Parity-related variation in cortisol concentrations in hair during pregnancy.

OBJECTIVE: To investigate hair cortisol concentrations (HCC) monthly in pregnant women and to explore the effect of parity. DESIGN: Prospective cohort study from gestational week (GW) 26, at childbirth and postpartum. SETTING: An antenatal care clinic in southeast Sweden. SAMPLE: 390 pregnant women. METHODS: Cortisol was measured using radioimmunoassay in methanol extracts of ground hair samples. MAIN OUTCOME MEASURES: Hair cortisol concentrations. RESULTS: Both primi- and multiparae exhibited an increase in HCC throughout pregnancy. Primiparae had significantly higher HCC in the latter part of the last trimester compared with multiparae (1 month P = 0.003, 2 months P = 0.038). The use of psychotropic medication in the first trimester correlated to HCC postpartum (P < 0.001). HCC in GW 14-17 was associated with HCC in GW 18-21 (primiparae and multiparae, P < 0.001), GW 22-25 (primiparae P = 0.036, multiparae P = 0.033), and 2 months postpartum (primiparae P = 0.049). HCC in GW 18-21 was associated with GW 22-25 in both primiparae (P < 0.001) and multiparae (P < 0.001) as well as 2 months prior to childbirth among primiparae (<0.037). In general, all estimates of HCC in pregnancy and postpartum showed a significant association between HCC for a specific month and the HCC in the previous month (all P < 0.001), except for the association of HCC among primiparae in GW 22-25 and 3 months prior to childbirth. CONCLUSIONS: Increased cortisol concentrations in hair were observed during pregnancy, which decreased 3 months prior to childbirth in multiparae. The results indicate a quicker suppression of the hypothalamic CRH (corticotropin-releasing hormone) production by placenta CRH in multiparous women. TWEETABLE ABSTRACT: Multiparae have a quicker suppression of hypothalamic CRH production by placenta CRH during pregnancy compared to primiparae.

Genetic and environmental aspects in the association between attention-deficit hyperactivity disorder symptoms and binge-eating behavior in adults: a twin study.

BACKGROUND: Prior research demonstrated that attention-deficit hyperactivity disorder (ADHD) is associated with binge-eating behavior, binge-eating disorder (BED), and bulimia nervosa (BN). The aim of this study was to investigate these associations in an adult twin population, and to determine the extent to which ADHD symptoms and binge-eating behavior share genetic and environmental factors. METHODS: We used self-reports of current ADHD symptoms and lifetime binge-eating behavior and associated characteristics from a sample of over 18 000 adult twins aged 20-46 years, from the population-based Swedish Twin Registry. Mixed-effects logistic regression was used to examine the association between ADHD and lifetime binge-eating behavior, BED, and BN. Structural equation modeling was used in 13 773 female twins to determine the relative contribution of genetic and environmental factors to the association between ADHD symptoms and binge-eating behavior in female adult twins. RESULTS: ADHD symptoms were significantly associated with lifetime binge-eating behavior, BED, and BN. The heritability estimate for current ADHD symptoms was 0.42 [95% confidence interval (CI) 0.41-0.44], and for lifetime binge-eating behavior 0.65 (95% CI 0.54-0.74). The genetic correlation was estimated as 0.35 (95% CI 0.25-0.46) and the covariance between ADHD and binge-eating behavior was primarily explained by genetic factors (91%). Non-shared environmental factors explained the remaining part of the covariance. CONCLUSIONS: The association between adult ADHD symptoms and binge-eating behavior in females is largely explained by shared genetic risk factors.

Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study.

BACKGROUND: Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding. METHOD: Data from 18 168 adult twins, aged 20-46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins. RESULTS: CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37-0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21-0.36) and MZ (0.18, 95% CI 0.10-0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results. CONCLUSIONS: CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

Cerebral blood flow in subjects with social phobia during stressful speaking tasks: a PET study.

OBJECTIVE: The central nervous system representation of social phobia (social anxiety disorder) is largely unknown. The aim of this study was to examine brain activity during symptom provocation in social phobics. METHOD: Positron emission tomography with the use of (15)O water was used to measure regional cerebral blood flow (rCBF) in 18 subjects with DSM-IV-defined social phobia and a nonphobic comparison group while they were speaking in front of an audience and in private. Heart rate and subjective anxiety were also recorded. RESULTS: During public versus private speaking, subjective anxiety increased more in the social phobics than in the comparison group. Increased anxiety was accompanied by enhanced rCBF in the amygdaloid complex in the social phobics relative to the comparison subjects. Cortically, brain blood flow decreased in the social phobics and increased in the comparison subjects more during public than private speaking in the orbitofrontal and insular cortices as well as in the temporal pole and increased less in the social phobics than in the comparison group in the parietal and secondary visual cortices. Furthermore, rCBF increased in the comparison group, but not in the social phobics, in the perirhinal and retrosplenial cortices. CONCLUSIONS: An rCBF pattern of relatively increased cortical rather than subcortical perfusion was observed in the nonphobic subjects, indicating that cortical evaluative processes were taxed by public performance. In contrast, the social phobia symptom profile was associated with increased subcortical activity. Thus, the functional neuroanatomy of social phobia involves the activation of a phylogenetically older danger-recognition system.

Citalopram in patients with fibromyalgia--a randomized, double-blind, placebo-controlled study.

