Category: Anxiety

— Insomnia is bad news for software engineers' quality of life and deserves greater recognition and attention, according to new research by Sara Sarrafi Zadeh and Khyrunnisa Begum from the University of Mysore in India. Their work shows that poor sleep has a bearing on quality of life — affecting physical and mental health in particular — in this group with high levels of job-related stress.

The paper is published online in Springer's journal Applied Research in Quality of Life.

Insomnia, a disorder of insufficient or poor quality sleep, has been shown to have adverse daytime consequences ranging from fatigue, irritability and memory impairment to loss of productivity and relationship difficulties. Left untreated, it has also been linked to severe depression and coronary heart disease. Because the majority of insomniacs do not seek medical treatment, poor sleep is also thought to affect quality of life.

Sarrafi Zadeh and Begum believe that a high incidence of insomnia, alongside minimal recognition of the problem by healthcare professionals, has led to the tangible consequences of chronic insomnia being underestimated.

They studied the relationship between the amount of sleep and the quality of life of 91 software engineers aged between 21 and 45, working for a software company in Mysore, in order to determine the prevalence of insomnia among this group particularly prone to job-related stress. The participants completed two questionnaires: The first looked at insomnia and sleep quality; the second assessed their quality of life.

The authors found that 56 percent of the participants had mild (35 percent) or severe (21 percent) insomnia, compared to 23 percent in the general population. In contrast to what other studies have shown, younger engineers were more likely to be insomniacs than their older counterparts. In terms of gender differences, more women suffered from mild insomnia than men while more men suffered from severe insomnia than women.

Quality of life in general, and mental and physical health in particular, were significantly lower in subjects with insomnia than in other participants. The association between insomnia and poor quality of life was particularly strong for mental health. There were no gender differences in the effects of poor sleep on quality of life.

The authors conclude: "In view of the serious health consequences of insomnia in software engineers who are at high risk, suitable awareness programs should be developed as a preventative measure. Sleep assessment should be included as part of routine medical check-ups so that management of the problem is easier in the early stages. Lifestyle management programs which include sleep hygiene and care should be incorporated as a policy matter in the IT industry."

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Journal Reference:

1. Sara Sarrafi Zadeh, Khyrunnisa Begum. Association Between Insomnia and Quality of Life: An Exploratory Study Among Software Engineers. Applied Research in Quality of Life, 2010; DOI: 10.1007/s11482-010-9131-5

Research from the Norwegian Institute of Public Health (NIPH) shows that children with severe congenital heart defects have twice the risk of anxiety at 18 months of age compared to healthy children. Children with mild and moderate heart defects, on the other hand, did not show an increased risk of anxiety.

"These findings suggest that children with severe forms of congenital heart defects are prone to emotional problems at a very young age. The increased risk of anxiety could be related to the number of medical procedures and hospital admissions that characterise the first years of life for these children," said PhD student Kim Stene-Larsen at the NIPH.

Part of the HEARTKIDS project

The NIPH is collaborating with the Department of Paediatric Cardiology at Oslo University Hospital on a major research project, HEARTKIDS. In this follow-up study the researchers examined whether children with congenital heart defects had an increased risk of internalising problems such as anxiety or sleep problems at 18 months of age.

Out of 198 eighteen month old children with a congenital heart defect who were studied, 58 had a severe heart defect. Analysis showed that the children with a severe heart defect had a doubled risk of anxiety compared to healthy children.

In addition to the severity of the heart defect, maternal anxiety and depression explained some of the anxiety in these children. Children with mild or moderate heart defects, however, showed no signs of anxiety or other internalising problems.

The HEARTKIDS project is a sub-study of the Norwegian Mother and Child Cohort Study (MoBa). The project is funded by the Norwegian Research Council. This longitudinal study aims to explore the psychological and developmental consequences of congenital heart defects in infants and toddlers. Through a merge of the MoBa and the Oslo University Hospital's nationwide register of congenital heart defects, which provides accurate diagnostic information about heart defects, it is possible to compare children with varying severity of heart defects with healthy children.

