Anxiety Disorder Journal

African-Americans and other racial minorities have sleep durations associated with increased mortality. This is consistent with the belief that unhealthy sleep patterns among minorities — long sleep or short sleep — may contribute to health differentials, according to a study published in the journal SLEEP.

The study, authored by Lauren Hale, PhD, assistant professor in the graduate program in public health at Stony Brook University, focused on the responses of 32,749 people 18 years of age and older to a National Health Interview Survey (NHIS).

According to the results, African-American respondents had an increased risk of being short and long sleepers (less than or equal to six hours and greater than or equal to nine hours, respectively) relative to Caucasian respondents. Hispanics, excluding Mexican-Americans, and non-Hispanic “others” were also associated with increased risk of short sleeping.

The study also found that living in an inner city was associated with increased risk of short sleeping and reduced risk of long sleeping, compared to non-urban areas. Some of the higher risk of short sleeping among African-Americans can be explained by a higher prevalence of African-Americans’ habitation in the inner city.

“Inadequate or prolonged sleep durations may be due to an abundance of life stressors among racial minorities and residents of urban environments,” said Dr. Hale. “For example, people from disadvantaged communities may not have the luxury of sleeping through the night if they work night shifts or multiple jobs. People in poorer neighborhoods may also experience greater levels of psychosocial stress or depression that makes it difficult to fall or stay asleep.”

Social factors may also play a role in explaining these relationships, said Dr. Hale, adding that, for example, late-night socializing may be more common in the large cities because of the proximity of friends, households and increased opportunities for various social activities.

Structural conditions related to neighborhood and living environment may also contribute to the increased likelihood of high-risk sleep duration among racial minorities and city residents, noted Dr. Hale.

“Environmental factors of the inner city may prevent a solid night’s rest. Noise or light pollution may keep city residents awake later or wake them up earlier than those in less urban areas. These factors might lead to either shortening sleep or increasing fragmentation of sleep leading to prolonged reported sleep durations,” said Dr. Hale.

Lastly, Dr. Hale added that there may also be physiological differences in the demand for or the ability to sleep by racial category that are also associated with neighborhood characteristics.

Dr. Hale warned that these cross-sectional relationships are not sufficient to identify a causal link between race and sleep duration, and should not be over-interpreted.

“There may also be concerns about the use of self-reported data,” said Dr. Hale. “For example, people with sleep apnea may be reporting longer sleep times because they are in bed for longer, but they may not be sleeping more. That said, the results of this study are consistent with the hypothesis that unhealthy sleep patterns among African-Americans and city residents may contribute to health differentials.”

Dr. Hale noted that this information can assist public health and health care professionals in identifying segments of the population that are at a higher risk for sleep or sleep-related disorders. An understanding of the correlations between race, neighborhood context and sleep duration may also provide help in explaining outcomes where there are other racial disparities, such as test score gaps, educational attainment, employment and crime, said Dr. Hale. It may also lead to the incorporation of sleep and other biological variables in future public health, urban planning and social science research, added Dr. Hale.

Since 1957, the NHIS has conducted nationwide household interviews to collect information concerning the health of the U.S. civilian non-institutionalized population. The survey collects information on race/ethnicity, socioeconomic characteristics and health status.

Experts recommend that adults get 7-8 hours of sleep each night for good health and optimum performance.

Those who suspect that they might be suffering from a sleep disorder are encouraged to discuss their problem with their primary care physician or a sleep specialist.

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Treatment that combines a certain type of psychotherapy with an antidepressant medication is most likely to help children with anxiety disorders, but each of the treatments alone is also effective, according to a new study funded by the National Institutes of Health’s National Institute of Mental Health (NIMH). The study was published online Oct. 30, in the New England Journal of Medicine.

“Anxiety disorders are among the most common mental disorders affecting children and adolescents. Untreated anxiety can undermine a child’s success in school, jeopardize his or her relationships with family, and inhibit social functioning,” said NIMH Director Thomas R. Insel, M.D. “This study provides strong evidence and reassurance to parents that a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective.”

The Child/Adolescent Anxiety Multimodal Study (CAMS) randomly assigned 488 children ages 7 years to 17 years to one of four treatment options for a 12-week period:

• Cognitive behavioral therapy (CBT), a specific type of therapy that, for this study, taught children about anxiety and helped them face and master their fears by guiding them through structured tasks;

• The antidepressant sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI);
• CBT combined with sertraline;
• pill placebo (sugar pill).

The children, recruited from six regionally dispersed sites throughout the United States, all had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia. Many also had coexisting disorders, including other anxiety disorders, attention deficit hyperactivity disorder, and behavior problems.

John Walkup, M.D., of Johns Hopkins Medical Institutions, and colleagues found that among those in combination treatment, 81 percent improved. Sixty percent in the CBT-only group improved, and 55 percent in the sertraline-only group improved. Among those on placebo, 24 percent improved. A second phase of the study will monitor the children for an additional six months.

