Depression Mood Disorders Research Articles

Executive Functioning and Self-Reported Depressive Symptoms Within an Adolescent Inpatient Population

Although the relationship between executive dysfunction and depressive disorders has been well established in the adult population, research within the adolescent population has produced mixed results. The present study examined executive-functioning subdomains in varying levels of self-reported depression within an adolescent inpatient sample diagnosed with primary mood disorders. Via retrospective chart review, the sample consisted of those adolescents (ages 13–18 years) who completed a combined psychological/neuropsychological assessment during hospitalization (N = 105). When the sample was divided into adolescents with mood disorders with self-reported depressive symptoms and adolescents with mood disorders without self-reported depressive symptoms, no differences in various executive functions were identified. There were also no correlations between overall self-reported depressive symptoms and overall executive functioning. However, there were negative correlations between select executive subdomains (e.g., problem solving and response inhibition) and certain depressive symptom subdomains (e.g., negative mood and interpersonal problems). Based on these findings, there was no difference in executive functions between mood disorders with depressive symptoms and mood disorders without depressive symptoms, although there may be select executive subdomains that are particularly involved in certain depressive symptoms, providing important information for the treatment of adolescent depression.

Effects of Chronic Central Arginine Vasopressin (AVP) on Maternal Behavior in Chronically Stressed Rat Dams.

Exposure of mothers to chronic stressors during pregnancy or the postpartum period often leads to the development of depression, anxiety, or other related mood disorders. The adverse effects of mood disorders are often mediated through maternal behavior and recent work has identified arginine vasopressin (AVP) as a key neuropeptide hormone in the expression of maternal behavior in both rats and humans. Using an established rodent model that elicits behavioral and physiological responses similar to human mood disorders, this study tested the effectiveness of chronic AVP infusion as a novel treatment for the adverse effects of exposure to chronic social stress during lactation in rats. During early (day 3) and mid (day 10) lactation, AVP treatment significantly decreased the latency to initiate nursing and time spent retrieving pups, and increased pup grooming and total maternal care (sum of pup grooming and nursing). AVP treatment was also effective in decreasing maternal aggression and the average duration of aggressive bouts on day 3 of lactation. Central AVP may be an effective target for the development of treatments for enhancing maternal behavior in individuals exposed to chronic social stress.

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate–severe psoriasis and psychiatric comorbidity: a retrospective study

It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease. Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed. The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus. Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.

Amyotrophic lateral sclerosis/frontotemporal dementia with predominant manifestations of obsessive–compulsive disorder associated to GGGGCC expansion of the c9orf72 gene

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving upper and lower motor neurons. Up to 50 % of ALS cases have cognitive and/or behavioral impairment falling into the spectrum of frontotemporal dementia (FTD) [1]. Approximately 10 % of cases are familial (FALS), while the others are considered sporadic, as their occurrence seems to be random throughout the population. Recently, a GGGGCC hexanucleotide repeat expansion in the first intron of c9orf72 gene on chromosome 9p21 has been related to familial and sporadic cases with ALS, ALS-FTD, or FTD. [2–4]. We describe a 52-year-old man carrying the GGGGCC expansion in the c9orf72 gene. At 50, he developed muscle weakness and wasting at the right hand. Soon after he developed intrusive thoughts of urine loss, not supported by clinical evidence. After a pantoclastic episode characterized by aggressiveness towards objects and auditory hallucinations due to an obsessive impulse to urinary stimuli, he was admitted to our hospital. He had muscle weakness and atrophy of upper limbs (predominantly right) and spasticity of upper and lower limbs, hyperactive deep tendon reflexes, hyperactive jaw jerk, and fasciculations at limbs and trunk muscles. Bulbar and respiratory muscles were spared. Needle EMG showed a diffuse pattern of chronic and active denervation, with normal nerve conduction studies. Motor-evoked potentials demonstrated increased central motor conduction time. Psychiatric evaluation was consistent with obsessive–compulsive disorder (OCD) with predominantly Obsessional Thoughts or Rumination (ICD-10 code F42.0), with psychotic manifestations. The patient’s father died at 42 years old from spinal amyotrophic lateral sclerosis (ALS); he had no cognitive or behavioral impairment. The patient’s sister and a paternal uncle had a depressive disorder. The patient was found to carry a hexanucleotide repeat expansion in c9orf72 gene ([50 repeats); no other mutations of major ALS-FTD related genes were found. Magnetic resonance imaging (MRI) revealed bilateral reduction of fractional anisotropy along the corticospinal tract (predominantly right). Brain positron emission tomography (PET) with FDG presented reduced hypometabolism in the motor cortex bilaterally, in the fronto-mesial cortex bilaterally between the anterior and the middle cingulate gyrus (predominantly right) and in the postero-lateral occipital cortex bilaterally (Fig. 1). The neuropsychological assessment was consistent with a diagnosis of behavioral FTD, associated to OCD, hallucinations, and depressive mood disorder. In the following months, the patient developed dysarthria, dysphagia, tongue atrophy with fasciculations, lower limb weakness and hypotrophy, and worsening of spasticity at the upper and lower limbs. A. Calvo (&) C. Moglia A. Canosa A. Ilardi E. Bersano D. Bertuzzo A. Chio Department of Neuroscience, University of Turin, via Cherasco 15, 10126 Turin, Italy e-mail: andreacalvo@hotmail.com

