S. Hahn

Prevalence and implications of anxiety in polycystic ovary syndrome: results of an internet-based survey in Germany

BACKGROUNDnComparatively little attention has been paid to the symptoms of anxiety in polycystic ovary syndrome (PCOS), although anxiety disorders constitute the most common psychiatric diagnoses among endocrine patients and in the general population. Therefore, our goal was to address the prevalence, determinants and implications of anxiety alone or anxiety in combination with depression in German women with PCOS.nnnMETHODSnIn this nation-wide, internet-based survey, anxiety and depression (Hospital Anxiety and Depression Scale, HADS) and quality of life (SF-12) were assessed together with sociodemographic information and clinical PCOS symptoms in 448 PCOS women.nnnRESULTSnOf the patients, 34% showed clinically relevant HADS anxiety scores and 21% had clinically relevant HADS depression scores. Quality of life was significantly impaired in PCOS women with anxiety (P < 0.001), in particular, in women with comorbid anxiety and depression (P < 0.001). The risk for clinically relevant HADS anxiety scores was significantly enhanced in PCOS women with acne (odds ratio (OR) = 1.52; 95% confidence interval (CI) = 1.03-2.52) and an unfulfilled wish to conceive (OR = 1.50; 95% CI = 1.01-2.23).nnnCONCLUSIONSnPCOS women may be at an increased risk for clinically relevant anxiety, and comorbid anxiety and depression is also very common. Anxiety contributes to impaired quality of life in PCOS. Given the high prevalence and the serious implications, and the availability of effective treatment options given proper diagnosis, clinicians should be more aware of anxiety disorders in women with PCOS.

Disturbed stress responses in women with polycystic ovary syndrome

BACKGROUNDnWe analyzed the neuroendocrine and immune cell responses to psychosocial stress in PCOS patients compared to BMI-matched healthy controls.nnnMETHODSnResponses to public speaking stress were analyzed in 32 PCOS patients and 32 BMI-matched healthy controls. At baseline, during, and 10- and 45-min after stress, state anxiety, cardiovascular responses, cortisol, ACTH, as well as circulating leukocyte subpopulations were analyzed, together with hsCRP and serum IL-6 concentrations.nnnRESULTSnIn response to public speaking stress, both groups showed significant but comparable increases in state anxiety, and blood pressure (all p<0.001; time effects). The ACTH and cortisol stress responses were significantly enhanced in PCOS (both p<0.05; interaction effect). In addition, heart rate was significantly higher in PCOS (p<0.05; group effect). PCOS patients displayed a reduced upregulation of IL-6 levels in response to stress (p<0.05; interaction effect). Baseline levels of circulating leukocyte subpopulations, IL-6 and hsCRP concentrations did not differ between BMI-matched controls and PCOS patients. PCOS patients were characterized by markedly increased psychological distress.nnnCONCLUSIONSnPCOS patients showed enhanced HPA-axis and heart rate reactivity as well as a reduced upregulation of IL-6 in response to stress. The altered stress reactivity in PCOS patients may constitute a link between depression, overweight, and the cardiovascular and diabetes risks associated with the diagnosis.

Psychological implications of infertility in women with polycystic ovary syndrome

BACKGROUNDnIn polycystic ovary syndrome (PCOS), one of the main features is chronic anovulation associated with lower pregnancy rates. Little is known regarding the psychological aspects associated with infertility in these patients. Therefore, we examined the influence of an unfulfilled wish to conceive on various aspects of psychological functioning in PCOS women.nnnMETHODSnStandardized questionnaires assessing quality-of-life (36-item short-form health survey, SF-36), depressiveness (Beck Depression Inventory), emotional distress (Symptom Check List 90, SCL-90-R), sexual satisfaction and self-worth (visual analogue scales), and a questionnaire on the desire for a child (FKW) were administered at the outpatient endocrine clinic to consecutive PCOS patients.nnnRESULTSnQuestionnaires from 115 PCOS patients were analysed. The majority (76.1%) worried about remaining childless in the future, and 51.3% reported a current wish to conceive. 23.9% of patients had scores indicating mild to moderate depression, and 25.2% had scores indicating clinically relevant depression. Furthermore, all quality-of-life scores were significantly lower compared with normative data (P < 0.001). Unexpectedly, comparisons of patients with a current unfulfilled desire to conceive to those with no present wish for a child revealed no discernable impact on depressive symptoms, quality-of-life or emotional distress. Reduced sexual satisfaction and self-worth were largely determined by partnership status and not infertility. However for PCOS patients who wished to conceive, the wish for a child was a significantly greater priority when compared with normative data from infertile patients.nnnCONCLUSIONSnPCOS represents a major risk factor for psychosocial and emotional problems, but at least in this sample of PCOS patients, infertility does not appear to constitute a primary determinant of psychological problems.

