Disorders In Population Research Articles

Improving the K6 short scale to predict serious emotional disturbance in adolescents in the USA

Effective screening for emotional and behavioral disorders among youth requires brief screening scales with good validity to identify youth requiring further evaluation and to estimate prevalence of target disorders in populations of interest such as schools or neighborhoods. This paper examines the psychometric properties of a very short (six-item) screening scale, the K6, to assess serious emotional disturbance (SED) among youth. The K6, which is made up of symptoms of depression and anxiety, has been shown in previous research to be a strong predictor of serious mental illness (SMI) in adults, but no information is available on the ability of the scale to screen for SED among youth. The current report examines the K6 as a screen for SED in a national survey of US adolescents, the National Comorbidity Survey Replication Adolescent Supplement (NCS-A). The K6 is shown to provide fairly good prediction of SED [area under curve (AUC) = 0.74] that is somewhat higher for internalizing (AUC = 0.80) than behavior (AUC = 0.75) disorders. Based on this result, we augmented the K6 with questions about symptoms of behavior disorders. This improved prediction of SED (from AUC = 0.74 to AUC = 0.83) as well as of SED associated with pure behavior disorders (from AUC = 0.53 to AUC = 0.78). These results show that although the symptoms of depression and anxiety in the K6 are sufficient to detect SMI among adults, high rates of behavior disorders among adolescents require indicators of behavior disorders to be added to the K6 to screen adequately for adolescent SED.

Iodine intake as a determinant of thyroid disorders in populations

Depending on the availability of iodine, the thyroid gland is able to enhance or limit the use of iodine for thyroid hormone production. When compensation fails, as in severely iodine-deficient populations, hypothyroidism and developmental brain damage will be the dominating disorders. This is, out of all comparison, the most serious association between disease and the level of iodine intake in a population. In less severe iodine deficiency, the normal thyroid gland is able to adapt and keep thyroid hormone production within the normal range. However, the prolonged thyroid hyperactivity associated with such adaptation leads to thyroid growth, and during follicular cell proliferation there is a tendency to mutations leading to multifocal autonomous growth and function. In populations with mild and moderate iodine deficiency, such multifocal autonomous thyroid function is a common cause of hyperthyroidism in elderly people, and the prevalence of thyroid enlargement and nodularity is high. The average serum TSH tends to decrease with age in such populations caused by the high frequency of autonomous thyroid hormone production. On the other hand, epidemiological studies have shown that hypothyroidism is more prevalent in populations with a high iodine intake. Probably, this is also a complication to thyroid adaptation to iodine intake. Many thyroid processes are inhibited when iodine intake becomes high, and the frequency of apoptosis of follicular cells becomes higher. Abnormal inhibition of thyroid function by high levels of iodine is especially common in people affected by thyroid autoimmunity (Hashimoto's thyroiditis). In populations with high iodine intake, the average serum thyroid-stimulating hormone (TSH) tends to increase with age. This phenomenon is especially pronounced in Caucasian populations with a genetically determined high tendency to thyroid autoimmunity. A small tendency to higher serum TSH may be observed already when iodine intake is brought from mildly deficient to adequate, but there is at present no evidence that slightly elevated serum TSH in elderly people leads to an increase in morbidity and mortality. Even minor differences in iodine intake between populations are associated with differences in the occurrence of thyroid disorders. Both iodine intake levels below and above the recommended interval are associated with an increase in the risk of disease in the population. Optimally, iodine intake of a population should be kept within a relatively narrow interval where iodine deficiency disorders are prevented, but not higher. Monitoring and adjusting of iodine intake in a population is an important part of preventive medicine.

The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis

Anxiety disorders are the most prevalent mental disorders in developed countries. Obesity is hypothesized to be a risk factor for anxiety disorders but evidence supporting an association between these two conditions is not clear. The objectives of this paper were to systematically review the literature for a link between obesity and anxiety disorders in the general population, and to present a pooled estimate of association. We performed a systematic search for epidemiological articles reporting on obesity (explanatory variable) and anxiety disorders (outcome variable) in seven bibliographical databases. Two independent reviewers abstracted the data and assessed study quality. We found 16 studies (2 prospective and 14 cross-sectional) that met the selection criteria. Measures of effect from prospective data were mixed but cross-sectional evidence suggested a positive association between obesity and anxiety. The pooled odds ratio from cross-sectional studies was 1.4 (confidence interval: 1.2-1.6). Subgroup analyses revealed a positive association in men and women. Overall, a moderate level of evidence exists for a positive association between obesity and anxiety disorders. Questions remain regarding the role of obesity severity and subtypes of anxiety disorders. The causal relationship from obesity to anxiety disorders could not be inferred from current data; future etiologic studies are recommended.

