin Psychol. · Pubmed #17828763 No free full text.

Abstract: Evidence-based practice suggests that clinicians should integrate the best available research with clinical judgment and patient values. Treatment of religious patients with scrupulosity provides a paradigmatic example of such integration. The purpose of this study is to describe potential adaptations to make exposure and response prevention, the first-line treatment for obsessive-compulsive disorder, acceptable and consistent with the values of members of the Ultra-Orthodox Jewish community. We believe that understanding these challenges will enhance the clinician's ability to increase patient motivation and participation in therapy and thereby provide more effective treatment for these and other religious patients.

Gibbons MB, Crits-Christoph P, Hearon B. · Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. · Annu Rev Clin Psychol. · Pubmed #17716035 No free full text.

Abstract: The goal of the current review is to examine the evidence for the efficacy of dynamic psychotherapy, primarily focusing on studies that meet the rigorous criteria proposed by Chambless & Hollon (1998). We examine whether any progress has been made over the past decade in evaluating the efficacy of dynamic psychotherapy using well-controlled randomized designs. Over the past decade, multiple studies have been published supporting the efficacy of dynamic psychotherapy for the treatment of specific mental disorders. Dynamic psychotherapy should now be included as a possibly efficacious treatment for panic disorder and borderline personality disorder, as well as the original designation of possibly efficacious in the treatment of opiate dependence. In the context of medication usage, dynamic psychotherapy should be considered efficacious in the treatment of major depressive disorder (MDD). Studies suggest that dynamic psychotherapy has great promise as a monotherapy for MDD and alcohol dependence and thus should be evaluated further.

Khalid-Khan S, Santibanez MP, McMicken C, Rynn MA. · Department of Psychiatry, Mood and Anxiety Disorders Clinic, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. · Paediatr Drugs. · Pubmed #17705562 No free full text.

Abstract: Social anxiety disorder (SOC) is characterized by marked and persistent fear of one or more social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny. The person fears that she or he might act in a way that will be humiliating or embarrassing. Children and adolescents with this disorder often have great impairment in their academic performance, social skills, peer relationships, and family life. Early diagnosis is vital. Primary care providers are in a unique situation to first diagnose and treat SOC in children and adolescents. There is evidence of successful pharmacologic and psychosocial treatment in pediatric SOC. Serotonin reuptake inhibitors, which are considered first-line medications for SOC, have shown promising results in open-label and double-blind trials. Studies have demonstrated that psychosocial treatments, specifically cognitive-behavioral therapy and group therapy, are efficacious in pediatric SOC. There is some evidence that the use of combination therapy, both pharmacology and psychosocial treatment, is beneficial in the management of pediatric SOC.

Thase ME. · Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19380, USA. · J Clin Psychiatry. · Pubmed #17640153 No free full text.

Abstract: The term atypical depression dates to the first wave of reports describing differential response to monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). In contrast to more TCA-responsive depressions, patients with so-called atypical symptoms (e.g., hypersomnia, interpersonal sensitivity, leaden paralysis, increased appetite and/or weight, and phobic anxiety) were observed to be more responsive to MAOIs. After several decades of controversy and debate, the phrase "with atypical features" was added as an episode specifier in the DSM-IV in 1994. The 1-year prevalence of the defined atypical depression subtype is approximately 1% to 4%; around 15% to 29% of patients with major depressive disorder have atypical depression. Hardly "atypical" in contemporary contexts, atypical depression also is common in dysthymic bipolar II disorders and is notable for its early age at onset, more chronic course, and high rates of comorbidity with social phobia and panic disorder with agoraphobia. The requirement of preserved mood reactivity is arguably the most controversial of the DSM-IV criteria for atypical depression. When compared with melancholia, the neurobiological profiles of patients with atypical depression are relatively normal. The utility of the atypical depression subtype for differential therapeutics diminished substantially when the TCAs were supplanted as first-line antidepressants by the selective serotonin reuptake inhibitors. Although introduction of safer MAOIs has fostered renewed interest in atypical depression, the validity and importance of the DSM-IV definition of atypical depression for the nosology of affective illness remains an open question.

Kazak AE, Rourke MT, Alderfer MA, Pai A, Reilly AF, Meadows AT. · The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. · J Pediatr Psychol. · Pubmed #17626069 No free full text.

