Human stiff-person syndrome IgG induces anxious behavior in rats

Background

Anxiety is a heterogeneous behavioral domain playing a role in a variety of neuropsychiatric diseases. While anxiety is the cardinal symptom in disorders such as panic disorder, co-morbid anxious behavior can occur in a variety of diseases. Stiff person syndrome (SPS) is a CNS disorder characterized by increased muscle tone and prominent agoraphobia and anxiety. Most patients have high-titer antibodies against glutamate decarboxylase (GAD) 65. The pathogenic role of these autoantibodies is unclear.

Methodology/Principal Findings

We re-investigated a 53 year old woman with SPS and profound anxiety for GABA-A receptor binding in the amygdala with (11)C-flumazenil PET scan and studied the potential pathogenic role of purified IgG from her plasma filtrates containing high-titer antibodies against GAD 65. We passively transferred the IgG fraction intrathecally into rats and analyzed the effects using behavioral and in vivo electrophysiological methods. In cell culture, we measured the effect of patient IgG on GABA release from hippocampal neurons. Repetitive intrathecal application of purified patient IgG in rats resulted in an anxious phenotype resembling the core symptoms of the patient. Patient IgG selectively bound to rat amygdala, hippocampus, and frontal cortical areas. In cultured rat hippocampal neurons, patient IgG inhibited GABA release. In line with these experimental results, the GABA-A receptor binding potential was reduced in the patient''s amygdala/hippocampus complex. No motor abnormalities were found in recipient rats.

Conclusion/Significance

The observations in rats after passive transfer lead us to propose that anxiety-like behavior can be induced in rats by passive transfer of IgG from a SPS patient positive for anti-GAD 65 antibodies. Anxiety, in this case, thus may be an antibody-mediated phenomenon with consecutive disturbance of GABAergic signaling in the amygdala region.     

Perceived Social Support Moderates the Link between Attachment Anxiety and Health Outcomes

Two literatures have explored some of the effects intimate relationships can have on physical and mental health outcomes. Research investigating health through the lens of attachment theory has demonstrated that more anxiously attached individuals in particular consistently report poorer health. Separate research on perceived social support (e.g., partner or spousal support) suggests that higher support has salutary influences on various health outcomes. Little to no research, however, has explored the interaction of attachment anxiety and perceived social support on health outcomes. The present study examined the attachment-health link and the moderating role of perceived social support in a community sample of married couples. Results revealed that more anxious persons reported poorer overall physical and mental health, more bodily pain, more medical symptoms, and impaired daily functioning, even after controlling for age, relationship length, neuroticism, and marital quality. Additionally, perceived social support interacted with attachment anxiety to influence health; more anxious individuals'' health was poorer even when perceived social support was high, whereas less anxious individuals'' health benefited from high support. Possible mechanisms underlying these findings and the importance of considering attachment anxiety in future studies of poor health in adulthood are discussed.     

Faces in a Crowd: High Socially Anxious Individuals Estimate that More People Are Looking at Them than Low Socially Anxious Individuals

Background

People with social anxiety disorder are afraid of being scrutinized by others and often feel that they are the excessive focus of other people''s attention. This study investigated whether, when compared to low socially anxious individuals, high socially anxious individuals overestimate the proportion of people in a crowd who are observing them. It was hypothesized that any potential overestimation would be modulated by self-focused attention.

Method

Forty-eight high and 48 low socially anxious participants performed a “faces in a crowd” computer task during which they briefly saw matrices of faces, which varied in terms of the proportion of people who were looking at them. Participants estimated the proportion of people who were looking at them. The task was performed once with mirrors present (to induce an enhanced self-focused state) and once without mirrors present (neutral state).

Results

Participants'' subjective estimates and the objective proportion of faces looking towards them were strongly correlated in both the high and low socially anxious groups. However, high socially anxious participants estimated that more people were looking at them than low socially anxious participants. In the first phase of the experiment, but not in the later phases, this effect was magnified in the mirror condition.

