Anxiety Disorders: University of Pittsburgh

Howland RH. · University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA. · J Psychosoc Nurs Ment Health Serv. · Pubmed #15884474 No free full text.

This publication has no abstract.

Kaye WH, Frank GK, Bailer UF, Henry SE, Meltzer CC, Price JC, Mathis CA, Wagner A. · University of Pittsburgh, School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, United States. · Physiol Behav. · Pubmed #15869768 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, raises the possibility that these symptoms reflect disturbed brain function that contributes to the pathophysiology of this illness. Recent brain imaging studies have identified altered activity in frontal, cingulate, temporal, and parietal cortical regions in AN and BN. Importantly, such disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Emerging data point to a dysregulation of serotonin pathways in cortical and limbic structures that may be related to anxiety, behavioral inhibition, and body image distortions. In specific, recent studies using PET with serotonin specific radioligands implicate alterations of 5-HT1A and 5-HT2A receptors and the 5-HT transporter. 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.

Kaye WH, Frank GK, Bailer UF, Henry SE. · Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. · Int J Eat Disord. · Pubmed #15852312 No free full text.

Abstract: Recent evidence suggests that genetic and neurobiologically mediated mechanisms contribute to the etiology of anorexia nervosa (AN). Serotonin neuronal systems, in particular, may create vulnerabilities related to pathological feeding, anxiety and obsessions, and extremes of impulse control, that make individuals susceptible to developing an eating disorder, perhaps in combination with environmental stressors.

Bukstein OG, Trunzo AC. · Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA. · Minerva Pediatr. · Pubmed #15791198 No free full text.

Abstract: Alcohol use and abuse by children and adolescents remains a critical problem for modern developed countries. Although tolerance and public policy for alcohol use varies among Western countries, the use of alcohol and other harmful substances is common among adolescents. The use of alcohol can lead to a variety of negative consequences for youth. The risk for alcohol use and abuse, the acquisition of use behaviors, and development into alcohol use disorders and interventions for such problems should be considered in a comprehensive manner that considers neurobiology, development, and the adolescent's environmental ecology. Although the nature and extent of the alcohol problems between countries may vary, approaches to assessment and treatment from the United States may be useful to clinicians in other countries. This paper presents essential background information for the clinician in order to understand the presentation, risk, prevention and treatment of adolescents with alcohol use problems.

Cornelius JR, Clark DB, Bukstein OG, Salloum IM. · School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2593, USA. · Recent Dev Alcohol. · Pubmed #15789875 No free full text.

Abstract: Comorbid psychiatric disorders and drug use disorders (DUDs) are common among adolescents with alcohol use disorders (AUDs). These comorbid disorders have a large potential significance on the clinical course of the AUDs among adolescents, and can predict a shorter time to relapse of alcohol use. The use of medication for treatment of the various comorbid adolescent populations has increased dramatically in recent years, despite the lack of double-blind, placebo-controlled studies that demonstrate their safety and efficacy. Consequently, to date, no empirically proven treatment exists for most of these comorbid disorders. This chapter reviews the state of the art regarding the treatment of comorbid adolescents. This chapter also identifies gaps in knowledge regarding the treatment of comorbid adolescents, and outlines directions for future research in this field.

Thase ME. · Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2593, USA. · Gen Hosp Psychiatry. · Pubmed #15763121 No free full text.

Abstract: Approximately one half of patients with insomnia have a primary psychiatric disorder such as a depression or anxiety. Insomnia is associated with increased risk of new or recurrent psychiatric disorders, increased daytime sleepiness with consequent cognitive impairment, poorer prognoses, reduced quality of life and high healthcare-related financial burden. Emerging data suggest that resolution of insomnia may improve psychiatric outcomes, which underscores the importance of vigorous treatment. Unfortunately, only a small percentage of patients receive such care. An ideal monotherapeutic strategy would treat both depression and insomnia. There are, however, only a handful of modern antidepressants that objectively improve sleep maintenance problems, and none do so without causing adverse next-day effects such as sedation. Thus, a significant number of patients must take adjunctive hypnotic medications, even though longer-term efficacy has not been established. New and emerging anti-insomnia agents may prove useful in the long-term treatment of chronic insomnia. Further research is needed to establish the benefits of such treatment.

Mulsant BH, Whyte E, Lenze EJ, Lotrich F, Karp JF, Pollock BG, Reynolds CF. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. · CNS Spectr. · Pubmed #14978461 No free full text.

