Cigarette smoking, nicotine dependence and anxiety disorders : a systematic review of population-based, epidemiological studies

Background Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized.

Methods We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)) for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders.

Results In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder), although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified.

Conclusions Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as increasing the risk of panic disorder and generalized anxiety disorder. The literature assessing anxiety disorders increasing smoking and nicotine dependence is inconsistent. Potential issues with the current literature are discussed and directions for future research are suggested.

What mediates psychopathology in stalking victims? The role of individual-vulnerability and stalking-related factors

Stalking victims report significant psychiatric morbidity, which often persists long after the stalking itself has ceased. Elucidating predictors of psychopathology in victims is critical to informing the clinical management of this population. This study examined demographic, individual-vulnerability and stalking-related predictors of general psychopathology and post-traumatic stress in a community sample of victims (n = 236). Regression analyses showed that both general psychopathology and post-traumatic stress were influenced by individual-vulnerability factors, particularly the use of avoidance coping, and stalking-related factors, most notably being subjected to threats. This study provides the most comprehensive analysis to date of factors that mediate psychiatric morbidity among stalking victims, and highlights the utility of clinicians focussing on modifying dynamic risk factors such as maladaptive avoidance behaviours to help alleviate victims' psychological distress.

Symptoms of posttraumatic stress in Australian women with ovarian cancer

The aim of the study was to assess the prevalence and nature of symptoms of posttraumatic stress disorder (PTSD) in women with ovarian cancer. A further aim was to examine the demographic, medical and psychosocial factors associated with PTSD symptoms.

The performance of trauma in moving image art

With reference to recent neurological research into Post-Traumatic Stress Disorder (PTSD) using new imaging technologies and models of implicit and explicit memory systems developed from this research, The Performance of Trauma in Moving ...

Association between attributions of responsibility for motor vehicle crashes, depressive symptoms, and return to work.

Perceptions surrounding the underlying causes of accidents and injuries may be a key mechanism influencing postaccident health and functional outcomes among people injured in road crashes. In particular, attributions of responsibility may influence rates of postcrash depressive symptomatology and return-to-work.

Selective serotonin reuptake inhibitors in mixed anxiety-depression.

The overlap between the depressive and anxiety disorders is extremely common. The introduction of the selective serotonin reuptake inhibitors (SSRIs) has, more than any other development, bridged the gap in terms of efficacy in both sets of disorders. A substantial body of data exists suggesting that the available SSRIs have substantial efficacy in anxiety symptoms co-occurring with depression. The clear utility of the SSRIs in disorders classified apart from depression is also established. Whilst panic disorder is the best studied, evidence on the efficacy of the SSRIs in disorders that previously did not attract much pharmacotherapeutic interest, such as social anxiety disorder and post-traumatic stress disorder is accumulating.

Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis

OBJECTIVE: The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. METHODS: A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. RESULTS: Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5-93.9) and lifetime (75.5%, 95% CI 46.5-91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9-34.0), alcohol use disorders (21.2%, 95% CI 15.6-28.1), anxiety disorders (17.6%, 95% CI 10.8-27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7-24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7-75.2) and major depressive disorder (29.9%, 95% CI 20.5-41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4-24.2), alcohol dependence (15.2%, 95% CI 10.2-22.0), social phobia (14.9%, 95% CI 2.0-59.8), generalised anxiety disorder (14.4%, 95% CI 3.9-40.8), panic disorder (13.7%, 95% CI 6.7-26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4-35.7), cannabis use disorder (11.5%, 95% CI 4.8-25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1-19.6), adjustment disorder (9.2%, 95% CI 4.8-17.2), bipolar disorder (8.8%, 95% CI 4.4-17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4-18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. CONCLUSIONS: The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.

