Time-limited Moderating Effect of Neuroticism on the Cortisol-Depression Relationship after Physical Injury.

BackgroundMajor Depressive Disorder (MDD) is the leading psychiatric disorder in low- and middle-income countries, and is to be the second leading cause of burden of disease by 2020. Cortisol plays a significant role in pathophysiology of MDD. Depression can alter serum cortisol level. However, the change in serum cortisol level and its association with depressive symptom severity and improvement among patients with MDD is not well studied.ObjectiveTo outline change in serum cortisol levels and its association with severity and improvement of depressive symptoms in newly diagnosed patients with MDD.MethodHospital based longitudinal study was conducted among 34 newly diagnosed patients who met DSM-V criteria of MDD. Venous blood sample was performed twice; pre- and post- 8 weeks of treatment. Serum cortisol concentration was measured using an extracted radioimmunoassay. The 17-item Hamilton Depression Scale (HAM-D) was used to rate depression at baseline and after 8 weeks of treatment. Paired t-test was done to look the mean difference of serum cortisol level and HAM-D, before and after treatment. Pearson correlation was done to look the association between serum cortisol levels, HAM-D scores and, sociodemographic and clinical factors. Statistical significance was set at p<0.05.ResultsThere is no significant difference in cortisol concentrations at baseline and end line (t (33) = 2.02, p = 0.052). However, there is significant difference in HAM-D total score (t (33) = 5.67, p<0.001). Baseline and end line serum cortisol levels were significantly correlated (r = .561, p = .001). Monthly family income is correlated with baseline HAM-D total score (r = -0.373, p = .030). There is no significant relationship between baseline serum cortisol level and HAM-D score. There is also no significant relationship between end line serum cortisol level and HAM-D score.ConclusionsThe symptoms of MDD were reduced following treatment but there is no significant difference in serum cortisol levels. Baseline and end line serum cortisol levels were significantly correlated. We recommend further research based on large sample.

Introduction:Glucocorticoid-induced adrenal insufficiency (AI) is underestimated and under-reported in children with nephrotic syndrome (NS). This study aimed to estimate the prevalence of AI in children with steroid-sensitive NS, defined by serum cortisol level <18 mcg/dL 30 minutes after low-dose adrenocorticotropin stimulation test (LDST) and/or baseline (8 AM) serum cortisol level <5 mcg/dL, 4–12 weeks after stopping steroid therapy.Methods:In this cross-sectional study, 73 children with steroid-sensitive NS, in remission and off steroids for 4–12 weeks, were enrolled from the Paediatrics Department at a tertiary care hospital. Baseline (8 AM) serum cortisol was measured, and LDST was done using 1 mcg tetracosactide acetate intravenously. The proportion of AI was calculated. Clinical features of AI and steroid toxicity were noted, and the association between the two was analysed.Results:Out of 73 children (45 males), 52 (71.2%, 95% confidence interval: 59.3%–80.9%) had AI as defined by serum cortisol level <18 mcg/dL 30 min after LDST and/or baseline (8 AM) serum cortisol level <5 mcg/dL at 4–12 weeks after completion of steroid therapy. A strong positive correlation was observed between 8 AM baseline serum cortisol levels and post-LDST serum cortisol levels. Children exhibiting features of steroid toxicity, such as cushingoid facies, had 4.96 times higher odds of having AI.Conclusion:There remains a high risk of AI even 4–12 weeks after completion of alternate-day steroid therapy in children with NS. Clinical features of steroid toxicity may serve as useful predictors of AI.

This study aimed to explore the relationships between serum cortisol levels, personality traits, and the development of Post-Traumatic Stress Disorder (PTSD) over 2 years among individuals with physical injuries. Participants were consecutively recruited from a trauma center and followed prospectively for 2 years. At baseline, serum cortisol levels were measured, and personality traits were categorized into five dimensions (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness), using the Big Five Inventory-10. The diagnosis of PTSD during follow-up (at 3, 6, 12, and 24 months post-injury) was determined using the Clinician-Administered PTSD Scale for DSM-5. Binary and multinomial logistic regression analyses were conducted to examine the interactions between cortisol levels, personality traits, and PTSD development. Among 923 patients analyzed, 112 (12.1%) were diagnosed with PTSD at some point during the study period, with prevalence rates decreasing from 8.8% at 3 months to 3.7% at 24 months post-injury. Direct associations between cortisol levels or personality traits and PTSD were not observed. However, a significant interaction between lower cortisol levels and higher Neuroticism in relation to PTSD risk was identified, especially during the early follow-up periods (3 to 6 months), but this association waned from the 12-month follow-up onward. Our findings reveal Neuroticism-dependent associations between serum cortisol levels and PTSD development, exhibiting temporal variations. These results suggest that PTSD development may be influenced by a complex, time-sensitive interplay of biological and psychosocial factors, underscoring the importance of considering individual differences in stress reactivity and personality in PTSD research and treatment.

