Showing papers in "Psychosomatic Medicine in 2007"

Exercise and pharmacotherapy in the treatment of major depressive disorder

Abstract: Objective To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls.

Neural correlates of dispositional mindfulness during affect labeling.

Abstract: Objective Mindfulness is a process whereby one is aware and receptive to present moment experiences. Although mindfulness-enhancing interventions reduce pathological mental and physical health symptoms across a wide variety of conditions and diseases, the mechanisms underlying these effects remain unknown. Converging evidence from the mindfulness and neuroscience literature suggests that labeling affect may be one mechanism for these effects. Methods Participants (n = 27) indicated trait levels of mindfulness and then completed an affect labeling task while undergoing functional magnetic resonance imaging. The labeling task consisted of matching facial expressions to appropriate affect words (affect labeling) or to gender-appropriate names (gender labeling control task). Results After controlling for multiple individual difference measures, dispositional mindfulness was associated with greater widespread prefrontal cortical activation, and reduced bilateral amygdala activity during affect labeling, compared with the gender labeling control task. Further, strong negative associations were found between areas of prefrontal cortex and right amygdala responses in participants high in mindfulness but not in participants low in mindfulness. Conclusions The present findings with a dispositional measure of mindfulness suggest one potential neurocognitive mechanism for understanding how mindfulness meditation interventions reduce negative affect and improve health outcomes, showing that mindfulness is associated with enhanced prefrontal cortical regulation of affect through labeling of negative affective stimuli.

Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample.

Abstract: Objective: To assess if posttraumatic stress disorder (PTSD), recognized as a common mental disorder in the general population and veteran samples, has a unique impact on comorbidity, disability, and suicidal behavior (after adjusting for other mental disorders, especially depression). Methods: Data came from the Canadian Community Health Survey Cycle 1.2 (n = 36,984; age >/=15 years; response rate 77%). All respondents were asked if they had been given a diagnosis of PTSD by a healthcare professional. A select number of mental disorders were assessed by the Composite International Diagnostic Interview. Chronic physical health conditions, measures of quality of life, disability, and suicidal behavior were also assessed. Results: The prevalence of PTSD as diagnosed by health professionals was 1.0% (95% CI = 0.90-1.15). After adjusting for sociodemographic factors and other mental disorders, PTSD remained significantly associated with several physical health problems including cardiovascular diseases, respiratory diseases, chronic pain conditions, gastrointestinal illnesses, and cancer. After adjusting for sociodemographic factors, mental disorders, and severity of physical disorders, PTSD was associated with suicide attempts, poor quality of life, and short- and long-term disability. Conclusions: PTSD was uniquely associated with several physical disorders, disability, and suicidal behavior. Increased early recognition and treatment of PTSD are warranted. Language: en

Area under the curve and other summary indicators of repeated waking cortisol measurements.

Abstract: Objective:To derive the area under the curve and related summary measures of stress from saliva samples collected over time and to provide insight into the interpretation of the derived parameters. In research designed to assess the health consequences of stress these samples are often used as a phy

Efficacy of treatment for somatoform disorders: a review of randomized controlled trials.

Abstract: OBJECTIVE To review the evidence from randomized clinical trials (RCTs) that have focused on the treatment of patients with Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition (DSM-IV) somatoform disorders. Although somatoform disorders are among the most common mental disorders presenting in the general medical setting, the strength of evidence for specific treatments has not been well synthesized. METHODS MEDLINE search of articles published in English from 1966 to 2006, using the following search terms: randomized clinical trial, somatoform disorders, somatization disorder, undifferentiated somatoform disorder, hypochrondriasis, conversion disorder, pain disorder, and body dysmorphic disorder. RESULTS A total of 34 RCTs involving 3922 patients were included. Two thirds of the studies involved somatization disorder (n = 4 studies) and lower threshold variants, such as abridged somatization disorder (n = 9) and medically unexplained symptoms (n = 10). Cognitive behavioral therapy (CBT) was effective in most studies (11 of 13), as were antidepressants in a small number (4 of 5) of studies. RCTs examining a variety of other treatments showed benefit in half (8 of 16) of the studies, the most consistent evidence existing for a consultation letter to the primary care physician. Effective treatments have been established for all somatoform disorders except conversion disorder (1 of 3 studies showing benefit) and pain disorder (no studies reported). CONCLUSION CBT is the best established treatment for a variety of somatoform disorders, with some benefit also demonstrated for a consultation letter to the primary care physician. Preliminary but not yet conclusive evidence exists for antidepressants.

