Cardiovascular risk factors in children and adolescents with anxiety disorders and their association with disease severity / Factores de riesgo cardiovascular en niños y adolescentes con trastorno de ansiedad y su asociación con la gravedad de la enfermedad

Introduction: Studies suggest that anxiety is an independent predictor of adverse cardiovascular events. However, few studies have investigated the association between cardiovascular risk factors (RF) and severity of anxiety disorders (AD) in childhood and adolescents. Objectives: To assess the prevalence of cardiovascular RF in children and adolescents with anxiety disorders and their association with disease severity. Method: Cross-sectional study assessing nutritional and anthropometric RF, as well as % body fat (BF), blood pressure (BP), physical activity level, anxiety symptoms and severity of the anxiety disorder of children and adolescents. Results: A total of 65 children and adolescents (8.6 ± 1.7 years) took part in the study. Excess saturated fatty acid intake (52.3%), high body mass index (50.8%), high BP (50.8%) and physical inactivity (50.0%) were the most prevalent cardiovascular RF. There was a significant association between the severity of the anxiety and the presence of ≥ 6 RF per patient (p=0.026), excess abdominal body fat as assessed by waist circumference (p=0.019) and conicity index (p=0,053), and excess % BF (p=0.035). Generalized anxiety disorder was significantly associated with high BP (p=0.044). Conclusion: A high prevalence of cardiovascular RF was found in the present sample, and individuals with more severe anxiety had greater cardiovascular risk. The characterization of the cardiovascular risk in young populations, especially in individuals with AD who are therefore more susceptible to CVD, is crucial for the development of lifestyle interventions in these patients (AU)

Introducción: Evidencias sugieren que la ansiedad es una prediciente independiente de los eventos cardiovasculares adversos. Entretanto, pocos estudios evaluaron la presencia de factores de riesgo (FR) para estas enfermedades en ninos y adolescentes. Objetivos: Identificar la prevalencia de FR cardiovasculares en ninos y adolescentes diagnosticados con disturbio de ansiedad y su asociacion con la gravedad de la enfermedad. Metodología: Estudio transversal que avaluo FR nutricional, antropometricos, % de gordura corporal (CG), presion arterial (PA), nivel de actividad fisica y escalas de sintomas y gravedad de la ansiedad. Resultados: 65 ninos y adolescentes (8.6 ± 1.7 anos) fueron incluidos en el estudio. Cuanto a los FR, el consumo excesivo de acidos grasos saturados (52.3%), índice de masa corporal alto (50.8%), PA alterada (50.8%) y la falta de ejercicio fisico (50.0%) fueron los mas prevalecientes. Hubo asociacion significativa entre la mayor gravedad del disturbio y el acumulo de ≥ 6 FR (p=0,026), exceso de gordura abdominal medida por la circunferencia de cintura (p=0.019) y por el indice de conicidad (p=0.053) y exceso en el % GC (p=0.044). Conclusión: Los resultados encontrados indican que hay una alta prevalencia de FR cardiovascular en la amuestra estudiada y los pacientes mas graves presentaron mayor riesgo. La caracterizacion del perfil de riesgo en las poblaciones con predisposicion a las enfermedades cardiovasculares es crucial para la elaboracion de estrategias de intervencion que oportunicen la reduccion en la prevalencia de estas enfermedades (AU)

Serotonin transporter gene (5HTT) polymorphisms and temporal lobe epilepsy.

OBJECTIVE: Preclinical and clinical studies have shown that serotonin levels might modulate susceptibility to seizures. Here we evaluated an association between 5HTTLPR and 5HTTVNTR allele variants in serotonin transporter gene and epileptogenesis in temporal lobe epilepsy (TLE). METHODS: A case-control candidate gene study evaluating the frequencies of 5HTTLPR biallelic and 5HTTVNTR allele variants in patients and healthy subjects. Genotypes were grouped according to transcriptional efficiency. Cases were 175 patients with TLE selected from the Epilepsy Outpatient Clinic of Hospital de Clínicas de Porto Alegre, classified according to the electroclinical classification of the ILAE and neuroimaging findings. The control group consisted of 155 healthy unrelated subjects selected from the same population. RESULTS: We observed that less efficient transcriptional genotypes for 5-HTT polymorphisms were more frequent in epileptic patients (O.R.=3.24; 95% C.I.=1.08-9.73; p=0.036). Our results suggest that less efficient transcriptional genotypes for serotonin transporter gene are associated with TLE. CONCLUSION: In this study we observed an association between the presence of 5HTTLPR and 5-HTTVNTR less transcriptional efficient combined genotypes and TLE. Our results suggest that modulation of the serotoninergic system might be implied in epileptogenesis in TLE.

Association between suicide attempts in south Brazilian depressed patients with the serotonin transporter polymorphism.

A polymorphism in the serotonin transporter gene (5-HTTLPR) is being studied for association with suicidal behavior. We verified the relationship between the frequencies of the 5-HTTLPR alleles in 84 depressed patients with suicide attempts compared with 152 controls. We found a higher risk for suicide behavior among depressed patients bearing SS or LS genotypes.

One-year follow-up of pharmacotherapy-resistant patients with panic disorder treated with cognitive-behavior therapy: Outcome and predictors of remission.

