Stigma and perception of psychological distress and depression in Australian-trained medical students: Results from an inter-state medical school survey

Stigmatisation towards depression has previously been reported amongst medical students from a variety of backgrounds. This study explored personal and perceived stigmas associated with depression, and their relationship with demographics, knowledge of depression, levels of personal stress and history of medical illness amongst Australian-trained medical students. A cross-sectional survey was undertaken amongst students enroled June-to-August 2009 across four Australian medical schools. In total, 1010 students completed the survey, a response rate of 29.6%. Approximately 25% of students reported a past history of depression. Higher stress (K-10 scores) was reported by females and those with a past history of depression. On a scale of 0-to-5, the mean (±S.D.) personal and perceived stigma depression scores were 1.83±1.49 and 4.05±1.42 respectively. In multivariate analysis, higher perceived stigma and K-10 scores, a past history of anxiety and Year 3 of medical school indicated higher personal stigma scores. Perceived stigma was positively associated with K-10 scores, personal stigma scores, and a Caucasian background. Our findings suggest a high level of personal and particularly perceived stigma associated with depression amongst medical students, especially those displaying higher levels of stress. Adequate support and screening for psychological stress may de-stigmatise depression and improve mental health amongst future Australian doctors.     

Decreased levels of d-aspartate and NMDA in the prefrontal cortex and striatum of patients with schizophrenia

The potential implication of a decrease in the function of N-methyl-d-aspartate receptors (NMDARs) in the pathophysiology of schizophrenia has long been hypothesised. Accordingly, compounds that inhibit the glycine-1 transporter or target the glycine-binding site of NMDARs, including the co-agonists d-serine and glycine, have shown promise in treating the symptoms of schizophrenia. Clinical interest for d-serine has also been supported by evidence for its abnormal metabolism in schizophrenic patients. Together with d-serine, another d-form amino acid, d-aspartate, exists in the brain of mammals. Synthesised by the enzyme aspartate racemase, d-aspartate is highly concentrated in the prenatal brain; after birth, its levels sharply decrease due to the catabolising activity of the enzyme d-aspartate oxidase. d-aspartate is able to stimulate NMDAR-dependent neurotransmission through direct action at the glutamate-binding site of NMDARs, thus functioning as an endogenous agonist for this subclass of glutamate receptors. In this study, we evaluated for the first time the content of d-aspartate and of its derivative, NMDA, in the post-mortem prefrontal cortex and striatum of schizophrenic patients. Moreover, in the same brain samples, we analysed the expression levels of the subunits that form NMDARs, which are the in vivo targets of d-aspartate and NMDA. Interestingly, we found that d-aspartate and NMDA are consistently decreased in schizophrenia brains compared to control brains. In the prefrontal cortex, this decrease is correlated with a marked downregulation of NMDAR subunits. Overall, these results agree with the innovative therapeutic research in schizophrenia that is aimed at targeting glutamatergic transmission viad-amino acids.     

Enfermedad de Parkinson avanzada. Características clínicas y tratamiento. Parte II

Introduction

Many patients who have had Parkinson's disease (PD) for several years will present severe motor fluctuations and dyskinesias which require more aggressive therapies. The different approaches which are now available include deep brain stimulation of the subthalamic nucleus or medial globus pallidus, subcutaneous infusion of apomorphine, and intestinal infusion of levodopa-carbidopa.

Objective

To define the indications and results for the 3 available therapies for advanced PD.

Development

Exhaustive review of the literature concerning the indications and results of deep brain stimulation, subcutaneous apomorphine infusion and duodenal infusion of levodopa/carbidopa gel to treat patients with advanced Parkinson disease.

Conclusions

Although numerous studies have confirmed the efficacy of the 3 different therapies in advanced PD, there are no comparative studies that would allow us to define the best candidate for each technique.     

Effects of a behavioural intervention on quality of life and related variables in angioplasty patients : Results of the EXhaustion Intervention Trial

Objectives

The EXhaustion Intervention Trial investigated the effect of a behavioural intervention programme on exhaustion, health-related quality of life (HRQL), depression, anxiety, hostility, and anginal complaints in angioplasty patients who felt exhausted after percutaneous coronary intervention (PCI).

