Since new regulations were established in Germany in 2002, differ

Since new regulations were established in Germany in 2002, different local concepts for emergency medical care in undergraduate education were published, which incorporated BLS or ALS training in differing amounts [16-18]. However, no systematic and comparable nationwide survey exists to date. The present

enquiry gives for the first time a nationwide overview of key elements of undergraduate education in emergency medical care and helps to update knowledge about curricula in order to describe international comparisons. The interdisciplinary aspect of emergency medical care as a discipline is confirmed by the academic specialties involved, even though Inhibitors,research,lifescience,medical in particular cases selleck substantial variation resulted from

the local impact of special disciplines. At each site, different Inhibitors,research,lifescience,medical specialties are involved, along with a differing quantity – measured in semester periods per week – and quality with respect to the educational methods Inhibitors,research,lifescience,medical that are used. Putting these observations together, we can state that there is a sound foundation upon which the interdisciplinary development potential can be built, particularly with regard to teaching methods and their corresponding objectives. Against this background it is certainly arguable if in future emergency medicine as an own specialty of post-graduate training might be necessary or useful in Inhibitors,research,lifescience,medical order to harmonize curricular

structure and content. In fact these issues are viewed very critically by existing specialties involved in emergency medical care such as anaesthesiology or traumatology. In respect of course topics we found first of all that BLS and ALS is implemented at all faculties, but the time-frames are varying to a great extend (3 to 13 teaching units). In contrast to this diversity, as regards content the training of resuscitation in basic or advanced life support is very consistent: 94% follow the current ERC guidelines, and only two faculties are mostly AHA orientated. This is Inhibitors,research,lifescience,medical remarkable insofar as only five locations have an adequate pool of certified ERC-ALS-instructors available. Certainly this is a consequence of the fact that the German Resuscitation Council was founded as recently as 2007, and a structure ADP ribosylation factor for resuscitation training and qualification of instructors that is comparable to the Resuscitation Council UK or ERC does not exist to date. Undoubtedly international concepts have to be valuated and if necessary adapted and consequently implemented on a nationwide basis. However, many universities are offering high quality courses or activities with respect to methodical and didactic competencies for their own faculty, but without a widespread acceptance through all disciplines.

2010) Interestingly, measures of increased anxiety behavior in

2010). Interestingly, measures of increased anxiety behavior in the Elevated Plus Maze in those rats exposed to prenatal nicotine were present in adulthood but not in adolescence, and although the result was more prominent in female rats, males also demonstrated the response (Eppolito

et al. 2010). The exposure to nicotine before and shortly after birth was associated with impairment to fear extinction (Eppolito et al. 2010), which replicated results from chronic nicotine exposure in adolescence but not adulthood (Smith et al. 2006). This may suggest that exposure to nicotine in high-activity neurodevelopmental periods may exert more deleterious Inhibitors,research,lifescience,medical effects than in adulthood. It is possible that chronic administration of nicotine, via altered nAChR activity, may influence gene expression and

plasticity in the medial PFC and amygdala (Brown and Kolb 2001; Li et al. 2004; Polesskaya et al. 2007). This interaction may underpin the lack of extinction learning displayed in rats that are exposed to chronic nicotine Inhibitors,research,lifescience,medical (Eppolito et al. 2010). Nicotine induces production of oxidative stress markers and reduces antioxidant defenses, contributing a major proportion of the net oxidative stress from cigarette use (Bhagwat et al. 1998; Yildiz et al. 1998; Guan et al. 2003; Qiao et al. 2005; Das et al. 2009), although nicotine is known exhibit Inhibitors,research,lifescience,medical both pro- and antioxidant effects (Li et al. 2000; Tizabi et al. 2003). Nicotine increases lipid peroxidation markers that can be prevented by coadministration of free radical scavenger vitamin E (Qiao et

