Past History Of Depression Research Articles

Psychosocial predictors of salivary cortisol among older adults with depression.

ABSTRACT Background: Previous studies have identified a number of psychosocial risk factors of dysregulated cortisol (frequently referred to as the "stress hormone") among older adults with depression. However, these studies have typically only examined a handful of risk factors at a time and have sometimes yielded inconsistent results. Method: This study aims to address this gap in the literature by simultaneously examining a range of relevant psychosocial predictors of diurnal cortisol among 54 older adults with a depressive disorder. Salivary cortisol was assessed upon awakening, at 5 PM, and at 9 PM across two consecutive days. Participants also completed measures of global psychosocial stress, current psychiatric symptomatology, pervasive distress (e.g. history of past depression), and protective factors (e.g. social support, resiliency, extent to which one has "made sense" of a significant stressor). Results: High levels of current depressive symptoms, psychiatric comorbidities, past depressive episodes, trait anxiety, and poorer ability to make sense of one's stress were found to be associated with flatter (more abnormal) cortisol slopes. However, when all of these variables were entered simultaneously in a multiple regression analysis, only history of past depression and the degree of sense made of stress emerged as unique predictors of cortisol in the model. Conclusions: These findings have important implications for identifying depressed elderly individuals with dysregulated cortisol patterns who may be most at risk for health complications. Treatments that aim to limit the chronicity of depression and help to increase the sense made of stress could potentially have a positive impact on health.

Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

BackgroundThis study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong.MethodsA cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management.Results10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ≤34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ≥ two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ≥35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice.In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor.ConclusionAbout one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications.

Risk factors associated with trajectories of mothers’ depressive symptoms across the early parenting period: an Australian population-based longitudinal study

Approximately 14% of women experience depressive symptoms in the first postnatal year. Few studies have examined the persistence of symptoms beyond this time. This study aims to (a) assess the course of women's depressive symptoms from the first postnatal year to when their children were aged 6-7years, (b) identify distinct groups of women defined by their symptom trajectories over time, and (c) identify antenatal and early postnatal risk factors associated with persistent symptoms. Data from 4,879 women participating in the Longitudinal Study of Australian Children were analysed using latent growth modelling and logistic regression to identify risk factors associated with class membership. For the overall sample, depressive symptoms were highest during the first postnatal year and then gradually decreased over 6-7years. Two distinct classes were identified with the majority of women (84%) reporting minimal symptoms over time, and 16% experiencing persistently high symptoms. Risk factors were younger maternal age, being from a non-English speaking background, not completing high school, having a past history of depression, antidepressant use during pregnancy, child development problems, lower parenting self-efficacy, poor relationship quality, and stressful life events. This research identifies risk factors that may predispose mothers to enduring depressive symptoms, offering opportunities for early identification and targeted early intervention.

A case–control study regarding relative factors for behavioural and psychological symptoms of dementia at a Canadian regional long‐term extended care facility: a preliminary report

Behavioural and psychological symptoms of dementia (BPSD) are prevalent and have an impact on the care of persons with dementia. Previous studies regarding predisposing factors have included pharmacotherapy, but other factors may not have been sufficiently studied. We hypothesized that psychotropic medications, past history, comorbid psychiatric disorders and other factors may be relevant factors related to BPSD. Data were collected from patients' medical charts at an extended care facility over a 2-year period from 1 May 2008 to 30 April 2010. Information obtained included the presence of BPSD, gender, age, marital status, past history, comorbid psychiatric disorder and medication use. Patients were divided into two groups: a group with BPSD (n = 29) and a group without BPSD (n = 10). A binomial logistic regression analysis was performed for the above factors. Comorbid major depression was linked to BPSD (odds ratio = 12.57, 95% confidence interval: 1.31-120.74) as well as to the use of antidepressants (odds ratio = 6.49, 95% confidence interval: 1.02-41.25). There was a trend towards statistical significance in the relationship between greater use of antidepressants for the patients with comorbid major depression and the presence of BPSD. Past history of depression (Fisher's exact test; P = 0.03) and cerebral vascular accident (degrees of freedom = 1, χ(2) = 4.44, P = 0.04) were linked to the presence of BPSD and comorbid major depression. Accurate evaluation and treatment of comorbid major depression may affect BPSD. In order to reduce the burden of BPSD on patients and caregivers, there should be a careful and thoughtful diagnosis of comorbid major depression in patients with dementia.