Previous findings from the HEARTKIDS project have shown that 6-month-old children with moderate or severe congenital heart defects show a higher risk of emotional reactivity (irritability, frequent and powerful crying).

Need for more knowledge about children with congenital heart defects

Approximately one percent of all newborn children have a congenital heart defect. The severity of the heart defects varies widely from minor defects to complex conditions that require a series of operations throughout the child's first year.

Several studies have shown that children with congenital heart defects down to 3 years of age are more prone to emotional problems like anxiety and depression. However, there is little knowledge about the emotional problems in infancy and early childhood, which is the phase of life where most of the medical treatment is carried out. The HEARTKIDS project is focusing on the phase from birth to child age 3 years of age.

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Journal Reference:

1. Kim Stene-Larsen, Ragnhild Eek Brandlistuen, Henrik Holmstrøm, Markus A Landolt, Leif T Eskedal, Bo Engdahl, Margarete E Vollrath. Longitudinal findings from a Norwegian case-cohort study on internalizing problems in children with congenital heart defects. Acta Paediatrica, 2010; DOI: 10.1111/j.1651-2227.2010.02015.x

Alcohol exposure during adolescence alters the body's ability to respond to stress in adulthood, according to new research in rats presented at Neuroscience 2010, the annual meeting of the Society for Neuroscience, held in San Diego. Because problems regulating stress are associated with behavioral and mood disorders, the findings may indicate that binge drinking in adolescence leads to increased risk of anxiety or depression in adulthood.

Binge drinking, defined as more than four or five drinks in a single session, typically begins around age 13 and peaks between ages 18 and 22. According to the Substance Abuse and Mental Health Services Administration, 36 percent of teens aged 18 to 20 reported at least one binge-drinking episode in the previous 30 days.

The researchers, directed by Toni Pak, PhD, at Loyola University Stritch School of Medicine, found that rats exposed to a binge pattern of alcohol consumption around the time of puberty had lower circulating levels of the stress hormone corticosterone — akin to the human hormone cortisol — in adulthood. However, in response to the physical stress of alcohol exposure, these same rats showed a greater spike in corticosterone than rats that had not previously been exposed to alcohol.

"Our findings suggest that alcohol exposure during puberty permanently alters the system by which the brain triggers the body to produce stress hormones," said Pak. "This indicates that exposing young people to alcohol could permanently disrupt connections in the brain that are normally formed during puberty and are necessary to ensure healthy adult brain function," she said.

Research was supported by the National Institute on Alcohol Abuse and Alcoholism.

 Binge-drinking teenagers may be putting themselves at higher risk in adulthood for mood disorders such as anxiety and depression, Loyola University Health System researchers report.

A new Loyola study has found that exposing adolescent rats to binge amounts of alcohol permanently altered the system that produces hormones in response to stress. This disruption in stress hormones "might lead to behavioral and/or mood disorders in adulthood," researchers reported.

Senior author Toni Pak, PhD, and colleagues reported their findings Nov. 15 at the annual meeting of the Society for Neuroscience in San Diego.

While results from animal studies don't directly translate to people, the findings do suggest a mechanism by which teenage binge drinking could cause mental health problems in adulthood, Pak said.

"Exposing young people to alcohol could permanently disrupt normal connections in the brain that need to be made to ensure healthy adult brain function," Pak said.

Binge drinking is defined as a woman having at least four drinks or a man having at least five drinks on one occasion. Heavy binge drinkers can consume 10 to 15 drinks. Binge drinking typically begins around age 13 and peaks between 18 and 22, before gradually decreasing. Thirty-six percent of youths ages 18 to 20 reported at least one binge-drinking episode during the past 30 days, according to the Substance Abuse and Mental Health Services Administration.

The Loyola study examined the long-term effects of alcohol on the production of the stress hormone corticosterone in rats. (The equivalent stress hormone in humans is cortisol).

