Depressive Symptoms Predict Mucosal Wound Healing.

Posted on September 26, 2007 by Maurice Preter MD
Psychosom Med. 2007 Aug 31; [Epub ahead of print] Related Articles, Links
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Depressive Symptoms Predict Mucosal Wound Healing.

Bosch JA, Engeland CG, Cacioppo JT, Marucha PT.

College of Dentistry (J.A.B., C.G.E., P.T.M.), University of Illinois at Chicago, Chicago, Illinois; School of Sport and Exercise Sciences (J.A.B.), University of Birmingham, Birmingham, UK; Department of Psychology (J.T.C.), University of Chicago, Chicago, Illinois; and Institute for Behavioral Medicine Research (J.A.B., C.G.E., P.T.M.), Ohio State University, Columbus, Ohio.

Objective: There is mounting evidence that psychosocial stress can delay wound healing, but this literature almost exclusively pertains to dermal wound healing. Many surgical procedures involve damage to mucosal tissues and the time course and the role of repair processes, such as inflammation, in the healing of these tissues are markedly different from those in dermal healing. Feelings of depression and social isolation are common among surgical patients, and the present study therefore investigated if these factors predict the rate of mucosal wound healing. Methods: Undergraduate students were invited to participate in the study if they reported high or low levels of loneliness or depressive symptoms, corresponding to the upper or lower quintile of their peer group. The UCLA loneliness scale and the Beck Depression Inventory [short form] were used for this screening. A sample of 193 healthy young adults (age range 18-31 years) received a 3.5-mm circular wound on the oral hard palate, under local anesthesia. Healing was monitored by daily videographs of the wound. Results: The median healing rate was 7 days. High dysphoric participants were, however, more likely to heal slower than this median healing rate (odds ratio 3.57 (1.58-8.07); p < .001). This association remained robust after correction for a broad range of demographic and behavioral variables, including gender, age, ethnicity, and health behaviors. High dysphoric individuals also exhibited significantly larger average wound sizes from day 2 post wounding onward. Loneliness and diurnal cortisol secretion (measured over 5 days) were unrelated to healing. Conclusion: Depressive symptoms predict the rate of mucosal wound healing in healthy young adults. We discuss potential pathways that warrant further investigation.

PMID: 17766687 [PubMed – as supplied by publisher]

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Association between reduced sleep and weight gain in women.

Posted on September 24, 2007 by Maurice Preter MD
Am J Epidemiol. 2006 Nov 15;164(10):947-54. Epub 2006 Aug 16. Related Articles, Links
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Association between reduced sleep and weight gain in women.

Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB.

Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA. srp20@case.edu

Physiologic studies suggest that sleep restriction has metabolic effects that predispose to weight gain. The authors investigated the association between self-reported usual sleep duration and subsequent weight gain in the Nurses’ Health Study. The 68,183 women who reported habitual sleep duration in 1986 were followed for 16 years. In analyses adjusted for age and body mass index, women sleeping 5 hours or less gained 1.14 kg (95% confidence interval (CI): 0.49, 1.79) more than did those sleeping 7 hours over 16 years, and women sleeping 6 hours gained 0.71 kg (95% CI: 0.41, 1.00) more. The relative risks of a 15-kg weight gain were 1.32 (95% CI: 1.19, 1.47) and 1.12 (95% CI: 1.06, 1.19) for those sleeping 5 and 6 hours, respectively. The relative risks for incident obesity (body mass index: >30 kg/m(2)) were 1.15 (95% CI: 1.04, 1.26) and 1.06 (95% CI: 1.01, 1.11). These associations remained significant after inclusion of important covariates and were not affected by adjustment for physical activity or dietary consumption. These data suggest that short sleep duration is associated with a modest increase in future weight gain and incident obesity. Further research is needed to understand the mechanisms by which sleep duration may affect weight.

Publication Types:

PMID: 16914506 [PubMed – indexed for MEDLINE]

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DSM Biases Evident in Clinical Training and Courtroom Testimony

Posted on September 16, 2007 by Maurice Preter MD


An important article by Gopal and Bursztajn on the limitations of manual-driven diagnosis (and treatment). It starts:

