The epidemiology of panic disorder and agoraphobia in Europe

A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7–2.2) and 1.3% (0.7–2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability

Factors associated with dropout from treatment for eating disorders: a comprehensive literature review

<p>Abstract</p> <p>Background</p> <p>Dropout (DO) is common in the treatment of eating disorders (EDs), but the reasons for this phenomenon remain unclear. This study is an extensive review of the literature regarding DO predictors in EDs.</p> <p>Methods</p> <p>All papers in PubMed, PsycINFO and Cochrane Library (1980-2009) were considered. Methodological issues and detailed results were analysed for each paper. After selection according to inclusion criteria, 26 studies were reviewed.</p> <p>Results</p> <p>The dropout rates ranged from 20.2% to 51% (inpatient) and from 29% to 73% (outpatient). Predictors of dropout were inconsistent due to methodological flaws and limited sample sizes. There is no evidence that baseline ED clinical severity, psychiatric comorbidity or treatment issues affect dropout. The most consistent predictor is the binge-purging subtype of anorexia nervosa. Good evidence exists that two psychological traits (high maturity fear and impulsivity) and two personality dimensions (low self-directedness, low cooperativeness) are related to dropout.</p> <p>Conclusion</p> <p>Implications for clinical practice and areas for further research are discussed. Particularly, these results highlight the need for a shared definition of dropout in the treatment of eating disorders for both inpatient and outpatient settings. Moreover, the assessment of personality dimensions (impulse control, self-efficacy, maturity fear and others) as liability factors for dropout seems an important issue for creating specific strategies to reduce the dropout phenomenon in eating disorders.</p

What matters for life satisfaction among the oldest-old? Evidence from China

The world population is aging rapidly and the well-being of older people is of great interest. Therefore, this study investigates the determinants of life satisfaction among the oldest-old (i.e. individuals aged 80 or over) in China. Materials and methods We use the 2011/2012 Chinese Longitudinal Healthy Longevity Survey data (n = 6530) for this paper. Logistic regression is used to analyse the effects of socio-demographic, economic, health, instrumental activities of daily living, family and community factors on life satisfaction and depression among the oldest-old in China. Results Our analysis confirms the significance of many factors affecting life satisfaction among the oldest-old in China. Factors that are correlated with life satisfaction include respondent’s sex, education, place of residence, self-rated health status, cognitive ability (using mini mental state examination), regular physical examination, perceived relative economic status, access to social security provisions, commercialized insurances, living arrangements, and number of social services available in the community (p<0.05 for all these variables). Although life satisfaction is negatively associated with instrumental activities of daily living (β = -0.068, 95%CI = -.093—.043), and depression (β = -0.463, 95%CI = -.644—.282), the overall effect of self-rated health status is positive (p<0.001). This confirms the primacy of health as the determinant of well-being among the oldest-old. Conclusions Majority of the oldest-old in China rated their life satisfaction as good or very good. Our findings show that health and economic status are by far the most significant predictors of life satisfaction. Our finding on the primacy of health and relative income as determinants of well-being among the oldest-old, and the greater influence of self-rated health status over objective health measures is consistent with the findings of many past studies. Our results suggest that efforts should be directed at enhancing family support as well as health and social service provisions in the community to improve life satisfaction of older people

