Zung Scores Research Articles

Depressive symptoms are correlated with periaqueductal gray matter functional connectivity in migraine

IntroductionDepression is the most common comorbidity of migraine. The brain of migraineurs with depression shows differences compared to migraine only or depression only patients. The comorbidity may affect specific regions such as the periaqueductal gray matter (PAG) which is important in negative emotion regulation and pain modulatory system.ObjectivesWe hypothesized that the alterations in PAG functional connectivity (FC) may play a role in migraineurs vulnerability for depression.MethodsA resting-state fMRI was conducted with 34 episodic migraine without aura patients and 41 control subjects. All participants were medication free and they did not have any psychiatric or chronic disorders. Depressive symptoms were measured with Zung Self-Rating Depression Scale. To investigate the relationship between depressive symptoms and PAG functional connectivity, Zung scores were used as covariates in each groups’ PAG-FC analysis using the Statistical Parametric Mapping (SPM12) toolbox in MATLAB environment.Results There were no significant difference between migraine and control group in Zung scores (p=0.394). Negative correlation was found between Zung scores and PAG-FC with thalamus, fusiform gyrus, middle occipital gyrus and calcarine (pFWE<0.05) in migraine group. However, there was no significant correlation between Zung scores and PAG-FC in healthy control group.ConclusionsOur results suggest that PAG-FC with emotion and pain processing areas is affected by depressive symptoms in migraine patients, but not in healthy controls. Migraine patients without comorbid depression might have vulnerable neuronal pathways for depressive symptoms. A follow-up of these patients could be interesting to determine whether these connectivity alterations predict the possible comorbid depression.DisclosureHungarian Brain Research Program (2017-1.2.1-NKP-2017-00002, KTIA_13_NAPA-II/14, KTIA_NAP_13-1-2013- 0001, KTIA_NAP_13-2- 2015-0001); 2020-4.1.1.-TKP2020; ERA PerMed (2019-2.1.7-ERA-NET-2020-00005); ÚNKP-21-4-I-SE-15 (DB).

Health Conditions, Lifestyle Factors and Depression in Adults in Qingdao, China: A Cross-Sectional Study.

Background: Depression is a common mental illness. Previous studies suggested that health conditions and lifestyle factors were associated with depression. However, only few studies have explored the risk factors of depression in a large representative sample of the general population in the world.Methods: A population-based cross-sectional survey was conducted in the 2006 survey and 2009 survey in Qingdao, China. The participants with insufficient information were excluded: Zung score, body mass index (BMI), diabetes items, physical activity, smoking, or drinking. Finally, a total of 3,300 participants were included in this analysis. The category of depression was used in the Zung self-rating depression scale (ZSDS). The associations between different indicators of health conditions (diabetic status, BMI), lifestyle factors (physical activity, smoking, and alcohol consumption), and depression were assessed by the logistic regression model.Results: The mean Zung scores for all participants, male participants, and female participants were 29.73 ± 7.57, 28.89 ± 7.30, 30.30 ± 7.70, respectively. In all participants, those who were pre-diabetes status (OR: 1.53, 95% CI: 1.04–2.27), and irregular physical activity (OR: 0.39, 95% CI: 0.17–0.89) had an increased risk of depression. In man, the analysis showed an increased risk of depression those with pre-diabetes (OR: 2.49, 95% CI: 1.25–4.97), previously diagnosed diabetes (OR: 4.44, 95% CI: 1.58, 12.48), and in those irregular activities (OR: 0.07, 95% CI: 0.01–0.61). In women, those who were underweight (OR: 5.66, 95% CI: 1.04–30.71) had a greater risk of depression.Conclusions: These results suggested that health conditions and lifestyle factors were the potential risk factors for depression. Men with pre-diabetes, previously diagnosed diabetes, and irregular activity had an increased risk for depression; women with underweight status had a higher risk for depression.