“CAMS clearly showed that combination treatment is the most effective for these children. But sertraline alone or CBT alone showed a good response rate as well. This suggests that clinicians and families have three good options to consider for young people with anxiety disorders, depending on treatment availability and costs,” said Walkup.

Results also showed that the treatments were safe. Children taking sertraline alone showed no more side effects than the children taking the placebo and few children discontinued the trial due to side effects. In addition, no child attempted suicide, a rare side effect sometimes associated with antidepressant medications in children.

CAMS findings echo previous studies in which sertraline and other SSRIs were found to be effective in treating childhood anxiety disorder. The study’s results also add more evidence that high-quality CBT, with or without medication, can effectively treat anxiety disorders in children, according to the researchers.

“Further analyses of the CAMS data may help us predict who is most likely to respond to which treatment, and develop more personalized treatment approaches for children with anxiety disorders,” concluded Philip C. Kendall, Ph.D., of Temple University, a senior investigator of the study. “But in the meantime, we can be assured that we already have good treatments at our disposal.”

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Put a mouse or a rat under stress and what does it do? It stops eating. Humans should be so lucky. When people suffer nontraumatic stress they often head for the refrigerator, producing unhealthy extra pounds.

When Syrian hamsters, which are normally solitary, are placed in a group-living situation, they also gain weight. So scientists at the Center for Behavioral Neuroscience at Georgia State University are using hamsters as a model for human stress-induced obesity. They want to begin unraveling the complex factors that lead people to eat when under stress and hope that the information can eventually be used to block appetites under this common scenario.

The study, “Social defeat increases food intake, body mass, and adiposity in Syrian hamsters,” by Michelle T. Foster, Matia B. Solomon, Kim L. Huhman and Timothy J. Bartness, Georgia State University, Atlanta, appears in the May issue of the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology published by The American Physiological Society.

Hamsters similar to humans

In the study, the researchers look at nontraumatic stress — the stress we experience in everyday life, such as getting stuck in traffic or trying to complete a major project at work. It is distinct from traumatic stress, such as suffering the death of a loved one. Traumatic stress typically dulls the human appetite, said Bartness, the study’s senior researcher and an authority on obesity.

In the U.S., where food is plentiful and relatively cheap, overeating can be difficult to control. Stress-related overeating is more difficult to control than the overeating that people do just because food tastes good and is available, Bartness said. If scientists could learn how to reduce the urge to eat in the face of stress, it could improve the health of a lot of people. And that was the point of this study.

The researchers used Syrian hamsters, the kind commonly found in pet stores. They set up a situation in which subordinate hamsters would suffer a “social defeat” at the hands of a dominant hamster. The researchers wanted to see if the defeated hamsters would eat more and gain weight under the stress, just like a human. Mice and rats eat less and lose weight when subjected to a similar stress, making them a poor subject for human stress-induced obesity research.

The study asked three questions:

* Does repeated social defeat increase food intake, weight and fat in hamsters?
* If so, how many defeats are necessary?
* Do intermittent (unpredictable) defeats increase fat and food intake more than consecutive (predictable) defeats, as is true in humans?

An uncomfortable situation

To answer these questions, the researchers placed an 11-week-old hamster (the subordinate intruder) into the cage of an older and larger hamster (the dominant resident). The intruder remained in the aggressor’s cage for seven minutes per trial. The situation set up a clear dominant versus subordinate situation between the hamsters, the authors explained.

“Hamster aggression is highly ritualized, with dominance or submission generally established within the first minute and maintained thereafter through social signals and social communication between the opponents,” the authors wrote. The intensity of most agonistic encounters was moderate, with some chasing and biting, but with no actual tissue damage.

A trained observer recorded submissive behaviors and also ensured that no harm came to either of the hamsters, which normally live alone. Because the smaller hamster was the intruder, the outcome of the dominance/submissive tussle was a foregone conclusion.

The researchers found that, as a result of the stress of being placed in the home cage of a larger resident, intruder hamsters subsequently:

* ate significantly more
* gained significantly more weight
* gained significantly more fat, including visceral fat

These results occurred when the intruder hamsters were placed in the foreign cage as few as four times, a total of 28 minutes, over the 33-day experiment, Bartness explained. Hamsters that were placed in the situation only once during the experiment did not eat more or gain weight compared to a control group. In addition, the intruder hamsters that were placed in the cage intermittently (at unpredictable times) showed comparable weight and fat gain compared to those placed in a foreign cage consecutively (at regular times).

However, while the intermittent group increased on all measures of fat gain, the consecutive group increased on only two of the fat measures. Still, this was an unexpected result.

