Anxiety Disorders: University of Pennsylvania

Foa EB. · Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia 19104, USA. · J Clin Psychiatry. · Pubmed #17092193 No free full text.

Abstract: Controlled clinical trials in social anxiety disorder (SAD) have shown benefit with the use of medication and cognitive-behavioral therapies as well as incorporation of combined therapeutic modalities. This article briefly summarizes the literature on the outcome of group and individual cognitive-behavioral therapy for SAD and concludes that individual therapy is superior to group therapy. Finally, the article discusses comorbidity of depression and SAD and its implications for cognitive-behavioral therapy.

Coyne JC, Thompson R. · Department of Psychiatry, University of Pennsylvania School of Medicine, 3400 Spruce St., 11 Gates, Philadelphia, PA 19014, USA. · J Anxiety Disord. · Pubmed #17084064 No free full text.

Abstract: The articles in this special issue provide a wide range of challenges to current conceptions, nosology, and assessment procedures for posttraumatic stress disorders. At best, they overcome the negative heuristic posed by these disorders, reopening issues that have preemptively been closed about dissociation, the presumed causal connection between a life threatening event and the symptoms of posttraumatic stress disorders, and the adequacy of checklist assessments of symptoms. They note discontinuities between current thinking about these disorders and the dominant thinking of the past. We make recommendations for more studies that similarly challenge the validity of current conceptions of posttraumatic disorders and dissociation, and the adequacy of checklist assessments of symptoms. With this goal, we note the value of studying ersatz posttraumatic stress response. Finally, we call for greater transparency in this literature with author disclosure of activity as expert witnesses.

Cahill SP, Foa EB, Hembree EA, Marshall RD, Nacash N. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. · J Trauma Stress. · Pubmed #17075914 No free full text.

Abstract: Since the introduction of posttraumatic stress disorder (PTSD) into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980), considerable research has demonstrated the efficacy of several cognitive-behavioral therapy (CBT) programs in the treatment of chronic PTSD. Among these efficacious treatments is exposure therapy. Despite all the evidence for the efficacy of exposure therapy and other CBT programs, few therapists are trained in these treatments and few patients receive them. In this article, the authors review extant evidence on the reasons that therapists do not use these treatments and recent research on the dissemination of efficacious treatments of PTSD.

Baldassano CF. · Department of Psychiatry, Outpatient Program, University of Pennsylvania, PA, USA. · J Clin Psychiatry. · Pubmed #17029490 No free full text.

Abstract: Among patients with bipolar disorder, comorbid conditions are common. Comorbidity is associated with a more difficult course of illness (such as longer episodes, shorter time euthymic, and earlier age at onset) and an increase in related problems (such as suicidality and violence). Data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) reveal that anxiety disorders, attention-deficit/hyperactivity disorder, and substance and alcohol use disorder are conditions that commonly co-occur with bipolar disorder. This article details these findings and discusses the complications associated with these comorbid conditions. STEP-BD data about gender differences are also discussed, and correlates of suicidal ideation among patients entering the program are described.

Pai AL, Kazak AE. · The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA. · Curr Opin Pediatr. · Pubmed #16969172 No free full text.

Abstract: PURPOSE OF REVIEW: Traumatic stress offers a helpful framework by which the ongoing reactions of children with cancer and their families can be understood. Family systems interventions in pediatric oncology are reviewed, with a focus on reducing pediatric medical traumatic stress (PMTS) across members of the family. RECENT FINDINGS: A recently developed model of PMTS is presented and applied to the pediatric cancer population. Two family interventions to decrease traumatic stress systems are reviewed. Reductions in traumatic stress symptoms were observed at postintervention follow-ups for family members in both studies. SUMMARY: The pediatric medical traumatic stress model provides a useful heuristic for understanding the psychological consequences of pediatric cancer on the child and their family over the course of treatment and beyond. Two family systems interventions show promise in improving outcomes for childhood cancer survivors and their parents. Although interventions are promising, future development of these interventions to modify them for dissemination is needed.

Foa EB. · Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA 19104, USA. · J Clin Psychiatry. · Pubmed #16602814 No free full text.

