Anxio-depressive Symptoms Research Articles

Mindfulness mechanisms and psychological effects for aMCI patients: A comparison with psychoeducation

Amnestic mild cognitive impairment (aMCI), an Alzheimer's disease prodrome, is characterized by cognitive and psychological symptoms, the latter aggravating prognosis. A mindfulness-based intervention (MBI) represents a promising non-pharmacological framework for Alzheimer's disease prevention. The Monitoring + Acceptance Theory (MAT) postulates that MBI improves cognition through monitoring, and psychological well-being, through acceptance. This single-blind preliminary randomized-controlled study investigated the effects of a MBI on anxio-depressive symptoms, quality of life, and memory, compared to a psychoeducation-based intervention in older adults with aMCI. The contribution of MAT components and of ruminations' reduction to intervention efficacy were examined. Participants assigned to both conditions experienced similar benefits regarding anxio-depressive symptoms and aging-related quality of life. General quality of life and memory remained unchanged. A partial support of the MAT and of ruminations reduction to the MBI's efficacy was found. The findings provide new insights on the effects and mechanisms of a MBI on aMCI symptoms.

Validity of the central sensitization inventory with measures of sensitization in people with knee osteoarthritis.

Our purpose was to determine the validity of the Central Sensitization Inventory (CSI) with psychophysical tests, psychological and physical factors in patients with Knee Osteoarthritis (KOA). Patients with KOA were recruited from three Montreal hospitals. Psychophysical tests (pressure pain threshold, conditioned pain modulation, temporal summation) were conducted and questionnaires administered to determine the presence of neuropathic pain, somatization, anxiodepressive symptoms, pain catastrophizing (PC), and widespread pain (WSP). Relations between the CSI, psychophysical tests, and questionnaires were assessed using correlations and chi-square analysis. Receiver Operating Characteristics (ROC) curves determined sensitivity and specificity scores. Multiple linear regression was performed to predict the association of CSI scores with somatization, anxiodepressive symptoms, PC, and WSP factors. One hundred thirty-three participants were assessed, 56.4% female, mean age 63.5years. The CSI was weakly correlated with decreased pressure pain thresholds locally (rs - 0.264, p = 0.004) and remotely (rs - 0.235, p = 0.011) and with conditioned pain modulation (rs 0.187, p = 0.045). ROC curve analyses suggested an optimal CSI cut-point of 36 (Sn 75%, Sp 63.4%). Performance of the CSI used in combination with a neuropathic pain questionnaire was not significantly superior. After adjustment for covariates, a multivariable linear regression determined WSP (unstandardized ß 4.161(0.067, 8.255) p =0.046), somatization (unstandardized ß 1.828 (1.368, 2.288) p < 0.005), and anxiodepressive symptoms (unstandardized ß 0.419 (0.107, 0.730) p = 0.009) significantly predicted CSI scores. The CSI is more strongly associated with psychological factors than psychophysical test results in a KOA population. Its moderate sensitivity and specificity suggest it should be used as part of a more comprehensive evaluative toolkit.

Body image, satisfaction with sexual life, self-esteem, and anxiodepressive symptoms: A comparative study between premenopausal, perimenopausal, and postmenopausal women

ABSTRACTMenopause is an important life transition in women, and it is associated with significant physical and psychological changes. This study aimed at examining how the menopausal transition influences body image and satisfaction with sexual life. To this aim, body image dissatisfaction, sexual dissatisfaction, and self-esteem were compared in three groups of women with distinct menopausal status (premenopausal n = 142, perimenopausal n = 66, or postmenopausal n = 149), while controlling for depressive and anxiety symptoms and BMI. Using ANOVA between these three groups, we observed that dissatisfaction with body image was significantly higher in the perimenopausal sample compared with its premenopausal counterpart. In the postmenopausal sample, body image improved, as this group displayed body image scores close to the premenopausal level. In addition, sexual dissatisfaction was significantly increased in the perimenopausal and postmenopausal samples, which is compatible with the concept that higher body appreciation positively predicted sexual function. We conclude that body image dissatisfaction reaches a maximum during the perimenopausal phase, before returning to a level nearly identical between the premenopausal and the postmenopausal phases.

