Antianxiety Medications Research Articles

Metastatic paraganglioma presenting as a primary shoulder mass

Paragangliomas uncommonly metastasize, including to the bones, wherein these tumors are designated as malignant paragangliomas. A 56-year-old man presented with pain and immobility in his right arm for 1year. He had a history of controlled hypertension and diabetes mellitus for 2years. He had also been taking anti-anxiety medications for 25years. His shoulder imaging revealed an expansile, lytic, destructive lesion in the glenoid cavity, measuring 4.6 × 3.9 × 3.2cm, involving the adjacent bones and soft tissues. A whole-body PET-CT scan revealed a hypermetabolic destructive mass in the right glenoid cavity and another lesion in his abdomen in the aortocaval region. Initial biopsy and subsequent scapular resection microscopically revealed a multinodular tumor with polygonal cells arranged in a nesting and diffuse pattern, in a vascularized and sclerotic stroma. Tumor cells displayed moderate to abundant, eosinophilic to clear cytoplasm, fine nuclear chromatin, focal intranuclear inclusions, and scattered mitotic figures. Immunohistochemically, tumor cells were positive for vimentin, synaptophysin, chromogranin, and CD56 and negative for AE1/AE3, CK, EMA, CD10, SMA, Melan A, HMB-45, desmin, and S100-P. Biopsy of the abdominal mass revealed foci of tumor cells resembling the scapular tumor. Diagnosis of a malignant paraganglioma was finally offered. The patient's post-operative blood pressure is controlled. Currently, his urinary vanillylmandelic acid and metanephrine levels are normal. He is asymptomatic 11months post-surgery and is on follow-up. This unusual case is presented to increase a diagnostic index of suspicion for a malignant paraganglioma, including at unconventional musculoskeletal sites. The diagnostic challenge and therapeutic implications are discussed herewith.

Adolescents' Access to Their Own Prescription Medications in the Home

The objective of this descriptive study was to determine adolescents' access to their own medications at home, specifically prescription pain, stimulant, antianxiety, and sedative medications. Semistructured interviews were conducted with a cohort of 501 adolescents from two southeastern Michigan school districts. Participants were asked what medications had been prescribed to them during the previous 6 months; if they had received prescription medications, they were asked in-depth questions about them, including how medications were stored and supervised at home. The sample was comprised of adolescents in the 8th and 9th grades, and 50.9% were male. Participants were primarily white (72.9%, n = 365) or African-American (21.6%, n = 108). Slightly less than half of the adolescents (45.9%, n = 230) reported having been prescribed medications in the previous 6 months. Of this group, 14.3% (n = 33) had been prescribed pain medications, 9.6% (n = 22) stimulants, 1.7% (n = 4) antianxiety medications, and .9% (n = 2) sedatives. In total, 57 adolescents were prescribed medications in the pain, stimulant, antianxiety, or sedative categories (including controlled medications), and the majority (73.7%, n = 42) reported that they had unsupervised access to medications with abuse potential. The majority of adolescents who were prescribed medications in the pain, stimulant, antianxiety, or sedative categories during the previous 6 months had unsupervised access to them at home. It is critical that clinicians educate parents and patients about the importance of proper storage and disposal of medications, particularly those with abuse potential.

Intensive Care Unit Versus Hospital Floor: A Comparative Study of Postoperative Management of Patients with Adolescent Idiopathic Scoliosis

