Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder.

OBJECTIVE: Generalized anxiety disorder (GAD) in elderly persons is highly prevalent, but little is known about its course, age at onset, and relationship to comorbid major depressive disorder (MDD). The authors assessed the course and comorbidity of late-life GAD and MDD. METHODS: Authors assessed elderly subjects in anxiety or depression intervention studies who had a lifetime history of GAD, with current MDD (N=57) or without (N=46). Subjects' lifetime course of illness was charted retrospectively. RESULTS: The 103 subjects had a mean age of 74.1 years, and a mean age at onset of GAD of 48.8 years; 46% were late-onset. GAD episodes were chronic, and 36% were longer than 10 years. Of the comorbid GAD-MDD patients, most had different times of onset and/or offset of the disorders; typically, GAD preceded MDD. CONCLUSIONS: Elderly subjects with GAD tended to have chronic symptoms lasting years-to-decades, without interruption, and many have late onset. Elderly persons with lifetime GAD and MDD tend to have different onset and offset of the two disorders. Findings characterize late-life GAD as a chronic disorder distinct from MDD.     

Alexithymia,Suicide Ideation,C-Reactive Protein,and Serum Lipid Levels Among Outpatients with Generalized Anxiety Disorder

The aim of the present study was to investigate the relationships between alexithymia, suicide ideation, C-Reactive Protein (CRP), and serum lipid levels in adult outpatients with a DSM-IV diagnosis of Generalized Anxiety Disorder (GAD). Seventy consecutive patients with GAD were recruited and evaluated. Measures were the Hamilton Anxiety Scale, the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation (SSI), and the Montgomery Åsberg Depression Rating Scale (MADRS). All patients were assessed for: CRP, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG), and very-low-density lipoprotein cholesterol (VLDL-C). TC/HDL-C and LDL-C/HDL-C ratios were also evaluated. Alexithymic patients showed higher scores on almost all rating scales and altered serum CRP and lipid levels vs. non-alexithymics. In the hierarchical regression model, the presence of higher MADRS scores together with higher scores at the Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher rates of suicide ideation. Although alexithymic subjects with GAD may show a CRP and cholesterol dysregulation, this latter seems independent on increased suicide ideation, rather to Difficulty in Identifying Feelings, and subthreshold depressive symptoms. Study limitations and future research implications are discussed.     

Serum lipid levels in patients with dissociative disorder

OBJECTIVE: There may be an association between a low serum cholesterol level and dissociative disorders. METHOD: The subjects of the study were 16 patients with dissociative disorder and 16 normal comparison subjects (two men and 14 women in each group). Total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, and very low density lipoprotein levels were compared. RESULTS: Patients with dissociative disorders had lower serum triglyceride, total cholesterol, low-density lipoprotein, and very low density lipoprotein levels than normal comparison subjects. CONCLUSIONS: Low serum lipid concentrations may be related to a high incidence of self-injurious behaviors and borderline features in patients with dissociative disorders.     

EEG sleep studies in patients with generalized anxiety disorder

Sleep polygraphic recordings were performed during 3 consecutive nights in 12 inpatients with generalized anxiety disorder (GAD) in comparison with age- and sex-matched groups of patients with major depressive disorder (MDD) and normal subjects. GAD patients differed significantly from those with MDD. A lower number of awakenings and stage shifts in night 1 and the mean of the 3 nights and a shorter rapid eye movement (REM) duration in night 1 but longer REM latency in the mean of the 3 nights were observed in GAD in comparison to MDD. GAD patients also showed a significantly longer sleep onset latency and shorter duration of total sleep time and Stage 2 than control subjects. Electroencephalographic sleep recordings, as well as other laboratory tests, may help the clinician to differentiate anxiety from depressive disorders.     

Noradrenergic function in generalized anxiety disorder, major depressive disorder, and healthy subjects

Plasma norepinephrine (NE), free 3-methoxy-4-hydroxyphenethylene glycol (MHPG), and binding of tritiated yohimbine to platelet membranes were measured in 14 patients with generalized anxiety disorder (GAD), who were matched for age and sex with 14 patients with unipolar major depressive disorder (MDD) and 14 normal subjects. Plasma NE and MHPG levels were increased and the number of alpha2-adrenoreceptors (Bmax) was decreased in GAD patients compared with MDD and normal subjects. No differences were found between MDD patients and normal subjects for plasma NE, MHPG, and alpha2-adrenoreceptor binding. Plasma NE and MHPG were significantly correlated in MDD patients and tended toward a significant positive correlation in GAD patients. Plasma MHPG and affinity of binding platelet alpha2-adrenoreceptors (Kd) were significantly correlated in normal subjects. Thus, noradrenergic activity seems to be increased in patients with GAD, but not in patients with MDD. In GAD patients, higher levels of catecholamines may lead to a down-regulation of presynaptic alpha2-adrenoreceptors.     