Discussion

This study provides preliminary evidence of a social anxiety related perceptual difference that may be amplified by self-focused attention. Clinical implications are discussed.     

Antenatal screening for carriers of cystic fibrosis: randomised trial of stepwise v couple screening.

OBJECTIVE--To perform a rigorous comparative evaluation of stepwise and couple approaches to antenatal carrier screening for cystic fibrosis. DESIGN--Pragmatic randomised trial. SETTING--Hospital antenatal clinic serving a regional population. SUBJECTS--2002 women (couples) attending for booking antenatal visit at less than 17 weeks'' gestation with no family history of cystic fibrosis. INTERVENTIONS--Offering counselling and carrier testing for cystic fibrosis, either to women in the first instance (stepwise) or to couples (couple screening). MAIN OUTCOME MEASURES--Uptake rates; anxiety; knowledge of cystic fibrosis and carrier status (both partners); attitudes to health, pregnancy, the baby, and screening (both partners); and uptake of carrier testing by relatives. RESULTS--Uptake of screening was the same for both approaches (90%). After delivery most women remembered test results and their meaning, but 53/253 (21%) of those with negative results of couple testing had forgotten that repeat testing would be advisable if they had a pregnancy with a new partner. With stepwise screening women identified as carriers had high levels of anxiety when results were received (mean anxiety score 52.3). This dissipated with a reassuring partner''s result (carriers'' mean anxiety score 36.1) to levels similar to those receiving negative results from couple screening. Of those receiving negative results, women who had stepwise screening were significantly less anxious than those who had couple screening (mean score with result 32.1 v 35.4, 95% confidence interval for difference -4.7 to -2.1). CONCLUSIONS--Couple screening allows carriers to avoid transient high levels of anxiety, but is associated with more anxiety and false reassurance among most screenees who will test negative. Stepwise screening gives carriers and their relatives genetic information and is, in our opinion, the better method.     

Opening Pandora's box: the unpredictability of reassurance by a normal test result.

OBJECTIVES--To determine the rate of failure of patient reassurance after a normal test result and study the determinants of failure. DESIGN--Replicated single case study with qualitative and quantitative data analysis. SETTING--University teaching hospital. SUBJECTS--40 consecutive patients referred for echocardiography either because of symptoms (10 patients) or because of a heart murmur (30). 39 were shown to have a normal heart. INTERVENTIONS--Medical consultations and semistructured patient interviews were tape recorded. Structured interviews with consultant cardiologists were recorded in survey form. MAIN OUTCOME MEASURES--Patient recall of the explanation and residual understanding, doubt, and anxiety about the heart after the test and post-test consultation. RESULTS--All 10 patients presenting with symptoms were left with anxiety about the heart despite a normal test result and reassurance by the consultant. Of 28 patients referred because of a murmur but shown to have no heart abnormality, 20 became anxious after detection of the murmur; 11 had residual anxiety despite the normal test result. CONCLUSIONS--Reassurance of the "worried well"-anxious patients with symptoms or patients concerned by a health query resulting from a routine medical examination or from screening-constitutes a large part of medical practice. It seems to be widely assumed that explaining that tests have shown no abnormality is enough to reassure. The results of this study refute this and emphasise the importance of personal and social factors as obstacles to reassurance.     

