Suicide risk among adults with epilepsy in Kaduna,Nigeria

Objective

There is paucity of information on epilepsy and suicide in Nigeria. The objective of this study therefore was to assess the prevalence and determinants of suicide risk among adults with epilepsy (AWE) in Kaduna, Nigeria.

Method

We administered the suicidality module of the Mini International Neuropsychiatric Interview, the three-item Oslo Social Support Scale and the Hospital Anxiety and Depression Scale to 170 consecutive AWE attending the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna, between January and June 2011 to determine the prevalence of suicide risk, the level of social support and the psychological symptoms, respectively. We also recorded the sociodemographic and clinical characteristics of the subjects.

Results

There are 99 males and 71 females. The subject’s mean age was 28.7±12.1 years. The prevalence of suicide risk was 20.0%. Short seizure-free periods (χ²= 4.658, P= .031), previous suicide attempts (χ²= 12.216, P< .001), anxiety symptoms (χ²= 5.075, P= .024) and depressive symptoms (χ²= 5.093, P= .016) were significantly associated with suicidal tendencies. However, after a logistic regression analysis, none of the above variables predicted suicide risk.

Conclusion

Suicide risk is common among AWE. Poor seizure control, previous suicidal attempts and emotional distress are associated factors.     

Diagnostic validity and reliability of a Korean version of the Parent and Adolescent General Behavior Inventories

Objectives

The purpose of this study was to evaluate the validity and reliability of a Korean version of the Parent General Behavior Inventory-10-item Mania Scale (P-GBI-10M) and the Adolescent General Behavior Inventory (A-GBI) for bipolar and depressive disorder in youths.

Methods

Ninety-two subjects with mood disorder and their parents were recruited from September 2011 to June 2013 through the Department of Psychiatry at the Asan Medical Center, Seoul, Korea. In addition, 125 community participants were recruited through two middle schools and one high school in Seoul. The parents of subjects completed the Parent-version Mood Disorder Questionnaire (P-MDQ), P-GBI-10M and Attention-deficit/hyperactivity disorder Rating Scale (ARS). Adolescents complete the 76-item A-GBI, Beck Depression Inventory (BDI), and Adolescent version of the Mood Disorder Questionnaire (A-MDQ).

Results

Different profiles were evident between the clinic-referred group and the community control, including different P-GBI-10M (t = 3.07, p = 0.003), A-GBI Depressive (t = 4.99, p < 0.001), Hypomanic/Biphasic subscales (t = 3.17, p = 0.002), and BDI (t = 4.76, p < 0.001) scores. The A-GBI Depressive subscale score (t = 3.02, p = 0.003), BDI score (t = 2.12, p = 0.037) and A-GBI Hypomanic/Biphasic subscale score (t = 2.71, p = 0.008) were significantly different between patients with bipolar disorder and those with depressive disorder. Of the 73 items of the Depressive and Hypomanic/Biphasic subscales of the A-GBI, eight discriminated between bipolar and depressive disorder. Furthermore, A-GBI Depressive subscale scores were significantly correlated with BDI (r = 0.81, p < 0.001), A-GBI Hypomanic/Biphasic subscale (r = 0.88, p < 0.001), A-MDQ (r = 0.58, p < 0.001), P-MDQ (r = 0.22, p = 0.005), and ARS (r = 0.26, p < 0.001) scores. Cronbach's α of the A-GBI was 0.98.

Conclusion

The Korean version of the Parent and Adolescent General Behavior Inventories showed excellent internal consistency, fair-to-good construct, and discriminant validity.     

The patient health questionnaire-15 and its abbreviated version as screening tools for depression in Korean college and graduate students

Objective

Over half of all suicides worldwide occur in Asia. Given the close association between suicide and depression, it is quite unexpected that depression is least frequently diagnosed in Asia. This is, in part, due to the fact that Asians somatize depression. Young adults including college and graduate students are no exceptions. Therefore, a somatic symptom-focused screening tool would be useful in detecting depression in Asian college and graduate students. The purpose of this study was to evaluate the psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) in screening for depression among Korean college and graduate students. In addition, we developed an abbreviated version of the PHQ-15 (aPHQ-15) and studied validity measures.