Depressive symptoms in adolescents with early and continuously treated phenylketonuria: Associations with phenylalanine and tyrosine levels

BackgroundPrevious research has suggested an increased risk for individuals with phenylketonuria (PKU) of developing depression and other mood disorders. As PKU can disrupt neurotransmitter synthesis via biochemical mechanisms, depressive symptoms are hypothesised to result from neurotransmitter dysregulation. Whilst adherence (or return) to the phenylalanine-restricted diet may resolve or improve symptoms of depression, data to demonstrate a direct relationship between biochemistry and mood in this population are lacking. MethodsThirteen adolescents with early and continuously treated PKU and eight sibling controls were compared in their total reported depressive symptoms. A general executive function assessment was also undertaken in the PKU group. Correlations between depressive symptoms and biochemical markers were examined within the PKU group only. ResultsCorrelational analyses within the PKU group demonstrated strong and significant associations between depressive symptoms and long term exposure to either a high phenylalanine:tyrosine ratio, or low tyrosine. Increasing symptoms of depression were also found to be associated with poorer executive function in the PKU sample. However, both groups of adolescents scored within the normal range in symptoms of depression (p>0.05). ConclusionsSignificant associations were observed between biochemical markers indicating poorer dietary control and increasing depressive symptoms in a sample of adolescents with early and continuously treated PKU, although symptoms of depression remained within the normal range. An association between depressive symptoms and poorer EF was also demonstrated. Further research is needed to establish whether the depressive symptoms observed in this young population represent an emerging (subclinical) risk for major depressive disorder as they age.

Neonates born to mothers using antidepressant drugs

Depression is a pathological condition frequently observed during pregnancy. It has been estimated that depression and other mood disorders may affect up to 20% of pregnant women [1], and the importance of adequately treating depression during pregnancy is currently well-recognised. Several pharmacological therapeutic options are currently available: selective serotonin reuptake inhibitors (SSRIs); serotonin-norepinephrine reuptake inhibitors (SNRIs); noradrenergic and specific serotonergic antidepressants (NaSSAs) or tetracyclic antidepressants (TeCAs); and norepinephrine reuptake inhibitors (NRIs) have largely replaced older tricyclic antidepressants (TCAs). Fetal exposure to maternal antidepressant drugs occurs both via placental and amniotic fluid passage [2], and evaluation of safety of antidepressants use during pregnancy, with a focus on teratogenic potential and neonatal complications, has recently become the objective of several studies.

