Dehydroepiandrosterone decreases behavioral despair in high- but not low-anxiety rats.

Prasad A, Imamura M, Prasad C.

Department of Medicine, Louisiana State University Medical Center, New Orleans 70112, USA.

Outbred Sprague-Dawley rats exhibit considerable heterogeneity within a population when evaluated for a variety of biologic functions, such as dietary fat intake, alcohol preference, and expression of anxiety. To understand the neuroendocrine basis for depression and anxiety, we routinely assess outbred rats for behavioral despair (Porsolt's test), anxiety (elevated plus-maze), and urinary excretion of a variety of hormones. In one such study, we observed a significant correlation (r2 = 0.337; n = 30; p < 0.01) between the level of anxiety and the degree of behavioral despair. Within the above population, two distinct subgroups emerged: one with high anxiety and the other with low anxiety. We next evaluated the effect of dehydroepiandrosterone (DHEA), an anxiolytic neurosteroid, on the despair response in the two groups of rats. Treatment of high-anxiety rats with DHEA significantly diminished behavioral despair. In contrast, DHEA did not affect behavioral despair in low-anxiety rats. In conclusion, the results presented here show DHEA to be effective as an antidespair agent in rats with both high anxiety and despair.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9333199&dopt=Abstract anxiety medicine




Patient anxiety during gynecologic examinations. Behavioral indicators.

Reddy DM, Wasserman SA.

Department of Psychology, University of Wisconsin-Milwaukee, USA.

OBJECTIVE: To identify behaviors that indicate anxiety during a gynecologic examination. STUDY DESIGN: Five hundred twenty-two women visiting a private obstetrician/gynecologist's office completed the A-State scale of the State-Trait Anxiety Inventory and specific questions about their first pelvic examination and experiences with health practitioners performing subsequent gynecologic examinations. In addition, the hand placement a woman exhibited as the speculum was inserted was recorded, as were the reasons for her visit, reports of any symptoms, performance of any special procedures (e.g., colposcopy) and whether the pelvic examination was her first. RESULTS: Five behaviors observed during speculum insertion--holding hands/eyes covered or shut, hands on shoulders, hands covering pelvis, hands on legs, hands holding table--indicated increased anxiety. Together these behaviors were exhibited by one of every four patients and were found to be associated with high levels of anxiety. Greater anxiety was related to colposcopy, a less positive first pelvic examination experience, overall less positive experiences with examiners and performance of the first gynecologic examination at the present visit. CONCLUSION: Easily recognizable behaviors reflecting high anxiety in gynecologic patients were identified. Upon recognizing these behaviors, examiners can take necessary measures to reduce patient anxiety and prevent delays in and avoidance of gynecologic examinations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9350018&dopt=Abstract anxiety medicine




Panic disorder, anxiety and depression in resistant hypertension--a case-control study.

Davies SJ, Ghahramani P, Jackson PR, Hippisley-Cox J, Yeo WW, Ramsay LE.

Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, UK.