Avaliação e intervenção psicológica para meninas vítimas de abuso sexual intrafamiliar

O abuso sexual contra crianças e adolescentes é um fenômeno complexo que envolve aspectos psicológicos, sociais e jurídicos. Esta forma de violência tem sido considerada um problema de saúde pública devido aos altos índices de incidência e ao impacto negativo para o desenvolvimento das vítimas. O presente estudo teve como objetivo aplicar e avaliar o efeito de um modelo de grupoterapia cognitiva-comportamental para meninas vítimas de abuso sexual intrafamiliar. Participaram do estudo 10 meninas com idade entre 09 e 13 anos. As participantes foram clinicamente avaliadas em três encontros individuais, nos quais foram aplicados instrumentos psicológicos que avaliaram sintomas de ansiedade, depressão, transtorno do estresse pós-traumático, stress infantil e crenças e percepções da criança em relação à experiência abusiva. Após a avaliação clínica, as participantes foram encaminhadas para a grupoterapia, constituída por 20 sessões semi-estruturadas. O processo terapêutico foi dividido em três etapas, segundo os objetivos e técnicas aplicadas, em: psicoeducação, treino de inoculação do estresse e prevenção à recaída. A reavaliação clínica foi realizada após cada etapa da intervenção e os resultados apontaram que as meninas apresentaram melhoras significativas nos sintomas de depressão, ansiedade e transtorno do estresse pós-traumático, bem como reestruturaram crenças disfuncionais sobre culpa, diferença em relação aos pares, percepção de credibilidade e confiança. Tais resultados sugerem que a grupoterapia foi efetiva, reduzindo a sintomatologia das participantes e proporcionando a elaboração de pensamentos funcionais em relação ao abuso sexual.

Neurobiology and clinical implications of lucid dreaming

Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states.

Antidepressivos modificam a extinção de uma memória aversiva em ratas

Treatment of major depression, posttraumatic stress disorder and other psychopathologies with antidepressants can be associated with improvement of the cognitive deficits related to these disorders. Although the mechanisms of these effects are not completely elucidated, alterations in extinction of aversive memories are believed to be present in these psychopathologies. Moreover, researches with laboratory animals usually focus on male subjects, and we have recently verified that extinction of an aversive task is reduced in female rats when compared to males. In the present study, female rats were long-term treated with clinically used antidepressants (fluoxetine, nortriptyline or mirtazapine) and tested in the plus-maze discriminative avoidance and forced swimming tests in order to evaluate learning, memory, extinction, anxiety and depression-related behaviors. All groups learned the task, but learning was somewhat faster in nortriptyline and mirtazapine-treated animals . Task retrieval was also showed by all experimental groups. Chronic treatment with fluoxetine, but not with the other antidepressants, increased extinction of the discriminative task. In the forced swimming test, animals treated with fluoxetine and mirtazapine showed decreased immobility duration. In conclusion, antidepressants interfere with learning and female rats treated with fluoxetine presented increased extinction of the aversive memory task. On the other hand, both fluoxetine and mirtazapine were effective in the forced swimming test, suggesting dissociation between the antidepressant effects and the extinction of aversive memories

Clinical correlates of social adjustment in patients with obsessive-compulsive disorder

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Diagnóstico diferencial do transtorno obsessivo-compulsivo

Obsessive-compulsive disorder (OCD) has clinical features that overlap in various degrees with many other mental disorders. As a result, the differential diagnosis sometimes can be difficult. This review briefly summarizes the phenomenologic similarities and differences between OCD and the following disorders: depression, phobias, hypochondriasis and body dysmorphic disorder, Tourette syndrome and tic disorder, obsessive-compulsive personality disorder, impulse control and eating disorders, generalized anxiety, panic and post-traumatic stress disorders, and delusional and schizophrenic disorders. The accurate diagnosis is essential for adequate treatment planning and management.

Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Plant derived alkaloid (-)-cassine induces anti-inflammatory and anti-hyperalgesics effects in both acute and chronic inflammatory and neuropathic pain models

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Diagnóstico diferencial da fobia social: Uma revisâo

Social phobia is a common mental disorder that can cause considerable distress and impairment in functioning and quality of life but it is still an underdiagnosed and undertreated disorder. The differential diagnosis is not always simple. because its clinical features overlap with many other mental and non-mental disorders characterized by social avoidance. The aim of this study was to review the literature and discuss the differential diagnosis of social phobia with the following conditions. normal social anxiety (shyness), depressive disorders, alcoholism, body dysmorphic disorder, panic disorder and agoraphobia, simple phobias, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, delusional disorders and avoidant and schizoid personality disorders. A Medline and Lilacs search was conducted between 1990 and 2002, using the key words social phobia, social anxiety disorder, diagnosis and defferential diagnosis. The accurate diagnosis is very important for the appropriate treatment approach.