CRF receptor type 2 neurons in the posterior bed nucleus of the stria terminalis critically contribute to stress recovery.

The bed nucleus of the stria terminalis (BNST) is critical in mediating states of anxiety, and its dysfunction has been linked to stress-related mental disease. Although the anxiety-related role of distinct subregions of the anterior BNST was recently reported, little is known about the contribution of the posterior BNST (pBNST) to the behavioral and neuroendocrine responses to stress. Previously, we observed abnormal expression of corticotropin-releasing factor receptor type 2 (CRFR2) to be associated with post-traumatic stress disorder (PTSD)-like symptoms. Here, we found that CRFR2-expressing neurons within the pBNST send dense inhibitory projections to other stress-related brain regions (for example, the locus coeruleus, medial amygdala and paraventricular nucleus), implicating a prominent role of these neurons in orchestrating the neuroendocrine, autonomic and behavioral response to stressful situations. Local CRFR2 activation by urocortin 3 depolarized the cells, increased the neuronal input resistance and increased firing of action potentials, indicating an enhanced excitability. Furthermore, we showed that CRFR2-expressing neurons within the pBNST are critically involved in the modulation of the behavioral and neuroendocrine response to stress. Optogenetic activation of CRFR2 neurons in the pBNST decreased anxiety, attenuated the neuroendocrine stress response, ameliorated stress-induced anxiety and impaired the fear memory for the stressful event. Moreover, activation following trauma exposure reduced the susceptibility for PTSD-like symptoms. Optogenetic inhibition of pBNST CRFR2 neurons yielded opposite effects. These data indicate the relevance of pBNST activity for adaptive stress recovery.

Overshadowed by the amygdala: the bed nucleus of the stria terminalis emerges as key to psychiatric disorders.

The bed nucleus of the stria terminalis (BNST) is a center of integration for limbic information and valence monitoring. The BNST, sometimes referred to as the extended amygdala, is located in the basal forebrain and is a sexually dimorphic structure made up of between 12 and 18 sub-nuclei. These sub-nuclei are rich with distinct neuronal subpopulations of receptors, neurotransmitters, transporters and proteins. The BNST is important in a range of behaviors such as: the stress response, extended duration fear states and social behavior, all crucial determinants of dysfunction in human psychiatric diseases. Most research on stress and psychiatric diseases has focused on the amygdala, which regulates immediate responses to fear. However, the BNST, and not the amygdala, is the center of the psychogenic circuit from the hippocampus to the paraventricular nucleus. This circuit is important in the stimulation of the hypothalamic-pituitary-adrenal axis. Thus, the BNST has been largely overlooked with respect to its possible dysregulation in mood and anxiety disorders, social dysfunction and psychological trauma, all of which have clear gender disparities. In this review, we will look in-depth at the anatomy and projections of the BNST, and provide an overview of the current literature on the relevance of BNST dysregulation in psychiatric diseases.

The anxiolytic effect of environmental enrichment is mediated via amygdalar CRF receptor type 1.

Environmental enrichment (EE) is known to have an anxiolytic effect in several animal models; however, the molecular mechanisms underlying these behavioral changes are not understood. In this study, we have shown that the anxiolytic effect of EE is associated with alterations in the corticotropin-releasing factor receptor type 1 (CRFR1) expression levels in the limbic system. We found that the decrease in anxiety-like behavior after housing in enriched conditions was associated with very low levels of CRFR1 mRNA expression in the basolateral amygdala of C57BL/6 mice. We further showed using a lentiviral-based system of RNA interference, that knockdown of CRFR1 mRNA expression in the basolateral amygdala induces a significant decrease in anxiety levels, similar to those achieved by EE nurture. Our data strongly suggest that reduced expression of CRFR1 mRNA levels in the basolateral amygdala mediates the effect of EE on anxiety-like behavior.

The pill and the press: reporting risk.

Between 1986 and 1997, nine studies on health effects of oral contraceptives were published by the New England Journal of Medicine or JAMA. All of those studies showed no increased risk of breast cancer or protective effects against ovarian and endometrial cancer. Except for one study published in 1986, the major newspapers in the United States essentially ignored these findings, and The New York Times reported on other inconclusive studies that emphasized an oral contraceptive-breast cancer link.

Contraceptive advertising in the United States.