Body Integrity Identity Disorder

IntroductionBody Integrity Identity Disorder (BIID) is a rare, infrequently studied and highly secretive condition in which there is a mismatch between the mental body image and the physical body. Subjects suffering from BIID have an intense desire to amputate a major limb or severe the spinal cord in order to become paralyzed. Aim of the study is to broaden the knowledge of BIID amongst medical professionals, by describing all who deal with BIID.MethodsSomatic, psychiatric and BIID characteristic data were collected from 54 BIID individuals using a detailed questionnaire. Subsequently, data of different subtypes of BIID (i.e. wish for amputation or paralyzation) were evaluated. Finally, disruption in work, social and family life due to BIID in subjects with and without amputation were compared.ResultsBased on the subjects' reports we found that BIID has an onset in early childhood. The main rationale given for their desire for body modification is to feel complete or to feel satisfied inside. Somatic and severe psychiatric co-morbidity is unusual, but depressive symptoms and mood disorders can be present, possibly secondary to the enormous distress BIID puts upon a person. Amputation and paralyzation variant do not differ in any clinical variable. Surgery is found helpful in all subjects who underwent amputation and those subjects score significantly lower on a disability scale than BIID subjects without body modification.ConclusionsThe amputation variant and paralyzation variant of BIID are to be considered as one of the same condition. Amputation of the healthy body part appears to result in remission of BIID and an impressive improvement of quality of life. Knowledge of and respect for the desires of BIID individuals are the first steps in providing care and may decrease the huge burden they experience.

Electroconvulsive Therapy in Patients With Skull Defects or Metallic Implants

Head injury is often associated with psychiatric morbidity. While it is well understood that the loss of critical areas of the brain may play a role in cognitive dysfunction and change in personality, head injury can also have profound effects on mood and cognition. The role of medications in the treatment of mood disorders associated with brain injury is well documented, and there is also evidence favoring the use of electroconvulsive therapy (ECT) in this context. However, data are limited on the use of ECT in patients with skull defects or metallic head implants. First, a review of the literature on use of ECT in patients with metallic head implants is provided. Electronic databases and online sites, including PubMed, Cochrane Library of Systematic Reviews, and UpToDate, were used to search for relevant articles and case reports on the use of ECT in patients with and without metallic implants in the head (1964 to 2009). The search terms electroconvulsive, electroconvulsive therapy, ECT, electroshock therapy, EST, head injury, brain injury, metallic plates, metallic implants, skull prosthesis, and depression were used interchangeably. The search produced 7 articles discussing exclusively the use of ECT in patients with a metallic skull plate. Second, the case of the successful and safe use of ECT in an individual with a previous history of brain trauma and metallic plate implantation is described. Most cases of head injury are managed by neurologists and rehabilitation consultants; the more severe cases of depression and other mood disorders tend to be referred for specialist psychiatric care. With greater degrees of deficit following head injury, management becomes more complicated. Our patient showed positive results with ECT, including improvement in depressive features and resolution of suicidal ideas/plans. ECT is an effective and safe alternative in patients with a history of brain trauma and metallic plate implantation who subsequently develop treatment-resistant depression and associated suicidal ideas or plans refractory to management with medications.

Pattern of neuropsychiatric illnesses in older age group population: An inpatient study report from Nepal

Background:Inpatient institution-based geropsychiatric study reports are rare in the world psychiatric literature.Aims:To study the pattern of neuropsychiatric illnesses seen in older age group population and to study how the advancing age influences the pattern of physical and neuropsychiatric illnesses in these geriatric people.Materials and Methods:This was a retrospective review of the charts of all patients of age 60 years and above, during a specified period of 3.5 years. The present study reports the findings of 138 patients (83 males and 55 females) admitted during the said period. For comparison purpose, 194 patients, in the age range of 50-59 years, who were admitted during the same period, were taken up specially to study the changing pattern of diagnosis, if any, as well as to study the significance of increased rate of physical illness in the geriatric study group.Results:Our geriatric inpatients (138) formed only 3.73% of the total patient population (3698) admitted during the said period, which is in sharp contrast to 23-44% geriatric inpatients, the range that has been usually reported in the western literature. Common clinical diagnoses amongst male geriatric patients were alcohol dependence with or without various complications (27.7%), followed by mood disorder-mania (18.1%), organic mental disorders (18.1%), psychosis (16.9%), and mood disorder-depression (14.5%). Common clinical diagnoses amongst geriatric females were mood disorder-depression (36.4%) and psychosis (25.5%). Comorbid physical illness was seen to be present at a very high percentage (61.4%) in geriatric male patient population than in female patients (40%). Alcohol dependence in male and depressive disorder in female stood out as distinctive illness in patients above 50 years of age (including both study and comparative groups). In sharp contrast to elderly comparison group's 14.9% cases of comorbid physical illness, geriatric study population had a staggering 52.9% cases of additional burden of physical illness diagnosis.Conclusions:Being elder by a decade poses a significant threat in developing an additional physical illness to an already existing psychiatric illness in the geriatric community. Though the prevalence of mental illness in the geriatric age group is similar in developed and developing countries, poor inpatient attendance of geriatric neuropsychiatric patients probably indicates a poor delivery of healthcare facilities to our senior citizens.