“In humans, unpredictable [stress] events are more aversive than predictable events, causing greater alterations in homeostasis and thus increased stress,” the authors wrote. “In addition, previous research suggests that unpredictable events cause greater activation in brain regions responsible for fear and anxiety in laboratory rats and reduction in immune function compared with events that are predictable.”

Next steps

Syrian hamsters provide a good model for obesity research, not only because they eat more and gain weight, but because, like humans, they add fat to their abdomens — visceral fat. Visceral fat is particularly unhealthy because it affects the internal organs and is associated with diabetes, cancer and other serious illnesses, Bartness said.

Bartness’ team began a second study to determine whether other stressors, such as a mild foot shock, produce the same effect as the social defeat model; and whether the dominant hamsters gain weight and fat as the result of the intrusion of the submissive hamsters.

Another line of inquiry would be to compare mice and rats to hamsters. Humans and hamsters, which eat more under stress, share the same predominant stress hormone, cortisol, noted Bartness, Rats and mice, which eat less under stress, have a different primary stress hormone, corticosterone. This raises the question of whether stress-induced increases in cortisol play a more important role in the desire to eat and weight gain compared to corticosterone.

Researchers will also want to know if drugs can block stress-induced obesity, for example, by blocking the release of the stress hormone, corticotrophin releasing factor (CRF), or by blocking the body’s CRF receptors, Bartness said. CRF, also sometimes referred to as corticotrophin releasing hormone, produces the body’s “fight or flight” response under stress and helps kick off a cascade of physiological responses.

“There are a whole suite of physiological responses that occur as a result of stress,” Bartness said. It will take time to unravel all these physiological responses and to use that knowledge to block stress-induced obesity. It may even turn out that the reactions are too complex to easily block, he said.

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A woman’s daily stress can reduce her ability to fight off a common sexually transmitted disease and increase her risk of developing the cancer it can cause, according to a new study. No such association is seen, however, between past major life events, such as divorce or job loss, and the body’s response to the infection.

Human papillomavirus (HPV) is spread during sexual intercourse. The most common subtype of the virus is HPV16. Infection with HPV16 and other HPV subtypes can cause cervical cancer.

“HPV infection alone is not sufficient to cause cervical cancer,” explained Fox Chase Cancer Center’s Carolyn Y. Fang, Ph.D. “Most HPV infections in healthy women will disappear spontaneously over time. Only a small percentage will progress to become precancerous cervical lesions or cancer. An effective immune response against HPV can lead to viral clearance and resolution of HPV infection. But some women are less able to mount an effective immune response to HPV.”

Fang and her colleagues hypothesized that stress could lead to alterations in immune functioning that make the body less able to effectively clear the virus. Their study exploring this hypothesis appears in the February issue of Annals of Behavioral Medicine (volume 17, number 1).

In the study, researchers examined potential associations between stress and immune response to HPV among women who had precancerous cervical lesions. The women were asked to complete a questionnaire about their perceived stress in the past month and about major stressful life events that had occurred, such as divorce, death of a close family member or loss of a job.

“We were surprised to discover no significant association between the occurrence of major stressful life events and immune response to HPV16. This could be due to the amount of time that has passed since the event occurred and how individuals assess and cope with the event,” said Fang. “Our findings about subjective daily stress told a different story, however. Women with higher levels of perceived stress were more likely to have an impaired immune response to HPV16. That means women who report feeling more stressed could be at greater risk of developing cervical cancer because their immune system can’t fight off one of the most common viruses that causes it.”

Fox Chase Cancer Center was founded in 1904 in Philadelphia as the nation’s first cancer hospital. In 1974, Fox Chase became one of the first institutions designated as a National Cancer Institute Comprehensive Cancer Center. Fox Chase conducts basic, clinical, population and translational research; programs of cancer prevention, detection and treatment; and community outreach.

Fang’s study was funded by a grant from the National Cancer Institute.

In addition to Fang, other authors include Suzanne M. Miller, Ph.D., Fox Chase Cancer Center, Philadelphia, PA; Dana H. Bovbjerg, Ph.D., Mount Sinai School of Medicine, New York, NY; Cynthia Bergman, M.D., Fox Chase Cancer Center, Philadelphia, PA; Mitchell I. Edelson, M.D., Abington Memorial Hospital, Abington, PA; Norman G. Rosenblum, M.D., Ph.D., Thomas Jefferson University Hospital, Philadelphia, PA; Betsy A. Bove, Ph.D., Fox Chase Cancer Center, Philadelphia, PA; Andrew K. Godwin, Ph.D., Fox Chase Cancer Center, Philadelphia, PA; Donald E. Campbell, Ph.D., Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; and Steven D. Douglas, M.D., Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA.