The Distress and Risk Assessment Method predicts postoperative narcotic use in patients undergoing rotator cuff repair

The Distress and Risk Assessment Method (DRAM) predicts poor outcomes in spine, hip, and knee surgery. Unlike other areas of orthopedic surgery, DRAM scores are not predictive of lower postoperative patient-reported outcomes after arthroscopic rotator cuff repair (RCR). As concerns for opioid dependence and abuse grow, the purpose of this study was to analyze the correlation between preoperative DRAM scores, modified Zung scores, and postoperative narcotic use in patients who underwent arthroscopic RCR. This prospective cohort study identified and enrolled patients >18 years of age with full-thickness rotator cuff tears at a single institution. Patients with prior shoulder surgery, greater than 1-tendon RCR, and preoperative narcotic use were excluded. One-hundred and fifty patients were enrolled, with 114 (76%) completing all preoperative and postoperative questionnaires. Preoperative DRAM scores were collected from every patient. Postoperative narcotic use was evaluated via survey and converted to total morphine equivalents. Increased preoperative DRAM scores predicted higher postoperative morphine equivalent units (P = .002, r = 0.29). When dividing patients into those <17 or ≥17 on the modified Zung score, 44 of 114 (39%) met criteria for "at risk or depressed."This group showed a statistically significant trend towardhigher postoperative morphine equivalent unit intake (P = .004). Baseline psychological distress (DRAM) can predict narcotic requirements after RCR and serve as a powerful tool to identify patients at risk for increased narcotics requirements postoperatively. In our cohort, 39% of patients showed evidence of baseline depression, which highlights a potential role of the modified Zung score to identify patients in need of preoperative psychological counseling.

Efficacy of repetitive transcranial magnetic stimulation in the treatment of depression with comorbid anxiety disorders

BackgroundThe presence of comorbid anxiety is generally associated with poorer treatment outcomes in people with depression. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective for treatment resistant depression, but there has been little research examining rTMS in depressed patients with comorbid anxiety disorders. This study aimed to investigate the efficacy of rTMS in patients with treatment resistant Major Depressive Disorder (MDD) and comorbid anxiety disorders. MethodsThis study included 248 patients with treatment resistant MDD who were treated with rTMS. Of these, 172 patients had one or more comorbid anxiety disorders, so their outcomes were compared with patients who did not have comorbid anxiety. ResultsPatients both with and without comorbid anxiety disorders showed improvement in depression ratings after rTMS treatment, with no significant difference in remission rates between groups. In those with comorbid anxiety disorders, 23.3% met criteria for remission and 39.5% met response criteria. For each anxiety disorder diagnosis, there was a significant reduction in HAM-A, HAM-D21, MADRS and ZUNG scores (p = <0.001 for all). LimitationsThis was not a sham-controlled study, so placebo response rates are not known. Patients were referred by private psychiatrists so are not representative of all patients with depression. ConclusionOur study indicates that rTMS is an effective treatment for Major Depressive Disorder in people who have comorbid anxiety disorders.

THE OMNIGENIC ARCHITECTURE OF HUMAN COMPLEX TRAITS

The Distress and Risk Assessment Method (DRAM) predicts poor outcomes in spine, hip, and knee surgery. Unlike other areas of orthopedic surgery, DRAM scores are not predictive of lower postoperative patient-reported outcomes after arthroscopic rotator cuff repair (RCR).As concerns for opioid dependence and abuse grow, the purpose of this study was to analyze the correlation between preoperative DRAM scores, modified Zung scores, and postoperative narcotic use in patients who underwent arthroscopic RCR.This prospective cohort study identified and enrolled patients >18 years of age with full-thickness rotator cuff tears at a single institution. Patients with prior shoulder surgery, greater than 1-tendon RCR, and preoperative narcotic use were excluded. One-hundred and fifty patients were enrolled, with 114 (76%) completing all preoperative and postoperative questionnaires. Preoperative DRAM scores were collected from every patient. Postoperative narcotic use was evaluated via survey and converted to total morphine equivalents.Increased preoperative DRAM scores predicted higher postoperative morphine equivalent units (P = .002, r = 0.29). When dividing patients into those <17 or ≥17 on the modified Zung score, 44 of 114 (39%) met criteria for “at risk or depressed.” This group showed a statistically significant trend toward higher postoperative morphine equivalent unit intake (P = .004).Baseline psychological distress (DRAM) can predict narcotic requirements after RCR and serve as a powerful tool to identify patients at risk for increased narcotics requirements postoperatively. In our cohort, 39% of patients showed evidence of baseline depression, which highlights a potential role of the modified Zung score to identify patients in need of preoperative psychological counseling.

Association Between Different Indicators of Obesity and Depression in Adults in Qingdao, China: A Cross-Sectional Study.

