Anxiety Disorders: Planet Earth

Bremner JD, Vythilingam M, Anderson G, Vermetten E, McGlashan T, Heninger G, Rasmusson A, Southwick SM, Charney DS. · Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA. · Biol Psychiatry. · Pubmed #14512211 No free full text.

Abstract: BACKGROUND: Preclinical studies showed that early stress results in long-term alterations in the hypothalamic-pituitary-adrenal (HPA) axis. We performed a comprehensive assessment of the HPA axis in women with and without a history of early childhood sexual abuse and posttraumatic stress disorder (PTSD). METHODS: Fifty-two women with and without a history of early childhood sexual abuse and PTSD underwent a comprehensive assessment of the HPA axis, including measurement of cortisol in plasma every 15 min over a 24-hour period and cortisol and corticotropin (ACTH) following corticotropin-releasing factor (CRF) and ACTH challenge. RESULTS: Abused women with PTSD had lower levels of cortisol during the afternoon hours (12:00-8:00 PM) of a 24-hour period compared with non-PTSD women. Their ACTH response to a CRF challenge was blunted compared with nonabused non-PTSD (but not abused non-PTSD) women. There were no differences in cortisol response to CRF and ACTH challenges between the groups. Increased PTSD symptom levels were associated with low afternoon cortisol levels. CONCLUSIONS: These findings suggest that early abuse is associated with increased CRF drive as evidenced by decreased pituitary sensitivity to CRF, whereas in abuse with PTSD there is a specific hypocortisolemia that is most pronounced in the afternoon hours.

Antoniuk SA. · Departamento de Pediatria, Universidade Federal do Paraná, Curitiba, PR. · J Pediatr (Rio J). · Pubmed #15154073 No free full text.

Abstract: OBJECTIVE: To introduce pediatricians to the psychiatric and behavioral disorders that most frequently affect children with epilepsy, qualifying them to diagnose, evaluate risk factors and guide the treatment of these children. SOURCES OF DATA: MEDLINE (1979 to 2003) and epilepsy clinic at the Neuropediatrics Center, Universidade Federal do Paraná, Brazil. SUMMARY OF THE FINDINGS: Children with epilepsy are at increased risk for behavioral and emotional problems when compared to children in the general population and to children with other chronic illnesses not involving the central nervous system. Among these problems, the following should be emphasized: oppositional defiant disorder, conduct disorder, depression, anxiety and attention-deficit/hyperactivity disorder. The main risk factors include associated neurological impairment, severe or untreatable epilepsy and family, social or environmental problems. Neurobiological factors associated with epilepsy are also implicated. The usual treatments with specific drugs may be used in children with epilepsy. CONCLUSIONS: Due to the high incidence of neuropsychiatric disorders in epileptic children, the pediatrician should evaluate the risk factors associated with behavioral, emotional and psychiatric problems. The pediatrician is in a position to, and should, solve most of these difficulties, due to his/her close relationship with the family. In several cases, the associated psychiatric disorders are more harmful to the patient's quality of life than the epilepsy itself.

Cittadini E, Goadsby PJ. · Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK. · J Neurol Neurosurg Psychiatry. · Pubmed #15965225 links to  free full text

Abstract: A patient is reported with psychological change characterised by impaired concentration and thought projection, followed by both severe anxiety and depression, starting after three weeks on high dose methysergide. The acute problem settled slowly after methysergide withdrawal and is likely to represent an unusual and serious side effect of that drug.