Effects of obesity on neuroendocrine, cardiovascular, and immune cell responses to acute psychosocial stress in premenopausal women

OBJECTIVEnTo analyze the neuroendocrine and immune cell responses to acute psychosocial stress in obese compared to non-obese premenopausal women.nnnMETHODSnN=15 obese (BMI> or =30) and N=24 (BMI<30) non-obese premenopausal women underwent public speaking stress. State anxiety, ACTH, cortisol, and the redistribution of immune cells were measured before, during, and 10 and 45min after public speaking. Serum hsCRP and serum IL-6 levels were analyzed before, and IL-6 additionally 45min after stress.nnnRESULTSnIn response to public speaking stress, both groups showed significant but comparable increases in state anxiety, plasma ACTH, and blood pressure (all p<0.01; time effects). The cortisol stress response was significantly enhanced in obese women (p<0.05; interaction effect). In addition, heart rate and diastolic blood pressure were significantly higher in obese women 10min following stress (p<0.05, t-tests). Public speaking stress led to a significant increase in IL-6 concentrations (p<0.001; time effect), and obese women displayed higher IL-6 levels both pre- and post-stress (p<0.05; group effect; between-group t-tests: pre-stress p<0.05; post-stress p<0.01). Baseline numbers of circulating leukocytes, granulocytes, CD3+ cells and hsCRP concentration were significantly higher in obese women (between-group t-tests: all p<0.05, but the groups did not differ in the stress-induced redistribution of circulating leukocyte subpopulations.nnnCONCLUSIONSnOur data reveal a strong association of obesity with chronic low-grade inflammation in premenopausal women. This pro-inflammatory state, together with altered neuroendocrine and cardiovascular stress responsiveness, may conceivably constitute one of the mechanisms linking psychological stress and the long-term health risks associated with obesity.

1. Subclinical depressive symptoms are associated with galectin-1 and interleukin-6 levels

1. Subclinical depressive symptoms are associated with galectin-1 and interleukin-6 levels Sven Benson , Petra Arck , Sandra Blois , Susanne Tan , Susanne Hahn , Onno E. Janssen , Manfred Schedlowski , Sigrid Elsenbruch a a Inst. of Medical Psychology and Behavioral Immunobiology, University Hospital of Essen, Medical School, Essen, Germany b Center of Internal Medicine and Dermatology, Clinic for Internal Medicine and Psychosomatics, Charité, University Medicine Berlin, Germany c Dept. of Endocrinology and Div. of Laboratory Research, University Hospital of Essen, Medical School, Essen, Germany d Endokrinologische Praxis, Wuppertal, Germany e Endokrinologikum Hamburg, Germany

Das polyzystische Ovarsyndrom – Metabolische Konsequenzen

Objective: The polycystic ovary syndrome (PCOS) is often associated with insulin resistance. This article aims to demonstrate the metabolic consequences following insulin resistance in PCOS-affected women and the need of intervention. Methods: A systematic review of the published literature, using the MEDLINE database, was conducted to identify studies assessing the prevalence of insulin resistance and cardiovascular risk factors in PCOS patients. Results: Besides the classic cardiovascular risk factors like insulin resistance, visceral obesity, dyslipidemia and hypertension, patients with PCOS also show elevated markers of chronic inflammation and are often suffering from subclinical atherosclerosis. Conclusions: Patients with PCOS are at high risk for developing impaired glucose tolerance and show a distinct cardiovascular risk profile. Therefore, the early identification of affected patients and the institution of lifestyle changes or pharmacological treatments may help delay the progression to type 2 diabetes mellitus and cardiovascular disease.

The polycystic ovary syndrome phenotype modulates prevalence of the metabolic syndrome

Polycystic ovary syndrome (PCOS) affects about 6% of women of fertile age. Its main charasteristics are hyperandrogenism (HA) and chronic anovulation (CA). Many PCOS-patients also suffer from obesity and insulin resistance. The prevalence of the metabolic syndrome (MBS), possibly reflecting an elevated cardiovascular risk, is found to be elevated in PCOS. The phenotype of PCOS is heterogenous and its definition still controversial. We have now evaluated the prevalence of the MBS in different phenotypes of PCOS, as defined by the Rotterdam criteria. 206 PCOS-patients (mean age: 28.4±6.3 years, mean BMI: 30.8±9.2kg/m2) were recruited by the Rotterdam criteria and were subdivided according to their phenotype into three groups (I: HA, CA and polycystic ovaries (PCO), n=146; II: HA, CA but without PCO, n=30; III PCO with only one of either HA or CA, n=30). The groups did not differ significantly in age or BMI. Cardiovascular risk factors were evaluated by personal interview, physical examination and blood testing. The MBS was defined according to the ATP III criteria. An age-matched control group was derived from the PROCAM-study. Multivariate analysis were used for statistical testing. Prevalence of MBS differed significantly between the three groups (I: 32.2%, II: 36.7%, III: 10.0%; Chi2=6.7, p<0.05). The relative risk for MBS is 3.2 (95%CI 1.1–9.7) for I vs. III and 3.7 (95%CI 1.1–11.8) for II vs. III, respectively. In comparison to age-matched controls derived from the PROCAM study (6.5%) prevalence of MBS was 5-fold increased in PCOS-patients with the combination of CA and HA. Patients of group III had a 50% increase in comparison to the controls. Among the patients with the combination of CA and HA there was no difference in the prevalence of MBS. Thus, their MBS prevalence was independent of the presence of PCO. In conclusion, the prevalence of the MBS depends on PCOS phenotype. Patients with the combination of HA and CA seem to be at higher risk to develop a MBS than patients defined as PCOS by PCO and one of the two other features.