Anxiety Disorders: University of Pittsburgh

Howland RH. · University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA. · J Psychosoc Nurs Ment Health Serv. · Pubmed #19489510 No free full text.

Abstract: Treating mental disorders in pregnant or breastfeeding women is an important clinical issue. Antidepressant and antipsychotic drugs are generally considered to be relatively safe when used during pregnancy or breastfeeding. Benzodiazepine drugs, used for anxiety or insomnia, have a small but significant risk of birth defects. Antidepressant drugs could be used as an alternative for treating anxiety and insomnia. Lithium and anticonvulsant drugs (with the exception of lamotrigine) should generally be avoided during pregnancy. Antipsychotic drugs can be substituted for mood stabilizers. Use of anticonvulsant drugs is compatible with breastfeeding. Psychotherapy is a potential alternative to medication for the treatment of depression, anxiety disorders, and insomnia. Untreated maternal psychiatric illness can have adverse effects on pregnancy outcome and infant well-being. Available treatments and their potential risks when used during pregnancy or lactation should be discussed in the context of the risks of not treating maternal psychiatric illness effectively.

Goldstein TR. · Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #19264267 No free full text.

Abstract: This article describes what is known about the epidemiology of suicidal ideation and behavior in pediatric bipolar disorder. Risk factors associated with suicidality in this population are reviewed in detail. Clinical recommendations for assessment, management and treatment are provided based on the literature to date.

Weber S. · Nursing Education Graduate Program, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA. · J Child Adolesc Psychiatr Nurs. · Pubmed #19200286 No free full text.

Abstract: TOPIC: Dissociation is believed to be one of the most common underlying psychological processes among children and adolescents receiving mental health treatment, but most of the dissemination of information about dissociation has occurred among psychiatrists and psychologists. PURPOSE: Modes of treatment for dissociation as it affects children and adolescents are described. SOURCES USED: Current research and practice scholarly articles on treatment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed. CONCLUSIONS: Prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however, expert clinicians and researchers agree that early, intense treatment offers the greatest possibility of full recovery.

Gilbert AR, Maalouf FT. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. · Curr Opin Pediatr. · Pubmed #18781117 No free full text.

Abstract: PURPOSE OF REVIEW: Obsessive-compulsive disorder (OCD) is a severe neuropsychiatric condition with a substantial prevalence in childhood and adolescence. Our understanding of the etiopathogenesis of pediatric OCD continues to grow, along with diagnostic and treatment approaches. The present study attempts to provide a parsimonious review of important studies of pediatric OCD with particular emphasis on studies over the last year. RECENT FINDINGS: Consistent with many other pediatric conditions, OCD in childhood and adolescence has distinct yet overlapping features with the adult-onset type. It appears that OCD is a multidimensional disorder with substantial comorbidity with other neuropsychiatric disorders that may affect its course and treatment. Although its pathophysiology remains to be fully elucidated, evidence suggests that OCD likely results from a complex interaction between multiple genetic variants and nongenetic factors. Meanwhile, evidence supporting the efficacy of selective serotonin reuptake inhibitors, augmentation strategies affecting other neurotransmitter systems, and cognitive behavioral therapy for the treatment of pediatric OCD continues to emerge. SUMMARY: Results from the studies reviewed here reflect the heterogeneity of pediatric OCD. It is clear that clinicians need to consider specific symptoms, comorbid conditions, and the rapidly evolving clinical research when working with children and adolescents with OCD.

Sakolsky D, Birmaher B. · Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2592, USA. · Curr Opin Pediatr. · Pubmed #18781116 No free full text.

Abstract: PURPOSE OF REVIEW: Anxiety disorders are common in children and adolescents, with prevalence rates varying from 6 to 20%. These disorders can result in significant academic, social, and familial impairment. Early identification in pediatric primary care and effective management may help improve outcomes. RECENT FINDINGS: Self-report measures of pediatric anxiety can supplement the clinical interview and assist in screening children and adolescents for separation anxiety disorder, generalized anxiety disorder, and social phobia. Substantial evidence supports the use of cognitive behavioral therapy and selective serotonin reuptake inhibitors in the treatment of pediatric anxiety disorders. Although treatment with serotonin reuptake inhibitors may lead to a small increase in the risk for suicidal ideation in children and adolescents, the risk benefit ratio for serotonin reuptake inhibitor use in pediatric anxiety disorders is favorable with appropriate monitoring. SUMMARY: Although evidence-support treatments have emerged for pediatric anxiety disorders, their effectiveness in pediatric primary care has not been evaluated. Future research should assess the delivery of manual-based cognitive behavioral therapy for anxiety disorders by mental health professionals integrated into the primary care settings, the effectiveness of serotonin reuptake inhibitor prescription by pediatric primary care clinicians, and the use of collaborative models for providing anxiety treatments for children and adolescents in primary care settings.