Clinical and molecular characterisation of Bardet–Biedl syndrome in consanguineous populations: the power of homozygosity mapping

Bardet–Biedl syndrome (BBS) is a ciliopathy with pleiotropic effect that manifests primarily as renal insufficiency, polydactyly, retinal dystrophy and obesity. The current phenotype–genotype correlation is insufficient to predict the likely...

Pharmacotherapy of PTSD: Current Status and Controversies

<p>Posttraumatic stress disorder (PTSD) is a common psychiatric disorder in populations exposed to trauma, and it is among the most functionally-impairing, similar in scope to that observed in mood disorders. Recent years have seen many treatment studies assessing efficacy of diverse pharmacotherapies for PTSD. This article reviews the established, evidence-based pharmacotherapeutic treatments for PTSD and highlights current recommendations and controversial areas. The article primarily focuses on published randomized clinical trials that tested overall symptom reduction in PTSD compared to placebo. We also briefly review efforts to target particular symptoms commonly associated with PTSD (eg, sleep disturbance; psychotic symptoms) and at preventing PTSD among populations recently exposed to trauma. Where appropriate, recommendations are made for use of particular agents as first-line pharmacotherapies.</p> <H4>ABOUT THE AUTHORS</h4> <P>Gregory M. Sullivan, MD, is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York. Yuval Neria, PhD, is Associate Professor of Clinical Psychology, Department of Psychiatry, Columbia University College of Physicians & Surgeons, and Director, Trauma and PTSD Program, N.Y. State Psychiatric Institute.</P> <P>Address correspondence to: Gregory M. Sullivan, MD, 1051 Riverside Drive, Unit #41, New York, NY 10032; fax 212-543-5437; or e-mail <A HREF="mailto:gms11@columbia.edu">gms11@columbia.edu</A>.</P> <P>Dr. Sullivan and Dr. Neria have disclosed no relevant financial relationships.</P> <P>doi: 10.3928/00485713-20090515-01</P> <H4>EDUCATIONAL OBJECTIVES</H4> <OL><P><LI>Review the evidence from the literature for the pharmacologic treatment of posttraumatic stress disorder (PTSD).</LI> </P> <P><LI>Explain the progress in research on the pharmacologic prevention of PTSD for those who are exposed to trauma. </LI></P> <P><LI>Review the pharmacologic treatment of selected symptoms of PTSD.</LI> </P> </OL>

Commentary: Explaining enormous variations in rates of disorder in trauma-focused psychiatric epidemiology after major emergencies