Is postpartum depression a homogenous disorder: time of onset, severity, symptoms and hopelessness in relation to the course of depression

Postpartum depression (PPD) is a common illness, but due to the underlying processes and the diversity of symptoms, some variability is exhibited. The risk of postpartum depression is great if the mother has previously suffered from depression, but there is some evidence that a certain subgroup of women only experience depression during the postpartum period. The study group consisted of 104 mothers with postpartum major depression and a control group of 104 postpartum mothers without depression. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used for data collection. The severity of depression and other mental symptoms were assessed using several validated rating scales. A history of past depression (82%), including depression during pregnancy (42%) and during the postpartum period (53%), was very common in those with current PPD. Eighteen per cent of mothers with current PPD had previously not had any depressive episodes and four per cent had experienced depression only during the postpartum period. Therefore, pure PPD was rare. The onset of PPD was usually (84%) within six weeks of childbirth. Obsessive-compulsive symptoms, phobic anxiety, paranoid ideation, depressed mood, diminished pleasure/interest, decreased energy, and psychomotor agitation/retardation were common with all kinds of depression histories. Pure PPD was the most similar to the first depressive episode. Nevertheless, the severity of depression, the level of hopelessness, somatisation, interpersonal sensitivity, anxiety, hostility, psychoticism, sleep disturbance, and suicidal ideation were lower, appetite changed less, and concentration was better than in other recurrent depressions. According to this study, PPD is not a homogenous disorder. The time of onset, severity, symptoms, level of hopelessness, and the course of depression vary. Recurrent depression is common. All mothers must be screened during the sixth week postpartum at the latest. Screening alone is not effective; it is also important to give mothers information about PPD and to discuss the symptoms with them in order for them to recognise this disorder and possible new episodes in the future.

Incidence and evaluation of factors contributing towards postpartum depression

<b>Background:</b> Pregnancy and childbirth produce a variety of physiological, psychological and social consequences. Attitudes toward pregnancy and childbirth vary from culture to culture. There is evidence to suggest mothers with young infants experience depressive symptoms and 10-15% major depression. <b>Aim:</b> To study the incidence and factors contributing toward postpartum depression <b>Materials and Methods:</b> Married women 18-35 years of age attending the antenatal and postnatal out-patient clinic were studied during 2007 and January 2008. 200 women who had delivered between 1 June 2007 and 1 January 2008 were included in the postpartum phase to calculate the incidence of postpartum depression. The prospective mothers were approached in their 3 ^rd trimester of pregnancy. Critically ill, past history of depression, co morbid medical or psychiatric illnesses were excluded. The diagnosis of postpartum depression (PPD) was made as per international classification of diseases (ICD 10). They were administered the beck depression inventory (BDI), Presumptive stressful life event scale, Edinburgh Postnatal Depression Scale (EPDS) and General Health Questionnaire (GHQ-12) scale. The women were subsequently reviewed in their postpartum phase in the postnatal out-patient/child immunization clinic at 2, 4 and 6 weeks after delivery. The non-depressed mothers acted as the controls. <b>Results:</b> A Total of 186 women out of 200 registered for the study 40 had scores above 13 on EPDS and grouped as depressive met ICD 10 diagnostic criteria. The remaining 146 were non depressive. 14 women dropped out of the study. Incidence of PPD was 21.51%. The study found 14/27 (51.8%) of the risk factors associated with PPDs were statistically significant. Significant number of mothers had high antenatal GHQ and both antenatal and postnatal BDI scores. BDI and EPDS scores remained high during the postnatal follow-up in the depressed group, which showed the presence of PPD in mothers with young infants. <b>Conclusions:</b> There is a need for sensitizing primary health-care givers regarding PPD and is an important health issue that should not be ignored.