Weber S. · School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania 15261-2404, USA. · Issues Ment Health Nurs. · Pubmed #18569207 No free full text.

Abstract: Parenting and family life are fundamental social constructs in human society and in law and public policy. Family structures and support systems provide important economic and psychological advantages for parents as well as for their children. Stigma toward lesbian and gay parents often marginalize individuals in these families and restrict family members' full expression of social citizenship, humanity, and personhood. Stigma directly contributes to increased risk for substance abuse, anxiety, and depressive illness among both parents and children. This article reviews the relevant policy literature to deconstruct the impacts of stigma on the psychological health and well-being of sexual minority parents so that psychiatric/mental health nurses and other health care providers can identify and counter these effects in their practices and advocate for policy improvements.

Kaye W. · University of California, San Diego, 8950 Villa La Jolla Drive, Suite C207, La Jolla, CA 92037, United States. · Physiol Behav. · Pubmed #18164737 links to  free full text

Abstract: Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully reinforcing because it provides a temporary respite from dysphoric mood. Several factors may act on these vulnerabilities to cause AN to start in adolescence. First, puberty-related female gonadal steroids or age-related changes may exacerbate 5-HT dysregulation. Second, stress and/or cultural and societal pressures may contribute by increasing anxious and obsessional temperament. Individuals with AN may discover that reduced dietary intake, by reducing plasma tryptophan availability, is a means by which they can modulate brain 5-HT functional activity and anxious mood. People with AN enter a vicious cycle which accounts for the chronicity of this disorder because caloric restriction results in a brief respite from dysphoric mood. However, malnutrition and weight loss, in turn, produce alterations in many neuropeptides and monoamine function, perhaps in the service of conserving energy, but which also exaggerates dysphoric mood. In summary, this article reviews findings in brain chemistry and neuroimaging that shed new light on understanding the psychopathology of these difficult and frustrating disorders.

Germain A, Buysse DJ, Nofzinger E. · Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Room E-1124, Pittsburgh, PA 15213, USA. · Sleep Med Rev. · Pubmed #17997114 links to  free full text

Abstract: Posttraumatic stress disorder (PTSD) is a prevalent disorder that is associated with poor clinical and health outcomes, and considerable health care utilization and costs. Recent estimates suggest that 5-20% of military personnel who serve in current conflicts in Iraq and Afghanistan meet diagnostic criteria for PTSD. Clinically, sleep disturbances are core features of PTSD that are often resistant to first-line treatments, independently contribute to poor daytime functioning, and often require sleep-focused treatments. Physiologically, these observations suggest that PTSD is partially mediated by sleep disruption and its neurobiological correlates that are not adequately addressed by first-line treatments. However, polysomnographic studies have provided limited insights into the neurobiological underpinnings of PTSD during sleep. There is an urgent need to apply state-of-the-science sleep measurement methods to bridge the apparent gap between the clinical significance of sleep disturbances in PTSD and the limited understanding of their neurobiological underpinnings. Here, we propose an integrative review of findings derived from neurobiological models of fear conditioning and fear extinction, PTSD, and sleep-wake regulation, suggesting that the amygdala and medial prefrontal cortex can directly contribute to sleep disturbances in PTSD. Testable hypotheses regarding the neurobiological underpinnings of PTSD across the sleep-wake cycle are offered.

Driscoll HC, Karp JF, Dew MA, Reynolds CF. · Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, and the John A. Hartford Center for Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. · Drugs Aging. · Pubmed #17896830 No free full text.

