New trends in anxiety disorders

 Antonio E. Nardi; Leonardo F. Fontenelle; José Alexandre S. Crippa


Anxiety disorders are the most prevalent and economically burdensome of all psychiatric diagnoses, yet they are among the most commonly misdiagnosed and undertreated.¹ The experience of anxiety has a universality that extends across times and cultures. Only in the past few decades have scientists been able to develop rigorous diagnostic schemas to improve clinical and basic research data on anxiety disorders.² Over the last five years, however, research in the field of anxiety disorders is growing in such a rapid pace that an up-to-date supplement is just one tool in our effort to keep research results within reach of readers in the area.³
Anxiety disorders are not a problem of our time: several literary reports and antiquity myths demonstrate that symptoms of what we name anxiety disorders nowadays were observed long ago. Maybe one of the oldest examples lies in Greek mythology - the god Pan. He was responsible for anxiety and was the origin of the term "panic".¹ In several stories, Pan is reported to cause fright, screams, fears, terror and suffering. Like other woodland gods, he was feared by those who had to go through the forest, because meeting one of these deities could provoke overwhelming and irrational fear, for no reason at all, or what was known as "panic terrors" or "panic attacks". The fear of meeting Pan again and of being startled once more made travelers stop journeying through roads and avoiding going to the market (in Greek, ágora), thus developing agoraphobia (fear of large open or public places).¹
Paradoxically, anxiety is a complex and useful mental function.² It generates a range of behaviors that occur in response to any threat. During the last years, research into the phenomenology, pathophysiology, and neurobiology of anxiety disorders has grown so much that results translatable into clinical practice may offer hope and help to people with anxiety disorders.
The psychobiology of anxiety disorders is one of the most interesting and rewarding areas of contemporary medical research. At least three central neurotransmitter systems - noradrenergic, serotonergic, and gama-aminobutyric acid (GABA) -are acutely affected by certain pharmacological compounds that provide therapeutic benefit.² However, new neurotransmitter systems have also been discovered to underlie anxiety symptoms and disorders, such as the endocannabinoid system posing new challenges to investigators.⁴
The translation of neuroscience findings introduced new insights into the causes of anxiety and supported the development of novel psychosocial and pharmacological treatment approaches, besides leading to a better understanding of the interaction between genes and the environment. Animal studies have indicated that fear and anxiety-like states are mediated by structures that include the amygdala, hippocampus, prefrontal cortex, locus coeruleus, and periaqueductal gray matter.²
Today, the psychopharmacology of anxiety disorders has been leading psychiatry in the direction of biology. This biological perspective entails the consideration of anxiety within the framework of the evolutionist paradigm. Charles Darwin (1872), in The Expression of the Emotions in Man and Animals,⁵ pointed the way for the search for adaptive value of behavioral and psychological processes. Anxiety and fear are rooted in the defensive reactions of animals, observed in response to the danger normally found in the environment. The interpretation of a stimulus or situation as dangerous depends on the nature of cognitive operations. In humans, cognitive factors acquire importance due to the intervention of the system of socially codified symbols, whether verbal or non-verbal. The behavioral responses to fear are accompanied by intense physiological alterations - physical symptoms - and changes in the emotional state.
The 21^st century will probably be marked by the provision of genetic and neuroimaging data about panic and other anxiety disorders.⁶ Anxiety symptoms seem to originate from a fear network with altered sensitivity.² Recent research on the physiological correlates of anxiety features has yielded remarkable findings concerning regional brain activity and structure in different neuroimaging studies.⁶ It will also further our understanding of the sites of action of effective therapies.
Over the last century the mysteries of anxiety disorders have been revealed through basic and clinical research, and patients who suffer from a frightening anxiety disorder can be sure that its diagnosis and efficient treatment are already part of everyday clinical practices. We have, however, to perfect these practices so that we can continue to improve our knowledge about these disorders.
This supplement of RBP Psychiatry shall bring up some different and challenging conceptions of anxiety disorders. We are proud to organize this supplement with an outstanding collection of contributions by experts in the leading edge of research in the field.