There has been a surge of interest in the last 20 years in the mental health effects of conflict and other major disasters in lowand middle-income countries (LAMIC). In particular, post-traumatic stress disorder (PTSD) and major depression have received substantial attention. It has become evident that there are large, unexplained variations in prevalence rates identified through trauma-focused psychiatric epidemiology in such settings. For example, Mollica et al.’s classic study found prevalence rates of PTSD of 15% among genocide-exposed Cambodians, while Neugebauer et al.’s sophisticated report in this issue of the Journal identifies rates of 53–62% of PTSD in genocide-exposed Rwandans. The wide variation in the prevalence rates in studies of PTSD and depression may be attributable to differences in context, methodology or both. Discussion sections of reports often highlight only a few factors that could explain the size of obtained rates. Although peer review helps shape discussion sections, authors usually have enormous discretion in deciding what factors to report. Readers are left with the challenge of tracking all reported and unreported methodological and contextual factors that could explain a study’s results. We have developed a scheme that may help to systematically identify factors influencing the size of observed prevalence rates of disorders in populations affected by major emergencies in LAMIC. The scheme may prove useful for readers and journal peer reviewers alike. The scheme, which we will apply below to Neugebauer et al.’s study, was built as follows. We searched the following medical, psychiatry and speciality journal websites: American Journal of Psychiatry; Archives of General Psychiatry; British Journal of Psychiatry; British Medical Journal; Culture Medicine and Psychiatry; JAMA, Journal of Traumatic Stress, Lancet, Psychological Medicine; Social Science and Medicine; and Transcultural Psychiatry for studies published after 1998 with data collected on depression or PTSD among civilians after major emergencies in LAMIC (references available upon request). Of 43 studies, 11 (26%) pertained to major natural disasters and 32 (74%) pertained to major human-made disasters (e.g. war). All articles were original contributions, and 40 (93%) made comments explaining the magnitude of findings in the articles’ discussion sections. In addition, we reviewed editorials, commentaries and letters to the editor linked to the identified articles. We thematically analysed discussion sections of all papers. We categorized authors’ explanations for observed rates as (i) either methodological or contextual in nature and (ii) explaining either relatively higher or lower observed rates. In addition, we categorized some explanations as (iii) reflecting general methodological limitations causing uncertainty in the validity of the study, with unknown impact on the magnitude of observed rates. Table 1 provides an overview of the explanations for relatively high or low rates ascribed in these studies. We studied the research reported in this issue of the Journal and rated different methodological and contextual factors in the study from 1 (not a factor in explaining size of obtained rate) to 5 (definitive factor in explaining size of obtained rate) (see bracketed numbers in Table 1). If no information was available in the paper on an element, then we rated it 3. Starting with the cell in the bottom left, we will discuss here ratings of 4 and 5, which are of main interest in explaining findings. The study took place in 1995 in a context (recent genocide that was preceded and followed by violence, fears of revenge killings, ongoing mass displacements, risk of cholera outbreaks, etc.) that not only involved mass loss and trauma but also a highly stressful recovery * Corresponding author. Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. E-mail: vanommerenm@who.int 1 Faculty of Medicine, University of Toronto, Toronto, Canada. 2 Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. Published by Oxford University Press on behalf of the International Epidemiological Association

Genetics of hereditary hemochromatosis: a clinical perspective

Hereditary hemochromatosis due to homozygosity for the C282Y mutation in the HFE gene product is the most common autosomal recessive genetic disorder in populations of northern European descent, where it attains a maximum prevalence of approximately one in 200. Cross-sectional and longitudinal studies have revealed that clinically significant iron-overload disease develops in at least 28% of male and 1% of female HFE C282Y homozygotes. The relatively low clinical penetrance is largely unexplained. Current evidence suggests a limited role for digenic inheritance of mutations in iron homeostasis genes in modifying the penetrance of hemochromatosis. Male gender is a strong genetic factor, promoting expression of clinical disease. Dietary intake of alcohol and noncitrus fruit may also act as important environmental modifiers of penetrance. With genetic analyses becoming simpler to perform, new genetic modifiers of hepatic iron loading and liver fibrogenesis are likely to be forthcoming.

Intellectual disability and psychiatric disorders: more than a dual diagnosis ƒ

Background: Despite the difficulties associated with establishing a diagnosis of a mental illness in persons with intellectual disability, most authors agree to say that those persons are at high risk of developing comorbid serious mental illness but the prevalence of psychiatric disorders in this population varies widely. The main reason for this variation lies in the difficulty to diagnose intellectual disability and psychiatric disorders at the same time. The aim of the present study is to investigate the association between severity of intellectual disability and prevalence of psychiatric and somatic disorders in an adult population with intellectual disability treated in the Psychiatric Unit of Mental Development (UPDM) in Geneva, Switzerland. Methods: The present study is based on the analysis of the medical record of all ambulatory patients of the UPDM treated in March 2008. This population presents at least a dual diagnosis of intellectual disability associated with psychiatric disorders. Results: Data show that 59.1% of the total sample has behavioural disorders and this percentage increases with severity of intellectual disability since it is higher in persons with severe and profound intellectual disability (79.7%). Furthermore, 48.2% of our sample has psychiatric disorders and this percentage is higher for persons with mild intellectual disability (59.5%). The most frequent psychiatric diagnosis associated to intellectual disability are pervasive developmental disorders (27.4%) and its prevalence is higher in the severe and profound intellectual disability level (66.1%), while schizophrenia and disorders of adult personality are significantly more frequent in the mild intellectual disability level (20.4% and 23.0% respectively). Furthermore, 31% of the sample have somatic disorders and its prevalence is higher in persons with severe and profound intellectual disability (55.9%). Considering the total prevalence of all diagnoses, our results reveal that 65% of our sample have more than a dual diagnosis and that this is more frequent in persons with severe and profound intellectual disability (84.7%) compared to persons with mild intellectual disability (54.8%). Conclusions: The total prevalence of all psychiatric disorders decreases with severity of intellectual disability. These data are consistent with other studies, which found a lower prevalence of psychiatric disorders in participants with severe and profound intellectual disability. Our results also reveal that the total prevalence of all diagnoses increases with severity of intellectual disability, which is consistent with the literature since some authors underline the presence of multiple pathologies associated with intellectual disability. In general, our results are encouraging and suggest a progress in defining more precise diagnostic methods.

