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López-López A, Matías-Pompa B, Fernández-Carnero J, Gil-Martínez A, Alonso-Fernández M, Alonso Pérez JL, González Gutierrez JL. Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia? Behav Med 2021; 47:311-323. [PMID: 32356678 DOI: 10.1080/08964289.2020.1758611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.
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Affiliation(s)
- A López-López
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - B Matías-Pompa
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - J Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, King Juan Carlos University, Madrid, Spain
| | - A Gil-Martínez
- Department of Physical Therapy, Center of Higher Education Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | - M Alonso-Fernández
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - J L Alonso Pérez
- Department of Physical Therapy, European University of Madrid, Madrid, Spain
| | - J L González Gutierrez
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
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Abstract
Is there a clear line between normal and abnormal mood? Studies of manifest and latent structure provide strong support for a continuum that extends from asymptomatic to subsyndromal to syndromal cases of increasing severity. Subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor's visits and suicide attempts than the full syndromes, yet they are not recognized in the current classification. For most research and some clinical activities, dimensional diagnoses are recommended, and examples are offered for how such diagnoses could be made. For clinical activities requiring decisions, a multithreshold model is proposed in which both lower (e.g., mild depression, capturing subsyndromal cases) and upper (e.g., major depression, capturing clinically significant cases) diagnostic categories are used to inform clinical care. Beyond its implications for diagnosis, the dimensionality of depression and anxiety has implications for etiology and for research aimed at understanding how emotions become disrupted in psychopathology.
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Affiliation(s)
- Ayelet Meron Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6018, USA;
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Werneke U. Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry - Diagnostics and Treatment, Luleå, Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London). Nord J Psychiatry 2018:1-33. [PMID: 30547691 DOI: 10.1080/08039488.2018.1481525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND According to estimates from the European Commission, Europe has experienced the greatest mass movement of people since the Second World War. More than one million refugees and migrants have arrived in the European Union in the past few years. Mental health and primary care professionals are more likely than ever to meet patients from different cultures and backgrounds. AIMS To equip mental health and primary care professionals with transcultural skills to deal with patients from unfamiliar backgrounds. METHOD Lectures and case discussions to explore the latest advances in the diagnosis and treatment of serious mental health problems in a transcultural context. RESULTS Lectures covered transcultural aspects of mental health problems, treatment in different cultural and ethnic contexts, and assessment of risk factors for self-harm and harm in migrant populations. CONCLUSIONS Clinicians require a sound grounding in transcultural skills to confidently and empathically deal with patients from unfamiliar backgrounds.
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Affiliation(s)
- Ursula Werneke
- a Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit , Umeå University , Umeå , Sweden
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Öhlund L, Lieber I. Trainee editorial: psychiatry should be taught from day one in medical school ‡. Nord J Psychiatry 2018; 72:S3-S4. [PMID: 30523714 DOI: 10.1080/08039488.2018.1525646] [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] [Indexed: 10/27/2022]
Affiliation(s)
- Louise Öhlund
- a Sunderby Research Unit, Department of Clinical Sciences, Division of Psychiatry , Umeå University , 97180 Luleå , Umeå , Sweden
| | - Ingrid Lieber
- a Sunderby Research Unit, Department of Clinical Sciences, Division of Psychiatry , Umeå University , 97180 Luleå , Umeå , Sweden
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Cragg JJ, Noonan VK, Noreau L, Borisoff JF, Kramer JK. Neuropathic Pain, Depression, and Cardiovascular Disease: A National Multicenter Study. Neuroepidemiology 2015; 44:130-7. [DOI: 10.1159/000377726] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/05/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Individuals with spinal cord injury (SCI) have a more than twofold increased risk of heart disease and stroke compared with able-bodied individuals. The increased risk appears to be in excess of the risk conferred by several well-established risk factors, including diabetes, hypertension, and sex. This raises the question whether other factors, secondary to SCI, are also contributing to the development of cardiovascular disease (CVD). Two potential factors associated with SCI and CVD are pain and depression. Both are frequently reported among individuals with SCI, develop in the acute stages of injury, and are commonly described as severe. Therefore, the primary aim of this study was to examine the relationship between pain (and types of pain) and depression with CVD among individuals with SCI. Methods: A total of 1,493 individuals (referred sample) with chronic SCI participated in a self-report cross-sectional multicenter Canada-wide survey from 2011-2012 (mean age ± standard deviation: 49.6 ± 13.9 years). Results: After adjustment for age, sex, and injury characteristics, neuropathic pain and depression were significantly and independently associated with CVD (adjusted odds ratio and 95% confidence interval: 2.27 (1.21, 4.60) for neuropathic pain; 4.07 (2.10, 7.87) for depression). In contrast to neuropathic pain, non-neuropathic pain was not significantly associated with CVD (p = 0.13). Conclusion: In conclusion, these data illustrate important interrelationships between secondary complications following SCI, as well as raise the possibility of neuropathic pain (versus nociceptive pain) as a novel and emerging risk factor for CVD.