Abstract: In general, the pharmacological treatment of non-psychotic major depressive disorder in old age is only partially successful, with only approximately 50% of older depressed adults improving with initial antidepressant monotherapy. Many factors may predict a more difficult-to-treat depression, including coexisting anxiety, low self-esteem, poor sleep and a high coexisting medical burden. Being aware of these and other predictors of a difficult-to-treat depression gives the clinician more reasonable expectations about a patient's likely treatment course. If an initial antidepressant trial fails, the clinician has two pharmacological options: switch or augment/combine antidepressant therapies. About 50% of patients who do not improve after initial antidepressant therapy will respond to either strategy. Switching has several advantages including fewer adverse effects, improved treatment adherence and reduced expense. However, as a general guideline, if patients are partial responders at 6 weeks, they will likely be full responders by 12 weeks. Thus, changing medication is not indicated in this context. However, if patients are partial responders at 12 weeks, switching to a new agent is advised. If the clinician treats vigorously and if the patient and clinician persevere, up to 90% of older depressed patients will respond to pharmacological treatment. Furthermore, electroconvulsive therapy is a safe and effective non-pharmacological strategy for non-psychotic major depression that fails to respond to pharmacotherapy. Getting well and staying well is the goal; thus, clinicians should treat to remission, not merely to response. Subsequently, maintenance treatment with the same regimen that has been successful in relieving the depression strongly improves the patient's chances of remaining depression free.

Douaihy AB, Stowell KR, Kohnen S, Stoklosa JB, Breitbart WS. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. · AIDS Read. · Pubmed #17672014 No free full text.

Abstract: The high prevalence, underassessment, and undertreatment of pain throughout the course of HIV disease make understanding the barriers and inequalities in HIV/AIDS-related pain care essential. There is a tremendous need for integrated implementation of pharmacological and psychosocial interventions. Part 2 of this review aims to discuss mood, anxiety, and substance abuse assessments; barriers to care; and psychiatric treatments in the context of HIV-AIDS-related pain. Recommendations are made from the gathered data that highlight the need for an interdisciplinary comprehensive approach to managing pain in HIV disease. Further research is needed to examine the relationship of pain and psychiatric issues in order to formulate effective treatment strategies.

Howland RH. · University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213, USA. · J Psychosoc Nurs Ment Health Serv. · Pubmed #17334198 No free full text.

This publication has no abstract.

Baldisseri MR. · Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. · Crit Care Med. · Pubmed #17242598 No free full text.

Abstract: OBJECTIVE: The objective of the article is to present the available data from the literature on substance use disorders in healthcare professionals. Prevalence, risk factors, treatment options, and reentry into clinical practice are discussed. INTRODUCTION: Impairment of a healthcare professional is the inability or impending inability to practice according to accepted standards as a result of substance use, abuse, or dependency (addiction). The term substance use disorder can be divided into substance abuse and dependence (addiction). Substance abuse results in adverse social and professional consequences. Addiction manifests as physiologic and behavioral symptoms related to a maladaptive pattern of substance use. MAIN RESULTS: It is estimated that approximately 10% to 15% of all healthcare professionals will misuse drugs or alcohol at some time during their career. Although the rates of substance abuse and dependence are similar to those of the general population, the prevalence is disturbing because healthcare professionals are the caregivers responsible for the general health and well-being of the general population. Healthcare professionals have higher rates of abuse with benzodiazepines and opiates. Specialties such as anesthesia, emergency medicine, and psychiatry have higher rates of drug abuse, probably related to the high-risk environment associated with these specialties, the baseline personalities of these healthcare providers, and easy access to drugs in these areas. Drugs and alcohol are mostly used for "recreational" purposes by medical students. Residents and attending physicians use drugs of abuse for performance enhancement and as self-treatment for various reasons, such as, pain, anxiety, or depression. CONCLUSIONS: Institutional, local, and statewide impaired-physician programs are now available for the active treatment and rehabilitation of impaired healthcare professionals. Many of these programs are also designed to assist the clinician with reentry into clinical practice. Rarely is punitive action taken when the healthcare provider undergoes successful treatment and ongoing follow-up management. Overall recovery rates for impaired healthcare professionals seem to be higher compared with other groups, particularly with intensive inpatient management and subsequent follow-up care.

Thase ME. · Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA. · J Clin Psychiatry. · Pubmed #17201029 No free full text.

Abstract: Atypical depression, one of the 4 historically important ways of subdividing depression, was first used by West and Dally to describe a patient subgroup that was nonresponsive to imipramine but responsive to iproniazid. The definition was later refined to include reverse vegetative and hysteroid dysphoria symptoms, presaging adoption of the current DSM definition in 1984. However, focusing on hysteroid dysphoria symptoms drew attention away from anxiety symptoms, some of which are more strongly linked to atypical depression. Studies that have attempted to validate atypical depression have reinforced reverse vegetative symptoms criteria and have shown that atypical depression is probably more common than melancholia. Studies suggest that atypical depression is not preferentially responsive to monoamine oxidase inhibitors, but rather less responsive to tricyclic antidepressants.

Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. · Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA. · Sleep. · Pubmed #17040003 No free full text.

Abstract: STUDY OBJECTIVES: To present expert consensus recommendations for a standard set of research assessments in insomnia, reporting standards for these assessments, and recommendations for future research. PARTICIPANTS: N/A. INTERVENTIONS: N/A. METHODS AND RESULTS: An expert panel of 25 researchers reviewed the available literature on insomnia research assessments. Preliminary recommendations were reviewed and discussed at a meeting on March 10-11, 2005. These recommendations were further refined during writing of the current paper. The resulting key recommendations for standard research assessment of insomnia disorders include definitions/diagnosis of insomnia and comorbid conditions; measures of sleep and insomnia, including qualitative insomnia measures, diary, polysomnography, and actigraphy; and measures of the waking correlates and consequences of insomnia disorders, such as fatigue, sleepiness, mood, performance, and quality of life. CONCLUSIONS: Adoption of a standard research assessment of insomnia disorders will facilitate comparisons among different studies and advance the state of knowledge. These recommendations are not intended to be static but must be periodically revised to accommodate further developments and evidence in the field.

Brent DA, Birmaher B. · Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, BFT 311, Pittsburgh, PA 15213-2592, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16952773 No free full text.

Abstract: Approximately 20% of adolescents experience at least one depressive episode by the time they enter their adult years. For most adolescents, depression, although serious, either remits spontaneously or responds to treatment. For a smaller but significant proportion of adolescents, however, depression can be long-lasting and relatively unresponsive to initial treatment. In this article the authors provide an operational definition of treatment-resistant depression, identify factors associated with treatment nonresponse, describe an approach to the management of treatment-resistant depression, and advance suggestions for promising avenues of research.

Thase ME. · University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. · Expert Rev Neurother. · Pubmed #16533131 No free full text.

Abstract: When venlafaxine was introduced in 1994, it was the first of the newer generation antidepressants to be classified as a serotonin norepinephrine reuptake inhibitor (SNRI). An extended release (XR) formulation of venlafaxine, introduced in 1997, subsequently received regulatory approval for treatment of three anxiety disorders: generalized anxiety disorder, social anxiety disorder and panic disorder. Although less extensively studied, venlafaxine XR also appears to have efficacy for two other anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder. In contrast to the treatment of depression, for which meta-analyses suggest an efficacy advantage relative to selective serotonin reuptake inhibitors (SSRIs), evidence of differential efficacy has not yet been established for any of the anxiety disorders. The overall tolerability profile of venlafaxine XR is generally comparable to that of the SSRIs, although there is greater incidence of noradrenergically mediated side effects (i.e., dry mouth and constipation), as well as a dose-dependent risk of treatment-emergent high blood pressure. Concerns about safety in overdose have also recently emerged. Despite these caveats, venlafaxine XR is an effective and generally well-tolerated option for treatment of anxiety disorders.

Hariri AR, Holmes A. · Department of Psychiatry and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. · Trends Cogn Sci. · Pubmed #16530463 No free full text.

Abstract: Identifying biological mechanisms through which genes lead to individual differences in emotional behavior is paramount to our understanding of how such differences confer risk for neuropsychiatric illness. The emergence of techniques such as in vivo imaging of brain function in humans and genetic engineering in rodents has provided important new insights into the impact of serotonin (5-HT), a key modulator of emotional behavior, on neural systems subserving anxiety and depression. A major finding has been the discovery of genetic variation in a crucial regulatory molecule within the 5-HT system, the 5HT transporter (5-HTT), and its influence on emotional traits. The study of the 5-HTT provides a new foundation for understanding the neurobiological and genetic basis of emotional regulation and affective illness.

Thase ME. · University of Pittsburgh Medical Centre, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213-2593, USA. · Expert Opin Pharmacother. · Pubmed #16503815 No free full text.