Lipid profiles and outcome in patients treated by intravenous thrombolysis for cerebral ischemia

OBJECTIVE: To determine whether low low-density lipoprotein cholesterol (LDL-C) but not high-density lipoprotein cholesterol (HDL-C) and triglyceride concentrations are associated with worse outcome in a large cohort of ischemic stroke patients treated with IV thrombolysis. METHODS: Observational multicenter post hoc analysis of prospectively collected data in stroke thrombolysis registries. Because of collinearity between total cholesterol (TC) and LDL-C, we used 2 different models with TC (model 1) and with LDL-C (model 2). RESULTS: Of the 2,485 consecutive patients, 1,847 (74%) had detailed lipid profiles available. Independent predictors of 3-month mortality were lower serum HDL-C (adjusted odds ratio [(adj)OR] 0.531, 95% confidence interval [CI] 0.321-0.877 in model 1; (adj)OR 0.570, 95% CI 0.348-0.933 in model 2), lower serum triglyceride levels ((adj)OR 0.549, 95% CI 0.341-0.883 in model 1; (adj)OR 0.560, 95% CI 0.353-0.888 in model 2), symptomatic ICH, and increasing NIH Stroke Scale score, age, C-reactive protein, and serum creatinine. TC, LDL-C, HDL-C, and triglycerides were not independently associated with symptomatic ICH. Increased HDL-C was associated with an excellent outcome (modified Rankin Scale score 0-1) in model 1 ((adj)OR 1.390, 95% CI 1.040-1.860). CONCLUSION: Lower HDL-C and triglycerides were independently associated with mortality. These findings were not due to an association of lipid concentrations with symptomatic ICH and may reflect differences in baseline comorbidities, nutritional state, or a protective effect of triglycerides and HDL-C on mortality following acute ischemic stroke.     

胆红素和脂质对脑卒中发病影响的差异性探讨

目的探讨血清胆红素和脂质及其综合指数与脑出血(CH)、短暂性脑缺血发作(TIA)及脑梗死(CI)的关系。方法对128例CH、108例TIA及104例CI急性期患者血清胆红素、胆固醇等指标进行检测,并进行对比分析。结果CI组年龄显著高于CH组(P<0.05)。TIA、CI组患者血清总胆红素(TBIL)、间接胆红素(IBIL)、高密度脂蛋白胆固醇(HDL-C)显著低于CH组(P<0.05或P<0.01),血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(n-HDL-C)水平及LDL-C/HDL-C、TC/HDL-CTG/HDL-C比值显著高于CH组(P<0.05或P<0.01);CI组患者血清直接胆红素(DBIL)/IBIL比值显著高于CH组(P<0.01),血清IBIL、HDL-C水平显著低于TIA组(P<0.05),血清LDL-C、n-HDL-C水平及LDL-C/HDL-C、TC/HDL-C比值显著高于TIA组(P<0.05或P<0.01),各组间其它指标间差异无统计学意义(P>0.05)。结论血清胆红素和脂质及其综合指数不同程度的变化与脑卒中关系密切。     

Urinary pH in panic disorder

Urinary pH was evaluated in panic disorder (PD) patients compared with both psychiatric and healthy control subjects. Fourteen PD patients, eight major depressive disorder (MDD) patients, and 14 healthy control (HC) subjects were examined. All patients were drug-free and met DSM-IV diagnostic criteria. The PD patients had lower urinary pH and higher levels of anxiety than both MDD and HC subjects. Additionally, urinary pH inversely correlated with anxiety levels. Although preliminary, these findings suggest that PD patients have lower urinary pH than MDD and HC subjects. Future studies that simultaneously examine both urinary and blood pH in larger numbers of PD patients and patients with other anxiety disorders, before and after treatment, need to be conducted.     

Serum cholesterol level comparison: control subjects, anxiety disorder patients, and obsessive-compulsive disorder patients.

