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Alfaro-Rodríguez A, Reyes-Long S, Roldan-Valadez E, González-Torres M, Bonilla-Jaime H, Bandala C, Avila-Luna A, Bueno-Nava A, Cabrera-Ruiz E, Sanchez-Aparicio P, González Maciel A, Dotor-Llerena AL, Cortes-Altamirano JL. Association of the Serotonin and Kynurenine Pathways as Possible Therapeutic Targets to Modulate Pain in Patients with Fibromyalgia. Pharmaceuticals (Basel) 2024; 17:1205. [PMID: 39338367 PMCID: PMC11434812 DOI: 10.3390/ph17091205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/27/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
Fibromyalgia (FM) is a disorder characterized by widespread chronic pain, significant depression, and various neural abnormalities. Recent research suggests a reciprocal exacerbation mechanism between chronic pain and depression. In patients with FM, dysregulation of tryptophan (Trp) metabolism has been identified. Trp, an essential amino acid, serves as a precursor to serotonin (5-HT), a neuromodulator that influences mood, appetite, sleep, and pain perception through the receptors 5-HT1, 5-HT2, and 5-HT3. Additionally, Trp is involved in the kynurenine pathway, a critical route in the immune response, inflammation, and production of neuroactive substances and nicotinamide adenine dinucleotide (NAD+). The activation of this pathway by pro-inflammatory cytokines, such as tumor necrosis factor α (TNF-α) and interferon gamma (IFN-γ), leads to the production of kynurenic acid (KYNA), which has neuroprotective properties, and quinolinic acid (QA), which is neurotoxic. These findings underscore the crucial balance between Trp metabolism, 5-HT, and kynurenine, where an imbalance can contribute to the dual burden of pain and depression in patients with FM. This review proposes a novel therapeutic approach for FM pain management, focusing on inhibiting QA synthesis while co-administering selective serotonin reuptake inhibitors to potentially increase KYNA levels, thus dampening pain perception and improving patient outcomes.
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Affiliation(s)
- Alfonso Alfaro-Rodríguez
- Division of Basic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
| | - Samuel Reyes-Long
- Division of Basic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
| | - Ernesto Roldan-Valadez
- Division of Basic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
- Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia
| | - Maykel González-Torres
- Conahcyt & Biotechnology Laboratory, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 03940, Mexico
| | - Herlinda Bonilla-Jaime
- Department of Reproductive Biology, Universidad Autónoma Metropolitana Iztapalapa, Mexico City 09340, Mexico
| | - Cindy Bandala
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Alberto Avila-Luna
- Division of Basic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
| | - Antonio Bueno-Nava
- Division of Basic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
| | - Elizabeth Cabrera-Ruiz
- Division of Basic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
| | - Pedro Sanchez-Aparicio
- Pharmacology Department, Facultad de Medicina Veterinaria, Universidad Autónoma del Estado de México, Toluca 50090, Mexico
| | - Angélica González Maciel
- Laboratory of Cell and Tissue Morphology, Instituto Nacional de Pediatría, Mexico City 04530, Mexico
| | - Ana Lilia Dotor-Llerena
- Division of Clinic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
| | - José Luis Cortes-Altamirano
- Division of Basic Neurosciences, Instituto Nacional de Rehabilitación, "Luis Guillermo Ibarra Ibarra", Mexico City 14389, Mexico
- Department of Chiropractic, Universidad Estatal del Valle de Ecatepec, Ecatepec de Morelos 55210, Mexico
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Allen-Brady K, Fyer AJ, Weissman M. The multi-generational familial aggregation of interstitial cystitis, other chronic nociplastic pain disorders, depression, and panic disorder. Psychol Med 2023; 53:7847-7856. [PMID: 37458197 DOI: 10.1017/s0033291723001885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
BACKGROUND Interstitial cystitis/painful bladder syndrome (IC) is a chronic pelvic pain condition which has high comorbidity with other nociplastic, or unexplained, pain disorders [e.g. fibromyalgia (FM), irritable bowel syndrome (IBS), and myalgic encephalomyelitis/chronic fatigue (ME/CFS)] and some psychiatric conditions [major depressive disorder (MDD) and panic disorder (PD)]. Here we investigated the shared familiality of IC and these other nociplastic and psychiatric conditions. METHODS Subjects were identified in the Utah Population Database, which links genealogy data back to the 1800s to medical record diagnosis billing code data back to 1995. We computed the relative risk of each of these disorders among first (FDR), second (SDR), and third-degree relatives (TDR) of six proband groups: IC, FM, IBS, ME/CFS, PD, and MDD. Given the known familial aggregation of each of these disorders, we conducted our analyses to test for heritable interrelationships using proband subgroups whose members did not have the diagnosis assessed in their relatives. RESULTS We observed strong evidence for heritable interrelationships among all six disorders. Most analyses indicated significantly increased risk for each of the six disorders in FDR, SDR, and TDR of all or most proband groups. Out of 30 possible bidirectional disorder interrelationships, 26 were significant among FDR, 23 were significant among SDR, and 7 were significant among TDR. Clustering was observed in both close and distant relatives. CONCLUSIONS Our results support a common, heritable component to IC and other nociplastic and psychiatric conditions.
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Affiliation(s)
- Kristina Allen-Brady
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Abby J Fyer
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York State Psychiatric Institute, New York City, New York, USA
| | - Myrna Weissman
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York State Psychiatric Institute, New York City, New York, USA
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Li J, Li R, Li D, Zhang J, Luo X, Zhang Y. Serum BDNF levels and state anxiety are associated with somatic symptoms in patients with panic disorder. Front Psychiatry 2023; 14:1168771. [PMID: 37533888 PMCID: PMC10393281 DOI: 10.3389/fpsyt.2023.1168771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Background We aimed to explore the predictive role of serum BDNF and anxiety-related variables in changes in somatic symptoms post-escitalopram treatment in panic disorder (PD) patients. Methods Ninety PD patients and 99 healthy controls (HCs) were enrolled. PD patients received an 8-week escitalopram treatment. All patients were administered the Panic Disorder Severity Scale-Chinese Version (PDSS-CV) and State-Trait Anxiety Inventory (STAI) to assess panic and anxiety-related symptoms, respectively. Patient Health Questionnaire 15-item scale (PHQ-15) was performed to measure somatic symptoms, and the blood sample was collected to detect serum BDNF levels in all participants. We performed partial correlation analysis and multiple linear regression to explore correlates of PHQ-15 and predictors of PHQ-15 changes post-escitalopram treatment after controlling for age, gender, education levels (set as a dummy variable), the current duration, comorbid AP, and/or GAD. Results Compared to HCs, PD patients had lower serum BDNF levels and higher PHQ-15 scores that could be improved post-escitalopram treatment. Lower baseline STAI state (b = -0.07, p = 0.004), and PDSS-CV scores (b = -0.25, p = 0.007), but higher baseline serum BDNF levels (b = 0.35, p = 0.007) contributed to the prediction of PHQ-15 changes post-escitalopram treatment. Conclusion State anxiety, serum BDNF levels, and panic severity could predict changes in somatic symptoms post-escitalopram treatment, our results highlighted that serum BDNF could serve as a biological indicator for improving somatic symptoms in PD patients.
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Affiliation(s)
- Jiaxin Li
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Ru Li
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Dazhi Li
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Jian Zhang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Yong Zhang
- Unit of Bipolar Disorder, Tianjin Anding Hospital, Tianjin, China
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Evcili G, Yabalak A. Effectiveness of peripheral nerve blockage on the symptoms of both diseases in patients with fibromyalgia and chronic migraine coexistence. Rev Assoc Med Bras (1992) 2022; 68:1064-1067. [PMID: 36000602 PMCID: PMC9574977 DOI: 10.1590/1806-9282.20220202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Peripheral nerve blockage treatments reduce central sensitization and are effective in patients with migraine. We wanted to evaluate the efficacy of peripheral nerve blockage in patients with fibromyalgia and migraine whose etiology may be responsible for central sensitization, and their associations are common. METHODS The files of patients with chronic migraine who had peripheral nerve blockage treatment in our clinic and had fibromyalgia were scanned. The patients underwent bilateral great occipital nerve, lesser occipital nerve, and supraorbital nerve blockage at baseline and in the second week. The revised Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, Visual Analog Scale scores, the number of days in pain, and the number of analgesics taken in the last month were recorded. RESULTS In the third month, Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, and Visual Analog Scale scores were significantly lower from baseline. While Fibromyalgia Impact Questionnaire scores in the third month were significantly lower than in the first month, no significant difference was observed between Visual Analog Scale scores. In the third month, the number of days in pain and the number of analgesics taken in the last month was significantly lower than the baseline but higher than the first month. CONCLUSION Peripheral nerve blockage has been found to be an effective treatment for the symptoms of both diseases in patients with migraine and fibromyalgia coexistence.