al. 2005) and has demonstrated antimitotic properties (Qiao et al. 2003). Increased production of O&NS, and antimitotic properties, has been demonstrated during cell Inhibitors,research,lifescience,medical differentiation (in association with increased in nAChR density) (Qiao et al. 2003, 2005). It is possible that the balance between damaging and protective effects of nicotine may depend upon the degree of stimulated oxidative stress – a Inhibitors,research,lifescience,medical small amount of oxidative stress could have positive effects in stimulating normal cellular processes, but significantly increased oxidative stress could overwhelm protective mechanisms leading to direct cellular damage (Newman et al. because 2002a). Given the increased level of O&NS present in adolescence, it could be hypothesized that vulnerability to toxic effects of nicotine-induced oxidative stress would be heightened (Qiao et al. 2005). Nicotine has demonstrated adverse neurobiological effects during adolescence, with these effects seemingly dependent on only early small and infrequent exposure to nicotine (Abreu-Villaca et al. 2003b). In Luminespib order keeping with this hypothesis, administration of nicotine for 1 week to adolescent rats resulted in a significant increase in TBARS with effects that would have been observed at low levels of exposure (Qiao et al. 2005).

Competing interests The authors declare that they have no competi

Competing interests The authors declare that they have no competing interests. Authors’ contributions TI, TI, TK, CN, TS, KT, SH, TN, TS, OT, TK, AH, and TS participated in the idea formation, study design, data analyses, interpretation of results and writing of the report. All the authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: Acknowledgments We are greatly

indebted to all of the EMS personnel at the Osaka Municipal Inhibitors,research,lifescience,medical Fire Department and concerned physicians in Osaka City for their indispensable cooperation and support. Financial support This research was supported by a grant for Emergency Management Scientific Research from the Fire Disaster Inhibitors,research,lifescience,medical Management Agency (Study concerning strategy for applying the results of Utstein report for improvement of emergency service). The study sponsors had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript or in the decision to submit the manuscript for publication.
Currently Inhibitors,research,lifescience,medical older persons

make up an important group of patients served by Emergency Departments (EDs). The elderly have higher rates of utilisation of emergency Belnacasan services than other patient groups; in developed countries, older people represent 12% to 21% of all ED encounters [1]. The proportion

of older people aged 60 years and over is expected to rise from 19% in Inhibitors,research,lifescience,medical 2000 to 34% by 2050 [2], resulting in a commensurate increase in ED presentations by older persons. Awareness of the connection between ED use and the health of older people, has led to an increased focus on the quality of geriatric emergency medical care and patient outcomes [3-5]. Emergency practice is characterised by high volumes of high acuity and high complexity patients. This, Inhibitors,research,lifescience,medical combined with often-incomplete information and frequent interruptions, out creates an environment prone to error [6,7]. Older people have been identified as a particularly vulnerable population in ED, having substantially inferior clinical outcomes, with higher rates of missed diagnoses, and medication errors, when compared with younger, severity-matched controls [8-12]. Older persons discharged from ED are at high risk of adverse outcomes, such as functional decline, ED re-admission and hospitalisation, death, and institutionalisation [12-17]. While the quality of care for older people is a key issue, there may also be a need to consider older people with special needs as a separate sub-group as they may have some additional significant quality of care issues.

A thorough history and physical exam remains a critical step in t

A thorough history and physical exam remains a critical step in thyroid nodule evaluation. Symptoms of thyrotoxicosis or hypothyroidism, local compressive symptoms, voice changes, and/or the presence of dysphagia should be elicited. In addition, patients should be questioned regarding a personal history of head or neck irradiation, or a family history of either thyroid cancer or other familial syndromes, as there are several known to be associated Inhibitors,research,lifescience,medical with an increased risk for thyroid cancer (Table

1).5,6 Table 1. Familial Syndromes Associated With Thyroid Cancer.5,6 On exam, it is important to note both the character and size of the nodule in question, whether the nodule is fixed or mobile, as well as to assess

for the presence of neck tenderness, tracheal deviation, or potentially concerning cervical lymphadenopathy. All patients with dysphonia or prior history of cervical or thoracic operations with concern for recurrent laryngeal nerve injury Inhibitors,research,lifescience,medical should be evaluated with direct laryngoscopy to assess vocal cord function and for preoperative planning. An ultrasound (US) of the neck should be obtained in order to evaluate the nodule in question and the remainder of the gland for synchronous findings. Concerning features Inhibitors,research,lifescience,medical on US include nodules that are hypoechoic, have increased vascularity, contain calcifications, or have irregular shape (classically taller than wide) and borders, or evidence of extra-thyroidal extension or invasion of surrounding structures. The remainder of the neck (bilateral central