Background: This study was designed to investigate the perceived relationship between body weight and depression risk in a Chinese population in Qingdao, China.Methods: A population-based cross-sectional survey was performed with 4,573 participants (between 35 and 74 years) from the year 2009 to 2012 in Qingdao, China. We applied the Zung self-rating depression scale to ascertain the level of depression in participants. The associations between different indicators of obesity [body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)] and depression were assessed by logistic regression based on the Chinese criteria of obesity. Sensitivity analysis was done based on the Asian and WHO criteria of obesity.Results: The Zung scores for the 243 participants (5.2%) were over 45 and they were entitled as depression. Furthermore, multivariable logistic analyses revealed that being overweight [odds ratios (OR): 1.48, 95% confidence intervals [95% CI]: 1.08–2.03] and having abdominal obesity (WC category in Chinese criteria) (OR: 1.47, 95% CI: 1.08-2.00) were often associated with a higher risk for depression compared to normal weight subjects. Sensitivity analysis revealed that abdominal obesity (Asian criterion) (OR: 1.41, 95% CI: 1.03-1.91) was a significant risk factor for depression. Similarly, being overweight (WHO criterion) (OR: 1.39, 95% CI: 1.03-1.87) was an obvious risk factor for depression.Conclusion: Being overweight and having abdominal obesity (WC category) were found to be linked with a higher risk of depression. However, abdominal obesity (WHR category) was not associated with depression.

Relation of depressive symptoms to outcome of CI movement therapy after stroke.

Depressive symptoms after stroke have been associated with negative outcomes, including poorer functional ability, less efficient use of rehabilitation services, decreased quality of life, and increased mortality. It has been anecdotally noted that depressive symptoms do not limit motor recovery in patients who undergo Constraint-Induced Movement Therapy (CIMT), an efficacious intervention for chronic poststroke hemiparesis. Here we analyze depressive symptom and motor scores from 40 participants who received CIMT in 2 previously published studies. Adults more than 1-year after stroke with mild to moderate upper-extremity hemiparesis completed the Zung Self-Rating Depression Scale and Motor Activity Log (MAL) before and after CIMT. We used regression analysis to test whether Zung scores predicted response to CIMT and paired t tests to test whether depressive symptoms changed from pre- to posttreatment. Pretreatment Zung score did not predict outcome on the MAL Arm Use scale, ΔR2 (1, 30) = 0.004, p = .19, after controlling for pretreatment MAL scores. Additionally, participants had a small but statistically significant decrease in Zung score, t(39) = 3.0, p = .005, mean change = -3.6. These results suggest that depressive symptoms do not significantly limit motor recovery in patients treated with CIMT for chronic poststroke hemiparesis. Additionally, treatment with CIMT may improve depressive symptoms. (PsycINFO Database Record

Application of persistent nursing humanistic care on improving the satisfaction of PICU hospitalized children's family

Objective To compare and analyze the application of persistent nursing humanistic care on improving the satisfaction of PICU hospitalized children's family. Methods A total of 130 family members of PICU hospitalized children received from June, 2014 to June, 2015 were selected, divided into intervention group and control group according to number table randomly, and 65 patients in each group. Regular treatment and nursing care were conducted to the children of two groups according to change of illness. Persistent nursing mode was used to have comprehensive nursing care for the children of intervention based on usual care. The general information, Zung scoring 1 day and 3 days after admission to hospital and 24 hours after discharge from hospital and C-CCFSS scoring 1 month after children's family members left hospital were compared for the children and family members of two groups. Results The general information difference of the two groups of children and family members was small, which had no statistical significance. Zung scoring was close 1 day after two groups of children and family members were hospitalized, and the difference had no statistical significance. 3 days after nursing intervention and 24 hours after discharge, Zung scores (68.17±4.25) and (44.53±1.17) of family members of children in intervention group were significantly lower than that of the control group's (70.01±2.32) and (53.27±1.82), and the difference had statistical significance(P<0.05). C-CCFSS score was significantly higher than control group 1 month after the family members of children of intervention group left hospital, and the difference had statistical significance(P<0.05). Conclusions For the persistent humanistic nursing care applied to have comprehensive care for the family members of PICU hospitalized children, the satisfaction of the family members of children is higher, which can effectively improve Zung scoring, and the short-term effect is good. However, the long-term clinical effects still needs to be demonstrated by extending follow-up visit and increasing sample size. Key words: Continuous nursing; Humanistic care; PICU; Satisfaction of family

Evaluation of the Emotional Status in Patients with Retinitis Pigmentosa Using PHQ-9 and Zung Scores: Is the Depression Common in Retinitis Pigmentosa?

