Characteristics, Management, and Depression Outcomes of Primary Care Patients Who Endorse Thoughts of Death or Suicide on the PHQ-9

BACKGROUND

With increasing emphasis on integrating behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts.

OBJECTIVE

To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depression outcomes in a primary care-based mental health program.

DESIGN

Observational analysis of data collected from a patient registry.

PARTICIPANTS

Eleven thousand fifteen adults enrolled in the Mental Health Integration Program (MHIP).

INTERVENTIONS

MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model include: a disease registry; integrated care management; and organized psychiatric case review.

MAIN MEASURES

The independent variable, suicidal ideation (SI), was assessed by PHQ-9 Item 9. Depression severity was assessed with the PHQ-8. Outcomes included four indicators of depression treatment process (care manager contact, psychiatric case review, psychotropic medications, and specialty mental health referral), and two indicators of depression outcomes (50 % reduction in PHQ-9 score and PHQ-9 score?<?10).

KEY RESULTS

SI was common (45.2 %) at baseline, with significantly higher rates among men and patients with greater psychopathology. Few patients with SI (5.4 %) lacked substantial current depressive symptoms. After adjusting for age, gender, and severity of psychopathology, patients with SI received follow-up earlier (care manager contact HR?=?1.05, p?<?0.001; psychiatric review HR?=?1.02, p?<?0.05), and were more likely to receive psychotropic medications (OR?=?1.11, p?=?0.001) and specialty referral (OR?=?1.23, p?<?0.001), yet were less likely to achieve a PHQ-9 score?<?10 (HR?=?0.87, p?<?0.001).

CONCLUSIONS

Suicidal thoughts are common among safety-net patients referred by primary care providers for behavioral health care. Scores on Item 9 of the PHQ-9 are easily obtainable in primary care, may help providers initiate conversations about suicidality, and serve as useful markers of psychiatric complexity and treatment-resistance. Patients with positive scores should receive timely and comprehensive psychiatric evaluation and follow-up.     

Depressive symptoms in patients with obstructive sleep apnea/hypopnea syndrome

Objective

The objective of this study was to determine the frequency of depressive symptoms in Peruvian patients with obstructive sleep apnea/hypopnea (OSAH) and the association between the presence of depressive symptoms and OSAH severity.

Methods

Physical examination, Beck Depression Inventory (BDI), and Epworth Sleepiness Scale (ESS) were applied, and a polysomnography test was performed.

Results

Data on 312 patients, 12 % females, 46.1?±?11.7 years of age, were analyzed. BDI and ESS scores were 8.3?±?5.7 and 9.8?±?5.5, respectively. A total of 244 (78 %) patients had OSAH: 27 % of the cases were mild, 23 % were moderate, and 50 % were severe. Eighteen percent of the population had depression. A univariate analysis found a relationship between depressive symptoms and OSAH, as well as with some polysomnographic variables related to OSAH severity. The association between depression and OSAH was not significant in the multivariate analysis.

Conclusions

No association was found between depressive symptoms and OSAH.     

Symptoms of depression but not anxiety are associated with central obesity and cardiovascular disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study

Aims/hypothesis

The aim of the study was to identify risk factors for depression and anxiety in a well-characterised cohort of individuals with type 2 diabetes mellitus.

Methods

We used baseline data from participants (n?=?1,066, 48.7% women, aged 67.9?±?4.2 years) from the Edinburgh Type 2 Diabetes Study. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Obesity was characterised according to both overall (body mass index, fat mass) and abdominal (waist circumference) measurements. Cardiovascular disease was assessed by questionnaire, physical examination and review of medical records. Stepwise multiple linear regression was performed to identify explanatory variables related to either anxiety or depression HADS scores.

Results

Abdominal obesity (waist circumference) and cardiovascular disease (ischaemic heart disease and ankle–brachial pressure index) were related to depression but not anxiety. Lifetime history of severe hypoglycaemia was associated with anxiety. Other cardiovascular risk factors or microvascular complications were not related to either anxiety or depressive symptoms.