Humans and rats produce stress hormones in response to physical or psychological stress. For example, in a "fight-or-flight" situation, a jolt of cortisol provides a burst of energy and a lower sensitivity to pain, while suppressing functions that aren't immediately needed, such as digestion. However, chronic exposure to cortisol and other stress hormones has been linked to depression, cardiovascular disease and other problems.

In the study, researchers exposed adolescent rats to an 8-day binge drinking pattern: three days of alcohol binging, two days off, then three more days of binging. On binge days, rats were injected with enough alcohol to raise their blood alcohol concentration to between 0.15 percent and 0.2 percent. (In humans such concentrations would be roughly 2 to 2.5 times higher than the 0.08 legal limit for driving.)A control group of rats received injections of saline.

One month later, when the rats were young adults, they were exposed to one of three regimens: saline injections, a one-time alcohol injection or a binge-pattern of alcohol exposure. Alcohol is a form of stress, so not surprisingly, the animals that had either a one-time or binge alcohol exposure produced more of the corticosterone stress hormone. A more significant finding is that among rats that had received alcohol during adolescence, there was a significantly larger spike in corticosterone when they received alcohol during adulthood. These rats also had a lower base level of corticosterone than rats that had remained sober during adolescence. These findings suggest that alcohol exposure during puberty permanently alters the system by which the brain triggers the body to produce stress hormones.

Pak is a molecular neurobiologist and an assistant professor in the Department of Cell and Molecular Physiology at Loyola University Chicago Stritch School of Medicine. Two members of her lab are co-authors of the study: first author Magdalena Przybycien-Szymanska, a PhD student and Roberta Gillespie, a research assistant.

A brain scan with functional MRI (fMRI) is enough to predict which patients with pediatric anxiety disorder will respond to "talk therapy," and so may not need to use psychiatric medication, say neuroscientists from Georgetown University Medical Center.

Their study, being presented at the annual meeting of the Society for Neuroscience in San Diego, showed that children and adolescents, ages 8 to16, who show fear when looking at happy faces on a screen inside an fMRI scanner were those who had least success with an eight-week course of cognitive behavioral therapy.

Conversely, children who showed fear while looking at fearful faces benefitted from the treatment, which is also known as talk therapy, the researchers found.

"Anxiety and fear are intrinsically linked, so how the brain's fear center responds would naturally affect how anxiety disorders manifest," says the study's lead author, Steve Rich, a fourth year medical student.

"Indeed, the impact on their responses to therapy was impressive," he says. "Past studies have shown that many people react to fearful faces with fear themselves, but our most robust finding indicated that some anxiety disorder patients have more anxiety towards happy faces than fearful ones, and those patients were the least likely to respond to cognitive behavioral therapy."

The study enrolled 13 boys and 10 girls in this study, all of whom had been diagnosed with pediatric anxiety disorder.

While inside the fMRI machine, the participants were shown pictures of faces that expressed certain emotions strongly. "The questions we were trying to answer were: What emotions make people afraid when they witness them on others' faces, and does that pattern predict response to talk therapy," Rich says.

An fMRI is a type of scan that records changes in blood flow being used at each location in the brain, thus showing levels of activity. In this study, the researchers zeroed in on the amygdala, a brain structure known to represent the emotion of fear.

They then correlated the differing responses they saw in the amygdala with outcomes from an eight-week course in cognitive behavioral therapy.

The researchers found a significant correlation, indicating that pre-treatment fMRI can be used to select patients who likely do well with talk therapy alone, and those that may require other therapy, such as medication.

Rich says that one explanation for the results is that those patients who have greater anxiety towards happy faces than towards fearful ones have a subtly different disorder, one that is very similar but cannot be treated by cognitive behavioral therapy.

"In this subset of patients, that support may actually elicit even more anxiety, thus alienating them from the therapist," he says. "Further study is required to determine whether this is indeed a unique disease subtype, or whether a modified approach to cognitive behavioral therapy that requires the therapist to stay completely neutral could make therapy more effective for these patients."

Rich and his co-authors do not expect that every pediatric anxiety disorder patient should receive an fMRI diagnosis.