Methods

Three-hundred and fifty Korean college and graduate students were screened with the PHQ-15. Of all participants, 176 were interviewed using the Structured Clinical Interview for DSM-IV to diagnose major depressive episode, while the other 174 were evaluated with the Beck Depression Inventory-II (BDI-II) and the Inventory of Depressive Symptomatology-Self-Report (IDS-SR). Reliability and validity measures including the internal consistency, test–retest reliability, and criterion, convergent, and divergent validity were tested. Principal component analysis was used in developing the abbreviated version of the PHQ-15.

Results

The PHQ-15 showed good internal consistency and test–retest reliability (Cronbach's alpha 0.82, intra-class correlation coefficient 0.87). The optimal cut-off point for detecting depression was estimated to be 8. There were strong correlations between the PHQ-15 total scores and self-report measures of depressive symptom severity (BDI-II: r = 0.69 and p < 0.001, IDS-SR: r = 0.77 and p < 0.001). The 5-item aPHQ-15 had comparable validity with the PHQ-15.

Conclusions

The somatic symptom-focused PHQ-15 and aPHQ-15 can work as effective screening tools for depression.     

The relationship between impulsivity and lipid levels in bipolar patients: does temperament explain it?

Background

The aim of this study was to investigate whether there was a relationship between impulsivity and lipid levels in patients with bipolar disorder (BD) and to examine the correlation of impulsivity and lipid levels with temperament subtypes.

Methods

For this purpose, one hundred patients who were admitted to our out-patient unit for routine controls, had been in remission for at least 8 weeks, and diagnosed as BD according to the DSM-IV were evaluated consecutively. Impulsivity and temperament were evaluated with the BIS-11 and the TEMPS-A. Blood samples were obtained to measure levels of lipids (cholesterol, triglyceride, high density lipoprotein-HDL, low density lipoprotein-LDL).

Results

A weak correlation was found between impulsivity scores and triglyceride levels (r = 0.190, p = 0.050). Correlation was found between impulsivity scores and depressive, anxious, cyclothymic, and irritable temperaments (r = 0.371, p < 0.001; r = 0.458, p < 0.001; r = 0.541, p < 0.001; r = 0.530, p < 0.001), while triglyceride levels were only related with depressive and anxious temperaments (r = 0.485, p = 0.001 and r = 0.391, p = 0.006).

Conclusions

Temperament is an important mediator of the relationship between lipid levels and trait impulsivity in patients with BD.     

Exposure to secondhand smoke and depression and anxiety: A report from two studies in the Netherlands

Objective

Previous population-based studies suggest that exposure to secondhand smoke (SHS) is related to increased depressive symptoms and poor mental health among non-smokers. We examined whether these associations could be replicated in two independent Dutch samples.

Methods

Non-smoking adults were selected from two studies: 1) the Netherlands Study of Depression and Anxiety (NESDA), comprising individuals with current and remitted depressive and/or anxiety disorders, and healthy controls and 2) the Netherlands Twin Register (NTR), comprising twin-family studies on health-related behaviors. In both studies, SHS exposure was assessed with plasma cotinine levels (1–14 ng/ml vs. < 1 ng/ml). In NESDA, outcomes were current depressive and/or anxiety disorders, and depression and anxiety symptom severity scores. In NTR, the Adult Self Report derived DSM-subscales for depressive and anxiety problems, and anxious depressive scores were analyzed.

Results

In NESDA non-smokers (n = 1757), increased plasma cotinine level (≥ 1 ng/ml) was not related to current depressive and/or anxiety disorders [odds ratio (OR) 0.96, P = .77], nor to depression or anxiety severity indicators. Similarly, in NTR non-smokers (n = 1088) cotinine levels ≥ 1 ng/ml were not associated with the DSM-subscale for depressive problems [unstandardized regression coefficient (B) 0.04, P = .88], nor to other depression and anxiety measures.

Conclusions

In non-smoking adults from patient and population samples, we found no evidence that plasma cotinine levels were related to either depressive and/or anxiety disorders, or to depressive and anxiety symptoms. This suggests that SHS exposure is not related to depression and anxiety in non-smoking adults.     

Prevalence of depressive symptoms and predictors of treatment among U.S. adults from 2005 to 2010

Objectives

To determine nationally representative estimates of the prevalence of depressive symptoms and factors associated with treatment among those with moderate to severe symptoms.