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Soluble urokinase plasminogen activator receptor as a marker for use of antidepressants. PLoS One 2014; 9:e110555. [PMID: 25329298 PMCID: PMC4203805 DOI: 10.1371/journal.pone.0110555] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 09/24/2014] [Indexed: 12/22/2022] Open
Abstract
Objectives Inflammation is involved in the pathogenesis of depression. A few cross-sectional population-based studies have found that depression is associated with increased levels of inflammatory markers. Soluble urokinase plasminogen activation receptor (suPAR) is known to be a stable marker for inflammation. We investigated the bidirectional association between suPAR levels and use of antidepressants. Methods suPAR level was measured in 9305 blood donors and analysed in relation to 5-years follow-up data on purchase of antidepressants and hospital diagnoses of depression from a nationwide Danish register. Results For men and women without prior use of antidepressants we found a significantly higher risk for incident use of antidepressants with higher suPAR values. For men, the risk of first use of antidepressants increased by 72% from the 1st to the 4th quartile (HR = 1.72, 95% CI: 1.11–2.69). For women, it increased by 108% from the 1st to the 4th quartile (HR = 2.08, 95% CI: 1.45–2.98). Previous use of antidepressants was also significantly associated with higher suPAR levels (p = 0.002). Conclusions High suPAR levels are associated with an increased risk for both previous and future use of antidepressants in healthy men and women. High suPAR are also associated with increased risk for a hospital diagnosis of depression.
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Affiliation(s)
- Emeran A Mayer
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Matsunaga H, Hokari R, Ueda T, Kurihara C, Hozumi H, Higashiyama M, Okada Y, Watanabe C, Komoto S, Nakamura M, Kawaguchi A, Nagao S, Sekiyama A, Miura S. Physiological stress exacerbates murine colitis by enhancing proinflammatory cytokine expression that is dependent on IL-18. Am J Physiol Gastrointest Liver Physiol 2011; 301:G555-64. [PMID: 21719737 DOI: 10.1152/ajpgi.00482.2010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Psychological stress is an environmental factor considered to be a precipitating factor of inflammatory bowel disease. Interleukin (IL)-18 plays a role in stress-induced aggravation in some diseases. The aim of this study was to establish a model of murine colitis exacerbated by psychological stress and to clarify the role of IL-18 in this model. Male C57Bl/6 mice and IL-18(-/-) mice were used for this study. The mice received dextran sulfate sodium (DSS) for induction of colitis. Some mice were exposed to psychological stress using a communication box. Body weight, colonic length, and histological inflammation were measured for assessment of colitis. Tumor necrosis factor (TNF)-α and IL-18 expression in the colon and IL-18 expression in the adrenal gland were analyzed using real-time PCR. The effect of anti-IL-18 antibody was also investigated. Effects of TNF-α and IL-18 on cytokine expressions were studied using the colonic epithelial cell line LS174T. Induction of psychological stress in DSS-treated wild-type mice significantly exacerbated colitis with enhanced expression of proinflammatory cytokines and IL-18. However, induction of psychological stress in DSS-treated IL-18(-/-) mice did not aggravate colitis compared with that in the IL-18(-/-) group given only DSS treatment. Stress-induced aggravation of colitis was ameliorated significantly by anti-IL-18 antibody treatment. IL-18 did not enhance TNF-α-induced expression of intercellular adhesion molecule-1 or IL-8 in LS174T. We established a model of colitis exacerbated by psychological stress. Psychological stress enhanced IL-18 expression and plays a proinflammatory role in stress-induced aggravation of colitis.