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Affiliation(s)
- Gokhan Evcili
- Health Sciences University Kocaeli Derince Training and Research Hospital, Department of Neurology - Kocaeli, Turkey
| | - Ahmet Yabalak
- Düzce University Medical Faculty, Department of Neurology - Düzce, Turkey
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Brennan BP, Hudson JI. Applications of Machine Learning to Improve Diagnosis, Advance Treatment, and Identify Causal Factors for Mental Disorders. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:635-637. [PMID: 35809988 DOI: 10.1016/j.bpsc.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Brian P Brennan
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - James I Hudson
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Fructose and Uric Acid as Drivers of a Hyperactive Foraging Response: A Clue to Behavioral Disorders Associated with Impulsivity or Mania? EVOL HUM BEHAV 2021; 42:194-203. [PMID: 33994772 DOI: 10.1016/j.evolhumbehav.2020.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several behavioral disorders, including attention deficit hyperactivity disorder (ADHD), bipolar disorder, and aggressive behaviors are linked with sugar intake and obesity. The reason(s) for this association has been unclear. Here we present a hypothesis supporting a role for fructose, a component of sugar and high fructose corn syrup (HFCS), and uric acid (a fructose metabolite), in increasing the risk for these behavioral disorders. Recent studies have shown that the reason fructose intake is strongly associated with development of metabolic syndrome is that fructose intake activates an evolutionary-based survival pathway that stimulates foraging behavior and the storage of energy as fat. While modest intake may aid animals that would like to store fat as a protective response from food shortage or starvation, we propose that high intake of sugar and HFCS causes a hyperactive foraging response that stimulates craving, impulsivity, risk taking and aggression that increases the risk for ADHD, bipolar disease and aggressive behavior. High glycemic carbohydrates and salty foods may also contribute as they can be converted to fructose in the body. Some studies suggest uric acid produced during fructose metabolism may mediate some of these effects. Chronic stimulation of the pathway could lead to desensitization of hedonic responses and induce depression. In conclusion, a hyperactive foraging response driven by high glycemic carbohydrates and sugars may contribute to affective disorders.
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Iorfino F, Marangoni C, Cui L, Hermens DF, Hickie IB, Merikangas KR. Familial aggregation of anxiety disorder subtypes and anxious temperament in the NIMH Family Study of Affective Spectrum Disorders. J Affect Disord 2021; 281:751-758. [PMID: 33267979 DOI: 10.1016/j.jad.2020.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/30/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence from family and twin studies suggests that mood and anxiety disorders, and related temperamental factors may share common etiologic factors. We examine the familial aggregation and coaggregation of anxiety disorder subtypes and anxiety-related temperamental traits, and their association with mood disorders. METHODS A total of 477 probands and 549 first-degree adult relatives from a large community based family study of affective spectrum disorders completed semi-structured diagnostic interviews and self-reported assessments of temperamental traits including: negative affectivity on the 'Positive and Negative Affect Schedule' (PANAS), neuroticism anxiety on the 'Zuckerman-Kuhlman Personality Questionnaire' (ZKPQ), and anxiety sensitivity on the 'Anxiety Sensitivity Index' (ASI). RESULTS The anxiety-related temperamental traits of negative affectivity, neuroticism anxiety and anxiety sensitivity had significant familial specificity, even after controlling for comorbid mood and anxiety disorders in probands and relatives. Yet, these traits in probands did not predict anxiety disorders in relatives. Although some anxiety subtypes were familial, there were no longer familial links between anxiety disorder subtypes (generalized anxiety disorder, social anxiety or panic disorder) after controlling for mood disorder subtypes in probands and relatives. LIMITATIONS Cross-sectional interviews were used to estimate disorders, and self-report measures were used for temperamental traits. CONCLUSIONS These results confirm previous research regarding familial overlap between anxiety subtypes and mood disorders, however their shared liability cannot be fully explained by anxiety-related temperamental traits. These findings suggest that anxiety-related temperamental traits may indicate a vulnerability for mood and anxiety disorders or a potential consequence of these conditions.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Australia.
| | - Ciro Marangoni
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Lihong Cui
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | - Kathleen Ries Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
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Kawashima K, Fukuba N, Uemura Y, Ota K, Kazumori H, Sonoyama H, Oka A, Tada Y, Mishima Y, Oshima N, Yuki T, Katsube T, Kinoshita Y, Ishihara S. Comorbid irritable bowel syndrome symptoms and headache have greater association with anxiety than depression: Annual health check-up survey results. Medicine (Baltimore) 2020; 99:e23059. [PMID: 33217807 PMCID: PMC7676610 DOI: 10.1097/md.0000000000023059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
High rates of co-existing irritable bowel syndrome (IBS) and headache have been reported in western countries. We investigated that comorbidity in individuals in Japan, along with anxiety and depression in subjects with and without IBS symptoms and/or headache.This cross-sectional study was performed from April 2012 to January 2013 at the Matsue Seikyo General Hospital Health Check Center. Questionnaires concerning symptoms related to IBS (Rome III) and headache, as well as anxiety/depression score were sent to individuals scheduled to undergo an annual health check-up, then returned during the visit and analyzed in a blinded manner.A total of 2885 individuals returned completed questionnaires and were enrolled, of whom 218 (7.6%) met the IBS criteria. The rates of co-existing headache in subjects with and without IBS symptoms were 44.0% (96/218) and 22.9% (611/2667), respectively, indicating a significantly higher rate of co-existing headache in subjects with as compared to without IBS (odds ratio [OR] 2.65, P < .001). Furthermore, the percentage of subjects with anxiety along with comorbid IBS symptoms and headache was significantly greater as compared to those with IBS (OR 3.01, P = .001) or headache (OR 2.41, P < .001) alone. Unlike anxiety, the percentage of subjects with depression was not significantly different among the IBS/non-headache, non-IBS/headache, and IBS/headache groups.Subjects with IBS symptoms had a higher rate of co-existing headache as compared to those without IBS. Furthermore, those with comorbid IBS symptoms and headache had a greater association with anxiety than with depression, as compared to those with only IBS or headache.
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Affiliation(s)
- Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
- Department of Internal Medicine
| | - Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Yusuke Uemura
- Department of Neurology, Matsue Seikyo General Hospital, 8-8-8 Nishitsuda
| | - Kuniko Ota
- Department of Neurology, Matsue Seikyo General Hospital, 8-8-8 Nishitsuda
| | | | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Takafumi Yuki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
| | - Tomoko Katsube
- Department of Preventive Medicine, Matsue Red Cross Hospital, 200 Horo-machi, Matsue, Shimane
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
- Steel Memorial Hirohata Hospital, 3-1 Yumesaki-cho, Hirohata-ku, Himeji, Hyogo, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo
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Prabhakar A, Kaiser JM, Novitch MB, Cornett EM, Urman RD, Kaye AD. The Role of Complementary and Alternative Medicine Treatments in Fibromyalgia: a Comprehensive Review. Curr Rheumatol Rep 2019; 21:14. [PMID: 30830504 DOI: 10.1007/s11926-019-0814-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Fibromyalgia is a complex chronic pain syndrome that can have debilitating consequences for affected patients. When compared to the general population, patients with fibromyalgia experience lowered mechanical and thermal pain thresholds, altered temporal summation of painful stimuli, and higher than normal pain ratings for known noxious stimuli. RECENT FINDINGS There is no definitive cure for fibromyalgia and treatment primarily focuses on both symptom management and improving patient quality of life. This treatment strategy involves a comprehensive multidisciplinary approach consisting of lifestyle modifications, pharmacologic measures, and other complementary approaches including but not limited to acupuncture, yoga, tai chi, and meditation. This manuscript will discuss the diagnosis and treatment of fibromyalgia, as well as complementary and alternative therapies that should be considered by healthcare providers.