Participating in online mental health interventions: who is most likely to sign up and why?

Internet-based interventions are increasingly recognized as effective in the treatment and prevention of mental disorders. However, little research has investigated who is most likely to participate in intervention trials. This study examined the characteristics of individuals interested in participating in an online intervention to improve emotional well-being and prevent or reduce the symptoms of depression, factors reported to encourage or discourage participation, and preferences for different intervention types. The study comprised 4761 Australians participating in a survey on emotional health. Comparisons are made between those who expressed an interest in participating in the trial and those who were not. Compared to those who declined to participate, interested participants were more likely older, females, separated/divorced, and highly educated, have reported current or past history of depression, report higher depressive symptoms, and have low personal stigma. Despite the flexibility of online interventions, finding time to participate was the major barrier to engagement. Financial compensation was the most commonly suggested strategy for encouraging participation. An increased understanding of factors associated with nonparticipation may inform the design of future e-mental health intervention trials. Importantly, consideration needs to be given to the competing time pressures of potential participants, in balance with the desired study design.

Angiotensin-converting enzyme gene variants are associated with both cortisol secretion and late-life depression

Angiotensin-converting enzyme (ACE) is assumed to influence the activity of the hypothalamic–pituitary–adrenocortical (HPA) axis, which shows hyperactivity in depressed patients. ACE could thus be a promising candidate gene for late-life depression but this has not been examined previously. Depression was assessed in 1005 persons aged at least 65 years, at baseline and over the 10-year follow-up. A clinical level of depression (DEP) was defined as having a score of ⩾16 on the Centre for Epidemiology Studies-Depression scale or a diagnosis of current major depression based on the Mini International Neuropsychiatric Interview and according to DSM-IV criteria. Seven single-nucleotide polymorphisms (SNPs) in the ACE gene were genotyped and diurnal cortisol secretion, as an index of HPA axis activity, was measured. Multivariable analyses were adjusted for socio-demographic and vascular factors, cognitive impairment, and apolipoprotein E. Strong significant associations were found between all seven SNPs and DEP and, in particular, first-onset DEP in persons without a past history of depression (P-values ranging from 0.005 to 0.0004). These associations remained significant after correction for multiple testing. The genotypes that were associated with an increased risk of DEP were also significantly associated with an increase in cortisol secretion under stress conditions. Variants of the ACE gene influence cortisol secretion and appear as susceptibility factors for late-life depression in the elderly population. Whether this could represent a common pathophysiological mechanism linking HPA axis and late-life depression remains to be explored.

HDL cholesterol and the risk of depression over 5 years

[Extract] Abnormalities in lipid metabolism have been associated with prevalent depression and suicide behaviour, with low concentration of plasma high-density lipoprotein (HDL) cholesterol being consistently linked to depression.1 As most studies that have investigated this association have had a cross-sectional design, reverse causality and confounding could plausibly explain their findings. This prospective study sought to determine whether the plasma concentration of lipids, and more specifically of HDL cholesterol, was associated with increased risk of depression 5 years later, independent of cardiovascular diseases, diabetes, body mass, lifestyle factors and history of past depression.

Methamphetamine-related Psychiatric Visits to an Urban Academic Emergency Department: An Observational Study

