Table of Contents - Academy of Psychosomatic Medicine

of corticosterone responses to everyday stressors beginning
in early adulthood and enduring across the lifespan.
Among socially isolated rats, corticosterone recovery from
an acute stressor was highly attenuated and associated with
increased progression of mammary tumors.
Our study offers the first demonstration of nuclear glucocorticoid
receptors in malignant and benign mammary tumors
developing spontaneously, without exposure to a carcinogen
or xenograph. In addition to these findings, we present an array
of behavioral measures that suggest that socially isolated
females are a stress and tumor-prone, anxious, neophobic,
and hyper-vigilant phenotype. This animal model then demonstrates
the expression of genetic risk in the absence of a
social network and identifies mechanisms by which psychosocial
stressors increase growth and malignancy in a wide
variety of mammary tumors.
16. Perceived Stress, Anxiety, and Markers of
Endothelial Dysfunction in Major Depression:
Effects of Treatment
Presenting Author: Edwin Meresh, MD, MPH
Co-Authors: John Piletz, PhD, Zoe Wilson, MD, Santosh
Mathapati, MD, Angelos Halaris, MD, PhD, Christopher
Lowden
Purpose: Cardiovascular disease (CVD) and depressive illness
are two of the world’s leading health problems. There
are known physiological responses to stress and depression
(1). Repeated episodes of stress, anxiety, and depression
can lead to chronic inflammatory processes culminating
in atherosclerosis and cardiovascular diseases. We have
conducted a study to determine whether otherwise healthy
subjects in an acute episode of major depression, first or
recurrent, display endothelial dysfunction (assessed with
pulse wave analysis) (2), low heart rate variability, and/or
increased inflammation (3), as reflected in specific plasma
biomarkers, like Interleukin 1beta and 6 (IL1-beta & IL-6), C-
Reactive Protein (CRP), Tumor Necrosis Factor alpha (TNFalpha)
and Monocyte Chemoattractant Protein-1(MCP-1)
before treatment and after treatment with escitalopram for 12
weeks, relative to normal controls. This is an ongoing study.
Methods: This open-label pilot study compared patients with
Major Depressive Disorder (MDD) and matched healthy controls.
The screening assessment (visit 1) included completion
of Hamilton Rating Scale for Depression (HAMD), Hamilton
Rating Scale for Anxiety (HAMA) and Perceived Stress
Scale (PSS). Subjects underwent baseline assessment (visit
2) that included blood draw for biomarkers, and pulse wave
analysis (PWA). Pulse wave velocity (PWV) and heart-rate
variability (HRV) were measured in conjunction with a 3-lead
ECG. After completing the baseline assessment, depressed
subjects received escitalopram and were reassessed at
weeks 2, 4, 8, and 12. Escitalopram blood levels were measured
at specified visits. Subjects completed HAMD, and
HAMA at weeks 2, 4, 8 and 12, and PSS at week 12. Subjects
underwent PWA at weeks 2, 4, 8 and 12 (higher the
score of aortic augmentation index, higher the arterial stiffness
indicating endothelial dysfunction), and HRV at weeks
8 and 12. Blood draw for biomarkers after treatment was
done at week 12.
7
Reults: In the MDD group (n=9), mean baseline PSS score
was 51.1, HAMA score was 18, HAMD score was 21.66,
and Aortic Augmentation Index (A-Axl) score was 11.6. In
the healthy control group (n=5) mean PSS score was 29.6,
HAMA score was 1.2, HAMD score was 2.8, and A-Axl
score was 1.4. Statistical and regression analysis will be
presented.
Conclusions: This pilot study indicates that patients with
MDD have increased stress perception, underlying anxiety,
and increased arterial stiffness that may serve as prognostic
markers of subclinical cardiovascular disease.
References:
1. Miller GE et al. Clinical depression and regulation of the
inflammatory response during acute stress. Psychosomatic
Medicine, 2005 Sep-Oct; 67(5): 679-87
2. Hayward CS et al. Assessment of endothelial function using
peripheral waveform analysis: a clinical application, J Am
Coll Cardiol 40 (2002) 521-528
3. Piletz JE, Halaris A et al. Pro-inflammatory biomarkers in
depression: Treatment with Venlafaxine, World J Biol Psychiatry
(2008) Dec 31:1-11.
17. The MMPI-2 Restructured Form in
an Epilepsy Monitoring Unit Population-
Preliminary Data
Presenting Author: David Osborne, PhD
Co-Authors: Dona Locke, PhD, Kristin Kirlin, PhD, Duane
Hurst, PhD, Katherine Noe, MD, PhD, Joseph Drazkowski,
MD, Joseph Sirven, MD
Background: Personality assessment is a routine part of
evaluation of patients admitted for long-term video-EEG
monitoring. The MMPI-2 has been well studied in this context.
(Cragar, et al. ,2003) The MMPI-2-RF (Ben-Porath and
Tellegen, 2008) includes restructured clinical scales, which
were designed to remove overlap between scales, as well as
new scales to assess specific problems. No research has
appeared on the MMPI-2-RF in an EMU cohort.
Purpose: To provide preliminary data on the MMPI-2-RF
along with presentation of the original MMPI-2 clinical scales
in a prospective EMU cohort with confirmed diagnosis of epilepsy
or psychogenic non-epileptic events (PNES).
Methods: Comparison of epilepsy (n=11) and PNES (n=11)
patients on the MMPI-2-RF.
Results: Groups were equivalent on age, education, and
gender in this small preliminary sample. Results show significant
differences (p