1998; Tjora et al 2011) In addition, smoking appears to increas

1998; Tjora et al. 2011). In addition, smoking appears to increase the risk of developing increased anxiety (Breslau and Klein 1999; Johnson et al. 2000; Isensee et al. 2003; Goodwin et al. 2005; Cuijpers et al. 2007; Pedersen and von Soest 2009). Potential explanatory models for this include the effects

of smoking on neurotransmitters, neurobiology, respiratory health and autonomic control (Klein 1993; Niedermaier et al. 1993; Zvolensky et al. 2003; Zvolensky and Bernstein 2005; Preter and Klein 2008), in addition to effects on normal neurodevelopmental (Dwyer et al. 2008; Inhibitors,research,lifescience,medical Iniguez et al. 2009). Finally, INCB018424 numerous shared vulnerability factors have been identified that may increase the likelihood of both smoking and increased anxiety (Reichborn-Kjennerud et al. 2004; Hettema et al. 2005). For example, lower socioeconomic status is associated

with both increased smoking behaviors (Schaap and Kunst 2009; Tjora et al. 2011) and anxiety (Kessler et al. 2005). Inhibitors,research,lifescience,medical Despite the significant Inhibitors,research,lifescience,medical health impacts arising from the comorbidity between smoking and anxiety, the biological mechanisms underpinning this association have received less investigation than for other psychiatric disorders. The relationship between smoking and anxiety is complex as evidence supports that cigarette smoke can reduce anxiety in some smokers (see review Morissette et al. 2007). In addition, smokers often report increased anxiety post smoking

cessation, although recent data conflict with this finding (Bolam et al. 2011; McDermott et al. Inhibitors,research,lifescience,medical 2013). There is also significant heritability in both anxiety expression and smoking behaviors. Recent advances in understanding the etiology of mood and anxiety disorders support a key role for neurotransmitter systems, the immune system, oxidative and nitrogen stress (O&NS), mitochondrial dysfunction, neurotrophins (NTs) and neurogenesis, and epigenetic effects in pathogenesis (Berk et al. 2011; Moylan et al. 2012b). All Inhibitors,research,lifescience,medical of these systems are affected by exposure to cigarette smoke. This review critically examines and summarizes the literature that has explored how cigarette smoking may increase the likelihood of developing increased anxiety and anxiety disorders. In this review, we focus on relevant biological mechanisms Dipeptidyl peptidase (e.g., neurotransmitter systems, inflammation, oxidative and nitrosative stress, mitochondrial dysfunction, dysregulation of NTs and neurogenesis, and epigenetic effects) that potentially mediate how smoking may influence anxiety symptoms. Extensive literature has explored numerous psychological and social contributors to a relationship between anxiety and cigarette smoking. Readers interested in these pathways should consult the numerous excellent reviews available (Zvolensky et al. 2005; Morissette et al. 2007; Ameringer and Leventhal 2010).

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