BackgroundMethamphetamine, a stimulant of abuse, is associated with a significant number of Emergency Department (ED) visits. Methamphetamine use may produce psychiatric symptoms including acute psychosis, depression, and anxiety disorders. Study ObjectivesTo characterize psychiatric emergencies either directly or indirectly attributable to methamphetamine use in an urban academic ED. MethodsWe analyzed a database of patients determined to have an ED visit that was either methamphetamine related or non-methamphetamine related. We retrospectively reviewed the records of the subset of ED visits from this database with psychiatric diagnoses. We compared the characteristics of patients with methamphetamine-related psychiatric visits (MRPVs) and non-methamphetamine-related psychiatric visits (non-MRPVs). ResultsWe identified 130 patients with MRPVs. This represented 7.6% (130 of 1709) of all psychiatric visits. Patients with MRPV, compared to non-MRPV patients, were younger (34.4 years vs. 39.1 years, respectively, p = 0.0005), more likely to be uninsured (55% vs. 37%, respectively, p = 0.001), and less likely to have a past history of depression (10% vs. 19%, respectively, p = 0.011). Many characteristics between the two groups (MRPV vs. non-MRPV) were similar: likelihood of patient being placed on a psychiatric hold; hospital charges; previous histories of psychiatric visits; and history of anxiety, bipolar disorder, or schizophrenia. ConclusionsMethamphetamine may be related to a significant proportion (7.6%) of psychiatric ED visits. Furthermore, patients with methamphetamine-associated psychiatric visits are younger, have lower rates of depression, are more likely to be uninsured, and are less likely to have a substance abuse-related chief complaint than patients with non-methamphetamine-associated ED psychiatric visits.

The association of psychosocial factors and obstetric history with depression in pregnant women: focus on the role of emotional support

ObjectiveDepression during pregnancy can negatively affect both maternal and fetal health. The benefits of early detection and treatment for antenatal depression have been emphasized. Therefore, we investigated risk factors for antenatal depression with a focus on emotional support. MethodsWe conducted a cross-sectional study of pregnant women (n=1262) enrolled from the local division of a community mental health center. All subjects completed self-report questionnaires that assessed depressive mood, emotional support and other risk factors. Associations between antenatal depression and potential risk factors including emotional support were analyzed by logistic regression analysis. ResultsAntenatal depression was associated with various biopsychosocial correlates: unmarried state, low education, cigarette smoking, low income, familial history of depression, past history of depression, physical abuse history, sexual abuse history, premenstrual syndrome, primiparity and unplanned pregnancy. When the associations of emotional support with antenatal depression were specified by its resources, current emotional support from partner [odds ratio (OR)=2.26, 95% confidence interval (CI)=1.94–2.64] and mother (OR=1.43, 95% CI=1.26–1.62) and past experience for emotional support from mother (OR=1.52, 95% CI=1.32–1.74), but not from father significantly influenced depression during pregnancy. ConclusionsThe multidimensional biopsychosocial approach would be needed to identify and assess antenatal depression. Promoting emotional support from the partner, family member and, possibly, the health provider could be a protective effect against the development of antenatal depression.

Participation in productive activities and depression among older Europeans: Survey of Health, Ageing and Retirement in Europe (SHARE)

Although engagement in productive activities is associated with favourable outcomes with respect to the health and well-being of older individuals, the association between such activities and depression in older populations remains relatively unexplored. The purpose of this study was to evaluate the association among five productive activities (paid work, formal volunteering, caregiving, informal helping and caring for grandchildren) with depression in older adults in 14 European countries. This cross-sectional study used the first two waves of data collected by the Survey of Health, Ageing and Retirement in Europe and analysed a total sample of 7238 relatively healthy community residents aged 60 years and older from 14 European countries. The Survey of Health, Ageing and Retirement in Europe excluded potential participants with a past history of depression, cognitive impairment and physical limitations. Depression was categorised using the EURO-D instrument, and associations with participating in productive activities were investigated. Depression was less prevalent among those individuals who were employed or self-employed and those who participated in formal volunteering or informal helping, whereas caregiving was associated with a higher risk of depression. Caring for grandchildren was not associated positively or negatively with depression. Formal volunteering and caregiving remained associated with depression after adjustment for age, sex, marital status, education, economic status, country and presence of long-term illness. Availability of formal volunteering may be important in reducing depression risk, whereas caregiving is associated with a higher risk of depression in older European adults. Further research is required to clarify the direction of causation and evaluate interventions.

