Psychological and bioclinical CHD risk factors. quantitative differences between obese, normal and thin subjects

The etiological role played in coronary heart disease could be clarified further by taking into account the various components and modes of expression of anxiety or depression, which are specifically associated with different degrees of relative weight. To test this hypothesis, psychological and bioclinical differences are evaluated, before and after age 45, between obese, normal and thin subjects of an occupational sample. All 1,694 male subjects volunteered to a CHD screening test. The variables considered are anxiety and depression self-ratings, response style to the anxiety scale, blood pressure, serum lipids urea and blood glucose.

Results indicate significant differences between sub-groups considered. Obese subjects, both under and over 45, exhibit higher bioclinical risks, but lower anxiety and depression as compared to the normal and thin subjects. They are characterized by suspiciousness and an “intermediate” response style. Thin subjects exhibit comparatively lower risks, but higher psychological ones. They are characterized by anxiety, depression, and either agreeing or disagreeing response style. Their bioclinical and psychological scores are higher for the over-45's as compared to the under-45's. Normal subjects show intermediate bioclinical and psychological scores in all comparisons performed. Their scores are higher over 45 yr-of-age.

It is suggested that anxiety, depression and their style of expression are key elements in the relationship that holds between relative weight and proneness to coronary heart disease.     

Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of co-morbidity and specificity

It has been well established that early adversity is a major risk factor for depression and for anxiety disorders in various populations and age groups. Few studies have considered the relative strength of these associations and the possible role of co-morbid depression/anxiety in understanding them. Using data from a large community sample of Ontario, Canada, we examined the relative strength of the associations between early physical abuse, sexual abuse, and/or parental strain with depression alone, anxiety alone, and co-morbid depression/anxiety. The current sample consisted of 6,597 individuals 15-64 years of age who were interviewed using the World Health Organization Composite International Diagnostic Interview (CIDI). Using a multivariate design, we compared early adversity scores across four diagnostic study groups including normal controls, individuals with major depression but no anxiety disorders, individuals with one or more anxiety disorders without major depression, and individuals with co-morbid major depression and anxiety. Individuals with past disorders were considered separately from those with current disorders. For both past and current disorders, highly significant differences in early adversity scores were found across the four study groups. A novel and robust finding, consistent across all analyses, was a marked association between early sexual abuse and co-morbid depression and anxiety but not the "pure" disorders. A strong association between early parental strain and major depression (independent of anxiety) was also found. The overall pattern of results suggest that there may be unique relationships linking particular adversities to particular manifestations of depression and anxiety disorders later in life. A particularly strong association between early sexual abuse and co-morbid depression/anxiety was found.     

Relationships between anxiety, depression self-ratings and CHD risk factors among obese, normal and lean individuals.

Psychosomatic interactions leading to the development of Coronary Heart Disease (CHD) have yet to be clarified. This study explores further whether and how an important CHD risk factor, relative weight, affects the relationships between psychological and bioclinical parameters. A principal factorial components solution (linear procedure) and an extension of the median test (non-linear procedure) were run on the scores of self-reported anxiety (IPAT Anxiety Scale) and depression (Zung Self-rating Scale), the indices of anxiety expression style, and the bioclinical measures (systolic and diastolic blood pressure, fasting blood glucose, urea and lip concentrations). The statistical procedures were carried out separately in the six subgroups which subdivide 1,694 male volunteers to a CHD detection examination, according to age (under- and over-45 yr) and relative weight (obese, normal and lean subjects). Results indicate that the relationship between psychological and bioclinical measures are specific to the subgroup considered: they are recurrent in obese and lean individuals, and more frequent in older than in younger subjects. The composition of the first factorial component is psycho-bioclinical in the under-45 obese subgroup; the second factorial component is biopsychological in the obese and lean, under- as well as over-45-yr old, subgroups. The expression style indices and the lipid concentrations are associated when the statistical method does not presuppose linearity. Present theories on psychological and bioclinical determinants of relative weight are reported, since the experimental data upon which these theories are based parallel interestingly the results of our correlational study. Indeed, both approaches suggest that cognitive factors, operationally defined by response tendencies and anxiety expression style, are different in obese and nonobese humans, and that these differences determine psycho-bioclinical relationships which are specific to these relative weight groups. Could these mechanisms of action be specified, an important step would be made in the understanding of the CHD etiology.     