Abstract: This article reviews escitalopram, the S-stereoisomer of the racemic compound citalopram, and a highly selective and potent member of the selective serotonin re-uptake inhibitor class of antidepressants. Escitalopram has a straightforward pharmacokinetic profile, little effect on hepatic metabolism, and is relatively safe in overdose. Similar to other members of the selective serotonin re-uptake inhibitor class, escitalopram (10-20 mg/day) is a well-tolerated and effective treatment of major depressive disorder. Although relatively few head-to-head comparative studies with other antidepressants have been published, pooled analyses of studies using citalopram as the active comparator suggest a modest advantage for the stereoisomer. This advantage, which is more apparent among patients with greater symptom levels, may be attributable to a greater than predicted potency compared with citalopram, presumably as a result of the greater effect of escitalopram at the allosteric binding site of the serotonin transporter. Results of two published studies versus venlafaxine also suggest better tolerability in the context of comparable efficacy. Escitalopram is also approved for the treatment of generalised anxiety disorder (in the US) and social anxiety disorder and panic disorder (in the EU). Pharmacoeconomic models suggest that the greater drug acquisition cost of this patent-protected compound may be offset by greater efficacy (relative to generic citalopram) and tolerability (compared with extended release venlafaxine).

Hariri AR, Drabant EM, Weinberger DR. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213-2593, USA. · Biol Psychiatry. · Pubmed #16442081 No free full text.

Abstract: Advances in molecular biology and neuroimaging have provided a unique opportunity to explore the relationships between genes, brain, and behavior. In this review, we will briefly outline the rationale for studying genetic effects on brain function with neuroimaging. We will then use studies of genetically driven variation in serotonin transporter function on corticolimbic structure and function to highlight the effectiveness of this strategy to delineate biological pathways and mechanisms by which individual differences in brain function emerge and potentially bias behavior and risk for psychiatric illness. In a series of studies, a relatively frequent regulatory variant of the human serotonin transporter gene (5-HTTLPR) has been demonstrated to bias the reactivity of the amygdala to salient environmental cues. Moreover, the 5-HTTLPR affects the development of a broader corticolimbic circuit and alters the functional integration of emotional information between the amygdala and medial prefrontal cortex. In turn, corticolimbic circuit function predicts individual differences in an experimental index of temperamental anxiety and, thus, might reflect a predictive biological marker of increased risk for mood disorders associated with the 5-HTTLPR.

Oland AA, Shaw DS. · University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · Clin Child Fam Psychol Rev. · Pubmed #16362255 No free full text.

Abstract: Co-occurring internalizing and externalizing disorders are moderately prevalent in children, adolescents, and adults (Anderson, Williams, McGee, & Silva, 1987; McConaughy & Skiba, 1994), but much remains to be understood regarding why some children show "pure" versus co-occurring internalizing and externalizing symptoms. One possible influence that has previously not been considered is the failure to attain socio-developmental milestones, which paradoxically may prevent the development of co-occurring symptoms for some children. The present study proposes a model in which failure to attain relevant socio-developmental milestones might explain why some children may not develop heterotypic co-occurring symptoms. Specifically, it is proposed that specific clusters of internalizing symptoms (i.e., high social anxiety, withdrawal, and inhibition) and externalizing symptoms (i.e., high impulsivity, hyperactivity, and emotional reactivity) may be associated with the failure to attain socio-developmental milestones (i.e., poor peer relations for anxious children, lack of self-reflection and evaluation for impulsive/reactive children) that, in turn, may prevent subgroups of children from developing co-occurring, heterotypic symptoms.

Williamson DE, Forbes EE, Dahl RE, Ryan ND. · Department of Psychiatry, University of Pittsburgh, School of Medicine/Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16171699 No free full text.

Abstract: Current research indicates that there is a strong relationship between the depression and anxiety that first appear during childhood. Both depression and anxiety co-segregate in families, indicating that the familial risk for the two disorders is shared. Epidemiologic and clinical evidence has shown that anxiety often precedes the onset of depression and the two disorders share a common genetic pathway that may be expressed differentially across development. From a preventive health perspective, children with depressed or anxious relatives are at increased risk for developing anxiety or depression. In addition, anxious children are at increased risk for developing depression particularly during adolescence.

Dew MA, DiMartini AF. · Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. · J Cardiovasc Nurs. · Pubmed #16160585 No free full text.

