Sex-specific cardiac remodeling in aged rats after adolescent chronic stress: associations with endocrine and metabolic factors.

Background: Cardiovascular disease is a leading cause of death worldwide. Rates of cardiovascular disease vary both across the lifespan and between sexes. While multiple factors, including adverse life experiences, impact the development and progression of cardiovascular disease, the potential interactions of biological sex and stress history on the aged heart are unknown.

Sex-Specific Cardiac Remodeling in Aged Rats after Early-Life Chronic Stress: Associations with Endocrine and Metabolic Factors.

Background: Cardiovascular disease is a leading cause of death worldwide. Rates of cardiovascular disease vary both across the lifespan and between sexes. While multiple factors, including adverse life experiences, impact the development and progression of cardiovascular disease, the potential interactions of biological sex and stress history on the aged heart are unknown.

Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study.

Objective: Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment.

Method: In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care.

Glucoregulation and coping behavior after chronic stress in rats: Sex differences across the lifespan.

The purpose of the current study was to determine how biological sex shapes behavioral coping and metabolic health across the lifespan after chronic stress. We hypothesized that examining chronic stress-induced behavioral and endocrine outcomes would reveal sex differences in the biological basis of susceptibility. During late adolescence, male and female Sprague-Dawley rats experienced chronic variable stress (CVS).

Clinical and neural responses to cognitive behavioral therapy for functional tremor.

Objectives: To evaluate changes in tremor severity and motor/emotion-processing circuits in response to cognitive behavioral therapy (CBT) delivered as treatment for functional tremor (FT), the most common functional movement disorder in adults.

Methods: Fifteen patients with FT underwent fMRI with motor, basic-emotion, and intense-emotion tasks before and after 12 weeks of CBT. Baseline fMRI was compared to those of 25 healthy controls (HCs).

Another Step Toward Clarifying the Benefits and Burdens of Selective Serotonin Reuptake Inhibitors.

Selective serotonin reuptake inhibitors (SSRIs) have substantial beneficial effects for the treatment of major depressive mood disorders and other conditions but can also result in unwanted clinical outcomes. One of the reported disadvantages of SSRIs, based on cross-sectional studies, is their adverse effects on glycemic control. However, in this issue of Psychosomatic Medicine, Tharmaraja et al.

Innovations for integrated care: The Association of Medicine and Psychiatry recognizes new models.

This editorial looks at the current state of the integration of medicine and psychiatry in clinical practice. We note selected recent triumphs and barriers to implementing integrated care, highlighting some gaps and priorities for future innovations. In contrast to the relatively more orderly culture of health services research, where some notable innovations in integrated care were funded, tested, and published, the health care marketplace can be a difficult place to identify and track the innovations that could shape health care reform.

California's Efforts To Cover The Uninsured: Successes, Building Blocks, And Challenges.

During the last century, California policy makers tried multiple approaches to achieve the goal of affordable health coverage for all: employer and individual requirements, single payer, and hybrids. All failed, primarily because of the amount of financing needed to cover the large numbers of uninsured Californians and the supermajority vote requirements for tax increases. These failures, however, provided important lessons for state and national reform efforts.

Cardiometabolic risks and omega-3 index in recent-onset bipolar I disorder.

Objectives: The aims of the present study were to characterize cardiometabolic risk factors in a cohort of bipolar disorder patients with limited exposure to psychotropic medications, and to evaluate their associations with mood symptoms and omega-3 polyunsaturated fatty acid (PUFA) blood levels.

Methods: Cardiometabolic risk assessments were compared in individuals with bipolar I disorder experiencing a first manic or mixed episode or an early depressive episode (n=117) and healthy subjects (n=56). Patients were medication free at assessment and had no or limited exposure to mood-stabilizer or antipsychotic medications prior to the current admission.

Stress, autonomic imbalance, and the prediction of metabolic risk: A model and a proposal for research.

Background: Devising novel prevention strategies for metabolic disorders will depend in part on the careful elucidation of the common pathways for developing metabolic risks. The neurovisceral integration model has proposed that autonomic imbalance plays an important role in the pathway from acute and chronic stress to cardiovascular disease. Though generally overlooked by clinicians, autonomic imbalance (sympathetic overactivity and/or parasympathetic underactivity) can be measured and modified by methods that are available in primary care.

The Contribution of Autonomic Imbalance to the Development of Metabolic Syndrome.

