Pregnancy-related depression linked to eating disorders and abuse histories

ScienceDaily (June 16, 2011) — One in 10 women experience depression during pregnancy or shortly after giving birth. Although the problem has received increased attention in recent years, little is known about the causes or early-warning signs of pregnancy-related depression. In a study published in the June 2011 issue of Journal of Women's Health, researchers at the University of North Carolina at Chapel Hill School of Medicine offer new clues to help doctors identify at-risk patients and refer them to treatment early on.

The researchers surveyed 158 pregnant and postpartum women undergoing treatment for depression at UNC's Perinatal Psychiatry Clinic. One-third of the patients reported a history of eating disorders; in addition, many had a history of physical or sexual abuse. The findings suggest these psychiatric factors may increase a woman's likelihood of developing depression during pregnancy or postpartum.

Mental health screening tools that include questions about eating disorders, abuse and other factors should be incorporated into routine prenatal care, said Samantha Meltzer-Brody, MD, the lead author of the study and director of UNC's Perinatal Psychiatry Program. "Screening by obstetrical providers is really important because they can refer patients for appropriate treatment," she said. "And that can prevent long-lasting problems for mom and baby."

Undiagnosed and treated postpartum depression "causes enormous distress to the family, and it can have long-lasting consequences for the child," said Meltzer-Brody. Children of depressed mothers are more likely to develop mental health problems, and children of mothers with an active eating disorder may also be more likely to develop an eating disorder themselves. Making sure mothers struggling with mental health issues receive adequate assessment and treatment is critical to breaking that cycle, said Meltzer-Brody.

"The message we need to get out is that these things are incredibly common and routine screenings need to occur," said Meltzer-Brody. "The prevalence of abuse and eating disorder histories may be much higher than people appreciate."

Up to 25 percent of women experience physical or sexual abuse during their lifetime, a rate the UNC associate professor of psychiatry called "staggering." An estimated 6-8 percent of women are at some point affected by an eating disorder, with binge eating and bulimia nervosa being the most common, followed by anorexia and other disorders.

"Pregnancy and the postpartum period is a very vulnerable time for women," said Meltzer-Brody. Rapid changes in body shape, weight and hormone levels, combined with major lifestyle changes during the transition to motherhood, can take a toll on women -- especially those with a history of previous psychiatric issues.

Despite these challenges, Meltzer-Brody said pregnancy represents an ideal time for doctors to intervene and help women get mental health treatment if they need it. "[Pregnancy] is a time when people are really motivated to make changes and get treatment, because that can have serious consequences for how you do and for how your children do," she said, adding that by conducting mental health screens during prenatal care, doctors can help curb pregnancy-related depression.

The study's co-authors included Stephanie Zerwas, PhD, Jane Leserman, PhD, Ann Von Holle, Taylor Regis, and Cynthia Bulik, PhD, all from the Department of Psychiatry at the UNC School of Medicine, UNC Center for Women's Mood Disorders and UNC Eating Disorders Program.

Support for the research came from the NIH Building Interdisciplinary Careers in Women's Health (BIRCWH) Award to Dr. Meltzer-Brody.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of North Carolina School of Medicine.

Journal Reference:

Samantha Meltzer-Brody, Stephanie Zerwas, Jane Leserman, Ann Von Holle, Taylor Regis, Cynthia Bulik. Eating Disorders and Trauma History in Women with Perinatal Depression. Journal of Women's Health, 2011; 20 (6): 863 DOI: 10.1089/jwh.2010.2360

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

Inpatient hospitalization rates appear to have increased among children and adolescents with psychiatric disorders, but decreased among elderly

ScienceDaily (Aug. 1, 2011) — Over a 10-year period, rates of short-stay inpatient hospitalizations increased for children and adolescents but decreased for elderly who had a primary psychiatric diagnosis, according to a report published Online First today by Archives of General Psychiatry, one of the JAMA/Archives journals. The article also finds the proportion of inpatient days paid for by private health insurance appeared to decline among children, adolescents and adults.