and lateral compartments) should be assessed to evaluate for the presence of abnormal lymph nodes.2 Modeled Inhibitors,research,lifescience,medical after the Breast Imaging Reporting and Data System (BIRADS), developed by the American College of Radiology, the Thyroid Imaging Reporting and Data System (TIRADS) was designed in order better to standardize the classification of thyroid lesions and allow for enhanced Inhibitors,research,lifescience,medical communication among treating physicians in co-ordinating clinical management. The selleck screening library TIRADS scale ranges from 1 to 6, a score of 1 representing a normal thyroid gland, a 2 signifying a benign condition with no risk of malignancy, 3 being Oxalosuccinic acid used for nodules that are likely benign, with a corresponding risk of malignancy of less than 5%, 4 denoting a suspicious nodule, with malignancy risk ranging from 5% to 80%, 5 being used to describe a nodule that is likely malignant, with a greater than 80% estimated likelihood, and, similarly to the BIRADS scale, a 6 signifying known malignancy, proven by prior biopsy. In a prospective study of nearly 2,000 lesions, the TIRADS scale was found to have a sensitivity and specificity of 88% and 49%, respectively. In addition, they found a positive predicative value of 49%, negative predictive value of 88%, and accuracy of 94%.

However, recent evidence supports the notion that a subpopulation

However, recent evidence supports the notion that a subpopulation of activated glial cells may be

deleterious in PD, particularly for highly dysfunctional neurons that are metabolically compromised. Strong support for this hypothesis came from a study of young drug addicts who developed a parkinsonian syndrome after MPTP intoxication.99 In a recent, study, the same authors reported a postmortem neuropathological study of three subjects with MPTP-induced parkinsonism.100 Interestingly, gliosis and clustering of microglial cells around DA neurons were detected, despite survival times ranging from 3 to 16 years. These findings not only indicate Inhibitors,research,lifescience,medical an ongoing nerve cell loss after a time -limited insult, but also suggest, that, activated microglial cells may perpetuate neuronal degeneration.

One may thus speculate that after a primary Inhibitors,research,lifescience,medical insult of environmental and/or genetic origin, the glial reaction may perpetuate the degeneration of DA neurons. The mechanism by which microglial cells Inhibitors,research,lifescience,medical can amplify injury to nigral DA neurons is not yet known. However, the factors involved in this deleterious effect, are very likely cytokines, including tumor necrosis factor a (TNF-α), interlcukin 1β (II-1β), and interferon γ (IFN-γ). Accordingly, several selleck compound studies have reported a marked increase of cytokine levels in the brain and cerebrospinal fluid (CSF) of PD patients.101 In addition, a higher density of glial cells expressing TNF-α, II-1γ, and IFN-γ was observed in the SN of PD patients compared with agematched Inhibitors,research,lifescience,medical control subjects.102,103 Some of these cells were close to blood vessels and degenerating DA neurons, suggesting their involvement in the pathophysiology of PD. Two mechanisms, which are not mutually exclusive, may explain the deleterious role of cytokines in the parkinsonian SNpc: Proinflammatory Inhibitors,research,lifescience,medical cytokines induce the production

of nitric oxide in glial cells.104 TNF-α receptors directly activate DA neurons of the Phosphatidylinositol diacylglycerol-lyase human SN.102 The question of whether inflammation plays a prominent role in PD pathogenesis cannot be resolved by postmortem studies alone, and experimental PD models have much contributed to strengthening this hypothesis, making inflammation a prime candidate for neuroprotective studies in PD patients.98 Importantly, recent primate studies have replicated chronic glial activation in the SNpc following a time-limited MPTP insult105-107 and may thus represent a valuable model to study the long-term consequences of this process. Apoptosis There has been much interest, in whether DA neurons in PD die by apoptosis, necrosis, or some other form of cell death. This is because apoptosis is amenable to pharmacological inhibition and may thus be a therapeutic target in PD.