OBJECTIVE: To determine whether panic disorder is associated with elevated serum cholesterol levels. Serum cholesterol levels of panic disorder patients are reported to be elevated. This could explain the higher-than-expected cardiovascular mortality in this population. Some evidence exists wherein cholesterol levels are also increased in patients with general anxiety disorder and phobias. To date, there are only 2 reports on cholesterol levels of obsessive-compulsive disorder (OCD) patients, giving controversial results. METHOD: We compared serum cholesterol levels of anxiety disorder patients, OCD patients, and normal control subjects with each other (n = 60 in each group). Serum cholesterol was measured in each subject before treatment. Subjects of the 3 groups were matched by age and sex. RESULTS: Patients with anxiety disorders and OCD had elevated cholesterol levels, compared with normal control subjects. Cholesterol levels in OCD patients were comparable with those in patients with phobia. CONCLUSIONS: Our data support the assumption that elevation in cholesterol level is not a specific feature of panic disorder (as most assumed), but more generally associated with anxiety disorders. Increased cholesterol levels in patients with anxiety disorders and OCD may be of clinical relevance.     

Growth and lipid metabolism in girls and young women with epilepsy during pubertal maturation

Summary:  Purpose: To assess growth and the serum lipid profile in girls with epilepsy receiving monotherapy at a mean age of 12.6 years and approximately 6 years later.
Methods: A population-based cohort of 77 girls with epilepsy and 49 healthy controls participated in this follow-up study including two cross-sectional evaluations (age range, 8–18.5 years on the first evaluation, and 12.5–25.8 years on the second evaluation). Forty of the patients were initially taking valproate (VPA), 19, carbamazepine (CBZ), and 18, oxcarbazepine (OXC). Growth data were compiled, body mass index (BMI) was calculated, and serum total (TC), and high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol and triglyceride concentrations were analyzed.
Results: Linear growth and final height did not differ between the patients and the controls. At follow-up, the mean BMI of the patients who were off medication (61%) was similar to that of the controls, whereas the patients initially treated with VPA who were still taking any medication had a higher BMI. On the first evaluation, the patients taking VPA had low serum HDL-C, and those taking CBZ or OXC had high serum TC and LDL-C concentrations. At follow-up, serum lipid levels were similar in the patients off medication and the controls.
Conclusions: Neither epilepsy nor antiepileptic therapy affects linear growth or final height, but they may have unfavorable effects on body weight and serum lipid concentrations. Lipid-profile impairment seems to be transient if the medication is discontinued. Overweight is common in patients treated with VPA during puberty if epilepsy and medication continue into adulthood.     

Hypoesthesia in generalised anxiety disorder and major depression disorder

Abstract

Objective: The determination of soft signs can be a conducive practice to understand the differential etiology between depression and anxiety. This study aims at examining malleolar hypoesthesia role in distinguishing between patients with generalised anxiety disorder (GAD) and major depression disorder (MDD).

Methods: This study examines the presence of malleolar hypoesthesia in patients with GAD (n?=?47) compared to patients with MDD (n?=?48) and healthy individuals (controls; n?=?99). The Wartenberg wheel, a medical device for neurological use, was employed to determine the presence of hypoesthesia on both sides of the ankles.

Results: The data revealed: i) MDD patients showed higher hypoesthesia than GAD patients (p?=?.008), ii) participants with hypoesthesia had higher anxiety and depression scores than participants without hypoesthesia (all p?<?.001) and iii) logistic regression model indicated that hypoesthesia can be a predictor of MDD relative to GAD diagnosis (Odds Ratio: 17.43 (1.40–217.09; p?=?.026)).

Conclusions: Malleolar hypoesthesia was higher in MDD than GAD. The detection of hypoesthesia may help to investigate the differential etiology between MDD and GAD diagnosis.     

Serum lipid levels, suicidality, and panic disorder

Although the effects of serum total cholesterol and other lipids have been implicated as a predictor of suicidal behavior in major depression, the role of cholesterol level on suicide risk for panic disorder patients is not considered as a biological marker in the literature. In this study, we examined the relationship of suicidality with serum cholesterol concentration in panic disorder. The subjects of the study were 10 suicidal panic disorder patients, 19 nonsuicidal panic disorder patients, and 15 normal control subjects. The suicidal patients with panic disorder had lower serum total cholesterol and low-density lipoprotein (LDL) levels than normal control subjects. These findings suggest that there may be an association between suicidality and low serum cholesterol levels in panic disorder. We also discuss the possible role of serotonin in the brain in the relationship of suicidal behavior or ideation with low cholesterol concentration in panic disorder.     

