Do foods precipitate seizures? A cross-cultural comparison

OBJECTIVES: It has been reported that a common belief of the families of the patients with epilepsy in Iran is that foods provoke seizures. Our aim in the present study was to ascertain whether a culturally different population of patients with epilepsy in the United States believe that foods precipitate seizures. METHODS: Adults aged 18 and older with epilepsy were recruited in either the inpatient epilepsy monitoring unit or the outpatient epilepsy clinic at Thomas Jefferson University from September to December 2006. Patients completed a questionnaire asking their age, sex, education, seizure control, and beliefs about the relationship between foods and seizures. RESULTS: One hundred ninety-three patients participated, with a mean age of 40.3 +/- 16. Only 11 (5.7%) patients reported foods as a precipitating factor for seizures. The difference between the results of the Iranian study, in which 55.2% of the families of children with epilepsy reported a relationship between specific foods and seizures, and the present results is significant (P=0.0001). CONCLUSION: The perception of foods as a seizure precipitant differs greatly between a Middle Eastern country (Iran) and a Western country (United States). This discordance suggests that cultural factors may play a large role in the perception of probable precipitating factors related to seizures. Some commonly reported seizure precipitants may represent cultural beliefs, and this raises a question as to whether foods truly precipitate seizures.     

Do pigeons perceive the motion aftereffect? A behavioral study

The motion aftereffect (MAE) describes an illusory motion in the opposite direction after the sudden halt of a prolonged moving visual stimulus. Behaviorally, this illusion was mostly analyzed in humans and other mammals. Up to now, birds were never tested. Since a new neural mechanism for the MAE was recently discovered in the pigeons' midbrain, the aim of this study was to investigate if pigeons can perceive this illusion. In two successive experiments, we trained animals to discriminate black and white grating patterns with two moving directions: upward or downward, or standing still. During transfer tests, animals were shortly confronted with the static pattern after prolonged exposure to a moving stimulus. The choice behaviors of these animals were highly indicative for the perception of an MAE. The possible neuronal substrate for the movement aftereffect is discussed.     

Do implantable cardioverter defibrillators contribute to new depression or anxiety symptoms? A retrospective study

Objective: In this retrospective cross-sectional study, we evaluated the existence of psychiatric symptoms which appeared after implantation of an implantable cardioverter defibrillator (ICD). Methods: Patients with ICDs were diagnosed using the Mini International Neuropsychiatric Interview (MINI) and were excluded if they had any psychiatric diagnosis prior to ICD implantation. Depression and anxiety were evaluated using the HAM-D and HAM-A rating scales and their attitude towards the ICD using a visual analog scale (VAS). Ninety five ICD patients with mean age of 66 years (±11.5) were recruited, 80 (84%) were men. Results: Four (4%) patients were diagnosed with new-onset MDD and one patient (1%) with anxiety. Twenty seven (28%) were found to have significant depressive symptoms (HAM-D >8), without MDD diagnosis; half of them attributing these symptoms to the device. Seven (8%) patients experienced phantom shocks and had relatively higher depressive scores (HAM-D 10.3 vs. 5.8; F?=?3.696; p?=?0.058). The MDD rates in our study were rather consistent with those reported for cardiac patients. Conclusions: We suggest that ICD contributed little, if any, additional depressive or anxiety symptoms after implantation. We found that the overall attitude towards the device was positive and that shocks and phantom shocks were related to depressive symptoms.     

Is atypical depression a moderate severity depression? A 536-case study.

OBJECTIVE: To determine if atypical depression is less common among outpatients with severe depression than among those with nonsevere depression. DESIGN: Case series. SETTING: Private practice. PATIENTS: Five hundred and thirty-six consecutive outpatients presenting for treatment of unipolar or bipolar II depression. OUTCOME MEASURES: Prevalence of atypical depression among patients with severe depression (Global Assessment of Functioning Scale [GAF] score of 50 or less) and nonsevere depression. RESULTS: There was no significant difference in the prevalence of atypical depression between patients with severe and nonsevere depression. CONCLUSIONS: Results do not support previous studies that atypical depression is usually of moderate severity. A rating scale like the GAF, which assesses both symptom severity and impairment of functioning, may give a more complete assessment of depression severity than a symptoms rating scale (used in previous studies), which does not cover atypical features and does not assess functioning.     

