Norsk Psykiatrisk Forening

Abstract

Background: The association between subclinical hypothyroidism (SCH), with and without raised thyroid peroxidase antibodies (anti-TPO), and well-being or depression is still controversial, in spite of many studies on the topic. Aims: In this large general population study of 8214 individuals, we aim to clarify the significance of elevated levels of anti-TPO as a marker of poor well-being and depression in euthyroid individuals and individuals with SCH. Methods: In participants from the Danish General Suburban Population Study (GESUS), serum thyroid stimulating hormone (TSH), total triiodothyronine (tT₃), free thyroxine (fT₄) and anti-TPO was measured. Prevalence of poor well-being and depression was measured using the WHO-5 Well-being questionnaire and WHO MDI [Major (ICD-10) Depression Inventory] questionnaire. Results: Raw score for well-being or depression overall and stratified for sex was not more significantly different in euthyroid individuals than in individuals with SCH, with or without high anti-TPO, except that euthyroid women with elevated anti-TPO had better well-being (P = 0.03) compared with euthyroid women with anti-TPO within the reference range. Conclusion: Elevated anti-TPO levels cannot be used as a general marker of poor well-being or depression in the general population.     

Hormonal changes and their impact on cognition and mental health of ageing men

Demographic changes resulting in ageing of the world's population have major implications for health. As men grow older, circulating levels of the principal androgen or male sex hormone testosterone (T) decline, while the prevalence of ill-health increases. Observational studies in middle-aged and older men have shown associations between lower levels of T and poorer mental health in older men, including worse cognitive performance, dementia and presence of depressive symptoms. The role of T metabolites, the more potent androgen dihydrotestosterone (DHT) and the oestrogen receptor ligand estradiol (E2) in the pathophysiology of cognitive decline are unclear. Studies of men undergoing androgen deprivation therapy in the setting of prostate cancer have shown subtle detrimental effects of reduced T levels on cognitive performance. Randomised trials of T supplementation in older men have been limited in size and produced variable results, with some studies showing improvement in specific tests of cognitive function. Interventional data from trials of T therapy in men with dementia are limited. Lower levels of T have also been associated with depressive symptoms in older men. Some studies have reported an effect of T therapy to improve mood and depressive symptoms in men with low or low-normal T levels. T supplementation should be considered in men with a diagnosis of androgen deficiency. Beyond this clinical indication, further research is needed to establish the benefits of T supplementation in older men at risk of deteriorating cognition and mental health.     

Prevalence of depression,its correlates among students,and its effect on health-related quality of life in a Turkish university

Objective.The aims were to investigate the prevalence of depression among university students, and to determine some of the risk factors connected to depression, and also to evaluate its effect on health-related quality of life (HRQoL).

Methods.This cross-sectional survey was conducted between 1 December 2007 and 31 January 2008 at Osmangazi University, Eskisehir, in western Turkey. The study group consisted of 822 students. The questionnaire included the students’ socio-demographic characteristics, the Beck Depression Inventory, and the Medical Outcomes Study Short Form-36 (SF-36). The data were analyzed by using chi-square, Student's t test, percent (%) ratios, and backward logistic regression analysis with a significant value of P<0.05.

Results. Of the students, 377 (45.9%) were males and 445 (54.1%) females. Overall, the prevalence of depression was 21.8% (n=179/822). Family history of depression, acne on face, any physical defect on body, smoking, alcohol consumption, and future-related occupational preoccupation were all deemed important risk factors for depression (P <0.05, for each one). It was found that, in those with depression, all the mean domain scores of SF-36 scale were lower than those without depression (P <0.05, for each one).

Conclusions.The prevalence of depression among the university students in this region of Turkey was wide-spread, affecting negatively the HRQoL of the students. For prevention and control of depression, depression information and knowledge need to be addressed by health education programs.     

Novel pharmacological approaches to the treatment of schizophrenia

From a clinical point of view, orthostatic hypotension is a significant side effect during antidepressant treatment, particularly in the case of tricyclic antidepressants (TCAs). This prospective, randomized clinical trial evaluated the effects of clomipramine and moclobemide on orthostatic blood pressure during treatment for depression. One hundred and fifteen depressed inpatients, age up to 70?years, were randomized to treatment with either moclobemide (400?mg/day) or clomipramine (150?mg/day) after 1?week of placebo treatment. Orthostatic blood pressure was measured weekly over the 6-week study period. Clomipramine, but not moclobemide, caused a statistically significant fall in systolic (F=9.37, P=0.0037) and diastolic orthostatic blood pressure (F=3.74, P=0.0017). In the clomipramine-treated group of patients, we found no correlation between subjective complaints of orthostatic dizziness and the size of systolic orthostatic blood pressure. In conclusion, this study indicates that moclobemide does not induce orthostatic side effects, which is a significant problem in treatment with TCAs. However, the choice of antidepressants depends on other factors as well, e.g. the therapeutic efficacy.     