Absolute and relative stability of alexithymia in alcoholic inpatients undergoing alcohol withdrawal: relationship to depression and anxiety

To evaluate whether alexithymia in alcohol-dependent patients is a personality trait or a state-dependent phenomenon related to depression and anxiety, we evaluated absolute stability (the extent to which alexithymia scores change over time) and relative stability (the extent to which relative differences among individuals remain the same over time) of alexithymia during alcohol withdrawal. Seventy alcohol-dependent inpatients were assessed for alexithymia, depression and anxiety with the 20-item Toronto Alexithymia Scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory at the onset of withdrawal, after 2 days and 2 weeks. Paired t-tests and correlational analyses were performed to evaluate absolute and relative stability of alexithymia and hierarchical regression analyses to assess whether alexithymia was related to anxiety and depression. Alexithymia decreased significantly from onset to end of withdrawal, but two of its three subfactors remained stable. Alexithymia scores at onset correlated significantly with scores at end, after partialling out the effects of depression and anxiety. In conclusion, the relative stability of alexithymia contrasting with large decreases in depression and anxiety during alcohol withdrawal supports the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon.     

An evaluation of the absolute and relative stability of alexithymia in women with breast cancer

OBJECTIVES: In the controversy for alexithymia as a state or a trait dimension, recent studies showed that, whereas absolute changes (i.e., extent of alexithymia scores change over time) were observed, alexithymia was relatively stable (i.e., extent to which relative differences among individuals remain the same over time). The present study extended this question by investigating a disease with highly threatening outcomes (breast cancer), by looking at changes in depression and anxiety, and by examining stability for total and factor alexithymia scores. METHODS: One hundred twenty-two women in treatment for a first instance of breast cancer were assessed for alexithymia (TAS-20), depression, and anxiety (HADS) the day before surgery (T1) and six months later (T2). RESULTS: Alexithymia scores changed from baseline to follow-up (lack of absolute stability). Strong evidence of relative stability was also demonstrated, as alexithymia scores at baseline correlated significantly with alexithymia scores at follow-up and were also a significant predictor of follow-up alexithymia scores, after partialling the effects of depression and anxiety severity. Changes in alexithymia were explained only to a small extent by changes in depression and anxiety from T1 to T2. Results at the factor level revealed that "difficulty identifying feelings" follow-up and change score accounted for the highest variations in depression and anxiety, and "externally oriented thinking" for the lowest ones. CONCLUSIONS: The finding of relative stability of alexithymia supports the view that this construct is a stable personality trait rather than a state-dependent phenomenon, even in a context of high threat for physical and psychological integrity.     

Correlations between alexithymia and pain severity,depression, and anxiety among patients with chronic and episodic migraine

Aims: Some studies have found elevated alexithymia among patients with chronic pain, but the correlations between alexithymia and the severity of pain, depression, and anxiety among migraine patients are unclear. The aims of the present study were to investigate whether individuals suffering from episodic migraine (EM) differ from those with chronic migraine (CM) in regards to depression, anxiety, and alexithymia measures and to investigate the association of alexithymia with the results of depression and anxiety test inventories and illness characteristics. Methods: A total of 165 subjects with EM and 135 subjects with CM were studied. The Beck Depression Inventory (BDI), State–Trait Anxiety Inventory (STAI), and Toronto Alexithymia Scale (TAS) were administered to all subjects. The correlation between alexithymia and sociodemographic variables, family history of migraine and illness characteristics (pain severity, frequency of episode, duration of illness) were evaluated. Results: Compared with EM patients, the CM patients had significantly higher scores on measures of depression but not alexithymia and anxiety. There was a positive correlation between TAS scores and age and education in both migraine groups, but there was no correlation between TAS scores and other demographic variables. Depression and anxiety were significantly correlated with alexithymia in both migraine groups. Conclusion: Our results indicate that CM patients are considerably more depressive than EM patients. In this study, depression and anxiety were significantly correlated with alexithymia in both migraine groups. Our results demonstrate a positive association between depression, anxiety, and alexithymia in migraine patients.     

