The effect of stress on salivary cortisol in panic disorder patients

Updating Beliefs under Perceived Threat

Humans are better at integrating desirable information into their beliefs than undesirable information. This asymmetry poses an evolutionary puzzle, as it can lead to an underestimation of risk and thus failure to take precautionary action. Here, we suggest a mechanism that can speak to this conundrum. In particular, we show that the bias vanishes in response to perceived threat in the environment. We report that an improvement in participants' tendency to incorporate bad news into their beliefs is associated with physiological arousal in response to threat indexed by galvanic skin response and self-reported anxiety. This pattern of results was observed in a controlled laboratory setting (Experiment I), where perceived threat was manipulated, and in firefighters on duty (Experiment II), where it naturally varied. Such flexibility in how individuals integrate information may enhance the likelihood of responding to warnings with caution in environments rife with threat, while maintaining a positivity bias otherwise, a strategy that can increase well-being.SIGNIFICANCE STATEMENT The human tendency to be overly optimistic has mystified scholars and lay people for decades: How could biased beliefs have been selected over unbiased beliefs? Scholars have suggested that although the optimism bias can lead to negative outcomes, including financial collapse and war, it can also facilitate health and productivity. Here, we demonstrate that a mechanism generating the optimism bias, namely asymmetric information integration, evaporates under threat. Such flexibility could result in enhanced caution in dangerous environments while supporting an optimism bias otherwise, potentially increasing well-being.

Effects of the cortisol stress response on the psychotherapy outcome of panic disorder patients

BACKGROUND

A proportion of patients with panic disorder (PD) fail to show a remission after psychotherapy. Biological correlates of psychotherapy non-response have rarely been described in the literature. The aim of the present study was to research the relationship between the cortisol stress response and the psychotherapy outcome in PD patients.

METHODS

Twenty-eight PD patients (20 females, mean age±SD: 35.71±13.18) seeking psychological treatment for PD and n=32 age- and sex-matched healthy control participants (21 females, aged 34.66±12.07) participated in this study. The patients underwent five weeks of cognitive behavioural therapy (CBT). Within the first two weeks of the CBT, both study groups were confronted with the Trier Social Stress Test (TSST). Blood sampling for cortisol and adrenocorticotropic hormone (ACTH) evaluation as well as fear-rating (Visual Analogue Scale; Primary Appraisal and Secondary Appraisal Questionnaire, PASA) accompanied the TSST. The global severity of PD (Panic & Agoraphobia Scale; PAS), agoraphobic cognitions (Agoraphobic Cognitions Questionnaire; ACQ), fear of bodily sensations (Bodily Sensations Questionnaire; BSQ), agoraphobic avoidance (Mobility Inventory; MI), and depressiveness (Beck Depression Inventory; BDI) were assessed before and after the CBT (except the BDI).

RESULTS

The statistical analysis revealed significant main effects of time for cortisol and the ACTH concentration in response to the TSST, independently of the study group. 42.9% of the PD patients and 65.6% of the healthy control participants showed a cortisol stress response to the TSST≥55.2nmol/l (descriptive finding). The data showed a significant inverse association of the TSST cortisol stress response with the MI total score when accompanied. Further, a significant association of the PASA subjective level of fear and the BSQ as well as a trend for an association of the PASA with the ACQ were observed.

CONCLUSION

Consistent with prior research, we could replicate findings of decreased cortisol concentrations in the PD patients in comparison to the healthy control participants. Furthermore, our findings agree with previous data showing an association of the attenuated cortisol stress response with the psychotherapy non-response. In the present sample, those patients with the lowest cortisol concentrations showed the least improvement in agoraphobic avoidance after psychotherapy. The patients with the highest level of fear showed the most improvement in fear of bodily sensations. Study limitations as well as implications for future studies will be discussed.