According to background information in the article, inpatient care for psychiatric conditions in short-stay settings increased from 1970 through the 1990s as long-term psychiatric hospitalization decreased. Since then, payers have reduced expenditures in these acute care settings and mental health policy makers and advocates have emphasized treatment alternatives with less restrictiveness and less negative stigma. Between 1990 and 2000, admissions to U.S. inpatient psychiatric services declined, but various data have suggested an increase in more recent years.

Joseph C. Blader, Ph.D., from the Stony Brook University School of Medicine, State University of New York, Stony Brook, evaluated trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007, segmented by patient-level variables. He used demographic, clinical and payment data from the National Hospital Discharge Survey on a probability sample of discharges from short-stay facilities. Patients included in the study had a primary psychiatric diagnosis and were classified as children (ages 5 to 13 years), adolescents (ages 14 to 19 years), adults (ages 20 to 64 years) or elderly individuals (ages 65 years and older). Payers were classified as private, government or other (self-pay, no charge and other payment).

The study found increases in discharges for children and adolescents, as well as more moderate increases for adults, while discharge rates for elderly patients declined. However, the total inpatient days increased from 1,845 days per 100,000 in 1996 to 4,370 days in 2007 for children and from 5,882 days per 100,000 in 1996 to 8,247 days in 2007 for adolescents; again, a decrease was seen among elderly individuals, from 10,348 days per 100,000 in 1996 to 6,517 in 2007. Also, during the years studied, the proportion of inpatient days covered by private payers decreased among children, adolescents, and adults. Through the period surveyed, primary diagnoses of bipolar disorder increased and primary diagnoses of anxiety decreased.

"In conclusion, a substantial increase in acute care psychiatric hospitalization rates and inpatient occupancy for children and adolescents, a moderate increase in the hospitalization rate of adults, and a steep decline for elderly individuals represent significant developments in mental health treatment in the United States with potentially strong ramifications for quality of care and service financing," writes Blader. "Investigation of the clinical and organizational determinants of these trends, and their impact on patient outcomes, are vital to understanding their implications."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Joseph C. Blader. Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 2007. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2011.84

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

Stress in the city: Brain activity and biology behind mood disorders of urbanites

ScienceDaily (June 23, 2011) — Being born and raised in a major urban area is associated with greater lifetime risk for anxiety and mood disorders. Until now, the biology for these associations had not been described. A new international study, which involved Douglas Mental Health University Institute researcher Jens Pruessner, is the first to show that two distinct brain regions that regulate emotion and stress are affected by city living. These findings, published in Nature may lead to strategies that improve the quality of life for city dwellers.

"Previous findings have shown that the risk for anxiety disorders is 21 percent higher for people from the city, who also have a 39 percent increase for mood disorders," says co-author Jens Pruessner, a Douglas researcher. "In addition, the incidence for schizophrenia is almost doubled for individuals who are born and brought up in cities. These values are a cause for concern and determining the biology behind this is the first step to remedy the trend."

Distinct brain structures

Pruessner, with his colleagues from the Central Institute of Mental Health in Mannheim, looked at the brain activity of healthy volunteers from urban and rural areas. In a series of functional magnetic resonance experiments involving the Douglas' previously developed 'Montreal Imaging Stress Task',(MIST) protocol, they showed that city living was associated with greater stress responses in the amygdala, an area of the brain involved with emotional regulation and mood. In contrast, urban upbringing was found to be associated with activity in the cingulate cortex, a region involved in regulation of negative affect and stress.

"These findings suggest that different brain regions are sensitive to the experience of city living during different times across the lifespan," says Pruessner. "Future studies need to clarify the link between psychopathology and these affects in individuals with mental disorders.These findings contribute to our understanding of urban environmental risk for mental disorders and health in general. They further point to a new approach to interface social sciences, neurosciences and public policy to respond to the major health challenge of urbanization."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Douglas Mental Health University Institute.

