Exploring the Relationship Between Depressive and Anxiety Symptoms and Neuronal Response to Alcohol Cues

Background: Depressive and anxiety symptoms tend to co‐occur with heavy drinking. Specifically, their presence may exacerbate the severity and intractability of heavy drinking. Similarly, heavy drinking may increase the risk for and experience of depressive and anxiety symptoms. Although depressive and anxiety symptoms have been significantly correlated with alcohol craving in cue‐exposure paradigms, physiological responses have not always mapped onto emotional responses. Therefore, this study sought to examine the role of depressive and anxiety symptoms using a more basic science approach, through examining functional brain changes. Methods: Seventy nontreatment seeking, heavy drinking adults were recruited through a college campus (n = 45 men; mean age = 22.8). They completed measures of drinking, smoking, depressive symptoms, anxiety symptoms, and a functional magnetic resonance imaging (fMRI) cue‐exposure paradigm. Results: As hypothesized, depressive symptoms were positively correlated with activation during the alcohol (vs. appetitive control) cue in the insula, cingulate, ventral tegmentum, striatum, and thalamus (cluster‐corrected p < 0.05, z = 2.3). Similarly, anxiety symptoms were positively correlated with activation during the alcohol (vs. appetitive control) cue in the striatum, thalamus, insula, and inferior frontal, mid‐frontal, and cingulate gyri (cluster‐corrected p < 0.05, z = 2.3). Conclusions: Significant correlations were found between depressive symptoms, anxiety symptoms, and differential brain activation in response to an alcohol versus an appetitive control cue in an fMRI paradigm. Moreover, the pattern of activation mapped onto expected regions. This study strongly supports the posited relationships between depressive symptoms, anxiety symptoms, and differential brain activation in an alcohol cue‐exposure paradigm with a sample of heavy drinking adults.     

Situational Anxiety and Blood Pressure Lability in the Physician's Office

In order to evaluate the association between situational anxiety levels and blood pressure variability during physician's office visits, 19 patients were assessed at the beginning of the visit and before and after being examined by the physician. Assessment included blood pressure measurement as well as self-report of current anxiety level. Previous findings that systolic readings do significantly diminish over the course of the visit were replicated for both hypertensive and normotensive patients, accompanied by correlative decreases in state anxiety. Diastolic blood pressure readings were more stable and less associated with fluctuations in state anxiety, except in patients with initially higher diastolic readings. Results were interpreted as indicating the importance of using more than one blood pressure measurement in diagnosing hypertension and monitoring its management. In particular, patients’ anxiety responses upon entering the examining room may produce artificial elevations.     

Low Blood Pressure and Depressive Symptoms among Chinese Older Subjects: A Population-based Study

Background

The relationships between blood pressure and depression are unclear. There are inconsistent reports of an association between low blood pressure and depressive symptoms.

Methods

In a population-based sample of 2611 Chinese older adults aged 55 years and above, including participants with treated (n = 1088), untreated (n = 545), or no hypertension (n = 978), depressive symptoms were determined by the 15-item Geriatric Depression Scale (≥5), and current systolic blood pressure and diastolic blood pressure measurements were used to classify participants into high, normal, and low blood pressure groups. Estimates of association were adjusted for confounding by use of antihypertensive and depressogenic drugs and other covariables in hierarchical regression analyses.

Results

Systolic blood pressure and diastolic blood pressure were negatively associated with Geriatric Depression Scale scores, independent of other variables. Low systolic blood pressure (odds ratio [OR] 1.54; 95% confidence interval [CI], 1.07-2.22), low diastolic blood pressure (OR 1.67; 95% CI, 0.98-2.85), and low systolic blood pressure or diastolic blood pressure (or both) (OR 1.55; 95% CI, 1.10-2.19) were independently associated with depressive symptoms. The associations with depressive symptoms were particularly observed for low systolic blood pressure (OR 2.13; 95% CI, 1.13-4.03) among treated hypertensive participants, and low diastolic blood pressure (OR 2.42; 95% CI, 1.26-4.68) among untreated or nonhypertensive participants.

Conclusion

Low blood pressure was independently associated with depressive symptoms in both older subjects who were treated for hypertension and those who were not.     