Methods

A cross-sectional, retrospective analysis of adults age ≥ 18 years in the 2005–2010 National Health and Nutrition Examination Survey data who responded to the Patient Health Questionnaire (PHQ-9) was conducted (n= 13,320). Depressive symptoms and severity were defined by PHQ-9 scores. Depression treatment was defined as either receiving antidepressants or seeing a mental health professional. Multivariable logistic regression analyses using population weights identified factors associated with having depressive symptoms and receipt of any treatment.

Results

The prevalence of depressive symptoms increased from 20.92% to 25.66% over 6 years. Among patients with moderate to severe depression, 38.66% received treatment. Multivariable analyses found that being female, other Hispanic, younger age, having certain chronic comorbidities or previous hospitalization, no health insurance and in poverty status were associated with having depressive symptoms (P< .05). Among patients with moderate to severe depression, being female, white, younger age, having comorbidities (arthritis and hypertension) or previous hospitalization were associated with receipt of treatment (P< .05).

Conclusions

The prevalence of depressive symptoms is high, and only a small portion of patients with moderate to severe depression received treatments. Treatment disparities exist and need improvement.     

Association between subjective well-being and depressive symptoms in treatment-resistant schizophrenia before and after treatment with clozapine

Background

We examined the relationship between subjective well-being and depressive symptoms in patients with treatment-resistant schizophrenia before and after treatment with clozapine to contribute to the growing body of research regarding the determinants of patients' perspective of their own well-being in schizophrenia.

Methods

Forty patients with treatment-resistant schizophrenia were comprehensively evaluated for subjective well-being, schizophrenic symptoms, and depressive symptoms before and 8 weeks after the initiation of treatment with clozapine. Correlation analysis and Fisher's z-transformation statistics were performed.

Results

There were significant improvements in all Positive and Negative Syndrome Scale (PANSS) factor scores and Beck Depression Inventory (BDI) score over the treatment period (P < .05). Before clozapine administration, the subjective well-being score had significant negative correlations with the PANSS depression factor score (P < .05) and the BDI score (P < .05). After clozapine treatment, the subjective well-being score still had significant negative correlations with the PANSS depression factor score (P < .05) and the BDI score (P < .05) and no new associations emerged with treatment. Fisher's z-transformation statistics revealed that the correlations between the subjective well-being score and the depression score were not significantly different before and after clozapine treatment.

Conclusions

These results indicate that depressive symptoms are significantly associated with low subjective well-being in patients with treatment-resistant schizophrenia. The association was equally significant before and after treatment with clozapine, suggesting that the relationship does not change with clozapine treatment, even when depressive symptoms improve significantly, and that there may be a common pathophysiological basis for depressive symptoms and the subjective appraisal of well-being in schizophrenia.     

Psychosocial correlates of sleep quality and architecture in women with metastatic breast cancer

Background

Sleep disturbance is prevalent among women with metastatic breast cancer (MBC). Our study examined the relationship of depression and marital status to sleep assessed over three nights of polysomnography (PSG).

Methods

Women with MBC (N = 103) were recruited; they were predominately white (88.2%) and 57.8 ± 7.7 years of age. Linear regression analyses assessed relationships among depression, marital status, and sleep parameters.

Results

Women with MBC who reported more depressive symptoms had lighter sleep (e.g., stage 1 sleep; P < .05), less slow-wave sleep (SWS) (P < .05), and less rapid eye movement (REM) sleep (P < .05). Single women had less total sleep time (TST) (P < .01), more wake after sleep onset (WASO) (P < .05), worse sleep efficiency (SE) (P < .05), lighter sleep (e.g., stage 1; P < .05), and less REM sleep (P < .05) than married women. Significant interactions indicated that depressed and single women had worse sleep quality than partnered women or those who were not depressed.

Conclusion

Women with MBC and greater symptoms of depression had increased light sleep and reduced SWS and REM sleep, and single women had worse sleep quality and greater light sleep than married counterparts. Marriage was related to improved sleep for women with more depressive symptoms.     