Conclusions/interpretation

Depression but not anxiety is associated with abdominal obesity and cardiovascular disease in people with type 2 diabetes mellitus. This knowledge may help to identify depressive symptoms among patients with type 2 diabetes who are at greatest risk.     

Perianal disease is associated with psychiatric co-morbidity in Crohn’s disease in remission

Background and aim

Crohn’s disease is a life-long inflammatory disease which can impair quality of life, in particular in patients with psychiatric co-morbidities such as depression and anxiety. The aim of this prospective cohort study was to assess the prevalence of depression and anxiety and related risk factors in patients with quiescent Crohn’s disease.

Methods

A consecutive series of adult patients with confirmed diagnosis of Crohn’s disease, in clinical remission, were included and investigated during ambulatory visits using a standard questionnaire assessing demographic and clinical features of the disease. Within 1 month after the ambulatory visit, all patients were interviewed by phone to assess the presence of psychiatric disorders using standardized questionnaires. The questionnaire assessed the development of psychiatric disorders after the diagnosis of Crohn’s disease, the use of antidepressant or antianxiety therapy and current anxiety or depression by means of the Hospital Anxiety and Depression Scale.

Results

One hundred and ninety-five patients were included. Seventy-two (36.9 %) patients showed anxiety and/or depression symptoms, 46 (23.6 %) patients showed anxiety symptoms, 6 (3.1 %) patients showed depression symptoms and 20 (10.3 %) patients showed both symptoms. Forty-eight of these patients (58 %) were without any antidepressive or antianxiety treatment. Anxiety with or without depression was significantly correlated with female sex (p?=?0.017), history of perianal disease (p?=?0.003) and perianal surgery (p?=?0.042).

Conclusion

Anxiety is a frequent, often untreated, condition in patient affected by Crohn’s disease in clinical remission. Female sex, history of perianal disease and perianal surgery are major risk factors for anxiety.     

The Interconnections Project: Development and Evaluation of a Community-Based Depression Program for African American Violence Survivors

BACKGROUND

Multi-faceted depression care programs based within the healthcare system have been found to be effective, but may not fully address the needs of African American Intimate Partner Violence (IPV) survivors, many of whom are not seeking depression care in healthcare settings.

OBJECTIVES

To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV.

METHODS

We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data.

RESULTS

Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants’ unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p?<?0.001), self-efficacy, self-management behaviors, and self-esteem (all p?<?0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value.

CONCLUSION

Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.     

A Randomized Trial of Treatments for High-Utilizing Somatizing Patients

BACKGROUND

Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients.

OBJECTIVE

To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting.

DESIGN

Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients’ primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later.

SUBJECTS

Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization.

MEASUREMENTS

Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database.

RESULTS

At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (p?< 0.01), hypochondriacal symptoms (p?<?0.01), overall psychiatric distress (p?< 0.01), and role impairment (p?<?0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (p?=?0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (p?=?0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged.

CONCLUSIONS

Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.     

Psychiatric comorbidities in patients with inflammatory bowel disease

Background

Psychiatric comorbidities are associated with inflammatory bowel disease (IBD). We conducted an observational study to evaluate the prevalence of depression and anxiety in patients with IBD.

Methods

Seventy consecutive consenting patients with IBD (62 ulcerative colitis [UC], 8 Crohn’s disease [CD]; 40 males, mean age [SD] 36.2 [11.3] years) and 100 healthy volunteers (44 males, age 31.22 [SD] [10.5] years) as controls were enrolled. All participants were directed to take self-assessment tests, Patient Health Questionnaire -9 (PHQ-9) and Symptom Checklist Anxiety Scale (SCL-A20). Participants having a score ≥ 10 on PHQ-9, or ≥ 29 on SCL-A20 were administered the Hamilton Depression Rating Scale (HAM-D) or Hamilton Anxiety (HAM-A) scales, respectively. The severity of depression and anxiety was graded with HAM-D and HAM-A scales, respectively. The protocol was approved by the Institutional Ethics Committee.

