ACTIVE: a cognitive intervention trial to promote independence in older adults.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.

Depressive relapse following acute tryptophan depletion in patients with major depressive disorder.

Acute tryptophan depletion (ATD) lowers serotonin synthesis and elicits depressive symptoms in some, though not all, remitted patients with major depressive disorder (MDD). In the present study, eight medication-free remitted patients with MDD, seasonal pattern, were tested twice, once following the ingestion of a tryptophan-containing mixture, once following ATD. ATD significantly increased Hamilton depression scores (p < 0.001). Four of the patients had a family history of psychiatric disorders: substance abuse (n = 4), mood disorders (n = 3) or Cluster B personality disorders (n = 3). The mood-lowering response to ATD was significantly greater in those patients with, than without, affected relatives (p < 0.001). These preliminary findings (1) support the hypothesis that depressed states are related to disturbed serotonin neurotransmission and (2) suggest that depressive symptoms following ATD might identify a subgroup of patients at high genetic risk for disorders associated with affective lability and dysregulated impulse-control, conditions thought to be related to low serotonin neurotransmission.

Anger expression, gender, and ambulatory blood pressure in mild, unmedicated adults with hypertension.

The suppression of anger has been associated with the development of hypertension. This study evaluated the association between anger management style (anger-in and anger-out) and ambulatory blood pressure (ABP) in patients with repeated clinic diastolic blood pressures (DBPs) between 90-105 mmHg, unmedicated and with no known coronary artery disease. A total of 128 men (46.0 years) and 66 women (46.6 years) participated. Fourteen percent of men and 35% of women were classified as having "white coat" hypertension (daytime DBP < 85 mmHg). Mean awake and sleep DBP and systolic blood pressure (SBP) were evaluated in a repeated measures analysis of variance (ANOVA). Anger-in and anger-out scores were categorized into low, medium, and high t-scores (< 50, 50-59, > or = 60). Results indicated that in women, increasing anger-in is associated with greater SBPs while awake and sleeping, whereas no effect was found for DBP, nor any effect in men. No significant association was found between gender, anger-out, and ABP. The clinical diagnostic status of white coat hypertension was not differentially associated with anger-in or anger-out in men and women. In conclusion, in a sample of mild unmedicated adults with hypertension, suppression of anger is associated with greater ambulatory SBP in women, but not in men.

Alexithymia and health behaviors in healthy male volunteers.

The association between alexithymia and maladaptive health behaviors was evaluated in 118 young, healthy men, aged 18-45 years. Subjects completed the Toronto Alexithymia Scale (TAS-26), and a health behaviors questionnaire, measuring alcohol and drug use, sedentary lifestyle, poor nutritional consumption, and risky sexual practices. In forced hierarchical regression analyses, the association between alexithymia and health behaviors was evaluated after adjusting for age, body mass index, social support, ambivalence over expression of emotion, and the expression of emotion. Results indicated that: (1) the TAS-26 and difficulty identifying feelings was associated with poor nutritional consumption; (2) difficulty identifying feelings was associated with greater alcohol and drug use; and (3) difficulty communicating feelings was associated with a more sedentary lifestyle. There was no association between risky sexual practices and alexithymia. These results suggest that, in young men, difficulties with identifying emotions and communicating emotions are associated with maladaptive nutritional habits, a sedentary lifestyle, and substance abuse, even after adjusting for other psychosocial and demographic variables. Such maladaptive health behaviors may help explain the association between alexithymia and premature mortality.

The effect of sucrose on acute tobacco withdrawal in women.

Carbohydrate consumption is thought to attenuate symptoms of tobacco withdrawal, but direct evidence for this idea does not exist. Using a 2 x 2 (smoking/smoking deprived x sucrose/placebo) factorial design, we examined in 67 women whether sucrose would decrease acute withdrawal symptoms observed after 12 h of tobacco abstinence. Sucrose decreased tobacco abstinence-induced drowsiness and anxiety and preference for foods high in carbohydrate and fat content. Sucrose, however, had no effect on several other acute withdrawal symptoms, including restlessness, irritability and concentration difficulties. These results provide modest support for the idea that increased carbohydrate intake during tobacco withdrawal reduces certain withdrawal symptoms even after only 12 h of abstinence.