Narcolepsy has thus often been associated with psychiatric distur

Narcolepsy has thus often been associated with psychiatric disturbance, but surveys have produced contradictory results. Schizophrenia has been found at rates ranging from 0% to 14% and depression at rates ranging from 5% to 30 %.9,21-23 Krishnan et al,23 for example, showed that two thirds of narcoleptic patients had psychiatric disorders according to Diagnostic and Statistical Manual of Mental

Health, Third Sirtuin inhibitor Edition (DSM-III) criteria, including adjustment disorder, major depressive episode, alcohol dependence, and personality disorder. However, those studies were made in small samples,22,23 with no control group,21-23 Inhibitors,research,lifescience,medical often based on case notes and in patients taking amphetamines, which were, until recently, the mainstay of treatment for narcolepsy. Inhibitors,research,lifescience,medical The well-documented side effects of amphetamines (including increased feelings of anxiety, irritability and agitation, sexual dysfunction, and insomnia) may exacerbate existing or underlying psychiatric conditions.24 In a recent study, Vourdas et al25 investigated the frequency of major and minor psychiatric disorders among patients with narcolepsy, as compared with a group of matched normal individuals, using a detailed

structured psychiatric Inhibitors,research,lifescience,medical diagnostic interview. This study took advantage of the recent introduction of the wake-promoting drug modafinil, which improves vigilance via a nondopaminergic/adrenergic mechanism and does not appear to induce psychosis. This study found little evidence for an increased frequency of psychotic disorders in narcolepsy. Although Inhibitors,research,lifescience,medical four patients (out of 45) had experienced episodes meeting criteria for probable psychotic disorder (in contrast to none of the controls), there were clear indications that the psychotic symptoms were related

to amphetamine use in the past, since they Inhibitors,research,lifescience,medical disappeared when the dose was lowered or medication was changed to modafinil. None of the patients taking modafinil showed psychotic symptoms. They found that 24% of patients had criteria for simple depression, a rate similar of that found in other surveys in unless narcolepsy1,2,7 and chronic medical disorders in general.26 Although some studies have shown a possible therapeutic role of stimulant medication for improving affect,27 others have shown that depression in narcolepsy is independent of pharmacological treatment or did not improve after treatment.1 Goswami28 reported that, despite treatment for excessive daytime sleepiness, narcolepsy patients remain at significant risk for psychiatric and psychosocial limitations. Beusterien et al8 have shown that treatment with modafinil produces higher scores than placebo for the physical role, energy/vitality, social function, and emotional role on the SF-36.

With the recent development of higher energy collision-induced di

With the recent development of higher energy collision-induced dissociation (HCD) even the low mass cut off problem of product ion spectra acquired in the LTQ could be overcome [30]. The Nanomate® provides plenty of time to be spent on each sample with only a few Selleck AG 13736 microliters of it consumed. This opens up the avenue for data-dependent acquisition of product ion spectra on all possible precursor ions, resulting in full scan precursor spectra and product ion spectra of literally every detectable lipid species at a resolution of 100,000 or more. Additionally, exact assignment of fatty acyl side chains can be achieved on a regular basis with this system. Quantitation is done Inhibitors,research,lifescience,medical by one

internal standard per lipid class [31], which is sufficient to compensate for varying ionization efficiencies. Figure 1 Schematic outline of a high throughput Inhibitors,research,lifescience,medical shotgun lipidomics platform consisting of an LTQ-Orbitrap mass spectrometer coupled to a NanoMate. An interesting alternative to gas chromatography-mass

spectrometry (GC-MS) analysis of fatty acids is published by the Welti group [32]. The CID-TOF system uses a quadrupole-TOF analyzer coupled to negative ESI direct infusion. Thereby mass selection in Q1 is turned off, Q2 fragments all ions and the TOF analyzer records intact fatty acid carboxylates with accurate mass. This provides Inhibitors,research,lifescience,medical the fingerprint of fatty acids including modified fatty acids without any prior derivatization step being necessary. Mentionable, this method only works for lipids which generate negative ions in ESI, but nevertheless comparison with Inhibitors,research,lifescience,medical GC-flame ionization detector (GC-FID) data shows good correlation [32]. 3. LC-MS 3.1. Low Resolution Mass Spectrometry The invention of ESI enabled

coupling of HPLC with mass spectrometry in a highly efficient manner for the first time [33]. This instrumental combination opened up completely new analytical perspectives in lipid research by combining the separation power of HPLC with the selectivity Inhibitors,research,lifescience,medical of mass spectrometry. Complex lipid classes like glycerolipids, glycerophospholipids or even glycolipids were analytically amenable on a regular basis by chromatography coupled to mass spectrometry, now termed LC-MS. Compared to direct infusion systems HPLC adds retention time as another layer of selectivity. Ketanserin On one hand this results in increased specificity for lipid identification, but on the other hand it complicates quantitation, because every spectrum in an LC-MS run has to be regarded as a single event with unique matrix effects and solvent composition (Figure 2). Therefore quantitative aspects are generally more difficult to be standardized than for direct infusion methods. Figure 2 (a) Total ion chromatogram of a lipid droplet extract acquired on C-18 reversed phase HPLC coupled to an LTQ-FT in positive ESI mode (b) consisting of 487 individual full scan mass spectra at a resolution of 200,000.