Family History of Alcoholism in Women with Generalized Anxiety Disorder Who Have Premenstrual Syndrome: Patient Reports of Premenstrual Alcohol Consumption and Symptoms of Anxiety

This study sought to determine whether family history of alcoholism is related to patient reports of premenstrual alcohol consumption and whether family history of alcoholism is related to severity of anxiety-related symptoms, in women who suffer simultaneously from both premenstrual syndrome and generalized anxiety disorder. Fifty-four women with generalized anxiety disorder and prospectively demonstrated premenstrual syndrome were questioned about family history of alcoholism and alcohol consumption patterns across the menstrual cycle. Seventy-six percent of the sample reported having an alcoholic first- or second-degree relative. Furthermore, 74% of those women having a paternal-side family history of alcoholism, but only 22% of those without such a family history, reported increased alcohol consumption premenstrually. Forty-one of these women were assessed by means of psychiatric rating scales during both the premenstrual and follicular phases of the menstrual cycle. During the premenstrual, but not the follicular, phase of the menstrual cycle, women with a paternal-side family history of alcoholism experienced more severe anxiety-related somatic, but not psychic, symptoms of anxiety, than those without such a family history. These findings suggest that family history of alcoholism may be related to premenstrual alcohol consumption patterns and to the severity of premenstrually experienced somatic symptoms of anxiety in women with premenstrual syndrome, and that these women may be self-medicating with alcohol.     

Chronic Alcohol Intake Induces Reversible Disturbances on Cellular Na+ Metabolism in Humans: Its Relationship with Changes in Blood Pressure

The effect of chronic alcohol consumption on Na(+)-K+ ATPase, Na(+)-Li+ countertransport, outward Na(+)-K(+)-Cl- cotransport system and the Na+ leak was investigated in red blood cells from 18 normotensive subjects with a daily alcohol intake of more than 150 g. The study was repeated after 3 months of alcohol withdrawal, and results were compared with a group of 20 healthy normotensive teetotalers. Maximal efflux rate (Vmax) and apparent dissociation constant for internal Na+ (KNa) of the Na(+)-K+ pump and the Na(+)-Li+ countertransport were significantly higher in alcohol consumers. A positive correlation between daily alcohol intake and Vmax of both transport systems (p less than 0.05) was observed. These values significantly decreased after alcohol withdrawal. A simultaneous stimulation of the Na(+)-K(+)-Cl- cotransport system after alcohol withdrawal was also observed. Blood pressure values were higher in alcoholics (133.7/82.3) than in abstainers (121.4/75 mmHg) and significantly decreased (128.5/76.9 mmHg) after withdrawal. A positive correlation between the stimulation of the Na(+)-K(+)-Cl- cotransport and the decrease of blood pressure after withdrawal was observed. In conclusion, chronic alcohol intake induces disturbances on red blood cell Na+ metabolism that dissipate with the cessation of drinking. Similar abnormalities also reported in humans and animals with primary hypertension have been associated in the pathogenesis of essential hypertension. Therefore, the pressor effect of chronic alcohol intake could be mediated through these changes in cellular Na+ metabolism.     

A Small Dose of Morphine Leads Rats to Drink More Alcohol and Achieve Higher Blood Alcohol Concentrations

Male Sprague-Dawley rats were maintained on a daily regimen of 22 hr of fluid deprivation followed by a 2-hr opportunity to take a sweetened alcoholic beverage and water for over 6 months. Durinc the week before the formal procedures of the experiment describee herein, access to the alcoholic beverage was limited to 1.5 hr, but access to water was still for 2 hr. Intakes of ethanol, in terms of g/kg, were tabulated at 30 min for half of the rats and at 90 min for the rest. On the day of formal procedures, half of the rats of the 30- and 90-min measures were given 1 mg/kg of morphine sulfate just before the drinking session, whereas the rest received physiological saline Morphine increased mean g/kg intakes of ethanol, as compared with controls, at 30 and 90 min. Blood alcohol levels were also increased These data suggest that the well-documented ability of small doses of morphine to increase rats' intake of ethanol is probably not related to its ability to produce gastrointestinal effects, but rather due to its ability to modulate central motivational mechanisms associated with ingestion.     