Do spirituality and religiousness differ with regard to personality and recovery from depression? A follow-up study

BackgroundThe studies show that both spirituality and religiousness are protective for mental health. Personality is related with course and outcome of depression, as well as spirituality and religiousness, and their relations toward to recovery from depression are underresearched. This study followed influence of spirituality and religiousness on course and outcome of depression in patients with depressive episode, controlled for personality dimensions.MethodsThe patients were assessed with self-report measures of depression (Beck Depression Inventory), spirituality (WHO-Quality of Life-Spiritual, Religious, Personal Beliefs), religiousness (Duke University Religion Index) and personality (Temperament and Character Inventory). Ninety nine patients finished a year long follow up.ResultsHigher spirituality influenced recovery of depression in patients with depressive episode, but religiousness did not show to be significant predictor of recovery for depression. Dimension harm avoidance was significant predictor of improvement of depression in all points of measurement.LimitationsSome limitations of this research are small sample size, usage of the self-report measures of depression in follow-up period, and the predominantly Catholic affiliation of the participants that can impact the generalizability of our data to other denominations.ConclusionSpirituality and dimension harm avoidance are significant predictors of recovery from depression during a year long follow up.     

Do health professionals' attitudes interfere with the treatment of depression?

Might the attitudes of health care professionals help to explain why most persons with a depressive disorder do not receive adequate care? To assess this question, the authors surveyed the faculty and staff of a midwestern university. One hundred percent of the social workers who responded found psychotherapy or counseling to be extremely or quite effective in treating persons with a major depressive episode, compared to 55% of the psychologists and 31% of the psychiatrists. For medication, the corresponding figures were 88% of psychiatrists, 64% of psychologists, and 46% of social workers. Many respondents noted problems with interprofessional communication, while most psychiatrists felt that individuals treated by two or more professionals for their depression usually receive poorer care. If future studies indicate that nonmedical therapists who view antidepressants as relatively ineffective are less likely to refer depressed clients for medication evaluation, these findings might help to explain why many depressed individuals who could benefit from medication do not receive it. Concerns about interprofessional communication, as well as psychiatrists' beliefs about the quality of care received by persons treated by more than one professional, might also explain why joint treatment occurs less often than would be desirable. The authors discuss some of the implications that these findings may have for the education of health care professionals.     

A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population

OBJECTIVE: The purpose of this study was to examine whether there is a bidirectional relationship between, on one hand, anxiety and depression and, on the other hand, insomnia over the course of a year. METHODS: A randomly selected sample of 3000 participants from the general population filled out a baseline survey (N=1812) and a 1-year follow-up survey (N=1498) on anxiety, depression, and insomnia. RESULTS: On cross-sectional analyses, bivariate correlations showed that anxiety, depression, and insomnia were significantly intercorrelated (varphi=.31-.54). On prospective analyses, logistic regression analyses demonstrated that anxiety at baseline [odds ratio (OR)=4.27 (8% of variance)] and depression at baseline [OR=2.28 (2% of variance)] were related to new cases of insomnia on follow-up. Furthermore, insomnia at baseline was related to new episodes of high anxiety and high depression on follow-up [OR=2.30 (2% of variance) and OR=3.51 (4% of variance), respectively]. CONCLUSION: Evidence suggests that there is a bidirectional relationship between, on one hand, anxiety and depression and, on the other hand, insomnia. This suggests that anxiety, depression, and insomnia are intertwined over time, implying implications for theoretical conceptualizations and interventions.     

A pilot study of the phase angle between cortisol and melatonin in major depression - A potential biomarker?

Introduction

Hypothalamic-pituitary-adrenal (HPA) axis and melatonin rhythm alterations have been independently reported in major depression (MDD) as well as in insomnia. In this pilot study, we link cortisol and melatonin rhythms and propose that the phase angle between cortisol acrophase (CA) and dim-light melatonin onset (20 pg/ml) (DLMO-20) may yield a useful state specific biomarker for MDD.