Fox Chase Cancer Center
7701 Burholme Ave.
Philadelphia, PA 08065
United States
http://www.fccc.edu

AstraZeneca announced new SEROQUEL XR™ (extended release quetiapine fumarate) clinical study data in patients with Generalised Anxiety Disorder (GAD), presented at the 21st European College of Neuropsychopharmacology (ECNP) Congress in Barcelona. In this study, extended release quetiapine fumarate significantly improved symptoms of anxiety at Week 8 compared with placebo and this was observed as early as day 4. The active comparator arm, escitalopram 10mg/day, was also effective at improving symptoms of GAD at week 8 compared with placebo although improvement was not observed at day 4.

During their lifetimes, it is estimated between 2.7% and 5.4% of people in Europe will suffer from GAD.1 Characteristic symptoms include chronic anxiety, exaggerated worry and tension – it is often accompanied by depression or other anxiety disorders2,3 – and it has a substantial negative impact on Health-Related Quality of Life (HRQoL), productivity at work (including absenteeism) and healthcare costs1.

Antidepressants (SSRIs (selective-serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors)) are standard treatments that are generally effective but approximately 30 percent of patients treated with SSRIs or SNRIs will have an inadequate response4. Additionally, they may have a relatively slow onset of action, sometimes requiring combination with a short course of benzodiazepines (BZDs) to achieve initial symptom control – however, BZDs may have the potential for dependence and withdrawal symptoms5.

The data presented today in Barcelona are the results of Study 10 – conducted across 64 centres in the U.S. and part of the clinical development programme for extended release quetiapine fumarate for the treatment of GAD6. A total of 854 patients aged 18-65 with a DSM-IV3 diagnosis of GAD were randomized to receive either extended release quetiapine fumarate 150mg/day (n=219), 300mg/day (n=207), escitalopram 10mg/day (n=213) or placebo (n=215). At week 8, extended release quetiapine fumarate 150mg/day, 300mg/day and escitalopram 10mg/day, significantly reduced mean Hamilton Anxiety Rating Scale (HAM-A) total scores from randomization compared with placebo (-13.9 [p<0.001], -12.3 [p<0.05], -12.3 [p<0.05] versus – 10.7). At day 4, mean HAM-A total scores were significantly reduced from randomization with extended release quetiapine fumarate 150mg/day, 300mg/day (-6.7, -6.3, p<0.001) but not with escitalopram 10mg/day (-4.6, p=0.889), compared with placebo (-4.5) 6.

Both extended release quetiapine fumarate and escitalopram were generally well tolerated. Among extended release quetiapine fumarate treated patients, adverse events with incidence greater than 10% and twice that of placebo were dry mouth, somnolence, sedation and constipation; among escitalopram-treated patients they were sedation and nausea.

The incidence of AEs associated with EPS among patients treated with extended release quetiapine fumarate 150mg/day, 300mg/day, escitalopram 10mg/day or placebo were 4.2%, 6.0%, 6.8% and 5.7% respectively; the incidence of AEs associated with sexual dysfunction were were 4.1%, 3.9%, 8.1% and 3.7% respectively. The proportions of patients who experienced a clinically important shift in fasting blood glucose (from normal to >126mg/dL) were 3.7%, 1.6%, 1.1% and 3.2% in the quetiapine fumarate 150mg/day, 300mg/day, escitalopram 10mg/day or placebo groups, respectively; the proportions of patients experiencing >7% increase in weight were 3.8%, 3.9%, 0.5% and 0.9% respectively6.

About Generalized Anxiety Disorder (GAD)

GAD is characterized by chronic anxiety, exaggerated worry, and tension, even when there is little or nothing to provoke it. People with GAD anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work.2,3

People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flushes. GAD is diagnosed when someone excessively worries about a number of everyday problems for at least 6 months2,3.

About SEROQUEL and SEROQUEL XR

In May 2008, SEROQUEL XR™ (extended release quetiapine fumarate) became the first ever antipsychotic to complete a clinical development programme and be filed with the FDA in the U.S. for approval in the treatment of GAD7 – today it is not approved in any country for the treatment of GAD but remains under review with the FDA. SEROQUEL XR™ is approved in the US and 28 further countries for the treatment of schizophrenia in adult patients and for maintenance treatment of schizophrenia in adult patients. It was launched in the US in 2007 and earlier this year AstraZeneca announced the submission of regulatory applications in both the US and European Union for SEROQUEL XR in the treatment of manic episodes associated with bipolar disorder, and the treatment of depressive episodes associated with bipolar disorder. An sNDA for SEROQUEL XR seeking approval for the treatment of Major Depressive Disorder in the US was also announced in February. SEROQUEL XR is not approved for these indications at this time and the applications remain under review by the regulatory authorities.

Launched in 1997, it is estimated that SEROQUEL has been prescribed to more than 22 million patients worldwide*. It is approved in 88 countries for the treatment of schizophrenia, in 79 countries for the treatment of bipolar mania, and in 11 countries including the US for the treatment of bipolar depression. It was also recently approved by the FDA in the USA for the for the maintenance treatment of patients with bipolar I disorder, as adjunct to lithium or valproate – a similar submission has been made in Europe.