Frailty is associated with incident Alzheimer's disease and cognitive decline in the elderly.

Abstract: Objective:To assess the association between frailty and incident Alzheimer’s disease (AD) and cognitive decline. Frailty is common in older persons and associated with adverse health outcomes.Methods:Study subjects included 823 older persons without dementia who participated in the Rush Memory and A

Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence.

Abstract: Objective:To assess whether adolescent obesity is associated with risk for development of major depressive disorder (MDD) or anxiety disorder. Obesity has been linked to psychosocial difficulties among youth.Methods:Analysis of a prospective community-based cohort originally from upstate New York, a

Cultural models and somatic syndromes.

Abstract: Objectives To review the relevance of cultural models in the generation and amplification of somatic symptoms and syndromes. Methods Based on a selective review of literature, we examine evidence that cultural and personal explanatory models can contribute to the pathogenesis, symptomatology, and chronicity of medically unexplained symptoms and functional somatic syndromes. Results In the contemporary world, culture involves flows of information, roles, and institutions that offer individuals multiple models for understanding illness. Cultural models include 1) explanatory models, which make causal attributions and impute specific mechanisms or processes of pathophysiology; 2) prototypes, which are salient images or exemplars drawn from personal experience, family, friends, mass media, and popular culture that are used to reason analogically about one's own condition; and 3) implicit models and procedural knowledge that may be difficult to articulate because they are embedded in body practices and ways of experiencing distress. Symptom attributions and explanations can participate in vicious circles of symptom amplification that give rise to culture-specific varieties of panic disorder, hypochondriacal worry, and medically unexplained symptoms. Conclusions Clinical research using the methods of experimental cognitive and social psychology as well as community-based ethnographic and ecological research are needed to advance our understanding of the impact of personal and cultural models on somatic distress. Nevertheless, the current state of knowledge on social and cultural dimensions of somatic syndromes suggests a typology of forms of psychosomatic and sociosomatic looping that has implications for the nosology of somatoform disorders.

Anxiety, depression, and cause-specific mortality: the HUNT study.

Abstract: Objective:To investigate empirically the association between anxiety/depression and cause-specific mortality with particular attention to the underlying mechanisms and causes of death. Depression reportedly increases general mortality. For cause-specific mortality, there is evidence depression has a

Neuroticism, extraversion, and mortality in the UK Health and Lifestyle Survey: a 21-year prospective cohort study.

Abstract: OBJECTIVE: To examine the influence of neuroticism and extraversion on all-cause and cause-specific mortality over 21 years after controlling for risk factors. METHODS: Participants were members of the Health and Lifestyle Survey, a British nationwide sample survey of 9003 adults. At baseline (1984 to 1985), individuals completed a sociodemographic and health questionnaire, underwent physical health examination, and completed the Eysenck Personality Inventory. Mortality was assessed for 21 years after baseline. A total of 5424 individuals had complete data. RESULTS: After controlling for age and gender, 1-standard deviation (SD) increase in neuroticism was related to 9% (hazard ratio (HR) = 1.09; 95% Confidence Interval (CI) = 1.03-1.16) increased risk of mortality from all causes. The association was nonsignificant (HR = 1.05; 95% CI = 0.99-1.11) after additionally controlling for occupational social class, education, smoking, alcohol consumption, physical activity, and health. There was 12% (HR = 1.12; 95% CI = 1.03-1.21) increased risk of death from cardiovascular disease associated with 1-SD increase in neuroticism. This was still significant after adjustment. When the sample was divided into 40- to 59-year-olds and those >or=60 years, neuroticism remained a significant risk for all-cause mortality and cardiovascular disease mortality; associations were nonsignificant after controlling for all covariates. Neuroticism was not associated with deaths from stroke, respiratory disease, lung cancer, or other cancers. Extraversion was protective of death from respiratory disease (HR = 0.84; 95% CI = 0.70- 1.00). CONCLUSIONS: After controlling for several risk factors, high neuroticism was significantly related to risk of death from cardiovascular disease. The effects of neuroticism on death from cardiovascular disease may be mediated by sociodemographic, health behavior, and physiological factors. Language: en

Symptoms and syndromes of bodily distress: An exploratory study of 978 internal medical, neurological, and primary care patients

Abstract: Objective:Physical complaints not attributable to verifiable, conventionally defined diseases, i.e., medically unexplained or functional somatic symptoms, are prevalent in all medical settings, but their classification is contested as numerous overlapping diagnoses and syndrome labels have been intr

Benefit-finding in the cancer caregiving experience.