Methods

Seven hundred ten patients were randomized into an intervention group and a usual care control group. The group intervention focused on stressors leading to exhaustion and on support of recovery. HRQL (measured by the MacNew questionnaire), exhaustion [measured by the Maastricht Questionnaire and the Maastricht Interview Vital Exhaustion (MIVE)], anxiety (measured by the State-Trait Inventory), and depression (measured by the structured clinical interview for DSM-IV) were assessed at intake and at 6 and 18 months. Presence of anginal complaints was assessed at 18 months.

Results

The intervention had a significant beneficial effect on all psychological factors except hostility and on the presence of anginal complaints. The effect of the intervention on exhaustion, as assessed by the MIVE, was modified by a previous history of coronary artery disease (CAD). Gender modified the effect of the intervention on exhaustion and on anxiety, the strongest effect being observed in women.

Conclusions

The behavioural intervention improved HRQL and related psychological factors. Somatic comorbidity and a history of CAD limited the effect of the intervention.     

Evaluation of acetylcholinesterase in an animal model of mania induced by d-amphetamine

The present study aims to investigate the effects of mood stabilizers, lithium (Li) and valproate (VPA), on acetylcholinesterase (AChE) activity in the brains of rats subjected to an animal model of mania induced by d-amphetamine (d-AMPH). In the reversal treatment, Wistar rats were first given d-AMPH or saline (Sal) for 14 days. Between days 8 and 14, the rats were treated with Li, VPA, or Sal. In the prevention treatment, rats were pretreated with Li, VPA, or Sal. AChE activity was measured in the brain structures (prefrontal cortex, hippocampus, and striatum). Li, alone in reversion and prevention treatments, increased AChE activity in the brains of rats. VPA, alone in prevention treatment, increased AChE activity in all brain regions evaluated; in the reversion, only in the prefrontal. However, d-AMPH decreased activity of AChE in the striatum of rats in both the reversion and prevention treatments. VPA was able to revert and prevent this AChE activity alteration in the rat striatum. Our findings further support the notion that the mechanisms of mood stabilizers also involve changes in AChE activity, thus reinforcing the need for more studies to better characterize the role of acetylcholine in bipolar disorder.     

l-histidine induces state-dependent memory deficit in mice mediated by H1 receptor

This study investigated the role of H₁ receptor in the state-dependent memory deficit induced by l-histidine (LH) in mice using Trial 1/2 protocol in the elevated plus-maze (EPM). The test was performed for two consecutive days: Trial 1 (T1) and Trial 2 (T2). Before both trials, mice received a combined injection i.p. of saline + saline (SAL/SAL), 500 mg/kg l-histidine + saline (LH/SAL), 500 mg/kg l-histidine + 16 mg/kg chlorpheniramine (LH/CPA) or saline + 16 mg/kg chlorpheniramine (SAL/CPA). The trials were performed in the EPM 10 min after the last injection. Each animal was placed in the center of the maze facing the open arm and had five minutes to explore it. On both days, test sessions were videotaped. The behavioral measures were scored from videotape. Data were analyzed based on Analysis of Variance (ANOVA) and the Fisher’s LSD test. The data showed no effects on anxiety since there was no difference between the SAL/SAL and the other groups in Trial 1, respectively, open arm entries (OAE), open arm time (OAT) and their percentages (%OAE and %OAT). During Trial 2, OAE, OAT, %OAE and %OAT were reduced in mice treated with SAL/SAL, LH/CPA and SAL/CPA, while the group LH/SAL did not show any difference in these measures. No significant changes were observed in enclosed arm entries (EAE), an EPM index of general exploratory activity. Thus, it can be suggested that LH induces emotional memory deficit and the treatment with chlorpheniramine was able to revert this effect, suggesting this action of LH was mediated by the H₁ receptor.     