Predictors of Treatments Acceptable to Patients for Late-Life Depression

Objectives. Describe older patients' perceptions about depression and characteristics associated with acceptance of treatments. Design. Cross-sectional study. Setting. Three primary care clinics in Iowa. Participants. Consecutive sample of 529 primary care patients. Measurements. Depression screening tool (a 9-item patient health questionnaire [PHQ-9]) and questionnaire including sociodemographic data, patient attitudes about depression, and acceptability of different treatments. Results. Mean age was 71.9 years (range 60–93 years), 314 (59%) female. Among the 529 participants, 93 (17.5%) had history of depression and 60 (11.3%) had PHQ-9 scores of 10 or greater. Participants believed depression is a disease for which they would use medication and counseling. Accepting medications from primary physicians was strongly associated with a past history of depression (P < 0.01) and with agreeing that depression needs treatment (P < 0.01). Counseling was not acceptable for those believing that they can control depression on their own (P < 0.01). Older patients (P < 0.001) and those with higher education levels (P < 0.01) were less likely to accept herbs or supplements as treatment options. Willingness to discuss treatments with family was associated with not using alcohol as a treatment and acceptance of all other treatment options (P < 0.001). Conclusions. Attitude that depression is a disease and the willingness to discuss depression with family may enhance treatment acceptance.

Developing a comprehensive smoking cessation program in patients with lung cancer: The role of social smoking environments.

75 Background: Smoking during cancer treatment negatively impacts outcome, survival, and quality of life. Social smoking environments (SSEs) (i.e., smoking in household, peers, and spouse) influence cessation rates in non-cancer patients, but are understudied in cancer patients. Methods: Lung cancer patients, recruited from Princess Margaret Hospital (2006-2012) were given baseline and follow-up questionnaires (median of 2 years apart) evaluating changes in smoking habits and SSEs. Multivariate logistic regression and Cox-proportional hazard models evaluated the association of socio-demographics, clinicopathological and SSE factors with smoking cessation and time to quitting, respectively. Results: 721 patients completed both questionnaires. Of the 261 current smokers at diagnosis, 180 (69%) had quit by follow-up. Among 318 ex-smokers, 5 re-started smoking after diagnosis. All of the 140 never smokers remained non-smoking. Home smoke exposure (OR=9.4; 95% CI: 3.4-26.2; p=2.0 x 10E-5), spousal smoking (OR=4.7, 95% CI:1.7-12.6; p=3.0 x 10E-3) and peer smoking (OR=2.6; 95% CI:1.1-6.1; p=0.03) were each associated with reduced cessation, adjusted for a base multivariate model that included education and past history of depression. Individuals with no SSE factors had a much higher chance of quitting smoking when compared to patients with multiple areas of SSEs (0 vs. 3, OR=16.4; 95% CI: 4.1-66.7; p=7.3 x 10E-5). Similar results were seen when using time-to-quitting as the outcome (0 vs 3, OR=4.4, 95% CI=1.4-14.1, p=0.01). Time to quitting analysis found that 60% of patients with at least one SSE who did quit, did so within 6 months of diagnosis. Subgroup analysis revealed similar associations in early- and late-stage patient groups. Conclusions: SSE is a key factor in smoking cessation, where household smoke exposures reduces the chance of quitting up to 9-fold. SSEs should be a key consideration when developing smoking cessation programs in lung cancer patients, as part of quality improvement strategies. Approaches incorporating household members or spouses into the smoking cessation intervention, around the time of diagnosis, should be researched further. GL and WX are co-senior authors.

What predicts persistent depression in older adults across Europe? Utility of clinical and neuropsychological predictors from the SHARE study

BackgroundDepression in later life frequently persists and perpetuating factors are of immediate therapeutic relevance to clinicians. No studies of this scale have examined both clinical and neuropsychological predictors of persistent depression in a cross-national European context. Methods4095 community dwelling older adults (≥50yr) with clinically signficant depression (EURO-D≥4) from eleven European countries in the Survey of Heath, Ageing, and Retirement in Europe (SHARE) were followed for a median of 28 months. Logistic regression analyses were conducted to determine predictors of persistent depression. Results2187 (53.4%) remained depressed at follow up. Independent predictors included: female gender, baseline functional impairment, functional decline, physical symptoms, past history of depression, increased severity of depression, early age of onset (<50yr), life events, financial distress and country of residence. Neuropsychological variables were associated with persistent depression but not independently of other variables. LimitationsThe assessment of depression was by self-report and the data source did not contain a number of potentially relevant predictors. ConclusionIndividuals at risk of persistent depression may be identified and targeted for intervention. Therapeutic interventions should adopt a multimodal approach to optimise current function, prevent further functional decline and treat symptoms of depression. Country of residence may be associated with further modifiable variables.

