Abnormal Levels Of Anxiety Research Articles

210EMF Four-Week Text Messaging Follow-Up of Subjects With Low-Risk Chest Pain Associated With Anxiety

Approximately 40% of patients presenting to the emergency department (ED) with low-risk chest pain have anxiety as a significant contributor to their symptoms. Often unaddressed in this population, anxiety is associated with multiple psychological comorbidities, impaired quality of life, and significantly higher ED recidivism. Although evidence points to persistent anxiety symptom elevation at six-weeks, traditional methods of follow-up assessment in this population are prone to recall bias given the unpredictable nature of anxiety symptomatology. One method of overcoming this propensity for recall bias is through frequent repeated measures known as ecological momentary assessment (EMA). Short message service (SMS) messaging or text-messaging is a readily accessible and cheap EMA method. Our objective is to determine the feasibility of using an automated weekly SMS text message protocol to assess the prevalence and rate of persistent anxiety symptoms, chest pain recurrence, and ED utilization among a cohort of ED subjects with low-risk chest pain. This is a single academic center, two hospital, prospective observational cohort study of ED subjects with low risk chest pain. Eligible subjects between 18 and 70 years old with no history of acute coronary syndrome (ACS) and a physician-reported HEART score < 4, are eligible for enrollment. The Generalized Anxiety Disorder 7 item scale (GAD-7) is used to stratify participants by anxiety symptom severity: (none ≤4, mild 5-9, moderate 10-14, and severe ≥15). Subjects are followed for a total of 12 weeks receiving automated SMS conversations from our Research Electronic Data Capture (REDCap) software facilitated by third-party partner Twilio. These 9-item SMS conversations assess anxiety symptoms, chest pain recurrence and ED utilization in weeks 1-5 and 7-11. This is an interim analysis using descriptive statistics of this cohort through 4 weeks of follow-up. To date, 117 of the 200 planned subjects have been enrolled and their baseline characteristics are shown in Table 1.The prevalence of abnormal levels of anxiety (moderate or severe) at enrollment was 44% (n=51). GAD-7 scores ≥15 (severe) were found in 30 subjects (26%). The overall study response rate to SMS prompts is 76%. Two and four-week follow-up SMS response rates are 74% and 72% respectively. At 2 weeks, of the 41 responding subjects with abnormal anxiety at enrollment, 26 (64%) had persistently abnormal scores. Additionally, of the subjects with severe anxiety at enrollment, 77% remained abnormal compared with 40% of those with moderate scores at 2 weeks. For subjects with severe anxiety at enrollment, the rate of persistently abnormal anxiety was 72% at 4 weeks. In this interim analysis investigating the feasibility of using automated SMS conversations for follow-up of low risk chest patients, our rate of SMS response is >75%, which is currently higher than our a priori feasibility threshold of 70%. Additionally, >70% of those with severe anxiety symptoms at enrollment had persistently abnormal anxiety scores at 2- and 4-week SMS follow-up.Tabled 1Baseline cohort demographicsGAD-7 ≤9 (n=66)GAD-7 ≥10 (n=51)Age43.743.8Female Sex39 (59%)33 (65%)Race/EthnicityBlack28 (42%)37 (73%)White34 (52%)12 (24%)Hispanic3 (5%)4 (8%) Open table in a new tab

Anxiety Screening in the Emergency Department

Background and Hypothesis: &#x0D; Preliminary research completed in the Indiana University Health Methodist Emergency Department (ED) determined that the prevalence of undetected or unaddressed abnormal anxiety levels in patients with low-risk chest pain was greater than 45%. This subset was noted to have abnormal anxiety symptoms that persisted following visits and increased ED recidivism. We hypothesize that the prevalence of abnormal anxiety in the general ED population will be similar to the subset of patients with low-risk chest pain shown previously. &#x0D; Methods: &#x0D; We enrolled a convenience sample of adult patients with non-psychiatric chief complaints who presented to IUH Methodist and Eskenazi Emergency Departments. Participants were assessed for abnormal anxiety levels using the Generalized Anxiety Disorder 7-item Scale (GAD-7) and the Hospital Anxiety Depression Scale (HADS). Subjects will also complete these assessment tools at 30-days post-enrollment via phone or REDCap survey. Data regarding ED disposition, discharge diagnosis, and ED utilization over the previous 12 months and the 30 days post-enrollment will be collected from the electronic medical record (EMR). &#x0D; Results: &#x0D; Over four weeks, 108 patients were screened and 37 gave informed consent and were enrolled. Preliminary analysis shows that 21 subjects (56%) had a GAD-7 score ≥10, indicating abnormal anxiety levels. Full data analysis including comparison of HADS and GAD-7 scores will take place after 50 subjects have been enrolled, completed their 30-day follow-up surveys, and EMR review has taken place. &#x0D; Conclusion: &#x0D; Given data regarding ED visits in patients with low-risk chest pain, identification of anxiety and referral may reduce ED utilization.