References
1. Berrios GE. The History of mental Symptoms. Descriptive psychopathology since the nineteenth century. Cambridge: University Press; 1996.         [ Links ]
2. Gorman JM, Kent JM, Sullivan GM, Coplan JD. Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry. 2000;157:493-505.         [ Links ]
3. Machado S, Paes F, Velasques B, Teixeira S, Piedade R, Ribeiro P, Nardi AE, Arias-Carión O. Is rTMS an effective therapeutic strategy that can be used to treat anxiety disorders? Neuropharmacology. 2012;62:125-34.         [ Links ]
4. Zuardi AW, Crippa JA, Hallak JE. [Cannabis sativa: the plant that can induce unwanted effects and also treat them]. Rev Bras Psiquiatr. 2010;32(Suppl1):S1-2.         [ Links ]
5. Darwin C. The Expression of Emotion in Man and in Animals [1872]. London: Fontana Press; 1999.         [ Links ]
6. Linares IM, Trzesniak C, Chagas MH, Hallak JE, Nardi AE, CrippaJA. Neuroimaging in specific phobia disorder: a systematic review of the literature. Rev Bras Psiquiatr. 2012;34(1):101-11.         [ Links ]

The Crash Report: Hemp for Victory

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Written by Crash Barry

Since 2009, Maine law has allowed farmers to grow industrial hemp, but the federal Drug Enforcement Agency will lock 'em up if they try. Even though everyone agrees you can't get high from smoking the stuff. It's just another example of government-sponsored reefer madness stigmatizing anything cannabis-related.
Doesn't matter that industrial hemp has the potential to bring much needed cash to Maine's agricultural sector and new manufacturing jobs to unemployed workers across the state. To the feds, the harmless plant needs to stay on the "bad" drug list, along with heroin, cocaine, crystal meth and opium. The irony, of course, is that the U.S. annually imports about $400 million worth of hemp products, mostly from China and Canada. And yet if Maine farmers decided to sow a field with industrial hemp, they'd face five to 20 years behind bars for growing a plant with such low THC levels, you'd pass out from smoke inhalation long before catching a buzz.