Clinical penetrance of C282Y homozygous HFE hemochromatosis

Following the discovery of the HFE gene, it became apparent that C282Y homozygous HFE hemochromatosis is the most common autosomal recessive genetic disorder in populations of northern European descent, where it attains a maximum prevalence of approximately 1 in 200. Cross-sectional studies have revealed that the clinical penetrance of symptoms of iron-loading disease is relatively low and highly variable. Although there is no standard definition of clinical penetrance, large studies of newly diagnosed C282Y homozygotes that have specifically assessed liver disease have obtained data showing that penetrance occurs in between 24 and 43% of males and 1 and 14% of females. This relatively low clinical penetrance is largely unexplained. Current evidence suggests a limited role for digenic inheritance of mutations in iron homeostasis genes in modifying the penetrance of HFE hemochromatosis. Currently, the single most important environmental and genetic variables promoting penetrance are alcohol consumption and male gender, respectively. With genetic analyses becoming simpler to perform, new genetic modifiers of hepatic iron loading and liver fibrogenesis await identification.

RESPECT-Mil: Feasibility of a Systems-Level Collaborative Care Approach to Depression and Post-Traumatic Stress Disorder in Military Primary Care

U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and significant structural barriers to mental health services. Improvements in primary care may help address these issues, and evidence supports the effectiveness of a systems-level collaborative care approach. To test the feasibility of systems-level collaborative care for PTSD and depression in military primary care. We named our collaborative care model "Re-Engineering Systems of Primary Care for PTSD and Depression in the Military" (RESPECT-Mil). Key elements of RESPECT-Mil care include universal primary care screening for PTSD and depression, brief standardized primary care diagnostic assessment for those who screen positive, and use of a nurse "care facilitator" to ensure continuity of care for those with unmet depression and PTSD treatment needs. The care facilitator assists primary care providers with follow-up, symptom monitoring, and treatment adjustment and enhances the primary care interface with specialty mental health services. We report assessments of feasibility of RESPECT-Mil implementation in a busy primary care clinic supporting Army units undergoing frequent Iraq, Afghanistan, and other deployments. Thirty primary care providers (family physicians, physician assistants, and nurse practitioners) were trained in the model and in the care of depression and PTSD. The clinic screened 4,159 primary care active duty patient visits: 404 screens (9.7%) were positive for depression, PTSD, or both. Sixty-nine patients participated in collaborative care for 6 weeks or longer, and the majority of these patients experienced clinically important improvement in PTSD and depression. Even although RESPECT-Mil participation was voluntary for providers, only one refused participation. No serious adverse events were noted. Collaborative care is an evidence-based approach to improving the quality of primary care treatment of anxiety and depression. Our version of collaborative care for PTSD and depression, RESPECT-Mil, is feasible, safe, and acceptable to military primary care providers and patients, and participating patients frequently showed clinical improvements. Efforts to implement and evaluate collaborative care approaches for mental disorders in populations at high risk for psychiatric complications of military service are warranted.

DSM-IV Personality Disorders and Their Axis I Correlates in the South African Population

Background: The prevalence of personality disorders (PD) in the South African population is largely unknown. Thus, we undertook to estimate prevalence, demographic correlates, co-morbidity and treatment rates of DSM-IV PD among South Africans. Sampling and Methods: A three-stage probability sample design was used. Of the 4,433 interviews obtained, based on quality control criteria, 4,315 interviews were retained for analysis. All participants were screened for PD and axis I disorders with the World Health Organisation Composite International Diagnostic Interview. The multiple imputation method was then used to estimate prevalence. Results: The multiple imputation prevalence estimate in the total sample was 6.8%. All three PD clusters were significantly co-morbid with each other and with other axis I disorders. Male gender was the only significant predictor of PD. Of note was the finding that less than one fifth of participants with a possible PD diagnosis had received treatment for a mental health or substance abuse problem in the previous 12 months. Conclusion: The high co-morbidity of PD with axis I disorders in South Africa is consistent with previous reports elsewhere. However, more research is indicated to determine the reasons for the higher prevalence of cluster A disorders than of cluster B and C disorders in this population.