Anxiety, depression, and quality of life in backache patients before and after spinal traction

BackgroundChronic pain has a negative impact on quality of life and psychological well-being. The objectives of this study are to investigate the psychological status and quality of life in backache patients before and after spinal traction and reflect how this maneuver is effective in treating backache.MethodsForty-seven backache patients completed the hospital anxiety and depression scale (HADS) and Short-Form 36 Health Survey (SF-36) before and after treatment with spinal traction. Forty-eight healthy controls, matched with patients for age and sex, completed the same questionnaires. Pain was assessed before and after the maneuver using a visual analog scale (VAS). Traction was added to patients’ medications which were not enough to control patients’ symptoms and did not change during the course of traction.ResultsBefore spinal traction, the mean VAS score was 7 ± 1.36, abnormal levels of anxiety and depression were found in 36.17% and 40.43%, respectively, of patients, and all SF-36 domains of the study population, except for physical functioning, showed mean scores < 50%. After spinal traction, the mean VAS score dropped significantly to 5.44 ± 1.51, abnormal levels of anxiety and depression became 14.9% and 21.3%, and all SF-36 domains improved significantly, with six of the eight domains showing mean scores > 50%. There were significant differences regarding all SF-36 domains, and anxiety and depression scores between patients and controls, in favor of controls, before traction. These differences disappeared after spinal traction.ConclusionPain, psychological status, and quality of life improved when spinal traction was added to medications reflecting its efficacy for patients with backache.

28 Comorbid Psychological Factors in Emergency Department Patients With Low Risk Chest Pain Associated With Anxiety

Anxiety is thought to be a significant contributor to chest pain symptoms in approximately 40% of patients with low risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale - Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. These patients have been shown to have persistent anxiety symptoms at follow-up and significantly higher ED utilization. The objective of this study was to determine the prevalence of abnormal anxiety levels in a cohort of low-risk chest pain patients and characterize their comorbid psychological contributors. We hypothesized that those with abnormal anxiety scores would have worse concomitant depression, optimism and pain catastrophizing scores in addition to experiencing more life trauma. This was a pre-planned secondary analysis of a single-center, prospective observational cohort study of ED subjects with low risk chest pain. Eligible subjects between 18 and 70 years old with no history of acute coronary syndrome (ACS) and a physician-reported HEART score < 4, were enrolled. The HADS-A was used to stratify participants into 2 groups: Low Anxiety (score<8) and High Anxiety (score≥8). Outcomes assessed included concomitant depression via the Hospital Anxiety Depression Scale - Depression subscale (HADS-D), previous trauma (Traumatic Life Events Questionnaire), optimism (Life Optimism Test-Revised), and pain catastrophizing (Pain Catastrophizing Scale). These groups were analyzed and compared using t-tests for continuous data and chi-square for proportional/categorical data. Of 442 screened subjects, 304 met enrollment criteria and 163 (36.8%) gave informed consent. Seventy-six (47%) were stratified into the High Anxiety group with a score≥8. There were no differences in baseline demographics between groups. Overall, there was a moderate positive correlation between HADS-A and HADS-D scores with a Pearson’s R of 0.519. Thirty percent of all subjects had abnormal depression scores ≥8 on the HADS-D and 35 subjects (45%) had both abnormal anxiety as well as depression. Mean depression scores were significantly different between the low anxiety and high anxiety groups (3.64, 95% CI 2.17 to 5.10). Traumatic experiences of assault with a weapon (p=0.000), physical assault (p=0.012), sexual assault (p=0.046), witnessing fire (p=0.034), natural disaster (p=0.035) were all associated with abnormal levels of anxiety. However, only sexual assault (p=0.030) and other unwanted sexual encounters (p=0.040) were associated with abnormal levels of depression. Optimism was negatively correlated with both anxiety (R=-0.489) and depression (R=-0.504). Additionally, optimism was significantly lower for subjects with either abnormal anxiety (mean difference of 3.86, 95% CI 2.46 to 5.26) or abnormal depression (mean difference 4.32, 95% CI 2.80 to 5.83). Pain catastrophizing was also significantly higher in subjects with either abnormal anxiety or depression (p=0.000). The prevalence of abnormal levels of anxiety in our low risk chest pain cohort was 47%. These patients were more likely to have concurrent symptoms of depression, multiple traumatic exposures, a less optimistic outlook, and a pain catastrophizing phenotype. These data indicate there may be an opportunity to address these problems in many low risk chest pain patients as a best practice.