PIP: Despite the fact that most Americans support the advertising of family planning methods, the minority opposition has influenced the formulation of contraceptive advertising policies. This article attempts to clarify the current status of contraceptive advertising and to suggest a sensible public policy for the future. Opening with a review of opinion polls taken since 1985, the article points out that 70% of station managers reported their belief that contraceptive advertising would offend many people despite the fact that 87% of respondents in a public survey indicated no objection to such advertising. The policies that network television stations have adopted are traced from those instituted in the 1960s by the National Association of Broadcaster's Code Authority. These policies govern the airing of Public Service Announcements (PSAs) as well as advertisements. Magazines and newspapers also resist accepting contraceptive advertising, although they do not face the same regulations as the broadcast media. US Food and Drug Administration policies also act as a barrier to product-specific advertisements on network television despite the fact that the American Medical Association no longer opposes such advertising and the American College of Obstetricians and Gynecologists offered to provide valid information about advertising claims to the media. A review of attempts to advertise contraceptives shows that opposition has dropped significantly in the past 10 years for advertisements in newspapers, on cable television, in magazines, on some commercial television stations, and on many radio stations. However, the major television networks still fail to accept such advertisements. Part of the change that is occurring can be attributable to the emergence of AIDS and the need to promote methods to prevent the disease. However, much AIDS-related advertising has been in the form of PSAs, which are less and less available. The major obstacles to contraceptive advertising today are media reluctance, government regulation, lack of consistent effort on the part of advertisers, and a lack of consensus in society about the importance of this issue. These limits are the symptoms of a society which has an unrealistic view of sexual activity. Therefore, contraceptive advertising alone will not change the US's high unintended pregnancy and abortion rates.^ieng

Women's health and the mass media: the reporting of risk.

News about women's health risks is prevalent in the mass media, and how that news is presented is important for the woman who uses it to make decisions about her health. Conferees at a Jacobs Institute symposium reviewed the presentation and discussion of risk factors in scientific articles and the subsequent translation of this information by the media to their consumers. The symposium participants made four major recommendations to improve the reporting of risk: 1) as information sources, the scientific community, institutions, and media organizations should share the responsibility of clearly presenting information on risk factors affecting women's health, 2) institutional public affairs officers, journal public affairs officers, and mass media editors should require that reports on single studies be placed within the context of current scientific knowledge, with limitations prominently described, 3) measures of absolute and relative risk should be interpretable by a general audience, and 4) news makers (the scientific community) and news writers (reporters and editors) should have more training opportunities to achieve a clearer understanding of the constraints on the news media and the limitations of science.

Meige's disease misdiagnosed as anxiety disorder.

A woman in her late 40s with a 5 year history of anxiety was treated with relaxation training and cognitive restructuring. Her anxiety was manifested by facial twitching, hand fidgeting, vocal tremor, loss of self-esteem, and depression. Therapy seemed to reduce motor symptoms and improve her self-esteem, confidence, and mood. Six months after the start of therapy the client was found to have Meige's Disease. Following treatment with botulinum toxin, motor symptoms disappeared. This case highlights the need for psychotherapists to be more aware of neurological and medical problems which may mimic psychological ones.

Patient transfers to a public hospital.

This is a study of interhospital patient transfers to a medium-sized county sponsored hospital. During the three-month period studied, there were 416 patients who met the study criteria. Thirty-eight (9%) of the patients were transferred because the county hospital offered a higher level of medical care or medical services not available at the presenting facility, while the remaining 378 (91%) were transferred because of their health insurance status. Two hundred and ninety-six patients (71%) had no medical insurance of any kind, 117 (28%) had government sponsored health insurance, and three (1%) had private insurance. Of these transferred patients, 32 (8%) arrived in a medically unstable condition and one patient died shortly after suffering a respiratory arrest en route. It is concluded that interhospital transfer of underinsured or uninsured patients may represent a significant risk to patients.

Practice of gynecology in the elderly.

All practitioners must become more familiar with the practice of gynecology in the elderly in order to better serve their patients, of whom an increasing proportion are geriatric gynecologic patients. Advances in medical technology have increased the average life span, and better understanding of "senescent changes" may make it possible to improve the quality of life as well.

An exploration of obese observational learning in modifying selected eating responses of obese children.

The present study investigated the effects of two observational learning paradigms in modifying the eating behavior of obese children. A total of 18 subjects ranging in age from seven to 12 years and in weight from 74 to 160 lb (33 to 72 kg) were randomly assigned to three conditions. Intervention consisted of four sessions in which subjects viewed videotapes of their baseline eating behaviors compared with a model eating at a reduced speed. Based on the assumption that children may acquire their parents' eating behaviors, one condition included videotapes of a same-sex adult model. In order to maximize model-observer similarity, subjects in a second treatment condition observed videotapes of themselves eating at a reduced speed. Subjects in the control condition viewed only their baseline eating behavior videotapes. Dependent measures of eating behavior were found to be significantly affected by both model treatments, while no significant differences were evidenced in the control group.

Operant conditioning-based behavior modification: one approach to treating somatic disorders.

The applicability of behavior modification as a process for treating somatic difficulties is examined within the framework of measurement, modification, and evaluation. Illustrations of this process are presented throughout. In particular, the last section of the paper gives an example of a currently operative and multifaceted approach to the problem of obesity. Among the topics considered herein are the use of behavioral contracts that specify ameliorative weight reduction practices and the assessment as well as manipulation of eating speed.