History Of Psychiatric Disease Research Articles

Perceived sleep deficit is a strong predictor of RLS in multisite pain – A population based study in middle aged females

BackgroundChronic pain conditions as well as Restless Legs Syndrome (RLS) are known to be associated with subjectively and objectively disturbed sleep. RLS has been recently described as highly prevalent in multisite pain and the role of sleep as a modifying factor in this RLS phenotype is unknown. This study aimed to investigate if perceived sleep deficit and other sleep related parameters predict RLS in subjects with multisite pain. Current knowledge/study rationaleWe have recently demonstrated a strong association between Restless Legs Syndrome (RLS) and number of pain locations. In the current analysis we hypothesized that impaired sleep predicts RLS in subjects with multisite pain. MethodQuestionnaire-based data from 2727 randomly selected women aged 18–64 years were used to analyze RLS symptoms, self-reported sleep quality, and the degree of daytime sleepiness (Epworth Sleepiness Scale (ESS)) in relation to type, degree and localization of body pain. Potential confounders including anthropometrics, pain localization, co-morbidities, and medication were adjusted for in the Generalized Linear Models (GLM). ResultsPerceived sleep deficit ≥90min (OR 2.4 (1.5–3.8), p<0.001) and frequent nocturnal awakenings (OR 2.3 (1.4–3.6), p<0.001) were the strongest sleep related predictors for RLS in subjects with multisite pain. Additional factors include prolonged sleep latency (≥30min, OR 1.8 (1.1–2.8), p=0.01) and daytime symptoms like elevated daytime sleepiness (ESS score ≥9, OR 1.8 (1.2–2.7), p=0.005). Accordingly, RLS diagnosis was associated with impaired sleep quality (TST (Total Sleep Time) −8.2min, sleep latency +8.0min, and number of awakenings from sleep +0.4, p<0.01). ESS score increased with RLS diagnosis (+0.74, p<0.01) and number of pain locations (0.5, 1.7, and 1.8 for 1, 3, and 5 pain areas, p<0.001). In addition, confounders like pain severity, the history of psychiatric disease, and current smoking were associated with impaired sleep quality in this group of females. ConclusionsPerceived sleep deficit and sleep fragmentation are the strongest sleep related predictors of RLS in multisite pain. Potential implication of our results are that clinical management programmes of RLS in subjects with multisite pain need to consider both sleep quality and sleep quantity for individually tailored treatment regimes. Study impactRLS, pain, and sleep disorders are highly interrelated. Our study strongly suggests that clinical management of RLS in patients with multisite pain needs to consider sleep quality as an independent risk factor.

APP 3’UTR VARIANT IN A PATIENT WITH MCI AND WITHOUT SIGNS OF CEREBRAL AMYLOID ANGIOPATHY: A CASE REPORT

Familial Alzheimer's disease (FAD) is associated with mutations in the amyloid precursor protein gene (APP). Recent studies discussed possible relations between cerebral amyloid angiopathy (CAA) and APP variants or duplications (Nicolas G et al. Mutation in the 3'untranslated region of APP as a genetic determinant of cerebral amyloid angiopathy. European Journal of Human Genetics 2016; 24: 92–98). Nicolas et al. identified APP 3'UTR (3'untranslated region of APP) sequence variants including c.*18C>T as possible genetic determinants of CAA. This is the case of a 51-year-old female patient with an APP 3'UTR sequence variant, admitted to the clinic due to depressive symptoms. After full remission of the severe depressive episode (ICD-10), the patient still suffered from cognitive impairment. Brain MRI-scan revealed frontal lobe atrophy. Electroencephalogram was normal. Neuropsychological assessments showed moderate impairment in tasks on recall of nonverbal visuospatial information as well as in the ability to learn new task rules and slight impairment in tasks on delayed recall of verbal information. 18FDG-positron-emission-tomography and cerebrospinal fluid analysis including beta-amyloid and tau-protein were unremarkable. Due to these conflicting findings and to the patient's relatively young age, genetic DNA analysis was conducted. Genetic DNA analysis led to detection of the heterozygous APP 3'UTR sequence variant c.*18C>T, so far of unknown significance and with a minor allele frequency of less than 0.01 %. No radiological signs of cerebral amyloid angiopathy were found in this patient. She had no family history of psychiatric diseases and was currently diagnosed with mild cognitive impairment, not meeting the criteria for dementia (yet). Thorough follow-up examinations including frequent evaluations of vascular risk factors are necessary to detect early signs of CAA in this patient and to reduce her risk of brain hemorrhage. The reported APP 3'UTR sequence variant could be a genetic determinant of the development of cognitive impairment, possibly of Alzheimer's disease. Further research and longitudinal studies are necessary to test this hypothesis and to also examine if this variant is a genetic determinant of CAA.