BACKGROUND: It has been suggested that panic disorder can cause or contribute to hypertension or resistance to antihypertensive drugs. OBJECTIVE: To compare the prevalences of panic disorder, panic attacks, anxiety and depression between patients with resistant hypertension and age- and sex-matched patients with non-resistant hypertension. DESIGN: A case-control study of patients attending the Sheffield Hypertension Clinic, using self-completed postal questionnaires to assess panic disorder, anxiety and depression. PATIENTS CASES: With resistant hypertension were defined as patients who presently or previously had systolic blood pressure above 160 mmHg or diastolic blood pressure above 90 mmHg despite the use of three or more antihypertensive agents at full dose. For each of 136 cases, one control with non-resistant hypertension, defined as controlled to < or = 160/90 mmHg by one or two antihypertensive agents, was identified by a bias-free method. Cases and controls were matched for age and sex. MAIN OUTCOME MEASURES: Lifetime and current prevalence of panic attacks, the prevalences of panic disorder, anxiety and depression by Hospital Anxiety and Depression Scale scores, and the severity and frequency of panic attacks. RESULTS: Of the resistant hypertensive patients, 33% had experienced a panic attack compared with 39% of the control non-resistant hypertensives (resistant-non-resistant -6%, 95% confidence interval -19 to +7%). Twelve per cent of the resistant patients and 14% of controls fulfilled the criteria for a current or previous diagnosis of panic disorder (resistant-non-resistant -2%, 95% confidence interval -11% to +7%). There were also no significant differences between the groups in the prevalences of current panic attacks, panic attacks rated as moderate or worse, spontaneous panic attacks and in the frequency of panic attacks. There remained no significant difference between the groups for panic attacks and panic disorder when the analysis was limited to those patients who had idiopathic hypertension. The two groups did not differ significantly in scores for anxiety and depression measured by the Hospital Anxiety and Depression Scale. CONCLUSION: We observed no differences in the prevalences of panic, anxiety and depression between patients with resistant hypertension and non-resistant controls. These factors are probably not implicated in resistance to drug treatment. However, the prevalences of panic disorder and panic attacks were remarkably high in both groups of patients attending a hospital hypertension clinic. The relationship between panic disorder and hypertension deserves further study in a general hypertensive population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9350581&dopt=Abstract anxiety medicine




Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status.

Addolorato G, Capristo E, Stefanini GF, Gasbarrini G.

Institute of Internal Medicine, Universita Cattolica del Sacro Cuore, Rome, Italy.

BACKGROUND: The etiology of inflammatory bowel disease is unclear, and the role played by anxiety and depression is highly controversial. Anxiety and depression in patients with inflammatory bowel disease could be secondary to disabling symptoms, but the interaction between physical morbidity and psychologic illness in these subjects has not been sufficiently investigated. Patients with inflammatory bowel disease are nevertheless frequently undernourished, but there are no studies on the association between anxiety and depression and malnutrition. This study was designed to characterize anxiety and depression in subjects affected by inflammatory bowel disease and to establish the influence of physical morbidity and/or nutritional status on psychologic disorders. METHODS: Seventy-nine consecutive patients, 43 with Crohn's disease (CD) and 36 with ulcerative colitis (UC), were enrolled in the study. An index of the disease activity and physical morbidity was obtained by the simplified Crohn's Disease Activity Index and Truelove-Witts criteria and using the Clinical Rating Scale. Thirty-six healthy volunteers were studied as controls. All the subjects were given the State and Trait Anxiety Inventory (STAI) test and the Zung self-rating Depression Scale. RESULTS: The percentage of subjects with state anxiety was significantly higher in the CD (P < 0.001) and UC (P < 0.001) groups than in control subjects. There was no significant difference in trait anxiety among groups. The percentage of subjects with depression was significantly higher in the CD (P < 0.05) and UC (P < 0.05) groups than in control subjects. State anxiety and depression were significantly associated with physical morbidity and correlated with malnutrition in CD and UC patients. CONCLUSION: Anxiety and depression in patients with inflammatory bowel disease could be reactive to the disabling symptoms and to malnutrition. As measured with the STAI, personality trait of anxiety does not seem to play an important role in inflammatory bowel disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9361174&dopt=Abstract anxiety medicine




Anxiety in adult fixed-wing air transport patients.

Demmons LL, Cook EW 3rd.

Critical Care Transport, University Hospital, Birmingham, AL 35233, USA.