Family history of alcohol dependence and antidepressant response to an N‐methyl‐D‐aspartate antagonist in bipolar depression

Luckenbaugh DA, Ibrahim L, Brutsche N, Franco‐Chaves J, Mathews D, Marquardt CA, Cassarly C, Zarate CA Jr. Family history of alcohol dependence and antidepressant response to an N‐methyl‐d ‐aspartate antagonist in bipolar depression. Bipolar Disord 2012: 14: 880–887. Published 2012. This article is a U.S. Government work and is in the public domain in the USA. Objectives: Both ketamine and ethanol are N‐methyl‐d ‐aspartate (NMDA) receptor antagonists. Ketamine has rapid antidepressant properties in major depressive disorder (MDD) as well as bipolar depression. In individuals with MDD, a positive family history of alcohol dependence (FHP) was associated with greater improvement in depressive symptoms after ketamine administration compared to individuals whose family history of alcohol dependence was negative (FHN). This study investigated whether FHP influences ketamine’s antidepressant and perceptual effects in individuals with bipolar depression. Methods: A post hoc analysis was conducted on 33 subjects with DSM–IV bipolar disorder (BD) type I or II depression pooled from two previously published studies. All subjects had undergone a double‐blind, randomized, crossover trial of a single intravenous infusion of ketamine (0.5 mg/kg) combined with lithium or valproate therapy. Subjects were rated at baseline; at 40, 80, 120, and 230 min; and at days 1, 2, 3, 7, 10, and 14 post‐infusion. The primary outcome measure was Montgomery‐Åsberg Depression Rating Scale (MADRS) scores. Patients were categorized as FHP when they reported at least one first‐degree relative with alcohol dependence. Measures of psychosis, dissociation, and dysphoria were also collected. Results: After ketamine infusion, subjects with FHP showed significantly greater improvement on MADRS scores than FHN subjects. In addition, patients with FHP had attenuated psychotomimetic and dissociative scores compared to FHN patients. Conclusions: FHP appears to predict a more sustained antidepressant response to ketamine in individuals with BD. Family history of alcoholism may be an important consideration in the development of glutamatergic‐based therapies for depression.     

Alexithymia in adolescents with borderline personality disorder

ObjectiveThe aim of this study was to explore the relationship between alexithymia and borderline personality disorder (BPD) in adolescents.MethodsThe study investigated a sample of 59 consulting or inpatient adolescents with a well-established diagnosis of BPD (SIDP-IV) and a control sample of healthy adolescents individually matched by gender, age and socio-economic status. Alexithymia, depression and trait-anxiety were rated using the Twenty-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI-II) and the trait-anxiety subscale from the State-Trait Anxiety Inventory (STAI-T), respectively. A confirmatory factorial analysis (CFA) was performed to test the fit of the three-factor structure of the TAS-20 in the adolescent sample (N = 140). BPD and control groups were compared on alexithymic scores using ANCOVA analyses controlling for the potential confounding effects of depression and anxiety.ResultsThe ratio of the chi-square to its degrees of freedom, the goodness-of-fit index, the adjusted goodness-of-fit index and Steiger's root-mean-square error of approximation had satisfactory values of 1.54; 0.87; 0.83 and 0.058, respectively. The two ANCOVA demonstrated no significant difference for TAS-20 scores. BPD subjects were more alexithymic than healthy subjects but this difference was mainly explained by the levels of depression or anxiety.LimitationsSince BPD subjects have high comorbidity with depression or anxiety, longitudinal studies examining the absolute and relative stability of TAS-20 scores are necessary to determine whether alexithymia constitutes a state or a trait in BPD.ConclusionsBPD adolescents are characterized by alexithymia, probably of a secondary or state-dependent nature.     