Abstract: Depression and anxiety disorders are very common in the elderly. Data accumulated over the past 2 decades have shown that most older patients can tolerate and respond to acute treatment with serotonergic antidepressants, other psychotropic agents, or manual-based psychotherapy. However, outcomes under usual-care conditions remain poor. This review proposes that clinicians may significantly improve the long-term outcomes of their older patients with depression and anxiety by focusing on four key factors: (1) identification and treatment of comorbid conditions; (2) full remission of acute symptoms; (3) education of patients, families, and professional colleagues about the need for long-term treatment; and (4) prevention and management of medication side-effects.

Lenze EJ, Pollock BG, Shear MK, Mulsant BH, Bharucha A, Reynolds CF. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. · CNS Spectr. · Pubmed #14978458 No free full text.

Abstract: Anxiety is common in the elderly and can present as a primary anxiety disorder or as a symptom of another disorder. Generalized anxiety disorder, in particular, is a common syndrome in late life. Anxiety symptoms are also common features of late-life depression and dementia. Treatment of anxiety in elderly persons has typically involved the use of benzodiazepines, which are often effective but problematic because they are associated with increased risk of cognitive impairment, falls, and fractures. Based on their safety and efficacy, antidepressants, particularly serotonergic medications, are considered first-line treatment for most anxiety disorders as well as anxiety symptoms of major depressive disorder. Psychotherapy, particularly cognitive-behavioral therapy, may be effective in these disorders as well; research is underway to adapt this therapy to the needs of elderly persons. Anxiety symptoms in dementia are poorly understood but may respond to atypical antipsychotics, serotonergic antidepressants, or mood stabilizers. Overall, the research in late-life anxiety has not caught up to the literature in late-life depression and, for the most part, treatment recommendations must be extrapolated from studies in young adults.

Hariri AR, Weinberger DR. · Clinical Brain Disorders Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA. · Genes Brain Behav. · Pubmed #14653306 No free full text.

Abstract: Serotonin (5-hydroxytryptamine; 5-HT) is a potent modulator of the physiology and behavior involved in generating appropriate responses to environmental cues such as danger or threat. Furthermore, genetic variation in 5-HT subsystem genes can impact upon several dimensions of emotional behavior including neuroticism and psychopathology, but especially anxiety traits. Recently, functional neuroimaging has provided a dramatic illustration of how a promoter polymorphism in the human 5-HT transporter (5-HTT) gene, which has been weakly related to these behaviors, is strongly related to the engagement of neural systems, namely the amygdala, subserving emotional processes. In this commentary, we discuss how functional neuroimaging can be used to characterize the effects of polymorphisms in 5-HT subsystem genes on the response of neural circuits underlying the generation and regulation of mood and temperament as well as susceptibility to affective illness. We argue that in time, such knowledge will allow us to not only transcend phenomenological diagnosis and represent mechanisms of disease, but also identify at-risk individuals and biological pathways for the development of new treatments.

Ryan ND. · Department of Psychiatry, University of Pittsburgh Medical Center, PA 15213, USA. · Int J Methods Psychiatr Res. · Pubmed #12830309 No free full text.

Abstract: As with adult major depressive disorder (MDD), child and adolescent MDD is characterized as a common, chronic and recurrent disorder. It is also associated with short- and long-term functional impairment, morbidity, and mortality. Effective treatments, both psychotherapeutic and pharmacotherapeutic, are available for the short-term treatment and management of youth with MDD. However, to date, there are no data on the long-term treatment and management of children and adolescents with MDD and how long-term treatment may affect the outcomes of either high-risk or already affected youth. Understanding the long-term consequences of MDD during youth is as important as understanding how to treat a single episode of depression. Available data on the pharmacotherapeutic and psychotherapeutic options are discussed. In general, tricyclic antidepressants (TCAs) are not as effective for the treatment of youth with MDD as adults with MDD. The selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in children and adolescents with MDD and non-obsessive compulsive anxiety disorders. The serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine XR, has been shown to be effective for the treatment of generalized anxiety disorder in children and adolescents. Understanding the long-term clinical consequences of depressive disorders in youth may provide opportunities for better intervention across the clinical course of illness. Early recognition, diagnosis and adequate treatment of 'high-risk' youth with subsyndromal depressive symptoms, treatment of acute episodes of depression to prevent 'kindling', and aggressive prophylaxis have the potential to improve the mental health of youth throughout their lives.

