Abstracts
Computers
This study refined the instrument, Nurses' Computer Attitudes Inventory (NCATT), which was developed to measure nurses' attitudes toward computers in an Australian setting.
On the basis of factor and item analysis the 40-item NCATT was reduced to 22 items. Three factors for the revised NCATT were identified:
1. Computers and Patient Care,
2. Computer Anxiety, and
3. Patient Confidentiality and Computers.
These three factors accounted for 90.0% of the variance (factor 1, 56.6%; factor 2, 24.8%; and factor 3, 8.6%).
The revised NCATT is a practical instrument that is useful to assess nurses' attitudes before computer implementation and training.
Jayasuriya R & Caputi P Computer attitude and computer anxiety in nursing. Validation of an instrument using an Australian sample. Comput Nurs, 1996 Nov-Dec, 14:6, 340-5.
Dietary
Dietary Factors
This article reviews dietary protein, fats, carbohydrates, caffeine and benzodiazepines in foods, and the roles of acetylcholine and glucose metabolism in memory. The dietary amino acid tryptophan produces the neurotransmitter molecule serotonin, and the amino acid tyrosine produces the neurotransmitter molecules dopamine, norepinephrine, and epinephrine.
It is noted that some foods can resemble endogenous neuropeptides that may actively influence our mood and general sense of well-being. An example of this would be the peptides that were found with pharmacologic activity similar to that of opiates and morphine, which were discovered in pepsin hydrolysates of wheat gluten, and casein. Dietary fats are important components of neural membranes and are important in the production of certain neurotransmitters and adrenal steroids. Omega-3 fatty acids are important in brain chemistry.
Dietary fats are also important in the biosynthesis of lecithin and its constituent choline, which is needed for the production of phosphatidylserine and other constituents of the neural membrane. Choline is rich in foods including eggs, liver, soybeans, wheat germ and peanuts. Most fruits and vegetables contain very low levels of choline. Carbohydrates act as a precursor to the formation of many different neurotransmitter compounds. Dietary carbohydrates increase the release of insulin which may help elevate tryptophan in the brain, thereby increasing serotonin production. Deficits in the ability of normal age animals to regulate glucose levels in the blood are associated with deficits in learning and memory. In human models, glucose supplementation or a dietary carbohydrate supplement may be a reasonable approach to enhancing moderately impaired cholinergic function that may accompany normal aging.
Carbohydrate consumption can modulate at least 4 separate neurotransmitter systems:
The production and release of serotonin is increased because tryptophan uptake in the brain is increased by glucose; the production and release of dopamine and norepinephrine are decreased because tyrosine uptake in the brain is decreased by glucose; and the formation of acetylcholine is increased because glucose can act as a precursor to the production of acetyl coenzyme-A. Caffeine naturally occurs in foods such as tea, coffee and cocoa. Caffeine can enhance both mood and cognitive abilities in normal individuals. Detectable levels of up to .5 ng per gm of the antianxiety agents diazepam and desmethyldiazepam have been discovered in wheat grain, potato tuber, brown lentils, yellow soybeans, rice, maize corn, cherries, egg whites and mushrooms. These drugs may produce amnesia and impair cognitive functions in both humans and laboratory animals. It is possible that humans and animals may regulate their own anxiety level by specific choices in food.
In review, the major emphasis of this article is to help regulate glucose metabolism, since this is a primary energy source for the brain. Impaired glucose regulation can occur with aging and may lead to dysfunction of cholinergic and many noncholinergic neural systems in the brain. Impaired glucose function may result in a shift in timing behavior, or a deficit in learning and memory. The author feels that someday a nutrient or drug may enhance the ability of the brain to utilize glucose, which may reverse many age-related cognitive impairments and/or enhance learning and memory.
"Dietary Factors That Influence the Neural Substrates of Memory", Wenk, Gary L., The Vulnerable Brain and Environmental Risks, Volume I: Malnutrition and Hazard Assessment, Plenum Press, New York, 1992; Chapter 3;67-74.
Emotions
Emotions in the Elderly
It has been suggested by experts that stress, anxiety and other emotional states can have an adverse effect on mental function in the elderly. In younger individuals, some stress can enhance performance while in older individuals there is an adverse reaction. In a study done, 45 young individuals mean age of 26.3 years and 45 elderly subjects mean age of 66.9 years who were physically healthy, underwent psychological testing before the trial. After a wide variety of tests, younger participants scored significantly higher on the recall test, with a mean score of 79.0 versus 66.1 among elderly individuals. The mean score among the younger group for high-imagery recall was 42.7 compared with 36.4 among the elderly counterparts while the mean scores for low-imagery recall were 36.3 and 29.6 respectively. All participants noted some anxiety, while the older individuals reported a higher level of depression.
The levels of withdrawal self-rating were similar, with a mean score of 35.6 in the younger participants and 35.0 among the older participants. In the older participants, all effective mood states correlated with the total number of words recalled. There was a higher self-rated level for anxiety, depression, or withdrawal associated with a lower number of recalled words.