Diagnosing social anxiety disorder in the presence of obesity: implications for a proposed change in DSM-5

Background: The proposed draft of the DSM‐5 from the Anxiety Disorder Workgroup recommends allowing the diagnosis of social anxiety disorder (SAD) in individuals with medical conditions, if the anxiety is considered to be excessive. Although prior research has examined diagnosing SAD in individuals with stuttering, such research has not yet been conducted in obese individuals. Methods: This study compared demographic and clinical characteristics of obese individuals diagnosed with DSM‐IV SAD (n = 135), modified SAD (clinically significant social anxiety related to weight only; n = 40), and a group of obese individuals with no history of psychiatric disorders (n = 616). All participants were seeking psychiatric clearance for bariatric surgery and completed a comprehensive diagnostic interview. Results: The two social anxiety groups differed from the no disorder group on adolescent and past 5 years social functioning, and overall current functioning. Individuals with modified SAD had a later onset of their social anxiety, yet reported greater impairment in social life and distress about their social anxiety compared to the DSM‐IV SAD group. Conclusions: Although both of the social anxiety groups differed from the no disorder group on social and overall functioning, there were few differences between those with DSM‐IV SAD and modified SAD. This suggests that obese individuals with social anxiety related to weight only may experience comparable severity of anxiety to those with DSM‐IV SAD, and supports adoption of the DSM‐5 Workgroup's recommendation to change criterion H. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Anxious and depressive disorders and their comorbidity: effect on central nervous system noradrenergic function.

BACKGROUND: Although comorbidity of anxiety with depression is common, investigations of physiologic abnormalities related specifically to comorbidity are rare. This study examined relationships of DSM-IV-defined depression, anxiety, and their comorbidity to noradrenergic function measured by blunting of the growth hormone (GH) response to the alpha2 adrenoreceptor agonist (and imidazoline receptor agent) clonidine and by blood pressure and symptom responses. METHODS: Fifteen subjects with pure social anxiety or panic disorder, 15 with pure major depression, and 18 with both depression and anxiety were compared with healthy control subjects matched for age and gender. Other factors known to affect GH (weight, menstrual status, prior antidepressant, or other drug exposure) were controlled. RESULTS: Anxiety produced GH blunting, but depression was associated with normal GH responses. The comorbid state did not affect results beyond the impact of anxiety. Preclonidine stress-related GH elevations were observed, to the greatest degree in anxious subjects. Relevant symptom, but not blood pressure, changes were significantly associated with blunting. CONCLUSIONS: With use of pure depression and anxiety groups and careful control of other factors known to affect GH, these results demonstrate central nervous system noradrenergic dysfunction in anxiety disorders. In contrast to less rigorously controlled studies, noradrenergic function in depression was normal.     

Relapse insomnia increases greater risk of anxiety and depression: evidence from a population-based 4-year cohort study