Toward a Culture of Healing: Why Alternative Therapies and a Feminist Framework are Needed in the Care of Pregnant Women and Treatment of Postpartum Mood Disorders

Pregnancy, birth, and early motherhood are areas of human development that have systematically migrated away from their roots as a series of natural life events to a highly, and perhaps unnecessarily, medicalized arena. This shift has been detrimental for women, especially for poor, socially isolated, single, and/or ethnic minority women. In this paper, I outline my concerns with the increased medicalization of birth and postpartum care, as well as with the status of mothers in the United States, and critically examine the patriarchal context in which this shift has occurred. My focus is on maternal health and mortality, including depression and other associated mood disorders during the pre, peri, and postpartum periods. The intent of this paper is not to vilify hospitals or allopathic medicine practitioners, but rather to increase awareness and knowledge of the childbirth process and postpartum period, including procedures and outcomes involved in traditional medical and midwifery care both in and out of the hospital setting. I hope to provide an argument for the use of complementary and alternative therapies and integrative medicine, specifically acupuncture, nutritional supplementation, meditation, and support groups to treat mental health conditions and support overall well-being in pregnant and postpartum women.

P-268 - Combined metabolic and psychological screening for mood disorders in children with type 1 diabetes

Objectives To compare the diagnostic accuracy and cost-effectiveness of screening models based on glycated hemoglobin level (HbA1c) and psychometric measures in detecting mood disorders among children with type 1 diabetes (T1DM) Methods A random sample of 26% out of 632 available subjects aged 8–18 years with T1DM lasting longer than 12 months were enrolled to the study. All subjects were tested using a semi-structured clinical interview (KSADS-PL, duration = 120 mins/patient) as a standard of reference for the diagnosis of major depression disorders (MDD) and mood disorders (MD). Four screening approaches evaluated by the authors were: 1- Children Depression Inventory (CDI, duration = 30 mins/patient); 2- centile of HbA1c; 3- centile of HbA1c with CDI; 4- centile of HbA1c with Children's Depression Rating Scale (CDRS duration=40 mins/patient). All tests were performed in all individuals and cost-effectiveness of all 4 approaches was calculated as total time needed to successfully detect one case of MD or MDD. Results The HbA1c+CDRS model was the best screening procedure for both MD and MDD. Diagnostic threshold for HbA1c was established at 93 rd percentile (8.7%) for MD and 95 th (9.0%) for MDD. Cut-off points for CDRS assessed after filtering by HbA1c percentile equaled 26 (MD) and 30 (MDD) points. Application of this procedure would result in a 76% workload reduction for one diagnosed patient with MD and 83% with MDD in comparison to standard screening with CDI. Conclusions Centile of HbA1c level with subsequent examination with CDRS is cost-effective procedure for screening individuals with T1D prior to psychiatric.