Abstract: Objective:To characterize the domains of benefit finding in caregiving among close family members of cancer survivors and to relate the domains of benefit finding in cancer caregiving to other psychosocial variables. Although cancer is a problem that involves the entire family, little is known about

Autonomic and Respiratory Characteristics of Posttraumatic Stress Disorder and Panic Disorder

Abstract: OBJECTIVE: Posttraumatic stress disorder (PTSD) and panic disorder (PD) are two anxiety disorders with prominent psychophysiological symptoms. The PTSD criterion of persistent hyperarousal suggests autonomic dysregulation, and the disorder has been associated with elevated heart rate. In contrast, PD has been associated with respiratory abnormalities such as low end-tidal Pco(2). An integrated analysis of automatic and respiratory function in a direct comparison of these anxiety disorders is currently lacking. METHODS: Electrodermal, cardiovascular, and respiratory psychophysiology was examined in 23 PTSD patients, 26 PD patients, and 32 healthy individuals at baseline and during threat of shock. RESULTS: At baseline, the PTSD patients, in contrast to the other two groups, were characterized by attenuated parasympathetic and elevated sympathetic control, as evidenced by low respiratory sinus arrhythmia (a measure of cardiac vagal control) and high electrodermal activity. They also displayed elevated heart rate and cardiovascular sympathetic activation in comparison with healthy controls. PD patients exhibited lower Pco(2) (hypocapnia) and higher cardiovascular sympathetic activation compared with healthy controls. PTSD patients, but not PD patients, sighed more frequently than controls. During the threat of shock phase, the PTSD group demonstrated blunted electrodermal responses. CONCLUSIONS: Persistent hyperarousal symptoms in PTSD seem to be due to high sympathetic activity coupled with low parasympathetic cardiac control. Respiratory abnormalities were also present in PTSD. Several psychophysiological measures exhibited group-comparison effect sizes in the order of 1.0, supporting their potential for enhancing differential diagnosis and possibly suggesting utility as endophenotypes in genetic studies of anxiety disorders.

Marital status, marital strain, and risk of coronary heart disease or total mortality: The Framingham offspring study.

Abstract: Objective To determine if marriage and marital strain are related to the 10-year coronary heart disease (CHD) incidence or total mortality. Research has demonstrated associations between marital strain and prognosis of heart disease, but little research has addressed the association between specific aspects of marital strain and incident CHD. Methods From 1984 to 1987, 3682 participants (mean age 48.5 +/- 10.1 (standard deviation) years; 52% women) of the Framingham Offspring Study were examined; measures of marital status, marital strain, and risk factors for CHD were collected at the baseline examination. The present study describes the 10-year follow-up for incident CHD and total mortality. Results After adjusting for age, systolic blood pressure, body mass index, cigarette smoking, diabetes, and total cholesterol/high density cholesterol, the married men compared with unmarried men were almost half as likely to die during follow-up (hazard ratio (HR) = 0.54; 95% confidence interval (CI): 0.34-0.83). Women who "self-silenced" during conflict with their spouse, compared with women who did not, had four times the risk of dying (HR = 4.01; 95% CI: 1.75-9.20). Men with wives who were upset by work were 2.7 times more likely to develop CHD (HR = 2.71; 95% CI: 1.22-6.03). Marital happiness, satisfaction, and disagreements were not related to the development of CHD or death in men or women. Conclusions Our study suggests that marital communication, conflict, and strain are associated with adverse health outcomes. Further research into the influence of marital stress on health is merited.

The central role of gastrointestinal-specific anxiety in irritable bowel syndrome: further validation of the visceral sensitivity index.

Abstract: Objectives:The Visceral Sensitivity Index (VSI) was developed as the first instrument to assess gastrointestinal-specific anxiety, the cognitive, affective, and behavioral response to fear of gastrointestinal sensations, symptoms, and the context in which these visceral sensations and symptoms occur

Depressive symptoms, omega-6:omega-3 fatty acids, and inflammation in older adults.

