Psychiatry - October 2008 - (Page 51)

[the interface] Genetic predisposition to mood/anxiety disorders Asthma Mood and anxiety disorders FIGURE 1. A proposed risk model for mood and anxiety disorders in asthmatics Childhood Trauma in Asthma adversity medications adulthood and illness chronicity comorbid mood and anxiety disorders. In our opinion, this is not an unexpected conclusion given our observation that mood and anxiety disorders appear to be commonly associated with chronic illness. However, there are also higher rates of mood disorders in the families of asthmatic individuals, suggesting a genetic predisposition—perhaps to both asthma and mood disorders. In addition, these prevalence rates may be mediated to some degree by the medications used in the treatment of asthma as well as trauma in either childhood or adulthood. Therefore, 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. Clearly, this is a cohort of patients who are plagued by wheezing (asthma), woes (mood disorders), and worries (anxiety). United States, 1980–2004. http://www.cdc.gov/mmwr/preview/ mmwrhtml/ss5608a1.htm Accessed June 2, 2008. Brown ES, Khan DA, Mahadi S. Psychiatric diagnoses in inner city outpatients with moderate to severe asthma. Int J Psychiatry Med. 2000;30:319–327. Afari N, Schmaling KB, Barnhart S, Buchwald D. Psychiatric comorbidity and functional status in adult patients with asthma. J Clin Psychol Med Settings. 2001;8:245–252. Goethe JW, Maljanian R, Wolf S, Hernandez P, Cabrera Y. The impact of depressive symptoms on the functional status of inner-city patients with asthma. Ann Allergy Asthma Immunol. 2001;87:205–210. Scott KM, Von Korff M, Ormel J, et al. Mental disorders among adults with asthma: results from the World Mental Health Survey. Gen Hosp Psychiatry. 2007;29:123–133. Wainwright NWJ, Surtees PG, Wareham NJ, Harrison BDW. Psychosocial factors and asthma in a community sample of older adults. J Psychosom Res. 2007;62:357–361. Goodwin RD, Jacobi F, Thefeld W. Mental disorders and asthma in the community. Arch Gen Psychiatry. 2003;60:1125–1130. Clarke DE, Goodwin RD, Messias mood and anxiety disorders; importantly, exposure to childhood adversity appeared to be an important mediating variable.24 These scant preceding data suggest that, in some individuals, early-developmental and adulthood trauma have associations with asthmatic disease. So, in addition to genetics and medications, trauma may secondarily mediate the emergence of mood and anxiety disorders in patients with existing asthma. 3. 4. A RISK MODEL Like many psychiatric syndromes, a risk model is perhaps the most practical way to integrate these various data. At the outset, genetics (i.e., a positive family history of mood disorders and/or predisposition to anxiety sensitivity) contribute to the development of mood and anxiety disorders in patients with asthma. Then, childhood adversity and the effects of chronic illness may have mediating roles in conjunction with trauma in adulthood and the medications used in the treatment of asthma. This model is illustrated in Figure 1 and does not exclude other mediating or contributory variables. 5. 6. 7. REFERENCES 1. Lifetime Asthma Prevalence Percents by Age, United States: National Health Interview Survey, 2006. http://www.cdc.gov/asthma/nhis/06/ table2-1.htm. Accessed June 2, 2008. US Centers for Disease Control. National Surveillance for Asthma— 8. CONCLUSION In summarizing these data, it appears that individuals with asthma have a higher-than-expected rate of 2. 9. [OCTOBER] Psychiatry 2008 51 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm http://www.cdc.gov/asthma/nhis/06/table2-1.htm http://www.cdc.gov/asthma/nhis/06/table2-1.htm

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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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