Investigation of cortisol levels in patients with anxiety disorders: a structured review

Anxiety disorders are common and distressing medical conditions, which typically arise in adolescence or early adult life. They can persist for many years, reducing quality of life, limiting academic and occupational achievement, and being responsible for considerable economic pressures. Although a range of psychological and pharmacological treatments are available, their success is often limited, and many patients remain troubled by significant symptom-related disability for long periods. The detailed pathophysiology of each anxiety disorder is not established, and novel treatments that are based solely on current understanding of conventional neurotransmitter function are unlikely to be substantially more effective or better tolerated than current treatments. Investigations of hypothalamo-pituitary axis function across panic disorder, generalized anxiety disorder, specific phobias and social anxiety disorder have produced intriguing findings but not revealed a consistent pattern of endocrine disturbance, perhaps reflecting differences in methodology and the nature and size of the clinical samples. There is a persistent need for large, prospective studies using standardized methods for investigation and data analysis (164 words).

Cortisol in the morning and dimensions of anxiety, depression, and aggression in children from a general population and clinic-referred cohort: An integrated analysis. The TRAILS study

Anxiety and depressive problems have often been related to higher hypothalamic-pituitary-adrenal (HPA)-axis activity (basal morning cortisol levels and cortisol awakening response [CAR]) and externalizing problems to lower HPA-axis activity. However, associations appear weaker and more inconsistent than initially assumed. Previous studies from the Tracking Adolescents Individual Lives Study (TRAILS) suggested sex-differences in these relationships and differential associations with specific dimensions of depressive problems in a general population sample of children (10-12 years). Using the TRAILS population sample (n=1604), we tested hypotheses on the association between single day cortisol (basal morning levels and CAR) and specifically constructed dimensions of anxiety (cognitive versus somatic), depressive (cognitive-affective versus somatic), and externalizing problems (reactive versus proactive aggression), and explored the modifying role of sex. Moreover, we repeated analyses in an independent same-aged clinic-referred sample (n=357). Structural Equation Modeling was used to investigate the association between cortisol and higher- and lower-order (thus, broad and specific) problem dimensions based on self-reports in an integrated model. Overall, findings were consistent across the population and clinic-referred samples, as well as with the existing literature. Most support was found for higher cortisol (mainly CAR) in relation to depressive problems. However, in general, associations were weak in both samples. Therefore, the present results shed doubt on the relevance of single day cortisol measurements for problem behaviors in the milder range. Associations may be stronger in more severe or persistent psychopathology.

Exploring patterns in cortisol synchrony among anxious and nonanxious mother and child dyads: a preliminary study

Given that anxiety is highly familial, the current pilot study explored the association between anxiety diagnosis and diurnal cortisol rhythm in mother-child dyads with the hypothesis that a predisposition toward homogenous cortisol profiles may partially explain the familial linkage of anxiety. The role of family environment in stress response was also examined. Participants were 27 mother-child dyads. Results indicated that patterns of cortisol secretion between mother and child are synchronous. Maternal anxiety and aspects of family functioning significantly predicted child awakening cortisol pattern. Further, affective involvement and gender of the child significantly predicted mother-child diurnal cortisol secretion synchrony. These findings provide support for the degree of synchrony in patterns of physiological responsiveness between mother and child, as well as the importance of a child's affective environment in the prediction of a diagnosis of anxiety.

Intensive two-day cognitive-behavioral intervention decreases cortisol secretion in soldiers suffering from specific phobia to wear protective mask

RESEARCH QUESTIONS

Wearing a protective mask is compulsory for those in professions such as fire-fighters, rescue personnel and soldiers. The phobia to wear a protective mask is considered a specific claustrophobia and may become of major concern during military service. To date, no data are available with respect to the hypothalamus-pituitary-adrenocortical system activity (HPA SA) for both the so-called protective mask phobia (PMP) and its treatment. The aim of the present study was three-fold: 1) to assess HPA SA in soldiers suffering from PMP before and after intensive cognitive-behavioral treatment, 2) to compare these data with controls, and 3) to relate these data to subjective sleep.

METHODS

46 Swiss Army recruits suffering from PMP were enrolled in a two-day intensive treatment course. During initial and final assessments, saliva was sampled to analyse HPA SA via salivary cortisol; saliva samples were also gathered in the morning. For comparison, saliva samples were gathered of 39 Emergency Rescue Service (ERS) recruits. All participants also completed a questionnaire related to sleep and to anxiety.

RESULTS

Compared to controls from the ERS, among army recruits suffering from PMP, cortisol secretion was significantly higher during initial and final assessments, and in the morning. Cortisol secretion decreased from initial and final assessment. Subjectively assessed sleep was more impaired in recruits suffering from PMP compared to controls. After cognitive-behavioral treatment, all recruits suffering from PMP were able to wear the protective mask.