Health status and anxiety in the elderly. A longitudinal perspective

The prognostic value of physical health for changes in anxiety symptoms in older people was investigated in a prospective longitudinal study design with data from the Longitudinal Aging Study Amsterdam (LASA). In a sample of 2165 older (> 55 yrs.) respondents anxiety symptoms were measured twice over a three year interval with the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). Utilizing a cut-off value of 4 on the HADS-A, subjects were considered as anxious or as non-anxious. Based on the first assessment two groups were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort the effect of physical health on the development of anxiety symptoms was studied; in the anxious cohort the same factors were evaluated on their predictive value for chronicity of anxiety. Indices of physical health included the presence of chronic diseases, functional limitations, and self-perceived health at the first assessment and changes on these variables over time. Results revealed that poor self-perceived health was predictive of incidence (OR = 1.5; 95% CI = 1.3-1.8) and chronicity of anxiety (OR = 1.2; CI = 1.0-1.5). Regarding chronic diseases, the results showed that suffering from more than one chronic disease predicted becoming anxious and chronicity of anxiety (OR = 1.7; CI = 1.2-2.5 and OR = 2.2; CI = 1.3-3.6, respectively). Specific chronic diseases were not strongly related to a change in anxiety levels. Thus, somatic diseases not only lead to depression, a finding reported in numerous studies, but also increase the likelihood of anxiety symptoms at a later point in time.     

Separation Anxiety,Attachment and Inter-Personal Representations: Disentangling the Role of Oxytocin in the Perinatal Period

In this paper, we aimed to assess cross-sectionally and longitudinally associations between disturbances in maternal early attachment experiences, symptoms of separation anxiety and depression and oxytocin plasma levels. We examined a mediational model that tested the hypothesis that anxious attachment style arising from the mothers’ early bonding experiences with her own parents was associated with high levels of separation anxiety which, via its impact on depression, was associated with reduced levels of oxytocin in the postnatal period. Data is reported on a structured sample of 127 women recruited during pregnancy from a general hospital antenatal clinic and an initial follow up cohort of 57 women who were re-assessed at 3-months post-partum. We found an association between lower oxytocin level in the post partum period and symptoms of separation anxiety and depression during pregnancy, as well as maternal negative interpersonal representations, upbringing attributes and anxious attachment style. Further meditational analysis revealed that the unique association between anxious attachment and depression is mediated by separation anxiety and that depressed mood mediated the relationship between separation anxiety and oxytocin. In conjunction with evidence from the literature suggesting that lower oxytocin level is associated with bonding difficulties, our findings have significant implications for understanding the biological processes underpinning adverse attachment experiences, negative affect state, and mother-to-infant bonding difficulties.     

Factors associated with dental anxiety among older people in Britain

Objective: This paper reports on a study of denial anxiety among adults aged 60 years living independently in Britain. Design: A national cross‐sectional study carried out with the assistance of the Office for National Statistics' Omnibus Surveys in 1999. Setting: Data was collected by face to face interviews with older people in their homes Measurements : Data on dental anxiety were collected from 973 subjects by means of face to face interviews and was measured by the Dental Anxiety Scale (DAS) (Corah, 1969). In addition, data on dental service use and oral health status (self‐reported) was collected. Results: The mean DAS score was 8.4 (sd 3.5), and 13% (129) of subjects were classified as dentally anxious (DAS ≥ 13). DAS scores were associated with numerous socio‐demographic factors (P<0.01), self‐reported oral health status (P<0.01) and dental service (P<0.01) factors. A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioural and oral health outcomes. Conclusion: One in eight older people in Britain are dentally anxious and this is associated with their use of services and oral health status (self‐reported).     

Trait-like brain activity during adolescence predicts anxious temperament in primates

Early theorists (Freud and Darwin) speculated that extremely shy children, or those with anxious temperament, were likely to have anxiety problems as adults. More recent studies demonstrate that these children have heightened responses to potentially threatening situations reacting with intense defensive responses that are characterized by behavioral inhibition (BI) (inhibited motor behavior and decreased vocalizations) and physiological arousal. Confirming the earlier impressions, data now demonstrate that children with this disposition are at increased risk to develop anxiety, depression, and comorbid substance abuse. Additional key features of anxious temperament are that it appears at a young age, it is a stable characteristic of individuals, and even in non-threatening environments it is associated with increased psychic anxiety and somatic tension. To understand the neural underpinnings of anxious temperament, we performed imaging studies with 18-fluoro-deoxyglucose (FDG) high-resolution Positron Emission Tomography (PET) in young rhesus monkeys. Rhesus monkeys were used because they provide a well validated model of anxious temperament for studies that cannot be performed in human children. Imaging the same animal in stressful and secure contexts, we examined the relation between regional metabolic brain activity and a trait-like measure of anxious temperament that encompasses measures of BI and pituitary-adrenal reactivity. Regardless of context, results demonstrated a trait-like pattern of brain activity (amygdala, bed nucleus of stria terminalis, hippocampus, and periaqueductal gray) that is predictive of individual phenotypic differences. Importantly, individuals with extreme anxious temperament also displayed increased activity of this circuit when assessed in the security of their home environment. These findings suggest that increased activity of this circuit early in life mediates the childhood temperamental risk to develop anxiety and depression. In addition, the findings provide an explanation for why individuals with anxious temperament have difficulty relaxing in environments that others perceive as non-stressful.     