Self-appraisals and episodic memory: Different psychological factors related to patient versus informant reports of apathy in severe traumatic brain injury

ABSTRACTIntroduction: Apathy is a core feature in patients with traumatic brain injury (TBI). The psychological processes underlying apathy are still unclear, and the few studies conducted on this subject have essentially focused on cognitive processes and informant reports of apathetic manifestations. The aims of the present study were to examine self-reports versus informant reports of diminished initiative/interest, as well as their relationship with different cognitive factors (attention/executive mechanisms, episodic memory, and multitasking) and personal identity factors (self-esteem and self-efficacy beliefs). Method: To this end, 74 participants (38 patients with severe TBI matched with 36 control participants) were given three questionnaires to assess self-esteem, general self-efficacy beliefs, and anxio-depressive symptoms and five tasks to assess cognitive processes, including real-life multitasking. In addition, a questionnaire that assessed self-awareness of functional competencies and a questionnaire that assessed lack of initiative/interest were administered to each participant and their relatives. Results: The main results showed that patients demonstrated an awareness of their lack of initiative/interest and that self-reported lack of initiative/interest was best predicted by low general self-efficacy beliefs and self-esteem, whereas informant-reported lack of initiative/interest was predicted by episodic memory difficulties. Conclusions: These results shed new light on the psychological processes related to apathetic manifestations, as well as the differing perspectives and lived experiences of patients and external observers in the TBI population, which opens interesting prospects for psychological interventions.

Prevalence and Factors Associated with the Anxio-Depressive Symptoms of the Families of Patients in Intensive Care Unit at Gabriel Toure University Hospital, Bamako, Mali

Introduction: Hospitalization in intensive care is a source of stress and anxiety for close to the patients. Anxio-depressive symptoms appear to be common in intensive care and their prevalence is poorly evaluated. The objective of this study was to evaluate the prevalence of anxio-depressive symptoms in families. Materials and method: Observational prospective study in families of patients hospitalized in the intensive care unit for a period of 5 months. Symptoms of anxiety and depression were measured using Hospital Anxiety and Depression Scale (HADS) during hospitalization. Anxiety and depression were defined by a score greater than 10. Factors associated with the onset of anxious-depressive symptoms were sought. The prevalence of post-traumatic stress disorder in close relatives was measured by the Impact Event Scale-Revised scale (IES-R). Results: A total of 107 patients were admitted to the intensive care unit, of which 49 families agreed to participate in our study. Overall mortality was 32.2% during this period. Fifty-eight (58) patients were not included for the following reasons: death or hospitalization of less than 48 hours, refusal of families, institution, and lack of parents speaking French. Forty-nine (49) relatives completed the HADS questionnaire. Forty-three families completed the IES-R questionnaire, a return rate of 87.7%. The prevalence of anxiety was 61.2% among parents in early hospitalization. The level of anxiety was significantly associated with male parents (p = 0.035) and those with lower education (p = 0.046). The prevalence of depressive symptoms in parents was evaluated 53% at D3. Education level (p = 0.048) and male parents (p = 0.048) appeared to be a significant depression factor. The prevalence of post-traumatic stress disorder was 55.1% among the relatives of the patients. The lack of co-morbidity in admission patients was significantly associated with the occurrence of post-traumatic stress disorder in the family. Conclusion: The prevalence of anxiety and depression symptoms was high in our study. Men were at greater risk of developing these symptoms. The parents of the patients carburized appear as a population with higher risk manifestation of psychological disorders; further research is needed in this group.

Un programme d’éducation thérapeutique destiné à des parents d’enfant avec un TSA : résultats préliminaires concernant l’efficacité du programme ETAP