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Affiliation(s)
- Hisayuki Matsunaga
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Abstract
The comorbid conditions erectile dysfunction (ED) and depression are highly prevalent in men. Multiple regression analysis to control for all other predictors of ED indicate that men with high depression scores are nearly twice as likely to report ED than nondepressed men. Depression continues to be among the most common comorbid problems in men with ED, both in the community and in clinical samples. This article reviews the current knowledge about the relationship between ED and depression, the effect of treatments for depression on ED, ways to improve screening for depression, and treatment of ED in patients with this comorbidity.
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Affiliation(s)
- Michael A Perelman
- Human Sexuality Program, Payne Whitney Clinic, The New York Presbyterian Hospital, New York, NY, USA.
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Abstract
In this article we review practice models for treating common mental disorders in primary care. Novel treatment approaches by primary care providers and specialty providers, including collaborative care and telepsychiatric models, show considerable promise. An understanding of remaining barriers to improved care suggests several possible solutions and future directions for outpatient psychosomatic medicine.
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Sigmon ST, Schartel JG, Boulard NE, Thorpe GL. Activity Level, Activity Enjoyment, and Weather as Mediators of Physical Health Risks in Seasonal and Nonseasonal Depression. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2010. [DOI: 10.1007/s10942-010-0106-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Smolders M, Laurant M, van Rijswijk E, Mulder J, Braspenning J, Verhaak P, Wensing M, Grol R. Depressed and a co-morbid condition: More psychotropics prescribed! Eur J Gen Pract 2009; 14:10-8. [DOI: 10.1080/13814780701855724] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Low serum IL-10 concentrations and loss of regulatory association between IL-6 and IL-10 in adults with major depression. J Psychiatr Res 2009; 43:962-9. [PMID: 19552919 DOI: 10.1016/j.jpsychires.2009.05.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/28/2009] [Accepted: 05/29/2009] [Indexed: 01/15/2023]
Abstract
Elevated circulating pro-inflammatory cytokines are associated with symptoms of depression, and disorders involving chronic inflammation are often co-morbid with major depression. Since healthy immune regulation is accomplished through counter-balancing effects of pro- and anti-inflammatory cytokines, we hypothesized that depressed subjects (compared to controls) would express lower concentrations of the anti-inflammatory/immunoregulatory cytokine interleukin (IL)-10, and a higher IL-6/IL-10 ratio. We also examined the possibility that depressed subjects may exhibit a deficiency in the regulatory loop involving IL-6 induced secretion of IL-10. Therefore, we hypothesized that circulating IL-6 and IL-10 would be positively correlated in controls, while the correlation would be weaker in depressed subjects. Resting state serum cytokine concentrations were quantified in 12 unmedicated depressed subjects, and 11 age, gender, and ethnicity-matched controls. Depressed subjects showed significantly lower IL-10 (p=0.03, Cohen's d=-0.96), non-significantly higher IL-6, and significantly higher IL-6/IL-10 ratios (p=0.05, Cohen's d=0.50). Across all participants, higher scores on the self-rated Inventory of Depressive Symptoms were associated with lower IL-10 (r(21)=-0.57, p=0.005) and non-significantly higher IL-6/IL-10 ratios (r(21)=0.38, p=0.07), but not related to IL-6 concentrations. As hypothesized, IL-6 and IL-10 concentrations were strongly and positively correlated in controls (r(9)=0.81, p=0.003), but were completely dissociated in depressed subjects (r(10)=0.01, p=0.98). These results suggest that lower IL-10 levels, a higher IL-6/IL-10 ratio, and the apparent absence of a counter-balancing, immunoregulatory increase in IL-10 in response to elevated IL-6 concentrations contribute to the pro-inflammatory physiological milieu that is known to be associated with major depression. Therefore, reduced induction/availability of IL-10, that would normally inhibit pro-inflammatory cytokine actions and resolve inflammation, may contribute to the depressogenic as well as the inflammatory disease-promoting effects of chronic, low-level elevations in pro-inflammatory cytokines.