Abstract: Depression is the most common psychiatric illness, and both major depression and subthreshold depressive symptoms carry substantial health risks (1, 2). A number of well-controlled prospective studies have linked depressive symptoms with coronary heart disease (CHD), the leading cause of death in the United States (3); moreover, the nearly 60-fold variance in the annual prevalence of major depression across countries is very similar to the pattern for cardiovascular disease, which shows a strong comorbidity for depression (4, 5). Epidemiological studies have demonstrated significant inverse relationships between annual fish consumption and prevalence of major depression (4). Fish oil is the prime source for two key omega-3 (n-3) polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). Several laboratories have provided evidence that depressed patients have, on average, lower plasma levels of n-3 PUFAs than nondepressed controls; furthermore, there are relationships within these populations between severity of depressive symptoms and lower plasma levels of the n-3 PUFAs (3–6). What is more, all but one of four randomized controlled trials reported significant improvement in the treatment of depression following n-3 PUFA supplementation compared to nonsupplemented controls (6). Significant relationships between lower n-3 PUFA plasma levels and greater negative mood have also been documented in nonpsychiatric populations (7). Omega-6 (n-6) PUFAs are also implicated in depression, with higher n-6:n-3 ratios observed in depressed patients compared to nondepressed controls (3–6). Arachidonic acid (AA) derived n-6 eicosanoids (primarily from refined vegetable oils such as corn, sunflower, and safflower) increase the production of proinflammatory cytokines, operating as precursors of the proinflammatory eicosanoids of the prostaglandin (PG)2-series (5). In contrast, the n-3 PUFAs, found most abundantly in fish, fish oil, walnuts, wheat germ, and flaxseed can curb the production of AA-derived eicosanoids (5, 8). Thus it is not surprising that both higher levels of n-3 PUFAs as well as lower n-6:n-3 ratios are associated with lower proinflammatory cytokine production (9). The fatty acid composition of the modern Western diet has changed dramatically during the last century, and these changes are thought to be related to increases in inflammatory-related diseases, including depression and cardiovascular disease (6, 10). For example, the early hunter-gatherer diet had an n-6:n-3 ratio of 2:1 to 3:1 (11). However, during the last century, the typical Western diet underwent fundamental alterations with the enormous growth in refined vegetable oil use, a central n-6 source that replaced n-3 PUFAs from fish, wild game, nuts, seeds, and green leafy vegetables (5, 11); in the contemporary North American diet, the n-6:n-3 ratio is 15:1 to 17:1 (12, 13). In fact, the heightened n-6:n-3 ratio in the Western diet since 1913 has been suggested as a central stimulus for the sharply increased incidence of major depression (4, 5). The n-6:n-3 ratio is related to serotonergic as well as catecholaminergic neurotransmission (14), providing mechanistic pathways that help explain the relationships with negative mood. Alterations in serotonin (5-HT) receptor numbers and function provoked by changes in PUFAs have been used to link fatty acids with contemporary theories of depression (5, 15). Moreover, immune activation may interact with 5-HT functioning to promote depression (5), because PUFAs influence the synthesis of proinflammatory cytokines. Furthermore, both syndromal depression and depressive symptoms can enhance production of proinflammatory cytokines, including interleukins 1 and 6 (IL-1 and IL-6) and tumor necrosis factor alpha (TNF-α) (2, 16–21). Brief laboratory stressors can also provoke transient increases in proinflammatory cytokines (1, 22, 23). Moreover, stress and depression may effectively “prime” inflammatory responses, promoting larger cytokine increases in reaction to subsequent stressors and/or pathogens (19, 24–27). Thus, chronic or longer-term stress and depression can elevate both acute and chronic proinflammatory cytokine production (16, 20, 23, 28). Importantly, these are bi-directional relationships; cytokines have substantial effects on the central nervous system (CNS), producing and enhancing negative moods, as well as physical symptoms such as lethargy and fatigue (18). Indeed, there is evidence that cytokines play a role in the neuroendocrine and behavioral features of depressive disorders (18). In a provocative study relevant to the present investigation, students who had higher n-6:n-3 ratios (above the mean) before exams demonstrated greater TNF-α production by lipopolysaccharide (LPS) and mitogen-stimulated peripheral blood leukocytes (PBLs) during exams than those with lower ratios (29). These data suggest that the n-6:n-3 ratio may influence the proinflammatory response to stressors; because TNF-α and IL-6 are produced by a variety of types of cells, serum cytokine levels may better reflect the overall inflammatory profile than stimulated PBLs or ex vivo production (8). Indeed, the aging and depression literatures have focused on proinflammatory cytokine levels assessed in serum (2, 30). Accordingly, we were interested in how depressive symptoms and the n-6:n-3 ratio would be related to serum TNF-α, IL-6, and the IL-6 soluble receptor (sIL-6r). We studied an older population because proinflammatory cytokine production is elevated following menopause or andropause even in the absence of infection, trauma, or stress (31). Both higher n-6:n-3 ratios and higher levels of depressive symptoms have been associated with greater production of proinflammatory cytokines; however, in accord with the student examination study (29), we expected that higher n-6:n-3 ratios and higher levels of depressive symptoms would predict higher levels of TNF-α, IL-6, and sIL-6r than either alone.

Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study.

Abstract: Objective: To determine if depression associated with low heart rate variability (HRV) in patients post myocardial infarction (MI), but not in patients with stable coronary heart disease (CHD), may be the result of differential associations of somatic and cognitive depressive symptoms with HRV. Methods: To examine the association of somatic and cognitive depressive symptoms with 24-hour HRV, we performed a cross-sectional study of 863 outpatients with stable CHD. The severity of somatic and cognitive depressive symptoms was determined using factor analysis of items of the Patient Health Questionnaire (PHQ-9). Time-domain (SDNN, SDANN) and frequency-domain (VLF, LF, HF, WBF) indices of HRV were derived using ambulatory monitoring. Results: Unadjusted analyses revealed that somatic symptom scores were significantly associated with HRV (r = -.09 for SDNN; r = -.08 for SDANN; r = -.08 for LnVLF; r = -.08 for LnLF; r = -.10 for LnHF; r = -.08 for LnWBF). After adjustment for demographic variables, comorbidities, and lifestyle factors, somatic symptom scores were no longer associated with lower HRV, with the possible exception of LnWBF (r = -.06). Cognitive depressive symptom scores were not associated with HRV using either unadjusted or adjusted analyses. Conclusions: We found that somatic depressive symptoms were associated with lower HRV, although cognitive depressive symptoms were not. The inverse association of somatic symptoms with HRV was largely explained by differences in comorbidities and lifestyle factors. These results suggest that individual symptoms of depression may have differential associations with HRV.

Depression-like behavior and stressor-induced neuroendocrine activation in female prairie voles exposed to chronic social isolation.

Abstract: Objective—Previous evidence suggests that responses to social stressors may play a mechanistic role in the behavioral and physiological changes associated with affective disorders such as depression. Prairie voles (Microtus ochrogaster) are socially monogamous rodents that share features of social behavior with humans, and therefore might provide a useful model for examining social regulation of behaviors and physiological responses related to depression. In the present study we hypothesized that social isolation in female prairie voles would induce depression-relevant behaviors and altered neuroendocrine responses to an acute social stressor. Methods—Twenty adult female prairie voles were exposed to either 60 days of social isolation or paired (control) housing, and tested for a depression-like behavior (anhedonia), numbers of corticotropin-releasing factor- and oxytocin-immunoreactive cells in the paraventricular nucleus of the hypothalamus, and circulating levels of hormones and peptide in response to an acute social stressor (resident-intruder test). Results—Chronic social isolation produced anhedonia, measured by a reduction in sucrose intake and sucrose preference relative to paired animals. Compared to paired animals, isolated prairie voles displayed increased plasma hormone and peptide levels (oxytocin, arginine vasopressin, and corticosterone) following a 5-minute resident-intruder test, mirrored by an increased number of oxytocin- and corticotropin-releasing factor-immunoreactive cells in the hypothalamic paraventricular nucleus. Conclusions—These findings suggest that isolation in a socially monogamous rodent model induces both behavioral and neuroendocrine changes that are relevant to depression, and may provide insight into the mechanisms that underlie the development and/or maintenance of depressive disorders in humans.