Plasma heart-type fatty acid binding protein level in acute ischemic stroke: Comparative analysis with plasma S100B level for diagnosis of stroke and prediction of long-term clinical outcome

Objectives

Heart-type fatty acid binding protein (H-FABP) is enriched in neuronal cell body as well as myocardium, and is rapidly released from damaged neuron into circulation in cerebral ischemia. We performed a comparative analysis between plasma H-FABP and S100B levels in the acute phase of ischemic stroke.

Methods

The present study included 111 consecutive patients with acute ischemic stroke and 127 control subjects. Measurement of plasma H-FABP and S100B levels was conducted during acute phase (<24 h) of stroke. Clinical severities were evaluated by the use of NIHSS scores at admission and mRS score at 3 months after symptom onset.

Results

Both the plasma H-FABP and S100B levels were significantly higher in stroke group than control group. In multiple logistic regression analysis, statistical significance of both markers remained significant after adjusting the vascular risk factors. In the receiver operator characteristic (ROC) curve analysis, neither H-FABP (area under curve [AUC] = 0.71, P < 0.001, sensitivity: 59.5%, specificity: 79.5%) nor S100B (AUC = 0.70, P < 0.001, sensitivity: 54.0%, specificity: 83.5%) showed a favorable degree of diagnostic value to discriminate stroke from stroke mimic. Plasma H-FABP (r = 0.46, P < 0.01) and S100B (r = 0.45, P < 0.01) were correlated with initial NIHSS score, and both marker were significantly higher in patients with poor clinical outcome.

Conclusion

Although plasma H-FABP is elevated in the acute phase of ischemic stroke, the diagnostic accuracy of H-FABP as a sole marker is not sufficient to be applied in the clinical setting. Plasma H-FABP can be used as a potential marker for stroke prognosis.     

Familiality and clinical outcomes of sleep disturbances in major depressive and bipolar disorders

Objective

Sleep disturbances are frequently observed in major depressive (MDD) and bipolar disorder (BD). This study reported sleep profiles of patients and their relatives versus controls, and examined the familiality of sleep features in mood disorder families. We also evaluated the influences of sleep disturbance on patients' quality of life (QOL), functional impairment, and suicidality.

Methods

We recruited 363 BD and 157 MDD patients, 521 first-degree relatives, and 235 healthy controls, which completed a diagnostic interview, Pittsburgh Sleep Quality Index (PSQI), and QOL questionnaire. The magnitude of heritability of sleep features was calculated and familiality was evaluated by mixed regression models and intraclass correlation coefficient (ICC). The associations between sleep problems and clinical outcomes were examined using multiple regression models.

Results

More than three-quarters of mildly-ill patients were classified as “poor sleepers”. MDD patients had significantly worse sleep quality as compared to BD patients. Moderate but significant familial aggregation was observed in subjective sleep quality, sleep latency, disturbance, daytime dysfunction, and global score (ICC = 0.10–0.21, P < .05). Significant heritability was found in sleep quality (0.45, P < .001) and sleep disturbance (0.23, P < .001). Patients with good sleep quality had better QOL and less functional impairment (P < .05) than poor sleepers. Poor sleep quality and nightmares further increased the risk for suicidal ideation (OR_adj = 2.8) and suicide attempts (OR_adj = 1.9–2.8).

Conclusion

Subjectively measured sleep features demonstrated significant familiality. Poor sleep quality further impaired patients' daily function and QOL, in addition to increasing the risk of suicidality, and thus requires special attention in related clinical settings.     

Validation of the Chinese Non-Motor Symptoms Scale for Parkinson's disease: Results from a Chinese pilot study

Objectives

To evaluate a Chinese version of the Non-Motor Symptoms Scale (NMSS) in Parkinson's disease (PD) as an instrument for measuring non-motor symptoms (NMSs) in Chinese patients with Parkinson's disease.

Methods

We conducted a psychometric analysis of the Chinese version of NMSS using a cross-sectional study of 126 patients with PD. The battery also included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Hamilton Anxiety Scale (HAMA), and was conducted by neurologists.

Results

There were significant correlations between the NMSS and PSQI scores (rS = 0.63, P < 0.001), as well as the NMSS and ESS scores (rS = 0.38, P < 0.001). Furthermore, significant positive correlations between NMSS and GDS, NMSS and HAMA, and NMSS and disease duration were also observed. Importantly, the sleep/fatigue index of the NMSS significantly correlated with the PSQI and ESS findings, the mood/cognition index of the NMSS significantly correlated with the GDS and HAMA findings, and the attention/memory index of the NMSS significantly correlated with the MMSE findings.