Objectives: Obesity, diabetes, and heart disease-the most costly epidemics of our time-share a common but rarely treated mechanism: autonomic imbalance. We examined the contribution of autonomic imbalance, relative to selected demographic and biobehavioral risk factors, to the development of metabolic syndrome in a community sample for 12 years.

Methods: We identified offspring cohort participants from the Framingham Heart Study who did not have metabolic syndrome at Examination 3 (1983-1987, baseline for this analysis) and whose metabolic syndrome status was assessed at the 4-, 8-, and 12-year follow-ups.

Autonomic Imbalance as a Predictor of Metabolic Risks, Cardiovascular Disease, Diabetes, and Mortality.

Context: Identifying novel early predictors of metabolic disorders is essential to improving effective primary prevention.

Objectives: The objectives were to examine the contribution of two measures of autonomic imbalance, resting heart rate (RHR) and heart rate variability (HRV), on the development of five metabolic risk outcomes, and on cardiovascular disease, diabetes, and early mortality.

Design: This study was a secondary analysis of prospective data from Offspring Cohort participants (N = 1882) in the Framingham Heart Study (FHS).

Prevalence rates for depression by industry: a claims database analysis.

Purpose: To estimate and interpret differences in depression prevalence rates among industries, using a large, group medical claims database.

Methods: Depression cases were identified by ICD-9 diagnosis code in a population of 214,413 individuals employed during 2002-2005 by employers based in western Pennsylvania. Data were provided by Highmark, Inc.

Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

Background: Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.

Methods And Results: Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees.

Somatic symptom disorder: an important change in DSM.

This paper describes the rationale for the new diagnosis of somatic symptom disorder (SSD) within DSM5. SSD represents a consolidation of a number of previously listed diagnoses. It deemphasizes the centrality of medically unexplained symptoms and defines the disorder on the basis of persistent somatic symptoms associated with disproportionate thoughts, feelings, and behaviors related to these symptoms.

Psychiatry's integration with medicine: the role of DSM-5.

Mental disorders represent a significant global burden whose effects are exacerbated by gaps in diagnosis and service provision. A substantial number of individuals seek services not through specialty psychiatric clinics but through primary care. Thus, the interface between psychiatry and the rest of medicine represents an appropriate area of focus in which to improve the detection and treatment of mental disorders.

Comparison of two depression measures for predicting stroke outcomes.

Objectives: Little is known about the effect of lifetime history of depression on ischemic stroke outcomes. This study compared a measure of current symptoms of depression at the time of the stroke and a measure of lifetime history of depression for their ability to predict quality of life and functioning at 3 and 12 months after stroke.

Methods: A cohort of 460 ischemic stroke patients from the 2005 Greater Cincinnati/North Kentucky Stroke Study was assessed within 2 weeks of the stroke, including the 10-item Center for Epidemiological Studies Depression Scale (CESD) for current symptoms of depression.

Acute psychosis and type 2 diabetes mellitus:should screening guidelines be revised?

Although psychosis increases the risk for developing type 2 diabetes, the temporal relationship between the onset of psychosis and the onset of diabetes has not been studied. We present 6 cases of acute psychosis, which led to the new diagnosis of type 2 diabetes during inpatient psychiatric admission within days to weeks of the psychotic episode. The implications of these findings and the efficacy of current diabetes screening guidelines are discussed.

Prevalence of depression among mothers of young children in Honduras.

Objective: Maternal depression is a substantial problem that has negative consequences on the health of both mother and child. Little research has been done on the prevalence of maternal depression in the developing world. This study aims to estimate the prevalence of current depression among mothers in Honduras and identify demographic predictors of depression in this sample.

Depression and whole blood serotonin in patients with coronary heart disease from the Heart and Soul Study.

Objective: To evaluate whether depression is associated with whole blood serotonin in outpatients with stable coronary heart disease (CHD). Depression is associated with incident CHD and with adverse cardiovascular outcomes. Dysregulation of peripheral serotonin, common to both depression and CHD, may contribute to this association.

Toward a 21st-century health care system: recommendations for health care reform.

The coverage, cost, and quality problems of the U.S. health care system are evident.

Dimensionality reduction for knowledge discovery in medical claims database: application to antidepressant medication utilization study.

Data mining, through its capacity to discover knowledge embedded in large databases to improve organizational decision-making, has the potential to contribute to efficiencies and cost savings in the increasingly costly healthcare industry. One important aspect of the methods of mining medical databases includes reducing dimensionality through feature selection. Traditionally feature selection is accomplished through stepwise regression, which tends to produce an unnecessarily high number of "significant" variables.