Psychiatry - October 2008 - (Page 50)

[the interface] colleagues reported a prevalence rate for panic disorder of 14 percent.17 DATA CONFOUNDS The preceding data indicate that among various community and clinical populations of adolescent and adult patients with asthma, there appears to be a higher-than-expected prevalence rate of mood and anxiety disorders. However, these data must be interpreted with caution. First, in some studies, the diagnosis of asthma was based upon self-report. We do not know if these individuals genuinely suffered from asthma—a factor that could contribute to selection bias. Second, the presence of a chronic medical condition may partially explain the high rates of mood and anxiety disorders. In our suggesting that asthma may function as a mediating variable. Any of these preceding factors could diminish a genuinely independent relationship between asthma, and mood and anxiety disorders. From another perspective, the rates of psychiatric disturbance observed in these populations may actually under-represent the association between asthma and mood/anxiety disorders. Specifically, a number of these studies examined child and adolescent populations and report current prevalence rates. Given an increasing risk for mood and anxiety disorders with age, these studies may under-represent the ultimate findings that one would encounter in adults. when evaluating individuals with asthma, we wish to stress the importance of exploring mood and anxiety disorders with special attention to a family history of mood disorders, a history of trauma in childhood or adulthood, and the potential role of medications. experience, mood and anxiety disorders are the most common psychiatric syndromes encountered in chronic disease states. Thus, these psychiatric findings may not be specific to the asthma disease state, itself, but rather to chronicity. Third, the medications used in the treatment of asthma may partially explain the observed psychiatric findings. For example, corticosteroids can contribute to mood disorders; the Food and Drug Administration is currently investigating montelukast with regard to mood and behavioral changes, suicidal ideation, and suicide; and beta agonists may cause nervousness and simulate anxiety syndromes. Finally, family studies among asthmatics suggest a possible genetic predisposition to depression, 50 Psychiatry 2008 [ O C T O B E R ] ASTHMA AND PSYCHOLOGICAL TRAUMA IN CHILDHOOD/ ADULTHOOD Given that mood and anxiety disorders appear to demonstrate a higher-than-expected association with asthmatic disease, is there any evidence that trauma histories are present in the lives of these individuals? If so, it is possible that trauma might function as yet another contributory or priming variable for mood and anxiety disorders. In support of this possibility, Ross and Wong discuss the role of anxiety sensitivity (i.e., one’s potential susceptibility to anxiety symptoms), which they attribute to both genetics and the environment.18 They describe emotional and physical abuses in childhood as important etiological factors for the subsequent development of anxiety sensitivity, which may act as a contributory variable in the ultimate expression of mood and/or anxiety disorders. While the literature in this area is relatively sparse, there are several elucidative studies. Most of these studies are based upon a similar methodology—the comparison among traumatized individuals of the actual versus expected frequencies of various medical disorders. For example, in a study of adolescents residing in Hong Kong, investigators surveyed more than 3,300 students regarding their exposure to corporal punishment at home. Corporal punishment, including being beaten for no reason and being beaten to the point of injury, was associated with a higher frequency of particular psychological and physical morbidities including asthma.19 In a study of 502 primary care patients with anxiety, investigators found a relationship between post-traumatic stress disorder and a number of medical problems including asthma.20 Among a sample of women residing in New Zealand, investigators found that childhood sexual abuse was related to the presence of current asthma (i.e., the past 12 months) (OR, 2.25; 95% CI, 1.06–4.80).21 In a sample of Australian Vietnam veterans, O’Toole and Catts found that posttraumatic stress disorder was associated with a variety of illnesses including asthma.22 Using a different methodological approach and in keeping with the preceding data, Potoczek and colleagues examined 97 patients with severe asthma for evidence of interpersonal loss.23 In this sample, 80 percent reported the suffering and/or death of an individual whom they were emotionally close to. Likewise, in a 21-year longitudinal study, investigators explored relationships between asthma and 50

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Psychiatry - October 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Treatment of Migraine and the Role of Psychiatric Medications Play Therapy: A Case-based Example of a Nondirective Approach Delirium and Antipsychotics: A Systematic Review of Epidemiologyand Somatic Treatment Options Severely Mood-disordered Youth Respond Less Well to Treatment in a Community Clinic than Youth with Bipolar Disorder Beyond Informed Consent: The Ethics of Informing, Anticipating, and Warning Asthma: Wheezing, Woes, and Worries Classified Advertising Journal Watch Information for Authors

Psychiatry - October 2008

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