Conclusion

The Chinese version of the NMSS can be considered a comprehensive, useful measure for NMS evaluation in Chinese PD patients.     

Correlations between night eating,sleep quality,and excessive daytime sleepiness in a severely obese UK population

Objective

The relationships between night eating, poor sleep quality, and obesity-related comorbidity in a severely obese UK clinic population is unknown. We used validated tools to identify prevalence and to explore this relationship.

Methods

Consecutive consenting clinic attendees completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS), and Night Eating Questionnaire (NEQ) to identify sleep quality, excessive daytime sleepiness (EDS) (a surrogate marker for suspected obstructive sleep apnea [OSA]), and night eating, respectively. Proportions of individuals above and below tool cutoff points were compared. Pearson product moment correlation coefficients examined relationships between total scores.

Results

Reported prevalence from 144 participants (mean body mass index [BMI] 46.9 [9.5] kg/m²; age 44.6 [12.1] years; 68% women) had poor sleep quality (73.0%), suspected OSA (30.8%), and night-eating behavior (2.8%). The strongest correlation between PSQI and NEQ scores (r = 0.54; P < .001) was undiminished after controlling for EDS. Although significantly correlated, PSQI and ESS scores (r = 0.31; P < .001) reduced after controlling for night eating (r = 0.21; P = .02). Correlation between NEQ and ESS scores (r = 0.26; P = .002) was smaller and nonsignificant after controlling for sleep quality (r = 0.12; P = .18).

Conclusions

Poor sleep quality is common in severe obesity, though night eating is rare. The association between poor sleep quality and night eating is not influenced by the presence of EDS.     

Relationships between cognitive appraisals of adolescents with OCD and their mothers

Objective

Our aim was to investigate cognitive models of OCD via the influence of mothers’ cognitive appraisals on children's cognitions and OCD symptoms.

Method

Our sample consisted of 21 adolescents with OCD, their mothers and 27 parent–child dyads for control group without OCD. Subjects with OCD and their mothers were administered The Beck Depression Inventory (BDI), The Thought–Action Fusion Scale (TAFS), The White Bear Suppression Inventory (WBSI), The Padua Inventory-Revised (PI-R) and The Penn Inventory of Scrupulosity (PIOS).

Results

While the BDI (t = 2.18, p < 0.05) and TAF Morality (t = 2.18, p < 0.05) scores of the mothers of OCD subjects were significantly higher than the mothers of control subjects, the comparisons for the PI, TAF likelihood and PIOS scores of groups were not significant. Intradyadic correlation revealed significant relationships for PI-Rumination, PI-Checking and WBSI scales between the scores of parent and child in OCD dyads, (respectively, r = 0.49, P = 0.11; r = 0.37, P = 0.045; and r = 0.47, P = 0.014). There was no significant relationship in the control group.

Conclusion

Our results partially supported that mothers’ cognitive appraisals are associated with the cognitive appraisal of adolescents. A cognitive intradyadic interaction between mother and child might be more likely in the presence of OCD in adolescents.     

The impact of childhood trauma on depression: Does resilience matter? Population-based results from the Study of Health in Pomerania

Objective

Data suggests that traumatic experiences at early age contribute to the onset of major depressive disorder (MDD) in later life. This study aims at investigating the influence of dispositional resilience on this relationship.

Methods

Two thousand and forty-six subjects aged 29–89 (SD = 13.9) from a community based sample who were free of MDD during the last 12 months prior to data collection were diagnosed for Lifetime diagnosis of MDD by the Munich-Composite International Diagnostic Interview (M-CIDI) according to DSM-IV criteria. Childhood maltreatment (CM) and resilience were assessed with the Childhood Trauma Questionnaire (CTQ) and the Resilience-Scale (RS-25).

Results

Both CM (OR = 1.03, 95% CI [1.02, 1.04], P < .000) and resilience (OR = 0.98, 95% CI [0.98, 0.99], P < .000) were associated with MDD later in life. The detrimental effects of low resilience on MDD were not only especially prominent in subjects with a history of CM (OR = 3.18, 95% CI [1.84, 5.50], P < .000), but also effective in subjects without CM (OR = 2.62, 95% CI [1.41, 4.88], P = .002).