Barbarich NC, Kaye WH, Jimerson D. · Anorexia and Bulimia Nervosa Research Module, University of Pittsburgh Medical Center, Western Psychiatric Institute & Clinic, 3811 O'Hara Street, 600 Iroquois Building, Pittsburgh, PA 15213, USA. · Curr Drug Targets CNS Neurol Disord. · Pubmed #12769813 No free full text.

Abstract: Anorexia and Bulimia Nervosa are disorders of unknown etiology that invariably begin during adolescence and near in time to puberty in young women. These disorders are associated with aberrant eating behaviors, body image distortions, impulse and mood disturbances, as well as characteristic temperament and personality traits. It is well known that malnutrition produces changes in neuroendocrine function. More recently, disturbances in neuronal systems have been found to play a role in the modulation of feeding, mood, and impulse control. These neuronal systems include neuropeptides (CRH, opioids, neuropeptide-Y (NPY) and peptide YY (PYY), vasopressin and oxytocin, CCK, and leptin) and monoamines (serotonin, dopamine, norepinephrine). Disturbances of most of these neuronal systems have been found when people are ill with an eating disorder, but it was not certain whether they were a cause or consequence of symptoms. In order to address these questions, a growing number of studies have investigated whether neuromodulatory disturbances persist after recovery. Studies from several centers tend to show altered serotonin activity persists after prolonged normalization of weight, nutrition, and menstrual function, as do anxiety, obsessionality, and perfectionism. While there are fewer data, there may be persistent alterations of dopamine or some neuropeptides in some subjects in a recovered state. The inaccessibility of the central nervous system has made it difficult to understand brain and behavior. In the past decade, new tools, such as brain imaging, have offered the possibility of better characterization of complex neuronal function and behavior. Such studies have tended to consistently find that alterations of brain regions, such as the temporal lobe, occur in people who are ill with anorexia nervosa and appear to persist after some degree of weight gain and recovery. New imaging technology, that marries Positron Emission Tomography (PET) imaging with selective neurotransmitter radioligands, confirms that altered serotonin neuronal pathway activity persists after recovery from an eating disorder and supports the possibility that these psychobiological alterations might contribute to traits, such as increased anxiety or extremes of impulse control, that, in turn, may contribute to a vulnerability to the development of an eating disorder. In summary, studies of pathophysiology are starting to nominate new candidates for treatment leading to the possibility of finding effective treatments for this often chronic or fatal disorder.

Mitchell AM, Sakraida TJ, Kameg K. · University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA. · Disaster Manag Response. · Pubmed #12704320 No free full text.

Abstract: Critical incidents disrupt people's lives by creating strong emotional reactions, which may range from normal stress reactions to post-traumatic stress disorders. Critical incident stress debriefing (CISD) has been used since 1983 as a component of Critical Incident Stress Management. The processes are intended to help individuals manage their normal stress reactions to abnormal events. Although used extensively, research findings to date yield mixed results. Meta-analyses of research studies are reviewed to identify the methods, results, strengths, and weaknesses of the studies that can be used for evidence-based practice.

Mitchell AM, Kameg K, Sakraida TJ. · University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA. · Disaster Manag Response. · Pubmed #12688305 No free full text.

This publication has no abstract.

Lenze EJ. · Intervention Research Center in Late-life Mood Disorders, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Room E1124, PA 15213, USA. · Curr Psychiatry Rep. · Pubmed #12686004 No free full text.

Abstract: Elderly patients with depression commonly suffer from concurrent symptoms of anxiety or comorbid anxiety disorders. Such comorbidity is associated with a more severe presentation of depressive illness, including greater suicidality. Additionally, most antidepressant treatment studies of elderly individuals with depression have found poorer treatment outcomes in those with comorbid anxiety, for example, delayed or diminished response and increased likelihood of dropout from treatment. In terms of treatment of anxious depression, there is evidence that tricyclic antidepressants and serotonin reuptake inhibitors are not different from each other in terms of efficacy or tolerability. Rather than the specific choice of antidepressant medication, it appears that quality of clinical management has the greatest impact on likelihood of remission in anxious depressed elderly individuals. Co-prescription of benzodiazepines is sometimes warranted for severe anxiety, but increases the risk of cognitive or motor impairment. Psychotherapy, including cognitive-behavioral therapy and interpersonal therapy, which are efficacious for late-life depression in general, should also be considered for treatment alone or in combination with appropriate medication. Future research areas are also addressed in this paper.