Epidemiology of the association between somatoform disorders and anxiety and depressive disorders : an update

Abstract: OBJECTIVE: To review the available epidemiological evidence on associations between somatoform disorders with anxiety and depressive disorders. RESULTS: Clinical and population-based studies have found that the co-occurrence of some types of somatoform disorders (e.g., somatization disorder, somatic-symptom-index (SSI)4,6, and pain disorder) and anxiety and depressive disorders is common. These findings may suggest either a causal relationship between these disorders or that they share some common etiological factors. For other forms of somatoform disorders, empirical evidence about co-occurrence is even thinner or not available at all, especially from non-western settings. CONCLUSION: Some implications of how these findings, or the absence of them, can help us understand better the etiology of somatoform disorders and improve the classification of mental disorders as a whole are discussed.

Diabetes, common mental disorders, and disability: Findings from the UK National Psychiatric Morbidity Survey

Abstract: Objectives: To determine a) the associations between diabetes and common mental disorders in a nationally representative sample and the effect of key covariates on such associations and b) the association of comorbid common mental disorders on the quality of life and diabetes self-care indicators. Methods: In a cross-sectional survey, people with diabetes were identified from a sample of 8580 individuals aged 16 to 74 years, drawn from the 2000 UK National Psychiatric Morbidity Survey. Diabetes was ascertained by self-report and prescribed medications. Psychiatric morbidity was assessed using the Revised Clinical Interview Schedule. Quality of life was measured using the Short Form-12, and questions were asked regarding diabetes self-care and functioning. Results: A total of 249 individuals were identified with diabetes. People with diabetes were more likely to suffer from common mental disorders (odds ratio (OR) = 1.5; 95% Confidence Interval (CI): 1.1-2.2; p < .05), and in particular mixed anxiety and depression (OR: 1.7; 95% CI: 1.1-2.6; p < .05), after controlling for age, gender, ethnicity, and socioeconomic status. The increased risk was uniform across diabetes subtypes. Among people with diabetes, common mental disorders were significantly associated with impaired health-related quality of life, more days off work, nonadherence, and difficulties with diabetes self-care. Conclusions: People with diabetes are more likely to suffer from common mental disorders, a finding which is highly relevant, given that psychiatric comorbidity in people with diabetes is also associated with higher levels of functional impairment, impaired quality of life, and difficulties with diabetes self-care.

Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study.

Abstract: Objective:To explore the long-term effect of anxiety and depression on outcome after cardiac surgery. To date, the relationship between psychosocial factors and future cardiac events has been investigated mainly in population-based studies, in patients after cardiac catheterization or myocardial inf

Self-rated health and mortality: short- and long-term associations in the Whitehall II study.

Abstract: To determine if self-rated health (SRH), a single-item measure of health status where individuals are asked to rate their own health, predicts mortality in a middle-aged sample and if the predictive ability of SRH diminishes with time. Data (6316 men and 3035 women) are drawn from the Whitehall II study. SRH and covariates were measured at baseline (1985-1988) when the average age of individuals was 44.5 years (SD = 6.1). The mortality follow-up was available for a mean of 17.5 years and was classified as having occurred in the first 10 years or the subsequent follow-up period (range 6 to 9 years). The association between SRH and mortality was assessed using a Cox regression model with relative index of inequality (RII) to summarize associations. There were no sex differences in the association between SRH and mortality in either the short (p = .39) or the long term (p = .16). Sex-adjusted short-term association (RII = 3.80; 95% confidence interval (CI) 2.28, 6.35) was significantly (p = .004) stronger than the long-term association (RII = 1.56; 95% CI 1.04, 2.34). Explanatory variables accounted for 80% of the SRH-mortality association in men and 29% in women. SRH predicts mortality equally well in men and women. However, the covariates explained a much larger proportion of the SRH-mortality relationship in men compared with women. In this middle-aged cohort, SRH predicts mortality strongly in the short term but only weakly in the long term.

