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Fear-potentiated startle history of drug dependence 500mg ponstel visa. Drug Alcohol Depend 1998;50: in adolescent offspring of parents with anxiety disorders order cheapest ponstel. Effect of darkness on acoustic components in air puff startle cheap ponstel 500mg. Physiol Behav 1991;49: acoustic startle in Vietnam veterans with PTSD. Startle potentia- variability in posttraumatic stress disorder patients in response to tion by threat of aversive stimuli and darkness in adolescents: a trauma-related reminder. Fear-potentiated startle conditioning York: Basic Books, 1994:261–262. Hemodynamic responses to laboratory traumatic stress disorder. Long-term potentiation in the amygdala: a mechanism stressors in children and adolescents: the influences of age, race, for emotional learning and memory. Types of panic attacks and their associa- Nature Neurosci 1999;2:833–839. Comorbidity of migraine and learning in mGluR1mutant mice. Heart rate variability in depressive and Genet 1997;17:335–337. Regional brain polygenes influencing susceptibility to anxiety. Hum Psycho- function, emotion and disorders of emotion. Curr Opin Neuro- pharmacol Clin Exposure 1999;14:S3–S10. Emotional arousal and formation through regulated expression of a caMKII transgene. Autonomic nervous sys- and anxiety: Brain mechanisms and psychophysiology. Biol Psy- tem activity distinguishes among emotions. Baseline and fear-poten- 882 Neuropsychopharmacology: The Fifth Generation of Progress tiated startle in panic disorder patients. Biol Psychiatry 1994; miology of anxiety disorders in Florence. Biologic findings in and their relation to anxiety and depressive disorders. J Abnorm panic disorder: neuroendocrine and sleep-related abnormalities. Reactivity to a 35% CO2 challenge in of stressful life events. Life events and panic disorder/ Psychiatry 2000;47:830–835. Arch Gen Psychiatry 1995;47: antecedent stressful life events to childhood and family history 21–26. Smoking and panic attacks: an epidemio- Gen Psychiatry 2000;51:960–962. Parental representa- in children with anxiety disorders. Am J Psychiatry 2000;157: tions of patients with panic disorder and generalised anxiety 1236–1242. Vulnerability factors in the anxiety disor- adolescent depression: a review of the past 10 years, part II. Lactate infusions: The ogy, parenting styles and the risk of social phobia in offspring: a role of baseline anxiety. Philos Trans R Soc on brain systems involved in the pathophysiology of anxiety Lond [B] 1997;352:1755–1759. Fear and the brain: where have we been, and where 169. The emotional Stroop section with anxiety disorders. Biol Psychiatry 1999;1999: task and psychopathology. The adolescent brain and age-related behavioral mani- and its amelioration by effective treatment with SSRis. KALIN ANIMAL MODELS OF PSYCHIATRIC fore, it is difficult to come up with an animal model for an ILLNESS illness that meets the aforementioned criteria and also models the pathologic syndrome in its entirety. An alterna- Animal Models: Types Of Validity tive approach that has been used involves the modeling of An important criterion for developing animal models to discrete symptom clusters and physiologic alterations rather study psychopathology involves establishing the validity of than the whole syndrome, with the assumption that what the model as a true representation of the process being stud- causes the symptoms contributes mechanistically to the ill- ied.

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Thereafter ponstel 250 mg online, line of workon parent–child interactions buy generic ponstel 500mg on line, Kendler et al purchase ponstel. Among those who actually try the ness or aloofness may affect the occurrence of alcohol or drug, the drug-using stage may or may not be followed by other drug dependence, but the evidence is not generally another stage—transition into drug dependence. Some supportive of an influence of active parenting styles (e. Soon, results will be available from indirect random- mental sequence in which different drugs are tried, first ized, controlled trials in which interventions have been used legally available beer or wine, then hard liquor or tobacco, to increase the aspects of parenting behavior suspected of then marijuana as the first 'illicit' drug in the sequence, being most influential in early drug involvement (e. Here, the causal inference is sup- sequence is use of prescription psychotherapeutic medicines ported by a fairly solid body of observational evidence con- (Fig. Nonetheless, as in the linkbetween sociopathy and drug Nonetheless, some observers have argued that this 'gate- dependence, replications from indirect randomized, con- way description' of sequences from drug to drug may rest trolled trials are apt to provide the most definitive evidence solely on different levels of availability or opportunity to regarding these issues of causal inference. Other investigators have challenged the randomized, controlled trials with large epidemiologic sam- stage transition concept as applied to drug dependence and ples will probably be performed, possibly with specific tar- youthful tobacco smoking (77). They have advocated an 1568 Neuropsychopharmacology: The Fifth Generation of Progress century, a new type of professional emerged—a public STAGE 1 health officer equipped with newly found knowledge of epi- BEER OR WINE demiology and armed with police powers necessary to pro- tect the larger population from the threat of infectious dis- STAGE 2 eases. In twentieth century efforts to mount