Mitchell AM, Sakraida TJ, Kameg K. · University of Pittsburgh School of Nursing, 415 Victoria Building, Pittsburgh, PA 15261, USA. · Disaster Manag Response. · Pubmed #12685460 No free full text.

Abstract: The purpose of this article is to provide an overview of the acute stress response with additional information on post-traumatic stress. There is an emphasis on the theoretical foundations and post-traumatic stress disorder symptoms. Risk factors, symptom clusters, and the diagnostic criteria for post-traumatic stress disorder are described as a foundation for clinical implications and a focused nursing assessment.

Cornelius JR, Bukstein O, Salloum I, Clark D. · Pittsburgh Adolescent Alcohol Research Center, Center for Education and Drug Abuse Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. · Recent Dev Alcohol. · Pubmed #12638646 No free full text.

Abstract: Comorbid psychiatric disorders and drug use disorders (DUDs) are common among alcoholics (Regier, Farmer, Rae, Locke, Keith, Judd, & Goodwin, 1990; Kessler, McGonagle, Zhao, Nelson, Hughes, Eshleman, Wittchen, & Kendler, 1994). These comorbid disorders often predict a shorter time to relapse of alcoholism (Greenfield, Weiss, Muenz, Vagge, Kelly, Bello, & Michael, 1998). However, despite the prevalence and the adverse effects of this comorbidity, few controlled treatment studies have been conducted involving this dual diagnosis population (Litten & Allen, 1999). To date, most of these few studies of alcoholics with comorbid disorders have been restricted to studies of alcoholics with either comorbid major depression or comorbid anxiety disorders (Litten & Allen, 1995). The results of these trials suggest efficacy for SSRI antidepressants and tricyclic antidepressants for treating alcoholics with comorbid major depression and suggest efficacy for buspirone for treating alcoholics with comorbid anxiety disorders (Mason, Kocsis, Ritvo, & Cutler, 1996; Cornelius, Salloum, Ehler, Jarrett, Cornelius, Perel, Thase, & Black, 1997; Kranzler, Burleson, Del Boca, Babor, Korner, Brown, & Bohn, 1994). However, controlled treatment studies involving alcoholics with other comorbid disorders are almost totally lacking. Consequently, to date, no empirically proven treatment exists for most of these comorbid disorders.

Balaban CD. · Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA. · Physiol Behav. · Pubmed #12526985 No free full text.

Abstract: This communication provides an update of our understanding of the neurological bases for the close association between balance control and anxiety. New data suggest that a vestibulo-recipient region of the parabrachial nucleus (PBN) contains cells that respond to body rotation and position relative to gravity. The PBN, with its reciprocal relationships with the extended central amygdaloid nucleus, infralimbic cortex, and hypothalamus, appears to be an important node in a primary network that processes convergent vestibular, somatic, and visceral information processing to mediate avoidance conditioning, anxiety, and conditioned fear responses. Noradrenergic and serotonergic projections to the vestibular nuclei also have parallel connections with anxiety pathways. The coeruleo-vestibular pathway originates in caudal locus coeruleus (LC) and provides regionally specialized noradrenergic input to the vestibular nuclei, which likely mediate effects of alerting and vigilance on the sensitivity of vestibulo-motor circuits. Both serotonergic and nonserotonergic pathways from the dorsal raphe nucleus and the nucleus raphe obscurus also project differentially to the vestibular nuclei, and 5-HT(2A) receptors are expressed in amygdaloid and cortical targets of the PBN. It is proposed that the dorsal raphe nucleus pathway contributes to both (a) a tradeoff between motor and sensory (information gathering) aspects of responses to self-motion and (b) a calibration of the sensitivity of affective responses to aversive aspects of motion. This updated neurologic model continues to be a synthetic schema for investigating the neurological and neurochemical bases for comorbidity of balance disorders and anxiety disorders.