CONCLUSIONS

Specific phobia about wearing a protective mask is treatable via a two-day intensive course. Treatment success is reflected in modified HPA SA. Methodology and results may be transferred to treat patients suffering from sleep apnea syndrome and presenting high anxiety about wearing continuous positive airway pressure devices.

Baseline 'state anxiety' influences HPA-axis sensitivity to one sham-controlled HF-rTMS session applied to the right dorsolateral prefrontal cortex

Although negative results have been reported, an important aspect of the physiology of repetitive transcranial magnetic stimulation (rTMS) could be related to the endocrinological response of the hypothalamic-pituitary-adrenal (HPA) axis, such as cortisol secretion. Because endocrinological responses are influenced by anxiety states, this could influence the effect of rTMS in healthy individuals. In this sham-controlled, "single blind" crossover study, we examined whether one session of HF-rTMS could affect the HPA-system, when taking into account individual state anxiety scores based on the State-Trait Anxiety Inventory (STAI). Twenty-four healthy rTMS naïve females received one sham-controlled high frequency (HF)-rTMS session delivered on the right dorsolateral prefrontal cortex (DLPFC). The Profile of Mood States (POMS) questionnaire, together with salivary cortisol samples, was collected before, just after and 30 min post HF-rTMS. To examine whether state anxiety could influence endocrinological outcome measurements, we administered the STAI-state just before each HF-rTMS experiment started. Based on the POMS questionnaire, no mood changes were observed. Without taking individual state anxiety scores into account, one sham-controlled right-sided HF-rTMS session did not influence the HPA-system. When taking into account individual STAI-state scores, we found that healthy women scoring higher on the STAI-state displayed a significantly more sensitive HPA-system, resulting in salivary cortisol concentration increases after real HF-rTMS, compared to those scoring lower on this anxiety scale. Our results indicate that healthy women scoring high on state anxiety display a more sensitive HPA-system when receiving one right-sided HF-rTMS session. Our findings suggest that the incorporation of individual anxiety states in experimental rTMS research could add further information about its neurobiological influences on the HPA-system.

Susceptibility to stress in transgenic mice overexpressing TrkC, a model of panic disorder

Stressful life events increase the susceptibility for subsequent onset of psychiatric disorders in humans. Previous research has implicated neurotrophins in the onset of some stress-related diseases, such as major depression disorder, post-traumatic stress disorder or panic disorder. We have tested the hypothesis that the neurotrophin-3 (NT-3)/TrkC system is a genetic interface mediating the deleterious effects of stress on the initiation of panic disorder and other pathologies. To this aim, we have analyzed the functionality of HPA axis and the behavioral consequences of different types of stressful conditions in a mouse model of panic disorder, which overexpresses TrkC, the high affinity-receptor for NT-3 (TgNTRK3). Our results reveal that TgNTRK3 mice exhibit an altered circadian corticosterone rhythm that is reversed by clonidine treatment, but normal expression of genes involved in the control of the hypothalamus-pituitary-adrenal (HPA) axis (CRH, GR) and normal corticosterone response to acute and chronic stressors. In contrast, they exhibit an altered pattern of activation of stress-related brain areas and showed enhanced anxiety-related behavior and more passive strategies than wild types under some chronic stress conditions. We conclude that TgNTRK3 mice present differences in their response to stress characterized by subtle changes in the HPA axis, marked changes in acute stress-induced brain activation and altered coping strategies, suggesting a key role of TrkC receptor in the stress neural circuitry and in the behavioral consequences of chronic stress.

