Sex and Age-Related Differences in Neuroticism and Allostatic Load Index in Urban Patients with General Anxiety Disorder Treated with Alprazolam

Abstract

Introduction: Allostatic load (AL) index proposes indicators for the functioning of the main potentially stress-affected systems. Sex differences in stress response and stress-related diseases susceptibility have been described for the general population. In this observational study we describe the effects of sex and age on AL variables, in a cohort of patients with general anxiety disorders and neuroticism treated with alprazolam during 12 weeks, before and after treatment. Methods: Patients with general (DSM IV) anxiety disorders with >6 in Hamilton scale, AL (>1 Crimmins and Seeman AL modified criteria) and neuroticism >18 (NEO-FFI inventory), were included. All patients completed psychiatric assessment, AL index determination before (−1 week) and after 12 weeks of treatment with alprazolam (0.25 -1 mg/t.i.d). Allostatic load parameters comprised cardiovascular, metabolic and inflammatory variables. Univariate analysis (two-way ANOVA), Student's t-test (related variables) and Pearson correlations were determined. Results: Fifty-four patients, 35 females (48.6 ± 11.7 years) and 19 males (44.2 ± 12.8 years) with general anxiety disorder were included; 28 patients with <50 years (60.7% females), and 26 with ≥50 years (69.2% females). Younger patients (<50 years) (two-way ANOVA, p = 0.02) were significantly associated with lower AL index after treatment. However, women showed higher anxiety levels in both, before (two-way ANOVA, p = 0.059) and after treatment (two-way ANOVA, p = 0.005), with a significantly better profile than men in many individual AL variables, particularly cardiovascular (systolic blood pressure), obesity (body mass index), and lipids (higher HDL levels). After treatment a higher reduc-How to cite this paper: Soria, C.A., Remedi, C., D'Alessio, L. and Roldán, E.J.A. (2018) Sex and Age-Related Differences in Neuroticism and Allostatic Load Index in Urban Patients with General Anxiety Disorder Treated with Alprazolam. Open Journal of Psychiatry, 8, 212-232. 213Open Journal of Psychiatry tion of fibrinogen levels was found in men (two-way ANOVA, p = 0.02). Conclusions: In this preliminary analysis we described sex and age differences in psychiatry aspects and AL indexes in patients with general anxiety disorders in the short-term treatment with alprazolam. These considerations remark the need of pondering sex and age differences during the use of drugs for protracted periods.

Semantic and Phonemic Verbal Fluency Performance in Patients with General Anxiety Disorders and Allostatic Load under Alprazolam Treatment

“…In this sample and psychiatric variables were described in detail in a previous publication [28]. The VFT scores according age a sex are resumed in Table 1 and was found between DHEA plasmatic levels (r = −027, p = 0.04) and phonemic verbal fluency z-score at basal (Figure 3).…”

“…Psychiatrynoradrenaline, 12 weeks after treatment with alprazolam, contributing to reduce AL[28]. In this regard an increment of noradrenergic function was described in patients with anxiety disorders[47] [48].…”

“…The rate of the outpatients' use of benzodiazepines has been increased substantially in the last years, especially among clinicians, psychiatrists and neurologists [20]; indeed clinical studies are continually needed to determine safety in long term uses. The GEMA project (Gador Study of Stress Modulation by Alprazolam) [21] consists of a series of consecutive studies performed on a group of high symptomatic outpatients with general anxiety disorder (GAD) 2 associated with chronic stress, determined by high allostatic load (AL) levels (indicators for the functioning of the main potentially stress affected systems) [22] [23] and neuroticism (a clinical condition well-known as a stress vulnerability factor and defined as an exaggerated response to psychosocial stressors with intense emotional reaction) [ In a previous analysis performed by our group in the same cohort of patients, we analyzed the AL index and determined the effects of sex and age on allostatic load variables before and after treatment [28]. In this study we found that female sex was associated with higher levels of anxiety with a better profile in the same allostatic load variables such as cardiovascular ones.…”

Reducing Allostatic Load in Depression and Anxiety Disorders: Physical Activity and Yoga Practice as Add-On Therapies

“…AL index includes different biological markers divided in two main groups; 1-Primary mediators: represented by stress hormones (adrenaline, noradrenaline, and cortisol) in combination with inflammatory cytokines (e.g., interleukin-6, tumor necrosis factor), 2-Secondary mediators: represented by biomarkers of metabolic, cardiovascular, and immune systems that compensate primary mediators alterations [e.g., insulin, glucose, total cholesterol, high density lipoprotein cholesterol, triglycerides, visceral fat depositing, systolic and diastolic blood pressure, fibrinogen, c-reactive protein; (2,8,28)]. Different authors have applied the AL index in population-based studies and/or in clinical trials and studied the association with depression and anxiety disorders (8,11,(28)(29)(30)(31)(32). Table 1 summarizes the AL index and the cut off points analyzed in a previous study performed by our group, in patients with general anxiety disorder (12,32).…”

“…Different authors have applied the AL index in population-based studies and/or in clinical trials and studied the association with depression and anxiety disorders (8,11,(28)(29)(30)(31)(32). Table 1 summarizes the AL index and the cut off points analyzed in a previous study performed by our group, in patients with general anxiety disorder (12,32).…”