Autism Spectrum Disorders (ASD) are characterized by particularities of cognitive and socio-adaptive functioning. Daily, they require specific interventions for the disabled person as well as support for parents who often report deterioration in their physical and mental health. To this end, the latest Autism Plan 2013–2017 highlights the need “to help families to be present and active alongside their loved ones, to avoid situations of exhaustion and stress and to enable them to play their role fully in the long term”. The support devices must therefore be based on an analysis of the parents’ needs and propose multiple intervention modalities, which respond to the complexity of the caregiving mission. Therapeutic education (TE) seems to answer to these different elements by proposing a global approach improving the development of child-centered skills and the educational challenges (self-care skills) but also of skills centered on the projects and the fulfillment of the parent (psychosocial skills). The ETAP (Therapeutic Education Autism and Parenting) program is an initial TE offer intended for parents of children with ASD aged between 3 and 10years. It consists of seven group sessions and two semi-structured interviews, called educational diagnosis. A booster session is also proposed three months after the last session. It was developed following rigorously the guidelines on program construction, published by the High Authority of Health. In addition, it is based on an assessment of the needs of the parents, an in-depth analysis of the literature and the opinion of nine experts in this area. The objective of this study is to evaluate the effectiveness of the ETAP program on the quality of life and anxio-depressive symptoms of parents of a child with ASD. To our knowledge, the ETAP program is the first TE program in France for parents of children with an ASD that has been evaluated. Our sample is composed of 40 participants, including 30 parents who participated in the ETAP program (“ETAP Group”), compared to ten controls who did not participate, but who are on a waiting list (“Control Group”). Each participant completed a Quality of Life Questionnaire (WhoQol-Brief) and an Anxiety-Depressive Symptomatology Questionnaire (HADS) prior to the start of the program (T1) and after the session 7 (T2). Preliminary analyses show a good intergroup matching on socio-demographic and medical data. Moreover, the two groups are not significantly different at T1 over the set of dependent variables measured. Our results show an improvement in the quality of life of the depressive symptomatology in the participants. On the other hand, we did not notice any significant decrease in anxiety symptoms. However, when we consider the proportion of parents with a significant anxiety state (in terms of the clinical threshold of HADS, score ≥10), we see that it tends to decrease after the program only for the group ETAP. These data should be interpreted with caution because of their preliminary nature and the small size of our sample. However, the first steps are encouraging and confirm the value of the therapeutic education model for parents of children with ASD. The different information given during the sessions takes into account the previous representations, knowledge and skills of the parent. Thus the program promotes the upholding and the development of individual resources in parents. In addition, the psychosocial skills targeted also to make access easier to available environmental resources. Finally, in a more indirect way, the ETAP program also aims to maintain or restore a positive parenthood and individual identity and the progressive development of new ways of to interact with the environment. An adaptation of the Hobfoll resource conservation model is proposed by the authors to formulate hypotheses on the mechanisms of action of the ETAP program.

Autres prises en charge dans la maladie de Parkinson : psychologique, rééducative, éducation thérapeutique et nouvelles technologies

Diagnosis of Parkinson's disease (PD) is often traumatic. It is then important to organize this announcement in order to support the patient in this major step of his care course. Anxiety and depression are present in about 50% of PD patients. Besides pharmacological treatment, cognitive-behavioral therapy induces improvement in anxio-depressive symptoms. We have to promote physical activity for PD patients, from the beginning of the disease, because it prevents from deconditioning, improves motor and non-motor symptoms, quality of life, and decreases loneliness. Rehabilitation may be also proposed (physiotherapy, speech therapy, occupational therapy). But there is no specific recommendation in PD, and usual activities can be proposed. Therapeutic education is an answer for PD patients who need to know and understand their disease and treatment. Organization of therapeutic education is different depending of the teams: group workshop and/or individual sessions, conduct by doctors or paramedical staff (nurse, physiotherapist, psychologist…). Therapeutic education programs are always evolving. It will soon be proposed therapeutic education for care partners, and some patients may join therapeutic education staff.

ЛЕЧЕНИЕ ТРЕВОЖНО-ДЕПРЕССИВНЫХ РАССТРОЙСТВ У ПАЦИЕНТОВ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ

Sixty patients at the age of 43 to 79 years with anxiodepressive symptoms with comorbid cardiovascular disease have been examined after admission to psychotherapeutic department. Patients have been divided into two groups. The first group including 30patients were treated by the tricyclic antidepressant amitriptyline with the average daily dose of 34.4±12.9mg. The 30 patients from the second group were treated by antidepressants of the selective serotonin reuptake inhibitors group. The sociodemographic characteristics in both groups did not differ significantly; the sever-ity of cardiovascular disease, additional somatic and other diseases were certainty lower in the first group than in the second (p&amp;#60;0.05). Examination of the patients with the use of Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale (HDRS and HARS) was carried out three times: at admission, in 1 week and in 4 weeks. At the time of admission, anxiety and depression in the first group were more expressed (p&amp;#60;0.05) than in the second due to frequent psychogeny. The treatment scheme included tranquilizers, neuroleptics, neurometabolic drugs, basic cardiotropic therapy and psychotherapy. After 4 weeks anxiodepressive symptoms were more than 50% reduced in both groups: 61% in the first group and 50.7% in the second group by the HDRC scale; 65.9% in the first group and 59.8% in the second group by the HARS scale. It has been shown that the small doses of antidepressant including amitriptyline involved in the complex treatment scheme were efficient and did not cause cardiotoxic effect