The Effect of Sodium Intake on the Blood Pressure Related to age and Sex

Two hundred and one volunteers with no known hypertension and 60 patients with untreated hypertension were entered into a study that compared the effect of two levels of sodium intake on blood pressure. One hundred and fifty-four volunteers and 46 hypertensive patients reached compliance goals, with a urinary sodium excretion on the high sodium diet twice that on the reduced sodium intake. The blood pressure on the high sodium diet was 4.5 ± 0.5 mmHg (n=154 p > 0.001) higher than on the reduced sodium diet in normotensive individuals and was increased by 8.4 ± 1.5 mmHg (n=46 p > 0.001) in hypertensive individuals. In the volunteer group the major rise in blood pressure occurred in people over the age of 50. In the hypertensive patients the alteration in blood pressure was not age dependent. In the younger age groups some individuals had an increase in blood pressure when on the high sodium intake which was outside the spontaneous variations in blood pressure of a control group. This implied that a number of young normotensive individuals were susceptible to this alteration in sodium intake.

Changes in sodium intake alter blood pressure in hypertensive people, in normotensive people over 50 and in a small number of younger normotensive people. Overall reduction of sodium intake from 200 - 70 mmol/day would reduce the blood pressure level of the population and would reduce the number of people who have a blood pressure that requires drug therapy.     

The Association between Generalized Anxiety Disorder,Subthreshold Anxiety Symptoms and Fear of Falling among Older Adults: Preliminary Results from a Pilot Study

ABSTRACT

Objective: A relationship between generalized anxiety disorder (GAD) and fear of falling (FOF) has long been proposed but never specifically studied. This study aimed at analyzing the relationship between FOF and GAD or anxiety symptoms, while controlling for major depressive episodes (MDE), depressive symptoms, fall risk, and sociodemographic variables.

Methods: Twenty-five older adults participated in this pilot study. Assessments included the following: Anxiety Disorder Interview Schedule, Geriatric Anxiety Inventory, Geriatric Depression Scale, Falls-Efficacy Scale—International. A multidisciplinary team evaluated fall risk.

Results: FOF was significantly correlated with GAD, MDE, anxiety and depressive symptoms, and fall risk, but not with sociodemographic variables. Multiple regression analyses indicated that GAD and anxiety symptoms were significantly and independently associated with FOF.

Conclusion: Although the results of this pilot study should be replicated with larger samples, they suggest that FOF is associated with GAD and anxiety symptoms even when considering physical factors that increase the risk of falling.

Clinical Implications: Treatment of FOF in patients with GAD may present a particular challenge because of the central role of intolerance of uncertainty, which may prevent patients from regaining confidence despite the reduction of fall risk. Clinicians should screen for GAD and anxiety symptoms in patients with FOF to improve detection and treatment.     

MAST Scores, Alcohol Consumption, and Gynecological Symptoms in Endometriosis Patients

Alcohol consumption (quantity, frequency, and pattern) and alcoholrelated problems were determined in endometriosis patients ( n = 137), patients with other gynecological disorders ( n = 91), and normal control subjects ( n = 98). Participants completed a self-administered questionnaire, including the Michigan Alcoholism Screening Test (MAST), questions to determine the quantity and frequency of alcohol use, and questions regarding the relationship between gynecological symptoms and alcohol intake. The percentage of endometriosis patients with MAST scores greater than five or seven was significantly greater than that of normal control subjects ( p = 0.045 and p = 0.009, respectively), but did not differ from that for patients with other gynecological disorders. Endometriosis patients with high MAST scores (≥5) tended to consume more alcohol on a yearly basis than normal control subjects with high MAST scores ( p = 0.07). Among participants who experienced gynecological symptoms and were not abstainers, 31% of endometriosis patients, 9.5% of normal control subjects, and 14.3% of patients with other gynecological disorders reported increasing their alcohol consumption when experiencing gynecological symptoms. Endometriosis patients tended to differ in this regard from normal control subjects ( p = 0.058) and were significantly different from patients with other gynecological disorders ( p = 0.039). The evidence suggests that the gynecological problems of endometriosis may be a major medical correlative of alcoholism in women.     