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Affiliation(s)
- Amit Prabhakar
- Department of Anesthesiology, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer M Kaiser
- Medical College of Wisconsin, 333 Pine Ridge Blvd Suite 2-730, Wausau, WI, 54476, USA
| | - Matthew B Novitch
- Medical College of Wisconsin, 333 Pine Ridge Blvd Suite 2-730, Wausau, WI, 54476, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA
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Hudson JI, Pope HG. Evolving Perspectives on the Public Health Burden of Eating Disorders. Biol Psychiatry 2018; 84:318-319. [PMID: 30115240 DOI: 10.1016/j.biopsych.2018.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 11/16/2022]
Affiliation(s)
- James I Hudson
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, and the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Harrison G Pope
- Biological Psychiatry Laboratory and Psychiatric Epidemiology Research Program, McLean Hospital, Belmont, and the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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11
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Affective spectrum symptoms and self-criticism: A behavioral genetic approach. J Psychosom Res 2018; 109:71-78. [PMID: 29655597 DOI: 10.1016/j.jpsychores.2018.03.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 12/19/2022]
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12
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Psychiatric comorbidity and childhood trauma in fibromyalgia syndrome. Turk J Phys Med Rehabil 2018; 64:91-99. [PMID: 31453497 DOI: 10.5606/tftrd.2018.1470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/25/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives In this study, we aimed to compare patients with fibromyalgia syndrome (FMS) and those with myofascial pain syndrome (MPS) and healthy women and to investigate the prevalence of childhood traumatic experiences (CTEs) in relation to comorbid mood and anxiety disorders. Patients and methods Between February 2014 and May 2014, a total of 136 women including 52 with FMS, 35 with MPS, and 49 healthy controls were included in the study. The Sociodemographic Data Form, Mood and Anxiety Disorders Modules of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) Axis I Disorders (SCID-I), Fibromyalgia- related Symptom Scale (FSS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Childhood Trauma Questionnaire-28 (CTQ-28) were applied to participants. Results As a result of the semi-structured clinical interview conducted by a psychiatrist experienced in psychological trauma, the prevalence of any mood or anxiety disorder were found to be significantly more common in the FMS group. Childhood traumatic experiences, not only in general, but also with all subtypes, were also reported to be significantly more in FMS patients. Besides, only in patients with FMS, a significant relationship was found between the psychiatric diagnoses and the presence of CTEs. Furthermore, the CTQ-28 scores were correlated positively with the FSS scores as well as HDRS and HARS. Among the symptoms screened by the FSS, only crying and over-reacting to incidents were significantly associated with CTEs in FMS group. Conclusion Based on our study results, CTEs may play a critical role in the development of fibromyalgia and may be related with comorbid mood and anxiety disorders in FMS patients. Associating psychological symptoms such as crying or over-reacting to incidents in FMS patients should be, therefore, alerting for psychiatric consultation.
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13
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Georgescu D, Reisz D, Gurban CV, Georgescu LA, Ionita I, Ancusa OE, Lighezan D. Migraine in young females with irritable bowel syndrome: still a challenge. Neuropsychiatr Dis Treat 2018; 14:21-28. [PMID: 29302188 PMCID: PMC5741982 DOI: 10.2147/ndt.s144955] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Migraine without aura is frequently reported in female patients with irritable bowel syndrome (IBS), but knowledge about the relationship between these two conditions is still lacking. This study was aimed to explore the particularities of migraine without aura in young female patients with IBS in order to establish a possible link between them. From a cohort of young female patients hospitalized with IBS in the Internal Medicine Department, 30 joined this pilot study, and they were assigned into two groups on the basis of presence or absence of migraine. In this sample, 15 patients have mild to moderate migraine without aura, with a recently taken normal brain scan, and 15 were without migraine. Diseases and conditions not related to migraine and other possible specific female comorbidities were ruled out. Patients undertook a thorough clinical examination in order to assess fibromyalgia (FM) and chronic pelvic pain (CPP), Questionnaires for migraine disability assessment (MIDAS) and generalized anxiety disorder (GAD) were performed. Laboratory testing of blood, urine, and stool were also performed. Optimized lymphocyte proliferation test for food allergy (FA) and a fecal microbiota (microbiological semiquantitative method) for dysbiosis (DB) assessment were performed. Based on the results, migraine-positive group displayed more severe comorbidities: FM (p=0.0002), FA (p=0.0006), CPP (p=0.026), higher scores of anxiety (GAD, p=0.0008), and more severe DB (p=0.0009). We noticed a strong positive correlation between MIDAS and GAD (r=0.83), a good positive correlation between MIDAS and DB (r=0.56), and a moderate positive correlation between MIDAS, FM, and FA (r=0.46 and 0.41). In conclusion, young female patients with IBS and migraine without aura displayed more severe associated issues - anxiety, intestinal DB, FM, FA, and CPP. The severity of migraine correlated well with anxiety range and DB magnitude and moderately with FM and FA.
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Affiliation(s)
- Doina Georgescu
- Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara
| | - Daniela Reisz
- Department of Neurology, "Victor Babes" University of Medicine and Pharmacy, Timisoara
| | - Camelia Vidita Gurban
- Department of Biochemistry and Pharmacology, "Victor Babes" University of Medicine and Pharmacy, Timisoara
| | | | - Ioana Ionita
- Department of Hematology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Oana Elena Ancusa
- Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara
| | - Daniel Lighezan
- Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara
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14
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Khalid S, Simonds E, Loukas M, Tubbs RS. The clinical anatomy of fibromyalgia. Clin Anat 2017; 31:387-391. [PMID: 29197121 DOI: 10.1002/ca.23029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 12/25/2022]
Abstract
Fibromyalgia is a disorder characterized by pain and a spectrum of psychological comorbidities, rendering treatment difficult, and often a financial burden. Findings regarding diagnosis, prevalence, comorbidities, and potential pathophysiological links are discussed herein. Fibromyalgia is a complex disorder and there are specific criteria that patients must meet for diagnosis, including scores on fibromyalgia questionnaires, commonalities of age, gender, menopause status, sleep disturbances, and mood symptoms. The close relationship between fibromyalgia and other chronic disorders should alert the physician to explore for comorbid illnesses. In this review of the clinical anatomy of fibromyalgia, we review new studies that could be significant for the current use of clinical interventions for patients with symptoms. Using standard search engines, the clinical anatomy of fibromyalgia is investigated and many related studies are mentioned herein. Fibromyalgia is considered a prototypical central chronic pain syndrome and is associated with widespread pain that fluctuates spontaneously. There is also substantial lifetime psychiatric comorbidity in individuals with fibromyalgia, resulting in a low health-related quality of life. These results have important clinical and theoretical implications, including the possibility that fibromyalgia could share underlying pathophysiological links with some psychiatric disorders. This reveals that patients with fibromyalgia have findings compatible with tissue injury pain, the pain mechanisms involving both the primary afferent neuron and the nociceptive systems in the central nervous system. (1) There is a relationship between fibromyalgia and chronic disorders. This should alert the physician to explore for comorbid illnesses. (2) There is substantial lifetime psychiatric comorbidity resulting in a low health-related quality of life. (3) Patients with fibromyalgia have findings compatible with tissue injury pain Clin. Anat. 31:387-391, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Shehzad Khalid
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Seattle Science Foundation, Seattle, Washington
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Seattle Science Foundation, Seattle, Washington
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15
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McClain Z, Peebles R. Body Image and Eating Disorders Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatr Clin North Am 2016; 63:1079-1090. [PMID: 27865334 PMCID: PMC6402566 DOI: 10.1016/j.pcl.2016.07.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence is a crucial period for emerging sexual orientation and gender identity and also body image disturbance and disordered eating. Body image distortion and disordered eating are important pediatric problems affecting individuals along the sexual orientation and gender identity spectrum. Lesbian, gay, bisexual, transgender (LGBT) youth are at risk for eating disorders and body dissatisfaction. Disordered eating in LGBT and gender variant youth may be associated with poorer quality of life and mental health outcomes. Pediatricians should know that these problems occur more frequently in LGBT youth. There is evidence that newer treatment paradigms involving family support are more effective than individual models of care.
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Affiliation(s)
- Zachary McClain
- Craig Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 11 Northwest Tower, Room 10, Philadelphia, PA 19104, USA.
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16
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Perveen I, Parvin R, Saha M, Bari MS, Huda MN, Ghosh MK. Prevalence of Irritable Bowel Syndrome (IBS), Migraine and Co-Existing IBS-Migraine in Medical Students. J Clin Diagn Res 2016; 10:OC09-OC13. [PMID: 28050419 PMCID: PMC5198372 DOI: 10.7860/jcdr/2016/20900.8832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Irritable Bowel Syndrome (IBS) and migraine frequently co-exist. Stress is a major contributing factor for both. Our medical students are subjected to stress related to the implicit responsibility of courses. But the prevalence of IBS, migraine and co-existing migraine in medical students is not known. AIM To estimate the prevalence of migraine, IBS and co-existing IBS and migraine among medical students. A Cross-Sectional Survey. MATERIALS AND METHODS Self-reported questionnaire based study, was conducted in which migraine was defined according to International Headache Society (IHS) criteria while IBS by both Asian criteria and Rome III criteria. Both preclinical (n=142) and clinical students (n=151) of four medical colleges (government and private) of Dhaka and Sylhet district participated in the study. Statistical Analysis: Student's t-test and chi-square test were used to compare the distributions of continuous data and categorical data respectively with significance level set at 0.05 or less. RESULTS Among the 293 students (mean age 21.09 ± 2.24 years) volunteered in the study (Males= 177), 14 (4.8%, 11 males, 3 females, p = 0.175) met the criteria for IBS with comparable prevalence among preclinical and clinical (4.2% vs. 5.3%, p = 0.787) students from both private and government institutions (2.1% vs. 7.2%, p = 0.055). IBS-D was the most prevalent subtype (n = 8, M = 6) and abdominal pain relieved by defecation (n = 11), was the most prevalent symptom. Fifty percent (n = 7) of IBS patients considered their bowel habit as normal. Among the 221 (75.4%) students with headache, only 51 (17.4%, 20 males and 31 females, p = 0.001) were diagnosed of migraine, with comparable prevalence among preclinical and clinical students (16.2% vs. 18.5%, p = 0.645). Only 17 (33%) subjects with migraine had accompanying aura. Common triggers were stress (n = 43), lack of sleep (n = 42), and daily life events. Twelve (23.5%) subjects with migraine had migraine-associated frequent disability. Only two female students with IBS-D (14.3%) had concomitant IBS and migraine. CONCLUSION IBS and concomitant migraine - IBS prevalence was found to be low in our medical students, but migraine prevalence corresponds to other countries as well as in medical students.