Results

The prevalence of depression (34.3% vs. 5%, p?<?0.0001, OR 9.7) and anxiety (18.6% vs. 2%, p?=?0.0002, OR 11.17) was higher in patients with IBD as compared to controls. The severity of depression was higher in patients compared to controls (mean rank 17 vs. 7, p?=?0.04). The prevalence of depression was not different between UC and CD; all IBD patients with anxiety had UC. The mean duration of disease and history of corticosteroid treatment or surgery for IBD were not associated with the presence of depression or anxiety. Patients with severe CD (Crohn’s disease activity index, CDAI?>?450) had more severe depression. The severity of UC did not correlate with severity of anxiety or depression in UC.

Conclusions

Anxiety and depression are more prevalent in IBD patients as compared to healthy individuals.

     

Levels of thioredoxin are related to the severity of obstructive sleep apnea: based on oxidative stress concept

Background

Oxidative stress is a typical feature of obstructive sleep apnea (OSA). Thioredoxin (TRX), as one of the oxidative stress biomarkers, is a potent protein disulfide reductase in antioxidant defense. Our study is designed to test whether thioredoxin could assess the severity of OSA.

Methods

Sixty-three adults suspected of having OSA were included in this study and were divided into four groups based on the results of polysomnography (PSG): control, mild, moderate, and severe. Subjects with chronic medical diseases (with the exception of essential hypertension) or taking any antioxidant medication were excluded. Blood samples were obtained within an hour after the overnight PSG test. Plasma TRX levels were detected by enzyme-linked immunosorbent assay.

Results

The plasma TRX level in severe group was obviously increased (8.62?±?2.14, 13.33?±?5.60, 14.71?±?5.53, and 16.10?±?7.34 ng/ml; p?<?0.05). The TRX positively related to AHI (r?=?0.313; p?<?0.05), while negatively related to the lowest O₂ saturation (r?=?0.266; p?<?0.037). The OSA patients associated with hypertension showed elevated TRX level (17.70?±?6.98 vs. 13.43?±?5.83 ng/ml; t?=?2.434, p?<?0.018). The cutoff value of TRX for identifying OSA was 9.39 ng/ml (sensitivity 91 %, specificity 78 %), and its cutoff value for differentiating moderate–severe OSA from mild OSA was 11.79 ng/ml (sensitivity 75 %, specificity 65 %).

Conclusion

These results suggest that plasma TRX level is associated with the severity of OSA. Therefore, TRX may be used as a severity indicator of OSA.     

Neuroendocrine markers and psychological features in patients with irritable bowel syndrome

Background and aims

The key role of the brain-gut axis in the pathophysiology of irritable bowel syndrome (IBS) has been recognized. The aim of this study was to assess the possible association between IBS, neuroendocrine markers, and psychological features.

Methods

One hundred and twenty-five consecutive IBS patients and 105 healthy subjects were enrolled. Plasma serotonin, plasma and urinary cortisol, and plasma neuropeptide Y levels were evaluated. All patients were given a questionnaire to assess IBS symptom severity. In 66 patients, a psychodiagnostic assessment was carried out.

Results

A high incidence of specific psychological features, including state anxiety (69.69 %), trait anxiety (54.54 %), obsessions and compulsions (28.78 %), was observed in IBS patients. A positive correlation between neuropeptide Y and state anxiety (r?=?0.287, p?=?0.024) and simulation/social ingenuity (r?=?0.269, p?=?0.039) was found in these patients. In diarrhea-predominant IBS, plasma cortisol was linearly related to plasma serotonin (r?=?0.5663, p?<?0.001).

Conclusions

In IBS patients, a significant correlation was found between specific psychological features and neuroendocrine markers, especially plasma cortisol and neuropeptide Y; in diarrhea-predominant IBS, a correlation between plasma cortisol and serotonin was found, although it needs to be confirmed in more extensive cohorts.     