脑卒中先兆证候分类与血压、血脂、血液流变学的相关性研究

目的：探讨脑卒中先兆证候分类的客观指标。方法：对84例脑卒中先兆病人按中医证候分组，观察各组病人血压、血脂、血液流变学变化，并与相同例数的正常对照组相比较。结果：肝胆火旺、痰瘀闭阻证组血压明显高于风痰内盛、瘀血阻络证组及气阻两虚、脉络瘀滞证组（P＜0．05）；肝胆火旺、痰瘀闭阻证组、风痰风盛、瘀血阻络证组及气阴两虚、脉络瘀滞证组脂质变化均较正常对照组明显升高（P＜0．05－0．01）；其中肝胆火旺、痰瘀闭阻证组及风痰内盛、瘀血阻络证组与气阴两虚、脉络瘀滞证组比较有统计学意义（P＜0．05）；三证型组血液流变学指标较正常组有统计学意义（P＜0．05－0．01）。结论：血压、血脂、血液流变学改变可为脑卒中先兆证候分类提供客观指标。     

Anxiety and Drinking Behavior: Moderating Effects of Tension-Reduction Alcohol Outcome Expectancies

We evaluated whether alcohol outcome expectancies moderate the association between measures of anxiety and alcohol use. Student subjects completed questionnaires related to their level of anxiety, recent alcohol-use patterns, and outcome expectancies for alcohol to be tension reducing. Interviews were used to determine the presence or absence of alcohol dependence in subjects and in their first- and second-degree relatives. Consistent with predictions, male subjects with high tension-reduction alcohol outcome expectancies showed a stronger positive correlation between measures of anxiety and drinking behavior than did male subjects with low tensionreduction outcome expectancies. However, this effect was not found for female subjects. We note past studies showing similar gender effects, and relate the overall study findings to the tension-reduction hypothesis of stress-induced drinking.     

血压负荷与诊室血压的关系

目的探讨诊室血压与动态血压负荷关系。方法选取不同血压水平受试者90mmHg组,≥90mmHg组(≥95mmHg(轻、中度高血压))组,比较其诊室血压水平与对应的动态血压负荷值(血压负荷界值定义白天140/90mmHg、夜间120/80mmHg)及其相关性。结果入选53例成年(18岁)正常血压及轻、中度高血压患者,其中男37例,女16例,平均年龄53.7±8.7岁。坐位舒张压(DBP)90mmHg者(组1)31例,≥90mmHg者(组2)22例,其中≥95mmHg者16例。血压负荷:舒张压:组1的血压负荷为17%-29%(组间P0.01)。组2的为75%-84%。组3的为86%-91%。组2与组3比较P0.05。②收缩压:组1的血压负荷为33%-53%(组间P0.01)。组2的为75%-88%。组3的为76%-90%,与≥90mmHg比P0.05。诊室血压与其血压负荷的相关性(CC:相关系数):.舒张压:组1的CC为0.70-0.76,组2的为0.50-0.70。组3的为0.08-0.57。②收缩压:组1的为0.78-0.86,组2的为0.54-0.68,组3的为0.35-0.57。结论血压水平与血压负荷成正相关;轻中度血压与血压负荷相关性对临床更有指导意义。     

Factors Associated with Anxiety and Depressive Symptoms in 2775 Patients with Arterial Hypertension and Coronary Heart Disease: Results from the COMETA Multicenter Study

Aim:To identify associations of anxiety symptoms (AS) and depressive symptoms (DS) with other psychosocial and lifestyle risk factors in primary care patients with arterial hypertension (AH) and/or coronary heart disease (CHD).Methods:COMETA (Clinical-epidemiOlogical prograM of studying psychosocial risk factors in cardiological practice in patiEnts with arterial hyperTension and ischemic heArt disease) is a multicenter cross-sectional study performed in 30 big cities of Russia with two to five out-patient clinics per city randomly selected and two to five general practitioners (GPs) per an out-patient clinic. Each GP included 8–10 consecutive patients with AH and/or CHD. AS and DS were assessed by the Hospital Anxiety and Depression Scale.Results:325 GPs enrolled 2775 patients (mean age 66.7 years, 72% women) with AH (60.8%), CHD (2.6%), and AH plus CHD (36.6%). Moderate/severe (≥11 HADS) AS were found in 25.5% and DS in 16.3% patients. The strongest associations of AS and DS were revealed for high stress level (OR 5.79; 95% CI [4.18–8.03]), moderate stress level (OR 2.34; 95% CI [1.73–3.16]), low social support (OR 1.87; 95% CI [1.31–2.68]) and female gender (OR 1.78; 95% CI [1.41–2.25]). Low physical activity, unhealthy eating, unemployment and low income were also positively associated with both AS and DS (p < 0.003 for all).Conclusion:In out-patients with AH and CHD, AS and DS were strongly associated with higher levels of stress, low social support, unemployment, low family income and unhealthy lifestyle such as low physical activity, low fruit and vegetables intake and excessive salt consumption. Our findings indicate that patients with AH and CHD, who have anxiety and depressive symptoms need extra attention and monitoring in regard to stress and lifestyle risk factor control.     