Cardiac Effects of Momentary Assessed Worry Episodes and Stressful Events

Abstract: Objective: To hypothesize that increased heart rate (HR) and decreased heart rate variability (HRV) occurs not only during stressful events but also during episodes in which stress is cognitively represented, but not necessarily present, i.e., during worry. Methods: Ambulatory HR and HRV of 73 female and male teachers were recorded for 4 days, during which they reported, on an hourly basis using computerized diaries, the number and characteristics of worry episodes and stressful events. Multilevel regression models were used, controlling for biobehavioral variables. Results: Compared with neutral periods, worry episodes and stressful events had independent effects on HR (2.00 beats/min and 2.75 beats/min, respectively) and HRV (−1.07ms and −1.05, respectively). Neither psychological traits nor biobehavioral variables influenced these results. Effects were most pronounced for work-related worry on HR (9.16 beats/min) and HRV (−1.19 ms), and for worry about anticipated future stress on HR (4.79 beats/min). Conclusions: Worry in daily life might have substantial cardiac effects in addition to the effects of stressful events, especially in the form of work-related and anticipatory stress, the latter being a type of stress that has been largely neglected in stress research.

Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland.

Abstract: OBJECTIVE To focus on the relationship between pregnancy-related anxiety and spontaneous preterm birth. Psychosocial factors have been the subject of inquiries about the etiology of preterm birth; a factor of recent interest is maternal prenatal pregnancy-related anxiety (worries and concerns related to the pregnancy). METHODS From 1991 to 1993, a total of 1820 women completed the study questionnaire during their first prenatal visit to clinics in Baltimore, Maryland. Pregnancy-related anxiety was assessed using six questions from the Prenatal Social Environment Inventory; scores ranged from 0 to 6. Data on pregnancy outcome and clinical and behavioral covariates were obtained from the women's clinical records. RESULTS After adjustment for covariates (first or second trimester bleeding, drug use, employment, prior poor pregnancy outcome, smoking, low body mass index, maternal education, age, and race), women with higher levels of pregnancy-related anxiety (scores of 5 or 6) had a significantly increased risk of spontaneous preterm birth compared with those with scores of < or =3. CONCLUSIONS If additional research confirms these results, then this finding may suggest the possibility of intervention to reduce maternal prenatal pregnancy-related worries and concerns, thereby reducing the risk of spontaneous preterm birth.

FMRI in patients with motor conversion symptoms and controls with simulated weakness.

Abstract: Background Conversion disorder (motor type) describes weakness that is not due to recognized disease or conscious simulation but instead is thought to be a "psychogenic" phenomenon. It is a common clinical problem in neurology but its neural correlates remain poorly understood. Objective To compare the neural correlates of unilateral functional weakness in conversion disorder with those in healthy controls asked to simulate unilateral weakness. Methods Functional magnetic resonance imaging (fMRI) was used to examine whole brain activations during ankle plantarflexion in four patients with unilateral ankle weakness due to conversion disorder and four healthy controls simulating unilateral weakness. Group data were analyzed separately for patients and controls. Results Both patients and controls activated the motor cortex (paracentral lobule) contralateral to the "weak" limb less strongly and more diffusely than the motor cortex contralateral to the normally moving leg. Patients with conversion disorder activated a network of areas including the putamen and lingual gyri bilaterally, left inferior frontal gyrus, left insula, and deactivated right middle frontal and orbitofrontal cortices. Controls simulating weakness, but not cases, activated the contralateral supplementary motor area. Conclusions Unilateral weakness in established conversion disorder is associated with a distinctive pattern of activation, which overlaps with but is different from the activation pattern associated with simulated weakness. The overall pattern suggests more complex mental activity in patients with conversion disorder than in controls.

Unfavorable Socioeconomic Conditions in Early Life Presage Expression of Proinflammatory Phenotype in Adolescence

Abstract: Objective: Unfavorable socioeconomic status (SES) circumstances early in life are associated with heightened vulnerability to respiratory and cardiovascular diseases in adulthood. However, little is known about mechanisms underlying this phenomenon. Methods: This study examined whether early-life SES predicts future activity of two genes involved in regulating inflammation. An ethnically diverse cohort of 136 adolescent females was enrolled in the study. SES was measured by home ownership. The messenger ribonucleic acid (mRNA) for glucocorticoid receptor (GR) and toll-like receptor 4 (TLR4) was quantified in peripheral blood leukocytes using real-time reverse transcriptase polymerase chain reaction (RT-PCR). Results: Three findings emerged: a) Years 2 to 3 of life were a critical period: the participants whose families owned homes during these childhood years showed higher GR mRNA and lower TLR4 mRNA during adolescence, a profile that suggests better regulation of inflammatory responses. b) These effects were not mediated through current economic circumstances, life stress, or health practices. C) Changes in SES during later years were unable to “undo” these effects. Conclusions: These findings suggest that unfavorable SES circumstances in the early years of life presage the expression of a proinflammatory phenotype in adolescence. To the extent that this proclivity toward inflammation persists over one’s lifespan it could explain the heightened incidence of respiratory and cardiovascular disease in low SES populations.