Conclusions

The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of child abuse and neglect.     

Increased serum concentrations of pentosidine are related to presence and severity of coronary artery disease

Background

There are limited data regarding the contribution of advanced glycation end products (AGEs) in the presence of coronary artery disease (CAD). We investigated whether serum pentosidine and Nε-carboxymethyllysine (CML) were related to the presence and the severity of CAD.

Methods

69 Tunisian patients with CAD (≥ 50% obstruction in ≥ 1 coronary artery), 32 Tunisian patients without CAD but with potential cardiovascular risk factors and 60 Tunisian control subjects were included in a cross-sectional study. Patients were classified as CAD and non CAD patients according to angiographic results. The severity of CAD was assessed using the Gensini score. Serum pentosidine and CML were measured by LC-MS/MS.

Results

Serum pentosidine and CML concentrations were significantly higher in non-CAD patients vs control subjects (P < 0.001). Serum pentosidine concentrations were significantly higher in CAD patients vs non-CAD patients (P < 0.001). A multiple logistic regression analysis demonstrated that pentosidine was independently associated with the presence of CAD (OR = 1.52, 95% CI: 1.12-2.07, P = 0.007). The area under curve (AUC) determined by ROC analysis was 0.74 (95% CI: 0.64-0.84, P < 0.001) and the optimal cut-off value of pentosidine to predict the presence of CAD was 3.2 μmol/mol Lys, with 64% sensitivity and 78% specificity. Furthermore, in a multivariate stepwise regression analysis, pentosidine was independently correlated with Gensini score (standardized β = 0.46, 95% CI: 0.70-1.99, P < 0.001).

Conclusions

High concentrations of pentosidine show the presence and the severity of CAD with high sensitivity.     

Patterns of care and survival of glioblastoma patients: A comparative study between 2004 and 2008 in Lyon,France

Introduction

The treatment of glioblastomas (GBMs) has changed significantly since 2005. However, the extent to which this change has improved overall survival (OS) of patients treated outside clinical trials remains to be determined.

Methods

We compared the patterns of care and OS of all GBM patients diagnosed in 2004 (n = 105) and in 2008 (n = 130) in our center.

Results

Younger patients (aged < 70 years) diagnosed in 2008 received temozolomide radiochemotherapy as the initial treatment and bevacizumab at recurrence more frequently than those diagnosed in 2004 (69% vs 26% P < 10⁻⁴ and 41% vs 3%, P < 10⁻⁴, respectively). Elderly patients (aged ≥ 70 years) diagnosed in 2008 received an oncological treatment (radiotherapy and/or chemotherapy) more frequently than those diagnosed in 2004 (67% vs 38%, P = 0.006). The patients diagnosed in 2008 had longer OS than those diagnosed in 2004 (10.5 months vs 5.3 months, P = 0.001). This finding was true for both younger and elderly patients (15.3 months vs 8.9 months, P = 0.02 and 6.4 months vs 3.2 months, P = 0.0002, respectively) and when considering only IDH1 wild-type patients (8.9 months vs 5.3 months, P = 0.004).

Conclusion

In our center, the change in the patterns of care for GBMs between 2004 and 2008 has been associated with a significant improvement in OS.     

The distinction between unipolar and bipolar depression: A cognitive theory perspective

Background

There is very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of Beck's cognitive theory.

Methods

In this study, 70 bipolar patients during a depressive episode, 189 unipolar depressed patients and 120 healthy subjects were recruited. The participants were interviewed by using a structured clinical diagnostic scale. To evaluate the cognitive structure differences, the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were used.

Results

We found that on the mean ATQ total score, the unipolar depressed patients scored significantly higher (92.9 ± 22.7) than both the bipolar depressed patients (73.2 ± 24.7) and the healthy subjects (47.1 ± 19.6), even after controlling for all confounding factors, e.g. gender, marital status, depressive symptom severity (F = 157.872, p < 0.001). The bipolar depressed patients also scored significantly higher on the mean ATQ total score than the healthy controls. On the mean DAS total score, and on the mean score of its subscale of need for approval, the bipolar depressed patients scored (152.8 ± 21.2 and 48.2 ± 7.4, respectively) significantly higher than both the unipolar depressed patients (160.9 ± 29.0 and 51.9 ± 9.7, respectively) and the healthy subjects (127.9 ± 32.8 and 40.2 ± 12.2, respectively), even after controlling for any confounding factor (F = 45.803 [p < 0.001] and F = 43.206 [p < 0.001], respectively). On the mean score of the perfectionistic attitude subscale of the DAS, the depressed groups scored significantly higher than the healthy subjects, but they did not seem to separate from each other (F = 41.599, p < 0.001).