The C'JAAD: a French team for early intervention in psychosis in Paris

The aim is to describe a centre operating in Paris that pioneers the early intervention for young people at the onset and at high risk of psychosis in France. Comprehensive descriptive analysis of different clinical and service measures is used in describing the implementation of the C'JAAD (Evaluation Centre for Young Adults and Adolescents) using data from an ongoing prospective non-interventional research programme. Over a 2-year period, 151 patients were referred to the C'JAAD and included in the ICAAR research programme. After evaluation by the Comprehensive Assessment of the At-Risk Mental States Scale, 53.7% were identified at risk of developing a psychosis, 20.6% presented a full-blown psychosis and 25.7% were considered not at risk of developing a psychosis. A total of 84% of the at-risk subjects suffered from a psychiatric co-morbidity, of which anxiodepressive symptoms being the most frequent (39%). The global functioning of these at-risk subjects was seriously impaired (average Social and Occupational Functioning Assessment Scale score = 48.9). More than one third of the patients was self-referred (33.8%), 22.5% were addressed by a psychiatrist whereas 10.6% were referred by a general practitioner. In this paper, we report for the first time the activities of the C'JAAD, the pioneer unit in France for early detection and treatment of young adults with early psychosis. These observations indicate that such early intervention centre is a feasible and sustainable extension of traditional care for people with mental disorders in this country and offers promising perspective for the development of further centres.

Approche psychométrique de la métacognition : étude pilote en population clinique

BackgroundMetacognition describes the process of thinking about one's own thought processes. This concept was introduced by Flavell in 1979 and has since been widely developed in the cognitive approach to mood and anxiety disorders. As it happens, many recent studies have underlined the links between metacognition and anxio-depressive symptoms, pointing out the interest of assessing its various dimensions. The short form of the Metacognitions Questionnaire is a brief multidimensional measure of a range of metacognitive processes and metacognitive beliefs about worry and cognition relevant to the vulnerability to and the maintenance of emotional disorders. The aim of this study was twofold: firstly to adapt and validate a French version of the short form of the Metacognitions Questionnaire (MCQ-30) and to assess its psychometric properties in a clinical sample, and secondly to investigate metacognitive predictors of anxiety and depression in this sample. MethodThe sample included 55 clinical participants (24 men, 31 women, mean age=51.33±14.62) with DSM-IV-TR psychiatric disorders (major depression, bipolar disorder and obsessive-compulsive disorder). Instrument reliability (internal consistency), construct validity (confirmatory factor analysis), and convergent validity were measured. The total score and the five subscale scores were also compared with previous results in non-clinical samples. ResultsReliability analyses indicated that the French version of the MCQ-30 possessed satisfactory internal consistency (Cronbach α=0.84), and confirmatory factor analysis supported the MCQ's original five-factor structure. Correlation with measurements of depression, anxiety and pathological worry demonstrated convergent validity (r=0.62, P<0.01 for anxiety; r=0.47, P<0.01 for rumination; r=0.33, P<0.05 for depression). Moreover, our clinical sample scored higher on the global scale when compared to previous non-clinical samples (mean score=71.85±13.57 while previous studies global scores ranged from 48.41±13.31 to 65.89±17.17). Consistent with others studies, negative beliefs about worry concerning uncontrollability and danger, as well as beliefs about the need to control thoughts were the strongest predictors of pathological worry (respectively r=0.68, P<0.01 and r=0.48, P<0.01) and depression (respectively r=0.45, P<0.01 and r=0.39, P<0.01), providing further support for the validity of the measure. ConclusionThese findings provide general support for the internal consistency of the French version of the MCQ-30, as well as its five-factor structure and its good concurrent validity in a clinical sample. They also confirm that this version is a valuable tool for the assessment of various dimensions of metacognition, in relation to the anxio-depressive symptomatology and the subsequent management of patients.