an effective TOBACCOTOBACCOTOBACCO societal response to drug dependence, the police authority HARD LIQUOR CIGARETTESCIGARETTESCIGARETTES was split from the public health authority. As a result, when most people now thinkof the prevention of drug depen- dence, what comes to mind are health education classes for TOBACCO young people of school age or mass media campaigns to HARD LIQUOR CIGARETTES publicize the hazards one faces once drug use starts. We do not tend to thinkof the international, federal, state, and local laws or police actions as societal instruments for pre- STAGE 3 vention. Nor do we tend to thinkof early interventions for drug-dependent cases, tracing of secondary contacts who MARIJUANA PRESCRIBED PSYCHOACTIVE may be sources of sustained outbreaks, or effective treatment DRUGS of active cases as a means of preventing new cases. Indeed, in some quarters, the opinion has been expressed that con- STAGE 4 cepts of epidemiology and public health should not be ap- OTHER plied to drug dependence because these concepts are tied ILLICIT inherently to coercive actions, such as quarantine (85). DRUGS Notwithstanding these concerns, during the past quarter- century, some epidemiologists have directed attention to FIGURE 109. Stages in the developmental sequence of adoles- cent drug involvement. Stages of progression in drug involvement from adoles- prevent and control drug dependence and associated haz- cence to adulthood: further evidence for the gateway theory. Starting in the 1960s, de Alarcon (86) and Hughes et Stud Alcohol 1992;53:447–57, with permission. Statistical methods for studying this hybrid transition pro- It may come as a surprise that epidemiologists have not gression model are being developed for epidemiologic re- been the ones to sustain this workor build on it. Separate lines of clinical and epidemiologic re- and methods (e. Indeed, more epidemio- search on the natural history of dependence on drugs other logic attention and evaluative research have been devoted than alcohol have also been initiated (e. REDUCE, OR AMELIORATE THE ADVERSE Noteworthy exceptions to this generalization about drug IMPACT? Gutman and Clayton (98) have recently urged little attention to intervention research. The person-to-person spread of heroin injection across time and space in the United Kingdom in the 1960s. Community Health (Bristol) 1969;1:155–161, with permission. The 'World Mental Health 2000' surveys, tistical models that take into account different levels of orga- organized by Professor Ronald Kessler of Harvard Univer- nization, from the community at large to the local neighbor- sity and Dr. Bedirhan Ustun of the World Health Organiza- hood to the household or individual, and in models of tion, will enlarge these national perspectives and offer epide- 'dependent happenings,' such as are seen when innovations miologic data on the prevalence of drug dependence in more (e. A carryover into the domain of prevention greater difficulty and complexity of the Epidemiologic research has been expressed in recent articles and a textbook Catchment Area studies, it is less likely that we will see (107). These developments, coupled with a greater apprecia- similar growth in prospectively derived estimates of the inci- tion of gene–environment transactions or reciprocities, dence of drug dependence and the riskfor becoming drug- rather than gene–environment competition, promise to dependent. Most likely, we will have to make do with ap- transform and sharpen the focus of prevention research dur- proximate estimates of riskbased on retrospective data from ing future decades as the human genome project yields new the cross-sectional surveys. The sustained attention given to determining the preva- lence of drug dependence within the context of more general surveys of psychiatric disturbances essentially guarantees a CONCLUSION AND FORECAST raft of new findings on the location of cases and 'psychiatric comorbidity' within the populations of the world. We are It is possible to make an optimistic forecast regarding the likely to see more and more data on the male excess in drug application of epidemiology to the study of drug depen- dependence cases, although in some countries, because of dence. Under the rubric of 'quantity,' sustained growth the use of psychotherapeutic medicines, a female excess may in the number of cross-sectional 'prevalence surveys' that be shown for some drug categories. Similarly, the excess estimate the frequency of drug dependence in various popu- occurrence among 15- to 44-year-olds in comparison with lations and subpopulations of the world is apparent. Diag- other age groups may prove to be a general rule via excep- 1570 Neuropsychopharmacology: The Fifth Generation of Progress tions, such as the high prevalence of heroin or opium depen- compelling evaluations of drug policies and societal re- dence among elderly persons living in the opium-growing sponses to drug dependence and illicit drug use. Nonetheless, it seems that new findings Under this same rubric, a ray of light has begun to shine from these cross-sectional surveys will be most useful in forth from the National Institute of Drug Abuse in the confirming past observations. One may hope for transfor- United States, where a new unit has been established to mative evidence, but the workis not likely to be ground- promote research on community mobilization and efforts breaking. Coupled with continuing progress miology intersects with the human genome project provides in the ongoing evaluation of school-based prevention pro- a basis for optimism.