乳腺癌根治术患者术前焦虑的影响因素分析及其对术后恢复、细胞免疫功能和生命质量的影响

摘要 目的：分析乳腺癌根治术患者术前焦虑的影响因素,并探讨术前焦虑对患者术后恢复、细胞免疫功能和生命质量的影响。方法：选择我院2020年3月~2021年12月期间收治的拟行乳腺癌根治术的120例患者作为研究对象,术前1 d采用焦虑自评量表（SAS）评估所有患者的焦虑状况,根据是否存在焦虑分为焦虑组和无焦虑组,乳腺癌根治术患者术前焦虑的影响因素采用多因素Logistic回归分析。对比焦虑组和无焦虑组的术后恢复、细胞免疫功能和生命质量情况。结果：120例乳腺癌根治术患者中,有31例患者无术前焦虑,89例患者存在焦虑症状,根据是否存在术前焦虑分为焦虑组（n=89）和无焦虑组（n=31）。乳腺癌根治术患者术前焦虑与年龄、文化程度、家庭人均月收入、付费方式、婚姻状况、家庭支持、既往有无全麻史、术前住院时长、定期体检有关（P<0.05）。多因素Logistic回归分析结果表明：年龄＜60岁、文化程度为小学及其以下、家庭人均月收入＜3000元、婚姻状况为未婚、无家庭支持、既往无全麻史、术前住院时长>1 d是乳腺癌根治术患者术前焦虑的危险因素（P<0.05）。焦虑组的术后首次肛门排气时间、首次下床活动时间、术后住院时间均长于无焦虑组（P<0.05）。两组术后1个月CD3⁺、CD4⁺、CD4⁺/CD8⁺水平升高,且无焦虑组高于焦虑组（P<0.05）,两组术后1个月CD8⁺水平下降,且无焦虑组低于焦虑组（P<0.05）。两组术后1个月生理状况、情感状况、社会/家庭状况、功能状况、附加关注评分和总分下降,且无焦虑组低于焦虑组（P<0.05）。结论：乳腺癌根治术患者术前焦虑发生率较高,其发生受到年龄、文化程度、家庭人均月收入、婚姻状况、家庭支持、既往有无全麻史、术前住院时长等多种因素的影响,可导致患者术后恢复时间延长,细胞免疫功能和生命质量降低。     

Socially anxious and confident men interact with a forward virtual woman: an experimental study

Background

Male volunteers entered an immersive virtual reality that depicted a party, where they were approached by a lone virtual woman who initiated a conversation. The goal was to study how socially anxious and socially confident men would react to this event. Interest focused on whether the socially anxious participants would exhibit sustained anxiety during the conversation or whether this would diminish over time, and differ from the responses of the more socially confident men.

Methodology

The scenario was a party with five virtual characters, four sitting at a distance from the participant and talking amongst themselves and one lone woman standing closer. The woman approached the participant, introduced herself and initiated a conversation that was first about mundane matters and then became more personal and intimate. Participants were men who were either relatively socially confident (18) or socially anxious in their relationships with women (18). A second experimental factor was whether or not the other four characters occasionally looked towards the participant. There was a post-trial questionnaire about social anxiety in relation to the experience, and skin conductance and ECG physiological measures were recorded. Our expectation was that the socially anxious participants would show greater anxiety throughout.