Sevrage tabagique chez les patients fumeurs VIH : expérience de la consultation de tabacologie de l’HEGP à Paris

IntroductionThere is a particular need among HIV-infected patients to stop smoking because of the risk of smoking-related complications and the high prevalence of cigarette smoking among them. Only a few studies have focused on this population in real-world settings. Aim of the studyInvestigate the effectiveness of a smoking cessation support for HIV-infected patients at the Georges Pompidou University hospital (HEGP) smoking cessation service during the 2011–2012 period. MethodsA retrospective study of smoking cessation medical records was performed for 39 smokers who had visited for the first time the HEGP smoking cessation service during the 2011–2012 period and declared to be infected by the HIV on their smoking cessation self-questionnaire. The study has described smokers’ characteristics and follow-up to measure the abstinence rate, validated by the patient declaration, the registration of the number of days without cigarettes between each visit and a measure of expired carbon monoxide ≤ 5ppm at each visit. We examined smokers lost to follow-up and they have been considered as smokers. Maintained abstinence rates at 3 month-follow-up and at 9 months/one year were registered. ResultsThe 39 HIV-infected smokers registered in the study were mainly male (30/39), were heavy smokers with a consumption mean of nearly 23 cigarettes per day. One third presented high nicotine dependence with a Fagerström test ≥ 7. A depression history was reported among one third of them. Symptoms of anxiety and depression were declared by 20% and 33% respectively among them. Thirteen percent of them received opioid replacement therapies, 41% were cannabis users (one out of four were daily users) and 10 % declared alcohol abuse. 85% of patients received nicotine replacement therapy (patch and/or oral forms) and 15% varenicline®, along with behavioral support techniques. At 3 month-follow-up, smoking cessation was validated for 20.5% of patients and at 9 months/1 year, smoking cessation rate decreased at 13%. When considering smokers with ≥ 2 visits, the maintained abstinence rates were respectively 27.6 and 17.2%. Discussion and conclusionWith a severe smoking profile, frequent co-addictions and anxiodepressive symptoms, our results suggest that behavioral techniques combined with nicotine replacement therapy or varenicline® among HIV-infected smokers can help severe smokers to quit. Our data underline the need to take into account the co-addictions and to maintain such patients in treatment to achieve smoking cessation in real-world settings.

Does multitasking mediate the relationships between episodic memory, attention, executive functions and apathetic manifestations in traumatic brain injury?

Apathy is frequently described in patients with traumatic brain injury (TBI); its negative consequences particularly affect functional independence. Among apathetic manifestations, lack of initiative and lack of interest have mainly been associated with cognitive impairments. However, few studies have been conducted to precisely identify the underlying cognitive processes. Our aims were (1) to determine the best predictor of apathy from among several cognitive processes, including episodic memory and attention/executive mechanisms and multitasking, and (2) to examine to what extent multitasking could mediate the relationships between specific cognitive processes and lack of initiative/interest. Seventy participants (34 patients with TBI matched with 36 control participants) were given a questionnaire to assess anxio-depressive symptoms, four tasks to assess specific cognitive processes, and one task to assess real-life multitasking. Participants' relatives completed an apathy questionnaire. Multitasking, as assessed by the number of goals not achieved, was the only significant predictor of apathetic manifestations. In addition, the mediation analyses revealed that multitasking performance mediated the relationships between verbal episodic memory and lack of initiative/interest, whereas executive and attentional functions were only indirectly related to lack of initiative/interest due to their significant impacts on multitasking. These results shed new light on the aetiology of apathetic manifestations in patients with TBI, indicating how specific cognitive deficits are expressed in real-life multitasking, and consequently, how they may lead to the development and/or maintenance of apathetic manifestations.

Validation de la version française du « Beliefs About Voices Questionnaire–Revised » (BAVQ-R)