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Abstract
Stress is a risk factor for depressive and anxiety disorders. Changes in lifestyle patterns that are associated with increased stress therefore place a greater burden on mental health. Stress challenges the organism's homeostatic mechanisms, triggering a cascade of events that should, normally, maintain or allow a return to equilibrium. Stressful events are perceived by sensory systems in the brain, facilitating evaluation and comparison of the existing and previous stimuli as well as the activation of hormones responsible for energy mobilization. The limbic system coordinates the release of corticosteroids, the primary stress hormones, by modulating activation of the hypothalamic paraventricular nucleus (PVN). The amygdala, a limbic structure related to emotional behavior, has a putative role in the evaluation of emotional events and formation of fearful memories; it is also a target of the neurochemical and hormonal mediators of stress. Clinical and experimental data have correlated changes in the structure/function of the amygdala with emotional disorders such as anxiety. In this chapter we review the neuroendocrinology of the stress response, focusing on the role of the limbic system in its establishment and supplementing that information with new experimental data that demonstrates the relationship between stress and anxiety disorders; we also discuss the structural changes that occur in the amygdala after stress.
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Papousek I, Schulter G. Effects of a mood-enhancing intervention on subjective well-being and cardiovascular parameters. Int J Behav Med 2008; 15:293-302. [DOI: 10.1080/10705500802365508] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thomas SA, Chapa DW, Friedmann E, Durden C, Ross A, Lee MCY, Lee HJ. Depression in Patients With Heart Failure: Prevalence, Pathophysiological Mechanisms, and Treatment. Crit Care Nurse 2008. [DOI: 10.4037/ccn2008.28.2.40] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sue A. Thomas
- Sue A. Thomas is a professor and assistant dean of the doctoral program, Erika Friedmann is a professor, and Cheryl Durden, Alyson Ross, Mei Ching Y. Lee, and Hyeon-Joo Lee are doctoral students at the School of Nursing, University of Maryland, in Baltimore
| | - Deborah Wince Chapa
- Deborah Chapa is an assistant professor and program director of the acute care nurse practitioner program at Florida Gulf Coast University in Fort Myers. She is also director of midlevel providers of critical care services at Lee Memorial Health System, Fort Myers, Florida
| | - Erika Friedmann
- Sue A. Thomas is a professor and assistant dean of the doctoral program, Erika Friedmann is a professor, and Cheryl Durden, Alyson Ross, Mei Ching Y. Lee, and Hyeon-Joo Lee are doctoral students at the School of Nursing, University of Maryland, in Baltimore
| | - Cheryl Durden
- Sue A. Thomas is a professor and assistant dean of the doctoral program, Erika Friedmann is a professor, and Cheryl Durden, Alyson Ross, Mei Ching Y. Lee, and Hyeon-Joo Lee are doctoral students at the School of Nursing, University of Maryland, in Baltimore
| | - Alyson Ross
- Sue A. Thomas is a professor and assistant dean of the doctoral program, Erika Friedmann is a professor, and Cheryl Durden, Alyson Ross, Mei Ching Y. Lee, and Hyeon-Joo Lee are doctoral students at the School of Nursing, University of Maryland, in Baltimore
| | - Mei Ching Y. Lee
- Sue A. Thomas is a professor and assistant dean of the doctoral program, Erika Friedmann is a professor, and Cheryl Durden, Alyson Ross, Mei Ching Y. Lee, and Hyeon-Joo Lee are doctoral students at the School of Nursing, University of Maryland, in Baltimore