Cardiovascular stress response and coronary artery disease: evidence of an adverse postmenopausal effect in women.

OBJECTIVES: To test the hypothesis that postmenopausal women demonstrate greater vascular instability, measured by enhanced cardiovascular stress responses during mental stress, compared with men and premenopausal women. BACKGROUND: Recent data suggest that estrogen plays a role in regulating vascular tone. The possible consequences of estrogen deficiency during menopause on systemic vascular reactivity is largely unexplored. METHODS: One hundred subjects (84 men and 16 women) underwent mental stress testing with radionuclide ventriculo graphy. Study subjects included 19 normal volunteers, 23 control subjects with chest pain syndromes or hypertension but without coronary artery disease, and 58 coronary artery disease subjects. The subjects performed a series of three mental stress tasks, during which hemodynamic data and radionuclide ventriculograms were obtained. RESULTS: Overall, women demonstrated greater hemodynamic responses during mental stress measured by changes in heart rate, systolic and diastolic blood pressure, and double product compared with those of men (all p < 0.05). Women with coronary artery disease demonstrated greater heart rate, diastolic blood pressure, and double product stress responses than their male counterparts (all p < 0.05). Women of postmenopausal age demonstrated significantly greater systolic blood pressure reactivity than men or premenopausal women (p < 0.05). CONCLUSIONS: Women of postmenopausal age have greater cardiovascular responses to stress than men or premenopausal women. These findings suggest an additional mechanism by which estrogen deficiency conveys a poor prognosis in female patients with coronary artery disease.

Stress and depressed mood in medical students, law students, and graduate students at McGill University.

PURPOSE: To investigate stress in medical students, law students, and graduate students at McGill University using a well-validated measure, the Derogatis Stress Profile (DSP). METHOD: The DSP was administered to the medical students in November and December 1994. For comparison, the DSP was also administered to the undergraduate law students and the graduate students. In November 1995 the DSP was administered to the first- and second-year medical students. Results were analyzed with a number of statistical methods. RESULTS: The response rates for the medical students, the law students, and the graduate students in 1994-95 were 70%, 96%, and 43%, respectively. The response rate for the first- and second-year medical students in 1995-96 was 57%. The medical students had subjective feelings of stress that are marginally above population norms, but their total-stress scores (related to environmental factors, personality mediators, and emotional responses) were below those of the general population, the law students, and the graduate students. Elevated depression scores in a minority of the students did not seem to be related directly to the stresses associated with medical school. The transition from basic science training to clinical training was associated with an increase in stress and depressed mood. CONCLUSION: Medical students are not greatly stressed relative to other groups, hence other explanations must be sought for the elevated levels of depression in some students. One situation in which stress appears to be particularly important is in the transition from basic science training to clinical training. Targeted interventions may be an effective way of dealing with this problem.

Defensive hostility, gender and cardiovascular levels and responses to stress.

Prior studies have demonstrated inconsistent relationships between the trait of hostility and cardiovascular responses to stress. To examine the hypothesis that only a subset of hostile subjects demonstrates greater cardiovascular responses to stress, we assessed relationships among hostility, defensiveness, and cardiovascular responses to stress in 33 healthy men and 34 healthy women. Stressors used were math and speech tasks. Median splits on Cook-medley Hostility Inventory (Ho) and defensiveness [Marlowe-Crowne Social Desirability scale (MC)] classified subjects into four groups: (a) Defensive Hostile (DH--high Ho and MC), (b) Low Hostile (LH--low Ho and MC), (c) High Hostile (HH--high Ho, low MC), and (d) Defensive (Def--low Ho, high MC). Results indicate that Defensive Hostility is differentially related to cardiovascular levels in men and women. DH men exhibited greater systolic blood pressure (SBP) levels than LH, Def, and HH men. Analyses of diastolic blood pressures (DBPs) suggested a trend that LH and DH men demonstrated greater DBP levels than Def and HH men. In contrast, DH women were indistinguishable from HH and Def women with respect to blood pressure, and LH women demonstrated the lowest SBP and DBP levels. There were no personality differences in cardiovascular change scores to stress. Gender differences for affect were observed which may mediate the cardiovascular responses. These data suggest that the personality trait of Defensive Hostility may provide significant associations with blood pressure levels and coronary disease associations with blood pressure levels and coronary disease in studies that do not find associations using hostility alone.