IntroductionThe BAVQ-R explores the beliefs and reactions that “voice hearers” have about their voices. Recently, the BAVQ-R was translated into French, but little is known regarding its validity and reliability. Thus, the aim of this study was to examine further the psychometric characteristics of the BAVQ-R French version. MethodSeventy-six adult outpatients participated in the study. In addition to the BAVQ-R, patients were administered a psychiatric symptoms severity interview, and self-esteem and quality of life questionnaires. Then, the BAVQ-R was again completed six weeks later after the seven sessions of brief group cognitive behavioral therapy: the Voices Group. ResultsThe BAVQ-R was well accepted and was completed in less than 10minutes. All items presented floor and ceiling effects. For 15 items, item-total correlations were inferior to 0.30. Internal consistency was 0.83 for the global score, 0.83 for the malevolence, 0.81 for the benevolence, 0.64 for the omnipotence, 0.82 for the resistance and 0.77 for the engagement. The temporal stability was superior to 0.70, except for the omnipotence (0.65). Regarding, the construct validity, on the one hand malevolence, omnipotence and resistance were correlated (0.56≤r≤0.64; P<0.001) and on the other hand benevolence and engagement (r=0.62; P<0.001). Regarding convergent validity significant correlations were found between malevolence, omnipotence resistance and severity of anxio-depressive symptoms, negative self-esteem (0.40≤r≤0.52; P<0.001). The BAVQ-R allows discriminating neither between psychotic and non-psychotic patients (Mann–Whitney, all P>0.05) nor between groups established on the basis of the voice sources (Kruskal–Wallis, all P>0.05). Moreover, the BAVQ-R does not seem to be sensitive to change: no difference was observed after Voices Group intervention (Mann–Whitney, all P>0.05). Sociodemographic variables are not related to BAVQ-R. DiscussionThe French version of the BAVQ-R has sufficiently adequate psychometric characteristics to be used in a clinical setting. However, floor and ceiling effects suggest a lack of sensitivity of the items. Psychometric characteristics of the BAVQ-R could be improved by selecting items and extending the Likert scale to score them.

Spirituality mediates state anxiety but not trait anxiety and depression in alcohol recovery

Background and objectives: Twelve-step based interventions promote the recovery from alcohol dependence, support relapse prevention and are associated with improved mental status indices (e.g. depression). This treatment model largely relies on spiritual experience. We tested three different alcohol treatment settings, which differently involve elements of spirituality in order to reveal its possible mediator effect on the level of depressive and anxiety symptoms. Methods: Patients were involved from (1) detoxification (n = 34), (2) long-term – 12-step based – therapeutic community treatment (n = 89), (3) and from Alcoholics Anonymous (AA) groups after at least 3 years of attendance (n = 46). Anxiodepressive symptoms and spirituality/transcendence were compared and the potential mediator role of spirituality was assessed in the levels of depressive and anxiety symptoms. Results: Long-term 12-step based rehabilitation and sustained AA attendance was connected to lower levels of anxiodepressive symptoms and to more pronounced spirituality. The spiritual component of the different treatments played a mediator role in the decrease of state anxiety but this mediation was not detected in the case of depressive symptoms and trait anxiety. Conclusions/Importance: The role of spirituality in the decrease of state anxiety indicates acute beneficial effect. Therefore, long term, regular attendance in AA groups is essential.

0008: Anxiety and depressive symptoms after acute coronary syndrome: prevalence, evolution and predictive factors

Anxiety and depressive symptoms after acute coronary syndrome (ACS) are associated with increased mortality and morbidity, more random cardiac rehabilitation, unhealthy behaviours. The aim of this study was to determine prevalence of these symptoms after ACS, and associated factors. During 6 months, all patients admitted to the Hospital of Reims for ACS were included. Hospital Anxiety and Depression Score (HADS) was used to screen anxiodepressive symptoms during initial hospitalization and 3 months later. The analysis focused on socio-demographic, clinico-biological and therapeutic data. We included 101 patients. 40,6% had anxiety and depressive symptoms on admission and 41,6% at 3 months. Factors associated with a high persistent 3 month score were: initial HADS score (r = 0,81 p<0.001), history of depression (OR 14,1; CI95% 1,7-42,4 p<0,001), history of coronary heart disease (OR 5,8; 95% CI95% 1,7-19,6 p<0,001), young age (54,4 years ± 10,9 p 0,039), social isolation (OR 12,5; CI95% 4,2-37,3 p<, 001), smoking (OR 8,7; CI95% 3,5-21,7 p<0.001), physical inactivity (OR 5,1; CI95% 2, 3-10,9 p <0.001), early ventricular arrhythmias (OR 13,5; CI95% 5,1-35,9 p<0,001). Also high C-reactive protein (OR 11,8; p< 0,001), a low HDL-cholesterol (mean 0,4g/L p < 0.001), and high level of liver enzyme (OR 0,3; p<0,001) were associated with positive score. 17 patients have attempted suicide and 2 patients have committed suicide. Patients after an ACS have a higher risk of anxio-depressive symptoms compared with other. Association between the two diseases is complex, involving among other, pro-inflammatory markers, neuro-hormones and the sympathetic system. Patients with high HADS score more often have unhealthy lifestyle which predict worse outcome and complicate their care. Anxio-depressive symptoms are common after an ACS, but often underdiagnosed. It is essential to train the cardiology team to early identify at risk patients, so to offer them appropriate care.