Abstract Objective: To assess the depression prevalence and its potential correlation with visual loss in patients with retinitis pigmentosa. Methods: Fifty-five patients with retinitis pigmentosa and 32 age- and sex-matched healthy individuals were recruited in this case-control study. All participants underwent a complete ophthalmological examination, which included measurement Best-corrected visual acuity (BCVA), slit lamp examination and fundoscopy, and completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Depression Inventory questionnaire. The diagnosis and the evaluation of retinitis pigmentosa were based on spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) examination with dilated pupils. Results: The patients’ group consisted of 44 males and 11 females with mean age of 41.4 ± 7.6 years old, whereas the controls’ group included 19 males and 13 females with mean age of 42.5 ± 10.1 years old. BCVA differed significantly between the two groups, as expected (Mann-Whitney test: p<0.0001). The mean values of PHQ-9 and Zung scores in patients with retinitis pigmentosa classified them as moderately depressive or normal, respectively. The control group was characterized as mildly depressive or normal, according to PHQ-9 and Zung scores, respectively. Both scores were increased among patients (10.0 ± 3.9 and 45.2 ± 2.1, respectively) compared to the control group (6.7 ± 5.4 and 41.1 ± 8.5, respectively) and these increments were statistically significant (Mann- Whitney test: p=0.005 and p=0.024, respectively). PHQ-9 and Zung scores appeared to be weakly but significantly correlated (Spearman’s coefficient=-0.29, p=0.006). The increased age seemed to be responsible for the depressive symptoms, according to the PHQ-9 score but not with respect to the Zung score. Conclusion: Patients with retinitis pigmentosa exhibited more frequently and intensely depressive symptoms in PHQ-9 scores, compared to the healthy individuals. Moderate depression was significantly correlated visual function decline and increasing age. Ophthalmologists should be aware of the emotional disorders and encourage the patients to receive psychological support.

Estimation of Depression Prevalence in Patients with Stargardt Disease using PHQ-9 and Zung Scores

To evaluate the psychological impact and depression prevalence in patients with Stargardt disease. We conducted a case-control study including 39 patients with Stargardt disease and 32 age- and sex-matched healthy controls. All participants underwent a complete ophthalmologic examination and completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Depression Inventory questionnaire. Results were analyzed using IBM SPSS 22.0 software. The patient group consisted of 19 men and 20 women with mean age of 36.9 ± 5.4 years and control group of 19 men and 13 women with mean age of 42.5 ± 10.1 years. The mean values of PHQ-9 and Zung scores for patients and healthy individuals were 10.9 ± 4.9, 46.7 ± 11.1, 6.7 ± 5.4, and 41.1 ± 8.5, respectively. There were statistically significant differences between the 2 groups in PHQ-9 scores (independent samples t test: p = 0.001), but not in Zung scores (Mann-Whitney test: p = 0.053). The PHQ-9 and Zung scores appeared to be moderately but significantly correlated (Pearson coefficient 0.44, p&lt;0.0001). In addition, PHQ-9 score seems to be raised along with age, whereas both scores are low when best-corrected visual acuity is high. Patients with Stargardt disease exhibited more depressive symptoms compared to healthy individuals according mainly to PHQ-9 scores. Moderate depression was significantly correlated visual function decline.

Circulating androgens are associated with mood disturbances in young postmenopausal women