Clinical and histopathological correlation of duodenal biopsy with IgA anti-tissue transglutaminase titers in children with celiac disease

Background

Data correlating anti-tissue transglutaminase (tTG) antibody titers with severity of duodenal involvement is limited.

Objective

The aim of this study was to correlate IgA anti-tTG antibody titers with symptoms, anthropometric parameters, and duodenal histopathology.

Methods

Consecutively diagnosed patients of celiac disease as per modified ESPGHAN criteria presenting over a year were enrolled. Demographic data, symptoms, weight-for-age z score (WAZ), height-for-age z score (HAZ), IgA anti-tTG titer, and duodenal histopathology graded as per modified Marsh criteria were recorded. Spearman rank correlation test was used for association between TTG age, WAZ, and HAZ. Receiver operating curve (ROC), sensitivity, specificity, negative predictive value, and positive predictive value were used to obtain anti-tTG cutoff value predictive of Marsh grade 3.

Results

One hundred and forty-two patients with celiac disease were evaluated. tTG showed significant correlation with WAZ (r?=?0.822, p?=?<0.001) and HAZ (r?=?0.722, p?=?<0.001) but not with age (r?=?0.202, p?=?0.066). The median anti-tTG titers rose progressively with higher Marsh grade on histopathology (p?=?0.001). The median anti-tTG titer was also significantly higher in patients with classic celiac disease as compared to non-diarrheal celiac disease (144 u/mL vs. 27, p?=?0.02). Anti-tTG titer of 62.5 u/mL was strongly predictive of duodenal histology of Marsh grade 3a and higher with sensitivity, specificity, positive predictive value, and negative predictive value of 95.4 %, 98 %, 93.8 %, and 88.3 % respectively.

Conclusions

There is a significant correlation between IgA anti-tTG titers and anthropometric parameters and severity of duodenal histopathology. With further validation, strongly positive titers may be sufficient to predict severity of this disease.     

Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression

Purpose

Obstructive sleep apnea is a disabling sleep disorder characterized by obstructions or near obstructions of the upper airway. Sleep apnea shares many common features with major depressive disorder, which is a serious psychiatric disorder that can persist despite multiple treatment attempts. The current study utilizes baseline data from a study designed to evaluate the effectiveness of continuous positive airway pressure treatment in patients with comorbid treatment-resistant depression and sleep apnea. The aim of this study is to examine the effectiveness of the Berlin questionnaire in predicting which individuals with treatment-resistant depression have obstructive sleep apnea.

Methods

Eighty-two outpatients with treatment-resistant depression completed the Berlin questionnaire and underwent overnight polysomnography to determine whether they were suffering from undiagnosed obstructive sleep apnea.

Results

Scoring in the high-risk category on the Berlin questionnaire predicted an apnea/hypopnea index greater than 5 with a sensitivity of 25 % and a specificity of 85.4 %, an apnea/hypopnea index greater than 10 with a sensitivity of 24.5 % and a specificity of 91.7 %, and an apnea/hypopnea index greater than 15 with a sensitivity of 22.2 % and a specificity of 92.9 %. The Berlin questionnaire was better at predicting the presence of sleep apnea in our sample of predominantly pre-menopausal women than men, and category 2 of the questionnaire (daytime somnolence) was the poorest predictor of sleep apnea.

Conclusions

The Berlin questionnaire appears to be a valid instrument for ruling out obstructive sleep apnea in treatment-resistant depression and may be a helpful tool in assisting with the allocation of diagnostic resources.     

The Effect of Targeted and Tailored Patient Depression Engagement Interventions on Patient–Physician Discussion of Suicidal Thoughts: A Randomized Control Trial

BACKGROUND

Despite improvements in the diagnosis and treatment of depression, primary care provider (PCP) discussion regarding suicidal thoughts among patients with depressive symptoms remains low.

