David L. Keegan

Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual physical and emotional abuse and neglect.

Objective Two recent reports have found associations between fibromyalgia and sexual victimization, but had methodologic characteristics that limited their interpretation. Method We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis by using structured interviews for sexual, physical, and emotional victimization histories, as well as dimensional self-report measures of victimization severity. Results Compared with the patients with rheumatoid arthritis, those with fibromyalgia had significantly higher lifetime prevalence rates of all forms of victimization, both adult and childhood, as well as combinations of adult and childhood trauma. Although childhood maltreatment was found to be a general risk factor for fibromyalgia, particular forms of maltreatment (eg, sexual abuse per se) did not have specific effects. Experiences of physical assault in adulthood, however, showed a strong and specific relationship with unexplained pain. Trauma severity was correlated significantly with measures of physical disability, psychiatric distress, illness adjustment, personality, and quality of sleep in patients with fibromyalgia but not in those with rheumatoid arthritis. Conclusions Fibromyalgia seems to be associated with increased risk of victimization, particularly adult physical abuse. Sexual, physical, and emotional trauma may be important factors in the development and maintenance of this disorder and its associated disability in many patients.

PSYCHOSOCIAL FACTORS IN FIBROMYALGIA COMPARED WITH RHEUMATOID ARTHRITIS : I. PSYCHIATRIC DIAGNOSES AND FUNCTIONAL DISABILITY

Objective Recent studies of the relationship between fibromyalgia and psychiatric disorders have yielded conflicting findings, and many of these inconsistencies seem to result from methodological differences. Method We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis from a tertiary care clinic using physician-administered, structured psychiatric interviews and self-reported measures of illness appraisal, coping, and functional disability. Results Patients with fibromyalgia had significantly higher lifetime prevalence rates of mood and anxiety disorders, as well as higher mean numbers of medically unexplained physical symptoms across several organ systems. Ninety percent of the patients with fibromyalgia had a prior psychiatric diagnosis compared with less than half of the patients with rheumatoid arthritis. Conclusions Despite the absence of organic pathology, the patients with fibromyalgia had equal or greater functional disability and were less well adapted to their illness. Although the pathophysiology of fibromyalgia remains unclear, co-morbid psychiatric disorders and functional disability remain an important focus of treatment in this population.

Expression of brain-derived neurotrophic factor mRNA in rat hippocampus after treatment with antipsychotic drugs.

Typical and atypical antipsychotic drugs, though both effective, act on different neurotransmitter receptors and are dissimilar in some clinical effects and side effects. The typical antipsychotic drug haloperidol has been shown to cause a decrease in the expression of brain‐derived neurotrophic factor (BDNF), which plays an important role in neuronal cell survival, differentiation, and neuronal connectivity. However, it is still unknown whether atypical antipsychotic drugs similarly regulate BDNF expression. We examined the effects of chronic (28 days) administration of typical and atypical antipsychotic drugs on BDNF mRNA expression in the rat hippocampus using in situ hybridization. Quantitative analysis revealed that the typical antipsychotic drug haloperidol (1 mg/kg) down‐regulated BDNF mRNA expression in both CA1 (P < 0.05) and dentate gyrus (P < 0.01) regions compared with vehicle control. In contrast, the atypical antipsychotic agents clozapine (10 mg/kg) and olanzapine (2.7 mg/kg) up‐regulated BDNF mRNA expression in CA1, CA3, and dentate gyrus regions of the rat hippocampus compared with their respective controls (P < 0.01). These findings demonstrate that the typical and atypical antipsychotic drugs differentially regulate BDNF mRNA expression in rat hippocampus.

Epinephrine and norepinephrine responses in continuously collected human plasma to a series of stressors.

&NA; The present study employed continuous blood withdrawal to examine epinephrine and norepinephrine responses to a cognitive stressor (mental arithmetic), active physical stressors (handgrip and knee bends), passive painful stressors (venipuncture and cold pressor), and a medical procedure that was considered nonstressful (blood pressure measurements). The data were analyzed by analysis of variance (ANOVA) and by time series analysis. The ANOVA indicated that epinephrine and norepinephrine increased significantly in response to the stressors. Epinephrine showed a greater increase to the cognitive stressor than to the others. Time series analysis, however, showed a more varied pattern. It indicated that the height and duration of response differed considerably across subjects and across interventions. The results from both analytic procedures are compared and discussed in terms of current hypotheses of catecholamine response.

Quetiapine attenuates the immobilization stress-induced decrease of brain-derived neurotrophic factor expression in rat hippocampus

Quetiapine is a new atypical antipsychotic drug widely used in the treatment of schizophrenia and other psychotic disorders. This study examined the influence of quetiapine on the decrease of brain-derived neurotrophic factor (BDNF) expression, induced by chronic immobilization stress, in the hippocampus of the rat. Pretreatment with 10 mg/kg of quetiapine markedly attenuated the stress-induced decrease in levels of BDNF protein, as determined by Western blot analyses, and the reduction of BDNF immunoreactivity, in hippocampal pyramidal and dentate granular neurons. These results suggest that the chronic administration of quetiapine could be neuroprotective to hippocampal neurons in schizophrenia and this effect may be related to its antipsychotic effect in patients with schizophrenia.

