- Email: [email protected]
347-MENTAL DISORDERS AND ASSOCIATED BURDEN IN THE COMMUNITY
Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
343 PSYCHONEUROIMMUNOLOGY AND CARDIOVASCULAR DISEASE: GLUCOCORTICOID SENSITIVITY OF SUBJECTS WITH INCREASED CARDIOVASCULAR RISK Wirtz P, Ehlert U. Department of Clinical Psychology and Psychotherapy. University of Zurich, Switzerland. Cytokine production by monocytes play a key role in the pathogenesis and progression of atherosclerosis. We investigated whether stimulated monocyte cytokine release and its inhibition by glucocorticoids would differ between subjects at risk for cardiovascular disease and non-risk control subjects. Study participants were 330 middle-aged industrial employees. Out of this population we identified subjects with elevated cardiovascular risk factors like hypertension, gender, vital exhaustion and increased basal inflammatory status. In vitro monocyte cytokine release following lipopolysaccharide (LPS)-timulation was assessed with and without coincubation with incremental doses of glucocorticoids. Monocyte glucocorticoid sensitivity was defined as the dexamethasone concentration inhibiting cytokine release by 50%. The findings suggest that pro-inflammatory activity of circulating monocytes is higher in subjects at risk for cardiovascular disease than in non-risk controls, providing one potential pathway explaining the increased atherosclerotic risk. 347 MENTAL DISORDERS AND ASSOCIATED BURDEN IN THE COMMUNITY Wittchen HU. Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden and Max Planck Institute of Psychiatry, Mu¨nchen, Germany. Over the past decade clinical epidemiological studies have shown that in any 12-month period about 1/3 of the general
673
population is suffering from mental disorders and revealed a lifetime risk for mental disorder of about 50%. These studies have provided evidence for the immense global and diagnosisrelated burden of disease in terms of disability, suffering and consequences for the individual, the social network and the society. Despite these advances, it is remarkable though, that most epidemiological research in the general population has been focussed almost entirely on a few well defined diagnostic groups, namely anxiety, depressive, substance and psychotic disorders, neglecting the association of mental disorders with physical disorders, and the broader range of conditions, summarized under the term ‘‘somatoform disorders’’. From a research, public health and clinical perspective the restricted diagnostic coverage in past studies can be regarded as a serious miss for various reasons. Namely underestimating of the total prevalence, inappropriate information about age of onset and course of mental disorders, increased risk of inappropriate attributions of associated disabilities and impairments to specific diagnoses and limited usefulness for need evaluation and health service planning. Using primarily data from the more recent ‘‘Health Interview and Examination Survey’’, this paper makes an attempt to provide a more complete overview of mental disorders in terms of prevalence and burden, paying in particular attention to somatoform disorders and comorbidity patterns of physical with mental disorders. Along with evidence from prospective-longitudinal studies findings suggest, that the inclusion of somatoform and comorbidity patterns has significant implications for a better understanding of aetiological and developmental pathways of both mental and somatic disorders. Further, the need for more comprehensive future epidemiological studies is highlighted to explore implications for prevention, treatment and the management of chronic conditions over the lifespan.
343 PSYCHONEUROIMMUNOLOGY AND CARDIOVASCULAR DISEASE: GLUCOCORTICOID SENSITIVITY OF SUBJECTS WITH INCREASED CARDIOVASCULAR RISK Wirtz P, Ehlert U. Department of Clinical Psychology and Psychotherapy. University of Zurich, Switzerland. Cytokine production by monocytes play a key role in the pathogenesis and progression of atherosclerosis. We investigated whether stimulated monocyte cytokine release and its inhibition by glucocorticoids would differ between subjects at risk for cardiovascular disease and non-risk control subjects. Study participants were 330 middle-aged industrial employees. Out of this population we identified subjects with elevated cardiovascular risk factors like hypertension, gender, vital exhaustion and increased basal inflammatory status. In vitro monocyte cytokine release following lipopolysaccharide (LPS)-timulation was assessed with and without coincubation with incremental doses of glucocorticoids. Monocyte glucocorticoid sensitivity was defined as the dexamethasone concentration inhibiting cytokine release by 50%. The findings suggest that pro-inflammatory activity of circulating monocytes is higher in subjects at risk for cardiovascular disease than in non-risk controls, providing one potential pathway explaining the increased atherosclerotic risk. 347 MENTAL DISORDERS AND ASSOCIATED BURDEN IN THE COMMUNITY Wittchen HU. Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden and Max Planck Institute of Psychiatry, Mu¨nchen, Germany. Over the past decade clinical epidemiological studies have shown that in any 12-month period about 1/3 of the general
673
population is suffering from mental disorders and revealed a lifetime risk for mental disorder of about 50%. These studies have provided evidence for the immense global and diagnosisrelated burden of disease in terms of disability, suffering and consequences for the individual, the social network and the society. Despite these advances, it is remarkable though, that most epidemiological research in the general population has been focussed almost entirely on a few well defined diagnostic groups, namely anxiety, depressive, substance and psychotic disorders, neglecting the association of mental disorders with physical disorders, and the broader range of conditions, summarized under the term ‘‘somatoform disorders’’. From a research, public health and clinical perspective the restricted diagnostic coverage in past studies can be regarded as a serious miss for various reasons. Namely underestimating of the total prevalence, inappropriate information about age of onset and course of mental disorders, increased risk of inappropriate attributions of associated disabilities and impairments to specific diagnoses and limited usefulness for need evaluation and health service planning. Using primarily data from the more recent ‘‘Health Interview and Examination Survey’’, this paper makes an attempt to provide a more complete overview of mental disorders in terms of prevalence and burden, paying in particular attention to somatoform disorders and comorbidity patterns of physical with mental disorders. Along with evidence from prospective-longitudinal studies findings suggest, that the inclusion of somatoform and comorbidity patterns has significant implications for a better understanding of aetiological and developmental pathways of both mental and somatic disorders. Further, the need for more comprehensive future epidemiological studies is highlighted to explore implications for prevention, treatment and the management of chronic conditions over the lifespan.