Seven-year predictors of self-rated health and life satisfaction in the elderly: the PROOF study.

To investigate the relationship between cognitive performance, affective state, metabolic syndrome and 7-year follow-up self-rated health (SRH) and perceived life satisfaction (PLS). Analysis of a prospective cohort study. The PROOF study, including 1011 elderly community residents. Six hundred and fifty seven subjects completed metabolic syndrome (Met S) variables, neuropsychological and affective measurements at baseline, and then returned a 7-year follow-up questionnaire which included SRH and PLS. The prospective association between cognitive function, Met S and each of its components, and affective disorders and subsequent subjective health and quality of life was examined. Covariates included educational level and use of tobacco. The analyses were made in men and women separately. In multivariate models, the presence of Met S was significantly associated to weaker SRH (OR = 2.78, p = 0.009 in men and OR = 2.0, p = 0.02 in women). Higher triglycerides rate were associated with weaker SRH in men (OR = 2.23, p = 0.002) and higher fasting glucose in women (OR = 2.54, p = 0.006). Global Met S and abdominal obesity was significantly associated to weaker PLS in women only (respectively OR = 2.70, p = 0.0002 and OR = 1.9, p = 0.02). Depressive symptoms were significantly associated to both weaker SRH and PLS in men (OR = 1.30, p = 0.002; OR = 1.44, p < 0.0001 for SRH and PLS respectively) and in woman (OR = 1.09, p = 0.04; OR = 1.26, p < 0.0001 for SRH and PLS respectively). Anxiety was linked to both weaker SRH and PLS in women (OR = 1.17, p = 0.002 and 0R = 1.11, p = 0.03 for SRH and PLS respectively). Finally, lower executive function was associated with weaker PLS in men (OR = 0.43, p = 0.0005). metabolic syndrome and certain of its components, anxiety and depressive symptoms, are independent predictors of poorer subjective health and quality of life as assessed over a period of 7 years in a population of a non-demented aging community. Moreover, executive performance was linked to subsequent quality of life in men. Many of these factors being treatable, our findings point to the necessity of providing preventive care strategies by the management of cardiovascular risk factors and anxio-depressive symptoms.

The impact of brief psychotherapy centred on parenthood on the anxio-depressive symptoms of mothers during the perinatal period

Depression and anxiety are major causes of distress amongst parents during the perinatal period. Their pervasive effects on the parents' self-confidence, on the parent-infant relationship and on the child's development have been well documented. The aims of the present study were to describe the psychological characteristics of mothers consulting during the perinatal period and to assess the effect of brief Psychotherapy Centred on Parenthood (PCP) on the mothers' depressive and anxiety symptoms. The evolution of the mother-infant relationship is also documented. PCP is a brief mother-infant psychotherapy which focuses on the mother-infant relationship as well as the mother's mental representations in order to reduce her psychological conflicts. Thirty-four mothers consulting an infant-parent outpatient clinic were assessed with respect to depression, anxiety, global functioning, severity of symptoms and the quality of their adaptation to the infant (T1). They were offered a brief PCP with an average of seven sessions. Outcome measures were collected after the end of the therapy (T2). Overall, 28 of 34 mothers completed the therapy (83%), and 23 participated in the post-therapy evaluation. Paired samples t-tests showed that completers of PCP displayed significant improvement in post-treatment measures of depression (EPDS: t = 5.13; p <0.001), anxiety (STAI-State: t = 3.06; p = 0.006), clinical impression (CGI: n = 21; t = 4.50; p <0.001), and global functioning (GAF: t = -5.05; p <0.001). The quality of adaptation in the infant-parent relationship showed a tendency to improve (PIRGAS: t = -1.98; p = 0.062). These preliminary results suggested that providing PCP to this sample of consulting mothers is feasible and accompanied by high rate of clinical and functional improvement.