* Based on assumptions: (1) estimated number of prescriptions per patient based upon IMS APLD data; and (2) IMS Prescription data for SEROQUEL covering 13 major markets in which this data is available since the time of launch.

About AstraZeneca

AstraZeneca is a major international healthcare business engaged in research, development, manufacturing and marketing of prescription pharmaceuticals and supplier for healthcare services. AstraZeneca is one of the world’s leading pharmaceutical companies with healthcare sales of US $29.55 billion and is a leader in gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection product sales. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.

http://www.astrazeneca.com

References

1 Wyrwich KW et al. A review of the humanistic and economic outcomes in European patients diagnosed with generalized anxiety disorder. Presented at the 161st Annual Meeting of the American Psychiatric Association, 2008. NR3-065.

2 National Institute of Mental Health: Anxiety Disorders. NIH Publication No. 06-3879. Available here. Accessed 5 August, 2008.

3 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000:472-475.

4 Bezerra de Menezes G, Fontenelle LF, Mulolo S et al. Treatment-resistant anxiety disorders: social phobia, generalized anxiety disorder and panic disorder. The Brazilian Journal of Psychiatry. 2007; 29(Supplement II):S55-60.

5 Nutt D, Argyropoulos S, Hood S et al. Generalized anxiety disorder: a comorbid disease. European Neuropsychopharmacology (2006) 16, S109-S118

6 Merideth C, Cutler A, Neijber A et al. Efficacy and tolerability of extended release quetiapine fumarate (Quetiapine XR) monotherapy in the treatment of GAD. 21st ECNP Congress, 2008.

7 Press release: AstraZeneca Submits sNDA for Seroquel XR™ for the Treatment of Generalised Anxiety Disorder – a First for the Atypical Antipsychotic Class of Medicines. 8 May 2008. See: http://www.astrazeneca.com/pressrelease/5392.aspx. Accessed 5 August, 2008.

http://www.astrazeneca.com

A groundbreaking new study by researchers in the US suggests that teenagers who smoke could be setting themselves up to become depressed adults.

Published pre-press as an early on line issue last month in the journal Neuropsychopharmacology, the research was the work of Florida State University Psychology Professor Carlos A Bolaños-Guzmán and colleagues.

In their background information Bolaños and colleagues said research has already established a strong link between tobacco consumption and mood disorders, and while some might say smokers use tobacco to manage their moods, there is also evidence that tobacco consumption induces negative mood.

For the study, Bolaños and colleagues used adolescent rats (their neurobiology is similar to that of humans) and showed that giving them nicotine induced a depression-like state that left them less able to feel pleasure and more sensitive to stress in adulthood. The researchers suggested the same might be true of humans.

As Bolaños explained, the finding is unique because:

“It is the first one to show that nicotine exposure early in life can have long-term neurobiological consequences evidenced in mood disorders.”

He also said their research showed that even brief exposure to nicotine raised the risk of mood disorders later in life.

For the study, they injected adolescent rats twice a day with various doses of nicotine or a saline solution (the controls) for 15 days. At various times during and then after exposure finished the rats also underwent tests that examined their responses to stressful circumstances and the offer of rewards. Separate groups of adult rats received a mid-range dose of nicotine to enable the researchers to rule out age-related effects.

The results showed that:

• Nicotine exposure during adolescence, but not adulthood, led to a depression-like state characterised by lower sensitivity to natural reward (sucrose) and enhanced sensitivity to situations that raised anxiety and stress in later life.
• Behavioural characteristics of depression can emerge 1 week after stopping nicotine exposure.
• A single day of nicotine exposure during adolescence is enough to trigger a depression-like state in adulthood.
• The depression behaviours went back to normal when the rats were given either nicotine or antidepressants (such as fluoxetine or bupropion) in adulthood.

The adult rats that had not been exposed to nicotine as teenagers did not show the depression-like symptoms, although they underwent tests in parallel with their teen-nicotine exposed counterparts.

Behaviours characteristic of depression and anxiety included repetitive grooming, less consumption of rewards like the sugary drinks they were offered, and “freezing” in stressful situations instead of trying to escape them.

Bolaños and colleagues concluded that:

“These data suggest that adolescent exposure to nicotine results in a negative emotional state rendering the organism significantly more vulnerable to the adverse effects of stress.”

“Within this context, our findings, together with others indicating that nicotine exposure during adolescence enhances risk for addiction later in life, could serve as a potential model of comorbidity,” they added.

Talking about the research to the press, Bolaños said that:

“Some of the animals in our study were exposed to nicotine once and never saw the drug again,” but then it was “surprising to us to discover that a single day of nicotine exposure could potentially have such long-term negative consequences.”