Patients undergoing posterior spinal instrumentation and fusion surgery for adolescent idiopathic scoliosis were admitted to the intensive care unit until two years ago, at which time we changed our protocol to admit these patients to the general hospital floor following a brief stay in a postanesthesia care unit. This study compared postoperative management on a hospital floor with that in the intensive care unit for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. A retrospective review of 124 consecutive patients with adolescent idiopathic scoliosis treated with spinal fusion from August 2007 to August 2010 was performed. Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis and posterior spinal instrumentation and fusion surgery. Of 124 patients, sixty-six were managed postoperatively in the intensive care unit and fifty-eight, on the hospital floor. The mean age at the time of surgery was fourteen years. A mean of eleven vertebral levels (range, six to fifteen levels) were fused. No significant difference between the groups was found with respect to the mean age at the time of surgery, mean weight, mean preoperative and postoperative Cobb angles, and mean number of levels fused (p ≥ 0.12). However, the use of analgesic and antianxiety medication, number of postoperative blood tests, days of hospital stay, and number of physical therapy sessions were significantly decreased in the floor group compared with the intensive care unit group (p ≤ 0.05). No patient from the floor group had to be admitted to the intensive care unit. The mean charge was $33,121 for the floor group and $39,252 for the intensive care unit group (p < 0.001). Initial postoperative management of patients with adolescent idiopathic scoliosis following a posterior spinal instrumentation and fusion surgery on a general hospital floor, rather than in an intensive care unit, was associated with a shorter hospital stay, fewer blood tests, less analgesic and antianxiety medication usage, and fewer physical therapy sessions at this high-volume, academic, tertiary-care children's hospital. In addition to improved patient outcomes, there was a significant decrease of 16% in hospital charges for the group that did not go to the intensive care unit.

Pharmacologic Treatment of Anxiety Disorders in Parkinson Disease

Neither best practices nor an evidence base for the pharmacologic treatment of anxiety in Parkinson disease (PD) has been established. This study investigated pharmacologic treatment of anxiety disorders in idiopathic PD and the associated clinical features. Cross-sectional. Three community-based movement disorder neurology practices. 250 subjects with PD. Anxiety disorder diagnoses were established by consensus using a panel of six psychiatrists with expertise in geriatric psychiatry and movement disorders. Current medications were provided by the treating neurologists at the time of interview. Among subjects with anxiety disorders only, 53% were untreated with medications. When anxious subjects with comorbid depressive disorders were included, 70.8% were on medications effective for treatment of anxiety. Subjects with anxiety and comorbid depressive disorders were more likely to be treated for their psychiatric disturbances than subjects with anxiety disorders alone (odds ratio: 8.33), as were subjects with comorbid motor fluctuations (odds ratio: 3.65). There were no differences in the types of anti-anxiety medications used in regard to the presence of depression or motor fluctuations. These findings suggest that over half of nondepressed PD patients with clinically significant anxiety are untreated with medication. A better understanding of the role of clinical features associated with anxiety in PD, such as depression and motor fluctuations, may improve the recognition and treatment of anxiety disorders in this population.

Religion and anxiety treatments in primary care patients

Earlier data suggested that religious physicians are less likely to refer to a psychiatrist or psychologist. This follow-up study measures how religious beliefs affect anxiety treatments in primary care. We surveyed US primary care physicians and psychiatrists using a vignette of a patient with anxiety symptoms. Physicians were asked how likely they were to recommend antianxiety medication, see the patient for counseling, refer to a psychiatrist, refer to a psychologist or licensed counselor, encourage meaningful relationships and activities, and encourage involvement in religious community. We experimentally varied symptom severity, whether the patient was Christian or Jewish, and whether she attended religious services. Physician attendance at religious services was assessed in the survey. The response rate was 896 out of 1427 primary care physicians and 312 out of 487 psychiatrists. Religious physicians were more likely to promote religious resources. There was no statistically significant difference between physicians' recommendations for religious and nonreligious patients. There was no statistically significant difference in religious and nonreligious physicians' referrals to a psychologist, licensed counselor, or psychiatrist. Ultimately, we did not find a difference in religious and nonreligious physicians' support for mental health referrals, however, religious physicians were more likely to encourage using religious resources.