Psychiatric picture of encephalitis: Stigmatisation of psychiatric patient

BackgroundPsychiatric symptoms/disorders in brain diseases are not specific and may have the same clinical presentations as functional psychiatric disorders, so they can compromise early diagnosing of disease.ObjectiveThis paper's objective is to show (negative) influence of stigma in a diagnostic process of patients with predominantly psychiatric symptoms in their clinical pictures.Materials and methodsThe subject is a 46 year-old female patient with no history of psychiatric disease. Her symptoms includes: confusion, disorientation, perseveration, visual and auditory hallucination, lack of motivation, inability to understand questions, developed following a 10-day long period of febricity. During the outpatient care, she has been examined by a neurologist, a specialist of urgent and internal medicine, and a psychiatrist. As the CT scan made in that stage was interpreted as normal, the patient was hospitalised in a psychiatric hospital. She was treated both with typical and atypical antipsychotics but no therapeutic effects have been reached. Thinking of organic etiology, advanced diagnostics have been made (MR, LP). MR scan showed lesion that is a characteristic for herpetic meningitis, which is also confirmed with positive serological tests.ConclusionIn patients with a sudden onset of psychiatric symptoms, patients with unexpected changes in mental status or suddenly developed headaches, as in the therapy- resistant psychiatric disorders, it is important to keep in mind the possibility of the coexistence of brain disease. Removing the stigma from psychiatric patients is important in order to be able to give every patient the chance of getting the correct diagnose on time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric event in multiple sclerosis: could it be the tip of the iceberg?

Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system. Psychiatric comorbidities are highly prevalent in patients with MS, and can have drastic impact on quality of life and interpersonal relationships. Despite this high prevalence, whether psychiatric manifestations may represent the first signs of MS is still debatable. This constitutes an important issue, since early diagnosis of “psychiatric-onset MS” would result in prompt management, which usually ameliorates long-term prognosis. Here, we discuss clinical and radiological hints that suggest a diagnosis of psychiatric-onset MS. Briefly, this entity should be considered in healthy patients presenting with late-onset psychiatric symptoms, with or without cognitive decline, and with negative family history of psychiatric diseases. A thorough neurological exam is crucial to detect any subtle neurological signs. Brain magnetic resonance imaging is recommended to rule out frontotemporal lesions that might explain the clinical picture. Poor response to standard psychiatric treatments provides additional evidence for the diagnosis of an organic disease (e.g., MS). Combining psychopharmaceuticals with intravenous corticosteroids would result in good outcomes, but patients should be monitored carefully for possible psychiatric exacerbation, a common side effect of steroids.

Screening for bipolar disorder among migraineurs: the impact of migraine-bipolar disorder comorbidity on disease characteristics.