Abstract: Immediately after experiencing a traumatic event, many people have symptoms of posttraumatic stress disorder (PTSD). If trauma victims restrict their routine and systematically avoid reminders of the incident, symptoms of PTSD are more likely to become chronic. Several clinical studies have shown that programs of cognitive-behavioral therapy (CBT) can be effective in the management of patients with PTSD. Prolonged exposure (PE) therapy-a specific form of exposure therapy-can provide benefits, as can stress inoculation training (SIT) and cognitive therapy (CT). PE is not enhanced by the addition of SIT or CT. PE therapy is a safe treatment that is accepted by patients, and benefits remain apparent after treatment programs have finished. Nonspecialists can be taught to practice effective CBT. For the treatment of large numbers of patients, or for use in centers where CBT has not been routinely employed previously, appropriate training of mental health professionals should be performed. Methods used for the dissemination of CBT to nonspecialists need to be modified to meet the requirements of countries affected by the Asian tsunami. This will entail the use of culturally sensitive materials and the adaptation of training methods to enable large numbers of mental health professionals to be trained together.

Foa EB, Stein DJ, McFarlane AC. · Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA, and the University of Adelaide, Department of Psychiatry, Queen Elizabeth Hospital, Woodville, Australia. · J Clin Psychiatry. · Pubmed #16602811 No free full text.

Abstract: A variety of reactions are observed after a major trauma. In the majority of cases these resolve without any long-term consequences. In a significant proportion of individuals, however, recovery may be impaired, leading to long-term pathological disturbances. The most common of these is post-traumatic stress disorder (PTSD), which is characterized by symptoms of reexperiencing the trauma, avoidance and numbing, and hyperarousal. A range of other disorders may also be seen after trauma, and there is considerable overlap between PTSD symptoms and several other psychiatric conditions. Risk factors for PTSD include severe exposure to the trauma, female sex, low socioeconomic status, and a history of psychiatric illness. Although PTSD may resolve in the majority of cases, in some cases risk factors outweigh protective factors, and symptoms may persist for many years. PTSD often coexists with other psychiatric disorders, such as depression, anxiety disorders, and substance abuse, and with physical (somatization) symptoms. There is growing evidence that PTSD does not merely represent a normal response to stress, but rather is mediated by specific neurobiological dysfunctions.

Jolin EM, Weller EB, Weller RA. · Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA. · Curr Psychiatry Rep. · Pubmed #16539883 No free full text.

Abstract: A neuropsychiatric phenotype specific to the velocardiofacial syndrome (VCFS) has not yet been identified. Neuropsychological research suggests that children with VCFS have problems in the domains of cognition, attention, and social interaction. Preliminary psychiatric studies of children and adolescents with VCFS suggest that they may be at higher risk than their nonaffected peers to develop mood disorders (including bipolar disorder), anxiety disorders, and attention deficit disorders. An unresolved question remains whether adults are at higher risk to develop psychotic mood disorders or schizophrenia in early adulthood. A research paradigm developed by Robins and Guze for the validation of psychiatric disorders may be helpful. Systematic studies in the areas of phenomenology, neurobiology, heredity, and the natural course of VCFS may clarify its psychiatric manifestations. Better understanding of the neuropsychiatric phenotype associated with VCFS will better inform ongoing genetic research. The study of VCFS holds the potential to give important insight into the pathogenesis of psychiatric disorders.

Jolin EM, Weller EB, Weller RA. · Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA. · Curr Psychiatry Rep. · Pubmed #16539882 No free full text.

Abstract: Recent advances in molecular genetics have led to new insights on the velocardiofacial syndrome (VCFS). Most patients have a large deletion on one copy of chromosome 22 (encompassing up to 30 genes), which can be confirmed with genetic testing. A wide spectrum of psychiatric symptoms has been reported in patients with VCFS, including schizophrenia and bipolar disorder. Preliminary studies of candidate genes from the deletion region suggest that allelic differences may increase susceptibility to psychiatric disorders, but these studies await replication. Mouse models with genetically engineered deletions have the potential to isolate the genes associated with VCFS neuropsychiatric symptoms. VCFS is likely to represent the deficiency of several genes with complex interactions. Further psychiatric research is warranted to delineate more comprehensively the neuro-psychiatric phenotype associated with VCFS. Accurate psychiatric diagnosis will better inform and advance ongoing genetic research.

Staab JP. · Department of Psychiatry, and The Balance Center, University of Pennsylvania, Philadelphia, PA 19104, USA. · Curr Opin Neurol. · Pubmed #16415676 No free full text.