Anxiety Associated With Increased Risk for Emergency Department Recidivism in Patients With Low-Risk Chest Pain

Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8). At 45-day follow-up, chest pain recurrence was assessed by patient report, whereas ED utilization was assessed through chart review. Of the 167 subjects enrolled, 78 (47%) were stratified to high anxiety. The relative risk for high anxiety being associated with at least one 30-day ED return visit was 2.6 (95% confidence interval 1.4 to 4.7) and this relative risk increased to 9.1 (95% confidence interval 2.18to38.6) for 2 or more ED return visits. Occasional chest pain recurrence was reported by more subjects in the high anxiety group, 68% vs 47% (p = 0.029). In conclusion, 47% of low-risk chest pain cohort had abnormal levels of anxiety. These patients were more likely to have occasional recurrence of their chest pain and had an increased risk multiple ED return visits.

Prevalence and correlates of bleeding and emotional harms in a national US sample of patients with venous thromboembolism: A cross-sectional structural equation model

IntroductionVenous thromboembolism (VTE) including deep vein thrombosis (DVT) or pulmonary embolism (PE) is associated with reduced survival, poorer quality of life, and substantial health-care-costs. Limited research, primarily qualitative, suggests that those with VTE may have elevated fear of recurrence, and associated emotional dysfunction and distress. MethodsA national online survey was administered to 907 patients who had experienced a VTE event in the past two years. The survey assessed for the prevalence of self-reported bleeding harms associated with VTE, the levels of anxiety, depression, cognitive dysfunction and distress experienced by patients, and a range of potential psychosocial correlates that may be associated with these bleeding or emotional harms. ResultsThe majority (63.0%) of respondents had experienced at least one bleeding related harm following their VTE diagnosis, and 40.6% indicated they experienced fear of another clot often or almost all the time. One-in-four (24.7%) and one-in-ten (11.6%) had abnormal levels of anxiety and depression, respectively. Structural equation modeling was used to define two composite latent bleeding harm and emotional harm factors. Emotional and bleeding harms were associated with younger age, a belief that one's health is due to luck, having multiple comorbidities, having a history of prior VTE events, having multiple barriers to VTE care, and experiencing medical mistakes in diagnosis or treatment. Emotional harms were uniquely predicted by having poorer health literacy, having low self-reported medication adherence, belief others are responsible for one's health, and more recent VTE events. Bleeding harms were uniquely predicted by having a lower frequency of primary care provider contact and having a history of switching between warfarin and direct oral anticoagulants for VTE treatment. ConclusionsThe findings show high levels of self-reported bleeding and emotional harms in a general population of VTE sufferers that are clearly associated with readily identifiable demographic, health status, and psychosocial characteristics. These represent targets for intervention and changes in clinical practice.

Fatigue and its associated factors in microscopic colitis.

Background:Fatigue is a well-recognized symptom in patients with inflammatory bowel disease and irritable bowel syndrome (IBS), and has been associated with psychological comorbidity and impaired quality of life in both. However, features associated with fatigue in patients with microscopic colitis (MC) are less clear.Materials and methods:We conducted a cross-sectional survey of patients with a new diagnosis of MC including levels of anxiety, depression, somatization, quality of life, and IBS-type symptoms. Levels and impact of fatigue were assessed using the Inflammatory Bowel Disease Fatigue self-assessment scale. Mean scores were compared against various patient characteristics, and were also correlated with anxiety, depression, somatization, and quality-of-life scores.Results:In total, 129 patients with MC diagnosed between 2010 and 2015 returned completed postal questionnaires. Common histological subtypes were collagenous colitis (53.5%, n = 69) and lymphocytic colitis (38.8%, n = 50). Higher mean fatigue severity and impact scores were associated with the presence of irritable-bowel-syndrome-type symptoms, abnormal levels of anxiety and depression, and high levels of somatization (p < 0.0001 for all), but those reporting ongoing symptoms attributable to MC did not report significantly higher scores. There were significant positive correlations between total anxiety, depression, or somatization scores and fatigue severity and impact scores, and significant negative correlations with quality-of-life measures (p < 0.001 for all).Conclusions:Fatigue in MC appears to be associated with reporting IBS-type symptoms, psychological comorbidity and impaired quality of life. It may therefore represent an important target for treatment.

Prevalence and correlates of anxiety and depression among family carers of cancer patients in a cancer care and treatment facility in Uganda: a cross-sectional study.