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Affiliation(s)
- Irin Perveen
- Associate Professor, Department of Gastroenterology, Enam Medical College, Dhaka, Bangladesh
| | - Rukhsana Parvin
- Associate Professor, Department of Medicine, Enam Medical College, Dhaka, Bangladesh
| | - Madhusudan Saha
- Associate Professor, Department of Gastroenterology, North East Medical College, Sylhet, Bangladesh
| | - Md. Shafiqul Bari
- Associate Professor, Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
| | - Md. Nazmul Huda
- Associate Professor, Department of Neuro-medicine, Enam Medical College, Dhaka, Bangladesh
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17
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Abstract
Many have criticized the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV), and few regard it as a vehicle of truth, yet its most serious limitation is that its frank operationism in defining manifest categories has distracted attention from theories about what is going on at the latent level. We sketch a Generalized Interpersonal Theory of Personality and Psychopathology and apply it to interpersonal aspects of depression to illustrate how structural individual differences combine with functional dynamic processes to cause interpersonal behavior and affect. Such a causal account relies on a realist ontology in which manifest diagnoses are only a means to learning about the latent distribution, whether categorical or dimensional. Comorbidity of DSM diagnoses suggests that dimensionality will be the rule, not the exception, with internalization and externalization describing common diagnoses.
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18
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Oxidative Stress Implications in the Affective Disorders: Main Biomarkers, Animal Models Relevance, Genetic Perspectives, and Antioxidant Approaches. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:3975101. [PMID: 27563374 PMCID: PMC4983669 DOI: 10.1155/2016/3975101] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/12/2023]
Abstract
The correlation between the affective disorders and the almost ubiquitous pathological oxidative stress can be described in a multifactorial way, as an important mechanism of central nervous system impairment. Whether the obvious changes which occur in oxidative balance of the affective disorders are a part of the constitutive mechanism or a collateral effect yet remains as an interesting question. However it is now clear that oxidative stress is a component of these disorders, being characterized by different aspects in a disease-dependent manner. Still, there are a lot of controversies regarding the relevance of the oxidative stress status in most of the affective disorders and despite the fact that most of the studies are showing that the affective disorders development can be correlated to increased oxidative levels, there are various studies stating that oxidative stress is not linked with the mood changing tendencies. Thus, in this minireview we decided to describe the way in which oxidative stress is involved in the affective disorders development, by focusing on the main oxidative stress markers that could be used mechanistically and therapeutically in these deficiencies, the genetic perspectives, some antioxidant approaches, and the relevance of some animal models studies in this context.
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19
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Ifergane G, Buskila D, Simiseshvely N, Zeev K, Cohen H. Prevalence of Fibromyalgia Syndrome in Migraine Patients. Cephalalgia 2016; 26:451-6. [PMID: 16556247 DOI: 10.1111/j.1468-2982.2005.01060.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic pain syndrome of unknown aetiology characterized by diffuse pain over more than 3 months and tenderness in specific sites named tender points. The aim of this study was to assess the prevalence and severity of FMS among patients suffering from episodic migraine. Ninety-two consecutive patients (20 male, 72 female) fulfilling the International Headache Society criteria for migraine with and without aura from a tertiary headache clinic were evaluated. A headache and generalized pain history was recorded, tender points were evaluated by thumb palpation. The diagnosis of FMS was made based on the 1990 American College of Rheumatology classification criteria for FMS. Sixteen (22.2%) of the female patients and none of the male patients were diagnosed as suffering from FMS. Migraine severity and characteristics were similar to other female migraine patients. Patients suffering from migraine-FMS had lower quality of life scores and higher levels of mental distress. A high incidence of FMS was found among female migraine patients but not in males. The coexistence of FMS should be considered when choosing a prophylactic migraine therapy.
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Affiliation(s)
- G Ifergane
- Headache Clinic, Department of Neurology, Soroka Medical Centre, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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20
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Jabbi M, Chen Q, Turner N, Kohn P, White M, Kippenhan JS, Dickinson D, Kolachana B, Mattay V, Weinberger DR, Berman KF. Variation in the Williams syndrome GTF2I gene and anxiety proneness interactively affect prefrontal cortical response to aversive stimuli. Transl Psychiatry 2015; 5:e622. [PMID: 26285132 PMCID: PMC4564573 DOI: 10.1038/tp.2015.98] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 12/18/2022] Open
Abstract
Characterizing the molecular mechanisms underlying the heritability of complex behavioral traits such as human anxiety remains a challenging endeavor for behavioral neuroscience. Copy-number variation (CNV) in the general transcription factor gene, GTF2I, located in the 7q11.23 chromosomal region that is hemideleted in Williams syndrome and duplicated in the 7q11.23 duplication syndrome (Dup7), is associated with gene-dose-dependent anxiety in mouse models and in both Williams syndrome and Dup7. Because of this recent preclinical and clinical identification of a genetic influence on anxiety, we examined whether sequence variation in GTF2I, specifically the single-nucleotide polymorphism rs2527367, interacts with trait and state anxiety to collectively impact neural response to anxiety-laden social stimuli. Two hundred and sixty healthy adults completed the Tridimensional Personality Questionnaire Harm Avoidance (HA) subscale, a trait measure of anxiety proneness, and underwent functional magnetic resonance imaging (fMRI) while matching aversive (fearful or angry) facial identity. We found an interaction between GTF2I allelic variations and HA that affects brain response: in individuals homozygous for the major allele, there was no correlation between HA and whole-brain response to aversive cues, whereas in heterozygotes and individuals homozygous for the minor allele, there was a positive correlation between HA sub-scores and a selective dorsolateral prefrontal cortex (DLPFC) responsivity during the processing of aversive stimuli. These results demonstrate that sequence variation in the GTF2I gene influences the relationship between trait anxiety and brain response to aversive social cues in healthy individuals, supporting a role for this neurogenetic mechanism in anxiety.
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Affiliation(s)
- M Jabbi
- Section on Integrative Neuroimaging, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA,Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA,Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, 9000 Rockville Pike, B10, Room 3C113, Bethesda, MD 20892, USA. E-mail: or
| | - Q Chen
- The Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - N Turner
- Section on Integrative Neuroimaging, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA,Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - P Kohn
- Section on Integrative Neuroimaging, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA,Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - M White
- The Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - J S Kippenhan
- Section on Integrative Neuroimaging, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA,Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - D Dickinson
- Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - B Kolachana
- Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - V Mattay
- The Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D R Weinberger
- The Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA,Departments of Psychiatry, Neurology, Neuroscience and the McKusick-Nathans Institute of Genomic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K F Berman
- Section on Integrative Neuroimaging, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA,Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA,Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, 9000 Rockville Pike, B10, Room 3C113, Bethesda, MD 20892, USA. E-mail: or
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21
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Boles RG, Zaki EA, Kerr JR, Das K, Biswas S, Gardner A. Increased prevalence of two mitochondrial DNA polymorphisms in functional disease: Are we describing different parts of an energy-depleted elephant? Mitochondrion 2015; 23:1-6. [PMID: 25934187 DOI: 10.1016/j.mito.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/18/2015] [Accepted: 04/22/2015] [Indexed: 12/19/2022]
Abstract
About 20% of the population suffers from "functional syndromes". Since these syndromes overlap greatly in terms of co-morbidity, pathophysiology (including aberrant autonomic activity) and treatment responses, common predisposing genetic factors have been postulated. We had previously showed that two common mitochondrial DNA (mtDNA) polymorphisms at positions 16519 and 3010 are statistically associated with the functional syndromes of migraine, cyclic vomiting syndrome and non-specific abdominal pain. Herein, among individuals with mtDNA haplogroup H (HgH), the presence of these two mtDNA polymorphisms were ascertained in additional functional syndromes: chronic fatigue syndrome, complex regional pain syndrome, sudden infant death syndrome, and major depressive disorder. Polymorphic prevalence rates were compared between disease and control groups, and within each disease group in participants with and without specific clinical findings. In all four conditions, one or both of the polymorphisms was significantly associated with the respective condition and/or co-morbid functional symptomatology. Thus, we conclude that these two mtDNA polymorphisms likely modify risk for the development of multiple functional syndromes, likely constituting a proportion of the postulated common genetic factor, at least among individuals with HgH. Pathophysiology likely involves broad effects on the autonomic nervous system.