Psychological risk factors associated with falls among elderly people in Baghdad city, Iraq

Background: Ageing of the population is one of the most important demographic facts that come to the foreground in the 21st century. Objective: To assess the relationship between psychological factors (depression, loneliness, using anti anxiety medication, fear from falls and internal displacement of the population) and falls among elderly people in Baghdad city, Iraq. Methods: A matched 1:1 community based case-control study involving 716 elderly respondents, recruited randomly from six Non Governmental Organization (NGO) in different areas of Baghdad. Interviews to each respondent were done accordingly. Geriatric depression scale (GDS) was used to assess the depression among the elderly people. Results: The minimum age for cases and controls was 60 years old while the maximum age for cases was 87 and for controls was 85 years old. The female was predominant than male, 53.6% to 46.4% respectively. The relation between depression, fear from fall, using anti anxiety medication, internal displacement and falls was statistically significant (p

434 – Excess burden of type 1 and type 2 diabetes due to psychopathology

Introduction Whether the prevalence of type 1 or 2 diabetes is rising among people with psychopathology is uncertain. This study investigates changes in the prevalence of type 1 and type 2 diabetes associated with psychopathology in the adult Australian population from 2001 to 2008. Methods Data analysed were from 48,359 participants aged ≥25 years from the 2001, 2004-05 or 2007-08 National Health Surveys. Lifetime diagnosis of type 1 and type 2 diabetes was determined by self-report. Psychopathology status was determined with the 10-item Kessler Psychological Distress Scale (using scores ≥30), and contemporaneous use of antidepressants or anti-anxiety medications. Results Overall, the prevalence of type 1 diabetes remained stable whereas the prevalence of type 2 diabetes increased by 36% between 2001 and 2008. On average, odds ratios with 95% confidence intervals (95% CI) for type 1 and type 2 diabetes ranged from 1.43 (0.98,2.10) to 2.44 (1.63,3.64) and 1.32 (1.13,1.53) to 1.67 (1.39,2.02) for people with compared to those without psychopathology by any definition independent of socio-demographic covariates, consistently over the 8-year period. After further adjustments for lifestyle covariates, the strength of these estimates were attenuated and ranged from 1.32 (0.90,1.95) to 2.24 (1.49,3.36) and 1.16 (0.99,1.36) to 1.51 (1.24,1.83) for type 1 and type 2 diabetes. Conclusions The prevalence of both type 1 and type 2 diabetes was consistently higher for people with psychopathology from 2001-2008. Clinicians should consider routinely screening patients with diabetes for psychopathology and vice versa, as well as lifestyle risk factors, to inform practice.