The effect of the selective serotonin reuptake inhibitor citalopram was studied in a randomized, double-blind, placebo-controlled, 4-month trial in patients with the fibromyalgia syndrome (FMS) who all fulfilled the American College of Rheumatology criteria. The citalopram doses varied between 20-40 mg daily. Forty female patients, 21 patients in the citalopram and 19 in the placebo group, participated. Assessment of pain, depressive symptoms and physical functioning were made using Visual Analogue Scales (VAS), the Montgomery Asberg Depression Rating Scale (MADRS) and the Fibrositis Impact Questionnaire (FIQ). In the global judgement of improvement, no significant changes were found between the citalopram and placebo groups as concerns pain or well-being, either in the Intention to Treat (ITT) analysis or in the completer analysis. However, among the completers, it was a tendency that more patients in the citalopram group (52.9%) were improved as compared to the placebo group (22.2%) concerning well-being. Furthermore, the results indicated that treatment with citalopram had a significant effect on pain on the VAS after 2 months of treatment compared to baseline. After 4 months, however, the effect had diminished. Measured with the FIQ, significant differences in the pain ratings were seen at the end of the trial. Significant effects on the depressive symptomatology measured by means of the MADRS were seen already after 1 month of treatment and were increasing further at the end of the trial, when a significant difference between the groups was also found.

Changes in dietary fatty acids alter phospholipid fatty acid composition in selected regions of rat brain.

1. Eighty rats were randomized into four groups receiving one of the following diets: rat chow containing (1) 6% soybean oil, (2) 6% primrose oil, (3) 6% fish oil, (4) a combination of 4.5% primrose and 1.5% fish oil. 2. Following two months of each regimen, the rats were sacrificed by microwave irradiation and the brain's fatty acid composition was analysed with gas chromatography for each of the following regions: frontal cortex, striatum, occipital cortex, hippocampus, hypothalamus, cerebellum and pituitary. 3. Linoleic acid was decreased by both primrose and fish oil supplementations. The fish oil substitution resulted in a significant elevation of 20:3n-6, a decrease of 22:4n-6 and a non-significant decrease of 20:4n-6, probably reflecting inhibition of delta-5-desaturation. At the same time the fish oil diet significantly elevated 22:5n-3 while 22:5n-6 was decreased. 4. The primrose oil diet lowered the n-3/n-6 ratio in all regions except in the cerebellum. In contrast, the fish oil diet elevated the n-3/n-6 ratio in all regions. 5. The results demonstrate that changes in dietary fat composition can alter the fatty acid composition of the adult rat brain and that these effects are region specific. 6. This is of interest since metabolites of essential fatty acids may be involved in physiological and pathological processes in the brain and it has been hypothesized that dietary intake of fats may influence the outcome of psychiatric disorders such as schizophrenia.

The impact of life events in female patients with fibromyalgia and in female healthy controls.

The aim was to investigate if female fibromyalgia patients (FMS) had experienced more negative life events than healthy women. Furthermore, the life events experienced in relation to onset of the FMS were evaluated. Another important area was to investigate the impact of the events experienced in the patients compared to healthy women. A new inventory was constructed to assess life events during childhood, adolescence and in adulthood as well as life events experienced in relation to the onset of the disorder. Forty female FMS patients and 38 healthy age-matched women participated in the study. During childhood or adolescence 51% of the patients had experienced very negative life events as compared to 28% of the controls. Conflict with parents was the most common life event. Before onset, 65% of the patients experienced some negative life event. Economic problems and conflicts with husband/partner were common. During the last year, 51% of the patients had life events which they experienced as very negative, compared to 24.5% of the controls (P < 0.01). Stressful life events in childhood/adolescence and in adulthood seem to be very common in FMS. Furthermore, the life events were experienced as more negative than the life events experienced by healthy controls.

Personality traits in social phobia.

The purpose was to assess personality traits in subjects with a DSM-IV diagnosis of social phobia. Thirty-two subjects were administered the Structured Clinical Interview for DSM-IV for Axes I and II disorders (SCID I and II). Personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Current and lifetime axis I co-morbidity was diagnosed in 28% and 53% of the subjects, respectively. In total, 59% had at least one personality disorder and 47% were diagnosed with an avoidant personality disorder. The social phobics scored significantly higher than a Swedish normative sample on the KSP measuring anxiety proneness, irritability, detachment, and indirect aggression but lower on the scales for socialisation and social desirability. The presence as compared to absence of avoidant personality disorder in the social phobics was associated with significantly higher psychic anxiety and inhibition of aggression. In addition, symptom severity was higher in social phobics with an avoidant personality disorder. Generally, the results support the view that social phobia and avoidant personality disorder reflect different aspects of a social anxiety spectrum.

Social phobia in the general population: prevalence and sociodemographic profile.

BACKGROUND: The present study examined the prevalence of social phobia in the Swedish general population and demographic characteristics associated with this anxiety disorder. METHODS: Data were obtained by means of a postal survey administrated to 2000 randomly selected adults. A questionnaire, validated against clinical interviews and established social phobia scales, was used to assess social distress in a broad range of phobic situations, as well as the diagnostic criteria for social phobia corresponding to DSM-IV. Interpretable questionnaires were obtained from 1202 respondents (60.1%). RESULTS: The point prevalence of social phobia was estimated at 15.6%, but prevalence rates varied between 1.9 and 20.4% across the different levels of distress and impairment used to define cases. Public speaking was the most common social fear. Social phobia was associated with female gender, low educational attainment, psychiatric medication use, and lack of social support. CONCLUSIONS: Although the exact diagnostic boundaries for social phobia are difficult to determine, it can be concluded that social anxiety is a distressing problem for a considerable proportion of the general population.