To investigate the prevalence and physicians' detection rate of depressive and anxiety disorders in gastrointestinal (GI) outpatients across China. A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13 general hospitals. A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale (HADS). The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results. Subjects with HADS scores ≥ 8 were subsequently interviewed by psychiatrists using the Mini International Neuropsychiatric Interview (MINI) to make further diagnoses. There were 1059 patients with HADS score ≥ 8 and 674 (63.64%) of them undertook the MINI interview by psychiatrists. Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition), the adjusted current prevalence for depressive disorders, anxiety disorders, and comorbidity of both disorders in the GI outpatients was 14.39%, 9.42% and 4.66%, respectively. Prevalence of depressive disorders with suicidal problems [suicide attempt or suicide-related ideation prior or current; module C (suicide) of MINI score ≥ 1] was 5.84% in women and 1.64% in men. The GI physicians' detection rate of depressive and anxiety disorders accounted for 4.14%. While the prevalence of depressive and anxiety disorders is high in Chinese GI outpatients, the detection rate of depressive and anxiety disorders by physicians is low.

Excess mortality in depressive and anxiety disorders: The Lifelines Cohort Study

Validation of Brief Screening Tools for Mental Disorders Among New Zealand Prisoners

The rates of antidepressant recommendation and use were determined in outpatients with major depression receiving services in mental health clinics. Site of service and the patients' sociodemographic and clinical characteristics were investigated as possible predictors. Patients admitted to six outpatient clinics were recruited through a two-stage sampling procedure. Patients with major depressive disorder (N = 124) according to the Structured Clinical Interview for DSM-IV--Patient Edition were assessed at admission and 3 months later. Drug therapy was recommended for most patients (71%), and minimal use (at least 1 week) was recorded for 59% of the subjects. White patients were nearly three times as likely to receive a recommendation for antidepressants. Antidepressant recommendation was also associated with severity of depressed mood, recent medication use, and clinic type. Recent antidepressant use was the only variable that predicted whether the patient actually took the recommended medication. Many patients with depression seeking treatment at community mental health clinics do not receive antidepressant drug therapy. The offer of medication is predicted by patient ethnicity, clinic type, and symptom severity. Minority patients are less likely to be offered antidepressant treatment.

Comorbidity of depressive and anxiety disorders is common and has been shown to be a consistent predictor of chronicity. Comorbidity patterns among specific depressive and anxiety disorders have not been extensively reported. This study examines comorbidity patterns and temporal sequencing of separate depressive and anxiety disorders using data from a large psychiatric cohort. Baseline data (N = 1,783) of the Netherlands Study of Depression and Anxiety, collected between September 2004 and February 2007, were used. Current and lifetime comorbidity rates for depressive and anxiety disorders (DSM-IV-TR criteria) were calculated. Associations of comorbidity with sociodemographic, vulnerability, and clinical characteristics, and temporal sequencing of disorders were examined. Of those with a depressive disorder, 67% had a current and 75% had a lifetime comorbid anxiety disorder. Of persons with a current anxiety disorder, 63% had a current and 81% had a lifetime depressive disorder. Comorbidity of depressive and anxiety disorders was associated with more childhood trauma (OR = 1.19; 95% CI, 1.06-1.33), higher neuroticism (OR = 1.05; 95% CI, 1.02-1.08), earlier age at onset of first disorder (OR = 1.59; 95% CI, 1.22-2.07), longer duration of depressive and/or anxiety symptoms (OR = 1.01; 95% CI, 1.01-1.01), and higher symptom severity (ORs ranging from 1.01 to 1.03; all P values < .05). In 57% of comorbid cases, anxiety preceded depression, and in 18%, depression preceded anxiety. Comorbidity with preceding depression compared to preceding anxiety was associated with a shorter duration of symptoms of depressive and/or anxiety symptoms (OR = 0.99; 95% CI, 0.98-0.99), earlier age at first onset (OR = 0.46; 95% CI, 0.31-0.68), and fewer fear symptoms (OR = 0.98; 95% CI, 0.97-0.99). Comorbidity rates in anxiety and depressive disorders were very high, indicating that it is advisable to assess both disorders routinely regardless of the primary reason for consultation. This is especially important since comorbid patients showed a specific vulnerability pattern, with more childhood trauma, neuroticism, and higher severity and duration of symptoms.