ObjectiveWe investigated the longitudinal impacts of insomnia on the subsequent developments of anxiety and depression during a four-year follow-up. We further categorized individuals with insomnia into different insomnia subgroups to examine whether the risk of anxiety and depression varies by subtype.MethodsParticipants were identified from National Health Insurance enrollees in Taiwan during 2002–2009. The study included 19,273 subjects with insomnia and 38,546 matched subjects without insomnia. All subjects did not have previous diagnosis of insomnia, sleep apnea, anxiety, or depression.ResultsCompared with non-insomniacs, insomniacs had a higher risk of developing anxiety only [adjusted hazard ratio (HR) = 8.83, 95% CI = 7.59–10.27], depression only (adjusted HR = 8.48, 95% CI = 6.92–10.39), and both anxiety and depression (adjusted HR = 17.98, 95% CI = 12.65–25.56). When breaking down the insomnia subgroups, individuals with a relapse of insomnia (adjusted HR = 10.42–26.80) had the highest risk of anxiety only, depression only, and both anxiety and depression, followed by persistent insomnia (adjusted HR = 9.82–18.98), then remitted insomnia (adjusted HR = 4.50–8.27). All three insomnia subgroups had a greater four-year cumulative incidence rate than the non-insomnia group for anxiety only, depression only, and both anxiety and depression (p < 0.0001).ConclusionOur findings reinforce the clinical predictor role of insomnia in the future onset of anxiety or/and depression. Awareness of insomnia and treatment of insomnia should be recommended at clinics, and patterns of insomnia should be monitored to help treatment and control of subsequent psychiatric disorders. Future research with comprehensive data collection is needed to identify factors that contribute to different insomnia subtypes.     

Subthreshold mania as predictor of depression during interferon treatment in HCV+ patients without current or lifetime psychiatric disorders

BACKGROUND: Depression is considered the most frequent interferon (IFN)-alpha-induced psychiatric disorder. However, other neuropsychiatric side effects of IFN treatment, such as irritability, anxiety, and manic episodes, are reported as well. We analyzed the impact of lifetime manic-hypomanic symptoms and anxiety on the development of depression in hepatitis-C-virus-infected subjects treated with two different types of IFN-alpha. METHODS: At baseline, subjects received thorough diagnostic assessment to exclude lifetime or current psychiatric symptoms. During treatment, subjects were administered interviewer-based and self-report instruments. RESULTS: Six (12%) of 49 individuals with a negative history of psychiatric disorders developed major depression during treatment with IFN. The onset of depression was significantly associated with the presence of lifetime subthreshold manic-hypomanic symptoms. Subjects exceeding manic threshold were more likely to develop depression than those below threshold (33.3% vs. 7.5%, P=.033). CONCLUSIONS: Our data suggest that individuals treated with IFN with no past history of psychiatric disorders are more likely to develop depression if they experienced subthreshold manic-hypomanic symptoms in their lifetime. These findings derive from an exploratory study and may have important implications for the prevention of IFN-induced depression if replicated in larger studies.     

Four Clinical Types of Panic Disorders

Abstract: The authors attempted to classify panic disorders into four types according to a clinical course and accompanying neurotic or depressive symptoms. The characteristics of each type are as follows; type I: a single panic attack is the only symptom, type 11 : only panic attacks occur frequently without any accompanying neurotic or depressive symptoms, type III: a recurrence of panic attacks and the gradual development of neurotic symptoms, such as anticipatory anxiety, generalized anxiety, agoraphobia, or hypo-chondriasis, type IV: depressive symptoms develop in the course of recurring panic attacks. Type IV is further divided into three subtypes. Type IV- 1 : depressive symptoms develop secondary to panic attacks and major depression later coexists with panic disorder. Type IV- 2 : panic disorder continuously changed into major depression. Type IV- 3 : panic attacks and depressive symptoms are seen independently. The most common types are type III and type IV-1, and seem to be a core group of the panic disorder. Typical cases of each type are presented and underlying psychopathology is discussed.     

Anxiety and impaired social function in the elderly.

The effect of anxiety on impairment in activities of daily living was examined among elderly individuals residing in a long-term care setting. Eighty one subjects received complete assessments of psychiatric symptoms, cognitive impairment, and ability to perform daily living tasks. A multivariate analysis was conducted to determine the relative influence of anxiety, cognitive status, and depressive symptoms on daily living skills. The presence of anxiety was significantly associated with reduced functional status in performing activities of daily living. This relationship remained significant even after controlling for the presence of concurrent depressive symptoms as well as cognitive impairment. Anxiety is a significant source of morbidity among elderly individuals and substantially impairs social function over and above the effects of depression and cognitive decline. Current interventions for anxiety such as benzodiazepines may have adverse cognitive effects, hence more specific intervention strategies for anxiety may be very important for this population.     