Neuroendocrine and psychometric evaluation of a placebo version of the 'Trier Social Stress Test'

The "Trier Social Stress Test" (TSST) is one of the most prominent laboratory stress paradigms. It is often used to investigate the effects of stress on cognitive or affective parameters. Such studies need a non-stress control condition. However, control conditions currently employed are often rather ill defined and do not parallel important modulating variables, e.g., physical or cognitive load of the TSST. We here introduce a placebo version of the TSST, which contains a free speech and a simple mental arithmetic task without uncontrollability and social-evaluative threat. In two studies, this control condition was evaluated using salivary markers of stress reactivity (cortisol and alpha-amylase) and a questionnaire for anticipatory cognitive stress appraisal (PASA). In experiment 1 participants who were treated with the placebo condition showed no cortisol response and a small, but significant salivary alpha-amylase (sAA) response. Both responses were significantly smaller than those of TSST-treated participants. The placebo-treated participants also rated the treatment situation as less stressful. In experiment 2 a crossover study with the use of an intercom to instruct the participants and ensure their compliance was conducted. Again there was a strong cortisol response to the TSST, which differed significantly from the cortisol levels observed during the placebo condition. Importantly the cortisol response was not influenced by treatment order (TSST or placebo first). However, in this study we found similar reactions between TSST- and placebo-treated participants with regard to sAA-response. We suggest that the introduced placebo protocol for the TSST is a promising tool for future psychobiological research. The exact procedure for a given experiment should be tailored to the specific needs of the empirical question studied.

Incorporating hypothalamic-pituitary-adrenal axis measures into preventive interventions for adolescent depression: are we there yet?

Altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis is a robust correlate of major depression in adults, and to a lesser extent, in adolescents. Premorbid differences in HPA axis function have been found to prospectively predict the onset of adolescent depression. To what extent might our knowledge of HPA axis function in adolescents with, or at risk for, depression, help guide efforts to prevent depression in this age group? We review evidence regarding the role of the HPA axis in the development of adolescent depression, and examine whether and which HPA axis measures might be useful in guiding prevention efforts as (a) as a criterion by which to select youth at risk for depression, (b) as a predictor of which youth will be most responsive to prevention efforts, and (c) as an indicator of whether prevention/intervention efforts are working. We conclude that our current understanding of the HPA axis, and its measurement, in adolescent depression are not sufficiently precise to be of immediate practical use in improving prevention efforts. Incorporating HPA axis measures into prevention studies, however, would be immensely useful in clarifying the role of the HPA axis in adolescent depression, such that future prevention efforts might more confidently rely on HPA axis information.

CO2 challenge induced HPA axis activation in panic

The hypothalamic-pituitary-adrenal axis (HPA axis) plays a critical role in stress management. Involvement of this physiological axis in the underlying mechanisms of panic disorder (PD) has been suggested. Studies using 35% CO(2) inhalation to provoke panic found no evidence for robust increases in cortisol levels in PD. However, cortisol levels alone may not be conclusive, as this hormone is merely the end product of a complex physiological axis. Sixteen PD patients and 16 healthy control subjects underwent a 35% CO(2) inhalation and a placebo inhalation on separate days according to a fixed order, double-blind design. Both serum and salivary cortisol, as well as adrenocorticotropic hormone (ACTH) were measured at regular time intervals. Cortisol and ACTH levels increased in the patient and control groups following 35% CO(2) inhalation. The magnitude of the increase was similar in patients and controls despite marked differences in anxiety. This study is the first to document a clear HPA response following 35% CO(2) inhalation in both PD patients and controls. This effect occurs independently of the specific panicogenic properties of the CO(2) challenge. It remains to be clarified whether panic is initially accompanied by major HPA axis activation or whether other stress-responsive systems underlie panic.

Ansiedade, pânico e o eixo hipotálamo-pituitária-adrenal

OBJETIVO: Este artigo discute a ativação diferencial do eixo hipotálamo-pituitária-adrenal no transtorno de ansiedade generalizada e no transtorno de pânico. MÉTODO: Resultados de recentes revisões da literatura são resumidos e discutidos. RESULTADOS: Os resultados de estudos experimentais que dosaram o hormônio adrenocorticotrópico, o cortisol e a prolactina mostram que ataques de pânico naturais, bem como os provocados por agentes panicogênicos seletivos - como lactato de sódio e dióxido de carbono -, não ativam o eixo hipotálamo-pituitária-adrenal. Agonistas do receptor de colecistocinina do tipo B, como o peptídeo colecistocinina-4 e a pentagastrina, elevam os hormônios de estresse, independentemente da ocorrência de um ataque de pânico, parecendo ativar diretamente o eixo hipotálamo-pituitária-adrenal. O antagonista benzodiazepínico flumazenil não eleva o nível dos hormônios de estresse; porém, este agente farmacológico não induz ataques de pânico de modo consistente. Agentes farmacológicos que aumentam a ansiedade em pacientes de pânico (cafeína, ioimbina, agonistas serotonérgicos), assim como em pessoas saudáveis, elevam o nível dos hormônios de estresse. CONCLUSÕES: Além das diferenças na sintomatologia e na resposta farmacológica, o transtorno de ansiedade generalizada e o transtorno de pânico afetam os hormônios de estresse de modo distinto. Enquanto a ansiedade antecipatória e o transtorno de ansiedade generalizada ativam tanto o eixo hipotálamo-pituitária-adrenal como o simpático-adrenal, o ataque de pânico causa acentuada ativação simpática; porém, afeta pouco o eixo hipotálamo-pituitária-adrenal.