Conclusions

Compared to baseline readings both socially confident and socially anxious groups on average showed signs of significantly increased stress at the initial approach of the virtual woman. The stress then diminished once the conversation entered into the mundane phase and then did not significantly change. Comparing pre- and post-questionnaire anxiety scores there was no change for the more confident participants but a significant decrease in average score amongst the anxious group. The methodology of placing socially anxious participants in a virtual reality where they can gain experience of how to act in a stressful situation promises a novel way forward for treating social anxiety.     

Response to Propranolol and Diazepam in Somatic and Psychic Anxiety

A total of 12 chronically anxious psychiatric outpatients were treated with racemic propranolol (Inderal), diazepam (Valium), and placebo for one week each, using a balanced cross-over experimental design. Six patients had predominantly somatic anxiety, complaining mostly of bodily symptoms, and six had mainly psychic anxiety, complaining primarily of psychological symptoms. Clinical ratings of anxiety were made by patient and psychiatrist after each treatment. Though diazepam was in general more effective than propranolol or placebo in relieving anxiety, propranolol was more effective than placebo in patients with somatic anxiety but not in those with psychic anxiety. We suggest that propranolol should be reserved for patients whose anxiety symptoms are mainly somatic.     

Intensified Neuronal Investment in the Processing of Chemosensory Anxiety Signals in Non-Socially Anxious and Socially Anxious Individuals

Background

The ability to communicate anxiety through chemosensory signals has been documented in humans by behavioral, perceptual and brain imaging studies. Here, we investigate in a time-sensitive manner how chemosensory anxiety signals, donated by humans awaiting an academic examination, are processed by the human brain, by analyzing chemosensory event-related potentials (CSERPs, 64-channel recording with current source density analysis).

Methodology/Principal Findings

In the first study cerebral stimulus processing was recorded from 28 non-socially anxious participants and in the second study from 16 socially anxious individuals. Each individual participated in two sessions, smelling sweat samples donated from either female or male donors (88 sessions; balanced session order). Most of the participants of both studies were unable to detect the stimuli olfactorily. In non-socially anxious females, CSERPs demonstrate an increased magnitude of the P3 component in response to chemosensory anxiety signals. The source of this P3 activity was allocated to medial frontal brain areas. In socially anxious females chemosensory anxiety signals require more neuronal resources during early pre-attentive stimulus processing (N1). The neocortical sources of this activity were located within medial and lateral frontal brain areas. In general, the event-related neuronal brain activity in males was much weaker than in females. However, socially anxious males processed chemosensory anxiety signals earlier (N1 latency) than the control stimuli collected during an ergometer training.

Conclusions/Significance

It is concluded that the processing of chemosensory anxiety signals requires enhanced neuronal energy. Socially anxious individuals show an early processing bias towards social fear signals, resulting in a repression of late attentional stimulus processing.     

Anxiety Level Predicts Post-Conflict Behaviour in Wild Japanese Macaques (Macaca fuscata yakui)

Reconciliation (i.e. the post-conflict exchange of friendly behaviour between former opponents) functions to control for the detrimental effects that aggression may have on social relationships. Studies conducted so far have investigated intra-individual sources of variation in post-conflict behaviour, showing that animals have a stronger increase in anxiety and are more likely to reconcile after conflicts with valuable partners, such as kin. Much less attention has been given to how differences between individuals in emotional profiles affect post-conflict behaviour. Our aim was to analyse whether inter-individual differences in baseline anxiety levels predicted the magnitude of the increase in anxiety following a conflict and the occurrence of reconciliation. We collected data on two groups of wild Japanese macaques ( Macaca fuscata yakui ). Animals having a higher baseline level of anxiety had a more dramatic anxious response following a conflict while controlling for a series of factors (e.g. relationship quality between opponents). These more anxious animals were also less likely to reconcile than more relaxed individuals. Therefore, more anxious animals face some social costs by being less able to cope with the post-conflict condition. We propose that differences in anxiety levels may be interpreted as tradeoffs between benefits and costs across conditions. For example, more anxious animals, who are less able to reconcile conflicts, might also be less exploratory and thus face a lower risk to eat unknown, poisonous food.     