In conclusion, it was found among the older participants a significant association between negative mood and poor memory function on 8 of 9 pairs, whereas there was no significant correlation demonstrated among the younger participants. This has implications for treatment, specifically noting behavioral modification and pharmacotherapy can result in increased memory performance in elderly patients. The presence of subclinical levels of depression and anxiety should be evaluated in older individuals with poor memory.
"Do Emotions Affect Memory Function in Elderly Persons?", Family Practice Recertification, May 1993;150(5):44/The Journal of Psychiatry, 1993;150(3):429.
Hypertension
Hypertension
In 20 adults, 1000mg/dayof ascorbic acid was evaluated. Supplementation reduced systolic blood pressure and pulse pressure. It enhances prostacyclin which reduces free radical damage to tissues and increases vasodilation. It can chelate heavy metals. Vitamin C supplementation may have therapeutic value in human hypertensive disease."Blood Pressure and Plasma Lipids During Ascorbic Acid Supplementation in Borderline Hypertensive and Normotensive Adults", Osilesi, Odutola, Ph.D., et al, Nutrition Research, 199 1; 11:405-412.
Magnesium deficiency
Stress intensifies release of catecholamines and corticosteroids that increase survival of normal animals when their lives are threatened. When magnesium (Mg) deficiency exists, stress paradoxically increases risk of cardiovascular damage including hypertension, cerebrovascular and coronary constriction and occlusion, arrhythmias and sudden cardiac death (SCD).
In affluent societies, severe dietary Mg deficiency is uncommon, but dietary imbalances such as high intakes of fat and/or calcium (Ca) can intensify Mg inadequacy, especially under conditions of stress. Adrenergic stimulation of lipolysis can intensify its deficiency by complexing Mg with liberated fatty acids (FA), A low Mg/Ca ratio increases release of catecholamines, which lowers tissue (i.e. myocardial) Mg levels. It also favors excess release or formation of factors (derived both from FA metabolism and the endothelium), that are vasoconstrictive and platelet aggregating; a high Ca/Mg ratio also directly favors blood coagulation, which is also favored by excess fat and its mobilization during adrenergic lipolysis.
Auto-oxidation of catecholamines yields free radicals, which explains the enhancement of the protective effect of Mg by anti-oxidant nutrients against cardiac damage caused by beta-catecholamines.
Thus, stress, whether physical (i.e. exertion, heat, cold, trauma--accidental or surgical, burns), or emotional (i.e. pain, anxiety, excitement or depression) and dyspnea as in asthma increases need for Mg. Genetic differences in Mg utilization may account for differences in vulnerability to Mg deficiency and differences in body responses to stress.
Seelig MS: Consequences of magnesium deficiency on the enhancement of stress reactions; preventive and therapeutic implications (a review). J Am Coll Nutr, 1994 Oct, 13:5, 429-46.
Panic
Panic Attacks and Urine pH
Urine samples were taken from 14 untreated panic attack patients as compared to 13 age and sex matched controls and it was found panic attack patients had significantly higher pH levels than controls (7.0 versus 5.5).
It is suggested panic disorder individuals may have a series of subtle hyperventilatory episodes accounting for this alkalinization. Screening urine pH could be a simple way to evaluate respiratory status and subsequently the success of breathing retraining in patients with panic disorder.
"Urine pH and Panic: A Possible Screening Device", Papp, Laszlo A. and Gorman, Jack M., The Lancet, February 10, 1990;335:335.
Phobia
To examine prospectively the association between self-reported symptoms of phobic anxiety and subsequent risk of coronary heart disease, a 2-year follow-up study was conducted of a cohort of 33,999 US male health professionals, aged 42 to 77 years in 1988, who were free of diagnosed cardiovascular disease at baseline.
Levels of phobic anxiety were assessed using the Crown-Crisp index, a short, diagnostic self-rating scale used for common phobias. Main outcomes were incidents of coronary heart disease consisting of nonfatal myocardial infarction (MI) and fatal coronary heart disease (CHD).
Risk of fatal CHD increased with levels of phobic anxiety. When fatal CHD was further categorized into sudden and nonsudden coronary death, the excess risk was confined to sudden death.
No association was found between phobic anxiety and risk of nonfatal MI. These findings remained essentially unchanged after adjusting for a broad range of cardiovascular risk factors.
The specificity, strength, and dose-response gradient of the association, together with the consistency and biological plausibility of the experimental and epidemiologic evidence, support a strong causal association between phobic anxiety and fatal CHD.
Kawachi I et al., Prospective study of phobic anxiety and risk of coronary heart disease in men. Circulation, 1994 May, 89:5, 1992-7.
Stalkers
Examines the social and psychological impact on victims of stalking.
A group of 100 victims of stalking completed a 50-item questionnaire on their experiences.
The majority of the victims were subjected to multiple forms of harassment including being followed, repeatedly approached and bombarded with letters and telephone calls for periods varying from a month to 20 years.
Threats were received by 58 subjects, and 34 were physically or sexually assaulted. All but six victims made major changes in their social and work lives, with 53% changing or ceasing employment and 39% moving home.