The authors also showed that when fast fibers are converted to a

The authors also showed that when fast fibers are converted to a slow phenotype, the MNs innervating those fibers express SV2A indicating a retrograde fiber type-specific signal that induces MN phenotype. In the SOD1 mouse slow muscle fibers may produce more MN survival promoting factors as compared with fast fibers. In support of this theory, slow fibers have been shown to express higher levels of Hsp70 as compared with more vulnerable fast fibers (Locke et al. 1991, 1994; Inhibitors,research,lifescience,medical Gifondorwa et al. 2012), and administration of recombinant Hsp70 can maintain

muscle innervation, delay symptom onset, and extend survival of SOD1G93A mice (Gifondorwa et al. 2007). Alternatively, slow muscles that contain Inhibitors,research,lifescience,medical more mitochondria may be better able to compensate for the JAK inhibitor increased oxidative stress shown to occur in the mutant SOD1 mice (e.g., Jang et al. 2010). Fast muscles may produce negative factors, including enhanced oxidative stress that promote NMJ dysfunction and denervation (e.g., Inhibitors,research,lifescience,medical Perlson et al. 2009). Empty cytoplasmic vacuoles The accumulations of small, empty vacuoles in mutant MN cytoplasm are observed by day 14. The vacuoles become more numerous by day 30 and at later stages the cytoplasm is full of these vacuoles. We are unable to definitely determine the

source of these vacuoles; however, it is unlikely that the vacuoles are an artifact of fixation as they were unique to SOD1G93A animals and not observed in WT animals. Similar vacuoles have been reported to originate from ER and may result from an unfolded protein response or ER stress (Ilieva et al. 2007; Nagata et al. 2007; Nishitoh et al. 2008; Kanekura et al. 2009). For example, vacuolization Inhibitors,research,lifescience,medical of the rER has been shown to occur in MNs following chronic excitotoxicity (Tarabal et al. 2005). Indeed, MNs that appear to Inhibitors,research,lifescience,medical be most susceptible in ALS, those that innervate fast, fatiguable muscle fibers, have been shown to initiate an unfolded

protein response at early as day 25 Mephenoxalone (Saxena et al. 2009), corresponding to the time when we begin to observe increased numbers of vacuoles. However, we did not observe vacuoles or other morphological changes selectively in MNs that innervate fast fibers, and we never observed structural perturbations of rER, even at late stages, although it is possible that the vacuoles originate from the smooth ER. We also observed small, empty vacuoles near the Golgi apparatus, suggesting either cis- or trans-Golgi elements as a possible source. These findings may indicate an early breakdown of cisternal maturation of Golgi membranes as previously suggested to occur in ALS mouse models (Gonatas et al. 1992, 2006; Mourelatos et al. 1996; Stieber et al. 1998; Martinez-Menárguez et al. 2001; Schaefer et al. 2007; Fan et al. 2008).

Early-onset cases with

a personal history of tics typical

Early-onset cases with

a personal history of tics typically show a male predominance, and prominent OC symptoms in the Symmetry, Forbidden thoughts, and Hoarding dimensions, but fewer OC symptoms in the Cleaning dimension.16-18 They are also much more likely to report, the presence of sensory phenomena.18,34,35 Another marker of the distinctive nature of early-onset OCD is a differing pattern of psychiatric comorbidity. Children with tic-related OCD typically have higher rates of disruptive behavior disorders (attention deficit-hyperactivity disorder [ADHD] and oppositional defiant, disorder), and Inhibitors,research,lifescience,medical trichotillomania, as well as other specific and pervasive developmental disorders.36-39 Thus Inhibitors,research,lifescience,medical far, with the possible exception of Slit and Trk-like 1 (SLITRK1), no specific genes have been associated with tic-related OCD.40 Neuroimaging studies have suggested that caudate volumes in childhood are predictive of future OCD severity in early adulthood as well as future tic severity.41 Although pediatric-onset Inhibitors,research,lifescience,medical OCD tends to respond well to behavioral interventions, particularly when combined with selective serotonin reuptake inhibitors (SSRIs),27,42 it appears that the presence of tics