OBJECTIVE

To determine whether a targeted depression public service announcement (PSA) video or an individually tailored interactive multimedia computer program (IMCP) leads to increased primary care provider (PCP) discussion of suicidal thoughts in patients with elevated risk for clinical depression when compared to an attention control.

DESIGN

Randomized control trial at five different healthcare systems in Northern California; two academic, two Veterans Affairs (VA), and one group-model health maintenance organization (HMO).

PARTICIPANTS

Eight-hundred sixty-seven participants, with mean age 51.7; 43.9 % women, 43.4 % from a racial/ethnic minority group.

INTERVENTION

The PSA was targeted to gender and socio-economic status, and designed to encourage patients to seek depression care or request information regarding depression. The IMCP was an individually tailored interactive health message designed to activate patients to discuss possible depressive symptoms. The attention control was a sleep hygiene video.

MAIN MEASURES

Clinician reported discussion of suicidal thoughts. Analyses were stratified by depressive symptom level (Patient Health Questionnaire [PHQ-9] score?<?9 [mild or lower] versus ≥ 10 [at least moderate]).

KEY RESULTS

Among patients with a PHQ-9 score ≥ 10, PCP discussion of suicidal thoughts was significantly higher in the IMCP group than in the control group (adjusted odds ratio?=?2.33, 95 % confidence interval?=?1.5, 5.10, p?=?0.03). There were no significant effects of either intervention on PCP discussion of suicidal thoughts among patients with a PHQ-9 score?<?9.

CONCLUSIONS

Exposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts.     

Systemic inhibition of nitric oxide synthesis in non-diabetic individuals produces a significant deterioration in glucose tolerance by increasing insulin clearance and inhibiting insulin secretion

Aims/hypothesis

Endogenous NO inhibits insulin release in isolated beta cells and insulin-degrading enzyme activity in hepatocytes, while NO release from endothelial cells has been suggested to enhance insulin action. We assessed the overall effect of systemic inhibition of endogenous NO synthesis on glucose homeostasis in humans.

Methods

Twenty-four non-diabetic volunteers underwent two hyperglycaemic (+7 mmol/l) clamps with either saline or L-NG-nitroarginine methyl ester (l-NAME, at rates of 2.5, 5, 10 and 20 μg?min^?1?kg^?1) infusion. Another five volunteers underwent an OGTT with either saline or l-NAME (20 μg?min^?1?kg^?1) infusion. Blood pressure and heart rate were measured to monitor NO blockade; during the OGTT, endothelial function was assessed by peripheral arterial tonometry and insulin secretion by C-peptide deconvolution and insulin secretion modelling.

Results

Compared with saline, l-NAME at the highest dose raised mean blood pressure (+20?±?2 mmHg), depressed heart rate (?12?±?2 bpm) and increased insulin clearance (+50%). First-phase insulin secretion was impaired, but insulin sensitivity (M/I index) was unchanged. During the OGTT, l-NAME raised 2 h plasma glucose by 1.8 mmol/l (p?<?0.01), doubled insulin clearance and impaired beta cell glucose sensitivity while depressing endothelial function.

Conclusions/interpretation

In humans, systemic NO blockade titrated to increase blood pressure and induce endothelial dysfunction does not affect insulin action but significantly impairs glucose tolerance by increasing plasma insulin clearance and depressing insulin secretion, namely first-phase and beta cell glucose sensitivity.     

Anxiety and depression in rheumatoid arthritis: an epidemiologic survey and investigation of clinical correlates in Iranian population