Fear conditioning in adolescents with anxiety disorders: results from a novel experimental paradigm

OBJECTIVE: Considerable research examines fear conditioning in adult anxiety disorders but few studies examine youths. Adult data suggest that anxiety disorders involve elevated fear but intact differential conditioning. We used a novel paradigm to assess fear conditioning in pediatric anxiety patients. METHOD: Sixteen individuals with anxiety disorders and 38 healthy comparisons viewed two photographs of actresses displaying neutral expressions. One picture served as the conditioned stimulus (CS), paired with a fearful expression and a shrieking scream (CS+), whereas the other picture served as a CS unpaired with the aversive outcome (CS-). Conditioning was indexed by self-reported fear. Subjects participated in two visits involving conditioning and extinction trials. RESULTS: Both groups developed greater fear of the CS+ relative to CS-. Higher fear levels collapsed across each CS characterized anxious relative to healthy subjects, but no significant interaction between group and stimulus type emerged. Fear levels at visit 1 predicted avoidance of visit 2. Fear levels to both CS types showed stability even after extinction. CONCLUSIONS: Consistent with adult data, pediatric anxiety involves higher fear levels following conditioning but not greater differential conditioning. Extending these methods to neuroimaging studies may elucidate neural correlates of fear conditioning. Implications for exposure therapies are discussed.     

Moderating effects of major depression on patterns of comorbidity in patients with panic disorder

Given the high rate of co-occurring major depression in patients with panic disorder, it is unclear whether patterns of comorbidity in individuals with panic disorder reported in the literature are associated with panic disorder or with the presence of major depression. Subjects were 231 adult subjects with panic disorder and major depression (n=102), panic disorder without comorbid major depression (n=29), major depression without comorbid panic disorder (n=39), and neither panic disorder nor major depression (n=61). Subjects were comprehensively assessed with structured diagnostic interviews that examined psychopathology across the life cycle. Panic disorder, independently of comorbidity with major depression, was significantly associated with comorbid separation anxiety disorder, simple phobia, obsessive-compulsive disorder, generalized anxiety disorder, and agoraphobia. Major depression, independently of comorbidity with panic disorder, was significantly associated with comorbidity with psychoactive substance use disorders and childhood disruptive behavior disorders. Overanxious disorder was associated with both panic disorder and major depression. Major depression has important moderating effects on patterns of comorbidity of panic disorder in referred adults.     

Anxious-depressive comorbidity: effects on HPA axis and CNS noradrenergic functions

Psychiatric comorbidity is all too common. An important example is the high comorbidity frequency of depressive and anxiety disorders, 25%-50%, much higher than the 5% or less expected by chance. Possible reasons for this comorbidity include definitional, environmental, and biological factors. Few previous studies have assessed, with proper methodology, potential biological changes associated with this co-occurrence. We assessed both hypothalamic-pituitary-adrenocortical axis (HPA) responses to the Trier Social Stress Test and growth hormone (GH) responses to clonidine, a centrally active alpha-2 adrenoreceptor agonist, in 15 persons with major depression without anxiety, 15 with an anxiety disorder without depression, 18 comorbid for anxiety and depression, and 48 individually matched control subjects. Individuals with depression only were normal on both tests, while those with anxiety only had normal HPA responses but blunted GH responses. Comorbid individuals showed elevated HPA responses and only those comorbid persons with anxiety symptoms predominant also showed blunted GH responses. Controls and anxiety-only subjects showed significant correlations between the results of the two tests. This association was disrupted by the presence of depression with or without comorbidity. Comorbidity is fundamental to understanding the pathophysiologies of depression and anxiety.     

Drug treatment of older people with affective disorders in the community: lessons from an attempted clinical trial.