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Affiliation(s)
- Richard G Boles
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA USA.
| | - Essam A Zaki
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Jonathan R Kerr
- Division of Clinical Sciences, St. George's University of London, Cranmer Terrace, London United Kingdom
| | - Kingshuk Das
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Sawona Biswas
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Ann Gardner
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm Sweden
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22
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Wesselhoeft R, Pedersen CB, Mortensen PB, Mors O, Bilenberg N. Gender-age interaction in incidence rates of childhood emotional disorders. Psychol Med 2015; 45:829-839. [PMID: 25110838 DOI: 10.1017/s0033291714001901] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The post-pubertal association of female gender with emotional disorder is a robust finding. However, studies exploring the association of gender and emotional disorders before puberty are few and present diverging results. The aim of this study was to present gender-specific incidence rates of emotional disorders throughout childhood. METHOD This is a population-based cohort study of 907,806 Danish 3- to 18-year-olds. The outcome was assignment of an emotional disorder diagnosis based on in-patient and out-patient data from The Danish Psychiatric Central Register. Outcome measures were incidence rates and cumulative incidences for unipolar depressive disorder (ICD-10: F32-F33), anxiety disorders (ICD-10: F40-F42), and emotional disorders with onset specific to childhood (ICD-10: F93). RESULTS Pre-pubertal incidence rates for depressive and anxiety disorders were higher for boys than girls. At age 12 years the pattern reversed. The cumulative incidence for any emotional disorder (F32-F33, F40-F42, F93) on the 11th birthday was 0.52% (95% CI 0.50-0.55) for boys and 0.31% (95% CI 0.29-0.33) for girls. On the 19th birthday cumulative incidence was 2.33% (95% CI 2.24-2.43) for boys and 3.77% (95% CI 3.64-3.90) for girls. The pre-pubertal male preponderance was also significant for depressive disorders (F32-F33, p = 0.00144) and anxiety disorders (F40-F42, F93, p < 0.00001) separately. CONCLUSIONS Emotional disorders seem to display a male preponderance before the age of 12 years and a female preponderance thereafter. Studies exploring this gender-age interaction are needed. Still, the results question the general assumption that females throughout the lifespan are more at risk for emotional disorders than males.
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Affiliation(s)
- R Wesselhoeft
- Department of Child and Adolescent Mental Health Odense, Research Unit,University of Southern Denmark,Odense C,Denmark
| | - C B Pedersen
- National Centre for Register-Based Research, Business and Social Sciences,Aarhus University,Aarhus,Denmark
| | - P B Mortensen
- National Centre for Register-Based Research, Business and Social Sciences,Aarhus University,Aarhus,Denmark
| | - O Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,Denmark
| | - N Bilenberg
- Department of Child and Adolescent Mental Health Odense, Research Unit,University of Southern Denmark,Odense C,Denmark
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23
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Knight JR, Locke GR, Zinsmeister AR, Schleck CD, Talley NJ. Family history of mental illness or alcohol abuse and the irritable bowel syndrome. J Psychosom Res 2015; 78:237-41. [PMID: 25582802 PMCID: PMC4505618 DOI: 10.1016/j.jpsychores.2014.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/20/2014] [Accepted: 11/24/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We have observed that many patients with IBS drink very little alcohol and postulated that this may reflect membership in families affected by alcoholism and mental illness. We aimed to evaluate whether a family history of substance or alcohol abuse, or psychiatric illness, is associated with IBS. METHODS A valid GI questionnaire was mailed to a randomly selected population-based cohort to identify IBS and healthy controls. The electronic medical record was reviewed to record the subjects' self-reported personal and family health histories. RESULTS A total of 2300 subjects responded (response rate 55%; IBS 13%, n=287); 230 subjects with IBS and 318 controls were eligible. Family history of alcohol/substance abuse was reported by 33% of cases and 25% of controls (OR=1.4, 95% CI=1.0-2.1, p=0.06). Family history of psychiatric illness was reported by 37% of cases and 22% of controls (OR=2.0, 95% CI=1.3-2.9, p<0.001). In the absence of a personal history of alcohol use, a family history of alcohol/substance abuse was predictive of IBS status (OR adjusted for age and gender=1.5, 95% CI=1.0-2.3, p=0.05). In the absence of a personal history of alcohol use, reporting both a family history of alcohol/substance abuse and anxiety/depression/mental illness was clearly predictive of IBS status (OR=2.5, 95% CI=1.4-4.5; p<0.005). Substance abuse as a child was associated with an increased risk of IBS (OR=2.3, 95% CI=1.1-4.8; p<0.03). CONCLUSION IBS is independently associated with a family history of psychiatric illness and may be linked to a family history of alcohol/substance abuse.
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Affiliation(s)
- James R. Knight
- Division of Hospital Medicine, Department of Internal Medicine and Pediatrics, The Ohio State University Medical Center, Columbus, OH, USA
| | - G. Richard Locke
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Alan R. Zinsmeister
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Cathy D. Schleck
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Nicholas J. Talley
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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24
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Modestino EJ, Blum K, Oscar-Berman M, Gold MS, Duane DD, Sultan SG, Auerbach SH. Reward Deficiency Syndrome: Attentional/Arousal Subtypes, Limitations of Current Diagnostic Nosology, and Future Research. JOURNAL OF REWARD DEFICIENCY SYNDROME 2015; 1:6-9. [PMID: 26306327 PMCID: PMC4545661 DOI: 10.17756/jrds.2015-002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We theorise that in some cases Attention Deficit Hyperactivity Disorder (ADHD) predisposes to narcolepsy and hypersomnia, and that there may be a shared pathophysiology with various addictions [Reward Deficiency Syndrome (RDS)]. Reticence to acknowledge such connections may be due to a narrow nosological framework. Additionally, we theorise that the development of narcolepsy on a baseline of ADHD/RDS leads to an additional assault on the dopaminergic reward system in such individuals. In this study, we propose to test these hypotheses by using a combination of broad genetic screening, and neuroimaging with and without pharmacological intervention, in those with pure ADHD, pure narcolepsy, and the combined ADHD-narcolepsy phenotype. Results of this proposed study may reveal a common pathophysiology of ADHD, narcolepsy and RDS, and perhaps an additional compromise to the reward system in those with combined ADHD-narcolepsy. If the evidence supports the hypothesis that indeed there is a shared pathophysiology for narcolepsy with RDS and thus its subtype ADHD, early intervention/preventative treatment amongst those with ADHD may be beneficial with the putative dopaminergic compound KB220Z™.
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Affiliation(s)
- Edward Justin Modestino
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston VA Healthcare System, Boston, MA, USA
| | - Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL,USA
- Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, Department of Psychiatry, College of Medicine, Burlington, VT, USA
- Dominion Diagnostics, LLC, North Kingstown, RI, USA
- Department of Addiction Research & Therapy, Malibu Beach Recovery Center, Malibu Beach, CA, USA
| | - Marlene Oscar-Berman
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Departments of Psychiatry, Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Boston VA Healthcare System, Boston, MA, USA
| | - Mark S. Gold
- Departments of Psychiatry & Behavioral Sciences at the Keck, University of Southern California, School of Medicine, CA, USA
- Director of Research, Drug Enforcement Administration (DEA) Educational Foundation, Washington, D.C, USA
| | - Drake D. Duane
- Institute for Developmental Behavioral Neurology Scottsdale, AZ, USA
- Department of Speech and Hearing Sciences, Arizona State University, Tempe, AZ, USA
- Department of Neurology, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sarah G.S. Sultan
- Department of Psychiatry, St. Mary's Hospital Centre, Montreal, QC, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sanford H. Auerbach
- Departments of Neurology & Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Sleep Disorders Center & Behavioral Neurology, Boston Medical Center, Boston, MA, USA
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25
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Hudson JI, Zanarini MC, Mitchell KS, Choi-Kain LW, Gunderson JG. The contribution of familial internalizing and externalizing liability factors to borderline personality disorder. Psychol Med 2014; 44:2397-2407. [PMID: 24406267 PMCID: PMC4090302 DOI: 10.1017/s0033291713003140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with borderline personality disorder (BPD) frequently display co-morbid mental disorders. These disorders include 'internalizing' disorders (such as major depressive disorder and anxiety disorders) and 'externalizing' disorders (such as substance use disorders and antisocial personality disorder). It is hypothesized that these disorders may arise from latent 'internalizing' and 'externalizing' liability factors. Factor analytic studies suggest that internalizing and externalizing factors both contribute to BPD, but the extent to which such contributions are familial is unknown. METHOD Participants were 368 probands (132 with BPD; 134 without BPD; and 102 with major depressive disorder) and 885 siblings and parents of probands. Participants were administered the Diagnostic Interview for DSM-IV Personality Disorders, the Revised Diagnostic Interview for Borderlines, and the Structured Clinical Interview for DSM-IV. RESULTS On confirmatory factor analysis of within-person associations of disorders, BPD loaded moderately on internalizing (factor loading 0.53, S.E. = 0.10, p < 0.001) and externalizing latent variables (0.48, S.E. = 0.10, p < 0.001). Within-family associations were assessed using structural equation models of familial and non-familial factors for BPD, internalizing disorders, and externalizing disorders. In a Cholesky decomposition model, 84% (S.E. = 17%, p < 0.001) of the association of BPD with internalizing and externalizing factors was accounted for by familial contributions. CONCLUSIONS Familial internalizing and externalizing liability factors are both associated with, and therefore may mutually contribute to, BPD. These familial contributions account largely for the pattern of co-morbidity between BPD and internalizing and externalizing disorders.