Journal Reference:

Florian Lederbogen, Peter Kirsch, Leila Haddad, Fabian Streit, Heike Tost, Philipp Schuch, Stefan Wüst, Jens C. Pruessner, Marcella Rietschel, Michael Deuschle, Andreas Meyer-Lindenberg. City living and urban upbringing affect neural social stress processing in humans. Nature, 2011; 474 (7352): 498 DOI: 10.1038/nature10190

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View the original article here sciencedaily.com

Mouse with 'off switch' in key brain cell population developed; Research may increase understanding of SIDS, depressive disorders

ScienceDaily (July 30, 2011) — NIH-funded scientists have developed a strain of mice with a built-in off switch that can selectively shut down the animals' serotonin-producing cells, which make up a brain network controlling breathing, temperature regulation, and mood. The switch controls only the serotonin-producing cells, and does not affect any other cells in the animal's brains or bodies.

When the researchers powered down the animals' serotonin cells, the animals failed to sufficiently step up their breathing to compensate for an increase of carbon dioxide in the air, and their body temperatures dropped to match the surrounding temperature.

The finding has implications for understanding sudden infant death syndrome, or SIDS, which has been linked to low serotonin levels, and is thought to involve breathing abnormalities and problems with temperature control. The finding may also provide insight into depressive disorders, which also involve serotonin metabolism.

The study results appear in the current issue of the journal Science.

SIDS is the death of an infant before his or her first birthday that cannot be explained after a complete autopsy, an investigation of the scene and circumstances of the death, and a review of the medical history of the infant and of his or her family. According to the National Center for Health Statistics, SIDS is the third leading cause of infant death.

"The single most effective way to reduce the risk of SIDS is to always place infants on their backs for sleep," said Marian Willinger, Ph.D., special assistant for SIDS at the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development, which provided major funding for the study. "This new animal model of the serotonin-producing system holds the promise of helping us to understand the biological processes contributing to SIDS, which is critical for the development of tests and interventions to prevent these deaths.'' Additional NIH support was provided by the National Institute of Mental Health, National Institute on Drug Abuse, and National Center for Research Resources.

To conduct the study, the researchers developed mice with a unique molecule, or receptor, on the surface of their serotonin-producing brain cells, or neurons. Typically, cells communicate via chemicals that bind to receptors on their surfaces, with the molecules binding to their receptors in much the same way a key fits into a lock.

The researchers added this special receptor to the animal's serotonin-producing neurons using a genetic manipulation technique they developed called intersectional genetics. The special receptor was developed by NIH-funded researcher Bryan Roth. The approach consists of manipulating the animals' genetic material so that it manufacturers an additional receptor on the surface of its neurons. In this case, the animals' serotonin-producing cells began making a receptor that is not found in nature. Rather than binding to a naturally occurring brain chemical, the receptor binds to a chemical compound manufactured in a laboratory, clozapine-N-oxide (CNO).

"CNO was identified for its ability to bind specifically to this foreign receptor that we placed into the serotonin cells, and because it does not react with other cells or tissues in the animal's body," Dr. Dymecki explained.

When CNO binds with the receptor, it deactivates only the serotonin cells, effectively switching off all communications in the serotonin network. CNO does not affect any other cells in the animals' brains or bodies.

"By selectively switching off the serotonin-producing cells, we can get a definite idea of what bodily functions the serotonin cells specifically control" she said.

The researchers exposed genetically normal mice and mice with the receptor for CNO to elevated levels of carbon dioxide. Carbon dioxide is the waste product given off when a breath is exhaled. If carbon dioxide builds up in the body, due to insufficient breathing, it can be toxic, leading to loss of consciousness and death. The response to high carbon dioxide accumulation is increased breathing and a faster breathing rate, which releases carbon dioxide through the lungs.