>>The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM),1 which was most recently revised in 2000 with DSM, fourth edition, text revision (DSM-IV- TR), has been helpful in promoting inter-rater reliability or agreement among clinicians. This reliability has been achieved by moving from a causation-heavy, narrative-rich system to a causation-free, narrative- and context-empty system of diagnostic categories. However, as helpful as an increased degree of agreement among clinicians may be, this measure of the reliability of a diagnosis does not indicate if the diagnosis is valid. A challenge for those involved in the construction of the DSM, fifth edition (DSM-V) is how to retain the strength of reliability and increase diagnostic validity. When decisions need to be made quickly, heuristic processes are more likely to be used,2 reacting to the need for speed with simplifying strategies for diagnostic decision-making. However, when clinicians lack the time to check if the processes they used have led to a fundamentally misleading diagnosis,errors are more likely to go unnoticed. With insufficient time to learn about individual patients, and to observe them, there is a growing tendency to make premature cognitive commitments to diagnoses that fit the menu or bulletpoint layout of the DSM.3 Heuristic approaches are routinely employed to limit potential information overload in diagnostic decision-making.4 Unfortunately, reliance on simplifying procedures may introduce unintended biases, which are magnified by the categorical structure of the DSM.In this context, recent work on Holocaust survivors has shown that posttraumatic stress disorder (PTSD) combined with psychosis presents a diagnostic and clinical challenge.5 Throughout the course of repeated diagnostic interviews, PTSD symptoms decreased for some of these survivors; however, this does not mean that PTSD disappeared from their lives.

Posted in Forensic Neuropsychiatry |

Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

Posted on September 11, 2007 by Maurice Preter MD
J Affect Disord. 2007 Aug 27; [Epub ahead of print] Related Articles, Links
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Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

Esquivel G, Díaz-Galvis J, Schruers K, Berlanga C, Lara-Muñoz C, Griez E.

Academic Anxiety Center, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.

BACKGROUND: Chronic exercise has been shown to have therapeutic effects in panic disorder (PD). The mechanism of these effects is unknown. Acute exercise reduces the effect of a panic challenge in healthy volunteers. Such an effect has not yet been demonstrated in PD patients. The present study aimed at exploring the antipanic effects of acute exercise on a 35% CO(2) panic provocation in treatment-naïve PD patients to further elucidate the mechanisms of the beneficial effects of exercise on panic. METHODS: Eighteen PD patients performed either moderate/hard exercise or very-light exercise before a 35% CO(2) challenge in a randomized, between-group design. The reactivity to CO(2) was assessed with the Visual Analogue Anxiety Scale and the DSM-IV Panic Symptom List. RESULTS: Panic reactions to CO(2) were smaller in patients that performed moderate/hard exercise in contrast to those that performed very-light exercise. Increments in both measurements and panic rates were consistently reduced by intense exercise. LIMITATIONS: Since this study focuses on the acute effects of exercise on CO(2) sensitivity in patients with PD, the results of repetitive exercise sessions on the rate of spontaneous panic attacks and overall symptoms are warranted. The small sample size and other limitations are addressed. CONCLUSIONS: Exercise reduced the panicogenic effects of a CO(2) challenge. In addition to its therapeutic potential, exercise may also be useful as a laboratory maneuver with heuristic value in experimental research into the mechanisms of antipanic treatment.

PMID: 17727960 [PubMed – as supplied by publisher]

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Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Posted on August 19, 2007 by Maurice Preter MD

Progress in Neuro-Psychopharmacology and Biological Psychiatry
Article in Press, Accepted Manuscript – Note to users

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doi:10.1016/j.pnpbp.2007.07.029 How to Cite or Link Using DOI (Opens New Window)
Copyright © 2007 Elsevier Inc. All rights reserved.

Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Maurice Pretera, Corresponding Author Contact Information, E-mail The Corresponding Author and Donald F. Kleinb, 1, E-mail The Corresponding Author
aNew York State Psychiatric Institute Columbia University College of Physicians and Surgeons, 1160 Fifth Avenue, Suite 112 New York, NY 10029, USA
bNew York State Psychiatric Institute Columbia University College of Physicians and Surgeons 1051 Riverside Drive, New York, NY 10032, USA
Received 23 February 2007; revised 24 July 2007; accepted 24 July 2007. Available online 9 August 2007.


Corresponding Author Contact InformationCorresponding author. Tel.: +1 212 713 5336; fax: +1 212 713 5336.
1 Tel.: +1 212 543 6249.

Review article

Panic, suffocation false alarms, separation anxiety and endogenous opioids

Maurice Preter a,⁎, Donald F. Klein b,1

a New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1160 Fifth Avenue, Suite 112, New York, NY 10029, USA

b New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1051 Riverside Drive, New York, NY 10032, USA

Received 23 February 2007; received in revised form 24 July 2007; accepted 24 July 2007

Abstract

This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic [Klein DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry; 50:306-17.]. SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively
occur when the alarm is erroneously triggered. That panic is distinct from Cannon’s emergency fear response and Selye’s General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic–pituitary–adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO2 and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of “spontaneous” panic requires an integrative explanation. Because of the opioid system’s central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.

© 2007 Elsevier Inc. All rights reserved.

Keywords: Affective neuroscience; Endogenous opioids; Panic disorder; Respiratory physiology; Separation anxiety

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