Rett syndrome is associated with altered gut microbiota community

Introduction: Rett syndrome (RTT) is an X-linked neurodevelopmental disorder and the second most common cause of mental retardation in females. Changes in microbiota composition, as observed in other neurological disorders such as autism, may account for several typical symptoms associated to RTT. Indeed, it is shown that a dysbiotic microbiota in gastrointestinal tract may affect the function of the nervous system. The main goal of this preliminary study was to characterize gut microbiota in RTT patients, and to compare it with a healthy control group of female of the same age. Materials and Methods: Eight RTT patients were enrolled at the Child Neuropsychiatry Department of San Paolo Hospital of Milan. Age and sex-matched healthy women (CTR), working at the University of Milan, were recruited. From all subjects we collected stool samples, anthropomet ricric data and dietary habits. Microbiota characterization was achieved by amplicon sequencing using 16S rRNA regions (V3-V4) genomic region with a Next Generation Sequencing approach on Illumina platform. Concentration of short chain fatty acids (SCFAs) was determined by gas-chromatography analysis. Results: Body mass index (BMI, kg/m2) was 17.4 \ub1 3.9 (mean \ub1 SD) in RTT patients, and 20.9 \ub1 2.2 in control group (p = 0.0284). We did not observe differences in the mean value of Kcal/die (p = 0.43), but RTT diets were characterized by an increase in protein content (p = 0.029) and a lower intake of sugars (p = 0.0035). Microbiota analysis showed a significant lower alpha-diversity in RTT samples compared with control group (chao index and species richness p < 0.0001; shannon index p = 0.0015; and inverse simpson index p = 0.013). The predominant bacterial taxa in both groups were Firmicutes and Bacteroidetes. Although the Firmicutes/Bacteroidetes ratio was similar, at family level Bacteroidaceae were significantly higher in RTT samples (p = 0.0009), whereas Clostridiaceae, Ruminococcaceae and Christensenellaceae were strongly reduced. Desulfovibrio spp., as seen in autistic patients, was found increased in RTT patients (p = 0.0216). We did not find differences in butyrate and acetate concentration (p = 0.1144 and p = 0.6456, respectively) whereas fecal propionate was increased in RTT patients (p = 0.0248). Conclusions: We demonstrated in a small sample of patients that RTT gut microbiota is significantly different from the control group. Our hypothesis is that a dysbiotic gut in RTT patients could result in alterations of SCFAs that can worsen clinical symptoms by interacting at various levels (gut, brain, liver). Understanding critical changes could offer new tools for a diet intervention or probiotics supplementation to improve RTT associated symptoms and, ultimately, psycho-physical wellness

Rett syndrome is associated with altered gut microbiota community

Introduction: Rett syndrome (RTT) is an X-linked neurodevelopmental disorder and the second most common cause of mental retardation in females. Changes in microbiota composition, as observed in other neurological disorders such as autism, may account for several typical symptoms associated to RTT. Indeed, it is shown that a dysbiotic microbiota in gastrointestinal tract may affect the function of the nervous system. The main goal of this preliminary study was to characterize gut microbiota in RTT patients, and to compare it with a healthy control group of female of the same age. Materials and Methods: Eight RTT patients were enrolled at the Child Neuropsychiatry Department of San Paolo Hospital of Milan. Age and sex-matched healthy women (CTR), working at the University of Milan, were recruited. From all subjects we collected stool samples, anthropomet ricric data and dietary habits. Microbiota characterization was achieved by amplicon sequencing using 16S rRNA regions (V3-V4) genomic region with a Next Generation Sequencing approach on Illumina platform. Concentration of short chain fatty acids (SCFAs) was determined by gas-chromatography analysis. Results: Body mass index (BMI, kg/m2) was 17.4 \ub1 3.9 (mean \ub1 SD) in RTT patients, and 20.9 \ub1 2.2 in control group (p = 0.0284). We did not observe differences in the mean value of Kcal/die (p = 0.43), but RTT diets were characterized by an increase in protein content (p = 0.029) and a lower intake of sugars (p = 0.0035). Microbiota analysis showed a significant lower alpha-diversity in RTT samples compared with control group (chao index and species richness p < 0.0001; shannon index p = 0.0015; and inverse simpson index p = 0.013). The predominant bacterial taxa in both groups were Firmicutes and Bacteroidetes. Although the Firmicutes/Bacteroidetes ratio was similar, at family level Bacteroidaceae were significantly higher in RTT samples (p = 0.0009), whereas Clostridiaceae, Ruminococcaceae and Christensenellaceae were strongly reduced. Desulfovibrio spp., as seen in autistic patients, was found increased in RTT patients (p = 0.0216). We did not find differences in butyrate and acetate concentration (p = 0.1144 and p = 0.6456, respectively) whereas fecal propionate was increased in RTT patients (p = 0.0248). Conclusions: We demonstrated in a small sample of patients that RTT gut microbiota is significantly different from the control group. Our hypothesis is that a dysbiotic gut in RTT patients could result in alterations of SCFAs that can worsen clinical symptoms by interacting at various levels (gut, brain, liver). Understanding critical changes could offer new tools for a diet intervention or probiotics supplementation to improve RTT associated symptoms and, ultimately, psycho-physical wellness