PurposeThe aim of this study was to evaluate the prevalence of comorbid bipolar disorder (BD) among migraineurs and the impact of migraine–BD comorbidity on disease characteristics.Patients and methodsA total of 120 adult patients diagnosed with migraine at a single tertiary care center were included in this cross-sectional study. Data on sociodemographic and migraine-related characteristics, family history of psychiatric diseases, comorbid psychiatric diseases, and first-episode characteristics were recorded. Mood Disorders Diagnosis and Patient Registration Form (SCIP-TURK), Mood Disorder Questionnaire (MDQ), and Hypomania Checklist-32-Revised (HCL-32-R) were applied to all patients by experienced clinicians, and clinical diagnoses were confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Migraine Disability Assessment Scale (MIDAS) was used to evaluate the headache-related disability. Study parameters were compared between migraineurs with and without comorbid BD.ResultsThe diagnosis of comorbid BD was confirmed in 19.2% of migraineurs. A significantly higher percentage of patients with comorbid BD than those without comorbid BD had family history of BD (39.1% vs 6.2%, P<0.001), suicide attempt (30.4% vs 5.2%, P<0.001), and physical abuse (52.2% vs 26.8%, P=0.019). MIDAS scores were significantly higher (50.6 [43.2] vs 33.8 [42.7], P=0.0422) in migraineurs with comorbid BD than in those without comorbid BD. Multivariate logistic regression model revealed that a positive family history of type I BD (odds ratio [OR], 14.42; 95% confidence interval [CI], 2.94–70.73; P=0.001) and MIDAS scores >30 (OR, 3.69; 95% CI, 1.12–12.19; P=0.032) were associated with 14.42 times and 3.69 times increased likelihood of BD, respectively.ConclusionOur findings revealed comorbid BD in a remarkable percentage of migraineurs and a higher likelihood of having BD in case of a positive family history of type I BD and MIDAS scores >30. Comorbid BD was associated with a higher rate for a family history of BD, suicide attempt, and childhood physical abuse as well as aggravated migraine-related disability among migraineurs. Migraineurs with and without comorbid BD showed similar sociodemographic and migraine disease characteristics as well as similar high rates for comorbid anxiety and first-episode depression.

The Evaluation of the Deaths Related to Hypothermy in Eskisehir between 1997 and 2016

Introduction: In this study, it was aimed to investigate the frequency of autopsy findings and the frequency of cases decided to die due to hypothermia in EskiAŸehir. Materials and Method: This study is a descriptive study conducted in the 20-year period between 1997 and 2016 in EskiAŸehir province by retrospective examination of case files belonging to judicial qualifications. These deaths were included in the study because of the decision to die due to hypothermia. The cases were evaluated in terms of age, gender, location of the body, month in which the body was found, autopsy findings, psychiatric disease history, toxicological examination and death investigation information. Findings: It has been determined that in 20 year period, there were 16 deaths due to hypothermia in EskiAŸehir, Turkey. All cases were male and mean age (SD) was 62.4 ± 7.2 years. Wischnewsky ulcers occurred in 11 cases (68.8%) due to hypothermia. 9 cases (56.3%) had a history of psychiatric and neurological disease. Conclusion: Hypothermic deaths are preventable deaths and precautions should be taken to protect against hypothermia in elderly people, homeless people and those with mental illness that will affect the state of consciousness.

Signs of adult ADHD in university students and related factors

Objective: The purpose of this research is to determine the prevalence of Attention Deficit Hyperactivity Disorder (AADHD) in university students yet continuing during the adulthood, which causes social, individual and mental problems in adults and to contribute to the studies conducted and to examine the relation of ADHD with some factors such as age, gender and class. Methods: One thousand two hundred and forty-seven students from Cumhuriyet University participated in this study. Adult Attention Deficit and Hyperactivity Self Report Scale (ASRS) Turkish Form as well as socio-demographic information form were filled by all the participants. Results: In total 1247 persons from 11 different departments, and between 18 and 35 years old, mean age 21.88±1.92, and 57.7% women while 42.3% men participated in this study. Mean ASRS scores in the participants were detected to be 27.74 ±8.96. Upon considering ASRS score over two standard deviations AADHD sign prevalence was detected to be 3.1% (39/1208) while ASRS score over one and half standard deviations, it was detected to be 6.6% (82/1165). AADHD sign prevalence was statistically determined to be lower in those persons presenting with psychiatric disease history compared to those other groups. Conclusion: This study revealed that AADHD signs could be frequently detected in university students and that it could be associated with some other factors.

Depression in Women with Recurrent Miscarriages - an Exploratory Study.