The war over hemp isn't lost, though. Earlier this month, a bi-partisan amendment to the Senate Farm Bill to exempt hemp from the "Controlled Substances Act" was briefly discussed, then discarded. And in the House, the issue has been sent to committee via a bill introduced by Ron Paul and co-sponsored by 33 others, including Maine's Chellie Pingree. And on June 11, David Bronner — CEO of Dr. Bronner's, one of the largest natural soap manufacturers in America — locked himself in a cage across the street from the White House, with a dozen hemp plants. The stunt allowed Bronner to explain how he'd prefer to spend his company's annual $100,000 hemp oil budget on domestic hemp, rather than importing foreign oil.
When and if the ban is lifted, Maine could be poised to capitalize on hemp. According to a 2005 study by the Maine Agricultural and Forest Experiment Station, farmland across the state is well-suited for growing hemp for fiber. And most of Maine, south of Aroostook County, has adequate land and climate for cultivating hemp seed crops. Growing hemp is considered "green agriculture" because the plant doesn't require pesticides to thrive. And hemp is excellent to grow in rotation with other crops. Planting tight grids of hemp suppresses weeds, counters erosion and restores organic matter to depleted soil.
Hemp also fits well with Maine's long history of papermaking. An acre of hemp translates into four times more paper than an acre of forest. And it only takes four months, instead of many years, to grow and be harvested.
Plus, farmers can earn good money. Basing the numbers on Canadian prices, at $3,800 per acre, hemp is more valuable than Maine's traditional crops. An average acre of blueberry barrens generates about $3,100. An acre of potato field brings in about $2,700. (Due to fruit flies and blight, per acre yields tend to fluctuate.) The only legal crops more valuable than hemp are tomatoes and tobacco, neither of which thrive in Maine.
(Of course, these numbers are nothing compared to the value of Maine's number one cash crop: Marijuana of the "gets you high" variety. Imagine an acre of super-fine, six foot tall organic ganja shrubs. With one plant per square yard, an acre of marijuana grove could conservatively pull in $10,000,000. Of course nobody in Maine would ever plant an acre of ganja. The sheer number of employees required to tend a pot plantation of that size would make it tough to keep a mega-patch secret. Besides, to avoid federal drug charges, most guerilla growers tend to keep their garden plots to under 99 plants. But the image of an acre of primo weed is certainly nice to envision.)
Many conspiracy theories abound, trying to explain why hemp is illegal. Some claim the Dupont family unduly influenced government bureaucrats to favor post-war synthetic fibers and fabric, like nylon, over hemp. Others blame the Hearst newspaper syndicate for fomenting hatred toward marijuana and hemp as a way to protect the assets of lumber and woodlot barons, while demonizing the ethnic groups who loved to smoke the weed.
Propaganda from drug czar mouthpieces blurred the hemp issue even further. General Barry McCaffrey opposed legalizing the plant, insisting it would be confusing and send the wrong message to children. And local law enforcement officials, like Roy McKinney, the longtime head of the Maine DEA, complain that cops would have difficulty distinguishing between industrial hemp and the psychoactive variety, despite easy-to-spot dramatic differences in appearance and cultivation techniques for the two crops.
That sort of bureaucratic babble is maddening, especially since hemp could help bring back to Maine some of the manufacturing jobs lost in recent years to automation and overseas outsourcing. With 100,000 residents either under-or-unemployed, Maine continues to lag behind the rest of the country in recovering from the Great Recession. And the latest economic numbers show that Maine was the only New England state to have a reduction in gross domestic product in 2011.
A hemp industry could jump start, or at least stimulate, Maine's economy. In addition to the new farm and hemp processing jobs, there would be increased demand for trucking. Many abandoned fabric and paper mills could be retrofitted to handle hemp fiber. And the products that could be manufactured in the state are amazingly diverse. In addition to creating textiles and rope, hemp fiber can be mixed with Maine lime into "hempcrete," a greener form of concrete. Hemp is a helpful ingredient in paper recycling. Combined with wood, hemp turns into fiberboard for use in building construction. And hemp can be molded into chips or biofuel to burn for heat and electricity. Or the fiber can be pulped and transformed into rolling papers or Bible pages.
Hemp seed is an even more valuable food resource and an excellent vegan protein, chockfull of omega oils. Hemp, in various forms, has found its way into many types of breads, snacks, milks, oils and cereals. Hemp makes delicious beer. Paints, varnishes and lubricants can be also derived from the magic plant. And just think of all the ad agency, sales team and web design jobs connected to promoting and selling a plethora of Maine-made hemp products.
In fact, the only conceivable downside to the widespread cultivation of hemp in Maine would be the possible negative impact on the local marijuana crop. Industrial hemp fields have male and female plants in order to produce seeds. In recreational and medicinal cannabis gardens, however, growers only keep un-pollinated females to prevent unpleasant-to-smoke seeds from forming. The possible danger comes mid-summer when hemp pollen can catch a ride on the breeze and pollinate the marijuana. The solution, though, is simple. Mainers could mimic the north African ganja farmers who cover their pot plants with tight-meshed nets on windy days.
It's not far-fetched to envision a day soon when hemp is legal to grow in Maine. After all, interest is growing in legalizing the wunder-crop. Current Senate candidates Cynthia Dill, Andrew Ian Dodge and Charlie Summers have expressed support for the possibility, while the other three candidates — Danny Dalton, Angus King and Steve Woods — declined to comment.

Secret documents, incriminating evidence or whistle-blowing notes may be e-mailed to tips @ crashbarry.com.

By Marie Cendejas

There’s a increasing interest in the non-psychoactive medicinal benefits of cannabis, despite legislative resistance to appraise the long list of claims of the healing power of cannabis.

The plant's abilities as a painkiller and an anti-nauseant are well documented, but the plant also has a long history claims of other medical uses. In ancient Chinese traditional pharmacology, cannabis has a track record of helping over 120 ailments and conditions.

Inflammation has been found to both instigate and worsen a long list of diseases like heart disease, cancer, multiple sclerosis, and gastrointestinal tract disorders. Outside of its painkilling claim cannabis shows its ability as an anti-inflammatory aid. 

For the past three years there has been an ongoing study of 500 participants with multiple sclerosis. This has been the largest study of its kind to this date.

The study examined the effects of just the active chemical in cannabis, rather than the whole plant. The amount of tetrahydrocannabinol (THC) varies across a plant. Researchers found the THC provided subjects with some relief from the symptoms like stiffness and muscle paroxysms, but couldn't slow down the progression of the disease.

Multiple sclerosis is a progressively degenerative disease that affects the central nervous system. Nerve cells are coated in a fatty layer that helps them communicate with each other. In individuals with multiple sclerosis, the coating gradually degrades, leading to peripheral neuropathy and interference with mobility, eventually leading to nerve death.

Alzheimer's and Parkinson's disease are also neurodegenerative disorders, and likewise have very limited treatment options. Cannabis has shown to improve neural communication, which had given researchers a reason to be hopeful. In other studies, cannabinoids have been shown to be protective and capable of increasing neural plasticity.