Co-morbidity of migraine and major depression in the Turkish population

The aim of the present study was to estimate the co-morbidity of migraine and major depression in the Turkish population. The households were selected randomly from all district areas. The study included 947 subjects aged > or = 18 years. The diagnosis of migraine was made according to the criteria of the International Headache Society. The diagnosis of major depression was made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Migraine was identified in 163 subjects. Major depression was identified in 155 subjects, and in 53 subjects with migraine. The lifetime prevalence of major depression was approximately three times higher in persons with migraine in this Turkish population.     

Migraine, major depression and panic disorder: a prospective epidemiologic study of young adults

We examined prospectively the risk for major depression (MDD) and panic disorder in persons with prior history of migraine. A random sample of 995 young adults was interviewed in 1989 and reinterviewed in 1990. A history of migraine at baseline increased fourfold the risk for MDD during the follow-up interval. A history of any anxiety disorder exacerbated the risk for MDD in persons with migraine. Persons with a history of migraine were twelve times more likely to become cases of panic disorder than those with no history of migraine. The risk for MDD and/or panic disorder was unrelated to whether or not migraine was active during the year preceding the baseline interview or in remission for more than one year. The findings suggest that migraine, major depression and anxiety disorders might share common predispositions.     

Validation of the Zung self-rating depression scale (SDS) in older adults

Abstract

Objective: The main objective of this study was to investigate the psychometric properties of the Zung Self-Rating Depression Scale (SDS) and evaluate screening parameters capability of the SDS with the Beck Depression Inventory (BDI-21) among the elderly population.

Design: A population-based study

Setting: Community

Subjects: 520 adults, aged 72–73 years, living in the city of Oulu, Finland.

Main outcome measures: The screening parameters of the SDS questions and BDI-21 for detecting severity of depression. The Mini Neuropsychiatric Interview for diagnosing major depression.

Results: The optimal cut-off point for the SDS was 39. The sensitivity and specificity parameters for this cut-off point were 79.2% (95% CI 57.8–92.9) and 72.2% (95% CI 67.9–76.1), respectively. Positive and negative predictive values were 12.5% (95% CI 7.7–18.8) and 98.6% (95% CI 96.7–99.5), respectively. Moreover, there was no statistically significant difference in diagnostic accuracy indices of the cut-off points 39 and 40. In a receiver operating characteristic analysis, the area under the curve was 0.85 (95%CI 0.77–0.92) for the SDS total score and 0.89 (95% CI 0.83-0.96) for the BDI-21 (p?=?0.137).

Conclusion: Using the traditional cut-off point, the SDS was convenient for identifying clinically meaningful depressive symptoms in an elderly Finnish population when compared with the BDI-21 which is one of the most commonly used depression screening scales. The sensitivity and specificity of these two screening tools are comparable.

Based on our study, the SDS is convenient for identifying clinically meaningful depressive symptoms among older adults at the community level.

• Key points

• The widely used Zung Self-Rating Depression Scale (SDS) has not previously been validated among elderly people at the community level.

• The sensitivity and specificity of SDS (cut-off point 39) were 79.2% and 72.2%.

• The positive and negative predictive values for SDS were 12.5% and 98.6%.

• SDS is convenient for identifying major depression in an elderly population and regarding sensitivity and specificity comparable to BDI-21.

     

Functioning and primary healthcare utilization in older adults: a 1-year follow-up study

Background/Purpose: Older adults are high users of healthcare services, mainly due to health conditions and their impact on daily activities, challenging the ability of health systems to provide timely and high-quality care. Conceivably, using disability-related variables to predict future healthcare utilization could contribute to reduce both older adults’ disability and healthcare costs. This study aimed to explore the association between aspects of disability and older adults’ primary healthcare utilization and hospitalization over a period of 1 year. Methods: Older adults (n = 129) were assessed for self-reported disability, lower limb performance, pain intensity and number of painful body sites, depressive symptoms, and self-reported physical activity. Data on primary healthcare utilization and hospitalization were collected for the period of 1 year through registries and phone interviews. Results: Regression analysis, adjusted for potential confounders, showed that self-reported disability and pain intensity were significantly associated with total primary healthcare utilization and together with a confounding variable (number of chronic conditions) explained 16% of its variance (p < 0.05). Increased physical activity was significantly associated with a decreased likelihood of being admitted to hospital (95% CI for exponentiation (B) = 0.27–0.81). Discussion: Data suggest that decreasing self-reported disability and increasing physical activity may decrease primary healthcare utilization and hospitalization, respectively.     