Objective To assess depression, domestic violence and the use of substances in women with recurrent miscarriages. Methods The Abuse Assessment Screen (AAS), the Edinburgh Postnatal Depression Scale (EPDS) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess violence, depression and the use of substances among women with recurrent miscarriages. The population corresponded to patients receiving prenatal care from June to August 2014. Multiple logistic regression was used to assess the multivariable relationship between depression and sociodemographic, psychosocial and medical characteristics (p < 0,10). Results The prevalence of depression was of 41.3% (95% confidence interval [CI] = 28.3-55.7%). One third of the pregnant women (32.6%) reported emotional or physical violence, and 13% were classified as abusing or addicted to tobacco according to ASSIST. History of psychiatric diseases was associated with depression (p = 0.005). Violence during life demonstrated a modest association (p = 0.073) with depression, as well as the number of miscarriages (p = 0.071). Conclusion Depression is a frequent disease among pregnant women with recurrent miscarriages. The results of this investigation suggest that a systematic assessment of depression and its associated conditions, such as domestic violence and the use of substances, should be part of the prenatal follow-up visits for women with recurrent miscarriages.

A Survey on the Prevalence of Depression in Blood Donors with Hepatitis C in Shiraz.

BackgroundDepression is the most common psychiatric disorder associated with hepatitis C.ObjectivesThis study aimed to survey the prevalence rate of depression in patients with Hepatitis C Virus (HCV) before they were aware of their HCV test result.MethodsThis cross-sectional study was conducted on all blood donors with confirmed positive HCV test results who donated blood between March 21, 2012 to March 21, 2013 at Fars blood transfusion center in Iran as case group and age- and sex-matched blood donors with negative screening test results as control group. A semi-structured interview based on DSM IV-TR depressive disorder criteria and Beck depression inventory (BDI) was conducted. BDI contained 21 items, each scored from 0 to 3 and total score of 0 to 63 for the whole scale computed by summing up all the items. A cut-off score of ≥ 19 indicated clinically significant depressive symptoms. The prevalence rate and risk factors of depression were determined.ResultsThe most frequent risk factors for HCV infection were intravenous drug abuse (59.3%), unsafe sexual contact (30.5%), and history of being imprisoned (25.4%). The prevalence rate of depression in the HCV group was 55.9 % (95% CI: 42.99% - 68.87%) that was significantly higher than the corresponding rate of the control group as 17.7 % ( 95% CI: 8.49% - 28.79%) (P < 0.001). The severity of depression was also more in the HCV group (P < 0.001). Besides, the prevalence rate of depression was higher among HCV patients with lower education level, previous history of drug abuse, unsafe sexual contact, and previous history of psychiatric diseases. The prevalence rate of depression was higher in the case group even after adjusting for other variables.ConclusionsOur study underlined the remarkable prevalence of depression among HCV patients. Therefore, designing depression screening tests is suggested to help such patients before starting the treatment.

Risk factors for postoperative delirium after colorectal operation

A clear understanding of risk factors for postoperative delirium helps in the selection of individuals who might benefit from targeted perioperative intervention. The aim of this study was to identify risk factors for postoperative delirium after colorectal operation for malignancy. All consecutive patients who underwent elective or emergency operation because of malignancy of the colon, sigmoid, or rectum between 2009 and 2012 were included in this study. Potential risk factors for postoperative delirium were selected based on previous studies. These candidate factors were analyzed using univariate and multivariate logistic regression analysis. Based on this analysis, odds ratios and 95% confidence intervals were estimated. A total of 436 patients underwent an oncologic resection of the colon, sigmoid, or rectum. Postoperative delirium was observed in 45 (10.3%) patients. Patients with a delirium had a greater in-hospital mortality rate (8.9% vs 3.6%, P=.09), spent more days in the intensive care unit, and had a longer total hospital stay. Variables associated with postoperative delirium in univariate analyses were age, American Society of Anesthesiologists classification, blood transfusion, history of psychiatric disease, history of cerebrovascular disease, postoperative pain management, postoperative renal impairment, C-reactive protein levels, leukocyte blood count, and postoperative complications. Independent risk factors were history of psychiatric disease (odds ratio 8.38, 95% confidence interval: 1.50-46.82), age (odds ratio 4.01, 95% confidence interval; 1.55-10.37), and perioperative blood transfusion (odds ratio 2.37, 95% confidence interval; 1.11-5.06). This study shows that postoperative delirium is a frequently encountered complication after colorectal operation. Three independent risk factors for postoperative delirium were identified (history of psychiatric disease, age, and perioperative transfusion) that may contribute to risk estimation in this patient population.

