Case 16-2013

Bender, Suzanne L.; Sherry, Nicole; Masia, Ricard

doi:10.1056/nejmcpc1208145

Cited by 6 publications

(4 citation statements)

References 119 publications

(36 reference statements)

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“…In contrast, during early-intermediate abstinence (concurrently with the dip in peak CORT), CIE rats exhibited increased aggression-like behavior and reduced anxiety-like behavior compared to ethanol-naïve controls. The causal relations among the reduced peak CORT on the one hand and altered aggression- and anxiety-like behavior on the other remains to be determined, but the results are consistent with clinically observed co-occurrence of increased irritability and hypocortisolism (Bender et al, 2013; Hahner et al, 2007; Tiemensma et al, 2014). …”

Section: Discussionmentioning

confidence: 56%

“…For example, Addison's disease and adrenal insufficiency are associated with increased irritability, which is mitigated typically by hydrocortisone replacement therapy (Bender et al, 2013; Hahner et al, 2007; Tiemensma et al, 2014). Preclinical research also supports a relation of low corticosterone (CORT, the predominant glucocorticoid in rats) to high aggression (Haller et al, 2001; Miczek et al, 2015b).…”

Section: Introductionmentioning

confidence: 99%

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Abstinence from prolonged ethanol exposure affects plasma corticosterone, glucocorticoid receptor signaling and stress-related behaviors

Somkuwar

Vendruscolo

Fannon

et al. 2017

Psychoneuroendocrinology

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Alcohol dependence is linked to dysregulation of the hypothalamic-pituitary-adrenal axis. Here, we investigated effects of repeated ethanol intoxication-withdrawal cycles (using chronic intermittent ethanol vapor inhalation; CIE) and abstinence from CIE on peak and nadir plasma corticosterone (CORT) levels. Irritability- and anxiety-like behaviors as well as glucocorticoid receptors (GR) in the medial prefrontal cortex (mPFC) were assessed at various intervals (2h-28d) after cessation of CIE. Results show that peak CORT increased during CIE, transiently decreased during early abstinence (1-11d), and returned to pre-abstinence levels during protracted abstinence (17-27d). Acute withdrawal from CIE enhanced aggression- and anxiety-like behaviors. Early abstinence from CIE reduced anxiety-like behavior. mPFC-GR signaling (indexed by relative phosphorylation of GR at Ser211) was transiently decreased when measured at time points during early and protracted abstinence. Further, voluntary ethanol drinking in CIE (CIE-ED) and CIE-naïve (ED) rats, and effects of CIE-ED and ED on peak CORT levels and mPFC-GR were investigated during acute withdrawal (8h) and protracted abstinence (28d). CIE-ED and ED increased peak CORT during drinking. CIE-ED and ED decreased expression and signaling of mPFC-GR during acute withdrawal, an effect that was reversed by systemic mifepristone treatment. CIE-ED and ED demonstrate robust reinstatement of ethanol seeking during protracted abstinence and show increases in mPFC-GR expression. Collectively, the data demonstrate that acute withdrawal from CIE produces robust alterations in GR signaling, CORT and negative affect symptoms which could facilitate excessive drinking. The findings also show that CIE-ED and ED demonstrate enhanced relapse vulnerability triggered by ethanol cues and these changes are partially mediated by altered GR expression in the mPFC. Taken together, transition to alcohol dependence could be accompanied by alterations in mPFC stress-related pathways that may increase negative emotional symptoms and increase vulnerability to relapse.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Abstinence from prolonged ethanol exposure affects plasma corticosterone, glucocorticoid receptor signaling and stress-related behaviors

Somkuwar

Vendruscolo

Fannon

et al. 2017

Psychoneuroendocrinology

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“…Irritability could be an early manifestation of hyperthyroidism [37], Addison's disease [105], brain tumors [52,55], left temporal meningioma [92], and multiple sclerosis [73,87]. A case record of the Massachusetts General Hospital contains a striking illustration of a man who entered the hospital complaining of abdominal pain, headache, irritability, and nervousness and later had a diagnosis of cancer of the pancreas [106] (online suppl.…”

Section: Resultsmentioning

confidence: 99%

Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

Cosci

Fava²,

Sonino³

2014

Psychother Psychosom

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Background: Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. Methods: MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were ‘prodrome/early symptom', combined using the Boolean ‘AND' operator with ‘anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean ‘AND' operator with ‘medical illness/medical disorder'. PRISMA guidelines were followed. Results: A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Conclusions: Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

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“…18 Two studies have demonstrated that enactment of the dependent-coverage provision was associated with financial protection from medical costs. 19,20 However, a November 2014 study evaluated nationally representative data surrounding the implementation of the ACA confirmed that health care coverage for young adults increased but that young adults do not report improved health status, affordability of health care, or use of flu vaccination, compared with their older counterparts. 21 ersons aged 19–25 years were more likely to have a usual source of care than those aged 26 to 34 years, but both age groups saw declines in this measure of access to care.…”

Section: Aca Provisions Affecting Children and Familiesmentioning

confidence: 99%