Diagnostic Criteria for Depression in Type 2 Diabetes: A Data-Driven Approach

BackgroundWhile depression is a frequent psychiatric comorbid condition in diabetes and has significant clinical impact, the syndromal profile of depression and anxiety symptoms has not been examined in detail.AimsTo determine the syndromal pattern of the depression and anxiety spectrum in a large series of patients with type 2 diabetes, as determined using a data-driven approach based on latent class analysis (LCA).MethodType 2 diabetes participants from the observational community-based Fremantle Diabetes Study Phase II underwent assessment of lifetime depression using the Brief Lifetime Depression Scale, the Patient Health Questionnaire 9-item version (PHQ-9) for current depression symptoms, and the Generalized Anxiety Disorder Scale that was specifically developed and validated for this study. The main outcome measure was classes of patients with a specific syndromal profile of depression and anxiety symptoms based on LCA.ResultsLCA identified four classes that were interpreted as “major anxious depression”, “minor anxious depression”, “subclinical anxiety”, and “no anxious depression”. All nine DSM-IV/5 diagnostic criteria for major depression identified a class with a high frequency of major depression. All symptoms of anxiety had similar high probabilities as symptoms of depression for the “major depression-anxiety” class. There were significant differences between classes in terms of history of depression and anxiety, use of psychoactive medication, and diabetes-related variables.ConclusionsPatients with type 2 diabetes show specific profiles of depression and anxiety. Anxiety symptoms are an integral part of major depression in type 2 diabetes. The different classes identified here provide empirically validated phenotypes for future research.     

Behavioral and neurochemical changes in the zebrafish leopard strain

The zebrafish leopard phenotype (leo) displays abnormal pigmentation and shows increased anxiety‐like behavior. The neurochemical changes associated with this anxious phenotype are not known. Here, we demonstrate that leo show increased anxiety‐like behavior in the light/dark box and in the novel tank test. This anxious phenotype is rescued by acute treatment with a dose of a serotonin reuptake inhibitor, fluoxetine, that is inactive in wild‐type animals. Moreover, leo show decreased tissue levels of serotonin, increased serotonin turnover and slightly increased monoamine oxidase activity. These results suggest that the anxious phenotype observed in leo zebrafish is caused by a decrease in serotonin uptake. This work could open an important avenue in defining the neurochemical underpinning of natural variation in anxiety disorders .     

Comparative analysis of EEG spatial organization in the rats with different level of genetically determinated anxiety under ethanol

The pecularities of EEG changes in the rats with geneticaly different level of anxiety was studed after ethanol injection. The biopotentials spatial synchronization and entropy in the "high anxious" rats (strain MR) did not increase under low dose; on the contrary the above changes were characteristic for the rats without anxiety signs (strain MNRA). After injection of middle and high ethanol doses the "high anxious" rats as compared with "low anxious" ones had the "simplification" of reaction type--the increase of narrow frequency coherence (i.e. linear biopotentials relationship) and spectral power of theta-activity (5.75-7.25 Hz), which was combined with the decrease of nonlinear biopotential characteristics. This fact is interpreted as the predominance of subcortical mechanisms of the brain functional state regulation over cortical ones. The significant decrease of high frequency EEG components in "high anxious" rats takes place under more high ethanol doses, presumably reflecting the increase of the anxiolytic level of ethanol effect.     