Objectives We aimed to evaluate the association between circulating androgens and the presence of psychological symptoms in a sample of healthy middle-aged women.Methods Psychological and depressive symptoms were evaluated in a total of 207 postmenopausal women, using the Symptom Checklist-90-R (SCL-90R) and the Zung Depression Scale, respectively. We investigated the associations between the SCL-90R and Zung Scale scores, and anthropometric, lifestyle parameters, as well as serum levels of androgens.Results The free androgen index was positively associated with scores of depression (b-coefficient ± standard error (SE) = 0.2 ± 0.2, p = 0.040), anxiety (b-coefficient ± SE = 0.2 ± 0.2, p = 0.028), anger/aggressiveness (b-coefficient ± SE = 0.3 ± 0.2, p = 0.026), psychotism (b-coefficient ± SE = 0.3 ± 0.1, p = 0.013) as well as with the global index of the SCL-90R scale (b-coefficient ± SE = 0.2 ± 0.1, p = 0.036), while sex hormone binding globulin was negatively associated with depression (b-coefficient ± SE = −0.2 ± 0.0, p = 0.046) and psychotism (b-coefficient ± SE = −0.2 ± 0.0, p = 0.047). These associations were independent of vasomotor symptomatology, smoking and hormone therapy intake and were more pronounced in younger (≤ 5.5 years) compared to older postmenopausal women. Levels of dehydroepiandrosterone sulfate were positively associated with interpersonal sensitivity (b-coefficient ± SE = 0.3 ± 0.3, p = 0.042), psychotism (b-coefficient ± SE = 0.4 ± 0.2, p = 0.007) and the global index (b-coefficient ± SE = 0.3 ± 0.2, p = 0.040) in women < 5.5 years postmenopausal. No significant associations were observed between the Zung or Greene Scale scores and levels of androgens.Conclusion Higher androgenicity was positively associated with symptoms of anxiety and depression in postmenopausal women. These associations were stronger in women closer to the menopausal transition, a finding which may suggest that menopause rather than aging may mediate the association of androgens with mood disorders.

Is Self Disturbance the Core of Borderline Personality Disorder? An Outcome Study of Borderline Personality Factors

To determine which constellation of clinical features constitutes the core of borderline personality disorder (BPD). The criterion of endurance was used to identify the constellation of features which are most basic, or core, in borderline personality disorder. Two sets of constellations of DSM-III features were tested, each consisting of three groupings. The first set of constellations was constructed according to Clarkin's factor analysis; the second was theoretically derived. Broadly speaking, the three groupings concerned 'self', 'emotional regulation', and 'impulse'. Changes of these constellations were charted over one year in a comparison of the effect of treatment by the Conversational Model (n = 29) with treatment as usual (n = 31). In addition, measures of typical depression (Zung) were scored before and after the treatment period. The changes in the constellations were considered in relation to authoritative opinion. The changes in the two sets of constellations were similar. In the treatment as usual (TAU) group, 'self' endured unchanged, while 'emotional regulation' and 'impulse' improved. In the Conversational Model cohort, 'self' improved, 'emotional regulation' improved more greatly than the TAU group, while 'impulse' improved but not more than the treatment as usual group. Depression scores were not particularly associated with any grouping. A group of features including self/identity disturbance, emptiness and fear of abandonment may be at the core of BPD. Correlations between the three groupings and Zung scores favoured the view that the core affect is not typical depression. Rather, the central state may be 'painful incoherence'. It is suggested that the findings have implications for the refinement and elaboration of treatment methods in borderline personality disorder.

Efficacy of biofeedback for post-traumatic stress disorder

The authors investigated the potential effectiveness of biofeedback as a complementary treatment for PTSD. This exploratory study used heart variability biofeedback and determined its efficacy in treating PTSD through the use of two rating instruments, The Post-traumatic Stress Disorder Checklist (PCL)-Military version and the Zung Self-Rating Depression Scale. Active duty service members deployed to Iraq or Afghanistan were alternatively assigned to a treatment as usual control group and treatment as usual with the addition of biofeedback. The authors administered the two instruments before treatment and at the conclusion of three weeks of biofeedback therapy. Biofeedback did not produce a measurable improvement. A one way repeated measures analysis of variance (ANOVA) was used to examine change in PCL scores over time. There was a main effect for time, F(1, 36)=11.98, p<.001, indicating a decrease in PCL scores from baseline to three weeks for both the control and treatment group. Results demonstrated a nonsignificant main effect of group, F(1, 36)=.1.79, p=ns, and a nonsignificant group by time interaction, F(1, 36)=.2.59, p=ns. Similarly, for depression, results showed a significant main effect for time, F(1, 33)=10.26, p<.003, indicating a decrease in Zung scores from baseline to three weeks for both the control and treatment group. Results demonstrated a nonsignificant main effect of group, F(1, 33)=.385, p=ns, and a nonsignificant group by time interaction, F(1, 33)=3.52, p=ns. The addition of biofeedback did not produce a measurable improvement in PTSD or depression scores in this exploratory study.