Paradoxical reaction to midazolam in children

Midazolam is a short-acting benzodiazepine commonly used by anesthesiologists as a preoperative anti-anxiety medication or supplemental sedative in regional anesthesia and monitored anesthesia care. Moreover, a recent increase in the use of midazolam in children has been observed outside of operation rooms, such as mechanical ventilation in the intensive care unit, endoscopy, interventional angiography, and magnetic resonance imaging. The rapid onset, short duration, and anterograde amnesia are major reasons for midazolam to be considered a pre-procedural medication for children. The administration routes for midazolam in children may vary, such as intravenous (IV), intramuscular, oral, and buccal; the most common method used by anesthesiologists is IV. The IV route in children is safe and effective for most cases, but sometimes unexpected reactions occur. These may include hallucination, disorientation, uncontrollable crying or verbalization, agitation, restlessness, involuntary movement, self-injury, and aggressive or violent behavior, which sometimes requires restraints. The generic term for such reactions is a paradoxical reaction (or a disinhibitory reaction). These paradoxical reactions may vary in different reports, but mostly manifest within 5 minutes of midazolam IV administration. Almost all of these reactions are preceded by a brief period of apparent, definite, and transient sedation, after which the child is suddenly aroused and cries in a state of intense agitation [1]. These paradoxical reactions have not gained attention among anesthesiologists, because they do not greatly affect the vital signs and are often not recalled due to the amnesia-producing properties of the drug itself. However, in cases of aggressive behavior, when the children do not recognize their parents, and become uncontrollably agitated, the understanding of the causal factors and resolution is essential to reduce the effect of the shock on the children and even on the parents. Administration of additional midazolam, based on the judgment that its effect is insufficient, may be a major factor in worsening the situation. Although the exact mechanism of such paradoxical reactions is unknown, several theories have been suggested. First, the inhibitory action of benzodiazepines may cause a loss of cortical restraint in some patients, leading to excitement [2]. This mechanism is similar to the effect of alcohol consumption in some subjects. Second, benzodiazepines have also been found to reduce serotonin neurotransmission [2]. A decrease in serotonin concentrations may precipitate aggressive behavior. With regard to the risk factors for these reactions, dose of midazolam, younger age, gender, psychological background, alcohol abuse, and genetic background have been reported. Especially, genetic variability in the benzodiazepine receptors of GABAA channels resulting from the multiple allelic forms may lead to abnormal pharmacodynamic responses in some [3]. In this issue of the Korean Journal of Anesthesiology, Shin et al. [4] report a study about paradoxical reactions to midazolam in preschool aged children. This study was performed by dividing the patients into four groups, based on age and midazolam dose (1-3 years, 0.05 mg/kg; 1-3 years, 0.10 mg/kg; 3-5 years, 0.05 mg/kg; and 3-5 years, 0.10 mg/kg). The incidence of paradoxical reactions was found to be related to younger age (odds ratio [OR] = 5.3) and higher dose of midazolam (OR = 3.0). These reactions are not likely to resolve spontaneously over time and some sort of rapid tranquillization is necessary. As mentioned, administration of additional midazolam is not effective, but rather leads to delayed awakening. Low-dose ketamine (0.5 mg/kg), propofol, physostigmine, and haloperidol have been reported to be effective. Furthermore, recent reports have shown that flumazenil is effective for treatment of paradoxical reactions. Flumazenil is a competitive benzodiazepine antagonist with quick onset (1-2 min). Most paradoxical reactions in adults are treated successfully with 0.3-0.5 mg IV flumazenil, while retaining sedation and amnesia [5]. For pediatric patients, 0.01 mg/kg is usually effective [2]. However, it should be used cautiously if the patient has any history of cardiac arrhythmia or seizures controlled with benzodiazepines [2]. Paradoxical reactions have a low prevalence and are not life threatening. However, considering that an anesthesiologists' participation has been increasingly required for the pediatric sedation outside of operation rooms and that midazolam is the drug of choice, problems related to its use should be considered seriously. Early recognition and rapid pharmacological intervention are important to avoid aggravating the situation. In addition, thorough research on definite cause and ideal resolution is necessary in the future.

Excess burden of type 1 and type 2 diabetes due to psychopathology

Whether the prevalence of type 1 or 2 diabetes is rising among people with psychopathology is uncertain. This study investigates changes in the prevalence of type 1 and type 2 diabetes associated with psychopathology in the adult Australian population from 2001 to 2008. Data analysed were from 48,359 participants aged ≥25 years from the 2001, 2004-05 or 2007-08 National Health Surveys. Lifetime diagnosis of type 1 and type 2 diabetes was determined by self-report. Psychopathology status was determined with the 10-item Kessler Psychological Distress Scale (using scores ≥30), contemporaneous use of antidepressants or anti-anxiety medications, or both. Overall, the prevalence of type 1 diabetes remained stable whereas the prevalence of type 2 diabetes increased by 36% between 2001 and 2008. On average, odds ratios with 95% confidence intervals (95% CI) for type 1 and type 2 diabetes ranged from 1.43 (0.98, 2.10) to 2.44 (1.63, 3.64) and 1.32 (1.13, 1.53) to 1.67 (1.39, 2.02) for people with compared to those without psychopathology by any definition independent of socio-demographic covariates, consistently over the 8-year period. After further adjustments for lifestyle covariates, the strength of these odds ratios were attenuated and ranged from 1.32 (0.90, 1.95) to 2.24 (1.49, 3.36) and 1.16 (0.99,1.36) to 1.51 (1.24, 1.83) for type 1 and type 2 diabetes. Data were self-report from serial surveys. The prevalence of both type 1 and type 2 diabetes was consistently higher for people with psychopathology from 2001 to 2008. Clinicians should consider routinely screening patients with diabetes for psychopathology and vice versa, as well as lifestyle risk factors, to inform practice for more effective management and prevention planning.