Dental anxiety among middle-aged and elderly women in Sweden. A study of oral state,utilisation of dental services and concomitant factors

The aim of this project was to investigate dental anxiety and its expression in utilisation of dental services, oral health and oral symptoms. In a cross-sectional study of women's health in Göteborg (population 432,000), Sweden, 1016 women aged 38 to 84 years participated. This randomly selected population took part in a series of investigative procedures including medical and dental clinical examinations, interviews and questionnaires. Levels of dental anxiety were measured on the Corah Dental Anxiety Scale (DAS). The average DAS score obtained was 7.2. The study showed that older women were significantly less anxious than younger ones. Severe dental anxiety (DAS 15) was experienced by 3.9% of the participants. This frequency corresponds well with findings by Hällström and Halling in their analysis of data from the first Göteborg study of women's health 24 years ago. High levels of dental anxiety were correlated with longer intervals between dental visits, poorer oral function and aesthetics and a higher frequency of oral symptoms. Headaches were more prevalent in the younger age groups and a correlation with dental anxiety was revealed. Our previous studies have shown that symptoms such as tension headaches are prevalent among dental phobic patients and that they are reported to be reduced by therapy for dental fear. The clinical and radiographical examinations revealed a generally poorer oral status, with a statistically significant higher number of decayed teeth among women with high dental anxiety.     

Mom—It Helps When You're Right Here! Attenuation of Neural Stress Markers in Anxious Youths Whose Caregivers Are Present during fMRI

Close proximity to an attachment figure, such as a caregiver, has been shown to attenuate threat-related activity in limbic regions such as the hypothalamus in healthy individuals. We hypothesized that such features might be similarly attenuated by proximity during a potentially stressful situation in a clinically anxious population of youths. Confirmation of this hypothesis could support the role of attachment figures in the management of anxiety among children and adolescents. Three groups were analyzed: anxious children and adolescents who requested that their caregiver accompany them in the scanner room, anxious children and adolescents without their caregiver in the scanner room and healthy controls (each of N = 10). The groups were matched for age and, among the two anxious groups, for diagnosis (mean age 9.5). The children and adolescents were exposed to physical threat words during an fMRI assessment. Results indicate that activity in the hypothalamus, ventromedial, and ventrolateral prefrontal cortex were significantly reduced in anxious children and adolescents who requested that their caregiver accompany them in the scanner room compared to those without their caregiver in the scanner room. Mean activity in these regions in anxious children and adolescents with their caregiver in the scanner room was comparable to that of healthy controls. These data suggest links between social contact and neural mechanisms of emotional reactivity; specifically, presence of caregivers moderates the increase in anxiety seen with stressful stimuli. Capitalizing on the ability of anxious youths to manifest low levels of anxiety-like information processing in the presence of a caregiver could help in modeling adaptive function in behavioral treatments.     

Evaluation of a stroke family care worker: results of a randomised controlled trial.

OBJECTIVE: To examine the effect of contact with a stroke family care worker on the physical, social, and psychological status of stroke patients and their carers. DESIGN: Randomised controlled trial with broad entry criteria and blinded outcome assessment six months after randomisation. SETTING: A well organised stroke service in an Edinburgh teaching hospital. SUBJECTS: 417 patients with an acute stroke in the previous 30 days randomly allocated to be contacted by a stroke family care worker (210) or to receive standard care (207). The patients represented 67% of all stroke patients assessed at the hospital during the study period. MAIN OUTCOME MEASURES: Patient completed Barthel index, Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, mental adjustment to stroke scale, and patient satisfaction questionnaire; carer completed Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, caregiving bassles scale, and carer satisfaction questionnaire. RESULTS: The groups were balanced for all important baseline variables. There were no significant differences in physical outcomes in patients or carers, though patients in the treatment group were possibly more helpless less well adjusted socially, and more depressed, whereas carers in the treatment group were possibly less hassled and anxious. However, both patients and carers in the group contacted by the stroke family care worker expressed significantly greater satisfaction with certain aspects of their care, in particular those related to communication and support. CONCLUSIONS: The introduction of a stroke family care worker improved patients'' and their carers'' satisfaction with services and may have had some effect on psychological and social outcomes but did not improve measures of patients'' physical wellbeing.