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Affiliation(s)
- J I Hudson
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
| | - M C Zanarini
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
| | - K S Mitchell
- National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division, Veterans Affairs,Boston Healthcare System and Boston University School of Medicine,Boston, MA,USA
| | - L W Choi-Kain
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
| | - J G Gunderson
- Department of Psychiatry, Harvard Medical School,McLean Hospital,Belmont, MA,USA
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Park JW, Cho YS, Lee SY, Kim ES, Cho H, Shin HE, Suh GI, Choi MG. Concomitant functional gastrointestinal symptoms influence psychological status in Korean migraine patients. Gut Liver 2013; 7:668-74. [PMID: 24312707 PMCID: PMC3848535 DOI: 10.5009/gnl.2013.7.6.668] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/22/2013] [Accepted: 02/08/2013] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs). This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability. Methods This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital. The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headache-related disability. Results In total, 71% of patients met the Rome III criteria for at least one FGID. In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%). Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID. The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety. Conclusions FGID symptoms defined by the Rome III criteria are highly prevalent in migraine. These symptoms correlate with psychological comorbidities, such as depression and anxiety.
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Affiliation(s)
- Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
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Wang JY, Chen LC, Lin HM. Robust methods for detecting familial aggregation of a quantitative trait in matched case–control family studies. J Appl Stat 2012. [DOI: 10.1080/02664763.2012.702204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schwartz CE, Kunwar PS, Greve DN, Kagan J, Snidman NC, Bloch RB. A phenotype of early infancy predicts reactivity of the amygdala in male adults. Mol Psychiatry 2012; 17:1042-50. [PMID: 21894151 PMCID: PMC3241859 DOI: 10.1038/mp.2011.96] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 07/06/2011] [Accepted: 07/07/2011] [Indexed: 01/18/2023]
Abstract
One of the central questions that has occupied those disciplines concerned with human development is the nature of continuities and discontinuities from birth to maturity. The amygdala has a central role in the processing of novelty and emotion in the brain. Although there is considerable variability among individuals in the reactivity of the amygdala to novel and emotional stimuli, the origin of these individual differences is not well understood. Four-month old infants called high reactive (HR) demonstrate a distinctive pattern of vigorous motor activity and crying to specific unfamiliar visual, auditory and olfactory stimuli in the laboratory. Low-reactive infants show the complementary pattern. Here, we demonstrate that the HR infant phenotype predicts greater amygdalar reactivity to novel faces almost two decades later in adults. A prediction of individual differences in brain function at maturity can be made on the basis of a single behavioral assessment made in the laboratory at 4 months of age. This is the earliest known human behavioral phenotype that predicts individual differences in patterns of neural activity at maturity. These temperamental differences rooted in infancy may be relevant to understanding individual differences in vulnerability and resilience to clinical psychiatric disorder. Males who were HR infants showed particularly high levels of reactivity to novel faces in the amygdala that distinguished them as adults from all other sex/temperament subgroups, suggesting that their amygdala is particularly prone to engagement by unfamiliar faces. These findings underline the importance of taking gender into account when studying the developmental neurobiology of human temperament and anxiety disorders. The genetic study of behavioral and biologic intermediate phenotypes (or 'endophenotypes') indexing anxiety-proneness offers an important alternative to examining phenotypes based on clinically defined disorder. As the HR phenotype is characterized by specific patterns of reactivity to elemental visual, olfactory and auditory stimuli, well before complex social behaviors such as shyness or fearful interaction with strangers can be observed, it may be closer to underlying neurobiological mechanisms than behavioral profiles observed later in life. This possibility, together with the fact that environmental factors have less time to impact the 4-month phenotype, suggests that this temperamental profile may be a fruitful target for high-risk genetic studies.
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Affiliation(s)
- C E Schwartz
- Developmental Neuroimaging and Psychopathology Laboratory, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Saito YA, Larson JJ, Atkinson EJ, Ryu E, Almazar AE, Petersen GM, Talley NJ. The role of 5-HTT LPR and GNβ3 825C>T polymorphisms and gene-environment interactions in irritable bowel syndrome (IBS). Dig Dis Sci 2012; 57:2650-7. [PMID: 22855291 PMCID: PMC3912694 DOI: 10.1007/s10620-012-2319-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 07/07/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Smaller studies have evaluated SLC6A4 5-HTTLPR and GNβ3 825C>T polymorphisms in IBS, and interactions between 5-HTT LPR with life events have been reported in the psychiatric literature, but gene-environment studies in IBS are lacking. AIMS The purpose of this study was to assess the association of two polymorphisms with IBS and age of onset, and whether there are gene-environment interactions with IBS. METHODS Outpatients with IBS and controls completed a validated questionnaire and provided blood for DNA. Comparisons of genotype/allele frequencies between cases and controls were performed with logistic regression. Linear regression was used to evaluate the association between the variants and age of onset. Environmental variables tested included abuse, parental alcohol abuse, parental psychiatric disorders, and gastrointestinal infections. RESULTS Genotyping was performed in 385 cases and 262 controls with median age of 50 years (range, 18.0-70.0) and 498 (77 %) females. The IBS subtype distribution among cases was: 102 (26 %) D-IBS, 40 (10 %) C-IBS, 125 (32 %) M-IBS, 118 (31 %) other. No association was observed between IBS or age of onset and both variants. Significant interactions were observed between GI infection and the GNβ3 825T allele. For those reporting gastrointestinal infection, the OR for IBS was 3.9 (95 % CI 1.2-12.7) whereas the OR was 0.86 (95 % CI 0.65-1.13) for those without prior infection. CONCLUSIONS There was a significant interaction between the GNβ3 polymorphism and infection in the development of IBS, suggesting that its etiology is the result of a combination of specific genetic and environmental risk factors.
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Affiliation(s)
- Yuri A Saito
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Luyten P, van Houdenhove B, Lemma A, Target M, Fonagy P. A mentalization-based approach to the understanding and treatment of functional somatic disorders. PSYCHOANALYTIC PSYCHOTHERAPY 2012. [DOI: 10.1080/02668734.2012.678061] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gormsen L, Rosenberg R, Bach FW, Jensen TS. Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain. Eur J Pain 2012; 14:127.e1-8. [DOI: 10.1016/j.ejpain.2009.03.010] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 03/13/2009] [Accepted: 03/25/2009] [Indexed: 11/16/2022]
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Affective spectrum disorders in an urban Swedish adult psychiatric unit: a descriptive study. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:527827. [PMID: 22536500 PMCID: PMC3320004 DOI: 10.1155/2012/527827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/18/2011] [Accepted: 12/27/2011] [Indexed: 11/18/2022]
Abstract
Background. Several studies have found that patients with affective-/anxiety-/stress-related syndromes present overlapping features such as cooccurrence within families and individuals and response to the same type of pharmacological treatment, suggesting that these syndromes share pathogenetic mechanisms. The term affective spectrum disorder (AfSD) has been suggested, emphasizing these commonalities. The expectancy rate, sociodemographic characteristics, and global level of functioning in AfSD has hitherto not been studied neglected. Material and Method. Out of 180 consecutive patients 94 were included after clinical investigations and ICD-10 diagnostics. Further investigations included well-known self-evaluation instruments assessing psychiatric symptoms, personality disorders, psychosocial stress, adaptation, quality of life, and global level of functioning. A neuropsychological screening was also included. Results. The patients were young, had many young children, were well educated, and had about expected (normal distribution of) intelligence. Sixty-one percent were identified as belonging to the group of AfSD. Conclusion. The study identifies a large group of patients that presents much suffering and failure of functioning. This group is shared between the levels of medical care, between primary care and psychiatry. The term AfSD facilitates identification of patient groups that share common traits and identifies individuals clinically, besides the referred patients, in need of psychiatric interventions.
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Watkins CC, Pieper AA, Treisman GJ. Safety considerations in drug treatment of depression in HIV-positive patients: an updated review. Drug Saf 2011; 34:623-39. [PMID: 21751824 DOI: 10.2165/11592070-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Major depressive disorder (MDD) is one of the most prevalent illnesses associated with HIV infection, and negatively affects medication adherence, disease progression and mortality in HIV disease. Co-morbid treatment of major depression in HIV disease is the optimal therapeutic approach, but discriminating MDD from normal fluctuations in mood state, personality or physiology is difficult. Definitive diagnosis of MDD is critical for drug safety and for avoiding unnecessary exposure to psychotropic medications. HIV patients respond to antidepressant treatment like the general population, and medication adverse effects and patient adherence are the best predictors of treatment outcome. This review attempts to assist the medical provider with the diagnosis and treatment of MDD in HIV patients. We outline the initial steps in screening and psychiatric referral, the antidepressants that are particularly useful in HIV-infected patients, and the adverse effects and pharmacological strategies for overcoming potential barriers to medication adherence. Potential interactions between the various classes of antidepressants and HIV/antiretroviral therapy, as well as management of HIV medication-related psychiatric adverse effects, are also discussed.