No previous study has focused on recognition of myocardial infarction (MI) and the presence of both depressive and anxiety disorders in a large population-based sample. The aim of this study was to investigate the association of recognized MI (RMI) and unrecognized MI (UMI) with depressive and anxiety disorders. Analyses included 125,988 individuals enrolled in the Lifelines study. Current mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) were assessed with the Mini-International Neuropsychiatric Interview. UMI was detected using electrocardiogram in participants who did not report a history of MI. The classification of RMI was based on self-reported MI history together with the use of either antithrombotic medications or electrocardiogram signs of MI. Analyses were adjusted for age, sex, smoking, somatic comorbidities, and physical health-related quality of life as measured by the RAND 36-Item Health Survey in different models. Participants with RMI had significantly higher odds of having any depressive and any anxiety disorder as compared with participants without MI (depressive disorder: odds ratio [OR] = 1.86, 95% confidence interval [CI] = 1.38-2.52; anxiety disorder: OR = 1.60, 95% CI = 1.32-1.94) after adjustment for age and sex. Participants with UMI did not differ from participants without MI (depressive disorder: OR = 1.60, 95% CI = 0.96-2.64; anxiety disorder: OR = 0.73, 95% CI = 0.48-1.11). After additional adjustment for somatic comorbidities and low physical health-related quality of life, the association between RMI with any depressive disorder was no longer statistically significant (OR = 1.18; 95% CI =0.84-1.65), but the association with any anxiety disorder remained (OR = 1.27, 95% CI = 1.03-1.57). Recognition of MI seems to play a major role in the occurrence of anxiety, but not depressive, disorders.

The role of cortisol in Posttraumatic stress disorder (PTSD) remains controversial due to inconsistent findings. Childhood adversity may recalibrate the hypothalamic-pituitary-adrenal (HPA) axis, altering the prognostic value of cortisol. Furthermore, the biological mechanisms underlying earlier- versus delayed-onset PTSD trajectories may differ. A total of 895 patients hospitalized for physical injuries were prospectively followed for 2 years. Baseline serum cortisol levels and childhood adversity were assessed within one month of injury. PTSD diagnoses and onset timing were determined at 3, 6, 12, and 24 months using the Clinician-Administered PTSD Scale for DSM-5. Logistic regression models evaluated individual and interactive effects of cortisol and childhood adversity on PTSD onset, adjusting for relevant covariates. Neither baseline serum cortisol levels nor childhood adversity independently predicted PTSD onset. However, a significant interaction was observed for earlier-onset PTSD, such that lower cortisol levels were associated with increased risk only among individuals without childhood adversity. This interaction was not observed for delayed-onset PTSD. Cortisol levels were not correlated with childhood adversity. Baseline cortisol predicts earlier-onset PTSD only in the absence of childhood adversity, suggesting that developmental context modifies the prognostic significance of cortisol. Biological risk stratification for PTSD must consider developmental history and symptom onset timing.