Manic Episode Associated With Clarithromycin in a Patient With Medically Treated Depression

To the Editor: Antibiotic-induced mania, or antibiomania, is an uncommon cause of manic episodes.1 Clarithromycin is one of the most frequently implicated antibiotics.1 Here, a case of clarithromycin-associated mania in a patient with medically treated depression is presented. Case report. Mr A, a 53-year-old schoolteacher with a history of depression, developed increasing distractibility while driving on the highway in 2011, elevating to the point at which he had to stop driving. The patient believed he was having a stroke and presented himself to the emergency department. On examination, the patient displayed agitation, pressured and tangential speech, flight of ideas, distractibility, grandiosity, and disorganized behavior. He became increasingly agitated and a “code white” was called; as a result, the patient was restrained and given haloperidol and lorazepam intramuscularly, which calmed him down. Medical workup was negative for another cause of mania. Mr A had been taking oral citalopram 20 mg daily for the last 15 years to treat his depression. He was also taking oral clarithromycin 1,000 mg daily, which had been prescribed for sinusitis 5 days prior to presentation. The patient noted elevated mood, increased pleasure in his job, and requiring less sleep 1 day after starting clarithromycin. The patient was admitted, and clarithromycin and citalopram were discontinued. Three days later, Mr A’s condition was stable, and he had few manic symptoms. He was started on olanzapine, 10 mg at bedtime, and lamotrigine, which was titrated to 50 mg twice daily. The patient was discharged 10 days after admission. Nightingale et al2 described the first cases of clarithromycin-induced mania in 1995 in 2 patients with AIDS who were prescribed clarithromycin to treat a Mycobacterium avium complex infection. About a year later, in 1996, Cone et al3 described the first case of clarithromycin-induced mania in a patient without AIDS who was prescribed clarithromycin for a soft-tissue infection. Four other cases of clarithromycin-induced mania have since been described in which clarithromycin was prescribed for sinusitis or H pylori infection.4–7 In all cases, mania resolved with discontinuation of clarithromycin.2–7 In only 1 case did the patient have a history of depression.5 The mechanism for antibiotic-induced mania is currently unknown, although several theories have been proposed, including raised serum concentration of the antibiotic (leading to higher central nervous system penetration), antibiotic interactions with neurotransmitters, and antibiotic interactions with cortisol and prostaglandins.1 Management of antibiotic-induced mania typically involves discontinuation of the antibiotic and possible addition of mood-stabilizing medications.1,7 In this case, manic symptoms began to subside with discontinuation of clarithromycin. It is not clear whether clarithromycin is the direct cause of the manic episode, but it could be a contributing trigger. However, due to the past history of depression, the high degree of mania, and the occurrence during driving, mood-stabilizing medications were prescribed. Clarithromycin-induced mania is not a common occurrence, but consideration of this phenomenon could be useful in the differential diagnosis of an episode of mania.7

Coping Style and Depressive Symptomatology during Pregnancy in a Private Setting Sample