Speculating on the mechanisms that might underlie these findings, Bolaños said toxic effects in the brain could be responsible: effects which alter the way that neurotransmitter circuits behave later in life. Perhaps these mechanisms are sensitive at particular stages of development, such as during the teenage years. The researchers said this should be the focus of new studies.

In the meantime, the message to young people is:

“Don’t smoke and don’t even try it,” said Bolaños. They need to be made aware of the long term risks they are taking, even from having the occasional cigarette.

The research was paid for by grants from the state of Florida’s James and Esther King Biomedical Research Program and the National Institute on Drug Abuse. Funds also came from a McKnight Fellowship from the Florida Education Fund and Neuroscience Fellowships from Florida State University.

“Nicotine Exposure During Adolescence Induces a Depression-Like State in Adulthood.”
Sergio D Iñiguez, Brandon L Warren, Eric M Parise, Lyonna F Alcantara, Brittney Schuh, Melissa L Maffeo, Zarko Manojlovic and Carlos A Bolaños -Guzmán.
Neuropsychopharmacology advance online publication 17 December 2008.
doi: 10.1038/npp.2008.220

Click here for Abstract.

Sources: Journal Abstract, Florida State University.

Chocolate, excitement and the stress of Christmas: these are not just a headache for parents. They are also responsible for triggering migraines in many young people. Learning how to manage stress and avoid triggers are just as important as getting the right medication. However the German Institute for Quality and Efficiency in Health Care (IQWiG) has stressed that parents and young people need to be warned about the risks of using migraine medications that have only been approved for adults. The Institute has analysed the latest research on migraines and published information for children and young people on http://www.InformedHealthOnline.org .

Help for children and teenagers battling migraines

Migraines are common in children and teenagers: one in 10 young people battles these thumping headaches now and then. The good news: having migraines when you are a child does not necessarily mean a lifetime of these headaches. Many children will outgrow migraines.

Knowledge can help young people avoid and manage their migraines, according to the German Institute for Quality and Efficiency Health Care. It is important for children and young people to know the difference between the types of headaches, for example. Every headache is not a migraine. “Migraines in young people have the same throbbing pain on the side of the head as in adults, but there are differences as well,” said Professor Peter Sawicki, the Director of the Institute. “Children’s migraines can be shorter and they are more likely to also have abdominal pain or nausea. Most children will not have auras with flashing lights or wavy vision when they have migraines.”

Although researchers have yet to identify the exact causes of migraines, specific factors or foods can trigger migraines in individuals – including chocolate. Stress and poor sleep are other frequent causes. Once a young person knows what is causing their migraines, they might be able to avoid some of the triggers or manage the problem better. “Keeping a migraine diary can show when there are genuine patterns around the headaches and what happens when you avoid – or have – a food you suspect, for example,” Professor Sawicki said.

Medication for migraine: different therapy for children and adolescents

Lying down in a quiet dark room with a cold compress on the painful side of the head and trying to sleep it off will often be enough to get through a migraine attack. If more help is needed, the medicines proven to help young people the most without causing many adverse effects are ibuprofen and paracetamol. If they are not enough, a nasal spray of a migraine medication called sumatriptan is available for use from the age of 12.

There is a much wider variety of drugs available for adults, both as treatments and to take regularly to prevent very frequent migraines. However, these have not been approved for use in children and adolescents. “Medications often work differently in children and teenagers than they do in adults, and they can cause unexpected adverse effects in growing bodies,” said Professor Sawicki. “This means you cannot just use smaller doses of all adult medications in children. Unfortunately, almost all migraine medications have not been tested in enough trials in children and adolescents to meet the requirements for drug approval.”

Children and adolescents are often given adult medication. The Institute stresses that parents and young people need to be warned about the particular risks of what is called “off-label-use”. Off-label drug use does not have the same level of scientific, legal and financial protection as approved medicine use.

Information for parents and young people

The Institute has published the latest information from research in children and young people with migraines on its website, Informed Health Online, including information on preventing and treating attacks. To help children and teenagers learn more about migraines, the Institute has published a fact sheet for them as well.

The Institute’s website, http://www.InformedHealthOnline.org , provides the public with easy-to-understand information about current medical developments and research on important health issues. If you would like to be kept up-to-date with the latest publications on the independent health information website, you can subscribe to the informedhealthonline.org newsletter.

Information – Migraines in children and young people: http://www.informedhealthonline.org/migraines.583.56.en.html

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Children with older delinquent siblings are at high risk for becoming juvenile delinquents themselves. Researchers have been studying family interventions that prevent young high-risk children from following in the footsteps of their older siblings. Now a new study shows that a non-medical early family intervention that improves caregiving also results in important changes in children’s biological response to stress.

Delinquent adolescents and highly aggressive children have been shown to have abnormal stress responses, especially in social situations. They appear to be less tuned in to social cues and they are not as sensitive to positive reinforcement as normally developing children, explains Laurie Miller Brotman, Ph.D., the lead author of the study and the Corzine Family Associate Professor of Child and Adolescent Psychiatry at NYU School of Medicine.

