Our panic disorder study just accepted for publication in Psychological Medicine.
See also this post.
TITLE: Controlled cross-over study in normal subjects of naloxone-preceding-lactate infusions; respiratory and subjective responses: Relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss (CPL)
Short Title: Controlled study of naloxone-lactate infusions in normals.
Maurice Preter1, MD, Sang Han Lee2, PhD, Eva Petkova3, PhD, Marina Vannucci4, PhD, Sinae Kim5, PhD, Donald F. Klein6, MD, DSc
1 Corresponding Author. Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY, and Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NY.
Mailing address: 1160 Fifth Avenue, 112. New York, NY 10029, USA.
2The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962.
3 Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, U.S.A.
4 Department of Statistics, Rice University, Houston, Texas 77251-1892.
5Department of Biostatistics, University of Michigan, Ann Harbor, MI 48109.
6Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Department of Child and Adolescent Psychiatry, New York UniversityLangone Medical Center; Nathan S. Kline Institute for Psychiatric Research; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York.
ABSTRACT:
Background:The expanded suffocation false alarm theory (SFA; Preter and Klein, 2008) hypothesizes that dysfunction in endogenous opioidergic regulation increases sensitivity to CO2, separation distress and panic attacks. In panic disorder patients, both spontaneous clinical panics and lactate-induced panics markedly increase tidal volume, while normals have a lesser effect, perhaps due to their intact endogenous opioid system. We hypothesized that impairing the opioidergic system by naloxone could make normal controls parallel panic disorder patients’ response when lactate challenged.
Whether actual separations and losses during childhood (Childhood Parental Loss, CPL) affected naloxone-induced respiratory contrasts was explored. Subjective panic-like symptoms were analyzed although pilot work indicated that the subjective aspect of anxious panic was not well modeled by this specific protocol.
Methods: Randomized cross-over sequences of intravenous naloxone (2mg/kg) followed by lactate (10mg/kg), or saline followed by lactate were given to 25 volunteers. Respiratory physiology was objectively recorded by the LifeShirt. Subjective symptomatology was recorded.
Results: Impairing of the endogenous opioid system by naloxone accentuates tidal volume and symptomatic response to lactate. This interaction is substantially lessened by CPL.
Conclusions: Opioidergic dysregulation may underlie respiratory pathophysiology and suffocation sensitivity in panic disorder.Comparing specific anti-panic medications with ineffective anti-panic agents (e.g., propranolol) can test the specificity of the naloxone+lactate model. A screen for putative anti-panic agents and a new pharmacotherapeutic approach is suggested. Heuristically, the experimental unveiling of the endogenous opioid system impairing effects of childhood parental loss and separation in normal adults opens a new experimental, investigatory area.
Background: Patterns of suicide rates in China differ in many ways from those in the West. This study aimed to identify the risk factors characteristic for young rural Chinese suicides.
Method: This was a case-control psychological autopsy (PA) study. The samples were suicides and living controls (both aged 15-34 years) from 16 rural counties of China. We interviewed two informants for each suicide and each control with pretested and validated instruments to estimate psychosocial, psychiatric and other risk factors for suicides.
Results: The prevalence of mental disorders was higher among the young Chinese who died by suicide than among the living controls, but was lower than among suicides in the West. Marriage was not a protecting factor for suicide among young rural Chinese women, and never-married women who were involved in relationships were about three times more likely to commit suicide than single women who were unattached. Religion/religiosity was not a protecting factor in Chinese suicide, as it tended to be stronger for suicides than for controls. Impulsivity was significantly higher for suicides than for controls. Psychological strain, resulting from conflicting social values between communist gender equalitarianism and Confucian gender discrimination, was associated significantly with suicide in young rural Chinese women, even after accounting for the role of psychiatric illness.
Conclusions: Risk factors for suicide in rural China are different from those in the West. Psychological strain plays a role in suicide. Suicide prevention programs in China should incorporate culture-specific considerations. [PUBLICATION ABSTRACT]
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Boston, USA. THAYER9378@aol.com
PURPOSE: The purpose was to examine the incidence of traumatic events in childhood, such as sexual and physical abuse, in a chronic pain group and a control group of hospital employees without chronic pain. METHOD: Ninety two patients with chronic pain, age range 20-62, were consecutively recruited from the outpatient clinics of a rehabilitation hospital and a general hospital. Ninety eight hospital employees, age range 20-62, were consecutively recruited from the employee health office of a rehabilitation hospital. All participants responded to nine questions related to sexual, physical and verbal abuse in childhood and completed the Childhood Traumatic Events Scale. A logistic regression with age, gender, sexual, physical, and verbal abuse, death of a family member, childhood illness, major upheaval before age 17, as independent variables were used to predict membership in the pain group contrasted with the control group. RESULTS: Child abuse was reported in the childhood history by 54.4% of the chronic pain group, compared with 21.4% of the control group. A logistic regression showed that after adjusting for gender and age, sexual and verbal abuse were statistically significant predictors of being a member of the pain group. Odds ratios were sexual abuse: 2.67, p < 0.05, CI 1.00-7.14. Verbal abuse: 4.39, p < 0.001, CI 1.93-9.97. A logistic regression was modelled to predict child abuse when gender was taken into account. The results of the logistic regression showed that pain was a significant predictor for sexual abuse after adjusting for gender and age: odds ratio 4.37, p < 0.001, CI 1.80-10.60. Gender was not a statistically significant predictor for sexual abuse, after adjusting for pain and age: odds ratio 2.92, p < 0.072, CI 0.91-9.42. CONCLUSIONS: A history of physical, sexual and verbal abuse is more likely to occur in a chronic pain group than in a control group of hospital employees. Although child abuse is reported to be as high as 25% in the general American population, the statistics for chronic pain patients are twice as high as in the general population. The mechanisms for abuse include age, gender, and early family environment.
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK.
BACKGROUND: Rates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults. METHOD: Participants were enrolled in the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria. RESULTS: Participants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1.90 [95% confidence interval (CI) 1.22-2.98] in women, and 2.00 (95% CI 1.13-3.56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members’ socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder. CONCLUSIONS: Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.
PMID: 17407618 [PubMed – indexed for MEDLINE]
Maurice Preter, MD is a European and U.S. educated psychiatrist, psychotherapist, psychopharmacologist, neurologist, and medical-legal expert in private practice in Manhattan. He is also the principal of Fifth Avenue Concierge Medicine, PLLC, a medical concierge service and health advisory for select individuals and families.
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