Psychiatric disorders occur in a considerable proportion of patients with rheumatoid arthritis (RA). This study was conducted in order to evaluate the prevalence of anxiety and depression in Iranian RA patients. In the cross sectional study, 414 RA patients were enrolled prospectively during a period of 6 months from RA clinic of Rheumatology Research Center. Beck’s and Cattell’s inventories were applied to investigate depression and anxiety in RA patients. RA activity was measured by Disease Activity Score and patients’ disability was assessed by Health Assessment Questionnaire. Levels of pain perception were stratified based on Visual Analog Scale. The prevalence of depression was 63.6 % and anxiety was in 84.1 % among RA patients. Mixed anxiety and depression was detected in 60.2 % of the study population. Functional disability was significantly associated with severity of depressive and anxiety symptoms (p < 0.001); however there was no association between disease activity and depression or anxiety (p = 0.420). There was weak correlation between disease activity score and functional disability (Spearman’s rho = 0.33; p < 0.01). Severe levels of depression and anxiety were associated with higher levels of pain perception (p < 0.001). Our study stressed the impact of depressive and anxiety symptoms in functional disability and pain perception of RA patients. Our results point out the multidisciplinary management of RA.     

Left ventricular subclinical dysfunction associated with myocardial deformation changes in obstructive sleep apnea patients estimated by real-time 3D speckle-tracking echocardiography

Background

Previous studies have demonstrated that patients with obstructive sleep apnea (OSA) may develop left ventricular (LV) diastolic dysfunction. We aimed to study whether OSA patients have LV regional systolic dysfunction with myocardial deformation changes, despite a normal LV ejection fraction, using real-time 3D speckle-tracking echocardiography (Rt3D-STE).

Methods

Seventy-eight patients with OSA and no comorbidities were studied. They were divided into the following three groups according to the apnea–hypopnea index (AHI): 5~15/h as group I (mild OSA, 26 cases), 15~30/h as group II (moderate OSA, 29 cases), and ≥30/h as group III (severe OSA, 23 cases). Thirty gender–age-matched normal subjects were included as controls. The parameters of LV diastolic function were acquired with traditional echocardiography. The LV myocardial deformation parameters were obtained, including the longitudinal (LS), circumferential (CS), radial (RS), and area (AS) strains, with Rt3D-STE.

Results

LV global systolic function was normal in all patients, but diastolic function was impaired in groups II and III (E/E′ was 9.6?±?2.8 and 10.4?±?2.5, respectively, p?<?0.0001). The global LS and AS were significantly reduced in groups II and III compared with the controls and group I (LS 15.9?±?1.4 % and 14.8?±?1.5 % vs 18.2?±?1.7 % and 17.8?±?1.5 %; AS 27.4?±?1.8 % and 24.9?±?2.3 % vs 33.4?±?2.2 % and 32.7?±?2.9 %, respectively, p?<?0.0001), but the global CS and RS were significantly reduced only in group III (17.3?±?1.4 % and 43.1?±?6.5 % vs 19.6?±?1.6 % and 55.4?±?4.0 %, respectively, <0.0001). The severity of OSA was significantly associated with the LV global AS value (r?=??0.80, p?<?0.0001), LS (r?=??0.64, p?<?0.0001), CS (r?=??0.51, p?<?0.0001), and RS (r?=??0.62, p?<?0.0001).

Conclusions

Patients with moderate and severe OSA tended to have both LV diastolic dysfunction and abnormalities in regional systolic function with myocardial deformation changes, in spite of the normal LV ejection fraction. Myocardial strains of the LV were negatively correlated with the AHI. Rt-3DST had important clinical significance in the early evaluation of cardiac dysfunction in OSA patients.

     

Phasic jaw motor episodes in healthy subjects with or without clinical signs and symptoms of sleep bruxism: a pilot study

Background

To investigate the association between each clinical diagnosis criterion for sleep bruxism (SB) and the frequency of jaw motor events during sleep.

Methods

Video-polysomnography was performed on 17 healthy adult subjects (mean age, 26.7?±?2.8 years), with at least one of the following clinical signs and symptoms of SB: (1) a report of frequent tooth grinding, (2) tooth attrition with dentine exposure through at least three occlusal surfaces, (3) morning masticatory muscle symptoms, and (4) masseter muscle hypertrophy. Episodes of rhythmic masticatory muscle activity (RMMA) and isolated tonic activity were scored visually. These variables were compared with regards to the presence or absence of each clinical sign and symptom.