INTRODUCTIONErectile Dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection adequate for satisfactory sexual activity. The overall global prevalence is 13.1–71.2%. A study conducted in south India found prevalence of erectile dysfunction in 15.77%, with least in those aged 26-30 years(8.6%) and highest in those aged 51-60 years(27.6%). Emergence of erectile dysfunction may be attributed to organic or psychogenic factors, irrespective of which it often leads to psychological problems. Although ED is subjectively distressing, only a small proportion of males consider it a medical problem, and hence reported infrequently. This study tries to explore presence of co-morbid psychiatric diagnoses in patients with Erectile Dysfunction.SOURCE30 consecutive sexually active males attending the out-patient department of Urology, KIMS, Bangalore, diagnosed with erectile dysfunction were included in the study. ‘International Index of Erectile Function Questionnaire’ was used to assess severity and ‘The Mini International Neuropsychiatric Interview’ was used to assess the presence of co-morbid psychiatric disorders.RESULTS26 of the 30 study subjects had psychiatric co-morbidity, commonly anxiety spectrum disorder(46.15%), depressive spectrum disorder(38.46%) and substance use disorder(15.38%). 11 patients of the 26 had symptoms suggestive of psychiatric disorder before the onset of ED, though untreated. These were predominantly substance use disorder(4), generalized anxiety disorder(3), depressive disorder(3) and obsessive compulsive disorder(1) were seen. 15 patients developed psychological symptoms after the onset of ED, predominantly anxiety disorder(8) and depressive disorder(7). There was no association between psychiatry morbidity and socio-demographics of the patients.CONCLUSION57.6% of the study population developed psychiatric morbidity following the onset of erectile dysfunction, predominantly anxiety and depressive disorders. Since the occurrence of psychiatric morbidity is high in patients with erectile dysfunction, it is important to incorporate routine screening for the same at the outset.

Psoriasis may, in some patients, be triggered and/or exacerbated by stress. As activation of the hypothalamic-pituitary-adrenal (HPA) axis is critical to a successful stress response we investigated this in patients with psoriasis. Forty patients with chronic plaque psoriasis and 40 age-matched normal controls experienced three randomly presented acute psychological stressors (cognitive, emotional and social). Serial serum cortisol, pulse rate and blood pressure assessments were undertaken at baseline and following each of the stressors. Salivary cortisol samples were collected at 09.00 h on the day of testing. In control subjects there was a significant (r = 0.38; P < 0.05) correlation between pulse rate and serum cortisol level following the social performance stressor; this was not evident in the psoriasis group (r = 0.07; not significant). Patients who believed that their psoriasis was highly stress responsive had significantly lower salivary cortisol levels at baseline (P < 0.01) and lower serum cortisol levels following the social performance stressor (P = 0.016) than patients with nonstress-responsive disease who believed that stress had no impact. In contrast, there was no difference between the groups for change in pulse rate poststressor. This study shows that patients with psoriasis, and in particular those whose disease appears to be stress responsive, exhibit an altered HPA response to acute social stress. The implication is that such patients may perhaps be primed to flares of their psoriasis. Whether this is genetically predetermined and/or a consequence of the distress of living with psoriasis remains to be determined.

Objective To investigate the relationships of suicide risk and its associated risk factors in adult patients with epilepsy. Methods All 211 adult patients with epilepsy from the epilepsy clinic of the Second Affiliated Hospital,Zhejiang University School of Medicine,were enrolled to evaluate the presence of suicide risk and depressive disorder by using the suicide module and the depressive disorder module of the Mini International Neuropsychiatric Interview (MINI).Demographic variables for age,gender,employment status,marital status,years of education,and seizure factors for age of onset,types of seizure,seizure frequency and epilepsy duration,result of MRI and types of antiepileptic drugs were also recorded.We compared the differences of risk factors between the two groups with or without suicide risk and investigated the relationships between the depressive disorder and suicide risk. Results The suicide risk of the patients was 21.3%（45/211）,and 17.1%(36/211) of the patients had depressive disorder.The suicide risk of the epilepsy patients associated with depressive disorder was 75.0%(27/36)，and the suicide risk of the epilepsy patients associated with no depressive disorder was 10.3%（18/175）.There was statistical difference between the two groups（χ2=74.525，P<0.01）.About 60.0%(27/45) of the patients with suicide risk was accompanied with depressive disorder.As suicide risk increased,the proportion of concurrent depressive disorder elevated.There was significant statistical difference in the rates of depressive disorder among the different suicide risk groups. Conclusions The patients with epilepsy have suicide risk.The suicide risk is higher in patients with depressive disorder. Key words: Epilepsy; Suicide; Depressive disorder; Risk factors; Brief psychiatric rating scale