Prevalence of mental disorders based on general population surveys

In the last two decades, a multitude of investigations into the frequency of mental disorders in the population have emerged, making it difficult to keep track of recent findings and tasks. Building on a historical review, the present study provides a comprehensive overview of knowledge about the prevalence of mental disorders. The review is based on current national surveys with comparable methodology. Study selection, based on a consecutive literature search through August 2005, led to the inclusion of Australian, German, Dutch and US-American (NCS; NCS-R) surveys of mental disorders in the general population. A considerable proportion of the population is found to have a mental disorder. The most frequent disorders within the preceding 12 months are mood disorders (6.6-11.9%) and anxiety disorders (5.6-18.1%). Substance disorders (3.8-11.3%) and somatoform disorders (11.0%) are also very frequent. The prevalence rates presented in each survey are dependent on the specific disorders included and the classification system underlying them. Important risk factors are being female, being unmarried, being unemployed and having a low social status. Knowledge about mental disorders in the general population can contribute to bringing about considerable improvement in the treatment of mental disorders. In addition to available knowledge, however, there is a continued need to address existing challenges from both a methodological and content-related perspective, e.g. the lack of or inadequate inclusion of specific disorders, the lack of prevalence rates of mental disorders in childhood and adolescence, and the as yet only rare inclusion of personality disorders.

Psychiatric co-morbidity in vulnerable populations receiving primary care for HIV/AIDS

Considerable evidence suggests that people with HIV disease are significantly more distressed than the general population, yet psychiatric disorders are commonly under-detected in HIV care settings. This study examines the prevalence of three stress-related psychiatric diagnoses – depression, posttraumatic stress disorder (PTSD), and acute stress disorder (ASD), among a vulnerable population of HIV-infected patients. Among approximately 350 patients attending two county-based HIV primary care clinics, 210 participants were screened for diagnostic symptom criteria for depression, PTSD, and ASD. Standardized screening measures used to assess for these disorders included the Beck Depression Inventory, the Posttraumatic Stress Checklist, and the Stanford Acute Stress Questionnaire. High percentages of HIV-infected patients met screening criteria for depression (38 per cent), PTSD (34 per cent), and ASD (43 per cent). Thirty eight percent screened positively for two or more disorders. Women were more likely to meet symptom criteria for ASD than men (55 per cent vs. 38 per cent, OR=1.94, CI95 per cent=1.1–3.5). ASD was detected more commonly among African-American and white participants (51 per cent and 50 per cent respectively), compared with other ethnic groups. Latinos were least likely to express symptoms of ASD (OR=0.52, CI95 per cent=0.29–0.96). Of the 118 patients with at least one of these disorders, 51 (43 per cent) reported receiving no concurrent mental health treatment. Patients with HIV/AIDS who receive public healthcare are likely to have high rates of acute and posttraumatic stress disorders and depression. These data suggest that current clinical practices could be improved with the use of appropriate tools and procedures to screen and diagnose mental health disorders in populations with HIV/AIDS.

Social and communication development in autism spectrum disorders: early identification, diagnosis, and intervention

Part I: Assessment and Diagnosis. Wetherby, Understanding and Measuring Social Communication in Children with Autism Spectrum Disorders. Lord, Richler, Early Diagnosis of Children with Autism Spectrum Disorders. Part II: Screening and Surveillance. Charman, Baron-Cohen, Screening for Autism Spectrum Disorders in Populations: Progress, Challenges, and Questions for Future Research and Practice. Zwaigenbaum, Stone, Early Screening for Autism Spectrum Disorders in Clinical Practice Settings. Part III: Evidence-based Interventions. Yoder, McDuffie, Treatment of Responding To and Initiating Joint Attention. Rogers, Evidence-based Interventions for Language Development in Young Children with Autism. Wolfberg, Schuler, Promoting Social Reciprocity and Symbolic Representation in Children with Autism Spectrum Disorders: Designing Quality Peer Play Interventions. Nadel, Aouka, Imitation: Some Cues for Intervention Approaches in Autism Spectrum Disorders. Howlin, Augmentative and Alternative Communication Systems for Children with Autism. Part IV: Developmental and Neurobiological Issues. Walden, Hurley, A Developmental Approach to Understanding Atypical Development. Mundy, Thorp, The Neural Basis of Early Joint Attention Behavior.