The process of caregiving may cause emotional distress in form of anxiety and depression among family carers of cancer patients. Little is known about the prevalence of anxiety and depression among family carers of cancer patients in Uganda. To determine the prevalence of anxiety and depression and related factors associated with abnormal levels of anxiety and depression among family carers of cancer patients in a cancer care and treatment facility in Uganda. After obtaining ethical approval, we recruited family carers of cancer patients to this cross-sectional study. Data was collected with the use of the Hospital Anxiety and Depression Scale(HADS) standardized tool. A total of 119 family carers were recruited from the Uganda Cancer Institute. The prevalence of anxiety and depression among family carers was high (45% V. 26 %); Abnormal levels of anxiety (ALA)(OR 0.27, 95% CI, p= 0.01) and depression (ALD)(OR 0.37, 95% CI, p=0.05) were significantly associated with being a relative carer. Anxiety and depression is prevalent among family carers of cancer patients. Being a relative carer predisposes you to increased risk of developing anxiety and depression. Incorporating evidence based psychological therapies into usual care and targeting family carers is imperative.

Sexual function, anxiety, and surgical decision making in BRCA mutation carriers.

e21572 Background: To describe BRCA mutation carriers’ perspectives on quality of life from prophylactic surgical decision making. Methods: A cross-sectional survey of BRCA mutation carriers identified from a genetic counseling database at an academic women’s oncology program was conducted using Research Electronic Data Capture. Survey items included Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale, and investigator-generated questions. Statistical analysis was performed using Fisher’s exact test and Wilcoxon rank-sum or Kruskal-Wallis tests. Results: 66 BRCA mutation carriers completed the survey (39% response rate) with a median age of 50 (range 18 to 79); 23% of respondents were pre- or perimenopausal and 11% reported a history of ovarian/fallopian tube cancer. Overall, 25% of respondents reported anxiety regarding the timing of bilateral salpingo-oophorectomy (BSO) or mastectomy. Women who had a BSO were less likely to be sexually active and had lower total FSFI scores, with arousal and desire approaching significance compared to women without BSO (p = 0.05). Women who had a BSO had slightly higher median total anxiety scores, but were not more likely to have abnormal levels of anxiety. Women who were &lt; 40 years of age at discovery of mutation were more likely to have had a discussion regarding preimplantation genetic diagnosis (p &lt; 0.0001), more likely to have anxiety regarding prophylactic surgery and childbearing (p &lt; 0.0001), and more likely to say BRCA mutation impacted their decisions about childbearing (p = 0.001) compared to women &gt; 40. 57% of women age 18-39 at time of mutation diagnosis delayed BSO for childbearing as compared to none of the women &gt; 40 (p &lt; 0.0001). Only 20% of the pre- or perimenopausal women used hormone replacement therapy after BSO. Conclusions: BRCA mutation carriers face challenging decisions concerning prophylactic surgical management. Counseling sessions often focus on effective risk reducing surgeries but may not directly address other emotional and physical consequences of prophylactic surgery. Counseling regarding use of hormone replacement therapy is an area identified in this study that may improve quality of life issues seen in women undergoing prophylactic BSO.

Impact of the built environment on self-rated health and wellbeing and other health behaviours of people in social, intermediate, and market-rent accommodation: baseline characteristics of ENABLE London Study participants

BackgroundEast Village (formerly the 2012 London Olympic Games Athletes' Village) was designed for healthy active living. The Examining Neighbourhood Activities in Built Living Environments in London (ENABLE London) study is a 2 year longitudinal study examining whether health behaviours show sustained change among individuals moving to East Village, compared with a control population living outside. We aimed to report baseline characteristics of participants in this study. MethodsAll adults seeking social, intermediate, or market-rent accommodation in East Village were recruited. Self-rated health, wellbeing, anxiety, depression, and perceptions of the local built environment were ascertained through questionnaires. Accelerometers were used to assess physical activity. Body-mass index (BMI) was calculated. FindingsThe baseline cohort, before any move to East Village, comprises 1278 adults. Social housing participants were older (n=520, median age 37 years [IQR 28–45]) than those from intermediate (524, 31 [27–36]) and market-rent sectors (234, 28 [25–33]), were mostly women (n=379, 73% vs 251, 48% vs 103, 44%), and non-white (424, 82% vs 166, 32% vs 71, 30%). Baseline findings show that those in social housing were least likely to agree with enjoying living in their area (n=275, 53%) and walking in their neighbourhood (256, 49%) compared with the intermediate (361, 69% vs 318, 61%) and market-rent sectors (167, 71% vs 142, 61%). A graded increase of very good or good health status was reported across housing sectors (social n=393, 76%; intermediate 463, 88%; market-rent 212, 90%), with a decrease in abnormal levels of anxiety (80, 15%; 57, 11%; 23, 10%) and depression (58, 11%; 21, 4%; 6, 3%). The social sector recorded fewer daily steps (n=509, mean number of steps 7750 [SD 3312]), compared with intermediate (504, 9699 [2916]) and market-rent sectors (221, 9361 [2992]). BMI was higher in social sector participants (n=515, 27·3 kg/m2 [SD 6·0]) than in those in intermediate (518, 24·8 [4·6]) and market-rent sectors (226, 24·2 [4·0]). To date, 324 (54%) of 605 participants have moved to East Village. InterpretationThe ENABLE London study offers a unique opportunity for a natural experiment. These baseline data provide strong evidence of marked differences in perceptions of the built environment, and health behaviours across housing sectors. 2 year follow-up of the cohort will measure change in these health outcomes, associated with moving to the same environment. FundingMedical Research Council National Prevention Research Initiative (grant MR/J000345/1) and National Institute for Health Research (grant 12/211/69).