Association of Military Deployment of a Parent or Spouse and Changes in Dependent Use of Health Care Services

U.S. Armed Forces members and spouses report increased stress associated with combat deployment. It is unknown, however, whether these deployment stressors lead to increased dependent medication use and health care utilization. To determine whether the deployment of Army active duty members (sponsors) is associated with changes in dependent health care utilization. A quasi-experimental, pre-post study of health care patterns of more than 55,000 nonpregnant spouses and 137,000 children of deployed sponsors and a comparison group of dependents. Changes in dependent total utilization in the military health system, and separately in military-provided and purchased care services in the year following the sponsors' deployment month for office visit services (generalist, specialist); emergency department visits; institutional stays; psychotropic medication (any, antidepressant, antianxiety, antistimulant classes). Sponsor deployment was associated with net increased use of specialist office visits (relative percent change 4.2% spouses; 8.8% children), antidepressants (6.7% spouses; 17.2% children), and antianxiety medications (14.2% spouses; 10.0% children; P<0.01) adjusting for group differences. Deployment was consistently associated with increased use of purchased care services, partially, or fully offset by decreased use of military treatment facilities. These results suggest that emotional or behavioral issues are contributing to increased specialist visits and reliance on medications during sponsors' deployments. A shift to receipt of services from civilian settings raises questions about coordination of care when families temporarily relocate, family preferences, and military provider capacity during deployment phases. Findings have important implications for the military health system and community providers who serve military families, especially those with children.

Live and Non-Live Pregnancy Outcomes among Women with Depression and Anxiety: A Population-Based Study

BackgroundWomen taking antidepressant or anti-anxiety medications during early pregnancy have high risks of non-live pregnancy outcomes, although the contribution of the underlying illnesses to these risks remains unclear. We examined the impacts of antenatal depression and anxiety and of commonly prescribed treatments on the risks of non-live pregnancy outcomes.MethodsWe identified all pregnancies and their outcome (live birth, perinatal death, miscarriage or termination) among women aged 15–45 years between 1990 and 2009 from a large primary care database in the United Kingdom. Women were grouped according to whether they had no history of depression and anxiety, a diagnosis of such illness prior to pregnancy, illness during pregnancy and illness during pregnancy with use of medication (stratified by medication type). Multinomial logistic regression models were used to compare risks of non-live outcomes among these groups, adjusting for major socio-demographic and lifestyle characteristics.ResultsAmong 512,574 pregnancies in 331,414 women, those with antenatal drug exposure showed the greatest increased risks for all non-live pregnancy outcomes, relative to those with no history of depression or anxiety, although women with prior (but not currently medicated) illness also showed modest increased risks. Compared with un-medicated antenatal morbidity, there was weak evidence of an excess risk in women taking tricyclic antidepressants, and stronger evidence for other medications.ConclusionsWomen with depression or anxiety have higher risks of miscarriage, perinatal death and decisions to terminate a pregnancy if prescribed psychotropic medication during early pregnancy than if not. Although underlying disease severity could also play a role, avoiding or reducing use of these drugs during early pregnancy may be advisable.