Asthma-related deaths

Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthma deaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide

Associations of Serum Cytokine Receptor Levels with Melancholia, Staging of Illness, Depressive and Manic Phases, and Severity of Depression in Bipolar Disorder.

To examine cytokine receptor biomarkers in bipolar disorder (BD), we recruited 133 well-phenotyped BD patients and 50 normal controls and measured serum levels of soluble interleukin 1 receptor antagonist (sIL-1RA), soluble interleukin-2 receptor (sIL-2R), sIL-6R, and tumor necrosis factor receptor 60 and 80kDa (sTNFR60/80). sIL-1RA and sTNFR80 are significantly higher in BD than in controls and sTNFR80 and higher in melancholic than in non-melancholic patients and controls. Kapczinski's stages 3 + 4 are characterized by lowered sIL-2R and increased sTNFR80 levels. Acute phase depression is characterized by increased sTNFR80 levels as compared with controls, manic, and euthymic patients. Both sTNFR60 and sTNFR80 levels are significantly and positively related with severity of depression but not mania. Logistic regression analysis showed that the significant predictors for BD are increased sIL-1RA levels, nicotine dependence and a family history of depression and alcoholism. The risk factors for stages 3 + 4 are lowered sIL-2R levels and nicotine dependence. Melancholia is predicted by higher sTNFR80 levels and female sex. Severity of depression is predicted by female sex, nicotine dependence, and increased sTNFR60 and sTNFR80 levels. Cell-mediated immunity is activated during a current episode of depression but not (hypo)mania or the euthymic state. There are no associations between the biomarkers and age at onset, duration of illness, severity of mania, bipolar (BP)2 or BP1 subtypes, rapid cycling, atypical depression, psychotic or suicidal symptoms, and a family history of psychiatric disease. The results show that increased sIL-1RA may be a trait marker of BD, increased sTNFR80 a state marker of the depressive phase, especially melancholia, while lower sIL-2R but higher sTNFR80 may be staging biomarkers.

Dopa-testotoxicosis: disruptive hypersexuality in hypogonadal men with prolactinomas treated with dopamine agonists.

Dopamine agonists are the first line of therapy for prolactinomas, with high rates of biochemical control and tumour shrinkage. Toxicity is considered to be low and manageable by switching of agents and dose reduction. Dopamine agonist-induced impulse control disorders are well described in the neurology setting, but further data are required regarding this toxicity in prolactinoma patients. We performed a multicenter retrospective cohort study of eight men with prolactinomas and associated central hypogonadism. The eight men had no prior history of psychiatric disease, but each developed disruptive hypersexuality whilst on dopamine agonist therapy at various doses. Cabergoline, bromocriptine and quinagolide were all implicated. Hypersexuality had manifold consequences, including relationship discord, financial loss, reduced work performance, and illicit activity. We hypothesise that this phenomenon is due to synergy between reward pathway stimulation by dopamine agonists, together with rapid restoration of the eugonadal state after prolonged hypogonadism. We refer here to this distinct drug toxicity as 'dopa-testotoxicosis'. Given the profound impact in these patients and their families, cessation of dopamine agonists should be considered in men who develop hypersexuality, and pituitary surgery may be required to facilitate this. Awareness of this distinct impulse control disorder should enable further research into the prevalence, natural history and management of dopa-testotoxicosis. The condition is likely under-reported due to the highly personal nature of the symptoms and we suggest a simple written questionnaire to screen for hypersexuality and other behavioural symptoms within the first six months of dopamine agonist treatment.