Abstract: PURPOSE OF REVIEW: This paper reviews the often-enigmatic relationships between dizziness and psychiatric symptoms. Psychiatric causes of dizziness, neuro-otologic causes of anxiety, underrecognized co-morbid conditions, and medical illnesses that masquerade as 'psychogenic' dizziness are examined. Key clinical features and data from recent treatment trials are presented with potential pathophysiologic mechanisms. RECENT FINDINGS: Investigations at the interface between psychiatry and neuro-otology have identified the distinguishing features of several clinical conditions that present with non-vertiginous dizziness, subjective imbalance, and psychiatric symptoms. The most common condition is chronic subjective dizziness; a refinement of earlier concepts of psychogenic dizziness, phobic postural vertigo, and space-motion phobia. Chronic subjective dizziness is consistent with advancing research on anxiety and somatoform disorders and offers greater insights into the relationships between neuro-otologic illnesses and anxiety. Migraine, post-concussional syndrome, and dysautonomias also cause persistent dizziness and may be misdiagnosed or malingering or psychogenic dizziness because they often present with comorbid psychiatric symptoms in the absence of identifiable vestibular deficits. SUMMARY: Recent research has defined the key features of several medical-psychiatric conditions that cause chronic dizziness, permitting greater diagnostic precision and insight into underlying pathophysiologic processes. Treatment studies have identified potentially effective interventions, which must be evaluated in controlled clinical trials.

O'Reardon JP, Peshek A, Allison KC. · Division of Mood and Anxiety Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. · CNS Drugs. · Pubmed #16332142 No free full text.

Abstract: Night eating syndrome (NES) is an eating disorder characterised by the clinical features of morning anorexia, evening hyperphagia, and insomnia with awakenings followed by nocturnal food ingestion. The core clinical feature appears to be a delay in the circadian timing of food intake. Energy intake is reduced in the first half of the day and greatly increased in the second half, such that sleep is disrupted in the service of food intake. The syndrome can be distinguished from bulimia nervosa and binge eating disorder by the lack of associated compensatory behaviours, the timing of food intake and the fact that the food ingestions are small, amounting to repeated snacks rather than true binges. NES also differs from sleep-related eating disorder by the presence of full awareness, as opposed to parasomnic nocturnal ingestions. NES is of importance clinically because of its association with obesity. Its prevalence rises with increasing weight, and about half of those diagnosed with it report a normal weight status before the onset of the syndrome. The recognition and effective treatment of NES may be an increasingly important way to treat a subset of the obese population. Treatment of the syndrome, however, is still in its infancy. One clinical trial has reported efficacy with the SSRI sertraline. Other treatments, such as the anticonvulsant topiramate, phototherapy and other SSRIs, may also offer future promise.

Butler AC, Chapman JE, Forman EM, Beck AT. · University of Pennsylvania and Beck Institute for Cognitive Therapy and Research, USA. · Clin Psychol Rev. · Pubmed #16199119 No free full text.

Abstract: This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.

Beck AT. · Department of Psychiatry, University of Pennsylvania, Philadelphia, 19104, USA. · Arch Gen Psychiatry. · Pubmed #16143727 No free full text.

Abstract: The basic framework of the cognitive theory of psychopathology and cognitive therapy of specific psychiatric disorders was developed more than 40 years ago. Since that time, there has been continuing progress in the development of cognitive theory and therapy and in the empirical testing of both. A substantial body of research supports the cognitive model of depression and, to a somewhat lesser extent, the various anxiety disorders. Cognitive therapy (CT), often labeled as the generic term cognitive behavior therapy, has been shown to be effective in reducing symptoms and relapse rates, with or without medication, in a wide variety of psychiatric disorders. Suggestions for future research and applications are presented.

Diamond G, Josephson A. · Department of Psychiatry, University of Pennsylvania School of Medicine, and The Center for Family Intervention Science, The Children's Hospital of Philadelphia, PA 19104, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #16113616 No free full text.