Alcohol dependence is related to overall internalizing psychopathology load rather than to particular internalizing disorders: evidence from a national sample

Background: Alcohol dependence is more prevalent among those with any one of several anxiety or depressive (“internalizing”) disorders than among those in the general population. However, because internalizing disorders are highly intercorrelated, it is ambiguous whether alcohol dependence is related to internalizing psychopathology components that are: (i) unique to a particular internalizing disorder (“specific”); versus (ii) shared across a number of internalizing disorders (“general”). To clarify this ambiguity, we employed structural equation and logistic models to decompose the specific versus general components of internalizing psychopathology and then related these components separately to alcohol dependence. Methods: The data were based on face‐to‐face interviews of U.S. community residents collected in the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Results: Both analytic approaches demonstrated that increases in the general internalizing psychopathology load are accompanied by increases in the prevalence of alcohol dependence. Once the general internalizing psychopathology load is accounted for, knowing whether a particular internalizing disorder is present or absent provides little additional information regarding the prevalence of alcohol dependence. Conclusions: The components of internalizing psychopathology that are associated with alcohol dependence are shared and cumulative among common anxiety and depressive disorders. These findings have the potential to influence clinical and scientific conceptualizations of the association between alcohol dependence and internalizing psychopathology.     

Blood Glucose Level, Alcohol Heavy Drinking, and Alcohol Craving During Treatment for Alcohol Dependence: Results From the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study

Background: Heavy drinking may increase blood glucose levels. Moreover, in alcohol‐dependent subjects, glucose may play a putative role in alcohol preference. Methods: This study investigated the relationship between blood glucose levels and both alcohol heavy drinking and craving in alcohol‐dependent subjects participating in the COMBINE Study. The primary objective was to evaluate the relationship between baseline (pretreatment) glucose levels and percentage of heavy drinking day (PHDD) during treatment. The secondary objective was to evaluate the relationship between glucose levels, baseline PHDD, and craving measured by the Obsessive Compulsive Drinking Scale (OCDS). Results: This analysis consisted of 1,324 participants. Baseline glucose levels were significantly and positively associated with PHDD during treatment [F(1, 1225) = 5.21, p = 0.023], after controlling for baseline PHDD [F(1, 1225) = 36.25, p < 0.0001], gender [F (1, 1225) = 3.33, p = 0.07], and body mass index (BMI) [F(1, 1225) = 0.31, p = 0.58]. Higher glucose levels at baseline were associated with a higher percentage of PHDD at pretreatment [F(1, 1304) = 5.96, p = 0.015], after controlling for gender [F(1, 1304) = 0.29, p = 0.59] and BMI [F(1, 1304) = 0.90, p = 0.34]. Glucose was not significantly associated with the OCDS total score [F(1, 1304) = 0.12, p = 0.73], the OCDS Obsessive subscale [F(1, 1304) = 0.35, p = 0.56], or the OCDS Compulsive subscale [F(1, 1304) = 1.19, p = 0.28] scores, after controlling for gender and BMI. Discussion: A link between pretreatment glucose levels and heavy drinking during treatment was found, suggesting a role of glucose in predicting heavy alcohol consumption. Although caution is needed in the interpretation of these results, elevated glucose and heavy drinking may be affected by a common mechanism and manipulations affecting glucose regulation may influence alcohol consumption.