When the normal mice were exposed to carbon dioxide, they almost immediately began to breathe faster and more deeply. In contrast, after their serotonin-producing neurons were switched off, mice with the receptor to CNO had a smaller response to carbon dioxide and did not increase their breathing as much.

"This finding shows that the breathing response to carbon dioxide is regulated by serotonin neurons," Dr. Dymecki said.

The researchers next tested the ability of the CNO-responsive mice to regulate their body temperatures. When the room temperature was set at 74 degrees Fahrenheit, the body temperature of normal mice remained at about 98.6 degrees -- the normal temperature for mice. Normal mice can maintain a normal body temperature even when the room temperature is cool and below that of body temperature, Dr. Dymecki added. However, after their serotonin neurons were switched off with CNO, the body temperatures of the CNO mice soon plunged. Like reptiles faced with a sudden temperature drop, the body temperatures of the mice soon dropped to the 74 degree room temperature.

"Their body temperatures were equilibrating with the room temperature," Dr. Dymecki said. "Our finding affirms that temperature is regulated by the serotonergic system."

Dr. Dymecki explained that the researchers added the CNO receptor to all the animals' serotonergic neurons. In future studies, she and her colleagues plan to selectively add the receptor to subsets of serotonergic receptors, to better understand their functioning in health, and in disorders such as SIDS and depression.

The finding provides support for previous autopsy studies by NIH grantees implicating abnormalities in serotonin metabolism in the brainstem as playing a role in SIDS.

Researchers theorize that infants who die of SIDS may have been unable to respond to breathing challenges, such as low levels of oxygen or high levels of carbon dioxide. High levels of carbon dioxide may accumulate around the face of an infant sleeping face down, when the infant's exhaled breath accumulates in a pocket formed by bedding materials.

The ability to regulate body temperature is also thought to play a role in SIDS deaths. The NICHD's Back to Sleep campaign advises parents and caregivers to avoid letting infants overheat during sleep, to dress them in light sleep clothes, avoid blankets or coverings, and to keep the room at a temperature that is comfortable for an adult.

Other authors of the paper were Russell Ray and Rachael Brust, also of the Department of Genetics at Harvard Medical School; Andrea Corcoran and Eugene Nattie, Department of Physiology at Dartmouth Medical School, in Lebanon, N.H.; Jun Chul Kim, Department of Psychology, University of Toronto, Toronto, Ontario, Canada; and George B. Richerson, Department of Neurology, University of Iowa in Iowa City.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by NIH/National Institute of Child Health and Human Development.

Journal Reference:

R. S. Ray, A. E. Corcoran, R. D. Brust, J. C. Kim, G. B. Richerson, E. Nattie, S. M. Dymecki. Impaired Respiratory and Body Temperature Control Upon Acute Serotonergic Neuron Inhibition. Science, 2011; 333 (6042): 637 DOI: 10.1126/science.1205295

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Pregnancy-related depression linked to eating disorders and abuse histories

ScienceDaily (June 16, 2011) — One in 10 women experience depression during pregnancy or shortly after giving birth. Although the problem has received increased attention in recent years, little is known about the causes or early-warning signs of pregnancy-related depression. In a study published in the June 2011 issue of Journal of Women's Health, researchers at the University of North Carolina at Chapel Hill School of Medicine offer new clues to help doctors identify at-risk patients and refer them to treatment early on.

The researchers surveyed 158 pregnant and postpartum women undergoing treatment for depression at UNC's Perinatal Psychiatry Clinic. One-third of the patients reported a history of eating disorders; in addition, many had a history of physical or sexual abuse. The findings suggest these psychiatric factors may increase a woman's likelihood of developing depression during pregnancy or postpartum.

Mental health screening tools that include questions about eating disorders, abuse and other factors should be incorporated into routine prenatal care, said Samantha Meltzer-Brody, MD, the lead author of the study and director of UNC's Perinatal Psychiatry Program. "Screening by obstetrical providers is really important because they can refer patients for appropriate treatment," she said. "And that can prevent long-lasting problems for mom and baby."