| | - Hyeon-Joo Lee
- Sue A. Thomas is a professor and assistant dean of the doctoral program, Erika Friedmann is a professor, and Cheryl Durden, Alyson Ross, Mei Ching Y. Lee, and Hyeon-Joo Lee are doctoral students at the School of Nursing, University of Maryland, in Baltimore
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Strain JJ, Blumenfield M. Challenges for Consultation–Liaison Psychiatry in the 21st Century. PSYCHOSOMATICS 2008; 49:93-6. [DOI: 10.1176/appi.psy.49.2.93] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Newton SS, Girgenti MJ, Collier EF, Duman RS. Electroconvulsive seizure increases adult hippocampal angiogenesis in rats. Eur J Neurosci 2006; 24:819-28. [PMID: 16930411 DOI: 10.1111/j.1460-9568.2006.04958.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Electroconvulsive seizure has a proven therapeutic application in the treatment of severe depression and treatment-resistant depression. Despite the efficacy of electroconvulsive seizure as a non-chemical antidepressant treatment, the mechanism of action is unclear. Elevation in hippocampal trophic factor expression and concomitant cellular proliferation are thought to play a role in its action. We examined whether the reported induction of angiogenic factors and endothelial cell proliferation leads to an increase in vascular density. Two hippocampal regions, the dentate gyrus and the stratum lacunosum moleculare (SLM), were examined employing a combination of vascular density quantification, angiogenic gene expression analysis and immunohistochemistry. A 6% increase in vascular density was observed in the dentate gyrus but this did not achieve statistical significance. The SLM of the hippocampus exhibited a robust 20-30% increase in vascular density and was accompanied by an increase in expression of inhibitor of differentiation-3. There was also an induction of the angiogenesis markers alphaVbeta3 integrin and Del1. Increases in the vascular density of the SLM could be in response to enhanced metabolic activity in this region. This is supported by the induction of glutamine synthetase and the glutamate transporter GLT1.
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Affiliation(s)
- Samuel S Newton
- Division of Molecular Psychiatry, Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, Yale University School of Medicine, New Haven, CT, USA.
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Drescher KD, Rosen CS, Burling TA, Foy DW. Causes of death among male veterans who received residential treatment for PTSD. J Trauma Stress 2003; 16:535-43. [PMID: 14690350 DOI: 10.1023/b:jots.0000004076.62793.79] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Previous studies have shown elevated mortality among psychiatric and substance abusing patients, including veterans with PTSD. Although early studies showed elevated deaths from external causes among Vietnam veterans in the early postwar years, more recent studies have also shown increased health problems among veterans with PTSD. This study compared mortality due to behavioral causes versus other diseases among 1,866 male veterans treated for PTSD. Death certificates obtained for 110 veterans indicated behavioral causes accounted for 62.4% of deaths, standardized mortality ratio = 3.4-5.5, including accidents (29.4%), chronic substance abuse (14.7%), and intentional death by suicide, homicide, or police (13.8%). Results suggest possible opportunities to improve outcomes of this at-risk patient population through harm reduction interventions and improved continuity of care.
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Affiliation(s)
- Kent D Drescher
- Clinical Laboratory and Education Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California 94025, USA.