Defensive hostility: relationship to multiple markers of cardiac ischemia in patients with coronary disease.

Three studies assessed whether the combined traits of hostility and defensiveness identify a group of hostile individuals with functionally severe coronary artery disease (CAD). CAD patients completed the Cook-Medley Hostility Inventory (Ho) and the Marlowe-Crowne Social Desirability Scale (MC). Patients were classified into 4 groups: defensive hostile (DH: high Ho, high MC), low hostile (LH: low Ho, low MC), high hostile (HH: high Ho, low MC), and defensive (Def: low Ho, high MC). DH in comparison to HH, LH, and Def CAD patients demonstrate the greatest perfusion defects as measured by exercise thallium scintigraphy; DH patients exhibit the most frequent ischemic episodes during ambulatory electrocardiographic monitoring; and in a laboratory study, DH patients exhibit the most severe mental stress-induced ischemia assessed by echocardiography. Thus, the combination of high hostility and high defensiveness are associated with more functionally severe CAD and may predispose CAD patients to a more adverse prognosis.

Hostility and myocardial ischemia in coronary artery disease patients: evaluation by gender and ischemic index.

Two studies assess relationships of hostility to extent and severity of exercise-induced cardiac ischemia and daily life ischemia in patients with coronary artery disease (CAD). CAD patients (N = 80) who underwent exercise tomographic thallium testing to assess myocardial perfusion completed the Cook-Medley Hostility Inventory (Ho). A Composite Hostility (Chost) score obtained from the Ho scale was also used. Statistically controlling for the effects of gender in the full sample (N = 80), Chost was positively correlated with severity of perfusion defects (r = 0.22, p < 0.05). This relationship was nonsignificant in the 63 male patients, but was significant among women (N = 17, r = 0.42, p < 0.05) and among middle-aged men (less than 60 years, N = 17, r = 0.55, p < 0.05). In an overlapping sample of 42 CAD patients with ischemia (ST-segment depression > or = 1 mm) during 24 to 48 hours of ambulatory electrocardiographic monitoring, after controlling for gender, both Ho and Chost were positively correlated with total minutes of ischemia (r = 0.28 and r = 0.29, respectively, p < 0.05). In addition, there was a significant gender x hostility interaction, with stronger relationships with hostility evident for women. Results from these two studies indicate that in patients with coronary artery disease, hostility traits are significantly correlated with extent of daily life ischemia and with severity of exercise-induced myocardial ischemia. These relationships appear to be significant among female and middle aged male patients, but may be less evident among older male patients.

Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease.

This report evaluates the relationships of hemodynamic reactivity and determinants of myocardial oxygen demand to myocardial ischemia during mental stress in coronary artery disease patients. Thirty-nine patients and 12 controls were studied by radionuclide ventriculography during three mental tasks (arithmetic, Stroop task, and simulated public speaking). Patients were subdivided into three groups based on the severity of ischemic wall motion responses to the mental stressors. Results revealed that systolic blood pressure (SBP) levels during the mental tasks and SBP reactivity (increases) to stress were highest for the severely ischemic group, lowest for controls, with the mild-moderate ischemic and nonischemic patients in between. Severely ischemic patients started out with lower double product (heart rate x SBP) levels, and reached higher levels during the Stroop and speech tasks. There were no reliable group effects for diastolic blood pressure, heart rate, or left ventricular end-diastolic volumes. Among severely ischemic patients, the most potent task in eliciting ischemia (the speech) was associated with higher cardiovascular levels and elicited greater heart rate, double product, and ventricular volume responses. The present data indicate a relationship between cardiovascular levels and reactivity and the magnitude of ischemia induced by mental stress.