Screening for Mental Health Problems among Patients with Substance Use Disorders: Preliminary Findings on the Validation of a Self-Assessment Instrument

We conducted a preliminary study on the validation of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) among patients seeking treatment for substance use disorders (SUDs). We assessed 76 patients with SUDs, using the PDSQ, followed by the Structured Clinical Interview for DSM-IV. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were calculated. Overall, the psychometric properties identified with the PDSQ in patients with SUDs differed from those found in psychiatric outpatient populations. The ROC curves were calculated for major depressive disorder, posttraumatic stress disorder, and panic disorder. The areas under the curves were 0.86 (95% CI, 0.77 to 0.95; P < 0.001), 0.79 (95% CI, 0.68 to 0.90; P < 0.001), and 0.66 (95% CI, 0.51 to 0.82; P = 0.05), respectively. The use of the PDSQ to screen for other psychiatric disorders in populations with SUDs is promising but requires larger validation studies to provide data on its psychometric properties and inform the choice of cut-off scores for this population.

Co-Occurrence of Personality Disorders with Mood, Anxiety, and Substance use Disorders in a Young Adult Population

The purpose of this study was to determine the co-occurrence of DSM- III-R personality disorders (PDs) with mood, anxiety, and substance use disorders in a young adult population. The members of the Northern Finland 1966 Birth Cohort Project, living in the city of Oulu with an age of 31 years (N = 1,609) were invited to participate in a two-phase field study. The SCID I and II were used as diagnostic instruments. One hundred and seventy-seven out of 321 interviewed subjects met the criteria for mood, anxiety, or substance use disorders. Altogether 72 (41%) of the subjects with an Axis I disorder met the criteria for at least one PD. The weighted co-occurrence rate of any PD varied from 28% for mood disorders to 47% for anxiety disorders. PDs, especially those in Cluster C, are highly associated with Axis I psychiatric disorders in population.

Performance of the SF-36 Health Survey in screening for depressive and anxiety disorders in an elderly female Swedish population

To assess the sensitivity, specificity and predictive validity of suggested cut-off scores in the SF-36 mental health (MH) and mental component summary (MCS) in screening for depressive and anxiety disorders in a population sample of older Swedish women. The sample comprised 586 randomly selected females aged 70-84 years who took part in an in-depth psychiatric examination. This provided the 'gold standard' against which the usefulness of SF-36 recommended thresholds for screening for depressive and anxiety disorders in older Swedish women was examined. Based on DSM-III-R criteria, 69 women (12%) were diagnosed with depression (major depression, dysthymia and/or depression NOS) and 49 (8%) with generalised anxiety and panic disorders. The previously recommended MH and MCS cut-offs (i.e. 52 and 42) gave a specificity for diagnosis of depression of 92 and 82% and sensitivity of 58 and 71%, respectively. Both the MH and MCS were good predictors of depressive disorders but poor predictors of anxiety disorders. The study supports the predictive validity of suggested SF-36 MH and MCS cut-off scores in screening for depressive disorder but not for anxiety disorder in older women in Sweden.

A Review of Mood Disorders Among Juvenile Offenders

This article provides an overview of what is known about the prevalence, diagnosis, and effective treatment of mood disorders among youths, particularly among juvenile offenders, and discusses the unique problems that arise for the delivery of treatment services. The relationship between mood disorders and disruptive or delinquent behaviors as well as the particular importance of proper diagnosis and treatment of mood disorders in this population are discussed. A search was conducted of the MEDLINE and PsycINFO databases for articles that had been published since 1980 on mood disorders in the juvenile offender population as well as articles on adolescent mood disorders. The studies on the prevalence of mood disorders among juvenile offenders varied significantly in the methodology used and in the rates of prevalence found, although all studies showed that this population had high rates of mood disorders. The identification and effective treatment of mood disorders is critical because these disorders are a leading cause of suicide among adolescents and because mood disorders may contribute to or exacerbate delinquent and disruptive behaviors. Juvenile detainees have a constitutional right to needed mental health treatment. More comprehensive mental health services are required to ensure that juvenile offenders with mental illness are identified and cared for appropriately. Doing so not only will alleviate painful symptoms but may also contribute significantly to improvements in psychosocial functioning, interpersonal relations, and school performance and to decreases in delinquent, disruptive, and suicidal behaviors.