Methods

Six healthy (HC) and six depressed (MDD) psychotropic free subjects were admitted to the General Clinical Research Center. Blood was sampled for cortisol and melatonin from 1600 h to 1000 h, under dim lights (<20 lux) and constant routine. Time for DLMO-20 and peak cortisol concentration was determined for each subject. Phase angle was computed as the difference in time between CA and DLMO-20.

Results

Phase angle was significantly increased in MDD’s versus HC’s (13.40 ± 1.61 h. versus 11.61 ± 1.66 h, p = 0.026). Using ROC analysis, a phase angle greater than 13.57 h distinguished MDD’s from HC’s (sensitivity = 0.83, specificity = 1.0). Mean nocturnal melatonin (1600-1000 h) was significantly decreased in MDD’s versus HC’s (22.67 ± 9.08 pg/ml versus 47.82 ± 14.76 pg/ml, p = 0.015).

Conclusions

The phase angle between CA and DLMO-20 appears to distinguish HC’s from MDD’s and may be a useful biomarker to aid biologic assessment as well as treatment. Lower nocturnal melatonin in MDD’s highlights its importance in MDD’s pathophysiology. Additional study with larger sample size is needed to confirm the results of this pilot study. The mechanism for this phase angle difference and decreased melatonin, itself, requires further study.     

Does late onset depression predispose to dementia? A retrospective, case-controlled study

Background

Recent research suggests that there are clinical and biologic characteristics typical of late onset depression (LOD). Furthermore, evidence has been put forward that LOD may be a prodrome of dementia.

Objective

This study aims to assess the association between LOD and the development of dementia.

Setting

The study was conducted in a tertiary care, university-affiliated mental health center providing services for an urban catchment population of 800?000 subjects.

Method

A retrospective, case-controlled study was used.

Results

Fifty-one patients with LOD who developed dementia at least 1 year after diagnosis of LOD were defined as the index group: 18 males and 33 females, with a mean age of 75.4 ± 9.2 years. These were compared with 51 patients with LOD who did not develop dementia during a 10-year follow-up period. Dementia types were as follows: 73% Alzheimer disease, 24% vascular and mixed dementia, and 3% Parkinson dementia.Patients with LOD who developed dementia were significantly characterized by having longer hospitalization for their first depressive episode (P = .048), having a family history of dementia (P = .022), and having been exposed to the Holocaust as young adults (P = .013).

Conclusions

Patients with a history of significant traumatic experience in early life and a prolonged onset of depression may be at particular risk of developing dementia. This issue requires further long-term prospective studies.     

Do therapists address ethnic and racial differences in cross-cultural psychotherapy?

Ethnic and racial differences between client and therapist affect therapy processes and outcomes, but little is known about the extent to which therapists have dialogues about their differences in therapy. A survey on this topic was completed by 689 APA-licensed psychologists with experience conducting cross-cultural therapy. Most psychologists reported having such discussions, but with less than half of their cross-ethnic/racial clients. Therapists and clients were equally likely to initiate discussions. Reasons for discussing differences varied greatly. Therapists consistently described themselves as comfortable with and skilled at these discussions, and reported that discussions facilitated therapy. Therapists who were female, older, nonminority, less experienced with diverse clients, and viewed training as an important factor were more likely to have discussions about differences. Results point to the need to better understand if, when, and how ethnic and racial differences should be addressed in therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved).     

Do family-oriented interventions reduce poststroke depression? A systematic review and recommendations for practice

Introduction:Up to half of all stroke survivors become depressed. Poststroke depression (PSD) negatively impacts on quality of life and rehabilitation outcomes and increases risk of mortality. Depression is also common in carers, leading to poorer outcomes in survivors. Few stroke patients receive adequate care to support prevention and management of PSD. We aimed to systematically review the evidence regarding the effectiveness of family-oriented interventions to prevent and manage depression after stroke and identify components of effective interventions.

Methods:A systematic review was conducted, adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eight databases were searched, and relevant journals and reference lists were hand searched. Abstracts were screened for relevance and two authors independently assessed selected full texts against inclusion criteria. Studies were included if they (1) engaged stroke patients and their informal/family caregivers; (2) measured changes in depression due to an intervention; and (3) were available in English.

Results:Twenty-five of 2741 identified citations met the inclusion criteria. Five studies demonstrated significant reductions in depression. Commonalities across effective studies included the delivery of interventions that were structured and multicomponent, actively engaged patients and families, coordinated care, and were initiated soon after a stroke.