Results

In 17 subjects, 4.0?±?2.5/h (0.1–10.2) RMMA and 1.0?±?0.8/h (0–2.4) isolated tonic episodes were observed (total episodes: 5.0?±?2.4/h (1.2–11.6)). Subjects with self-reported grinding sounds (n?=?7) exhibited significantly higher numbers of RMMA episodes (5.7?±?2.3/h) than those without (n?=?10; 2.8?±?1.8/h) (p?=?0.011). Similarly, subjects with tooth attrition (n?=?6) showed significantly higher number of RMMA episodes (5.6?±?3.1/h) than those without (n?=?11; 3.2?±?1.6/h) (p?=?0.049). The occurrence of RMMA did not differ between the presence and absence of morning masticatory muscle symptoms or muscle hypertrophy.

Conclusions

Clinical signs and symptoms frequently used for diagnosing SB can represent different clinical and physiological aspects of jaw motor activity during sleep.     

Trends in Depressive Symptom Burden Among Older Adults in the United States from 1998 to 2008

CONTEXT

Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown.

OBJECTIVE

To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.

DESIGN

Serial cross-sectional analysis of six biennial assessments.

SETTING

Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N?=?16,184 in 1998).

MAIN OUTCOME MEASURE

The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none?=?0, elevated?=?4+, severe?=?6+), adjusting for demographic and clinical characteristics.

RESULTS

Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13–1.19), with significant increases in those aged ≥ 60 relative to those aged 55–59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88–0.98), which was most pronounced among those aged 80–84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06–1.28); however, this increase was limited to those aged 55–59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60.

CONCLUSIONS

Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.     

Tetramethylpyrazine Attenuates Atherosclerosis Development and Protects Endothelial Cells from ox-LDL

Purpose

We assessed whether tetramethylpyrazine (TMP), an active ingredient of Ligusticum wallichii Franchat, attenuates atherosclerosis (AS) development in rabbits and protects endothelial cells injured by ox-LDL.

Methods

In vivo, rabbits subjected to atherosclerosis were treated with TMP (75 and 150 mg/kg) by oral gavage for 12 weeks. In vitro, rat aortic endothelial cells (RAECs) were stimulated by ox-LDL.

Results

TMP treatment with 75 and 150 mg/kg significantly reduced the relative atherosclerosis area ratio in the aorta (0.41?±?0.042, 0.27?±?0.047 vs. 0.66?±?0.058 in AS), the ratio of intimal/medial thickness (0.54?±?0.09, 0.39?±?0.07 vs. 1.1?±?0.3 in AS) and the number of monocytes in intimal (10.1?±?2.8, 8.2?±?2.0 vs. 14.1?±?4.9 counts/mm² in AS). TMP also decreased levels of TC (15?±?4.2 to 6.1?±?1.2 mmol/L), TG (1.8?±?0.3 to 1.08?±?0.24 mmol/L), LDL-C (20.1?±?4.3 to 10.2?±?1.6 mmol/L) and increased HDL-C levels (0.40?±?0.08 to 0.85?±?0.17 mmol/L) in atherosclerosis rabbit plasma. TMP decreased the MCP-1 (187.3?±?38.4 to 86.1?±?17.2 pg/ml) and ICAM-1 (350.6?±?43.7 to 260.6?±?46.1 pg/ml) levels in plasma and inhibited LOX-1 expression in the rabbit aortas. Moreover, our in vitro study revealed that TMP suppressed monocyte adhesion to RAECs, inhibited RAEC migration, and down-regulated MCP-1 and ICAM-1 expression in ox-LDL-injured RAECs. Likewise, TMP inhibited LOX-1 and 5-LOX expression, and prevented nuclear accumulation of RelA/p65 and IκB degradation in ox-LDL-injured RAECs. Furthermore, TMP suppressed ox-LDL-induced activations of p-ERK, p-p38, and p-JNK MAPK.

Conclusion

TMP produces a tangible protection in atherosclerosis and endothelial cells. TMP might be a potential protective agent for atherosclerosis.