米氮平治疗青少年抑郁症的开放性研究

目的 探讨米氮平治疗青少年抑郁症的临床疗效和安全性。 方法 对32例符合《中国精神疾病分类方案与诊断标准》第3版(CCMD-3)抑郁症诊断标准的青少年患者进行为期8w的开放性米氮平治疗,以汉密尔顿抑郁量表(HAMD)和临床疗效总评量表(CGI)为评估临床疗效的工具。 结果31例患者全部完成研究,所用米氮平的平均剂量为28.8mg·d-1,在治疗结束时,HAMD和CGI得分较治疗前明显改善。副反应主要为过度镇静。 结论 米氮平治疗青少年抑郁症安全、有效。     

Modelling 5-year functional outcome in a major traumatic injury survivor cohort

Aim. To estimate associations between possible predictors of functional disability outcome at 5 years in a working adult population cohort of survivors of major traumatic injury and to develop a prognostic model of outcome.

Design. Population based retrospective cohort study.

Population. Persons who had experienced major traumatic injury (Injury Seventy Score >15) in the area of the former Yorkshire Regional Health Authority during the period 30 September 1988 to 1 October 1989 and who survived for 5 years (average 5.3 years).

Methods. The same interviewer saw each survivor at their home and used the OPCS Adult Disability Schedule to ascertain levels of functional disability. Disability scores for each survivor were then combined in accordance with the OPCS guidance to calculate a level of disability between 0 (no disability) to 10 (maximum disability). The OPCS level was then dichotomised with a cut-point at 4/5. Possible predictor and confounding variables from pre-injury, injury and post-injury periods were modelled in a logistic regression to identify those that predicted outcome level. Two reduced models were developed to allow early prognosis of late outcome.

Results. The full model correctly classified 91% of observed outcomes. Inpatient length of stay OR 1.031 (95% CI 1.014,1.048) per day predicted poorer 5-year outcome; Glasgow Coma Score OR 0.790(0.629,0.992) per 1 point increase; stay in Intensive Care Unit OR 0.931 (0.877,0.987) per day; attainment of degree-level education OR 0.014 (0.000,0.707); single civil status OR 0.110 (0.013,0.908); being taken initially to a hospital with a neurosurgical facility OR 0.064(0.010,0.420); being in paid work during the 2 weeks before index injury OR 0.093(0.009,0.969) predicted better 5-year disability outcome. Two reduced models were constructed that included a simple set of variables, one of these models excluded any rehabilitation variables but still correctly classified 85% of the observed outcomes.

Conclusion. As well as level of traumatic brain injury (TBI) and total inpatient stay, Pre-injury educational attainment and employment, civil status, immediate care in a hospital with a neurosurgical facility and stay in an Intensive Care Unit determined 5-year outcome. It is possible to efficiently predict outcome at an early stage. Previous work on predictors of disablement have suffered from large selection and attrition biases.     

重性抑郁症患者生存质量及其与氟西汀治疗的关系

目的探讨重性抑郁症患者的生存质量及其与氟西汀治疗的关系。方法本研究采用病例对照研究的方法，测量17项汉密顿抑郁量表（HAMD）、简明健康状况问卷（SF-36）和不良反应量表（TESS）。患者均使用氟西汀治疗6周，治疗前后分别进行上述量表的评定。均数间比较采用t检验和ANOVA分析，氟西汀临床疗效与生存质量的改善进行Pearson相关分析。结果（1）病例组（治疗前和治疗后）生存质量显著低于正常对照组（P〈0．01）。（2）与治疗前相比，治疗6周后病例组SF-36各因子分均有显著增高（P〈0．01～0．05）。（3）HAMD减分率与生活质量呈一定正相关性（P〈0．01～0．05）。同时，药物不良反应对生活质量也有一定的影响，有不良反应组生理功能（PF）和精力（VT）因子分显著低于无不良反应组（P≤0．05）。结论重性抑郁症患者生存质量显著下降，氟西汀在6周内可以显著提高重性抑郁症患者的生存质量，但尚未恢复到正常人群水平。患者生存质量的改善与临床疗效呈一定正相关，同时也受药物不良反应及其他因素的影响。     