A family intervention that results in an adaptive stress response in young high-risk children may prevent delinquency and psychiatric illness later in life.

“Our findings demonstrate the powerful influence of the caregiving environment on children’s biology,” says Dr. Brotman. “We have known for some time that parents play an important role in how young children behave. We have shown that parents of delinquent youth can improve their parenting and these changes result in lower rates of problems in their young children. We have now documented that a program that improves parenting and children’s behavior also leads to biological changes that are consistent with more adaptive non-delinquent behaviors.”

“We are really excited by these findings,” says Dr. Brotman, who is also Director of the Institute for Prevention Science at NYU Child Study Center “They suggest that antisocial behavior isn’t hard wired and parents can be part of the solution.”

The new study is published in the October issue of Archives of General Psychiatry.

The connection between the stress response and the caregiving environment has been well established in animal studies. The amount of nurturing that rat pups receive from their mothers in the form of licking and grooming in infancy has been shown to alter the stress response with lasting effects over the life cycle. However, until now, no experimental studies in humans have established this connection.

“This was the first study to look for a cause-and-effect relationship between parenting and children’s stress response, and the results tell us that there is such a relationship,” says Daniel S. Pine, M.D., Chief of the Section on Development and Affective Neuroscience of the National Institute of Mental Health, and a co-author of the study. “It brings home the importance of early intervention with families of children at high-risk for antisocial behavior.”

“The long-term consequences of the change in the cortisol response among the at-risk children in the study isn’t known, but the results provide further evidence that early, intervention can have a profound effect on children,” says Dr. Brotman.

“We have already documented that an early family intervention leads to important benefits for children at very high risk for a multitude of negative outcomes. Findings from this new study show that the effects are even greater in scope than we had imagined,” says Dr. Brotman. “This means that we may be underestimating the potential benefits from investments in early family intervention for high-risk children. Policy makers should consider the possibility that by investing in evidence-based family interventions, they may have the potential to change children’s biological make up as well as their mental health and behavior.”

Dr. Brotman and her colleagues evaluated whether a program designed to prevent antisocial behavior in high risk preschoolers could alter the children’s biological response to a stressful social situation. Participating families had a preschooler and an adolescent who was adjudicated for a delinquent act in family court in New York City between 1997 and 2002.

Ninety-two families participated in the study. Nearly half of the parents had not completed high school and nearly 60 percent of the families had household incomes under $15,000. A majority of the parents had suffered with depression or anxiety and had experienced numerous negative life events in addition to the adjudication of their teenage child.

Families were randomized to a family intervention or a no-intervention condition. The family intervention included 22 group sessions for parents and preschoolers and 10 home visits delivered by mental health professionals over an 8-month period. Parents learned to use nonharsh, consistent, and appropriate disciplinary tactics, be less critical, and use positive reinforcement, among other strategies. Preschoolers learned to socialize with peers, to identify feelings and to follow rules.

Children’s stress response was measured at home and before and after a socially stressful situation. Cortisol levels in saliva were measured before and after the children entered into an unfamiliar peer group. Normally developing, non-aggressive children are expected to show an increase in cortisol in anticipation of a social stressor.

For example, well-adjusted children show increased cortisol during the first few days of preschool. In this sample of high-risk children, as a group they did not show this expected pattern prior to intervention.

Following the family intervention, compared to children in the control group, children in the intervention group showed an increase in cortisol levels in anticipation of playing with a group of unfamiliar peers. As a result of the family intervention, children displayed a normal cortisol response relative to the control children who continued to show a pattern that resembles what has been found in older delinquent youth. Dr. Brotman and colleagues are studying these children and their older siblings during adolescence.

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A new study in the journal Psychology of Women Quarterly examined the effects of workplace sexual harassment and found that employees who were harassed report lower levels of job satisfaction, organizational commitment, and job performance. Employees also experienced higher levels of psychological distress and physical problems than those who were not harassed.

Darius K-S Chan, Chun Bun Lam, Suk Yee Chow, and Shu Fai Cheung examined the job-related, psychological, and physical outcomes of sexual harassment in the workplace. Using some statistical techniques, the researchers analyzed findings from 49 studies on workplace harassment, with a total sample size of 89,382 people, to investigate the effects of sexual harassment and job-related outcomes. The sample consisted of employees from different countries, with Americans being the vast majority.

Female employees did not appear to be more strongly impacted than males. However, age did play a role. Sexual harassment experiences were found to be more consistently tied to job-related outcomes, psychological well-being, and physical health among younger employees than older employees.

“An accurate understanding of sexual harassment outcomes sustains organizational efforts directed at preventive information and legislation,” the authors conclude. “Our results provide solid information for organizations to address the issue of sexual harassment.”