Factors Associated with the Type of Psychotropic Medications Purchased for Common Mental Disorders in the Largest Managed Care Organization in Israel

To evaluate patient and physician characteristics associated with the type of psychotropic medications (anti-anxiety, antidepressant, or both) purchased. The Clalit Health Care Services is the largest managed care health fund in Israel, a country that employs a universal healthcare system. We randomly sampled 30,000 primary care patients over the age of 22 as of January, 2006. Overall, 2,217 purchased either antidepressant or antianxiety medications at least once during the year 2006 and had no prior purchases during the last quarter of 2005. The majority (1,518; 68.4%) purchased only anti-anxiety medications and as many as 264 (12%) purchased both anti-anxiety and antidepressant medications. The remaining 435 (19.6%) patients purchased only antidepressant medications. Physician level characteristics explained only a small portion of the variance and, thus, were not included in further analysis. Several patient level characteristics, including age, somatic, and psychiatric diagnosis were associated with the purchase of different types of medications. Contrary to clinical guidelines, the purchase of anti-anxiety medications is more prevalent than the purchase of antidepressant medications. In a managed care setting, patient characteristics have a greater role in determining purchasing patterns than provider characteristics; potentially, because of the managed care characteristics that actively guide the care provided to patients.

Dry Eye Disease in Patients With Depressive and Anxiety Disorders in Shanghai

To investigate dry eye disease (DED) and risk factors in patients with depressive or anxiety disorders at a psychiatric clinic in China. Cross-sectional study. Subjects (≥16 years) who had depressive or anxiety disorders were evaluated with history, questionnaires (Self-rating Anxiety Scale, Self-rating Depression Scale, and Ocular Surface Disease Index), and eye examination. There were 472 psychiatric patients in the study, including 176 patients (37%) with depression, 170 patients (36%) with generalized anxiety disorder, 60 patients (13%) with depression and anxiety disorder, 55 patients (12%) with obsessive-compulsive disorder, and 11 patients (2%) with panic disorder. DED was present in 283 patients (60%). Compared with patients who did not have DED, patients with DED were significantly older, had longer duration of psychiatric disease and use of antianxiety or antidepressant medication, and more frequently were using a selective serotonin reuptake inhibitor (SSRI). Logistic regression analysis showed that older age, duration of psychiatric disorder, and use of an SSRI were significant independent predictors of the presence of DED. Older age, Self-rating Anxiety Scale >52, and use of tricyclic antidepressants were significant independent predictors of worse vision-targeted health-related quality of life (higher Ocular Surface Disease Index). DED is frequent in patients with depressive and anxiety disorders, especially patients who are older, have longer duration of psychiatric disorder, and use an SSRI. Psychiatric disorders and use of antidepressants should be considered in the differential diagnosis of DED.

Save Money or Give Better Care? How About Both?

Save Money or Give Better Care? How About Both?

PMH64 Anti-Anxiety Medication Utilization among Patients with Anxiety Disorder: Analysis of Medical Expenditure Panel Survey

PMH64 Anti-Anxiety Medication Utilization among Patients with Anxiety Disorder: Analysis of Medical Expenditure Panel Survey

Depression, Post-traumatic Stress Disorder, and Dry Eye Syndrome: A Study Utilizing the National United States Veterans Affairs Administrative Database

To study the scope of dry eye syndrome (DES) in veterans on a national level and to evaluate the relationship between psychiatric diagnoses and DES. Case-control study. Patients were seen in a Veterans Affairs (VA) eye clinic between 2006 and 2011. Patients were divided into cases and controls with regard to their dry eye status (cases = ICD-9 code for DES plus dry eye therapy; controls = patients without ICD-9 code plus no therapy). The prevalence of DES and the influence of psychiatric diagnoses on the risk of DES. A total of 2 454 458 patients were identified as either a dry eye case (n = 462 641) or control (n = 1 991 817). Overall, 19% of male patients and 22% of female patients had a diagnosis of DES, with female sex imparting an increased risk of DES at each decade compared to male sex (odds ratio [OR] 1.22-2.09). Several conditions were found to increase DES risk, including post-traumatic stress disorder (OR 1.92, 95% CI 1.91-1.94) and depression (OR 1.92, 95% CI 1.91-1.94) (analyses adjusted for sex and age). The use of several systemic medications was likewise associated with an increased risk of DES, including antidepressant medications (OR 1.97, 95% CI 1.79-2.17) and antianxiety medication (OR 1.74, 95% CI 1.58-1.91). Multivariate analysis (adjusted for age and sex) revealed that for psychiatric diagnoses, both the use of medication and the diagnosis remained significant risk factors when considered concomitantly, although the magnitude of each association decreased. DES is a disease associated with depression and post-traumatic stress disorder, and is prevalent among male and female veterans receiving eye care services. The association could be driven by underlying disease physiology or medications used to treat psychiatric conditions. Regardless of the causal link, this suggests that individuals with a known psychiatric diagnosis should be questioned about dry eye symptoms and, if applicable, referred to an eye care physician.