INTRODUCTION: Critically ill patients may experience anxiety because of the method of transport, possibly having an impact on both patients and their health care providers. The purpose of this research was to study the presence and degree of anxiety in fixed-wing air transport patients. METHODS: Subjects were 41 patients 25 to 79 years of age. Self-ratings of anxiety were obtained and vital signs were recorded at five predesignated points before, during, and after the flight. Additional questions addressed current and previous experiences and perceptions of flying. RESULTS: Anxiety ratings were generally low, averaging approximately 1.9 on a 1 ("worry-free") to 10 ("completely terrified") scale. Anxiety was greatest in anticipation of the flight. Fourteen percent of patients had never flown before; patients with little or no flight experience had significantly higher anxiety ratings. However, in all cases anxiety declined steadily as the flight progressed. Most patients (82%) reported greater worry about their medical condition than about the flight. CONCLUSION: Anxiety is generally low among adult fixed-wing air transport patients and decreases further over time. This decrease was true even for patients who initially reported high levels of anxiety before the flight. The data suggest that previous flight experience can be used to predict anxiety during air medical transport.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10169179&dopt=Abstract anxiety medicine




Dispositional anxiety and the experience of pain: gender-specific effects.

Jones A, Zachariae R, Arendt-Nielsen L.

Institute of Psychology, Aarhus University, Denmark. allanj psy.au.dk

AIM OF INVESTIGATION: Increased anxiety is believed to correlate with increased pain sensitivity in men and women. However, one laboratory-based study and one clinical-based study have offered evidence to suggest that the effect of anxiety in modulating pain sensitivity is specific to men only. The aim of the present study was to examine further whether anxiety differentially effects men and women's report of experimentally induced pain. METHODS: One hundred forty-four healthy university students (75 women, 69 men) were exposed to a contact heat pain procedure (ascending method of limits procedure, baseline temperature 30 degrees C, +/- 0.2 degrees C, rate of change 2.0 degrees C/s, cut-off limit 52 degrees C) and a cold pressor pain procedure (constant temperature +1 degrees C; +/-1 degrees C, cut-off limit 240 s). RESULTS: The results agreed with the previous two studies indicating a sex-specific effect of anxiety on pain report. Male participants scoring above the median on the Trait Anxiety Inventory reported significantly greater pain intensity, unpleasantness and showed lower pain tolerance compared to males scoring below the median on the cold pressor pain procedure, while no such differences in cold pressor pain report were found between high and low anxious women. No effect of anxiety was found on measures taken from the contact heat pain procedure, indicating that the sex-specific effect of anxiety on laboratory induced pain is dependent upon the method of stimulation used. CONCLUSION: Anxiety is an important factor when considering gender differences in pain perception and warrants further investigation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12935790&dopt=Abstract anxiety medicine




Changes in self-reported dental anxiety in New Zealand adolescents from ages 15 to 18 years.

Thomson WM, Poulton RG, Kruger E, Davies S, Brown RH, Silva PA.

Department of Community Dental Health, School of Dentistry, University of Otago, Dunedin, New Zealand.

Little is understood of the natural history of dental anxiety. The aim of this study was to examine three-year changes in self-reported dental anxiety among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated at ages 15 and 18 by means of the Corah Dental Anxiety Scale (DAS). A DAS score of 13+ defined high dental anxiety. Participants were assigned to one of four dental-anxiety study groups (Chronic, Incident, Remitted, or Never) on the basis of changes in reported level of anxiety from ages 15 to 18. Results are reported for the 691 participants who completed the DAS at both ages. The sample's overall dental anxiety score decreased significantly from age 15 (mean, 8.79) to 18 (8.52) (paired t test, t = 2.37; P < 0.05). The Chronic and Never groups had small negative DAS increments, the Incident group showed a substantial positive increment, and the Remitted group recorded an even larger negative increment. Multivariate analysis showed that the DAS score at age 15 was the sole predictor of the change in DAS score for the Chronic and Remitted groups, and was a co-predictor for the Incident and Never groups. An episodic dental visiting pattern was a strong predictor of a positive change in DAS score for the Incident group; and for the Never group, a higher DMFS score at age 15 predicted a positive change in DAS score at 18, but being female was predictive of a decrement. This study indicates lower stability of dental anxiety in late adolescence than has been reported from other age groups.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9168862&dopt=Abstract anxiety medicine