Inflammatory bowel disease and anxiety: links, risks, and challenges faced.

Inflammatory bowel disease (IBD) causes severe physical symptoms and is also associated with psychological comorbidities. Abnormal anxiety levels are found in up to 40% of patients with IBD. Anxiety symptoms are often related to flares of IBD but may persist in times of remission. Detection of anxiety disorder (AD) in patients with IBD can be challenging. Patients with anxiety may also exhibit symptoms in keeping with functional gastrointestinal disorders (FGID). Evidence for the effectiveness of pharmacological and psychological therapies for anxiety stems from patients without IBD. Studies in patients with IBD have either been small or shown negative results. In light of this, a combined approach involving IBD physicians to improve disease control and psychologists or psychiatrists to treat anxiety is advised. This review examines the evidence of anxiety issues in IBD with a focus on extent of the problem, risk factors for anxiety, and the effectiveness of interventions.

The effects of valproate and olanzapine on the abnormal behavior of diacylglycerol kinase β knockout mice

BackgroundDiacylglycerol kinase (DGK) is an enzyme that converts diacylglycerol to phosphatidic acid. Previously, we reported that DGKβ knockout (KO) mice showed mania-like behaviors such as hyperactivity, reduced anxiety, and cognitive impairment. Furthermore, lithium ameliorated the hyperactivity and reduced anxiety of DGKβ KO mice. In this study, we investigated the effects of the clinically active antimanic drugs valproate and olanzapine on the abnormal behaviors of DGKβ KO mice. MethodsValproate (100mg/kg/day) and olanzapine (1mg/kg/day) were administered intraperitoneally. Following drugs treatments, behavioral tests were performed to investigate locomotor activity, anxiety levels, and cognitive function of the mice. ResultsA single treatment of valproate and olanzapine did not ameliorate the hyperactivity or abnormal anxiety level of DGKβ KO mice. Chronic treatment with valproate and olanzapine significantly decreased locomotor activity and abnormal anxiety levels of DGKβ KO mice. Additionally, valproate also ameliorated cognitive function of DGKβ KO mice. ConclusionThese results suggest that the abnormal behaviors of DGKβ KO mice is responsive to antimanic drugs, and that DGKβ KO mice are useful as an animal model of mania.