Panic comorbidity with bipolar disorder: what is the manic-panic connection?

CONTEXT

Bipolar/panic comorbidity has been observed in clinical, community and familial samples. As both are episodic disorders of affect regulation, the common pathophysiological mechanism is likely to involve deficits in amygdala-mediated, plasticity-dependent emotional conditioning.

EVIDENCE

Neuronal genesis and synaptic remodeling occur in the amygdala; bipolar and panic disorders have both been associated with abnormality in the amygdala and related structures, as well as in molecules that modulate plasticity, such as serotonin, norepinephrine, brain-derived neurotrophic factor (BDNF) and corticotrophin releasing factor (CRF). These biological elements are involved in behavioral conditioning to threat and reward.

MODEL

Panic attacks resemble the normal acute fear response, but are abnormally dissociated from any relevant threat. Abnormal reward-seeking behavior is central to both manic and depressive syndromes. Appetites can be elevated or depressed; satisfaction of a drive may fail to condition future behavior. These dissociations may be the result of deficits in plasticity-dependent processes of conditioning within different amygdala subregions.

CONCLUSIONS

This speculative model may be a useful framework with which to connect molecular, cellular, anatomic and behavioral processes in panic and bipolar disorders. The primary clinical implication is that behavioral treatment may be critical to restore function in some bipolar patients who respond only partially to medications.

Regulation of the hypothalamic-pituitary-adrenocortical system in patients with panic disorder

Anxiety and depressive disorders are among the most common psychiatric disorders with a high number of hospital admissions and a lifetime prevalence of up to 25%. So far, the pathophysiological mechanisms for anxiety disorders remain to be found. Preclinical studies suggest that changes in hypothalamic-pituitary-adrenocortical (HPA) system function are causally related to the expression of anxiety-related behavior. The findings on HPA system function in patients with anxiety disorders are, however, heterogeneous. Both hypo- and hyperresponsiveness of HPA response in various anxiety disorders under different experimental conditions were found. In order to characterize putative case/control differences in HPA system function, we performed a Dex-CRH test, a widely used test to pick up changes in HPA system regulation with high sensitivity, in 30 patients with panic disorder, 35 patients with major depressive episode and in 30 controls individually matched for ethnicity, age and gender. The results indicate a similar dysregulation of the HPA system response in the Dex-CRH test in both patient groups. This finding further underlines the hypothesis that both, depression and panic disorder, share impaired HPA system regulation, supporting the notion that the impairment is involved in the pathophysiology of these clinical conditions. However, differences in the suppression effects and psychopathological correlation patterns between depressed and panic patients suggest different biological mechanisms of HPA system dysregulation in both disorders.

Psychological Reaction to Potential Malfunctioning of Implantable Defibrillators

BACKGROUND

Psychological problems following implantable cardioverter defibrillators (ICD) implantation are diverse and include increased levels of anxiety. Anxiety may even rise further when possible malfunctioning of an ICD is announced, with a higher risk of serious ventricular arrhythmias and death as a consequence. Following the public statement of Medtronic, all patients in the Netherlands with the specific Medtronic ICD were contacted for extra device evaluation. The aim of this exploratory study was to determine whether the proportion of ICD patients with high levels of anxiety would increase after this extra device evaluation.

METHODS

Patients were recruited from an ongoing prospective study on psychological effects of ICD implantation. Thirty-three patients completed the State subscale of the State-Trait Anxiety Inventory (STAI) before and after extra device evaluation. The STAI can identify patients with high levels of anxiety.