Abstract: OBJECTIVE: To provide an update on the state of the art of family-based treatment research. METHOD: Randomized clinical trials conducted in the past 10 years that included parents as a primary participant in treatment of child and adolescent psychiatric problems were reviewed. Studies were identified from major literature search engines (e.g., PsycINFO, Medline). Current significant pilot work was identified in the National Institute of Mental Health Computer Retrieval of Information on Scientific Projects (CRISP) Web page or from the authors themselves. RESULTS: Family treatments have proven effective with externalizing disorders, particularly conduct and substance abuse disorders, and in reducing the comorbid family and school behavior problems associated with attention-deficit/hyperactivity disorder. Several new studies suggest that family treatments or treatment augmented by family treatments are effective for depression and anxiety. CONCLUSIONS: For many disorders, family treatments can be an effective stand-alone intervention or an augmentation to other treatments. Engaging parents in the treatment process and reducing the toxicity of a negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of gains. Recommendations for the next decade of research and some implications of family-based treatment for child and adolescent psychiatry are explored.

Huppert JD, Franklin ME. · University of Pennsylvania School of Medicine, Center for the Treatment and Study of Anxiety, Philadelphia, PA 19104, USA. · Curr Psychiatry Rep. · Pubmed #16098280 No free full text.

Abstract: Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has been shown to be a highly effective treatment for children and adults. In the current review, we briefly describe the historical developments of the treatment, and recent findings related to five areas of inquiry: 1) Does intensity of CBT impact outcome? 2) Does CBT work better on some subtypes of OCD than others? 3) How do cognitive and behavioral strategies relate to outcome? 4) How well does CBT work for children and adolescents with OCD? and 5) Does the combination of CBT and medication work better than CBT alone? After a discussion of these questions, we mention some areas currently being examined.

Kazak AE, Kassam-Adams N, Schneider S, Zelikovsky N, Alderfer MA, Rourke M. · The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Room 1486 CHOP North, Philadelphia, Pennsylvania 19104-4399, USA. · J Pediatr Psychol. · Pubmed #16093522 No free full text.

Abstract: OBJECTIVE: To guide assessment and intervention for patients and families, a model for assessing and treating pediatric medical traumatic stress (PMTS) is presented that integrates the literature across pediatric conditions. METHODS: A model with three general phases is outlined--I, peritrauma; II, early, ongoing, and evolving responses; and III, longer-term PMTS. Relevant literature for each is reviewed and discussed with respect to implications for intervention for patients and families. RESULTS: Commonalities across conditions, the range of normative responses to potentially traumatic events (PTEs), the importance of preexisting psychological well-being, developmental considerations, and a social ecological orientation are highlighted. CONCLUSIONS: Growing empirical support exists to guide the development of assessment and intervention related to PMTS for patients with pediatric illness and their parents. The need for interventions across the course of pediatric illness and injury that target patients, families, and/or healthcare teams is apparent. The model provides a basis for further development of evidence-based treatments.

Rao VU, Apter AJ. · Division of Pulmonary, Allergy, Critical Care, Department of Medicine, 829 Gates Building, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104, USA. · Immunol Allergy Clin North Am. · Pubmed #16054544 No free full text.

Abstract: Adherence is important with all medications. It can be more difficult with inhaled steroids in light of concern about adverse effects. Although the degree of fear regarding inhaled steroids is difficult to quantify, it appears to be an important factor in adherence. These fears exist for several reasons, including misinformation obtained from such sources as the Internet. To improve adherence and decrease morbidity and mortality, it is vital that health care providers are aware of potential barriers to adherence. Measures such as simplifying and properly explaining medication regimens are helpful. Just as important is the establishment of a strong patient-provider relationship. This makes it easier to convince patients of the need for recommended medications. If the provider is able to effectively communicate and convince the patient of the benefit/risk ratio of steroids, improved patient outcomes can be achieved.

Cook JM, O'Donnell C. · University of Pennsylvania School of Medicine, Philadelphia, 19104, USA. · J Geriatr Psychiatry Neurol. · Pubmed #15911934 No free full text.

Abstract: Knowledge regarding the assessment and treatment of posttraumatic stress disorder in older adults continues to be limited in both psychological research and practice. This article provides a summary of this literature. In particular, the psychometric properties of several posttraumatic stress disorder assessment measures in their use with older individuals are reviewed. Although the evidence base on effective treatments for posttraumatic stress disorder in older adults is virtually nonexistent, this article highlights the innovative clinical endeavors that have been conducted in this regard. Explicit suggestions for best practices are made.

Jolin EM, Weller EB, Weller RA. · Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. · Curr Psychiatry Rep. · Pubmed #15802086 No free full text.