The role of cognitive processes in vestibular disorders

Equilibrium of the body is the result of perfect control of the relationship between the body and the environment in every life condition. Equilibrium is an essential function and hence cannot be entrusted to a single organ or apparatus. The function requires an entire balance system consisting of a set of communicating structures and processes. At every moment, the central nervous system (CNS) processes the inputs received from various receptors in the human body. Key steps in processing the different inputs involve recognition of the single afferences, comparison and integration of the multitude of afferences and their modulation to regulate the gain on the whole system. Furthermore, the CNS stores the experiences and finally programmes the responses to adapt to the ongoing reality. The vestibular system plays a critical role in maintaining the balance function and, therefore, its inputs must be integrated with the highest brain functions. From an anatomo-physiological perspective, the existence of cognitive-vestibular interaction is supported by the presence of neuronal projections between the vestibular centres in the brainstem and both the cerebral and cerebellar cortex. However, the vestibular system is connected to the whole CNS. In humans, galvanic and caloric vestibular stimulation activates several cortical regions. The so-called vestibular cortex is a multisensorial cortex because it receives not only vestibular inputs but also somatosensory and visual inputs. The vestibular system is tightly connected to the limbic system, which regulates emotions, homeostasis and storage of experiences. More specifically, the vestibular inputs are basic to the topokinetic memory of the hippocampus.Acute lesions affecting the peripheral receptors or nerves produce a sudden change in information reaching the balance system, which results in serious symptoms. Hence, all balance disorders lead to a significant degree of handicap and emotional disturbance for the patient.The evolution of vestibular symptoms is related to the ability of the CNS to adapt to the development of new and dangerous conditions. The plasticity of the CNS permits adaptation to both physiological and pathological conditions in every condition of life. Cognitive resources play a continuous role in the reorganization of the balance function during adaptation to vestibular loss. Despite the fact that the adaptation is usually satisfactory, a ‘vestibular cicatrix’ remains forever. The vestibular cicatrix is characterized by topokinetic memory disorganization at a high level of information processing, spatial working memory deficit, alerting state with abnormal levels of anxiety and depression, substitutional saccadic eye movements if the head is turned quickly in the direction of the damaged ear, errors in cognitive tasks and fewer attentional resources. Vestibular adaptation is not constant in time and is dependent on many individual factors (e.g. age, gender, emotions, stress).Vertigo has a negative impact on the quality of life, affects everyday activities and is associated with cognitive impairment. Hence, treatment of vertigo assumes great significance. Treatment must target the entire CNS and should aim to facilitate the vestibular adaptation process. It is preferred that the patient is not confined to bed after the first two days in order to allow the early initiation of dynamic experiences, which are vital for adaptation without running the risk of activating the mechanism of fear and traumatic memory.While selecting a drug for therapy, the plastic and cognitive neuronal mechanisms activated by vestibular deficits must be taken into account. If the use of symptomatic drugs in the past was simply a kind of ‘siesta strategy’, it is expected that in future we will rely on a more dynamic strategy, a ‘mind-energy strategy’, i.e. a vertigo treatment that would also involve a cognitive approach. Adaptation mechanisms require activation of neurons, synapses and neuronal metabolism, particularly in mitochondria. Thus, we need drugs that enhance neuronal metabolic activity, neurotransmission and facilitate the transfer of information between the two hemispheres. It may be particularly useful to counsel patients about the disease and its likely consequences.An excessive alerting state can be prevented by providing patients (and their families) with a simple but detailed explanation of how symptoms are provoked and about the process of adaptation following a balance disorder. In the first days following the vertigo attack, the new dynamic experiences are fundamental for the patients, who need to stay active instead of totally passive. For these patients, the use of sedative drugs should be limited, while the use of nootropic and/or neuromodulator drugs and possibly anti-anxiety drugs in anxious or stressed subjects should be continued. If symptoms persist, factors that interact with the processes of adaptation should be identified and limited, thus reducing stress. The other sensory problems that affect the visual or proprioceptive apparatus should be removed and should have vicarious compensatory activity. Possibilites of reducing the high levels of anxiety, depression and psychological conditions that interact negatively should be considered. The use of nootropics and/or neuromodulator drugs should be continued and a customized rehabilitation training should be implemented.

Comprehensive behavioral characterization of an APP/PS-1 double knock-in mouse model of Alzheimer's disease.

IntroductionDespite the extensive mechanistic and pathological characterization of the amyloid precursor protein (APP)/presenilin-1 (PS-1) knock-in mouse model of Alzheimer's disease (AD), very little is known about the AD-relevant behavioral deficits in this model. Characterization of the baseline behavioral performance in a variety of functional tasks and identification of the temporal onset of behavioral impairments are important to provide a foundation for future preclinical testing of AD therapeutics. Here we perform a comprehensive behavioral characterization of this model, discuss how the observed behavior correlates with the mechanistic and pathological observations of others, and compare this model with other commonly used AD mouse models.MethodsFour different groups of mice ranging across the lifespan of this model (test groups: 7, 11, 15, and 24 months old) were run in a behavioral test battery consisting of tasks to assess motor function (grip strength, rotor rod, beam walk, open field ambulatory movement), anxiety-related behavior (open field time spent in peripheral zone vs. center zone, elevated plus maze), and cognitive function (novel object recognition, radial arm water maze).ResultsThere were no differences in motor function or anxiety-related behavior between APP/PS-1 knock-in mice and wild-type counterpart mice for any age group. Cognitive deficits in both recognition memory (novel object recognition) and spatial reference memory (radial arm water maze) became apparent for the knock-in animals as the disease progressed.ConclusionThis is the first reported comprehensive behavioral analysis of the APP/PS1 knock-in mouse model of AD. The lack of motor/coordination deficits or abnormal anxiety levels, coupled with the age/disease-related cognitive decline and high physiological relevance of this model, make it well suited for utilization in preclinical testing of AD-relevant therapeutics.