Thase ME, Trivedi M. · Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213-2593, USA. · Psychopharmacol Bull. · Pubmed #12490825 links to  free full text

Abstract: The goal of the acute phase of pharmacotherapy of major depressive disorder or generalized anxiety disorder is remission (ie, complete resolution of symptoms) rather than simply a response (eg, at least a > or = 50% improvement in symptoms). Despite treatment, incompletely remitted patients often have persistent social and/or functional impairment, and are particularly vulnerable to relapse. To optimize outcomes, it is important to continue to adjust and refine the treatment plan until there is resolution of residual depressive symptoms and normalization of social functioning. Thereafter, prophylactic therapy is indicated to lessen the risk of recurrence and/or chronicity. Contemporary treatment options include older medications such as tricyclic antidepressants, newer compounds, such as selective serotonin reuptake inhibitors, the serotonin and norepinephrine reuptake inhibitor, venlafaxine, and a number of other medications with novel mechanisms of action. Although it has been conventional to assume that all antidepressants are equally effective, evidence from a recent pooled analysis of data from eight double-blind, randomized, controlled clinical studies suggests that venlafaxine therapy may be associated with higher remission rates.

Dahl RE, Lewin DS. · Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania 15213, USA. · J Adolesc Health. · Pubmed #12470913 No free full text.

Abstract: There are several converging reasons to focus on sleep regulation in relation to healthy adolescent development: (a) Sleep appears to be particularly important during periods of brain maturation; (b) there are substantial biological and psychosocial changes in sleep and circadian regulation exist across pubertal development; (c) interactions between physical and psychosocial domains can lead to dramatic alterations in sleep patterns and habits during adolescence; (d) increasing evidence that many adolescents frequently obtain insufficient sleep exists; (e) there is mounting evidence that sleep deprivation has its greatest negative effects on the control of behavior, emotion, and attention, a regulatory interface that is critical in the development of social and academic competence, and psychiatric disorders; (f) the most obvious direct health consequences of insufficient sleep are high-risk behaviors associated with substance abuse and automobile accidents; (g) substantial evidence for bidirectional effects between sleep and behavioral/emotional regulation exists. Although the past decade has seen research progress in these areas, there continue to be major gaps in existing knowledge and a paucity of well-controlled studies to guide specific health policy decisions and recommendations regarding sleep in adolescence. In particular, there is need for improved understanding of the acute and chronic effects of inadequate sleep in adolescents, guidelines for defining adequate sleep in adolescents, and a better delineation of the links among sleep, behavior, and affect regulation. Finally, this paper briefly examines one specific application of this knowledge area regarding early starting times among some high schools.

Shear MK, Cassano GB, Frank E, Rucci P, Rotondo A, Fagiolini A. · Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. · Psychiatr Clin North Am. · Pubmed #12462858 No free full text.

Abstract: The results of the authors' research efforts to date support the idea that the panic-agoraphobic spectrum is a robust and culturally transferable construct with important clinical implications for patients with mood and anxiety disorders. In particular, their findings suggest the need for alternate treatment strategies to treat mood patients with comorbid panic features [50,52]. They maintain that the spectrum approach could add to the knowledge of course and outcome of mood and anxiety disorders and inform treatment decisions. The spectrum concept has other potential implications. For the purposes of neurobiologic research, reliable identification of phenotypes that map [Figure 3: see text] onto specific brain processes in crucial. The definition of the diathesis phenotype is also important if we are to elucidate the cause and pathophysiology of mental disorders at a molecular level. A panic-agoraphobic spectrum assessment incorporate temperamental features and trait-like manifestations into a comprehensive symptom assessment to provide a detailed picture of the clinical features of PD. Such an approach holds some promise for progress in studies of neurobiologic basis of panic and may be useful in further efforts to overcome the nagging problem of the ambiguous boundaries of DSM diagnostic categories [53].

Lenze EJ, Mulsant BH, Shear MK, Houck P, Reynolds III CF. · Department of Psychiatry, Intervention Research Center in Late-Life Mood Disorders, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. · Drugs Aging. · Pubmed #12390052 No free full text.

Abstract: Depressed elderly persons frequently have concurrent symptoms of anxiety or comorbid anxiety disorders. Such comorbidity is associated with a more severe presentation of depressive illness, including greater suicidality. Additionally, most antidepressant treatment studies in the elderly have found poorer treatment outcomes in those with comorbid anxiety (including delayed or diminished response and increased likelihood of dropout from treatment). While antidepressants such as selective serotonin reuptake inhibitors and tricyclic agents are efficacious for late-life depression, there is no evidence that either class is superior, in terms of efficacy or tolerability, in the treatment of anxious depression. Rather, the amount and quality of clinical management, and not the particular medication chosen, appears to influence the likelihood of remission or treatment withdrawal in anxious depressed elderly patients. Co-prescription of benzodiazepines, typically lorazepam, is also warranted in some cases for severe anxiety or insomnia, but carries the risk of cognitive or motor impairment. It is our experience that close clinical monitoring, together with maximization of antidepressant treatment (by maximising dosage, augmenting or switching agents in cases of partial or no response, and/or adding psychotherapy) will almost always result in remission of depressive symptoms, together with improvement of anxiety, in these individuals. Therefore, optimism should be maintained when treating the depressed elderly individual, even when comorbid anxiety is present.