Investigation of inducing factors and psychological status of patients having peptic ulcer with hemorrhage

Objective To investigate and analyze the inducing factors and psychological status of peptic ulcer patients with hemorrhage so as to provide data for further health instruction.Methods 82 peptic ulcer patients with hemorrhage were underwent the investigation of self-designing questionnaire and Zung anxiety scale,and the relation of hemorrhagic frequency with factors inducing hemorrhage and the patients' psychological status was analyzed.Results The inducing factors and Zung scores on anxiety of peptic ulcer patients with hemorrhage were hisher than those of controls.The two-type scoces are positively related to the time of hemorrhage.The higher the Zung scores were.the more the hemorrhagic frequency were.Conclusions Nursing staff should strengthen instruction about inducing factors and psychological status,so as to avoid bleeding again among the patients. Key words: Peptic ulcer; Hemorrhage; Inducing factors; Psychological status investigation

The effect of bronchiolitis obliterans syndrome on health related quality of life.

Bronchiolitis obliterans syndrome (BOS) is the most important factor limiting long-term survival after lung transplantation, and has a substantial impact on patients' daily life in terms of disability and morbidity. Aim of our study was to examine the effects of BOS on health related quality of life (HRQL) in lung transplantation patients. Data on HRQL from 29 patients who developed BOS at least 18 months earlier were studied longitudinally. HRQL measures were: the Nottingham Health Profile (NHP), the State Trait Anxiety Inventory (STAI), the Self-rating Depression Scale (ZUNG), and the Index of Well Being (IWB). Furthermore questions concerning activities of daily life and dyspnea were asked. The majority of the patients were male, and the most common diagnosis was emphysema. After the onset of BOS, significantly more restrictions were reported on the dimensions energy and mobility of the NHP. These restrictions appeared to increase over time. After the onset of BOS, STAI scores remained more or less stable and close to the value of the general population. ZUNG scores were significantly higher after the onset of BOS, and patients experienced a lower level of well being than the general population. The percentage of patients that reported to be able to perform activities of daily life without effort declined dramatically after the onset of BOS. Furthermore, the percentage of patients complaining of dyspnea increased after the onset of BOS. In conclusion, our study showed that HRQL was negatively affected by the onset of BOS. However, in spite of these less favorable long-term results, even patients who develop BOS may at least temporarily benefit from a lung transplantation.

Pramipexole and pergolide in the treatment of depression in Parkinson's disease: a national multicentre prospective randomized study

An 8-month multicentre prospective randomized study aimed at comparing the effects of dopamine receptor agonists pramipexole (PPX; Mirapexin) and pergolide (PRG; Permax) as add-on to L-dopa therapy on depression [Montgomery and Asberg Depression Rating Scale (MADRS)] in 41 non-demented patients (25 men, 16 women) suffering from both mild or moderate depression and advanced Parkinson's disease (PD). The assessment was performed by a blinded independent observer. Motor symptoms (UPDRS III), motor complications (UPDRS IV), activities of daily living (UPDRS II and VI) and depressive symptoms as measured by Self - Rating Depression Scale by Zung were evaluated in an open-label design. The average value of Zung scores decreased significantly in both groups with no statistical difference between both groups. A significant decrease in the average value of MADRS scores was present only in the PPX group. The average UPDRS scores decreased significantly with no statistical difference between both groups at the comparable average total daily dose of both preparations. In both cases, the total daily dose of L-dopa decreased significantly but the decrease was statistically more pronounced in the PRG group. Our results demonstrate the antidepressant effect of PPX in patients with PD while we can't make any conclusions with regard to antidepressant effect of PRG.

Mental well‐being in people with non‐insulin‐dependent diabetes

We assessed the prevalence of minor mental disorder and depression in elderly patients with non-insulin-dependent (Type 2) diabetes mellitus as compared with control subjects and evaluated the associates of impaired mental well-being in diabetic patients. The study consists of a community-based group of patients (n = 82) with a 10 years' known duration of disease and nondiabetic control subjects (n = 115). In addition to clinical and laboratory examinations, self-rating questionnaires assessing minor mental disorder (General Health Questionnaire, GHQ) and depression (Zung Self-rating Depression scale) were completed by the patients and control subjects. The mean scores of GHQ and Zung scores tended to be higher in diabetic than in control subjects, but the frequency of case subjects was not different between the diabetic (GHQ: 40%; Zung: 11%) and nondiabetic groups (GHQ: 36%; Zung: 7%). These findings were explained by more severe symptoms in diabetic case subjects as compared to nondiabetic case-subjects. From the various parameters studied, the presence of symptomatic neuropathy was most strongly associated with depression and minor mental disorder in diabetic subjects. The results suggest that the impact of Type 2 diabetes per se on minor mental disorder or depression in elderly subjects is not overwhelming. However, a subgroup of diabetic patients seems to have markedly impaired mental well-being, and the treatment of its underlying factors may improve overall treatment compliance.