Molecular Diagnosis of the First Ferroportin Mutation (C326Y) in the Far East Causing a Dominant Form of Inherited Iron Overload.

Genetic hemochromatosis (HH) is a common inherited disorder in populations of European origin in which different types of genetic hemochromatosis (type 1–4) have been characterized. Most hemochromatosis-type 1 patients are homozygotes or compound heterozygotes for two HFE mutations C282Y and H63D. Studies of several non-HFE iron overload families led to identification of mutations in hemojuvelin and hepcidin (juvenile form-HFE2A and B), transferrin receptor 2 (HFE3) and ferroportin (HFE4) as a cause of different forms of hemochromatosis. In the Far East, inherited hemochromatosis has rarely been reported and may have been misdiagnosed due to the high prevalence of secondary iron loading from hemoglobin disorders. This report describes, for the first time, non-HFE iron overload in patients from Southeast Asia. The affected Thai family presented with a distinctive clinical phenotype including macrocytosis and elevated transferrin saturation (>95%), increased non-transferrin bound iron (NTBI) as well as raised serum ferritin and marked hepatic hemochromatosis. Our patients tolerated therapeutic phlebotomy well. DNAs from peripheral blood leukocytes were firstly analyzed for three common HFE mutations (C282Y, H63D and IVS5+1 G→A). Subsequently, we screened all coding sequences, promoters and exon/intron boundaries of the HFE, HAMP, TfR2, HJV and SLC40A1 genes using denaturing high performance liquid chromatography (DHPLC). The entire coding region and splice sites of these genes were amplified and directly sequenced. We identified a novel mutation (C326Y) in ferroportin (SLC40A1, IREG-1, MTP-1), a membrane iron transport protein due to a G→A substitution at nucleotide 1281 in exon 7. This mutation was confirmed by restriction fragment length polymorphism (RFLP) analysis using Sfa NI. Six hundred Thai and two hundred Vietnamese chromosomes were analyzed for the C326Y mutation by RFLP analysis and it was not detected in any of the healthy controls studied. This result suggested that the G→A substitution is not a common polymorphism and is likely to be the causative mutation for the phenotype in this family. Previous reported mutations of ferroportin, including A77D and V162del, which lead to type IV hemochromatosis, were characterized by increased serum ferritin despite normal transferrin saturation, in contrast to our patients' phenotype. These autosomal dominant mutants are postulated to lead to disease due to loss of iron exporting function. Preliminary in vivo assay using transient transfection of wild-type and ferroportin mutants in HeLa or 293T cells revealed, as expected, a loss of function and diminished surface membrane localisation in A77D and V162del mutants. Surprisingly, the C326Y mutant was indistinguishable from wt ferroportin in both iron status of the cell and protein localization suggesting different pathophysiology leading to iron overload in our patients.

Major depressive disorder in a population of urban, African-American young adults: prevalence, correlates, comorbidity and unmet mental health service need

Background: The U.S. Surgeon General recently highlighted the relative dearth of research on the mental health of minority populations in the U.S. The present report describes the prevalence of major depressive disorder (MDD) in an epidemiologically-defined population of 1197, predominately poor, African-American 19–22-year-olds, living in the greater Baltimore, MD metropolitan area. Method: The prevalence and correlates of MDD, its comorbidity with other mental and substance disorders, and unmet mental health service need were assessed via a structured clinical interview administered by lay interviewers. Results: Using DSM-IV criteria, the overall prevalence of lifetime MDD for the study population was 9.4%, whereas the last year and last month prevalences were 6.2 and 2.7%, respectively. Females were approximately 1.6 times more likely to report a lifetime episode of MDD than males. MDD was highly comorbid with substance disorders. Just under 10% of those who had experienced an episode of MDD within the last year reported receiving mental health specialty services within the last year. Limitations: A major limitation was the reliance on a single interview conducted by a lay interviewer as opposed to a comprehensive psychiatric assessment carried out by a highly trained clinician, integrating information on symptoms and functioning from multiple sources. Conclusions: The lifetime prevalence of MDD found in the present study suggests that it is a significant mental health problem in the African-American young adults studied, particularly amongst women. Moreover, most episodes of MDD went untreated.