Effects of different stimulation parameters on the antidepressant-like response of medial prefrontal cortex deep brain stimulation in rats

Subcallosal cingulate gyrus (SCG) deep brain stimulation (DBS) is currently being investigated as a treatment for major depression. Despite the encouraging findings of the initial clinical series, several questions remain unanswered, including the most effective stimulation parameters (i.e., current intensity and frequency) and whether unilateral stimulation is also beneficial. We have recently found that some of the effects of SCG DBS could be modeled by stimulating the ventromedial prefrontal cortex (vmPFC) of rats undergoing the forced swim test (FST). Here we investigate whether changes in a number of DBS parameters, including electrode placement, influence outcome in this paradigm. Overall, we found that the antidepressant-like effects of DBS varied as a function of stimulation settings and target. The strongest response was observed with a current intensity of 200 μA, followed by 100 μA, and 300 μA. In contrast, 400 μA produced no effect. Using 200 μA, a frequency of 130 Hz was more effective than 20 Hz. An intriguing finding was that left unilateral stimulation was as effective as bilateral DBS. When different targets within the vmPFC were considered, a significant antidepressant-like response was observed after PL DBS, whereas IL stimulation was associated with a non-significant reduction in immobility scores. In summary, vmPFC DBS at high frequency and moderate intensity led to a maximal response in the FST.     

芳香治疗改善台湾地区安宁科护士工作倦怠及情绪的初步研究

目的 探讨芳香治疗对安宁科护士情绪及工作倦怠的影响,为芳香治疗的研究提供有关刎数据资料.方法 对研究组进行2个月的芳香治疗,使用焦虑自评量表（SAS）、抑郁自评量表（SDS）、工作倦怠量表和症状自评量表（SCL-90）进行评估.结果 研究组焦虑和抑郁情绪评分在治疗前后有显著差异,SCL-90显示研究对象在8周芳香治疗后焦虑因子和抑郁因子分有显著减低.工作倦怠量表情绪衰竭、情感疏远显著高于常模,个人成就显著低于常模.治疗后情绪衰竭、情感疏显著减低.结论 芳香治疗可以改善安宁科护士焦虑和抑郁情绪,并改善安宁科护士的工作倦怠. ZHANG Kai-peng YANG Can WANG Gao-hua 作者简介： 作者单位：张愷破（430060,武汉大学人民医院精神卫生中心） 杨灿（430060,武汉大学人民医院精神卫生中心） 王高华（430060,武汉大学人民医院精神卫生中心） 王惠玲（430060,武汉大学人民医院精神卫生中心）     

Psychological factors contributing to perceptions pain intensity after acute orthopaedic injury

Psychological factors are capable of influencing an individual's perception of pain and may mediate the evolution from acute to chronic pain. Personality characteristics, such as alexithymia and anxiety sensitivity, can also influence perception of pain by somatising psychological distress associated with acute pain. The aim of this study was to understand if alexithymia and anxiety sensitivity interact with psychological distress at an early stage of recovery from orthopaedic injury, to accentuate perception of pain intensity and potentially mediate the development of chronic pain disorder. 62 patients who had recently suffered orthopaedic injury completed the British Pain Society Pain Rating Scale plus the Hospital Anxiety and Depression Scale, as well as measures of alexithymia and anxiety sensitivity. Pain intensity correlated with each of the psychological measures but a regression analysis found that only depression, in combination with anxiety sensitivity, contributed to a significant amount of the variance in pain scores. The authors suggest that early screening after orthopaedic injury could identify those vulnerable to developing persisting pain disorders. This could lead to effective early intervention using psychological methods of pain management to reduce the risk of acute pain evolving into a chronic pain disorder.     

Black sheep get the blues: A psychobiological model of social rejection and depression

Major life events involving social rejection are strongly associated with onset of depression. To account for this relation, we propose a psychobiological model in which rejection-related stressors elicit a distinct and integrated set of cognitive, emotional, and biological changes that may evoke depression. In this model, social rejection events activate brain regions involved in processing negative affect and rejection-related distress (e.g., anterior insula, dorsal anterior cingulate cortex). They also elicit negative self-referential cognitions (e.g., “I’m undesirable,” “Other people don’t like me”) and related self-conscious emotions (e.g., shame, humiliation). Downstream biological consequences include upregulation of the hypothalamic-pituitary-adrenal axis, sympathetic-adrenal-medullary axis, and inflammatory response. Pro-inflammatory cytokines play an important role in this process because they induce a constellation of depressotypic behaviors called sickness behaviors. Although these changes can be short-lived, sustained inflammation may occur via glucocorticoid resistance, catecholamines, sympathetic innervation of immune organs, and immune cell aging. This response also may be moderated by several factors, including prior life stress, prior depression, and genes implicated in stress reactivity.