Yoga for children

Excessive stress is harmful to academic performance in children and may lead to dropping out of school. To meet the demands of a modern life-style which is full of speed, stress and tension, an all-round child health program is crucial. The use of yoga for children has diverse applications in maintaining and developing their physical, mental, intellectual, emotional and spiritual levels. Yoga, through its physical postures (asana), breathing practices (pranayama), cleansing techniques (kriya), meditation therapies (dhyana) and relaxation training (yoga nidra) yields a positive effect in the management of stress in children. Yoga practice benefited children by improving their eye-hand coordination, attention span, levels of concentration, competitive performance and relaxation. Visually impaired children showed a significant decrease in their abnormal anxiety levels when they practiced yoga for three weeks, while a program of physical activity had no such effect. Socially disadvantaged children in a remand home showed significant improvements in sleep, appetite and general well being, as well as a decrease in physiological arousal after yoga. In one study, it is found that a 4-week program of asana and meditation lowers the aggressive behavior of children. Meditation helped to reduce problems related to maladaptive behavior, increase emotional and physical health and psychological well-being in children. Finally, the possible role of yoga in improving the mental state and general well-being of children with cancer is being explored.

Distress in the Radiology Waiting Room

To assess the level of distress in women awaiting radiologic procedures. In this institutional review board-approved and HIPAA-compliant study, 214 women between 18 and 86 (mean, 47.9) years of age completed the State Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Center for Epidemiologic Studies Depression Scale (CES-D), and Perceived Stress Scale (PSS) immediately prior to their procedures. One hundred twelve women awaited breast biopsy; 42, hepatic chemoembolization for cancer; and 60, uterine fibroid embolization. Data were analyzed with multivariate analysis of variance and post hoc Tukey tests. Results are reported as means and 95% confidence intervals (CIs). All three patient groups experienced abnormally high mean PSS, IES, and CES-D scores, but only the breast biopsy group had highly abnormal anxiety levels. Breast biopsy patients had a significantly higher mean STAI score of 48 (95% CI: 45, 50) than did women awaiting hepatic chemoembolization (mean score, 26; 95% CI: 22, 29; P < .001) and fibroid embolization (mean score, 24; 95% CI: 21, 27; P < .001). IES ratings did not differ significantly among the groups, with a mean score of 26 (95% CI: 23, 29) for breast biopsy patients, 23 (95% CI: 18, 28) for hepatic chemoembolization patients, and 23 (95% CI: 18, 27) for fibroid embolization patients. The CES-D score did not differ significantly among breast biopsy (mean score, 15; 95% CI: 13, 17), hepatic chemoembolization (mean score, 14; 95% CI: 11, 18), and fibroid embolization (mean score, 12; 95% CI: 9, 15) patients. PSS ratings of breast biopsy patients were significantly higher (mean score, 18; 95% CI: 16, 19) than those of hepatic chemoembolization patients (mean, 15; 95% CI: 13, 17; P < .01), but they were not significantly different from those of women awaiting fibroid embolization (mean, 16; 95% CI: 14, 18; P = .23). Uncertainty of diagnosis can be associated with greater stress than is awaiting more invasive and potentially risky treatment.

The role of stress and anxiety in the onset of familial Creutzfeldt-Jakob Disease (CJD): Review

Creutzfeldt-Jakob Disease (CJD) is considered to be a sudden and fatal degenerative brain disorder that leads to death within a few months. In the last decade, we have studied the course of familial CJD (fCJD) among Jews of Libyan descent, one of the largest clusters of fCJD in the world. Recently, we published results that included the identification of abnormal anxiety levels in healthy CJD E200K mutation carriers that were significantly different from those of healthy non-carriers from the same families. All participants were first-degree relatives of patients known to have been carriers of the E200K mutation and had died from CJD, and none of the participants was aware of his/her genetic make-up. In the current review, it is suggested that an abnormality in anxiety levels among the healthy fCJD mutation carriers may reflect the clinical presentation of the disease onset especially during and after any stressful experience. This hypothesis is supported by a summary of relevant literature, dealing with psychological, physiological, and cellular aspects.