Abstract: Treatment research in prepubertal bipolar disorder remains in a rudimentary stage. Phenomenological evidence suggests it is a heterogeneous disorder with varying degrees of rapid cycling, aggression, and psychosis often accompanied by comorbid diagnoses of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, and anxiety disorders including obsessive compulsive disorder. Longitudinal and family history studies suggest prepubertal bipolar disorder may be more treatment-resistant than later-onset bipolar disorder. Neurobiological studies to guide treatment, though promising, remain in their infancy. Clinical trials to date (mostly open studies) often have lumped together subjects with manic, hypomanic, and mixed presentations with different and/or undiagnosed comorbidities, making meaningful comparisons of treatment response difficult. Randomized, double-blind, placebo-controlled trials are needed to clarify best treatment options for bipolar subtypes with and without comorbid disorders. More homogeneous diagnostic groupings based on episode and duration criteria and a more patient-centered, symptom-based approach should be considered in treatment designs.

O'brien CP. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. · J Clin Psychiatry. · Pubmed #15762817 No free full text.

Abstract: Although benzodiazepines are invaluable in the treatment of anxiety disorders, they have some potential for abuse and may cause dependence or addiction. It is important to distinguish between addiction to and normal physical dependence on benzodiazepines. Intentional abusers of benzodiazepines usually have other substance abuse problems. Benzodiazepines are usually a secondary drug of abuse-used mainly to augment the high received from another drug or to offset the adverse effects of other drugs. Few cases of addiction arise from legitimate use of benzodiazepines. Pharmacologic dependence, a predictable and natural adaptation of a body system long accustomed to the presence of a drug, may occur in patients taking therapeutic doses of benzodiazepines. However, this dependence, which generally manifests itself in withdrawal symptoms upon the abrupt discontinuation of the medication, may be controlled and ended through dose tapering, medication switching, and/or medication augmentation. Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatment may be necessary for some patients; this continuation of treatment should not be considered abuse or addiction.

Stirman SW, Derubeis RJ, Crits-Christoph P, Rothman A. · Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-6196, USA. · J Consult Clin Psychol. · Pubmed #15709839 No free full text.

Abstract: To determine the extent to which published randomized controlled trials (RCTs) of psychotherapy can be generalized to a sample of outpatients, the authors matched information obtained from charts of patients who had been screened out of RCTs to inclusion and exclusion criteria from published RCT studies. Most of the patients in the sample who had primary diagnoses represented in the RCT literature were judged eligible for at least 1 RCT. However, many patients in the sample with substance use disorders or social anxiety disorder were not eligible for at least 2 RCTs. Common reasons that patients did not match with at least 2 published RCTs for psychotherapy included (a) patients were in partial remission, (b) patients failed to meet minimum severity or duration criteria, (c) patients were being treated with antidepressant medication, and (d) the disorder being studied was not primary (mostly for social anxiety patients). The implications of these findings for future research and clinical practice are discussed.

Valentino RJ, Commons KG. · Department of Anesthesiology and Critical Care Medicine, 402C Abramson Pediatric Research Ctr, The Children's Hospital of Philadelphia, Osler Cr, Philadelphia, PA 19104, USA. · Neuropeptides. · Pubmed #15627494 No free full text.

Abstract: The dorsal raphe nucleus (DR) contains serotonin (5-HT) neurons that innervate the cortex and limbic system and through these projections is thought to regulate cognition and behavior. Clinical and pharmacological findings implicate dysfunctions in the DR-5-HT system in affective disorders, including anxiety, depression and suicide. Although the DR is often considered in light of its 5-HT neurons, recent studies underscore the complexity of this nucleus and its heterogeneous nature. Of particular interest, are peptides that are either present within neurons in the DR, innervate DR-5-HT neurons or act upon local circuitry within the DR to indirectly impact on this 5-HT system. These peptides are positioned to fine-tune the activity of selective groups of serotonergic neurons within the DR and thereby 5-HT release in different terminal fields. This review will focus on substance P and corticotropin-releasing factor as two peptides that act independently and interdependently to influence DR-5-HT function. The role of non-serotonergic components of the DR in translating the effect of each of these peptides is discussed. This synthesis refines our views on the regulation of the DR-5-HT system and importantly, gives insight into mechanisms of endogenous control of DR function, the dysregulation of which may contribute to pathophysiology.