reduces the beneficial PTC124 in vitro effects of SSRI treatment but not cognitive-behavioral therapy (CBT) in children and adults.43-45 In addition, individuals with tic-related OCD respond better to neuroleptic augmentation than do OCD patients without a personal history of a tic disorder.46 The course and outcome of tic-related OCD may also be distinctive; characterized by an early peak in OC symptom severity at 12.5 years

and followed by an increased likelihood of remission.27,47 Familial, non-tic-related early-onset OCD Inhibitors,research,lifescience,medical This OCD subtype has been less fully characterized. First-degree family members are known to be at high risk for developing OCD and subclinical OCD, with approximately Inhibitors,research,lifescience,medical 25% being affected.19 Many of these children are likely to be afflicted with obsessional concerns about the safety of close family members as well as contamination and compulsive washing. Higher than expected rates of anxiety and affective disorders are seen in early-onset cases and their first-degree family members. Generalized anxiety disorder (GAD), panic disorder, agoraphobia, separation anxiety disorder (SAD) and recurrent, major depression are frequently encountered, especially if a first-degree relative was Mephenoxalone diagnosed with OCD.48,49 It also appears that some portion of these early-onset cases will remit before adulthood.50-53 A number of small neuroimaging studies have been conducted in pediatric-onset OCD.54 To a large extent, their findings are consistent with the prevailing frontal-striatalthalamo-cortical model of the neural substrates of OCD. These studies have also provided evidence to support, the role of glutamate in the pathology of OCD.

In their study of 62 patients, all four SSRI treatment groups sh

In their study of 62 patients, all four SSRI treatment groups showed significant improvement in depressive symptoms without worsening motor symptoms.

Bupropion, an antidepressant, with dopamine agonist, effects, has received little study in PD to date. It produced dose-limiting side effects in some subjects in the limited investigations that, have been conducted with PD patients.22 There are currently no studies on the efficacy of psychotherapy for treatment of depression in PD. Anxiety disorders Anxiety disorders (including generalized anxiety, social phobia, obsessive-compulsive disorder, and panic disorder) are probably increased in PD, although Inhibitors,research,lifescience,medical there has been little research Inhibitors,research,lifescience,medical in this area. Many PD learn more patients have anxiety symptoms due to legitimate concern about their chronic, progressive illness. In the small studies that have been conducted to date, PD patients also had higher rates of anxiety disorders compared with other neurological23-24 and medical illnesses.25 One study found actual anxiety disorders, separate from simple anxiety symptoms, interfered Inhibitors,research,lifescience,medical with normal function in 40% of patients with PD.26 Anxiety disorders are often seen in conjunction with

depression in PD, a common comorbidity in the general population.27 Anxiety symptoms may occur with “on-off fluctuations in medication treatment of motor symptoms.28, 29 There is some evidence that anxiety disorders in PD are linked to the underlying neurobiology of the illness. Noradrenergic dysfunction is implicated most strongly

in studies of anxiety disorders in the general population, and noradrenergic dysfunction may play a role in development, of anxiety symptoms Inhibitors,research,lifescience,medical in PD. Neuropathological changes in the noradrenergic system, including cell loss in the locus ceruleus, have been seen in PD brain autopsy studies.30 In a preliminary yohimbine challenge study, Richard et al31 administered oral yohimbine, an a2-adrenergic autorcccptor blocker, to 6 PD patients with anxiety or depression, 2 PD patients Inhibitors,research,lifescience,medical with no psychiatric symptoms, and 2 normal Edoxaban controls. The patients with a history of anxiety showed precipitation of panic attacks following the challenge at a rate similar to that, seen in anxiety disorder patients given yohimbine. All the PD patients showed increased sensitivity to development, of somatic symptoms following yohimbine challenge. This study, while too small to offer any conclusive evidence, does suggest that there are noradrenergic system alterations in PD mimicking those thought to occur in primary anxiety disorders. Further work is obviously needed to investigate noradrenergic dysfunction in PD. Deficits in both the serotonergic and GABAergic (GABA, y-aminobutyric acid) systems have also been implicated in the development of anxiety disorders, and PD has been reported to affect both systems.