Early intervention with fluoxetine reverses abnormalities in the serotonergic system and behavior of rats exposed prenatally to dexamethasone

Many psychiatric disorders emerge after adolescence. Among a variety of predisposing factors, prenatal stress has been thought to cause the symptoms of anxiety disorders. We recently reported that prenatal dexamethasone (DEX) exposure, which mimics some aspects of prenatal stress, induced anxiety-related behaviors in male offspring when they reached adulthood. Before the emergence of behavioral changes, abnormalities occurred in the hypothalamic–pituitary–adrenal axis during postnatal development. In the present study, we found abnormalities in serotonin (5-HT) signaling, including decreased expression of 5-HT1A receptor (5-HT1A-R) mRNA in the medial prefrontal cortex (mPFC) and 5-HT content in the hippocampus at postnatal week (PW) 4. These results support using early therapeutic interventions with serotonergic drugs to prevent late-emerging anxiety symptoms. To test this hypothesis, we treated rat pups born to DEX-administered mothers with fluoxetine (FLX), a selective serotonin reuptake inhibitor commonly used as an anti-anxiety medication, via breast milk from postnatal day (PD) 2–21. Anxiety-related behaviors examined at PW11–13 were not observed in the prenatally DEX-exposed offspring that were treated with FLX. Likewise, FLX increased 5-HT concentrations in the mPFC and ventral hippocampus at PW3 and normalized 5-HT1A-R mRNA concentrations in the mPFC at PW4. The decrease in brain-derived neurotrophic factor (BDNF) protein in the mPFC and dorsal hippocampus was also restored at PW4. Furthermore, administration of the 5-HT1A-R full agonist (R)-(+)-8-hydroxy-2-(di-n-propylamino)tetralin from PD2 to 21 also prevented the emergence of behavioral abnormalities in the prenatally DEX-exposed offspring, implicating the involvement of 5-HT1A-Rs in the neonatal FLX effect. Collectively, an early pharmacological intervention to normalize serotonergic transmission effectively suppressed the emergence of symptoms induced by prenatal DEX exposure in rats.

Changes in cardiovascular disease burden associated with psychopathology in Australian adults 2004–2008

ObjectiveThe objective was to investigate changes in self-reported cardiovascular disease (CVD) burden associated with psychopathology for Australia from 2004 to 2008. MethodData analyzed were from 32,073 participants aged ≥25 years from the 2004–2005 or 2007–2008 National Health Surveys. Lifetime diagnosis of CVD (heart attack or stroke) was by self-report. Psychopathology was determined by the 10-item Kessler Psychological Distress Scale (using scores ≥30) and use of antidepressants or antianxiety (AD/AA) medications. ResultsThe prevalence of CVD (4.1% to 4.5%, P=.045) had increased slightly from 2004 to 2008 for the general population, but not among those with psychopathology. On average, psychological distress only [odds ratio (OR) 2.00; 95% confidence interval, 1.52–2.62] and AD/AA medications with (OR 2.02; 1.41–2.88) and without psychological distress (OR 1.24; 1.00–1.55) were associated with increased odds of CVD over the 4-year period, independent of sociodemographic, lifestyle and chronic disease covariates. Both psychological distress only (OR 1.61; 1.15–2.25) and AD/AA medications with psychological distress (OR 1.62; 1.08–2.44) conferred higher odds of CVD than AD/AA medications without psychological distress. ConclusionIn comparison to those without psychopathology, the odds of self-reported CVD were persistently higher among people with psychopathology from 2004 to 2008, particularly for psychological distress.