重症抑郁症病人认知功能与焦虑的关系

目的 :探讨重症抑郁症病人的认知功能性失调与焦虑障碍的关系。方法 :对24例伴有严重焦虑障碍和21例不伴有严重焦虑障碍的重症抑郁症病人在入院治疗前及常规药物治疗后 ,分别同时应用功能失调状况评定量表“DAS”、HAMD抑郁量表及Beck抑郁自评量表“BDI”进行测评与对照研究。结果 :常规药物治疗后两组患者抑郁症状严重程度(HAMD总分)明显减轻或消失 ,疗效显著(P<0.01)。但是认知功能改善存在较大差异。不伴焦虑的抑郁症在药物治疗后其认知障碍的严重程度随着抑郁症状的减少也明显减轻 ,而伴有焦虑的抑郁症病人在药物治疗后 ,尽管抑郁症状已明显减少或消失 ,但其认知障碍依然存在。结论 :伴有焦虑的抑郁症病人 ,认知障碍更突出、顽固。因而在治疗过程中 ,必须将药物和认知行为治疗相结合 ,这样才能获得长期的疗效并能预防复发。     

老年人体育锻炼及其对抑郁障碍的影响

目的探讨老年人体育锻炼与抑郁障碍的现状、特点及体育锻炼对抑郁障碍的影响。方法采用《简明老年人抑郁量表》与自编《老年人体育锻炼量表》抽样调查宁波市三类不同生活环境(公共场所、社区及医院)的270名老年人。结果老年人抑郁障碍发病率较高,三类被试的体育锻炼态度及抑郁程度均存在显著性差异;锻炼态度较冷淡、次数较少、时间较短、伙伴较少、锻炼后感觉较累者的抑郁程度较高,反之,抑郁程度较低。结论体育锻炼是预防、减轻和克服老年人抑郁障碍的重要途径。     

老年期抑郁症患者认知功能障碍的P300检测及其意义

目的：探讨老年期抑郁症认知功能障碍的检测方法，分析其临床意义。方法：采用配对研究法，分别使用听觉诱发电位P300（AEP-P300）和老年认知功能量表（SECF）对42例老年期抑郁症患者（观察组）及42名正常老年人（对照组）进行检测。结果：SECF检测发现，观察组识记、广度、回忆1、回忆2、分类和总分等项目分值明显低于对照组，差异有统计学意义（P〈0．05或P〈0．01）；P300检测发现，观察组P3潜伏期及反应时间明显延长（P〈0．05及P〈0．01），波幅明显降低（P〈0．05）。且P3潜伏期延长与病期、SECF总分呈负相关关系（r=-0．607，P〈0．01）；以P3潜伏期延长2个标准差为标准，P300异常率诊断与SECF检测的一致率为86．67％。结论：老年期抑郁症患者的认知功能损害以注意、记忆功能障碍为主。SECF检测较为敏感，适合用于临床筛查，P300与SECF检测一致性好，是一种可靠的实验室检测方法。     

Safeguarding older adults with dementia,depression, and delirium in a temporary disaster shelter

Natural disasters impact people of every age in the communities where they occur, with older adults being a vulnerable subset of the population. Most disaster shelter volunteer nurses are experienced in addressing common health needs of older adult clients such as diabetes, hypertension, and pulmonary disease. These nurses also have the requisite training to respond to more acute medical events, including the symptoms of a heart attack or stroke. They provide care and comfort to those suffering from the distress, anxiety, and fear caused by disasters. However, they may be less adept at triaging and caring for older adults with mental health conditions such as delirium, depression, or dementia. The trauma associated with a disaster and relocation will challenge cognitive abilities in those with dementia, may exacerbate existing depression, or lead to the onset of delirium, which is a medical emergency. Older adults experiencing these conditions are at risk for harm and deterioration with serious short and long‐term consequences. Since disaster shelter volunteer health care staff may not be well‐versed in distinguishing between dementia, depression, or delirium, behavior observation, and safety considerations are critical determinants of whether it is possible to support the older adult in the shelter environment or it is necessary to transition to a higher level of care.     