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Canada – Emma was nine when the anxiety about school really began. When her twin sisters were born six years earlier, her mother had taken a break from her full-time career and stayed at home for four years. Her father worked from home and one set of grandparents lived with them. “There was always somebody there,” recalls her father, Ben. “It was a very stable environment.” When Emma’s mother returned to work three years ago, things started to change. All three children experienced separation anxiety-but no one more than Emma.

Still, things didn’t come to a head until the family moved during the summer of 2002 and the children had to change schools. Emma had been in a private school, close to home-loving, small, nurturing-and she had only ever been taught by female teachers. But for Grade 4, Emma, now 10, moved to a public school into a class of 34 kids–two-thirds of whom were boys–and a six-foot, three-inch male teacher who had the unenviable task of trying to keep them all in line.

Within about four weeks, Emma started to complain of headaches and stomachaches. At first, her parents believed her problem was physical and took her to the doctor for tests, all of which indicated that nothing was wrong. By the middle of October, the school was regularly calling Ben in the middle of the day to pick up Emma, who still complained of headaches. One night before school, she blew. “She ended up getting very violent one night before school,” Ben says of his normally reserved daughter. “We kept saying ‘You’ve got to go.’ She had a meltdown, gritting her teeth, screaming, hanging on, in a rage. That just freaked us out. Next morning, we looked for help.”

High anxiety

It’s probably safe to say that there isn’t anyone who doesn’t think back on their school days without remembering times of anxiety. What we don’t realize when we’re going through it, of course, is that many of our peers are going through the same thing. Indeed, certain extraordinary school-related stresses seem to land on kids at predictable stages. In some cases, however, children may feel so anxious about school or about what’s going on in their lives that they develop a fear of school and even, in some cases, refuse to attend. If that happens, extra help is often needed.

Predictable stages

While children can have trouble with anxiety at any time during their school lives, there do seem to be certain ages that routinely pose more difficulty than others. The first problem time is often in Grade 1; the transitions both from half day at school to full day and from running around and playing to sitting at a desk are exhausting for many children. Almost all kids in the age group go through periods of being difficult, cranky and overwhelmed.

Another potential trouble time is Grade 7, when children typically move away from their elementary schools. At this point, more of the problems are social rather than academic. “Often it is related to something really unpleasant-not necessarily bullying but being ostracized, teased, not fitting in, having a terrible hurt with respect to someone of the opposite sex,” explains Janet Morrison, a child psychoanalyst in Toronto. “Children between 12 and 15 are so intensely painfully self-conscious. They think everybody is judging them all the time-the whole world is looking at them.”

Morrison has known children who have not been able to go to school for days because of a skin breakout or because their clothes aren’t cool enough. “The rules are changing,” she says. “It’s not just about doing what your mother or your teacher tells you. It could be specifically about not doing what they tell you. You’re not known as part of your family anymore. You have to be able to cut it on your own.” The challenge-and it’s enormous if you’re a 12- or 13-year-old-is to be uniquely important and to stand out, but to stand out in just the right way.

But in Morrison’s mind, it is the 14-year-old who has it the worst. It’s the culmination of self-consciousness and it’s the beginning of real pressure to be dating and to be cool. “Everybody feels the pinch to be having a kiss, to be having a joint, to be having a beer,” says Morrison. “Kids who are busy can ignore it for a couple of years, but by 14 you really can’t.”

On top of all of the social pressure for many kids are concerns that may be difficult to pinpoint. Sharon Dembo is director of the Toronto-based Child Psychoanalytic Program. Recently, she saw a teenager who was a high achiever at school but who became increasingly less able to get herself to school every day. As a result, she was unable to do the work required of her and was in danger of failing high school. “I wouldn’t categorize that person as anxious per se,” says Dembo, “but at that teenage level I saw it more as an unwillingness or fearfulness of growing up, of becoming independent.”

In fact, school refusal can often be a side effect of an anxiety around something happening in the family. That may occur during a divorce or around a parent’s illness, which may make the child reluctant to leave home. It may also happen after a prolonged period of togetherness as a family, including summer holidays, or following a stressful change such as a move or change in school. One teenager Dembo treated simply folded because of the overwhelming amount of work that was required. “These can be very, very bright children; they just get overwhelmed with the workload they have so they can’t commit to finishing anything,” she explains. “They’re at risk of dropping out if they’re not supported.” And of course bullying may be at the root of school anxiety and refusal.

The ultimate transition for many kids is between high school and university. And as Morrison says, it’s often the kids who have “behaved” the best and who have had a seemingly smooth school life who have the most difficulty making the change “They haven’t developed any independence at all,” says Morrison. “They haven’t rebelled. They have no idea who they are.” Being on their own for the first time can be very stressful for kids, particularly for those who haven’t developed an identity separate from their parents.

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