New Thoughts on Talk Therapies

My idol in psychiatric-mental health nursing has always been Hildegard Peplau (1952). From Peplau I learned that the relationship between nurse and patient is the crucible within which all growth takes place—growth of nurse as well as patient. A great deal of “talk therapy”—dialogue—is required for the two persons to know one another and work together on the patient’s difficulties. Despite empirical evidence regarding the effectiveness of talk therapy (e.g., Imel, McKay, Malterer, & Wampold, 2008), fewer and fewer patients in the United States receive its benefits. Why? Because they are treated with medication alone. A 2010 study by Olfson and Marcus (cited in Clay, 2011) revealed that nearly 60% of mental health patients in the United States receive medication without any psychotherapy. Clay (2011) provides several reasons why psychotherapy has declined in the U.S.A.: (1) psychiatrists receive better reimbursement for three 15-minute prescription-writing sessions than a 45-minute session of talk therapy; (2) pharmaceutical companies bombard both clinicians and the public with advertisements about drugs for virtually every condition; (3) insurance companies are more likely to pay for drugs than for psychotherapy; and (4) primary care practitioners are not well equipped to deliver psychotherapy; it is easier and more convenient to write prescriptions for antidepressants and anti-anxiety medications. Against the backdrop of this discouraging American trend, something different seems to be happening in many other countries. I have written previously about the open-dialogue approach used in Finland, in which medication use is avoided if possible, even for psychotic patients (Thomas, 2011). Today I focus on Phil Barker’s Tidal Model, which is used in the UK, Canada, New Zealand, Australia, Japan, and many other countries (Brookes, 2010; Buchanan-Barker & Barker, 2008). Although familiar with the model through articles in this journal and elsewhere, my interest in it was heightened when teaching a master’s level course in nursing theory in the fall. A fairly large percentage of the students chose the Tidal Model as a guiding framework for their practice—the first time this has happened. It was exciting to see a new generation of nurses –so often beguiled by the bells and whistles of technology– inspired by a model focused on the relational aspect of nursing. tossed. Many of the individuals we see in psychiatric practice are sailing through life in rather fragile little boats. When we see them, they often feel as though they are drowning. They need some help in making their boats sturdier so that high waves do not overwhelm them. And they need to tell another human being what has been happening to them during the most recent segment of their voyage. What appealed to my students is Barker’s insistence on listening to the patient’s whole story, so that the patient’s experience may be grasped and understood before any goals are set. “The language of the story—complete with its unusual grammar and metaphors—is the ideal medium for illuminating the way to recovery” (Barker, 2003, cited in Brookes, 2010). The story is recorded in the patient’s words rather than the

Using Adjunctive Treatments When First-Line Antidepressants Fail

Treatment-resistant depression is a common challenge for clinicians, as the majority of patients with depression do not achieve remission after an initial antidepressant trial. Major strategies for managing treatment-resistant depression include switching to another antidepressant or augmenting the initial antidepressant with another medication. Switching may be appropriate for patients experiencing little or no symptom relief or intolerable side effects with the initial antidepressant. For patients who experience partial response from the first-line antidepressant, adjunctive therapies avoid the loss of this response and the wash-out and cross-titration that are required when switching antidepressants. Several effective antidepressant augmentation agents are available, including lithium, thyroid hormone, anti-anxiety medications, and atypical antipsychotics. The evidence for the efficacy and risks of these strategies is discussed.