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Affiliation(s)
- Crystal C Watkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Lee KH, Kim CH, Shin HC, Sung EJ. Clinical characteristics of patients with medically unexplained chronic widespread pain: a primary care center study. Korean J Fam Med 2011; 32:277-84. [PMID: 22745864 PMCID: PMC3383142 DOI: 10.4082/kjfm.2011.32.5.277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/16/2011] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Chronic widespread pain (CWP) is known as a common symptom of several organic and psychological disorders. Although medically unexplained CWP (MUE) has lots of clinical distress symptoms, there were no distinct symptoms or signs. Therefore, we conducted this study to investigate clinical distress symptoms of MUE distinct from those of medically explained CWP (ME). METHODS One hundred nine patients with CWP were enrolled in the study. We classified the study subjects into three groups depending on their medical problems associated with CWP: organic group (ORG), psychological group (PSY), and MUE. All subjects were asked to fill out self-report questionnaires consisting of clinical distress scales including the Korean version of the Fibromyalgia Impact Questionnaire (FIQ-K), fatigue scale, depression scale, and stress scale. And physicians examined 18 tender points over their entire body of the subjects. RESULTS MUE patients had higher FIQ-K and fatigue severity scores than ORG patients (all P < 0.05). The average number of tender points were 11.33 in MUE patients, 6.48 in ORG patients and 5.02 in PSY patients and statistically significant (P < 0.0001). There were no statistically different factors between MUE and PSY patients with exception for the number of tender points. Depressive symptom was the highest in PSY patients but not statistically different from MUE patients. CONCLUSION MUE patients had higher physical impairments, fatigue severity and more number of tender points than ORG patients, but had no different clinical characteristics from PSY patients except for the number of tender points.
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Affiliation(s)
- Kye Hwa Lee
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Aguglia A, Salvi V, Maina G, Rossetto I, Aguglia E. Fibromyalgia syndrome and depressive symptoms: comorbidity and clinical correlates. J Affect Disord 2011; 128:262-6. [PMID: 20674985 DOI: 10.1016/j.jad.2010.07.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/07/2010] [Accepted: 07/07/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fibromyalgia is characterized by chronic widespread musculoskeletal pain and higher pain perception in specific anatomic sites called tender points. Fibromyalgia is frequently associated with psychiatric symptoms, like depression and anxiety; indeed some authors have argued about the possibility to classify this syndrome into affective spectrum disorder. Few studies have analyzed the impact of depressive symptoms on pain threshold. This research is aimed at evaluating the prevalence and the clinical correlates of depressive symptoms in fibromyalgic patients, and investigating their impact on pain perception and quality of life. METHODS Outpatients between 18 and 75 years with diagnosis of fibromyalgia according to the criteria of the American College of Rheumatology have been included. All subjects have been evaluated with the following rating scales: HAM-D; VAS (to quantify pain); a visual analogical scale to evaluate quality of life; and Paykel's List of Recent Life Events. RESULTS Thirty subjects have been recruited. Most patients (83.3%) had clinically significant depressive symptoms as indicated by a HAM-D score >7. Depressive symptoms are associated with higher pain perception, worse quality of life and more severe life events. CONCLUSION The presence of depressive symptoms is associated with a great impairment in patients with fibromyalgia syndrome: indeed the psychiatric comorbidity lowers pain threshold and worsens the quality of life of our patients. Future studies should be conducted in order to identify the individual factors, e.g. stress or inflammatory processes, which drive the association between depression and higher severity of fibromyalgia syndrome.
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Affiliation(s)
- Andrea Aguglia
- Mood and Anxiety Disorders Unit, Department of Neuroscience, University of Turin, Italy
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Perugi G, Canonico PL, Carbonato P, Mencacci C, Muscettola G, Pani L, Torta R, Vampini C, Fornaro M, Parazzini F, Dumitriu A. Unexplained somatic symptoms during major depression: prevalence and clinical impact in a national sample of Italian psychiatric outpatients. Psychopathology 2011; 44:116-24. [PMID: 21228616 DOI: 10.1159/000319848] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 07/29/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to explore the prevalence and impact of unexplained somatic symptoms during major depression. SAMPLING AND METHODS A total of 560 consecutive outpatients with a major depressive episode according to the DSM-IV (text revision) were evaluated in 30 psychiatric facilities throughout Italy. 'Unexplained' somatic symptoms were evaluated using the 30-item Somatic Symptoms Checklist (SSCL-30). Somatic symptoms were considered explained if they were best accounted for as coming from a concomitant physical illness or side effects. Patients evaluated their own mood symptomatology using the Zung questionnaires for depression and anxiety and the Hypomania Checklist-32. RESULTS According to the SSCL-30, only 90 subjects (16.1%) had no unexplained somatic symptoms, while 231 (41.3%) had 1-5 unexplained symptoms and 239 (42.7%) had more than 5. Asthenia was the most commonly observed unexplained somatic symptom (53% of patients). Unexplained somatic symptoms were more common in females and among those suffering from major depression and depression not otherwise specified rather than in patients with recurrent major depression and bipolar disorders. No relationship between unexplained somatic symptoms and hypomanic features was observed. CONCLUSIONS The presence of a large number of unexplained somatic symptoms is associated with more severe depression and higher rates of misdiagnosis and inappropriate treatment.
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Affiliation(s)
- Giulio Perugi
- Dipartimento di Psichiatria, Università di Pisa, Institute of Behavioural Sciences G. De Lisio, Pisa, Italy.
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Wager-Smith K, Markou A. Depression: a repair response to stress-induced neuronal microdamage that can grade into a chronic neuroinflammatory condition? Neurosci Biobehav Rev 2011; 35:742-64. [PMID: 20883718 PMCID: PMC3777427 DOI: 10.1016/j.neubiorev.2010.09.010] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/17/2010] [Accepted: 09/21/2010] [Indexed: 12/19/2022]
Abstract
Depression is a major contributor to the global burden of disease and disability, yet it is poorly understood. Here we review data supporting a novel theoretical model for the biology of depression. In this model, a stressful life event leads to microdamage in the brain. This damage triggers an injury repair response consisting of a neuroinflammatory phase to clear cellular debris and a spontaneous tissue regeneration phase involving neurotrophins and neurogenesis. During healing, released inflammatory mediators trigger sickness behavior and psychological pain via mechanisms similar to those that produce physical pain during wound healing. The depression remits if the neuronal injury repair process resolves successfully. Importantly, however, the acute psychological pain and neuroinflammation often transition to chronicity and develop into pathological depressive states. This hypothesis for depression explains substantially more data than alternative models, including why emerging data show that analgesic, anti-inflammatory, pro-neurogenic and pro-neurotrophic treatments have antidepressant effects. Thus, an acute depressive episode can be conceptualized as a normally self-limiting but highly error-prone process of recuperation from stress-triggered neuronal microdamage.
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Affiliation(s)
- Karen Wager-Smith
- Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA.
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Luyten P, Kempke S, Van Wambeke P, Claes S, Blatt SJ, Van Houdenhove B. Self-critical perfectionism, stress generation, and stress sensitivity in patients with chronic fatigue syndrome: relationship with severity of depression. Psychiatry 2011; 74:21-30. [PMID: 21463167 DOI: 10.1521/psyc.2011.74.1.21] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chronic Fatigue Syndrome (CFS) is a highly disabling disorder that is part of a broader spectrum of chronic pain and fatigue disorders. Although the etiology and pathogenesis of CFS largely remain unclear, there is increasing evidence that CFS shares important pathophysiological disturbances with mood disorders in terms of disturbances in the stress response and the stress system. From a psycho-dynamic perspective, self-critical perfectionism and related personality factors are hypothesized to explain in part impairments of the stress response in both depression and CFS. Yet, although there is ample evidence that high levels of self-critical perfectionism are associated with stress generation and increased stress sensitivity in depression, evidence supporting this hypothesis in CFS is currently lacking. This study therefore set out to investigate the relationship between self-critical perfectionism, the active generation of stress, stress sensitivity, and levels of depression in a sample of 57 patients diagnosed with CFS using an ecological momentary assessment approach. Results showed, congruent with theoretical assumptions, that self-critical perfectionism was associated with the generation of daily hassles, which in turn predicted higher levels of depression. Moreover, multilevel analyses showed that self-critical perfectionism was related to increased stress sensitivity in CFS patients over a 14-day period, and that increased stress sensitivity in turn was related to increased levels of depression. The implications of these findings for future research and particularly for the development of psychodynamic treatment approaches of CFS and related conditions are discussed.
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Affiliation(s)
- Patrick Luyten
- Department of Psychology at the University of Leuven, in Leuven, Belgium.