Editorial introductions

Editorial introductions

A Case of Major Depressive Disorder and Symptoms of Polycystic Ovary Syndrome Responding to Escitalopram

To the Editor: Despite wide-ranging clinical use of antidepressants to treat depression alone as well as depression associated with polycystic ovary syndrome (PCOS), there have been no reports to date on the use of serotonin reuptake inhibition with a successful outcome of both major depressive disorder (MDD) and PCOS symptomatology, such as oligomenorrhea/amenorrhea and hirsutism. Case report. Ms A, a 40-year-old married woman, had a 20-year history of recurrent MDD (DSM-IV). Her first episode began when she was 20 years old. Seven years ago, her depressive symptoms began to appear slowly, characterized by depressed mood, irritability, diminished interest in her usual activities, loss of appetite, weight loss, lack of energy, poor concentration, insomnia, and recurrent thoughts of death, such as “It would be nice not being alive.” These symptoms led to impaired work and social functioning. Her mother had a history of chronic depressive mood disorder. Ms A also had a 26-year history of PCOS, characterized by oligomenorrhea or amenorrhea, hirsutism, hyperandrogenism, and polycystic ovaries, confirmed by several laboratory tests and ultrasound, meeting the 2003 Rotterdam, or European Society for Human Reproduction/American Society for Reproductive Medicine (ESHRE/ASRM), criteria.1 Twenty years ago, her gynecologist suggested lifestyle changes such as exercises, nutritional guidance, low doses of oral contraceptive pills, cosmetic therapy, and laser therapy for hirsutism. With the use of oral contraceptive pills, Ms A experienced an improvement in her menstrual cycles, although she continued to have mood swings, irritability, and severe headaches, which were extremely distressing. She was switched to several oral contraceptive pills, but all showed severe side effects. She discontinued all oral contraceptive pills after a few months of use. In 2003, Ms A presented for treatment of MDD. Escitalopram—a selective serotonin reuptake inhibitor, not an oral contraceptive pill—was administered at 5 mg/d, with the dosage reaching 20 mg/d in 3 weeks. After 4 weeks of treatment, Ms A experienced clinically significant depressive symptomatic relief. Remission was achieved in 8 weeks. Over the next 18 months, she continued to receive escitalopram and experienced a return of regular menstrual cycles and improvement in hirsutism. She reported transient mild nausea at the beginning of treatment; no other side effects were reported. Remarkably, 2 months after antidepressant discontinuation, she started experiencing menstrual irregularity and hair growth. Ten months later, MDD recurred. During the next 4 years, she was on treatment with escitalopram at 20 mg/d and remained symptom-free. Meanwhile, she achieved notable menstrual cycle improvement and reduction in hirsutism. As Ms A was feeling well, she stopped taking the medication on her own and her menstrual complaints immediately recurred. She restarted escitalopram in 4 months, and her PCOS symptoms remitted again. This was the longest regular menstrual cycle period she had ever had with no use of oral contraceptive pills. Last year, her ultrasounds continued to show polycystic ovaries. Reports have revealed that hyperandrogenism, hormonal disturbances, obesity, ovarian dysfunction, hypothalamic pituitary abnormalities, and insulin resistance are implicated in the etiology of PCOS.2,3 Hormonal dysregulation is involved with both MDD and PCOS. As mood disorders and PCOS share some level of genetic and pathophysiologic mechanisms,4,5 the intervention on common metabolic changes can treat both conditions.

Palliative Care and Support for Persons with HIV/AIDS in 7 African Countries

To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of life for individuals. Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.

Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States

Little is known about the prevalence and comorbidity of Major Depressive Episode (MDE) during pregnancy in the general population. This study presents nationally representative data on the prevalence, correlates, and psychiatric comorbidities of depression in women during pregnancy and postpartum in the United States. Data were drawn from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43,093 adults aged 18 years and older residing in households in the United States of whom 14,549 were women 18 to 50 years old with known past-year pregnancy status. Diagnoses of depression and other mood, anxiety, and drug disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version. The overall prevalence of MDE during pregnancy was 12.4%. Among pregnant and postpartum women, depression was associated with younger age, ethnicity other than Latino, being widowed, divorced, separated or never married, traumatic events within the past 12 months and pregnancy complication. Strong associations were found between MDE during pregnancy and postpartum and nearly all 12-month psychiatric disorders. Past-year depressed pregnant and postpartum women were more likely than nondepressed pregnant women to use substances (including alcohol, illicit drugs and cigarettes). Past-year pregnant and postpartum women were significantly less likely to receive past-year treatment for depression than nonpregnant women although not after adjusting for background sociodemographic characteristics. These results indicate that depression during pregnancy and postpartum is associated with a large range of psychiatric disorders. The high frequency of psychiatric comorbidities, the elevated use of any substances and the high rate of unmet needs should be kept in mind when considering the management of depression during pregnancy and postpartum.