惊恐障碍患者血清脂质水平的初步研究

探讨惊恐障碍患者的血脂水平及明确高胆固醇 (Tch)水平是否仅伴发于惊恐障碍或与其他精神障碍有关。　　方法　采用酶法测定在性别、年龄上相匹配的 3 0例惊恐障碍患者、3 0例抑郁症患者及 3 0例正常对照者的血清脂质水平。　　结果　惊恐障碍男患者的血清Tch水平明显高于抑郁症患者和正常对照者 ,稳定内科疾病与高血清Tch水平无关 ;在抑郁症组中 ,焦虑障碍史者的血清Tch水平显著增高。　　结论　提示惊恐障碍男患者的血清高Tch水平 ,可能涉及去甲肾上腺素或 5-羟色胺活性增高假说机制     

Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression

Although anxiety disorders have been associated with impairments in self-reported health functioning, the relative effect of various anxiety disorders has not been studied. We compared health functioning of patients with a principal diagnosis of posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Patients with PTSD and MDD were equally impaired on overall mental health functioning, and both were significantly worse than patients with PD and GAD. PTSD was associated with significantly worse physical health functioning relative to PD, GAD, and MDD. Hierarchical regression showed that the association of PTSD with physical health functioning was unique and was not caused by the effects of age, depression, or comorbid anxiety disorders. Both PTSD and comorbid anxiety accounted for unique variance in mental functioning. These results highlight the association of PTSD with impaired physical and mental functioning and suggest that effective treatment of PTSD may affect overall health.     

High cholesterol levels in patients with panic disorder.

OBJECTIVE: This study was undertaken to help clarify whether the higher cholesterol levels found in patients with panic disorder are a complication of panic disorder only or are associated with any psychiatric disorder. METHOD: The subjects of the study were 30 patients with panic disorder and 30 patients with major depression, diagnosed according to the Structured Interview for DSM-III-R, and 30 normal control subjects. The three groups were matched for sex and age, and none of the subjects had alcohol/drug abuse, abnormal ECGs, or unstable medical conditions. Blood samples were drawn at random times, and serum cholesterol levels were determined. RESULTS: The patients with panic disorder had significantly higher serum cholesterol levels than did the patients with major depression and the normal control subjects. Among the patients with major depression, histories (current or past) of anxiety disorders were associated with significant elevation of serum cholesterol levels. The presence of stable medical conditions was not associated with higher cholesterol levels in any of the three groups of subjects. CONCLUSIONS: Higher cholesterol levels were particularly associated with panic disorder in comparison with major depression. Higher levels of cholesterol in panic disorder are hypothesized to be a result of increased noradrenergic activity, which may be the underlying biological/neurochemical mechanism for symptoms of panic disorder, including anticipatory anxiety.     

补阳还五汤对脑卒中患者血脂及动脉粥样硬化的影响

目的 观察和评价补阳还五汤辅助治疗脑卒中对患者血脂和动脉粥样硬化情况的影响.方法 选取102例脑卒中患者为研究对象,随机分为观察组和对照组各51例,对照组给予常规西医治疗,观察组在此基础上加用补阳还五汤进行辅助治疗.对2组患者治疗前后血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平、颈动脉内膜中层厚度（IMT）和颈动脉血管阻力指数（RI）进行检测和记录.结果 2组血清TC、TG、HDL-C、LDL-C治疗后均显著改善（P＜0.05）,2组比较差异有统计学意义（P＜0.05）;观察组血清TC、TG、LDL-C水平显著低于对照组,HDL-C水平显著高于对照组;2组颈动脉IMT厚度均较治疗前有所下降,但差异无统计学意义（P＞0.05）;2组颈动脉RI均较治疗前显著下降（P＜0.05）,且观察组下降更为明显（P＜0.05）.结论 补阳还五汤对纠正脑卒中患者的脂代谢异常有积极作用,可在一定程度上改善患者动脉粥样硬化的症状,可作为脑卒中辅助治疗手段予以推广应用.     