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Nebigil CG, Maroteaux L. Functional consequence of serotonin/5-HT2B receptor signaling in heart: role of mitochondria in transition between hypertrophy and heart failure? Circulation 2003; 108:902-8. [PMID: 12925446 DOI: 10.1161/01.cir.0000081520.25714.d9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Canan G Nebigil
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Centre National de la Recherche Scientifique, Université de Strasbourg, 1 Rue Laurent Freies, BP 10142-67404 Illkirch Cedex, France
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Affiliation(s)
- Peter G Kaufmann
- National Heart, Lung, and Blood Institute, National Institutes of Health, Rockledge Center II, 6701 Rockledge Drive, Room 8118, Bethesda, MD 20892-7936, USA
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Abstract
Depressive disorders are a significant public health issue. They are prevalent, disabling, often chronic illnesses, which cause a high economic burden for society, related to both direct and indirect costs. Depressive disorders also influence significantly the outcome of comorbid medical illnesses such as cardiac diseases, diabetes, and cancer. In primary care, underrecognition and undertreatment of depressive disorders are common, despite their relatively high prevalence, which accounts typically for more than 10% of patients. Primary care physicians should be aware of the common risk factors for depressive disorders such as gender, neuroticism, life events and adverse childhood experiences, and they should be familiar with associated features such as a positive psychiatric family history and prior depressive episodes. In primary care settings, depressive disorders should be considered with patients with multiple medical problems, unexplained physical symptoms, chronic pain or use of medical services that is more frequent than expected. Management of depressive disorders in primary care should include treatment with the newer antidepressant agents (given the fact they are typically well tolerated and safe) and focus on concomitant unhealthy behaviors as well as treatment adherence, which may both affect patient outcome. Programs aimed at improving patient follow-up and the coordination of the primary care intervention with that of specialists have been found to improve patient outcomes and to be cost effective.
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Affiliation(s)
- Paolo Cassano
- Depression Clinical and Research Program, Massachusetts General Hospital, 15 Parkman Street-ACC 812, , Boston, MA 02114, USA
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Affiliation(s)
- Peter Muehrer
- Division of Mental Disorders, Behavioral Research, and AIDS, NIMH/NIH, 6001 Executive Blvd, Room 6189, MSC 9615, Bethesda, MD 20892-9615, USA.
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Knox SS. Psychosocial factors in cardiovascular disease: implications for therapeutic outcomes. Expert Rev Pharmacoecon Outcomes Res 2002; 2:147-59. [DOI: 10.1586/14737167.2.2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of smoking on the health status of spinal patients: the National Spine Network database. Spine (Phila Pa 1976) 2002; 27:313-9. [PMID: 11805698 DOI: 10.1097/00007632-200202010-00022] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, cross-sectional analysis of data from the National Spine Network. OBJECTIVES Investigate the association between the smoking status of spinal patients, duration and severity of symptoms, and their self-reported health status. BACKGROUND Although cigarette smoking was identified as a potential risk factor for lower back pain many years ago, more recent research is challenging this finding. METHODS The National Spine Network database contains information on the initial visit of spinal patients visiting physicians at 23 health care institutions in the United States. All patients for whom data were available regarding smoking status are included in this study (n = 25,455). RESULTS Data from a total of 25,455 patients (11,494 men and 13,961 women) were included in the study; 16.7% (n = 4249) were smokers. Smokers were younger than nonsmokers (44.2 vs. 48.7 years) and were more likely to report severe back symptoms (37 vs. 50%) and to report symptoms of depression (54 vs. 37%). Smokers of each gender scored 10-15 points lower than nonsmokers on each of the SF-36 subscales. These differences persisted when the absolute scores were compared with age- and sex-specific population norms and after adjustment for comorbid conditions, educational level, and depression. Similar results were obtained when the cohort was stratified by primary diagnosis or by surgical status. When postsurgical patients were grouped by time since surgery, those who were nonsmokers reported improved health status by time period; those who smoked did not. CONCLUSIONS Smokers and nonsmokers had had spinal symptoms for similar duration, but the smokers reported more severe symptoms, which were present for a greater proportion of time each day. Also, the smokers had lower physical and mental health status scores (based on the SF-36) than did nonsmokers.
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Affiliation(s)
- Molly T Vogt
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Affiliation(s)
- M A Whooley
- Department of Veterans Affairs Medical Center and the Department of Medicine, University of California, San Francisco 94121, USA.
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