Syndrome dépressif et absentéisme chez le personnel soignant de la région de Sousse (Tunisie)

Depression in the workplace is becoming more common. It is responsible for the upsurge in long-term sick leave. Its prevention requires the improvement of working conditions and the management of burnout. Health workers, faced with suffering, illness, death are subject to significant mental workload. Some authors believe that the mental workload is multiplied by 2–7 among hospital staff. Physical and nervous overload is expressed by psychosomatic and neuropsychiatric manifestations. We conducted a work aimed to study the interactions between depression and professional activity among health care workers in the Governorate of Sousse, Tunisia during five years from 1 January 2009 until 31 December 2013. Data was collected from medical and administrative records accessed at the Regional Commission of long-term sick leave in Sousse. Concerned patients were invited to answer additional questions during consultation. We have attempted to identify the socio-professional characteristics of absentees, and to determine the possible role of working conditions in the decompensation of depression in order to establish preventive measures. Our work is a retrospective descriptive study which surveyed 204 health workers who have obtained a long-term sick leave for depressive syndrome during the study period. The prevalence of absenteeism was estimated to 4.45%. Some employees have submitted more than one sick leave, which raises the number of sick leaves to 768 during the study period. The study population is relatively young, with about 50.9% of absentees aged between 50 and 59 years. A female predominance was noted (77.9% of absentees). Our population was composed mainly of married employees (79.9%) which had, in 88.7% of cases, at least one dependent child. Older paramedics were more affected than any other occupational group. The most affected services were, in descending order, medical, gynecological and obstetric services, administrative services, emergency services, outpatient and finally pediatric services. Most common medical affections were hypertension, diabetes, cancer and rheumatic diseases. Personal history of psychiatric diseases was mentioned by 38% of cases. As pointed by many authors, healthcare workers commonly relate the genesis of their psychiatric disorder to socio-professional conditions. Physical load was declared by 46.1% of cases and metal overload was described by 27.9% of questioned workers. Other common stressing situation was the permanent contact with patients and/or their family. Conflictual relationship with colleagues and/or superiors was declared by 17.6% of cases. It appears from our study that 10.8% of absent for depressive syndrome feel insecure in their work. This feeling seems to be more pronounced in recent years after the revolution in Tunisia (2011). Indeed, the rate of violence against care workers has tripled after the revolution. The most important consequence of this disease is long-term absenteeism which has an expensive cost expressed by economic and social outcomes. In our survey, we found that the absenteeism was 21.57% with 80,327 lost working days which is pretty near to 44 years lost per year of work during the of study period. The analysis of our results showed that the absenteeism indicators are very high and it is urgent to have a real plan of action. This plan primarily affects prevention. The management of depression in the workplace requires a multidisciplinary intervention and better coordination between occupational physician and psychiatrist or psychologist.

Darier disease in Israel: combined evaluation of genetic and neuropsychiatric aspects.

Darier disease (DD) is a rare genodermatosis caused by heterozygous mutations in the ATP2A2 gene. It has been associated with neuropsychiatric manifestations. To investigate the genetic basis of Israeli patients with DD, and its association with the neuropsychiatric phenotype. A cohort of 32 families comprising 74 affected individuals and 13 unaffected family members was recruited from the Haemek Dermatology Department and other dermatology clinics in Israel. The individuals were evaluated by detailed questionnaires, physical examination and genetic analysis. The main outcome measures were genetic mutations, psychiatric profile and their association. Twenty-three mutations in ATP2A2 were scattered over the entire gene, 14 of them novel. Two families shared the same mutation. Twenty-one patients (28%) had a history of psychiatric disorders, most of them mood disorders. Another seven patients (9%) were highly suspected of having a psychiatric disorder; 21 (28%) reported suicidal thoughts and five (7%) had attempted suicide. The psychiatric phenotype demonstrated inter- and intrafamilial variability, and was not associated with disease severity, family history of psychiatric disease or mutation location. The cohort demonstrated genetic heterogeneity with no mutation cluster along the gene, and a high prevalence of psychiatric disorders. Although no clear genotype-phenotype correlation was found, the results point to a major effect of genetic background on psychiatric phenotype, together with other modifiers.