Orenstein DM. · Antonio J. and Janet Palumbo Cystic Fibrosis Center Children's Hospital of Pittsburgh, PA 15213, USA. · Pediatr Clin North Am. · Pubmed #12296528 No free full text.

Abstract: In the overwhelming majority of exercising youngsters, exercise tolerance is limited by cardiovascular and muscular factors, not the lungs. Even at exhaustion, pulmonary reserve is considerable. Yet some young athletes do experience respiratory problems with exercise. These problems can be assigned to several categories, including those related to underlying acute and chronic respiratory conditions (principally respiratory tract infections, asthma, cystic fibrosis, chest wall deformities, and neuromuscular disorders), and apparent but nonpathological problems (the heavy breathing of anaerobic exercise, relative deconditioning, and anxiety). There are also situations that seem to be problematic but need not be (having the diagnosis of asthma or cystic fibrosis). Pharmacologic management of respiratory problems and perceived problems can be difficult and is discussed with the particular disorder.

Birmaher B, Arbelaez C, Brent D. · Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, 3811 O'Hara Street, Pittsburgh, PA 15213-3811, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #12222086 No free full text.

Abstract: Major depressive disorder (MDD) is a familial recurrent illness that significantly interferes with the child's normal development and is associated with increased risk for suicidal behaviors and psychiatric and psychosocial morbidity. Although most children and adolescents recover from their first depressive episode, 30-70%, in particular those with familial history of MDD, comorbid psychiatric disorders, dysthymia, subsyndromal symptoms of depression, anxiety, negative cognitive style, and exposure to negative life events (e.g., family conflicts and abuse) will experience one or more depressive recurrences during their childhood, adolescence, and adulthood. Depressed youth who present with psychosis, psychomotor retardation, pharmacological induced hypomania/mania, and/or family history of bipolar disorder are at high risk to develop bipolar disorder.

Wald A. · University of Pittsburgh Medical Center, Division of Gastroenterology, Hepatology & Nutrition, PUH, Mezzanine Level, C-Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA. · J Clin Gastroenterol. · Pubmed #12184140 No free full text.

Abstract: The use of antidepressants to treat patients with irritable bowel syndrome (IBS) has been extended in recent years because of their possible neuromodulatory and analgesic effects, generally in doses that do not have antidepressant effects. There seems to be sufficient evidence to support the recommendation that psychotropic agents may be effective in two clinical scenarios that are not mutually exclusive. The first is in patients with IBS who have pain and related symptoms that are unresponsive to medical therapy. The second is in patients with IBS who have concomitant psychologic dysfunction. This article reviews the evidence to support these recommendations and guidelines, which may be used to optimize medical management in these patients.

Lotrich FE, Pollock BG, Ferrell RE. · Department of Psychiatry, Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. · Am J Pharmacogenomics. · Pubmed #12083964 No free full text.

Abstract: Selective serotonin reuptake inhibitors (SSRIs) are used to treat a number of psychiatric disorders related to mood and anxiety, and variations in the serotonin transporter (5-HTT) gene may be involved in a number of these. A polymorphic site in the promoter region is associated with differences in 5-HTT gene expression. Studies suggest that the short allele of the 5-HTT promoter (5-HTTPR) site can adversely influence the antidepressant response to SSRIs, and is associated with anxiety-related traits, depression, and impulsive disorders such as alcohol abuse. Several studies do not replicate these findings; potential confounding factors include age, gender, and population stratification. Other 5-HTT polymorphisms also exist. For example, individuals with the short allele of a variable number of tandem repeats (VNTR) polymorphism, located in the second intron, may have reduced responsiveness to SSRIs, and the STin2.12 allele at this site has been associated with bipolar disorder. Findings both supporting and inconsistent with these conclusions are reviewed. The clinical effects of the polymorphisms may be associated with effects on platelets, neural 5-HTT levels, and indices of serotonergic function.