Conclusions

These results may help enhance the understanding of the potentially unique psychotherapeutic targets and the underlying cognitive theory of bipolar depression.     

Turning the pink cloud grey: Dampening of positive affect predicts postpartum depressive symptoms

Objective

Maladaptive response styles to negative affect have been shown to be associated with prospective (postpartum) depression. Whether maladaptive styles to positive affect are also critically involved is understudied, even though anhedonia (a correlate of low positive affectivity) is a cardinal symptom of depression. The present study is the first to investigate the predictive value of cognitive response styles to both negative (depressive rumination) and positive affect (dampening) for postpartum depressive symptoms.

Methods

During the third trimester of pregnancy, 210 women completed self-report instruments assessing depression (symptom severity and current and/or past episodes) and scales gauging the presence of depressive rumination and dampening. Of these women, 187 were retained for postpartum follow-up, with depressive symptoms being reassessed at 12 (n = 171) and 24 (n = 176) weeks after delivery.

Results

Regression analyses showed that higher levels of dampening of positive affect during pregnancy predicted higher levels of depressive symptoms at 12 and 24 weeks postpartum, irrespective of initial symptom severity, past history of depression and levels of rumination to negative affect. Prepartum trait levels of rumination, however, did not predict postpartum symptomatology when controlled for baseline symptoms and history of major depressive episode(s).

Conclusions

The results of this investigation suggest that the way women cognitively respond to positive affect contributes perhaps even more to the development of postpartum depression than maladaptive response styles to negative affect.     

Effects of vaginal delivery,cesarean section and exposure to labor on endothelial function of pregnant women

Introduction

This study was undertaken to assess the influence of labor and cesarean section on endothelial function.

Materials and Methods

Flow-mediated vasodilatation (FMD) was measured before and after delivery for an assessment of endothelial function in three groups: (1) the Vaginal delivery group (with spontaneous labor or induction of labor, n = 48), (2) the Elective C/S group (with a cesarean planned, n = 20), and (3) the C/S after FP group (scheduled for vaginal delivery but required to have an emergency cesarean section because of failure in progress, n = 11).

Results

There were statistically significant changes between the antepartum and postpartum FMD values in the Vaginal delivery group and the Elective C/S group but not in the C/S after FP group (P < 0.001, P = 0.023 and P = 0.22 respectively).

Conclusions

These observations suggest that labor may enhance endothelial function and that cesarean section may impair endothelial function.     

Comparison of the efficacy between paroxetine and sertraline augmented with aripiprazole in patients with refractory major depressive disorder

Objective

Only two-thirds of depressive patients respond to antidepressant treatment. In recent years, addition of an atypical antipsychotic drug to ongoing treatment with an antidepressant has been considered effective and well-tolerated. In the present study, we compared the efficacy between paroxetine and sertraline augmented with aripiprazole in patients with refractory major depression.

Subjects and methods

Twenty-four patients who met the DSM-IV criteria for major depressive disorder who did not at least two different classes of antidepressants were enrolled in the study. Nine were male and thirteen were female, and their ages ranged from 28 to 66 (mean ± SD = 39 ± 12) years. Patients were prescribed paroxetine (n = 11) or sertraline (n = 13) for 4 weeks. Then, those whose scores on the 17-item Hamilton Rating Scale for Depression (HAMD17) decreased below 50% received adjunctive therapy of aripiprazole for 4 weeks.

Results

Although the use of either combination treatment decreased the HAMD17 scores compared to the respective monotherapy, there was no significant difference in HAMD17 scores between the paroxetine plus aripiprazole group and sertraline plus aripiprazole group.

Conclusion

Aripiprazole augmentation therapy with paroxetine or sertraline was equally effective and tolerated in patients with refractory major depressive order.