Increased urinary 6-hydroxymelatoninsulfate levels in attention deficit hyperactivity disorder diagnosed children and adolescent

There are some studies in attention deficit hyperactivity disorder (ADHD) which note altered circadian rhythms, suggesting abnormalities in melatonin physiology. In order to better characterize the possible melatonin alteration in ADHD, in this study we aimed to detect daytime, nighttime and 24h levels of 6-hydroxymelatoninsulfate (6-OH MS) in the patients diagnosed with ADHD. Twenty-seven patients between 6 and 16 years-old, who had been diagnosed initially with ADHD, but without other physical and psychiatric disease history and who had not taken psychotropic pharmacotherapy for six months, plus 28 healthy volunteer controls, were included in the study. Urine samples were collected during the whole 24h cycle, daytime and nighttime separately to assess the time-dependent excretion of the 6-OH MS, which is the main urine metabolite of melatonin. The Enzyme-Linked Immunosorbent Assay (ELISA) method was used for measuring the urine 6-OH MS level. Daytime (15.4 (8.9–24.8) ng/ml vs 6.9 (2.5–15.9) ng/ml, p=0.002), nighttime (102.9 (65.3–197.7) ng/ml vs 61.5 (37.2–114.4) ng/ml, p=0.012) and 24h (54.1 (34.6–83.9) ng/ml vs 27.3 (14.3–48.9) ng/ml, p=0.000) 6-OH MS levels median (25p–75p) were found to be significantly higher in the ADHD group. After adjustment for age and sex, there was a statistically significant difference between the ADHD group (59.8±4.9) and control group (33.8±4.8) in 24-h 6-OH MS levels (F(1, 51)=13.673, p=.001, partial η2=.211). There was no relationship between 6-OH MS levels and Conners Parent Rating Scale short form subscale scores for the ADHD group. These findings indicate that melatonin production is increased in ADHD cases. Further research is needed to determine and thereby understand the mechanisms underlying the higher melatonin production, to assess the impact of altered melatonin on the pathophysiology of ADHD.

Do social determinants of health affect postpartum depression?

Objective: The aim of this study was to determine the incidence of postpartum depression and the risk factors that may play role in arising of it, at 16 family health centers in Kars. Methods: 409 women from 4 medical centre (total 16 family health centers) in central Kars were taken to the study, who aplied to their family health centers between the dates of 27.03.2015- 24.12.2015 and had 0-12 month-old babies, and accepted to participate in the study. 2 questionnaires was used for the resarch; the first questionnaire was to determine the mothers’ and their families’ sociodemografic, socioeconomic, biodemografic features, health status, and health service usage, and the second was Edinburgh Postpartum Depression Scale (EPPDS). The cut-off point was taken 12 for EPPDS. Results: The incidence of PPD has been found to be 24.9% in this study. In binary analyses, maternal age, level of education, place of residence, form of marriage, father’s job, mother’s working status, home’s income level, number of living children, delivery place, history of psychiatric disease in women are found statistically significant for PPD; in logistic regretion analysis, place of residence, form of marriage, mother’s job, home’s income level and history of psychiatric disease are determined as risk factors for PPD. Conclusion: It has been concluded to be essential that it must be increased the awareness of primary health care providers about determined risk factors, ensured the actively usage of postpartum care management guide, increased the health literacy about PPD of health care users, ensured the cooperation between sectors for multisectoral approach, and made studies to represent the city.

Alexithymia levels in patients with unipolar and bipolar depression and the effect of alexithymia on both severity of depression symptoms and quality of life

Objective: Aims of this study are to compare the alexithymia scores of patients with unipolar depression (UD), bipolar affective disorder depressive episode (BAD-D) and healthy controls, to explore the effects of alexithymia scores on both severity of depression symptoms and quality of life. Methods: Case group of the study is consisted of one hundred and eighteen UD diagnosed, forty eight BAD-depression diagnosed patients, based on DSM-IV-TR criteria. Control group of the study is consisted of ninety six people who had no history of psychiatric disease. Overall, 262 people had involved in the study. Sociodemographic and Clinical Data Form, Hamilton Rating Scale for Depression (HRDS), Beck Depression Inventory (BDI), Toronto Alexithymia Scale (TAS-20) and SF-36 Quality of Life Scale are used for acquiring information of the patients. Results: Mean of age, gender, marital status, place for living, level of income of UD, BAD-D and control groups were similar. Statistically significant differences were observed in between UD, BAD-D and control groups, in terms of HRDS, TAS-20 and SF-36 scores. Mean group scores of UD and BAD-D group were higher than controls, in terms of all scales. However, mean points of UD and BAD-D groups were similar in terms of four scales. Patients with UD and BAD-D had positive relationship with TAS-20, BRDS and BDI; negative relationship between SF-36, significantly. In conclusion, it is found that alexithymia scores of UD and BAD-D groups were higher; quality of life scores were lower than controls. It is also observed that patients with higher alexithymia scores have more severe depressive symptoms and having a less sense of quality of life. Although our findings indicate that presence of alexithymia is important in depressive disorders, however no difference were found between alexithymia scores in patients with UD and BAD-D. Discussion: Alexithymia scores of all groups had positively related with depression, negatively related with quality of life. Our findings showed that, alexithymia is an important factor to the diagnosis of depressive disorders, however alexithymia is not a marker to make differential diagnosis of BAD-D and UD.

