Novel dual repressor elements for neuronal cell-specific transcription of the rat 5-HT1A receptor gene.
(9/2412)
The level of expression of the 5-HT1A receptor in the raphe and limbic systems is implicated in the etiology and treatment of major depression and anxiety disorders. The rat 5-HT1A receptor gene is regulated by a proximal TATA-driven promoter and by upstream repressors that inhibit gene expression. Deletion of a 71-base pair (bp) segment between -1590/-1519 bp of the 5-HT1A receptor gene induced over 10-fold enhancement of transcriptional activity in both 5-HT1A receptor-expressing (RN46A raphe and SN48 septal) cells and receptor-negative (L6 myoblast and C6 glioma) cells. A 31-bp segment of the repressor was protected from DNase I digestion by RN46A or L6 nuclear extracts. Within the 31-bp segment, a single protein complex was present in receptor-expressing cells that bound a novel 14-bp DNA element; in receptor-negative cells, an additional complex bound an adjacent 12-bp sequence. In receptor-positive but not receptor-negative cells, mutation of the 14-bp element to eliminate protein binding abrogated repression to nearly the same extent as deletion of the -1590/-1519 bp segment. Additional mutation of both 14-bp and 12-bp elements abolished protein binding and repressor activity in receptor-negative cells. Thus a single protein-DNA complex at the 14-bp element represses the 5-HT1A receptor gene in 5-HT1A receptor-positive neuronal cells, whereas adjacent DNA elements provide a dual repression mechanism in 5-HT1A receptor-negative cells. (+info)
The association between chronic widespread pain and mental disorder: a population-based study.
(10/2412)
OBJECTIVE: Patients with chronic widespread pain (CWP) have been reported to have a greater prevalence of mental disorders and somatization than that found in the general population, but the true association between CWP and mental disorders is unknown. In this study, we investigated whether there is an increased prevalence of mental disorder in people with CWP from the general population. We also describe the psychiatric diagnoses associated with CWP. METHODS: In a population-based case-control study, 1,953 subjects (75% of a random sample of individuals age 18-65 years) completed a questionnaire that included a pain assessment and the 12-item General Health Questionnaire (GHQ-12). Of 710 subjects scoring >1 on the GHQ-12, 301 were assessed further using a structured psychiatric interview and detailed assessment of medical records to identify cases of mental disorder, in accordance with criteria of the 10th edition of the International Classification of Diseases. The association between CWP and mental disorder was modeled using logistic regression, adjusting for possible confounders including age, sex, and nonresponders. RESULTS: We estimated the overall population prevalence of mental illness to be 11.9%. The odds of having a mental disorder for subjects with versus those without CWP were 3.18 (95% confidence interval 1.97-5.11). Most subjects with mental disorders were diagnosed as having mood and anxiety disorders. Only 3 cases of somatoform disorders were identified, and all were associated with pain. CONCLUSION: This study, although unable to demonstrate a cause-and-effect relationship, showed that 16.9% of those with CWP were estimated to have a psychiatric diagnosis, suggesting that these disorders should be identified and treated. (+info)
The effect of the 1996 'beef crisis' on depression and anxiety in farmers and non-farming controls.
(11/2412)
This paper looks at the effect of the 1996 'BSE crisis' on the mental health of farmers from one semi-ural practice in North Yorkshire. In 1996, Hospital Anxiety and Depression (HAD) scales were sent to farmers and controls who had participated in a previous study in 1994. Comparative data for the two groups for the two years were obtained and analysed. The data showed that, despite fears raised as a result of the 'BSE crisis', the overall rates of depression and anxiety fell in both groups between 1994 and 1996, with the rates falling significantly more in the control group. However, the farmers were still more depressed and anxious than the controls, and those farmers that had been depressed or anxious in 1994 were more likely to be depressed or anxious in 1996. A longer period of time may be needed to determine the effect of the beef crisis on the mental health of farmers. (+info)
Addiction: part II. Identification and management of the drug-seeking patient.
(12/2412)
The medications most often implicated in prescription drug abuse are opioid analgesics, sedative-hypnotics and stimulants. Patients with acute or chronic pain, anxiety disorders and attention-deficit disorder are at increased risk of addiction comorbidity. It is important to ask patients about their substance-use history, including alcohol, illicit drugs and prescription drugs. Patients who abuse prescription drugs may exhibit certain patterns, such as escalating use, drug-seeking behavior and doctor shopping. A basic clinical survival skill in situations in which patients exert pressure on the physician to obtain a prescription drug is to say "no" and stick with it. Physicians who overprescribe can be characterized by the four "Ds"-dated, duped, dishonest and disabled. Maintaining a current knowledge base, documenting the decisions that guide the treatment process and seeking consultation are important risk-management strategies that improve clinical care and outcomes. (+info)
Recent care of common mental disorders in the United States : prevalence and conformance with evidence-based recommendations.