The Quality of Life and Hormonal Disturbances in Testicular Cancer Survivors in Cisplatin Era

ObjectivesTo assess the degree of hormonal abnormalities in testicular cancer survivors and the effect of these changes on patients’ quality of life. MethodsMen with complete remission of testicular cancer for over 2 yr were eligible. Patients completed the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), the International Index of Erectile Function (IIEF), and the Sexual Functioning Questionnaire (SFQ), and rated their physical and psychological well-being, quality of life, and relationship with their partner. Levels of the hormones testosterone, estradiol, thyreotropin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were determined. Relationships between hormone levels and questionnaire results were assessed. ResultsA total of 326 men were tested, of whom 269 were treated with platinum-based chemotherapy. The most common endocrine abnormalities were above-normal gonadotropin levels (LH, 55%, and FSH, 49% of cases) and lowered testosterone (15%). Twenty-seven percent (STAI) and 28% (HADS) of the patients had abnormal anxiety levels, while the depression rate was 15% (BDI) and 18% (HADS); 40% of patients had erectile dysfunction. Linear regression analysis excluding the influence of age showed higher depression levels in the BDI among patients with elevated LH (p=0.010) or FSH (p=0.017). Patients with above-normal LH showed increased sexual problems in the SFQ (p=0.030). Elevated gonadotropins correlated with deteriorated physical well-being (p=0.028). Men with abnormal estradiol were more prone to erectile dysfunction (p=0.009). ConclusionsHormonal abnormalities have a negative impact on the quality of life of testicular cancer survivors.

Hormonal status and the quality of life of testicular cancer survivors

4548 Background: Testicular cancer is a highly curable neoplasm and treated patients may potentially survive many decades. The aim of the study was to assess the rate of hormonal abnormalities among testicular cancer survivors and the effect of these changes on patients’ quality of life. Methods: Men with complete remission of testicular cancer lasting over 2 years were eligible. Patients completed State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS), Beck’s Depression Inventory (BDI), International Index of Erectile Dysfunction (IIEF), Sexual Functioning Questionnaire (SFQ) and rated their physical and psychological well-being, quality of life and relationship with partners. Levels of the following hormons were determined: testosterone, estradiol, thyreotropin, folicule stimulating hormone (FSH), luteinizing hormone (LH) and prolactin. Relations between hormone levels and questionaires results were analysed. Results: A total of 326 men were tested from November 2004 till December 2005. Median age was 37 years (range: 18–72). Median disease free survival was 59 months (range: 19–291). Only 24% of patients had all tested hormones within normal ranges. The most common of endocrine abnormalities were gonadotropins over normal (LH - 55% and FSH - 49% of cases) and lowered testosterone (15%). Percentage of patients with abnormal anxiety levels was 27% (STAI) and 28% (HADS), depression rate was 15% (BDI) and 18% (HADS), 40% of patients had erectile disfunction. Hormone levels and scores of the used scales corelated strongly with patients’ age, then a linear regression analysis was performed to exclude the influence of age factor. It was shown that higher depression levels in BDI are found amongst patients with elevated LH (p = 0.010) or FSH (p = 0.017). Men with higher than normal FSH were more anxious in STAI (p = 0.026). Patients with overnormal LH shown more sexual problems in SFQ (p = 0.030). Abnormal gonadotropins levels corelated with a deteriorated physical well-being (p = 0.028). Men with abnormal estradiol were more prone to erectile disfunction (p = 0.009). Conclusions: Hormonal abnormalities are frequent among testicular cancer survivors and have negative impact on the patients’ physical and psychological well-being as well as on their sexual functioning. No significant financial relationships to disclose.

Frontal and limbic metabolic differences in subjects selected according to genetic variation of the SLC6A4 gene polymorphism

Allelic variants in the promoter region of the serotonin transporter (5-HTT) gene have been implicated in several psychiatric disorders and personality traits. In particular, two common alleles in a variable repeat sequence of the promoter region (SLC6A4) have been differentially associated with a display of abnormal levels of anxiety and affective illness in individuals carrying the “s” allele. The aim of this study was to compare the basal cerebral metabolic activity of non-psychiatric subjects in fronto–limbic structures to determine whether differences exist in basal metabolic activity within this functional polymorphism. PET scans with fluorine-18 fluorodeoxyglucose as radiotracer were performed in 71 non-psychiatric subjects previously screened for psychopathology and subsequently genotyped for SLC6A4; PET images were compared with SPM2 according to s/s ( n = 27), s/l ( n = 25), and l/l ( n = 19) groups considering a significance threshold in a priori selected areas of P < 0.001 and an extent threshold ≥5 voxels. The analysis showed an effect of interest among the three genotype groups in right anterior cingulate gyrus (ACC), left middle frontal gyrus, and left posterior cingulate gyrus (PCC). Comparison between l/l vs. s/s showed increased metabolism for l/l in left middle frontal gyrus and an increase for s/s in right ACC and left PCC. Comparison between s/s vs. s/l showed an increase for s/s in left PCC and right ACC. Increased basal metabolism in fronto–limbic structures for the s/s group may be conceived as an “overactive metabolic state” of these structures, possibly related to an increased susceptibility for developing an anxiety–depression spectrum disorder.