"fMRI is expensive, and this study does not by any means suggest that it should be used as a universal screening tool," he says. "Even so, once the field develops further, our results suggest that neuroimaging studies like fMRI may be able to help us understand why a given patient might not be responding to the first-line treatment. In other words, when routine care is not enough, we can focus on the nuances of the individual."

The death of a spouse or child can cause elevated heart rate and other potentially harmful heart rhythm changes among the recently bereaved, according to research presented at the American Heart Association's Scientific Sessions 2010.

These changes in how the heart functions — which could increase the risk of heart attack and sudden cardiac death — tend to revert back to normal ranges within six months, researchers said.

"While the focus at the time of bereavement is naturally directed toward the deceased person, the health and welfare of bereaved survivors should also be of concern to medical professionals, as well as family and friends," said Thomas Buckley, Ph.D., the study's lead researcher, acting director of postgraduate studies at the University of Sydney Nursing School in Sydney, Australia.

"Some bereaved, especially those already at increased cardiovascular risk, might benefit from medical review, and they should seek medical assistance for any possible cardiac symptoms."

Although heart attacks and sudden cardiac death have been shown in some studies to be more common among recently bereaved people, researchers have not been able to explain the cause for this phenomenon, or why the risk appears to dissipate with time.

Researchers studied 78 bereaved spouses and parents within two weeks of the death of a spouse or child and after six months. They then compared them to a group of volunteers who had not lost a loved one. The bereaved participants consisted of 55 women and 23 men who were between 33 and 91 years old.

Using 24-hour heart monitors and other tests, the researchers documented increases in heart rate (the number of times a heart beats per minute), reduced heart rate variability (a measure of the heart's rhythmic regularity) and increases in clinical depression and anxiety.

"Increased heart rate and reduced heart rate variability in the early months of bereavement are possible mechanisms of increased cardiovascular risk during this often very stressful period," he said.

Among the researchers' findings:

• Bereaved patients had almost twice the number of episodes of rapid heartbeats, or supraventricular tachycardia (SVT), than non-bereaved participants in the first weeks after their loved one's death (2.23 vs. 1.23 episodes of SVT). However, after six months their numbers were lower than in the control group (0.58 vs. 0.66).
• The average heart rate for bereaved participants was 75.1 beats per minute (bpm) compared to 70.7 bpm in the non-bereaved in the early stages. But the rate for bereaved participants fell to 70.7 bpm after six months. Average minimum heart rates were 50.1 bpm initially for bereaved spouses and parents vs. 48.0 bpm in the others, and fell to 48.8 bpm after six months, almost identical to the non-bereaved volunteers.
• The average depression score in the bereaved was 26.3 compared to just 6.1 in the control group, using the Centre for Epidemiological Studies — Depression and Spielberger State Anxiety scales. This difference declined after six months, yet remained almost three times higher than among the controls.
• The average anxiety score was 46.7 in the bereaved and 28.8 in the control group. After six months, the rate increased to 29.1 in volunteers who had not experienced a loss and dropped to 37.2 among the bereaved participants.

"While our findings do not establish causality, they are consistent with evidence for psychosocial triggering of cardiovascular events," Buckley said. "They suggest the need for further investigation of the link between bereavement and cardiovascular risk, including the potential for preventive measures."

In the study, the bereaved had lost family members who were being treated in critical care areas of hospitals; so these results can't necessarily be generalized to the broader community, because deaths that occur in hospices or at home may elicit a different response to grief. Furthermore, there weren't enough bereaved parents in the study to assess their risk separately.

Co-authors are: Roger Bartrop, M.D.; Sharon McKinley, Ph.D.; Christopher Ward, Ph.D.; Anastasia Susie Mihailidou, Ph.D.; Marie-Christine Morel-Kopp, Ph.D.; Monica Spinaze, Dip. N.; and Geoffrey Tofler, M.D. Author disclosures are on the abstract.

The National Heart Foundation of Australia and the North Shore Heart Research Foundation in Sydney, Australia funded the study.