Increased levels of anxiety were reported by 83%, intrusive recollections and flashbacks by 55%, with nightmares, appetite disturbances and depressed mood also being commonly reported. Suicidal ruminations were acknowledged by 24% of victims. The criteria for a diagnosis of post-traumatic stress disorder were fulfilled in 37% of subjects, with a further 18% having the clinical features but not qualifying for a stressor involving threatened or actual physical harm.
The study indicates the extent of the social and psychological damage sustained by those subjected to persistent stalking, and underlines the inadequacy of the current legal and medical responses to the needs of these victims.
Pathe M & Mullen PE: The impact of stalkers on their victims. Br J Psychiatry, 1997 Jan, 170:, 12-7.
Anxiety
Effects of Asthma
This study shows that asthma patients who have difficulty managing stress are more likely to experience increased symptoms and lower peak flow readings. Stressed asthmatics also tend to use bronchodilators more often than necessary. The combination of self-efficacy, daily stress, emotion-oriented coping, and quality of life accounted for much of the variance in bronchodilator use. Patients whose asthma symptoms are triggered by stress, learning to challenge anxiety- provoking thoughts, progressive relaxation, and paced diaphragmatic breathing may be beneficial.
Stress Management Strategies Benefit Some Asthmatics, Modern Medicine, December, 1997:65:42-43.
Hunger
Hunger
This study demonstrates a correlation between hunger and behavioral problems in children. In reviewing more than 300 Pittsburgh families, the study found that 21% of hungry children were classified as dysfunctional, compared to 6% of children at risk for hunger and 3% who were well nourished. The prevalence of stealing was 12 times higher in the hungry, and the prevalence of fighting was 7 times higher. These figures suggest that emotional problems of aggression, anxiety, and irritability were more prevalent hungry children.
New Study Links Hunger to Behavioral and Emotional Problems in Poor Children, Nutrition Week, January 9, 1998; 27(2):1,6/Pediatrics, January, 1998;101(1):e3.
Erectile Dysfunction
Erectile dysfunction
Treatment of erectile dysfunction with yohimbine hydrochloride resulted in several undesirable side effects - anxiety, increase in cardiac frequency, increased urinary output, and headache. The study evaluated 22 patients averaging 58 years who had organic erectile dysfunction. The patients were treated for 30 days with placebo and 30 days with a daily single dose of 100 mg of oral yohimbine hydrochloride. Statistical analysis showed no significant difference between yohimbine compared to placebo.
Teloken, Claudio, et al: Therapeutic Effects of High Dose Yohimbine Hydrochloride on Organic Erectile Dysfunction, The Journal of Urology, January, 1998;159:122- 124.
Menopause
Menopause
According to this study, menopausal women who suffer from anxiety and depression might benefit from regular exercise. Exercise can fulfill many of the same benefits of hormonal therapy. It can slow bone re-absorption, reduce hot flashes, and improve depression/anxiety. Aerobic exercise can do more than estrogen replacement therapy with regard to increasing peripheral insulin sensitivity and enhancing aerobic fitness by increasing the maximal oxygen capacity. Estrogen alone will not improve cardiovascular fitness.
Goldman, Erik L.: Prescribe Exercise at the Onset of Menopause, Family Practice News, November 1, 1997;24.
Social Anxiety Disorder
Social Anxiety Disorder
According to this review, social anxiety disorder is a culmination of heritable and environmental stress factors. The authors reviewed several neurobiological models of the disorder based on animal studies and then examined recent literature about the clinical neurobiological aspects of the disorder. The clinical literature suggests neurotransmitter abnormalities as a cause of the disorder and mostly ignores neurodevelopmental processes, while the animal models focus on the features of the disorder (including attachment behavior, social subordination stress, and environmental rearing) and ignore the known neurobiological aspects. The authors suggest that future studies combine these two perspectives to better understand this disorder.
Mathew SJ, Coplan JD, Gorman JM: Neurobiological mechanisms of social anxiety disorder, Am J Psychiatry 2001 Oct;158(10):1558-67
Nausea & Anxiety
Nausea
Nausea incidence in the community may often be related to underlying anxiety and depressive disorders, according to this study involving Norwegians. Questionnaires concerning physical and mental health and demographic and life-style factors were sent to all residents over the age of 20 in Nord Trondelag county of Norway. Out of 94,197 questionnaires sent out, 62,651 people responded. Forty-eight percent of these people reported at least one gastrointestinal problem during the last year: 12.5% reported having nausea, 15.3% had an anxiety disorder, and 10.4% had depression based on HADS ratings. Nausea incidence was most strongly related to anxiety disorder, but there was also a significant relationship between nausea and depression. Since nausea is a common symptom in patients diagnosed with anxiety and depression, it is possible that nausea occurrence in the population may be related to undiagnosed anxiety disorders and depression.
Haug TT, Mykletun A, Dahl AA: The prevalence of nausea in the community: psychological, social and somatic factors, Gen Hosp Psychiatry 2002 Mar-Apr;24(2):81-6
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