Conclusion:Family-oriented stroke rehabilitation may reduce depression in stroke survivors and their family caregivers. More research is required to clarify the effectiveness, feasibility, and acceptability of working with families and patients living with or who may be at risk of PSD.     

Do racial patterns in psychological distress shed light on the Black–White depression paradox? A systematic review

Purpose

Major epidemiologic studies in the US reveal a consistent “paradox” by which psychiatric outcomes such as major depressive disorder (MDD) are less prevalent among Blacks relative to Whites, despite greater exposure to social and economic stressors and worse physical health outcomes. A second paradox, which has received less attention and has never been systematically documented, is the discrepancy between these patterns and Black–White comparisons in psychological distress, which reveal consistently higher levels among Blacks. By systematically documenting the latter paradox, this paper seeks to inform efforts to explain the first paradox.

Methods

We conduct a systematic review of the literature estimating the prevalence of MDD and levels of psychological distress in Blacks and Whites in the US.

Results

The literature review yielded 34 articles reporting 54 relevant outcomes overall. Blacks have a lower prevalence of MDD in 8 of the 9 comparisons observed. In contrast, Blacks have higher levels of psychological distress (in terms of “high distress” and mean scores) than Whites in 42 of the 45 comparisons observed. Tests of statistical significance, where available, confirm this discrepant pattern.

Conclusions

A systematic review of the epidemiologic evidence supports the existence of a “double paradox” by which Blacks’ lower prevalence of MDD relative to Whites’ is inconsistent with both the expectations of social stress theory and with the empirical evidence regarding psychological distress. Efforts to resolve the Black–White depression paradox should account for the discordant distress results, which seem to favor artifactual explanations.

     

Do reasons for major depression act as causes?

We make sense of human behavior using reasons, which produce understanding via a subjective empathy-based first-person perspective and causes, which leads to explanations utilizing objective facts about the world assessed scientifically. We evaluate the common sense hypothesis that for episodes of major depression (MD), reasons act as causes. That is, individuals who have highly understandable depressive episodes will have, on average, fewer objective scientifically validated causes than those who have un-understandable episodes. The understandability of a MD as defined by the Diagnostic and Statistical Manual, 4th Edition (DSM IV) experienced in the past year in 630 personally interviewed twins from a population-based registry was rated, with high reliability, from rich contextual information. We predicted, from these understandability ratings, via linear and logistic regression, 12 validated risk factors for MD reflecting genetic and long-term environmental liability. No significant association was observed between 11 of these indices and the understandability of the depressive episode. The only significant finding-higher cotwin risk for MD associated with greater understandability-was opposite that predicted by the reasons-as-causes hypothesis. Our results do not support the hypothesis that reasons for MD act as causes. These findings, unlikely to result from low power, may be explicable from an empirical and/or philosophical perspective. Our results are, however, consistent with 'the trap of meaning' hypothesis, which suggests that understanding does not equal explanation and that while reasons may be critical to help us empathize with our patients, they are unreliable indices of objective risk factors for illness.     

Do depression symptoms predict seizure frequency--or vice versa?

OBJECTIVE: The aim of this study was to test a theoretical explanatory model of the relationship between depression symptom scores and seizure frequency in people with epilepsy. METHODS: A community-based sample of adults with active epilepsy provided information on depression symptom scores and seizure frequency at two time points, 1 year apart. RESULTS: One thousand two hundred ten patients completed the initial questionnaire, and 976 of these individuals (80.7%) completed the final questionnaire. Depression scores and seizure frequency were significant predictors of each other, both within (beta = .07, P < .05 and beta = .09, P < .05) and across time (beta = .03, P < .01 and beta = .07, P < .05). CONCLUSION: The relationship between depression symptom scores and seizure frequency in those with epilepsy is bidirectional.     

Should the treatment of depression in the Netherlands be changed after the STAR*D study?

The main results of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study are discussed in order to find out whether the results should lead to changes in the way in which depression is treated in the Netherlands. The outcomes of the STAR*D study are not sufficient justification for altering the current recommendations about the successive steps to be taken according to the Dutch multidisciplinary guideline for the treatment of depression.