Anxio-depressive Symptoms in Patients with Cardiac Failure in Jos University Teaching Hospital (JUTH)

Background : Cardiac failure is a severe debilitating illness and a leading cause of sudden cardiac death in Nigeria. Diagnosis and subsequent management are often associated with psychological conditions. These impact on the patients' speed of recovery, cost of care as well as the quality of life. Identification, diagnosis and prompt treatment of these accompanying psychological conditions go a long way in reducing the cost of managing patients with cardiac failure. This study was undertaken to determine the prevalence of depressive and anxiety symptoms in patients admitted for cardiac failure in JUTH between October 2007 and April 2008 and the associated sociodemographic variables. Study Design : A descriptive crosssectional study of patients admitted for cardiac failure in JUTH between October 2007 and April 2008. Consenting patients were administered Hospital Anxiety and Depression Scale (HADS) and a short sociodemographic questionnaire. Other information was extracted from the patients' case-notes. Results : One hundred and twenty-eight patients, comprising those consenting, with complete data and strong enough to tolerate the interview, were analyzed. The study population was made up of 74 Females and 54 Males with a Mean Age of 47.4 (SD 18.3); Mean Age for females 45.5±18.8 and Males 50.0±17.3. More than 82% were married, 67.5% had some form of formal education, 61.3% had the illness diagnosed within a year while more than 54% were employed. Prevalence of Depression and Anxiety in the study population was 36.7% and 42.2% respectively. Significant association was found between depression and Marital status (pv=0.005) and the Educational level (pv=0.05) with a possible association with sex (p-v = 0.07). Though, similar trend was found with anxiety in the study population, the degree of association appeared more. The p-Values were Sex (0.01), Marital Status (0.02), and Educational level (0.03) Conclusion : Frequency of depressive and anxiety symptoms are high in patients with cardiac failure. Anxiety level seemed more in them. Prompt and adequate attention to anxiety and depression in this group of patients will not only improve their outcome but will go a long way in improving their quality of life.

Analysis and treatment of cardiac alterations in an animal model of anxio-depressive pathologies

Background: Anxiodepressive symptoms were associated with a significantly higher risk of fatal cardiovascular events. This appear to be attributable largely to an increase in sudden cardiac death, predicted by high sympathetic activity and decrease in heart rate variability. However, the central mechanism involved in this pathological alteration remained unknown. The dorsal medial nucleus of the hypothalamus (DMH) is part of acute arousal responses in stress (defense) situation, and its stimulation induces an increase in sympathetic activity. Our aim was to study the possible role of the DMH in the sympathetic alterations in chronic stress.

Le psychiatre de liaison et le Tako Tsubo…

Stress cardiopathy, also called "Tako Tsubo" is a cardiac pathology linked to an acute coronary syndrome with electrocardiographic signs and an increase in the level of cardiac enzymes, without any abnormality on coronarography. This syndrome is secondary to great physical or mental stress. Mortality and the risk of recurrence are low. However, there is no consensus for treatment or prevention.We report the case of 75-year-old woman presenting recurrent cardiogenic shocks. A symptomatic sinusal dysfunction motivated the introduction of a pacemaker in March 2008. One month later, she was hospitalized for a new cardiogenic shock with left ventricular dysfunction, a 40% ejection fraction, and a third degree mitral insufficiency. Cardiac enzymes were initially elevated. Electrocardiogram showed an ST elevation. The transthoracic echocardiogram revealed a left anterolateral ventriculogram dysfunction, and cardiac catheterization showed healthy coronary arteries. The cardiologist wondered about the existence of an anxiodepressive syndrome. No personal psychiatric background was known. The patient was widowed 3 years earlier. She described herself as a naturally anxious person. She hadn't experienced any recent stressing event. She was not depressed and wasn't taking any psychotropic drug. Her family was caring for her. The next day, the patient had another cardiogenic shock and died a few hours later. Maybe the introduction of the pacemaker occasioned one more stress for this patient…We know that people with a stressing job have probably more chance to suffer a myocardial infarction (the risks are 1.5 or two times greater for them). The prevalence of cardiomyopathy syndrome is 4.9% for women. These women have gone through the menopause, with a history of hypertension and anxiodepressive symptoms. However, we do not find any similar description (behavioural scheme type A) as is shown by the psychosomatic school in cases of patients who have gone through myocardial infarction. We also can question ourselves about the fact that some people can be predisposed to suffer from "Tako Tsubo" cardiomyopathy and about the existence of personality disorders. What then is the role of the psychiatrist with these patients?