To evaluate the association of antenatal depressive symptomatology (AD) with life events and coping styles, the hypothesis was that certain coping strategies are associated to depressive symptomatology. We performed a cross sectional study of 312 women attending a private clinic in the city of Osasco, São Paulo from 27/05/1998 to 13/05/2002. The following instruments were used: Beck Depression Inventory (BDI), Holmes and Rahe Schedule of Recent Events (SSRS), Folkman and Lazarus Ways of Coping Questionnaire and questionnaire with social-demographic and obstetric data. women with no past history of depression, psychiatric treatment, alcohol or drug abuse and no clinical-obstetrical complications. Odds ratios and 95% CI were used to examine the association between AD (according to BDI) and exposures variables. Hypothesis testing was done with Chi2 tests and ap value < .05. AD occurred in 21.1% of pregnant women. By the univariate analyses, education, number of pregnancies, previous abortion, husband income, situation of marriage and score of SSRS were associated with AD. All coping styles were associated with AD, except seeking support and positive reappraisal. By the multivariate analyses, four coping styles were kept in the final model: confront (p = .039), accepting responsibility (p < .001), escape-avoidance (p = .002), problem-solving (p = .005). AD was highly prevalent and was associated with maladaptive coping styles.

What psychiatrists should know about sporadic Creutzfeldt-Jakob disease

To provide psychiatrists with relevant, up to date information about sporadic Creutzfeldt-Jakob disease. A 59-year-old bookkeeper presented with psychiatric symptoms in the context of stressors and past history of depression, for which her GP prescribed sertraline and olanzapine. Following a further deterioration in her mental state she was referred to acute psychiatric services, and there found to have dementia and myoclonus, and investigations supported a diagnosis of probable Creutzfeldt-Jakob disease, sporadic type (sCJD). This paper serves to outline the emerging literature challenging the notion that suggests psychiatric symptoms are uncommon in the presentation of sCJD.

Risk Assessment for Psychological Disorders in Postmenopausal Women

Psychological symptoms are common & bothersome in post menopausal women. Hence, screening these women for risk factors for psychological disorders is an important measure to improve their health. To study the risk assessment for psychological disorders in postmenopausal women Material & Methods: This was a prospective and observational study conducted in the Department of Obstetrics and Gynecology of a North Indian tertiary care hospital. It included a cross-section of 200 postmenopausal women attending gynecology OPD and menopausal clinic. Psychological symptoms were present in 32% postmenopausal women while sleep disturbance and decreased concentration were reported by nearly 34%. Irritability, nervousness and depression were the presenting complaints in 31.5%, 28.5% and 23.5% women respectively. Mild depression was present in 41.5%, whereas 3% women suffered from clinical (moderate to severe) depression. Depression was significantly associated with vasomotor symptoms (p=0.000), past history of depression (p=0.048) and psychosocial stressors (p=0.000). Women during postmenopausal years are at increased risk of psychological disorders; hence assessment of mental health and address of related issues should be an integral part of comprehensive evaluation of these women.

Perimenstrual symptoms and symptoms at midlife in Puebla, Mexico

ABSTRACTObjectives To examine perimenstrual symptoms in relation to hot flushes and depressive symptoms among 755 pre- and postmenopausal women aged 40–60 years drawn from a general population in Puebla, Mexico.Methods Hot flushes and depressed mood during the past 2 weeks were queried, along with cramps and other symptoms experienced during or before menstruation. Relationships among perimenstrual symptoms were examined by factor analyses. Logistic regression was used to assess determinants of hot flushes and determinants of depressed mood at midlife.Results Fifty-four percent of the women reported abdominal cramping (cólicos) during menstruation; fewer reported irritability (8%) and depressed mood (9%). Gastrointestinal complaints were most frequently volunteered (12%), followed by breast tenderness (10%) and mid-back pain (9%). Emotional symptoms clustered separately from perimenstrual symptoms. In bivariate analyses, abdominal cramping and waist pain were associated with hot flushes at midlife (p <0.01) and remained significant determinants after controlling for potential confounders. Depressed mood with menstruation was associated with depressed mood at midlife (p <0.05). After controlling for education, socioeconomic status and parity, perimenstrual irritability and depressed mood raised the risk of midlife depressed mood, although significance was lost after adding current hot flushes and trouble sleeping.Conclusions The relationship between abdominal cramps and hot flushes may be hormonal or sociocultural. The lack of association between depressed mood with menstruation and depressed mood at midlife after controlling for current hot flushes and trouble sleeping suggests that concurrent difficulties were more important than past history of depression in this population.