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Abstract
The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.
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Kashikar-Zuck S, Parkins IS, Ting TV, Verkamp E, Lynch-Jordan A, Passo M, Graham TB. Controlled follow-up study of physical and psychosocial functioning of adolescents with juvenile primary fibromyalgia syndrome. Rheumatology (Oxford) 2010; 49:2204-9. [PMID: 20688804 DOI: 10.1093/rheumatology/keq254] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Currently, there are no prospective studies exploring the prognosis of patients with juvenile primary FM syndrome (JPFS) or their physical, emotional and social outcomes as they enter the early adult years. The primary objective of this study was to assess long-term outcomes of a paediatric sample of clinically referred JPFS patients and their matched healthy controls. METHODS Participants were 48 youths (current mean age = 19 years) diagnosed with JPFS in childhood or adolescence and 43 healthy controls matched in age, gender and race. The average length of follow-up was 3.67 years (range 2-6 years). Participants completed online (web-based) self-report questionnaires about current pain and physical symptoms, health status, anxiety, depressive symptoms and current and past treatments. RESULTS Results showed that 62.5% of participants in the JPFS group continued to experience widespread pain and 60.4% reported having all the cardinal features of FM syndrome (including widespread pain, poor sleep and fatigue) at follow-up. The JPFS group reported significantly lower scores on all measures of health status and physical functioning compared with healthy controls and significantly greater symptoms of anxiety and depression. CONCLUSION The results of this controlled follow-up study demonstrate that symptoms of FM appear to be chronic in a majority of clinically referred JPFS patients and the associated physical and emotional impairment can also be persistent. Implications for treatment and the need for further prospective longitudinal studies are discussed.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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The Interface of Pain and Mood Disturbances in the Rheumatic Diseases. Semin Arthritis Rheum 2010; 40:15-31. [DOI: 10.1016/j.semarthrit.2008.11.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/11/2008] [Accepted: 11/24/2008] [Indexed: 12/28/2022]
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Javaras KN, Hudson JI, Laird NM. Fitting ACE structural equation models to case-control family data. Genet Epidemiol 2010; 34:238-45. [PMID: 19918760 DOI: 10.1002/gepi.20454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Investigators interested in whether a disease aggregates in families often collect case-control family data, which consist of disease status and covariate information for members of families selected via case or control probands. Here, we focus on the use of case-control family data to investigate the relative contributions to the disease of additive genetic effects (A), shared family environment (C), and unique environment (E). We describe an ACE model for binary family data; this structural equation model, which has been described previously, combines a general-family extension of the classic ACE twin model with a (possibly covariate-specific) liability-threshold model for binary outcomes. We then introduce our contribution, a likelihood-based approach to fitting the model to singly ascertained case-control family data. The approach, which involves conditioning on the proband's disease status and also setting prevalence equal to a prespecified value that can be estimated from the data, makes it possible to obtain valid estimates of the A, C, and E variance components from case-control (rather than only from population-based) family data. In fact, simulation experiments suggest that our approach to fitting yields approximately unbiased estimates of the A, C, and E variance components, provided that certain commonly made assumptions hold. Further, when our approach is used to fit the ACE model to Austrian case-control family data on depression, the resulting estimate of heritability is very similar to those from previous analyses of twin data.
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Affiliation(s)
- K N Javaras
- Waisman Laboratory for Brain Imaging & Behavior, University of Wisconsin-Madison, Madison, Wisconsin 53705, USA.
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Abstract
Research in fibromyalgia has increased understanding of the possible genetic and environmental factors that could be involved in the etiology of fibromyalgia. There is now substantial evidence for augmentation of central pain processing in fibromyalgia. Because the clinical presentation of fibromyalgia is heterogeneous, treatment recommendations must be individualized for each patient. The rapid growth of trials in fibromyalgia in recent years has resulted in new evidence-based approaches to pharmacological and nonpharmacological treatment.
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Affiliation(s)
- Lesley M Arnold
- Women's Health Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, 222 Piedmont Avenue, Suite 8200, Cincinnati, OH 45219, USA.
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Goldberg DP, Krueger RF, Andrews G, Hobbs MJ. Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychol Med 2009; 39:2043-2059. [PMID: 19796429 DOI: 10.1017/s0033291709990298] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The extant major psychiatric classifications DSM-IV, and ICD-10, are atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis would be greatly enhanced by an understanding of risk factors and clinical manifestations. In an effort to group mental disorders on the basis of aetiology, five clusters have been proposed. This paper considers the validity of the fourth cluster, emotional disorders, within that proposal. METHOD We reviewed the literature in relation to 11 validating criteria proposed by a Study Group of the DSM-V Task Force, as applied to the cluster of emotional disorders. RESULTS An emotional cluster of disorders identified using the 11 validators is feasible. Negative affectivity is the defining feature of the emotional cluster. Although there are differences between disorders in the remaining validating criteria, there are similarities that support the feasibility of an emotional cluster. Strong intra-cluster co-morbidity may reflect the action of common risk factors and also shared higher-order symptom dimensions in these emotional disorders. CONCLUSION Emotional disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.
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Affiliation(s)
- D P Goldberg
- Institute of Psychiatry, King's College, London, UK.
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Abstract
This article reviews the biologic, genetic, and environmental factors that may contribute to the pathophysiology of fibromyalgia. As an affective spectrum disorder, fibromyalgia may share these causal factors with a number of related and co-occurring pain conditions, such as irritable bowel syndrome or temporomandibular disorder. There is strong evidence that cardinal pain symptoms of fibromyalgia may be due to alterations in central processing of sensory input, along with aberrations in the endogenous inhibition of pain. Genetic research has shown familial aggregation of fibromyalgia and other related disorders such as major depressive disorder. Exposure to physical or psychosocial stressors, as well as abnormal biologic responses in the autonomic nervous system and neuroendocrine responses, may also contribute to dysfunctional pain processing. As fibromyalgia research continues to progress, it is expected that the pathophysiology of this disorder will be further elucidated, leading to more rational and targeted strategies for the treatment of patients with this condition.
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Affiliation(s)
- Laurence A Bradley
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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Van Houdenhove B, Luyten P, Tiber Egle U. Stress as a Key Concept in Chronic Widespread Pain and Fatigue Disorders. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/10582450903284745] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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49
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Boles RG, Zaki EA, Lavenbarg T, Hejazi R, Foran P, Freeborn J, Trilokekar S, McCallum R. Are pediatric and adult-onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult-onset CVS with the migraine and pediatric CVS-associated common mtDNA polymorphisms 16519T and 3010A. Neurogastroenterol Motil 2009; 21:936-e72. [PMID: 19368653 DOI: 10.1111/j.1365-2982.2009.01305.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pediatric cyclic vomiting syndrome (CVS) is associated with a high prevalence of co-morbid migraine and other functional disorders, and with two adult migraine-associated mitochondrial DNA (mtDNA) polymorphisms: 16519T and 3010A. These potential associations have not been studied in adult CVS. The objective of this study is to determine the prevalence of 16519T and 3010A mtDNA polymorphisms and other functional disorders in adult CVS patients. Adults with CVS recruited from the University of Kansas meeting Rome III criteria and a population control group completed a self-reported survey that included questions relating to the diagnostic criteria for several functional disorders. DNA was isolated from blood or saliva and genotyping was performed by standard methodologies. Adult CVS subjects, compared to controls, had significantly more symptoms consistent with several other functional disorders. 16519T was present in 22/31 cases (71%) of child-onset (<12 years) and 9/31 (29%) cases of adult-onset (18+ years) CVS (P = 0.01), vs 27% of controls. Among subjects with 16519T, 3010A was present in 30% of child-onset vs 0% of adult-onset CVS (P = 0.05) and 2% of controls. The conclusions drawn were: (i) unlike pediatric CVS, adult CVS is not associated with the 16519T and 3010A mtDNA polymorphisms, suggesting a degree of genetic distinction and (ii) similar to the pediatric setting, adult CVS is associated with a substantial burden of co-morbid functional disorders.
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Affiliation(s)
- R G Boles
- Division of Medical Genetics and the Saban Research Institute, Childrens Hospital Los Angeles, CA 90027,USA.
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50
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Abstract
Major depression is an evolutionary paradox: it carries great disadvantages for survival and reproduction of both patients and their relatives, yet it is common and has significant heritability. We propose a new hypothesis to help explain many of depression's symptoms and its risk factors, most of them not explained by previous evolutionary theories. We hypothesize that the evolutionary costs of depression are offset by its benefits in combating existing infections and avoiding new ones. As our hypothesis predicts, depression can be elicited by various infections as well as by environmental stressors that compromise immune function. Moreover, many depressive symptoms tend to aid immune function and reduce exposure to new infections and stressors. The hypothesis makes many predictions about the epidemiology and physiology of depression that are supported by available evidence. The hypothesis also suggests that possible underlying infectious and immune factors deserve greater consideration in prevention and treatment of depression.
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