The Risk Factors of Readmission in Postoperative Gynecologic Oncology Patients at a Single Institution.

Hospital readmission rates are an important measure of quality care and have recently been tied to reimbursement. This study seeks to identify the risk factors for postoperative readmission in patients treated by a gynecologic oncology service. A 7-year retrospective review (2007-2013) of all patients operated on by the University of Virginia gynecologic oncology service who were readmitted within 30 days of discharge was performed. Abstracted data included demographics, dates of surgery, operative details, cancer history, and relevant medical history. The readmitted patients (n = 166) were compared with randomly selected controls (n = 168) from the same service in a matching time frame and analyzed using univariate and multivariate models. In the study period, 2993 operations were performed. One hundred sixty-six unique patients (5.5%) were readmitted within 30 days of discharge from their operative procedure. On multivariate analysis, the factors that were associated with a higher risk of readmission were a history of psychiatric disease, postoperative complication, type of insurance, surgical modality, and lysis of adhesions at the time of surgery. The most common readmission diagnoses were infection (44%), nausea/vomiting (28%), thrombosis (6%), bowel leak (4%), and bleeding (4%). Postoperative readmissions are a common problem and are increasingly important as a measure of quality. Although patients were generally admitted for infections or gastrointestinal complaints, we also found that individual factors such as mental health and socioeconomic status also contributed. Our data suggest that we can preoperatively identify high-risk individuals for whom extra resources can be directed postoperatively to avoid unnecessary readmissions.

Identification of hypertensive patients with dominant affective temperaments might improve the psychopathological and cardiovascular risk stratification: a pilot, case–control study

BackgroundAlthough mood disorders and cardiovascular diseases have widely studied psychosomatic connections, data concerning the influence of the psychopathologically important affective temperaments in hypertension are scarce. To define a possibly higher cardiovascular risk subpopulation we investigated in well-treated hypertensive patients with dominant affective temperaments (DOM) and in well-treated hypertensive patients without dominant temperaments the level of depression and anxiety, arterial stiffness and serum Brain-derived Neurotrophic Factor (seBDNF).Methods175 hypertensive patients, free of the history of psychiatric diseases, completed the TEMPS-A, Beck Depression Inventory and Hamilton Anxiety Scale questionnaires in two primary care practices. Of those 175 patients, 24 DOM patients and 24 hypertensive controls (matched in age, sex and the presence of diabetes) were selected for measurements of arterial stiffness and seBDNF level.ResultsBeck and Hamilton scores in DOM patients were higher compared with controls. Pulse wave velocity and augmentation index did not differ between the groups while in the DOM patients decreased brachial systolic and diastolic and central diastolic blood pressures were found compared with controls. SeBDNF was lower in the DOM group than in the controls (22.4 ± 7.2 vs. 27.3 ± 7.8 ng/mL, p < 0.05).ConclusionsAlthough similar arterial stiffness parameters were found in DOM patients, their increased depression and anxiety scores, the decreased brachial and central diastolic blood pressures as well as the decreased seBDNF might refer to their higher vulnerability regarding the development not only of major mood disorders, but also of cardiovascular complications. These data suggest that the evaluation of affective temperaments should get more attention both with regard to psychopathology and cardiovascular health management.