Ho WZ, Douglas SD. · Division of Allergy and Immunology, Joseph Stokes Jr. Research Institute at Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. · J Neuroimmunol. · Pubmed #15579279 No free full text.

Abstract: There is a high incidence of life event stress, depression, and associated symptoms in individuals with HIV infection/AIDS. Psychological and psychiatric symptomatology in individuals with HIV and AIDS may be related to the progression of AIDS disease. The association between depression, anxiety, and stress with HIV disease progression suggests that neurobiologic and neurophysiologic factors have an important role in modulating HIV. The immune effects caused by changes in behavioral state or brain activity are affected, at least in part, through the neuroendocrine-immune pathways. Life stress and depression may be associated with altered blood levels of CNS-released neuropeptides, including substance P (SP). SP is a powerful immunomodulator which is a critical link between the nervous and immune system. We have investigated the role of the neuropeptide SP and its preferred receptor, neurokinin-1, in HIV infection and AIDS. There are compelling data from our laboratories, as well as the findings in the literature, which demonstrate that SP may play an important role in the pathophysiology of neuropsychiatric disorders, including stress and depression in HIV-infected individuals and in the immunopathogenesis of HIV disease. Modulation of SP activity and SP receptor may offer a novel approach to the treatment of psychiatric disorders and to the design of new anti-HIV therapy.

Huppert JD, Moser JS, Gershuny BS, Riggs DS, Spokas M, Filip J, Hajcak G, Parker HA, Baer L, Foa EB. · Center for the Treatment and Study of Anxiety, University of Pennsylvania, 3535 Market St., Suite 600N, Philadelphia, PA 19104, USA. · J Anxiety Disord. · Pubmed #15488372 No free full text.

Abstract: Although case reports suggest the existence of a unique relationship between obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), results from large-scale epidemiological and clinical studies have been more equivocal. Furthermore, symptom overlap may artificially inflate the significance of the relationship between OCD and PTSD. Utilizing the Obsessive-Compulsive Inventory [OCI; Psychol. Assess. 10 (1998) 206] and the Posttraumatic Diagnostic Scale [PDS; Psychol. Assess. 9 (1997) 445], this study examined the relationship between OCD and PTSD symptoms in 128 patients diagnosed with OCD, 109 patients diagnosed with PTSD, 63 patients diagnosed with another anxiety disorder, and 40 college students. Experts in OCD and PTSD independently rated items on the OCI and PDS for the degree of overlap across the disorders. On the basis of these ratings, we created a scale from each measure that included only non-overlapping items. Results revealed that overall symptoms of OCD and PTSD were related in all samples. However, after controlling for depression and overlapping symptoms simultaneously, this relationship was no longer significant in the OCD and PTSD samples, although it remained significant in the anxious and college student comparison groups. These results support the presence of a relationship between symptoms of OCD and PTSD that may be largely accounted for by a combination of symptom overlap and depression.

Aston-Jones G, Harris GC. · Department of Psychiatry, University of Pennsylvania, 705 Stellar Chance/6100, 422 Curie Blvd, Philadelphia, PA 19104-6100, USA. · Neuropharmacology. · Pubmed #15464135 No free full text.

Abstract: Studies are reviewed indicating that both increased anxiety and altered hedonic processing accompany protracted withdrawal from opiates. Increased anxiety may be most apparent in response to stress, whereas decreased motivation for natural rewards but increased interest in drugs reveals substantial alterations in hedonic values. Our recent work indicates that increased norepinephrine (NE) release in the bed nucleus of the stria terminalis (BNST) may underlie anxiety associated with protracted withdrawal. Altered plasticity in afferents to the ventral tegmental area (VTA; accumbens, amygdala and lateral hypothalamus), or in the VTA itself, may be involved in the altered hedonic processing that occurs during protracted withdrawal. We hypothesize that conditioned release of NE in the BNST in response to stressors (including drug-associated stimuli) may elevate anxiety which then augments the reward value of drugs by a negative reinforcement mechanism. We also propose that plasticity in VTA neurons and their afferents during chronic drug exposure and protracted withdrawal decreases the valence of natural rewards whereas sensitization occurs to the motivational effects of drugs that increases their motivational valence. The combination of anxiety, decreased valence of natural rewards, and sensitized incentive for drugs make a potent formula for relapse and drug seeking during protracted withdrawal.