Abstract: OBJECTIVE: This paper describes the translation of psychological research into clinical services in pediatric oncology, based on two decades of research and clinical services in the Division of Oncology at The Children's Hospital of Philadelphia (CHOP). METHOD: Two models helpful in conceptualizing clinical care underlying intervention work at CHOP are summarized: The Pediatric Psychosocial Preventative Health Model (PPPHM; Kazak, 2006) and the Medical Traumatic Stress Model, specific to pediatric illness and injury (Kazak, Kassam-Adams et al., 2006). RESULTS: Integration of these two models offers a "blueprint" for development and evaluation of services to children with cancer and their families relevant for all families across the complete spectrum of disease and treatment. CONCLUSION: The dissemination of evidence-based psychosocial practice in pediatric oncology remains a large and challenging goal. The proposed blueprint may facilitate collaborative work to help assure that children with cancer and their families have access to evidence-based care.

Weintraub D, Stern MB. · University of Pennsylvania School of Medicine, Department of Psychiatry, 3535 Market Sreet, Room 3003, Philadelphia, PA 19104, USA. · Expert Rev Neurother. · Pubmed #17563252 No free full text.

Abstract: Although Parkinson's disease is considered a movement disorder, it has a wide range and high prevalence of affective, psychotic, cognitive, behavioral and sleep-related features. To treat such features, agents including antidepressants, anxiolytics, antipsychotics and cognition-enhancing agents are commonly prescribed, although the targeted syndromes are often incompletely understood and controlled studies demonstrating a treatment's efficacy and tolerability in Parkinson's disease patients are often lacking. Nevertheless, the available information does suggest the outlines of management methods, pending expanded research to identify optimal strategies specific to Parkinson's disease.

Kersun LS, Elia J. · Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. · Pediatr Blood Cancer. · Pubmed #17437286 No free full text.

Abstract: This review of depressive symptoms in pediatric cancer patients describes the challenge of recognizing depression in this group, prevalence, risk factors, and treatment, primarily with the selective serotonin reuptake inhibitors (SSRIs). Pediatric oncologists prescribe SSRIs, but there is limited data regarding their use in this setting. Adverse effects, pharmacokinetics and metabolism of SSRIs are reviewed to provide a reference for physicians and inform choices for SSRI prescription. Ongoing research includes incorporation of routine screening measures for depression and future studies might focus on physician recognition and prospectively evaluating treatment for children with cancer and depressive symptoms.

Benton TD, Ifeagwu JA, Smith-Whitley K. · Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. · Curr Psychiatry Rep. · Pubmed #17389120 No free full text.

Abstract: A growing body of evidence suggests that depressive disorders and anxiety disorders are much more prevalent among medically ill children and adolescents when compared with the general population, and that the presence of comorbidity may adversely affect medical outcomes and quality of life. Whereas the prevalence and impact of anxiety and depressive disorders have been described in chronic conditions such as asthma, diabetes, and epilepsy, much less is known about sickle cell disease (SCD), a disorder that affects more than 70,000 Americans, primarily those of African and Mediterranean descent. A hallmark of this disorder is recurrent, acute, and chronic pain that often requires emergency management and hospitalization. Medical advances in the treatment of this illness have transformed SCD from a condition associated with very early morbidity and mortality into a chronic condition of adulthood. This article reviews the evidence describing our knowledge of anxiety and depression in children and adolescents with SCD, its clinical impact, and effectiveness of interventions.

Michels G, Moss SJ. · Department of Neuroscience, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104-6074, USA. · Crit Rev Biochem Mol Biol. · Pubmed #17364682 No free full text.

Abstract: Fast synaptic inhibition in the brain and spinal cord is mediated largely by ionotropic gamma-aminobutyric acid (GABA) receptors. GABAA receptors play a key role in controlling neuronal activity; thus modulating their function will have important consequences for neuronal excitation. GABAA receptors are important therapeutic targets for a range of sedative, anxiolytic, and hypnotic agents and are involved in a number of CNS diseases, including sleep disturbances, anxiety, premenstrual syndrome, alcoholism, muscle spasms, Alzheimer's disease, chronic pain, schizophrenia, bipolar affective disorders, and epilepsy. This review focuses on the functional and pharmacological properties of GABAA receptors and trafficking as an essential mechanism underlying the dynamic regulation of synaptic strength.