Undiagnosed and treated postpartum depression "causes enormous distress to the family, and it can have long-lasting consequences for the child," said Meltzer-Brody. Children of depressed mothers are more likely to develop mental health problems, and children of mothers with an active eating disorder may also be more likely to develop an eating disorder themselves. Making sure mothers struggling with mental health issues receive adequate assessment and treatment is critical to breaking that cycle, said Meltzer-Brody.

"The message we need to get out is that these things are incredibly common and routine screenings need to occur," said Meltzer-Brody. "The prevalence of abuse and eating disorder histories may be much higher than people appreciate."

Up to 25 percent of women experience physical or sexual abuse during their lifetime, a rate the UNC associate professor of psychiatry called "staggering." An estimated 6-8 percent of women are at some point affected by an eating disorder, with binge eating and bulimia nervosa being the most common, followed by anorexia and other disorders.

"Pregnancy and the postpartum period is a very vulnerable time for women," said Meltzer-Brody. Rapid changes in body shape, weight and hormone levels, combined with major lifestyle changes during the transition to motherhood, can take a toll on women -- especially those with a history of previous psychiatric issues.

Despite these challenges, Meltzer-Brody said pregnancy represents an ideal time for doctors to intervene and help women get mental health treatment if they need it. "[Pregnancy] is a time when people are really motivated to make changes and get treatment, because that can have serious consequences for how you do and for how your children do," she said, adding that by conducting mental health screens during prenatal care, doctors can help curb pregnancy-related depression.

The study's co-authors included Stephanie Zerwas, PhD, Jane Leserman, PhD, Ann Von Holle, Taylor Regis, and Cynthia Bulik, PhD, all from the Department of Psychiatry at the UNC School of Medicine, UNC Center for Women's Mood Disorders and UNC Eating Disorders Program.

Support for the research came from the NIH Building Interdisciplinary Careers in Women's Health (BIRCWH) Award to Dr. Meltzer-Brody.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of North Carolina School of Medicine.

Journal Reference:

Samantha Meltzer-Brody, Stephanie Zerwas, Jane Leserman, Ann Von Holle, Taylor Regis, Cynthia Bulik. Eating Disorders and Trauma History in Women with Perinatal Depression. Journal of Women's Health, 2011; 20 (6): 863 DOI: 10.1089/jwh.2010.2360

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Prenatal exposure to certain antidepressants may modestly increase risk of autism spectrum disorders, study suggests

ScienceDaily (July 5, 2011) — Prenatal exposure to selective serotonin reuptake inhibitors, especially during the first trimester, is associated with a modest increase the risk of developing an autism spectrum disorder, according to a report published Online First in the Archives of General Psychiatry, one of the JAMA/Archives journals.

"The prevalence of autism spectrum disorders (ASDs) has increased over recent years," the authors write as background information in the article. "Use of antidepressant medications during pregnancy also shows a secular increase in recent decades, prompting concerns that prenatal exposure may contribute to increased risk of ASD."

To evaluate if prenatal exposure to antidepressants, including selective serotonin reuptake inhibitors (SSRIs), is associated with an increase in ASD, Lisa A. Croen, Ph.D., of Kaiser Permanente Northern California, Oakland, and colleagues examined medical records for children drawn from the Childhood Autism Perinatal Study conducted by Kaiser Permanente Medical Care Program in Northern California. The authors included 298 children with ASD (case group) and their mothers, and 1,507 control children and their mothers in the study.

Twenty mothers of children in the case group (6.7 percent) and 50 mothers of children in the control group (3.3 percent) had at least one prescription for an antidepressant in the year prior to the birth of the study child. Of the 20 case mothers who were prescribed antidepressants, 13 (65 percent) were prescribed SSRIs only, two (10 percent) were prescribed an SSRI in combination with another antidepressant and five (25 percent) were prescribed one or more non-SSRI antidepressants only. Of the 50 control mothers who were prescribed an antidepressant, 25 (50 percent) were prescribed SSRIs only, nine (18 percent) were prescribed an SSRI in combination with another antidepressant and 16 (32 percent) were prescribed one or more non-SSRI antidepressants only.