Stigmatising attitudes towards people with mental disorders: Results from a survey of Japanese high school students

The aim of the current study was to assess the stigmatising attitudes of Japanese high school students towards people with depression, social phobia and psychosis/schizophrenia. In 2011, 311 students aged 15–18 years filled out an anonymous self-report questionnaire, which included a case vignette describing either depression, schizophrenia or social phobia and two questionnaires to assess stigmatising attitudes towards people with these disorders. Exploratory Structural Equation Modelling (ESEM) was used to determine the dimensionality and loading pattern of the stigma items in the two scales, to establish dimensions of stigma and to compare levels on these dimensions between genders. Stigmatising attitudes towards people with mental disorders in young Japanese people are substantial. ESEM revealed that the structure of stigmatising attitudes in young Japanese people is comparable in personal and perceived attitude stigma, with each forming distinct dimensions and each comprising ‘weak not sick’ and ‘dangerous/unpredictable’ components. The social distance dimension of stigma was separate from other components. Stigmatising attitudes relating to dangerousness/unpredictability were the lowest for social phobia and highest for schizophrenia. Females had lower stigmatising attitudes than males. These findings echo those of Australian studies and extend them by demonstrating a similar structure of stigma in another cultural group, namely young Japanese people.     

Le Cannabis en France au xix siècle : une histoire médicale

This text draws a history of cannabis (hashish) in xixth century France, based on the study of medical, pharmaceutical and psychiatric texts. First is recalled the state of knowledge concerning cannabis at the beginning of the century. Are distinguished the geographical origins of such a knowledge, with paths leading from India, Near-East and North Africa until mid-xixth century. The work of the alienist Joseph Moreau de Tours (1804–1884) is then exposed, as well as the preceding contributions of Alexandre Brierre de Boismont (1787–1881). The travel of Moreau in Orient is evoked, and the cultural context of Romanticism. The acceptance of Moreau's book of 1845 by contemporary medical readers is commented. This book gives a general theory concerning mental illness, and a proposal for curing such illnesses with cannabis. The subsequent history of cannabis, considered as a medical remedy in the second half of xixth century is drawn as rise and fall of therapeutical hopes. The role of French chemists for the extraction of active principles is detailed, focused on the 1848 cholera epidemic. Cannabis as a psychiatric treatment after 1845 is specially analysed. Cannabis will then be progressively considered as a poison, responsible of public health problems. From the 1870 years is outlined a new nosographical category: toxic psychoses, among which “folies hachichiques” (cannabic madnesses). A brief sketch is drawn, of cannabis considered as a tool for psychological investigation at the beginnings of scientific psychology, with Charles Richet. At the end of xixth century is built the new frame of drug addictions (toxicomanias), in which cannabis addiction will take place. Psychiatry will then be involved in the treatment not only of the consequences but of the psychological causes of drug consumption. The role played by medicine in the diffusion of cannabis use in Occident is finally underlined.     

Neuropsychological functions and metabolic aspects in subclinical hypothyroidism: The effects of l-thyroxine

Thyroid hypofunction is a slowly progressing graded phenomenon [Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43(1):55–68]; subclinical forms (SCH) often represent a laboratory diagnosis in apparently asymptomatic patients. In the absence of adequate parameters for thyroid hormone action in tissues, the level of TSH increase corresponding to negative effects remains unsettled.     

Protein and lipid damage in maple syrup urine disease patients: l-carnitine effect

Maple syrup urine disease (MSUD) is an inborn error of metabolism biochemically characterized by elevated levels of the branched chain amino acids (BCAA) leucine, isoleucine, valine and the corresponding branched-chain α-keto acids. This disorder is clinically characterized by ketoacidosis, seizures, coma, psychomotor delay and mental retardation whose pathophysiology is not completely understood. Recent studies have shown that oxidative stress may be involved in neuropathology of MSUD. l-Carnitine (l-Car) plays a central role in the cellular energy metabolism because it transports long-chain fatty acids for oxidation and ATP generation. In recent years many studies have demonstrated the antioxidant role of this compound. In this work, we investigated the effect of BCAA-restricted diet supplemented or not with l-Car on lipid peroxidation and in protein oxidation in MSUD patients. We found a significant increase of malondialdehyde and of carbonyl content in plasma of MSUD patients under BCAA-restricted diet compared to controls. Furthermore, patients under BCAA-restricted diet plus l-Car supplementation presented a marked reduction of malondialdehyde content in relation to controls, reducing the lipid peroxidation. In addition, free l-Car concentrations were negatively correlated with malondialdehyde levels. Our data show that l-Car may have an antioxidant effect, protecting against the lipid peroxidation and this could represent an additional therapeutic approach to the patients affected by MSUD.