Ghrelin postsynaptically depolarizes dorsal raphe neurons in rats in vitro

Ghrelin promotes growth hormone (GH) secretion and feeding. Recent studies further showed that ghrelin displayed a defending effect against the depressive-like symptoms and affected sleep in animals and humans. Serotonergic system is considered to be implicated in feeding, depression and other mood disorders, and sleep. The dorsal raphe nucleus (DRN) utilizes serotonin (5-HT) as its major neurotransmitter and expresses GH secretagogue receptors (GHS-Rs). Therefore, the present study was carried out to examine the electrophysiological effect of ghrelin on rat DRN neurons in vitro and determine the ionic mechanism involved. Whole-cell recording revealed that ghrelin depolarized DRN neurons dose-dependently in tetrodotoxin-containing artificial cerebrospinal fluid (TTX ACSF). Pretreatment with [d-Lys3]-GHRP-6, a selective antagonist for GHS-Rs, antagonized the ghrelin-induced depolarization. The depolarization was significantly reduced in a low-Na+ TTX ACSF and in a high-K+ TTX ACSF and was abolished in the combination of both ACSFs, suggesting that the ghrelin-induced depolarization is mediated by a dual ionic mechanism including an increase in nonselective cationic conductance and a decrease in K+ conductance. The experiments on the reversal potential also supported an involvement of the dual ionic mechanism in the ghrelin-induced depolarization. On the basis of their electrophysiological and pharmacological properties, approximately 80% of DRN neurons were classified as putative 5-HT-containing neurons and ghrelin depolarized 75% of them. These results suggest that DRN neurons, especially 5-HT-containing neurons, might be involved in the neural mechanisms through which ghrelin participates in the development and/or regulation of feeding behavior, sleep-wake states and depressive-like symptoms.

Long-Term Outcome in Patients With Mild Traumatic Brain Injury: A Prospective Observational Study

Mild traumatic brain injury (MTBI) is common; up to 37% of adult men have a history of MTBI. Complaints after MTBI are persistent headaches, memory impairment, depressive mood disorders, and disability. The reported short- and long-term outcomes of patients with MTBI have been inconsistent. We have now investigated long-term clinical and neurocognitive outcomes in patients with MTBI (at admission, and after 1 and 10 years). Patients of a previous study investigating MTBI short-term outcome were prospectively reassessed after ±10 year using the same standardized data entry form and validated questionnaire (Beltztest with Beltz Score [BeSc]) for evaluation of Quality of life (QoL) and neurocognitive outcome (higher scores indicate lower QoL). Eighty-six of 176 patients (49%) could be reassessed (n = 75 lost to follow-up; n = 8 second brain trauma; n = 7 death), 10.4 ± 2 years after initial evaluation. Over time, overall BeSc was significantly increased (5.92 ± 10.3 [admission] vs. 10.7 ± 12.8 [1 year] vs. 20.86 ± 17.1 [10 year]; p < 0.0001); only 54 of 86 patients (62.8%) presented with a normal BeSc. Long-term complaints were fatigue, insomnia, and exhaustion. Ten of eighty-six patients (11.6%) had intracranial injury (ICI) and initial BeSc was almost twofold higher in patients with ICI than in patients without ICI (10.0 ± 8.4 vs. 5.3 ± 9.6; p = 0.007). This difference was not seen after 1 year or after 10 years (10.3 ± 11.6 vs. 10.3 ± 10.1 and 21.4 ± 17.3 vs. 16.1 ± 16.4, respectively). Eight of eighty-six patients (9.3%) lost their jobs because of persistent complaints after MTBI. BeSc deteriorates over time; our data suggest a decline in general health and QoL in a substantial proportion of patients (37.2%) 10 years after MTBI. Patients without ICI appear to have a better long-term outcome with regard to subjective complaints and QoL.