Objective To help physicians improve detection rate of depressive and anxiety disorders by exploring the complaints of gastrointestinal(GI) outpatients with these disorders in the general hospitals. Methods A multicenter cross-sectional study was conducted from May to June in 2007.A total of 1995 subjects from 13 general hospitals in China were screened with the hospital anxiety and depression scale(HADS) and patient health questionnaire 15-item (PHQ-15). Meanwhile patients' complaints were recorded. Psychiatrists interviewed subjects scored ≥8 on HADS and made diagnoses by using the mini international neuropsychiatric interview(MINI). There were 323 outpatients diagnosed as depressive or anxiety disorders and 1287 outpatients without diagnosis of depressive or anxiety disorders. The complaints and PHQ-15 sores were compared between these two groups.The logistic regression analysis was used to determine the risk of having depressive or anxiety disorders with the number of complaints as an independent variable. Results Some symptoms between two groups were statistically significant, including weakness(34.1% vs 18.8%; χ2 =18.04; P=0.000), fatigue(9.6% vs 5.7%; χ2 =6.58, P=0.010)and insomnia(7.1% vs 3.4%; χ2=8.87; P=0.003). Logistic regression analysis showed that with each additional complaint, the odds for an interview-based diagnosis of depressive or anxiety disorders increased, the odds ratio(OR) was 1.12(95%CI, 1.08~1.17, P=0.000). In comparison to the outpatients without depressive or anxiety disorders, outpatients with these disorders signifycantly had higher PHQ-15 scores ((11.12±4.92) vs (6.68±4.05); t=16.84, P=0.000). Conclusion The GI outpatients with depressive and/or anxiety disorders have worse mental heath and more complaints, compared to patients without these disorders.These results may help physicians to better identify depressive disorders and anxiety disorders. Key words: Gastrointestinal; Outpatients; Depression; Anxiety

BackgroundMusic therapy is a safe, non-pharmacological way to help reduce anxiety, especially before surgery. It helps to calm the nervous system, promotes relaxation, and offers comfort by blocking outside noise and distracting from pain. This can be helpful in managing preoperative anxiety and symptoms like hypertension and tachycardia. While the benefits of music therapy for stress and sedation are well known, its specific effects on patients receiving spinal anesthesia haven't been studied yet. Understanding this could improve care for these patients. Overall, music therapy could be a valuable tool in the surgical process.ObjectivesPrimary objective: The study aimed to compare sedative requirements between two patient groups.Secondary objectives: To compare anxiety levels between two patient groups using the State-Trait Anxiety Inventory. It also assessed hemodynamic changes and measured stress levels by analyzing serum cortisol and immunoglobulin A levels in both groups. Materials and methodsNinety-two American Society of Anesthesiologists physical status class I and II patients, aged 18-65 years, with a body mass index of 18-25 kg/m2 undergoing lower limb orthopedic surgery under spinal anesthesia were selected for the study. After spinal anesthesia, the group M (n=46) patients received the music of their choice from headphones connected to mobile phones and patients in group NM (n=46) were attached headphones without any music therapy. After the attachment of headphones, propofol was administered in both the groups for sedation in a bolus dose of 1-2mg/kg iv followed by an infusion dose of 5-50 μg/kg/min. The propofol infusion was titrated based on Bispectral Index (BIS) values kept between 70 and 80 for moderate sedation. Preoperatively, blood samples were collected to measure baseline serum cortisol and IgA levels. Intraoperatively, hemodynamic parameters were measured, and anxiety level was assessed using the State-Trait Anxiety Inventory (STAI) Scale 30 minutes prior to the administration of spinal anesthesia. Postoperatively, anxiety was re-evaluated, and additional blood samples for the assessment of cortisol and IgA were taken at 30 minutes and 12 hours after the administration of spinal anesthesia.ResultsThe mean serum cortisol was lower in Group M as compared to Group NM (15.1±1.2 vs. 17.1±1; p = 0.0001). Mean serum IgA was significantly lower in Group M as compared to Group NM (269.3±54.5 vs. 294.2±49.9; p = 0.024) during the intraoperative period. The mean STAI Score was lower in Group M compared to Group NM (34.87±4.53 vs. 34.61±5.06; p = 0.008). The mean propofol requirement (mg) was lower in Group M as compared to Group NM (147.8±11.3 vs. 193±16; p = 0.0001). The hemodynamic parameters were comparable between the groups (p>0.05).ConclusionPatients in the music therapy group experienced lower anxiety, stress, and serum cortisol levels during surgery, with reduced serum IgA levels and decreased propofol requirement for sedation. Overall, music therapy was effective in reducing anxiety, stress, and sedative requirements during surgery under regional anesthesia.