RESULTS

A high level of anxiety was experienced by two patients (6.1%) at baseline and eight patients (24.2%) at follow-up (P=0.031). Hence, ICD patients were significantly more likely to experience high levels of anxiety following the public statement of potential malfunctioning of their device.

CONCLUSION

A public statement regarding device safety may increase levels of anxiety among ICD patients. Given the potential triggering effect of high levels of anxiety on arrhythmias, psychological support may be considered for some of the ICD patients after such public statement.

Effects of genetically altered brain glucocorticoid receptor action on behavior and adrenal axis regulation in mice

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is associated with vulnerability to a number of psychiatric diseases including major depression, bipolar disorder, anxiety disorders, and schizophrenia. The HPA axis is activated in response to stress and in a characteristic circadian rhythm, resulting in the release of glucocorticoid hormones from the adrenal cortex. These hormones act on peripheral target tissues to restore homeostasis to the organism and engage glucocorticoid receptors (GR) in the CNS to control the intensity and duration of the stress response. Alterations in this glucocorticoid sensing system may underlie the HPA axis changes associated with psychiatric disorders. Recently, a number of lines of mice with genetically altered GR signaling in the CNS have been generated to address this hypothesis. Here, we summarize findings from new genetic models that indicate a critical role for GR signaling in the CNS in normal regulation of the HPA axis and behavioral/emotional stability.

Adrenocortical Response to Ovine Corticotropin-Releasing Hormone in Young Men: Cortisol Measurement in Matched Samples of Saliva and Plasma

BACKGROUND

Assessment of hypothalamic-pituitary-adrenal (HPA) axis function in stress-related health problems in humans is frequently carried out as a dynamic test by measuring the profile of increment in adrenocortical hormone (ACTH) and/or cortisol level in plasma in response to corticotropin-releasing hormone (CRH) administration. However, obtaining multiple blood samples for this type of test is not only an invasive procedure but also problematic to use in individuals with constricted or damaged veins which collapse during the blood draw such as the injecting drug users (IDUs) and HIV-1-infected individuals. Salivary cortisol measurement presents a non-invasive alternate approach to evaluate HPA axis activity in different situations. In order to validate the efficacy of salivary cortisol measurement for a dynamic test in IDUs and HIV-1-infected individuals, the present study was carried out to evaluate the cortisol profile in matched samples of plasma and saliva in healthy young men in response to ovine CRH (oCRH) administration.

METHODS

Cortisol levels were measured in matched samples of plasma and saliva of healthy young men at baseline and over a 90-min period after administration of a single low dose of oCRH (1 microg/kg).

RESULTS

Salivary cortisol levels were found to follow the profile similar to that of plasma, increasing significantly at each time point after oCRH administration from their respective baseline values (all Sign tests, p < 0.05). The peak level of cortisol occurred at 30 min in both fluids. Although salivary cortisol concentration was a fraction of the total plasma cortisol levels at all time points, there was a significant correlation in the values between the two fluids at baseline (r = 0.87, p < 0.02) as well as at 90 min (r = 0.70, p < 0.03).

CONCLUSION

The findings support the earlier studies and substantiate the efficacy of using salivary free cortisol measurement for assessment of dynamic function of pituitary-adrenal axis in healthy young men and its application in individuals such as IDUs and HIV-infected individuals who may have difficulty in donating multiple blood samples.

1st International Conference on Panic Attacks: diversity of theories and treatments

The 1st International Conference on Psychophysiology of Panic Attacks focused on the diversity of treatments and theories in this complex condition. Experimental research topics were featured, as well as treatment strategies, case studies and patient perspectives. The conference aimed to create a strong multi-cultural emphasis through international, interdisciplinary and patient-professional interaction. The experimental techniques of lactate provocation of panic, carbon dioxide provocation, respiratory measures and cholecystokinin tetrapeptide infusion were used in various ongoing studies aimed at investigating familial markers, protocols for inducing panic in subjects (including opioid-receptor blockade), brain stem mechanisms involved in mediating anxiety and correlation of respiratory variability with panic severity and treatment outcome. Internet-based questionnaire surveys of panic attack (PA) in subjects that had been sexually abused and of subjective feelings about PAs in patients undergoing fertility treatment were presented, as was a survey of panic epidemiology in Iranian students. Some novel treatment modes were discussed, including non-verbal imagery and art therapy and a telephone-conferencing delivery of cognitive-behavioural therapy. Several case studies were used to illustrate treatments and a personal account of panic disorder combined some time after onset with post-traumatic stress disorder highlighted the different responses of the two disorders to psychotherapies.

Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research

This meta-analysis reviews 208 laboratory studies of acute psychological stressors and tests a theoretical model delineating conditions capable of eliciting cortisol responses. Psychological stressors increased cortisol levels; however, effects varied widely across tasks. Consistent with the theoretical model, motivated performance tasks elicited cortisol responses if they were uncontrollable or characterized by social-evaluative threat (task performance could be negatively judged by others), when methodological factors and other stressor characteristics were controlled for. Tasks containing both uncontrollable and social-evaluative elements were associated with the largest cortisol and adrenocorticotropin hormone changes and the longest times to recovery. These findings are consistent with the animal literature on the physiological effects of uncontrollable social threat and contradict the belief that cortisol is responsive to all types of stressors.

The evaluation of anxiety and salivary cortisol levels in patients with oral lichen planus

OBJECTIVE

The aim of this study was to determine any association between anxiety and salivary cortisol levels in oral lichen planus (OLP) patients by the case-control method. DESIGN RELEVANT: Forty patients with OLP were evaluated. The OLP diagnosis was established through a composite of accepted clinical and histopathological characteristics. Forty patients from the register of patients who obtained general dental care were selected as controls.

MATERIAL AND METHOD

The saliva samples collected between 9:00 and 9:15 am were analysed for the level of cortisol with Cortisol EIA that used competitive enzyme-linked immunosorbent assay method. Trait and state anxiety levels of 80 patients were measured using the Spielberger's State-Trait Anxiety Inventory.

RESULTS

The mean level of cortisol from 40 saliva samples in study group was 1.46 and 0.93 microg dl(-1) in 40 controls (P=0.001). The mean level for state anxiety in the study group were 48.85 and 39.45 in control group (P=0.001). Trait anxiety levels in study group were 49.77 and 38.51 in control group (P=0.001). We found that salivary cortisol, state and trait anxiety levels in OLP group were significantly higher than in the control group.

CONCLUSION

Because of the fact that the level of anxiety and salivary cortisol of OLP patients were high, our findings concluded that this disease is closely related with stress. Thus besides traditional treatment of OLP patients, our findings suggest that psychological support is also needed.

Sequence and seasonal effects of salivary cortisol

Assessments of cortisol levels in saliva have been widely used by both researchers and clinicians as an index of adrenal functioning. Quarterly measurements of morning and evening cortisol levels were determined in a longitudinal study of 147 participants (72 women and 75 men) followed for 1 year each. The analysis of salivary cortisol revealed no significant gender or age differences in the sample. There was a sequence effect in quarterly cortisol values with a progressive decrease in serial measurements, especially notable in the morning values; as well as a seasonal variation in cortisol levels with significantly higher levels found in winter and fall, compared with spring and summer. The findings in this study suggest that repeated saliva sampling and seasonal variation in cortisol levels may independently affect adrenal response and, therefore, need to be accounted for in longitudinal studies.

Natural animal models of human psychiatric conditions: assessment of mechanism and validity

1. The classic animal models for human psychiatric conditions involves rodents. As prey species, their normal behaviors of avoidance would be considered pathological in humans and dogs. Hence, such models may not be homologous for similar behaviors found in psychiatric pathology in humans. 2. Dogs exhibit pathological behavioral conditions that may be equivalent to certain human psychiatric conditions. These canine conditions appear spontaneously or endogenously in the absence of genetic or neurochemcial manipulation, and as such, may be homologous to the human condition. 3. If canine conditions approach homology with human conditions they should have excellent face, predictive, and construct validity. 4. The canine conditions of separation anxiety, obsessive-compulsive disorder, cognitive dysfunction, dominance aggression, and panic disorder have good to excellent validity at all explored levels for human generalized anxiety disorder, obsessive-compulsive disorder, Alzheimer's disease, impulse control disorders, and panic disorder. 5. Natural canine models can aid our understanding of human psychiatric conditions.