DEPRESSION IN MOTHERS OF CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

Does having a child with attention deficit hyperactivity disorder (ADHD) increase the risk of depression in the child's mother? The present study was initiated to explore this issue in a primary care setting and evaluate the need for routine screening of maternal depression in mothers of children with ADHD.The subjects were 59 biological mothers of children with ADHD. All were patients in a rural, private, office-based family practice. Each subject was given a Zung Self-rating Depression Scale (SDS). After completion, the mothers were interviewed to confirm or exclude depression by Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria.Thirty-nine of the 59 mothers returned a completed Zung SDS. No statistically significant differences were noted between the respondents and nonrespondents, nor between ADHD children of respondents and nonrespondents. Twenty-one respondents had Zung scores in the depressive ranges. By DSM-III-R criteria, 15 were subsequently found to be depressed. None of the 18 mothers with normal scores on the Zung were found to be currently depressed.The incidence of major and minor depression in primary care outpatients is 4%-6% and 6%-14%, respectively. However, the present study reveals an incidence of 17.9% for major depression and 20.5% for minor depression in mothers of children with ADHD, suggesting that routine screening for maternal depression needs to be considered when children are diagnosed with ADHD in primary care settings.

Clinical Characteristics and Predisposing Factors in Acute Drug-Induced Akathisia

As subtypes of drug-induced akathisia have become accepted and attempts have been made at establishing diagnostic criteria, a prospective study of the clinical features and predisposing factors of acute akathisia is a significant deficiency in the literature. One hundred consecutive inpatients with non-organic psychotic disorders, not receiving neuroleptics or other drugs and free of akathisia and related disorders at admission, were assessed for psychiatric status and movement disorders at baseline and daily for 2 weeks, with detailed examinations on days 7 and 14. Multiple operational criteria for akathisia were used. The following risk factors were examined: age, sex, current neuroleptic dose, rate of increment of dose, drug type, duration of illness, past use of neuroleptics, extrapyramidal side effects score, Zung Depression Scale score, Spielberger State Anxiety Inventory score, psychosis score, and smoking. Using a global rating, mild akathisia developed in 41% and moderate-to-severe akathisia in 21%. The symptoms that best discriminated akathisia from non-akathisia were shifting weight from foot to foot or walking on the spot, inability to keep legs still, feelings of inner restlessness, and shifting of body position in the chair. The subjective and objective symptoms loaded on separate factors. Akathisia ratings had low correlations with the anxiety and Zung scores. Receiver operating characteristic analysis suggested a cutoff score of 4 on our 10-item Akathisia Scale as optimal for the diagnosis of akathisia, with a stricter criterion of scores of 2 or more on both the subjective and objective items being more suitable for research diagnosis. The most significant predisposing factors were the extrapyramidal side effects score and current neuroleptic dose and its rate of increment, with lesser contributions from serum iron status and medication type. Predictability was, however, modest. Acute akathisia is a common syndrome with well-defined clinical features. Its occurrence can be predicted with only modest accuracy.

Depression Late After Combat: A Follow-Up of Finnish World War Two Veterans from the Seven Countries East-West Cohort

An analysis from the Finnish East and West Cohort of the Seven Countries Study tested the hypothesis that front line service during modern warfare is associated with depression later in life. World War Two-era Finnish combat veterans were compared to Finnish veterans who were non-combatants. Both groups were followed from 1959 to 1984. Dependent variables were the Zung depression scale and other measures of psychosocial adaptation and mental health. Analysis of variance of Zung scores by combat exposure was close to statistical significance (p = 0.0501). Even if statistical significance had been reached, it is felt that the absolute magnitude of the differences between the populations appear quite trivial. A significant association was found for those who had participated in over nine battles and when grouping depression, sleeplessness, paranoia, hallucinations, schizophrenia, and other mental illness into the general category of any mental illness (O.R. = 4.414; 95% C.I. = 1.113, 17.503). This seems to support the residual stress hypothesis pertaining to modern combat exposure.