After adjusting for maternal and birth factors, mothers of children with ASD were twice as likely to have at least one antidepressant prescription in the year prior to delivery. When compared with women with no antidepressant prescription during the study period, those with a prescription for a SSRI were more than twice as likely to have a child later diagnosed with ASD. This association was not seen for the small group of women who were prescribed a non-SSRI antidepressant only.

Additionally, after adjustment for a history of depression during the year prior to delivery, SSRI exposure during the first trimester remained significantly associated with risk of ASD, as was a history of SSRI exposure at any point during the year prior to delivery. Conversely, no association was seen between risk of ASD and the indication for treatment (mother having a history of depression or any mental health disorder) for the year prior to delivery.

"Although the number of children exposed prenatally to selective serotonin reuptake inhibitors in this population was low, results suggest that exposure, especially during the first trimester, may modestly increase the risk of ASD," the authors conclude. "We recommend that our findings be considered as preliminary and treated with caution, pending results from further studies designed to address the very complex question of whether prenatal exposure to SSRIs may be etiologically linked to later diagnoses of ASDs in offspring."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Lisa A. Croen; Judith K. Grether; Cathleen K. Yoshida; Roxana Odouli; Victoria Hendrick. Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2011.73

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Patients with eating disorders have an elevated rate of death

ScienceDaily (July 5, 2011) — Individuals who have eating disorders have an elevated mortality rate, especially those with anorexia nervosa (AN), according to a meta-analysis of previous studies, reported in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

According to background information in the article, the majority of studies of eating disorder-related death rates focus on AN. Some research of bulimia nervosa (BN) implies that death rates are low for this condition. Moreover, there is limited information about the likelihood of death with eating disorders not otherwise specified (EDNOS), disordered eating that does not meet the criteria for AN or BN, say the authors: "Despite EDNOS being a common presentation in eating disorders services, few published data exist regarding mortality rates in patients given this diagnosis." In this study, the investigators sought to determine the death rates (and the factors thereof) for each of these types of eating disorders.

Jon Arcelus, L.M.S., M.Sc., M.R.C.Psych., Ph.D., from Leicester General Hospital in Leicester, England, and colleagues systematically searched, assessed and analyzed studies related to eating disorder death rates. They included English-language, peer reviewed articles published between January 1966 and September 2010 from a variety of scientific-literature databases and collections. The researchers examined 36 studies; almost all included AN, one-third included BN, and one-fifth included EDNOS. The studies included 17,272 different patients with eating disorders and reported a total of 755 deaths.

The total number of person-years represented by the studies was 166,642 for AN; 32,798 for BN; and 22,644 for EDNOS. For each 1,000 person-years, the AN group experienced 5.1 deaths (1.3 of which were from suicide), the BN group experienced 1.7 deaths, and the EDNOS group experienced 3.3 deaths. The standardized mortality ratio (the number of actual deaths compared with the number of expected deaths) was 5.86 for AN, 1.93 for BN and 1.92 for EDNOS. The age at which a patient presented for treatment was found to correlate with AN deaths, with patients in their late teens and 20s having a higher death rate than younger patients or those in their 30s.

The authors acknowledge that some of the deaths included in the studies may be due to factors other than an eating disorder. However, they found that death rates for eating disorders -- especially AN -- are higher than for some other psychiatric disorders, such as schizophrenia and depression. The elevated death rate for BN and EDNOS as well "highlights the seriousness of those conditions," write the authors. They call for more research into what factors might predict death risk in those two conditions in particular.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Jon Arcelus; Alex J. Mitchell; Jackie Wales; Soren Nielsen. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Archives of General Psychiatry, 2011; 68 (7): 724-731 DOI: 10.1001/archgenpsychiatry.2011.74

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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New 'chemical pathway' in the brain for stress: Breakthrough offers hope for targeted treatment of stress-related disorders

ScienceDaily (Apr. 20, 2011) — A team of neuroscientists at the University of Leicester, UK, in collaboration with researchers from Poland and Japan, has announced a breakthrough in the understanding of the 'brain chemistry' that triggers our response to highly stressful and traumatic events.