The relationship of hardiness and depression to disability in institutionalized older adults.

Disability is an often expensive and sometimes preventable consequence of chronic illness. This study explored the relationship of hardiness and depression to disability in a sample (N = 58) of aged, institutionalized persons, controlling for length of stay (LOS) in the nursing home and physical health status. Using hierarchical regression analysis, LOS and physical health status accounted for 14.7% of the variance in disability (p = .01). Hardiness explained an additional 10.5% of the variance (p = .008). Depression accounted for an additional 7.4% (p = .02) of the variance in disability. The results of this study support the premise that psychological factors may increase a person's degree of disability beyond what might be expected from the physical illness or injury alone.     

Current trends in the assessment and somatic treatment of resistant/refractory major depression: An overview

A significant proportion of depressed patients eventually present with treatment‐resistant/refractory major depression (TRD), a debilitating condition that imposes significant health, social, and economic burdens. Recently, a growing level of consensus has been reached on the general meaning of TRD, according to which, depression is considered resistant when at least two trials with antidepressants from different pharmacologic classes (adequate in terms of dose, duration, outcome, and compliance) failed to achieve clinical remission. Regarding the management of TRD, a two‐step approach is suggested, involving first the evaluation of factors that may contribute to treatment nonresponse (such as comorbid medical and psychiatric conditions), and second, the use of the four classical strategies for enhancing antidepressant efficacy (namely optimization, augmentation, combination, and switching). Finally, future research on TRD should include studies addressing, among other issues, the validity of the proposed definitional criteria, the evaluation of reliable predictors of treatment outcome, and the development of novel therapeutic strategies.     

Frontline healthcare providers’ views of depression and its prevention in older adults

Aims and objectives.  To describe healthcare providers’ views on depression and its prevention in older people. Background.  There is an urgent need to develop public health approaches to depression prevention in older adults because of the growing older population and the high rate of depression among community‐dwelling older adults in Taiwan. Prior studies have focused on the prevalence of and risk factors for depression in Taiwanese community‐dwelling older adults. Research from the viewpoints of prevention and healthcare providers is needed to guide these approaches. Design.  A qualitative study involving semi‐structured interviews. Methods.  A purposive sample of 25 healthcare providers was recruited from a city in northern Taiwan. Data were collected through in‐depth individual interviews and analysed using thematic analysis. Results.  Results were embedded within four major themes: lack of children’s support, maladaptation to distressing life circumstances in late life, innate vulnerability in the individuals and being unaware of or reluctant to accept an illness. Conclusions.  Participants’ accounts of depression and its prevention were conceptualised within the family and socio‐cultural contexts older adults lived in. Lack of children’s support was reported as a main contributor to depression in older adults. Society was reported as the main context in which depression prevention intervention should take place. Communal activities were described as important for mental wellness and depression prevention. Relevance to clinical practice.  Study findings show how family, Chinese culture and socio‐economic circumstances influence accounts of depression and its prevention in older adults. Attention to the cultural construction of meanings may help extend our vision beyond a focus on the biomedical discourse and promote innovative ways of tackling depression that match the policy goals with the needs of older adults and community.     

Migraine,major depression,panic disorder,and personality traits in women aged 40-74 years: a population-based study

This study investigates the associations between migraine on the one hand and lifetime major depression, lifetime panic disorder, and neuroticism evaluated using the Swedish universities Scales of Personality on the other. A neurologist clinically assessed 728 women aged 40-74 years attending a population-based mammography screening programme. The associations between lifetime migraine and personality traits and psychiatric disorders were insignificant in multivariable analysis. However, in old women (60-74 years) the risk for active migraine was strongly associated with a history of major depression and high levels of stress susceptibility and somatic trait anxiety. Furthermore, in old women, high levels of stress susceptibility and somatic trait anxiety were associated with low ratings of migraine pain intensity and lower levels of these traits with high ratings after controlling for disability during migraines, whereas there were only small differences in middle-aged women. The results suggest that certain aspects of neuroticism are important mental correlates of the ability of old women to endure migraine pain.