III. Determination of plasma catecholamines and free 3, 4-dihydroxyphenylacetic acid in continuously collected human plasma by high performance liquid chromatography with electrochemical detection

Abstract We have presented a sensitive and relatively simple and inexpensive method for continuous sampling and determination of plasma catecholamines and a major dopamine metabolite, DOPAC. This method provides the basis for determination of the short-term magnitude of catecholamine response as well as the time course of such a response following several physical or psychological interventions. Resting levels of plasma catecholamines--norepinephrine 292 pg/ml, epinephrine 81 pg/ml and dopamine 29 pg/ml--are comparable to those obtained by other methods. Dopamine and free DOPAC were unaffected by physical or psychological interventions while norepinephrine was considerably increased by isometric handgrip, knee bends, and cold pressor and epinephrine increased during knee bends, mental arithmetic, cold pressor, and blood pressure measurement.

Predictors of physician frustration in the care of patients with rheumatological complaints

Recent studies of the doctor-patient relationship have shown that certain patients are perceived as frustrating or difficult by their doctors; however, little is known about the characteristics of these patients that elicit this dissatisfaction. As part of a larger study of rheumatology clinic patients with fibromyalgia or rheumatoid arthritis (N = 68) we used stepwise multiple regression to select the factors most associated with physician frustration while controlling for the effects of other variables. Variable domains included demographics, psychiatric diagnoses, personality factors, functional disability, disease state, and trauma history. These domains as well as individual variables within these domains were systematically evaluated for their unique contribution to the prediction of physician frustration as measured by the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ). Initial bivariate correlates of physician frustration included marital status, current dysthymia and agoraphobia, lifetime panic disorder and obsessive-compulsive disorder, adult rape and physical abuse, somatization disorder, physical and social disability, the presence of fibromyalgia, as well as neuroticism, illness impact, and perceived loss of control. The best multivariable model for estimating frustration magnitude included somatization disorder, perception of lack of control over illness, and a lifetime history of obsessive-compulsive disorder. These factors explained 48% of the variance in DDPRQ score. Physicians in this study were most frustrated with patients who had ongoing preoccupation with multiple medically unexplained physical symptoms as well as the perception of greater impact and lack of control over their illness. These findings suggest that treatment of somatization in patients with chronic symptoms may decrease physician frustration.

A controlled trial of cognitive behavioral treatment of panic in alcoholic inpatients with comorbid panic disorder

Patients entering a 4-week inpatient alcoholism treatment program were screened for anxiety symptoms. Those with panic disorder with or without agoraphobia were randomly assigned to two groups. The treatment group received 12 hours of cognitive-behavioral treatment (CBT) for panic disorder in addition to the regular alcoholism treatment program: the control group received the regular program. Dropouts from the treatment group were also followed. Problem drinking and anxiety symptoms were measured at the start of the study, and at 3, 6, and 12 months posttreatment. Abstinence from drinking, and anxiety and mood symptoms improved after treatment in all of the groups; there were few differences in outcome between the groups. We concluded that this particular intervention had not been more effective than the regular alcohol treatment program in reducing problem drinking in those with panic disorder.

Reduction of Healthcare Resource Utilisation and Costs Following the Use of Risperidone for Patients with Schizophrenia Previously Treated with Standard Antipsychotic Therapy

SummaryThe objective of this study was to assess the change in healthcare resource utilisation and costs related to the initiation of risperidone therapy in patients with chronic schizophrenia. The study design used a retrospective cohort and linked data from 5 databases (patient, prescription drug, hospital, physician and mental health services) within the province of Saskatchewan. Study participants included all those patients who were registered in the Saskatchewan Health Linkable Data Files and received at least 1 prescription for risperidone between 1 July 1993 and 31 December 1993. In order to receive risperidone in Saskatchewan, patients needed to have failed or become intolerant to previous antipsychotic therapy. Utilisation information from the databases was collected for equivalent periods, in this case an average of 10 months, before and after initiation of risperidone.Results were as follows: hospital admissions decreased by 60.3%, length of hospital stay decreased by 58.2%, and physician visits decreased by 22.3%, after initiation of risperidone. There was also a slight reduction in visits to mental health services. The cost of antipsychotic medication increased during risperidone treatment; however, when all costs were added up, there was an estimated annual cost saving of

Differential effects of olanzapine on the gene expression of superoxide dismutase and the low affinity nerve growth factor receptor.

Can7925/patient/year after initiation of risperidone. Such results need to be interpreted in the light of possible mitigating effects operative in longitudinal studies of schizophrenia.