The discovery of a critical and previously unknown pathway in the brain that is linked to our response to stress is published in the journal Nature. The advance offers new hope for targeted treatment, or even prevention, of stress-related psychiatric disorders.

About 20% of the population experience some form of anxiety disorder at least once in their lives. The cumulative lifetime prevalence of all stress-related disorders is difficult to estimate but is probably higher than 30%.

Dr Robert Pawlak, from the University of Leicester who led the UK team, said: "Stress-related disorders affect a large percentage of the population and generate an enormous personal, social and economic impact. It was previously known that certain individuals are more susceptible to detrimental effects of stress than others. Although the majority of us experience traumatic events, only some develop stress-associated psychiatric disorders such as depression, anxiety or posttraumatic stress disorder. The reasons for this were not clear."

Dr Pawlak added that a lack of correspondence between the commonness of exposure to psychological trauma and the development of pathological anxiety prompted the researchers to look for factors that may make some individuals more vulnerable to stress than others.

"We asked: What is the molecular basis of anxiety in response to noxious stimuli? How are stress-related environmental signals translated into proper behavioural responses? To investigate these problems we used a combination of genetic, molecular, electrophysiological and behavioural approaches. This resulted in the discovery of a critical, previously unknown pathway mediating anxiety in response to stress."

The study found that the emotional centre of the brain -- the amygdala -- reacts to stress by increasing production of a protein called neuropsin. This triggers a series of chemical events which in turn cause the amygdala to increase its activity. As a consequence, a gene is turned on that determines the stress response at a cellular level.

"We then examined behavioural consequences of the above series of cellular events caused by stress in the amygdala," said Dr Pawlak. "Studies in mice revealed that upon feeling stressed, they stayed away from zones in a maze where they felt unsafe. These were open and illuminated spaces they avoid when they are anxious."

"However when the proteins produced by the amygdala were blocked -- either pharmacologically or by gene therapy -- the mice did not exhibit the same traits. The behavioural consequences of stress were no longer present. We conclude that the activity of neuropsin and its partners may determine vulnerability to stress."

Neuropsin was previously discovered by Professor Sadao Shiosaka, a co-author of the paper. This research, for which the bioinformatics modelling was done by Professor Ryszard Przewlocki and his team, has for the first time characterized its mechanism of action in controlling anxiety in the amygdala.

The study took four years to complete, during which scientists from the Department of Cell Physiology and Pharmacology collaborated with colleagues from the Medical Research Council Toxicology Unit at the University of Leicester, the Department of Molecular Neuropharmacology, Polish Academy of Sciences in Krakow, Poland and Nara Institute of Science and Technology in Japan. The work was supported by the European Union, the Medical Research Council and Medisearch -- the Leicestershire Medical Research Foundation. The first author, Benjamin Attwood, sponsored by Medisearch, took 3 years off from his medical studies curriculum to complete the necessary experiments. He commented: "It has been a thoroughly absorbing project to uncover how our experiences can change the way we behave. Hopefully this will lead to help for people that have to live with the damaging consequences of traumatic experiences."

Dr Pawlak added: "We are tremendously excited about these findings. We know that all members of the neuropsin pathway are present in the human brain. They may play a similar role in humans and further research will be necessary to examine the potential of intervention therapies for controlling stress-induced behaviours."

"Although research is now needed to translate our findings to the clinical situation, our discovery opens new possibilities for prevention and treatment of stress-related psychiatric disorders such as depression and posttraumatic stress disorder."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Leicester, via EurekAlert!, a service of AAAS.