Non-response to pharmacotherapy for panic disorder (PD) is a well-documented problem. However, little information exists to guide next-step strategies for these non-responders. In addition to pharmacologic augmentation strategies, several studies support the efficacy of cognitive-behavior therapy (CBT) for these patients, although data on long-term outcomes has been lacking. In this study, we provide one-year outcomes on a sample of 63 patients who completed group CBT for PD after failing to respond adequately to previous pharmacotherapy. Sustained significant benefit was found for all dimensional outcome scores, and nearly two-thirds of the sample met remission criteria. This occurred with reductions in medication use over the follow-up period. Negative predictors of remission status included comorbid dysthymia, social phobia, and generalized anxiety disorder. These results provide additional evidence for the efficacy of CBT for medication non-responders with PD.

Cardiovascular risk factors in children and adolescents with anxiety disorders and their association with disease severity.

INTRODUCTION: Studies suggest that anxiety is an independent predictor of adverse cardiovascular events. However, few studies have investigated the association between cardiovascular risk factors (RF) and severity of anxiety disorders (AD) in childhood and adolescents. OBJECTIVES: To assess the prevalence of cardiovascular RF in children and adolescents with anxiety disorders and their association with disease severity. METHOD: Cross-sectional study assessing nutritional and anthropometric RF, as well as % body fat (BF), blood pressure (BP), physical activity level, anxiety symptoms and severity of the anxiety disorder of children and adolescents. RESULTS: A total of 65 children and adolescents (8.6 } 1.7 years) took part in the study. Excess saturated fatty acid intake (52.3%), high body mass index (50.8%), high BP (50.8%) and physical inactivity (50.0%) were the most prevalent cardiovascular RF. There was a significant association between the severity of the anxiety and the presence of ≥ 6 RF per patient (p=0.026), excess abdominal body fat as assessed by waist circumference (p=0.019) and conicity index (p=0,053), and excess % BF (p=0.035). Generalized anxiety disorder was significantly associated with high BP (p=0.044). CONCLUSION: A high prevalence of cardiovascular RF was found in the present sample, and individuals with more severe anxiety had greater cardiovascular risk. The characterization of the cardiovascular risk in young populations, especially in individuals with AD who are therefore more susceptible to CVD, is crucial for the development of lifestyle interventions in these patients.

Introducción: Evidencias sugieren que la ansiedad es una prediciente independiente de los eventos cardiovasculares adversos. Entretanto, pocos estudios evaluaron la presencia de factores de riesgo (FR) para estas enfermedades en ninos y adolescentes. Objetivos: Identificar la prevalencia de FR cardiovasculares en ninos y adolescentes diagnosticados con disturbio de ansiedad y su asociacion con la gravedad de la enfermedad. Metodología: Estudio transversal que avaluo FR nutricional, antropometricos, % de gordura corporal (CG), presion arterial (PA), nivel de actividad fisica y escalas de sintomas y gravedad de la ansiedad. Resultados: 65 ninos y adolescentes (8.6 } 1.7 anos) fueron incluidos en el estudio. Cuanto a los FR, el consumo excesivo de acidos grasos saturados (52.3%), indice de masa corporal alto (50.8%), PA alterada (50.8%) y la falta de ejercicio fisico (50.0%) fueron los mas prevalecientes. Hubo asociacion significativa entre la mayor gravedad del disturbio y el acumulo de ≥ 6 FR (p=0,026), exceso de gordura abdominal medida por la circunferencia de cintura (p=0.019) y por el indice de conicidad (p=0.053) y exceso en el % GC (p=0.044). Conclusión: Los resultados encontrados indican que hay una alta prevalencia de FR cardiovascular en la amuestra estudiada y los pacientes mas graves presentaron mayor riesgo. La caracterizacion del perfil de riesgo en las poblaciones con predisposicion a las enfermedades cardiovasculares es crucial para la elaboracion de estrategias de intervencion que oportunicen la reduccion en la prevalencia de estas enfermedades.

Cognitive-behavioral group therapy in obsessive-compulsive disorder: a randomized clinical trial.

BACKGROUND: The present study was designed to verify the efficacy of cognitive-behavioral group therapy (CBGT) in reducing obsessive-compulsive symptoms and the intensity of overvalued ideas, as well as in improving the patient's quality of life. METHODS: Forty-seven patients meeting DSM-IV criteria for obsessive-compulsive disorder (OCD) were randomly assigned to either 12 weekly CBGT sessions or a waiting list (control group). Treated patients were followed for three months. RESULTS: There was a significant reduction in the Yale-Brown Obsessive-Compulsive Scale (p < 0.001), in the National Institute of Mental Health Obsessive-Compulsive Scale (p < 0.001), in the Overvalued Ideas Scale (p < 0.001), and a significant improvement in the quality of life in the four domains of the World Health Organization Quality of Life Assessment Scale: physical (p < 0.001), psychological (p < 0.017), social (p < 0.018) and environmental (p < 0.04). No significant reduction was found in the Hamilton Rating Scale for Anxiety (p = 0.111) and the Hamilton Rating Scale for Depression (p = 0.271). The concomitant use of anti-obsessional medications did not influence the results. The rate of improved patients was 69.6% in the treated group and 4.2% in the control group (p < 0.001). The therapeutic gains were maintained and an additional reduction in symptoms was observed during the 3-month follow-up period. CONCLUSIONS: The results suggest that CBGT is effective in reducing the intensity of OCD symptoms and of overvalued ideas, and that it improves the OCD patient's quality of life in a short period of time.