Treatment of post-myocardial infarction depressive disorder : A randomized, placebo-controlled trial with mirtazapine

Abstract: Objective: To examine the antidepressant efficacy of a dual-acting antidepressant (mirtazapine) in patients with post-myocardial infarction (MI) depressive disorder. Antidepressants used in post MI trials with a randomized, double-blind, placebo-controlled design have been restricted to selective serotonin reuptake inhibitors (SSRIs). Antidepressant effects have been limited. Methods: In a prospective multicenter study, 2177 patients with MI were evaluated for depressive disorder during the first year post MI. Ninety-one patients who met the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for major or minor depressive disorder were randomized to a 24-week, double-blind, placebo-controlled trial. Antidepressant efficacy was tested using last-observation-carried-forward procedure and repeated measurements analysis using the SPPS mixed models approach, with as primary outcome reduction in depressive symptomatology on the 17-item Hamilton-Depression Rating Scale (Ham-D), and secondary outcomes the Beck Depression Inventory (BDI) and depression subscale of the Symptom Check List 90 items (dSCL-90) as well as the Clinical Global Impression (CGI) scale. Results: Using the "last observation carried forward" (LOCF) method, mirtazapine did not show to be superior to placebo on the Ham-D, but did on the BDI, dSCL-90, and CGI scale over the acute treatment phase of 8 weeks (n = 91). Using mixed models analysis over the entire 24 weeks of treatment (n = 40), we did find a significant difference favoring mirtazapine to placebo on the Ham-D, BDI, and CGI, but on the dSCL-90, this difference was not significant. Conclusions: This trial shows efficacy of mirtazapine on primary and secondary depression measures. Mirtazapine seems to be safe in the treatment of post-MI depression.

Chronic distress, age-related neuropathology, and late-life dementia.

Abstract: Objective:The objective of this study was to test whether common age-related neuropathology could account for the relation of chronic distress to dementia.Methods:In a selected cohort of more than 1000 older Catholic clergy members undergoing annual clinical evaluations, 326 persons died, of whom 30

What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies.

Abstract: Objective To review published literature for the highest level of evidence on the efficacy of treatment for patients with medically unexplained symptoms. Methods A comprehensive literature search was carried out in Cochrane library, Medline (1971-2007), PsychINFO (1974-2006), and EMBASE (1980-2007) to identify pharmacological, nonpharmacological, psychological, and other interventions, using the search terms "medically unexplained symptoms," "somatisation," "somatization," "somatoform disorders," "psychological therapies," "cognitive behavior therapy," "pharmacological therapies," "management," "therapy," "drug therapy," and "anti-depressants" with Boolean operators AND and OR on the entire text. Searches were confined to literature in English. Results Studies were carried out in primary, secondary, and tertiary care settings. The therapists ranged from medical specialists, psychiatrists, and psychologists to primary care physicians. Three types of interventions (antidepressant medication, cognitive behavioral therapy (CBT), and other nonspecific interventions) were supported by evidence on the efficacy of treatment for patients with medically unexplained symptoms. There is more level I evidence for CBT compared with the amount for other approaches. There was only one study reported from the developing world. Conclusions CBT is efficacious for either symptom syndromes or for the broader category of medically unexplained symptoms, reducing physical symptoms, psychological distress, and disability. A relatively small number of studies were carried out in primary care, but the trend has been changing over the last decade. No studies have compared pharmacological and psychological treatments. Most trials assessed only short-term outcomes. Use of divergent selection procedures, interventions, outcome measures, and instruments, and other methodological differences observed in these studies hamper the ability to compare treatment effects across studies.

Impact of anxiety and perceived control on in-hospital complications after acute myocardial infarction.

Abstract: Objectives:We tested the hypothesis that perception of control moderates any relationship between anxiety and in-hospital complications (i.e., recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death) in patients with acute myocardial infarction (AMI).Ba