Abstract: This review summarizes and integrates evidence concerning mental health outcomes following heart, lung, and heart-lung transplantation. Drawing on English-language case reports and empirical studies published between January 1980 and December 2004, the goals of the review were to (a) describe the prevalence and clinical characteristics of psychological disorders, as well as the level and pattern of clinically significant distress in the years posttransplant; (b) review the major risk factors for poor posttransplant psychological outcomes; (c) consider evidence suggesting that posttransplant psychological outcomes predict physical morbidity and mortality after transplant; (d) summarize findings from intervention studies designed to improve posttransplant psychological outcomes; and (e) provide patient care recommendations for the practicing clinician and recommendations for continued clinical research. Several major conclusions can be drawn from this literature. First, depressive and anxiety-related disorders and associated distress are common posttransplant. While new onsets of disorder may decline after the first year posttransplant, the development of new medical complications in the late years posttransplant may provoke renewed distress and recurrences of disorder. Second, risk factors for posttransplant psychological disorders and elevated distress include both standard risk factors observed in other populations (eg, younger age, lifetime history of psychiatric disorder) and transplant-specific factors related to physical functional impairments, social supports, and strategies for coping with health problems. Third, while little evidence has been published to date, there is some indication that posttransplant psychological outcomes can predict subsequent physical health outcomes. Fourth, extremely few intervention studies in cardiothoracic transplant recipients have been performed. The few reports indicate that multicomponent psychosocial strategies focused on risk factor reduction and enhancement of personal coping resources may lead to reductions in psychological distress. An important caveat in considering all of the evidence reviewed is that most studies focus on heart rather than lung or heart-lung recipients. Recommendations for practicing clinicians focus on assessment and treatment options, based on the evidence to date. Research recommendations focus on the need for intervention effectiveness studies.

Mitchell AM, Sakraida TJ, Zalice KK. · University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA. · Nurs Clin North Am. · Pubmed #16111998 No free full text.

Abstract: Disasters are tragic events that disrupt the normal functioning ofa community and overwhelm personal and community resources. The people who experience or simply witness traumatic events can be affected emotionally and develop a range of physical and emotional responses, which in turn can produce psychological, social, and physiological dysfunction. The challenge for health care providers is to recognize the range of emotions and to be able to identify when professional help is indicated. This article provides an overview of the human stress response and describes sources of stress that follow disasters, acute stress disorder, post-traumatic stress disorder, and interventions and resources used to care for victims after disasters.

Kaye WH, Bailer UF, Frank GK, Wagner A, Henry SE. · University of Pittsburgh, School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic, Iroquois Building, PA 15213, USA. · Physiol Behav. · Pubmed #16102788 No free full text.

Abstract: Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders with relatively homogenous presentations such as age of onset and gender distribution. In addition, they share symptoms, such as extremes of food consumption, body image distortion, anxiety and obsessions, and ego-syntonic neglect. Taken together, these observations raise the possibility that these symptoms reflect disturbed brain function, which contributes to the pathophysiology of these illnesses. Several lines of evidence suggest that disturbances of serotonin (5-HT) pathways play a role. First, 5-HT pathways contribute to the modulation of feeding, mood, and impulse control. Second, medications that act on 5-HT pathways have some degree of efficacy in individuals with AN and BN. Third, such disturbances are present when subjects are ill and persist after recovery, suggesting that 5-HT alterations may be traits that are independent of the state of the illness. Positron emission tomography (PET) with radioligands offers an opportunity to directly characterize brain 5-HT pathways and their relationship with behavior. For example, reduced 5-HT(2A) receptor function occurs in AN whereas increased 5-HT(1A) receptor function occurs in BN. Moreover, imaging studies correlate altered 5-HT(1A) and 5-HT(2A) receptor function with traits often found in individuals with AN and BN, such as harm avoidance. Finally, alteration of these receptors tends to implicate pathways involving frontal, cingulate, temporal, and parietal regions. Alterations of these circuits may affect mood and impulse control as well as the motivating and hedonic aspects of feeding behavior. Such imaging studies may offer insights into new pharmacology and psychotherapy approaches.

Lenze EJ, Karp JF, Mulsant BH, Blank S, Shear MK, Houck PR, Reynolds CF. · Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA. · J Geriatr Psychiatry Neurol. · Pubmed #15911937 No free full text.

Abstract: Understanding and addressing somatic symptoms are complex in older adults, who have more comorbid medical illnesses. This article describes a systematic review of the literature on somatic symptoms in older patients with anxiety disorders. Additionally, the hypothesis was tested that somatic symptoms would respond to selective serotonin reuptake inhibitor treatment in 30 anxious patients aged 60 years and older who participated in a 32-week trial of citalopram. The literature review showed few original data articles about somatic symptoms in older patients with anxiety disorders. These articles suggest that such a relationship is common and that treatment of anxiety, or anxious depression, is associated with a reduction in somatic symptoms. In the analysis, citalopram treatment was associated with a significant decrease in several somatic symptoms from pretreatment baseline. It is concluded that somatic symptoms in older adults with anxiety disorders or anxious depression often improve with successful antidepressant treatment. However, additional treatment and integrated approaches are likely to be necessary for many such individuals.