Electroconvulsive therapy: a novel hypothesis for the involvement of purinergic signalling

It is proposed that ATP is released from both neurons and glia during electroconvulsive therapy (ECT) and that this leads to reduction of depressive behaviour via complex stimulation of neurons and glia directly via P2X and P2Y receptors and also via P1 receptors after extracellular breakdown of ATP to adenosine. In particular, A(1) adenosine receptors inhibit release of excitatory transmitters, and A(2A) and P2Y receptors may modulate the release of dopamine. Sequential ECT may lead to changes in purinoceptor expression in mesolimbic and mesocortical regions of the brain implicated in depression and other mood disorders. In particular, increased expression of P2X7 receptors on glial cells would lead to increased release of cytokines, chemokines and neurotrophins. In summary, we suggest that ATP release following ECT involves neurons, glial cells and neuron-glial interactions acting via both P2 and after breakdown to adenosine via P1 receptors. We suggest that ecto-nucleotidase inhibitors (increasing available amounts of ATP) and purinoceptor agonists may enhance the anti-depressive effect of ECT.

Impact of temperament on depression and anxiety symptoms and depressive disorder in a population-based birth cohort

BackgroundThe aim of this study was to characterize at the population level how innate features of temperament relate to experience of depressive mood and anxiety, and whether these symptoms have separable temperamental backgrounds. MethodsThe study subjects were 4773 members of the population-based Northern Finland Birth Cohort 1966, a culturally and genetically homogeneous study sample. Temperament was measured at age 31 using the temperament items of the Temperament and Character Inventory and a separate Pessimism score. Depressive mood was assessed based on a previous diagnosis of depressive disorder or symptoms of depression according to the Hopkins Symptom Check List – 25. Anxiety was assessed analogously. ResultsHigh levels of Harm avoidance and Pessimism were related to both depressive mood (effect sizes; d=0.84 and d=1.25, respectively) and depressive disorder (d=0.68 and d=0.68, respectively). Of the dimensions of Harm avoidance, Anticipatory worry and Fatigability had the strongest effects. Symptoms of depression and anxiety showed very similar underlying temperament patterns. LimitationsAlthough Harm avoidance and Pessimism appear to be important endophenotype candidates for depression and anxiety, their potential usefulness as endophenotypes, and whether they meet all the suggested criteria for endophenotypes will remain to be confirmed in future studies. ConclusionsPersonality characteristics of Pessimism and Harm avoidance, in particular its dimensions Anticipatory worry and Fatigability, are strongly related to symptoms of depression and anxiety as well as to depressive disorder in this population. These temperamental features may be used as dimensional susceptibility factors in etiological studies of depression, which may aid in the development of improved clinical practice.

The mutual relationship between shift work and depressive complaints – a prospective cohort study

The aim of this study was to examine longitudinally the mutual relationship between shift work and depressive complaints. Data from the ongoing Maastricht cohort study (1998-2008) were used. Firstly, the impact of shift work on the development of depressive complaints, defined as depressed mood, was studied. Both prospective and retrospective approaches were used, conducting, respectively, survival and logistic regression analyses, correcting for possible confounding factors. Secondly, the impact of depressed mood on changes in shift work at one-year follow-up was studied. All analyses were stratified for men and women and, where possible, for age (<45 versus ≥45 years). Overall, the impact of shift work on the development of depressed mood over a ten-year period was rather small, although, male shift workers ≥45 years did contribute to a higher risk of developing depressed mood [hazard risk (HR) 1.37, 95% confidence interval (95% CI) 1.01-1.86]. Retrospective analyses found higher odds of depressed mood and depressive disorder among former or current male shift workers than "never shift workers" [odds ratio (OR) 1.39, 95% CI 1.09-1.79 and OR 1.79, 95% CI 1.32-2.42, respectively]. Results lacked significance when correcting for demographic and work-related factors. Analyses studying the impact of depressed mood on changes in work schedules showed that the risk to change from shift to day work or from shift work to sick leave was higher when depressed mood was reported at baseline [relative risk (RR) shift to day work 1.98, 95% CI 1.13-3.47; RR shift work to sick leave 2.96, 95% CI 2.00-4.29]. Although shift work did not have a large impact on the development of depressed mood, results might be underestimated due to selection processes and possibly overcorrection.