The effects on lipid and apolipoprotein serum levels of long-term carbamazepine, valproic acid and phenobarbital therapy in children with epilepsy

The aim of the present study was to assess the effect of long-term carbamazepine (CBZ), valproic acid (VPA) and phenobarbital (PB) treatment on serum lipids and apolipoproteins in epileptic children. Serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C) and triglycerides (TGs) were measured and the LDL-C/HDL-C and TC/HDL-C ratios were calculated in 320 children and adolescents (129 receiving CBZ, 127 receiving VPA and 64 receiving PB) suffering from various types of epilepsy. Additionally, in a subgroup of 181 children (68 CBZ; 78 VPA; 35 PB) apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), HDL2-C and HDL3-C were measured and apoA-I/apoB and HDL2-C/HDL3-C ratios were calculated. Results of the measurements were compared with those of 169 age-and sex-matched healthy controls. None of the variables considered was significantly correlated with time elapsed since start of treatment or with drug concentration in serum. TC and LDL-C serum levels were high in children receiving CBZ or PB and low in those treated with VPA. Serum LDL-C level exceeded 130 mg/dl in 27.9% of CBZ-group, 31.8% of the subjects receiving PB, but only in 7% of those receiving VPA and in 11.8% of control group subjects. CBZ-treated children also showed high HDL-C and HDL3-C values. In the group receiving VPA, HDL2-C, HDL2-C/HDL3-C ratio and apo B were significantly lower than in the control group. Mean apoA-I levels were low in all treated groups: by contrast, in neither group did TGs, VLDL-C levels and TC/HDL-C or LDL-C/HDL-C ratios differ significantly from the corresponding control group. Our results suggest that the effects of long-term AED therapy on lipid profile and, particularly, on apolipoprotein serum levels increase risk of atherosclerosis-related disease. Moreover, these results confirm our previously reported increased risk in CBZ and PB-treated patients.     

Serum lipid concentrations in obsessive-compulsive disorder patients with and without panic attacks.

OBJECTIVE: To examine serum lipid levels in patients with obsessive-compulsive disorder (OCD) and to test whether panic symptoms affect lipid concentrations in OCD patients. METHODS: We assessed 33 OCD patients and 33 healthy control subjects matched for sex and age. RESULTS: OCD patients had higher low-density lipoprotein, very-low-density lipoprotein, and tryglyceride levels, but lower high-density lipoprotein levels, than normal control subjects. We also found that only OCD patients with panic attacks had higher serum lipid concentrations, compared with normal control subjects. Serum lipid levels of pure OCD patients did not differ from control values. CONCLUSION: These findings suggest that high serum lipid concentrations are related to panic anxiety rather than other symptoms of the illness.     

脑出血患者血清胆红素和脂质变化分析

目的探讨血清胆红素和脂质水平与脑出血(CH)的关系。方法对117例CH患者的血清胆红素、胆固醇等指标进行检测,并与114例健康对照者进行比较。结果CH患者血清甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及DBIL IBIL比值较对照组显著降低(P<0.001或P<0.05),胆固醇(TC)、直接胆红素(DBIL)较对照组低,总胆红素(TBIL)、间接胆红素(IBIL)、低密度脂蛋白胆固醇(LDL-C)较对照组高,但差异无统计学意义(P>0.05)。结论血清HDL-C降低可作为CH的危险因素,TG和DBIL TBIL比值与CH关系密切。     

Association between altered lipid profiles and attention deficit hyperactivity disorder in boys

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, which is multifactorial, complex, and seen most commonly in childhood.

Aims: The aim of this study was to examine the hypothesis that altered serum lipid profiles are associated with ADHD.

Methods: The study inluded 32 boys diagnosed with ADHD according to DSM-IV-R criteria and a control group of 29 healthy subjects. All patients were assessed with The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Turgay DSM-IV-based Disruptive Behavior Disorders Child and Adolescent Rating and Screening Scale, the Conners Parent Rating Scale-Revised Long Form, and the Conners Teacher Rating Scale. Measurements were taken of fasting plasma total cholesterol (T-Chol), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and 1-day food intake levels, and the groups were compared.

Results: The mean TC, LDL, and HDL levels were significantly lower in the ADHD group than the control group (p?=?.005, p?p?=?.002, respectively). There was no significant difference between the groups’ TG levels (p?=?.295). No significant differences were determined between the combined-type ADHD patients and the predominantly inattentive subtype of ADHD in respect to the lipid profile.

Conclusion: The results of this study add to the growing body of evidence indicating an association between serum cholesterol and ADHD in boys. Further genetic and molecular studies are required to elucidate the biochemical mechanisms underlying this relationship.