Journal Reference:

Benjamin K. Attwood, Julie-Myrtille Bourgognon, Satyam Patel, Mariusz Mucha, Emanuele Schiavon, Anna E. Skrzypiec, Kenneth W. Young, Sadao Shiosaka, Michal Korostynski, Marcin Piechota, Ryszard Przewlocki, Robert Pawlak. Neuropsin cleaves EphB2 in the amygdala to control anxiety. Nature, 2011; DOI: 10.1038/nature09938

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Pregnancy-related depression linked to eating disorders and abuse histories

ScienceDaily (June 16, 2011) — One in 10 women experience depression during pregnancy or shortly after giving birth. Although the problem has received increased attention in recent years, little is known about the causes or early-warning signs of pregnancy-related depression. In a study published in the June 2011 issue of Journal of Women's Health, researchers at the University of North Carolina at Chapel Hill School of Medicine offer new clues to help doctors identify at-risk patients and refer them to treatment early on.

The researchers surveyed 158 pregnant and postpartum women undergoing treatment for depression at UNC's Perinatal Psychiatry Clinic. One-third of the patients reported a history of eating disorders; in addition, many had a history of physical or sexual abuse. The findings suggest these psychiatric factors may increase a woman's likelihood of developing depression during pregnancy or postpartum.

Mental health screening tools that include questions about eating disorders, abuse and other factors should be incorporated into routine prenatal care, said Samantha Meltzer-Brody, MD, the lead author of the study and director of UNC's Perinatal Psychiatry Program. "Screening by obstetrical providers is really important because they can refer patients for appropriate treatment," she said. "And that can prevent long-lasting problems for mom and baby."

Undiagnosed and treated postpartum depression "causes enormous distress to the family, and it can have long-lasting consequences for the child," said Meltzer-Brody. Children of depressed mothers are more likely to develop mental health problems, and children of mothers with an active eating disorder may also be more likely to develop an eating disorder themselves. Making sure mothers struggling with mental health issues receive adequate assessment and treatment is critical to breaking that cycle, said Meltzer-Brody.

"The message we need to get out is that these things are incredibly common and routine screenings need to occur," said Meltzer-Brody. "The prevalence of abuse and eating disorder histories may be much higher than people appreciate."

Up to 25 percent of women experience physical or sexual abuse during their lifetime, a rate the UNC associate professor of psychiatry called "staggering." An estimated 6-8 percent of women are at some point affected by an eating disorder, with binge eating and bulimia nervosa being the most common, followed by anorexia and other disorders.

"Pregnancy and the postpartum period is a very vulnerable time for women," said Meltzer-Brody. Rapid changes in body shape, weight and hormone levels, combined with major lifestyle changes during the transition to motherhood, can take a toll on women -- especially those with a history of previous psychiatric issues.

Despite these challenges, Meltzer-Brody said pregnancy represents an ideal time for doctors to intervene and help women get mental health treatment if they need it. "[Pregnancy] is a time when people are really motivated to make changes and get treatment, because that can have serious consequences for how you do and for how your children do," she said, adding that by conducting mental health screens during prenatal care, doctors can help curb pregnancy-related depression.

The study's co-authors included Stephanie Zerwas, PhD, Jane Leserman, PhD, Ann Von Holle, Taylor Regis, and Cynthia Bulik, PhD, all from the Department of Psychiatry at the UNC School of Medicine, UNC Center for Women's Mood Disorders and UNC Eating Disorders Program.

Support for the research came from the NIH Building Interdisciplinary Careers in Women's Health (BIRCWH) Award to Dr. Meltzer-Brody.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of North Carolina School of Medicine.

Journal Reference:

Samantha Meltzer-Brody, Stephanie Zerwas, Jane Leserman, Ann Von Holle, Taylor Regis, Cynthia Bulik. Eating Disorders and Trauma History in Women with Perinatal Depression. Journal of Women's Health, 2011; 20 (6): 863 DOI: 10.1089/jwh.2010.2360

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