(13/2412)
OBJECTIVE: To relate the presence of recent mental disorders to use of mental health services. DESIGN: Cross-sectional survey. STUDY POPULATION: The study population was 3,032 respondents to the Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-and-mail survey conducted in 1996. Twelve-month diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition, of major depressive episode, panic disorder, generalized anxiety disorder, and serious mental illness were made using a structured assessment. Information was obtained on 12-month treatment for mental health problems in the general medical, mental health specialty, human services, and self-help sectors. Definitions of treatments consistent with evidence-based recommendations were developed using available practice guidelines. MEASUREMENTS AND MAIN RESULTS: Crude and adjusted likelihoods of receiving any mental health care and guideline-concordant care were measured. Although 53. 8% of respondents with at least one 12-month mental disorder received any mental health care in the previous year, only 14.3% received care that could be considered consistent with evidence-based treatment recommendations. Even among those with the most serious and impairing mental illness, only 25% received guideline-concordant treatment. Predictors of receiving guideline-concordant care included being white, female, severely ill, and having mental health insurance coverage. CONCLUSIONS: An epidemic of untreated and poorly treated mental disorders exists in the United States, especially among vulnerable groups such as African Americans and the underinsured. Cost-effective interventions are needed to improve both access to and quality of treatment. (+info)
Cholesterol levels in panic disorder, generalized anxiety disorder and major depression.
(14/2412)
Serum plasma total cholesterol levels were measured in 85 male or female outpatients with panic disorder (PD; N=41), generalized anxiety disorder (GAD; N=23) and major depression (MD; N=21) according to DSM-IV criteria. All the patients had a mean cholesterol level within the normal range; males (N=22) and females (N=63) had approximately the same serum cholesterol levels (p >.05). No significant differences in cholesterol levels emerged between PD, GAD and MD patient groups. Both female PD and female GAD subjects had a mean cholesterol level similar to their male counterparts (p>. 05). It is concluded that both Hayward and colleagues and Bajwa et al. findings could not be replicated by our study. (+info)
Factors predicting the clinical course of generalised anxiety disorder.
(15/2412)
BACKGROUND: Cross-sectional data show that generalised anxiety disorder (GAD) is a chronic condition with episodes lasting much longer than the six-month minimum required by DSM-III-R and DSM-IV. Although GAD is chronic, little is known about factors influencing illness duration. AIMS: To investigate variables that influence the clinical course of GAD. METHOD: A total of 167 patients with GAD participated in the Harvard-Brown Anxiety Research Program. Patients were assessed at intake and re-examined at six- to twelve-month intervals for five years. Kaplan-Meier curves were constructed to assess the likelihood of remission. Regression analysis was used to investigate factors predicting full or partial remission. RESULTS: The rate of remission was 0.38 after five years. Diminished likelihood of remission was associated with low overall life satisfaction, poor spousal or family relationships, a concurrent cluster B or C personality disorder and a low global assessment score. CONCLUSIONS: Full or partial remissions were less likely to occur in patients with poor relationships and personality disorders. These patients should be given more intensive and possibly multi-modal therapy. (+info)
Examining the psychological consequences of surviving childhood cancer: systematic review as a research method in pediatric psychology.
(16/2412)
OBJECTIVE: To report the results of a systematic review to determine the psychological consequences of surviving childhood cancer. METHODS: Searches were conducted using Psyclit, Medline, Cinahl, and Bids and articles selected on the basis of predefined criteria. Key information was extracted to data sheets and these were rated by two coders. RESULTS: Twenty studies were identified, seventeen from the United States. Survivors did not show deficits in measures of anxiety, depression, or self-esteem when compared with population norms or matched controls. Survivors of some cancers (bone tumors) have poorer outcomes. CONCLUSIONS: The results of this review support findings of previous descriptive reviews. Methodological problems include poorly reported medical information (for example, time since diagnosis), heterogeneous samples, self-selection of participants, poorly chosen/lack of suitable measures, and a lack of longitudinal work. Findings are discussed in terms of the need for cross-cultural work on adjustment to childhood cancer, the need for studies to take on a more developmental approach, and for greater national and international collaboration. (+info)