BACKGROUND: Depression and phobic anxiety disorders are the most common psychiatric disorders in people aged 65 and over. SSRI antidepressants are effective in treating both conditions in younger people, and in treating depression in hospital samples of older subjects. No studies have investigated the efficacy of SSRIs in older people with these conditions living in the community. OBJECTIVES: To evaluate the efficacy and feasibility of treating older people suffering from depression and/or phobic anxiety in the community with fluoxetine alone. DESIGN: Subjects identified as depressed and/or anxious at screening were offered open-label fluoxetine and were reassessed for affective illness at 3 and 6 months. MEASURES: Outcome was assessed using the depression subscale of the Short Comprehensive Assessment and Referral Evaluation (Short-CARE) Scale and the Anxiety Disorder Scale. RESULTS: Of 67 subjects with depression and/or phobic anxiety, 55 (81%) were eligible to take fluoxetine. Fifty-four (98%) of these agreed to follow-up but only six (11%) agreed to take medication. No subject was still taking medication by the end of the study. Among those subjects on whom follow-up data were available, 70% of subjects depressed at screening and 97% of those with phobic anxiety retained their diagnoses at 3 months; at 6 months, the figures were 65% and 92% respectively. CONCLUSIONS: Drug treatment alone is not acceptable to older patients in the community with depression and phobic anxiety disorders. Discussion of symptoms with an appropriate professional is insufficient therapy on its own. Further work is needed to evaluate the effectiveness of a key worker such as a mental health nurse in coordinating treatment of patients with these disorders.     

Cerebral accumulation of Tc-99m ethyl cysteinate dimer (ECD) in severe, transient hypothyroidism.

Thyroid dysfunction is a well-known contributor to psychiatric morbidity. To investigate the mechanism(s) by which thyroid hormone availability affects cerebral activity, a group of thyroidectomized individuals were studied at two points in time: when markedly hypothyroid in preparation for a thyroid cancer metastatic survey and when clinically and/or biochemically euthyroid. The analysis consisted of single photon emission computed tomography (SPECT) using a lipophilic radiopharmaceutical, technetium-99m (Tc-99m) ethyl cysteinate dimer (ECD), and measurement of mood, anxiety, and psychomotor function, at both points in time. Both increases and decreases in regional cerebral radiotracer activity were found in the hypothyroid condition relative to the euthyroid condition, and the neuropsychological assessment demonstrated significantly greater depression, anxiety, and psychomotor slowing during the hypothyroid state. Increased radiotracer activity was seen in frontal and temporal regions, posterior cingulate gyrus, thalamus, and putamen. Decreased activity was seen in the occipital cortex, and the pre- and postcentral gyri. This distribution pattern is partially consistent with findings in persons with depression and anxiety unrelated to thyroid disease, supporting the link between the symptoms observed in our subjects and their marked hypothyroidism. Finally, these results support the need to consider the effect of the thyroid state on cellular mechanisms of uptake and retention of cerebral blood flow radiopharmaceuticals when studying 'noneuthyroid' individuals.     

Parkinson's disease: a preliminary study of yohimbine challenge in patients with anxiety.

In this pilot study, we performed an oral yohimbine challenge in 6 patients with Parkinson's disease (PD) and anxiety or depression, 2 parkinsonian patients without psychiatric illness, and 2 healthy control subjects to determine whether patients with Parkinson's disease and anxiety respond to this adrenergic agent in the same way patients with idiopathic anxiety disorders respond. Given the atypical nature of depression in Parkinson's disease (characterized by prominent anxiety), we also wanted to see if patients with Parkinson's disease and depression (but no history of anxiety) are susceptible to yohimbine-induced panic. Parkinsonian patients with anxiety developed panic attacks at frequencies comparable to primary psychiatric patients with panic disorder. The one patient with PD and a history of major depression alone developed a panic attack. Regardless of their history of anxiety or depression, parkinsonian patients demonstrated a vulnerability to yohimbine-induced somatic symptoms.