Early adversity and 5-HTT-BDNF genes: new evidences of gene-environment interactions on depressive symptoms in a general population

Adverse childhood experiences have been described as one of the major environmental risk factors for depressive disorder. Likewise, the deleterious impact of early traumatic experiences on depression seems to be moderated by individual genetic variability. Serotonin transporter (5-HTT) and the Brain-Derived Neurotrophic Factor (BDNF) seem to modulate the effect of childhood adversity on adult depression, although inconsistencies across studies have been found. Moreover, the GxE interaction concerning the different types of childhood adversity remains poorly understood. The aim of this study is to analyse the putative interaction between the 5-HTT gene (5-HTTLPR polymorphism), BDNF gene (Val66Met polymorphism) and childhood adversity in accounting for adult depressive symptoms.

Early adversity and 5-HTT-BDNF genes: New evidences of Gene-Environment interactions on depressive symptoms in a general population

Background Adverse childhood experiences have been described as one of the major environmental risk factors for depressive disorder. Similarly, the deleterious impact of early traumatic experiences on depression seems to be moderated by individual genetic variability. Serotonin transporter (5-HTT) and brain-derived neurotrophic factor (BDNF) modulate the effect of childhood adversity on adult depression, although inconsistencies across studies have been found. Moreover, the gene×environment (G×E) interaction concerning the different types of childhood adversity remains poorly understood. The aim of this study was to analyse the putative interaction between the 5-HTT gene (5-HTTLPR polymorphism), the BDNF gene (Val66Met polymorphism) and childhood adversity in accounting for adult depressive symptoms. Method A sample of 534 healthy individuals filled in self-report questionnaires of depressive symptomatology [the Symptom Check List 90 Revised (SCL-90-R)] and different types of childhood adversities [the Childhood Trauma Questionnaire (CTQ)]. The 5-HTTLPR polymorphism (5-HTT gene) and the Val66Met polymorphism (BDNF gene) were genotyped in the whole sample. Results Total childhood adversity (β=0.27, p<0.001), childhood sexual abuse (CSA; β=0.17, p<0.001), childhood emotional abuse (β=0.27, p<0.001) and childhood emotional neglect (β=0.22, p<0.001) had an impact on adult depressive symptoms. CSA had a greater impact on depressive symptoms in Met allele carriers of the BDNF gene than in the Val/Val group (F=5.87, p<0.0001), and in S carriers of the 5-HTTLPR polymorphism (5-HTT gene) (F=5.80, p<0.0001). Conclusions Childhood adversity per se predicted higher levels of adult depressive symptoms. In addition, BDNF Val66Met and 5-HTTLPR polymorphisms seemed to moderate the effect of CSA on adult depressive symptoms.

Intervenció educativa per a la millora de la detecció precoç de la depressió major en adolescents

La depressió major és una patologia mental que afecta a persones de qualsevol edat, condició econòmica, nivell educatiu, cultural i suposen un gran cost per l’individu, la família, el sistema sanitari i la comunitat en general. Es creu que una de cada cinc persones arribarà a desenvolupar un trastorn depressiu al llarg de la seva vida i que al 2020 serà la segona causa de discapacitat i de pèrdua d’anys de vida saludables a escala mundial i la primera en països desenvolupats. L’objectiu d’aquest estudi quasi experimental és millorar la detecció precoç de la simptomatologia depressiva en adolescents, descriure els factors de risc i atendre les necessitats d’aquests joves. Utilitzarem el Test de Beck Depression Inventory-2nd (BDI-II) i el Patient Health Questionnaire-Adolescent version (PHQ-9) per detectar l’estat de salut mental dels alumnes. No tenim la certesa de que la mostra sigui representativa, ja que escollim un grup intacte d’alumnes de 1r d’ ESO, del municipi de Cardedeu, amb una edat per norma general de 12 -13 anys i per tant, potser una amenaça per la nostra validació ja que el factor entorn influeix directament en la situació sociodemografica de la població escollida, la situació econòmica i familiar.

Cost-effectiveness of a community pharmacist intervention in patients with depression: a randomized controlled trial (PRODEFAR study)

Background: Non-adherence to antidepressants generates higher costs for the treatment of depression. Little is known about the cost-effectiveness of pharmacist's interventions aimed at improving adherence to antidepressants. The study aimed to evaluate the cost-effectiveness of a community pharmacist intervention in comparison with usual care in depressed patients initiating treatment with antidepressants in primary care. Methods: Patients were recruited by general practitioners and randomized to community pharmacist intervention (87) that received an educational intervention and usual care (92). Adherence to antidepressants, clinical symptoms, Quality-Adjusted Life-Years (QALYs), use of healthcare services and productivity losses were measured at baseline, 3 and 6 months. Results: There were no significant differences between groups in costs or effects. From a societal perspective, the incremental cost-effectiveness ratio (ICER) for the community pharmacist intervention compared with usual care was 1,866 for extra adherent patient and 9,872 per extra QALY. In terms of remission of depressive symptoms, the usual care dominated the community pharmacist intervention. If willingness to pay (WTP) is 30,000 per extra adherent patient, remission of symptoms or QALYs, the probability of the community pharmacist intervention being cost-effective was 0.71, 0.46 and 0.75, respectively (societal perspective). From a healthcare perspective, the probability of the community pharmacist intervention being cost-effective in terms of adherence, QALYs and remission was of 0.71, 0.76 and 0.46, respectively, if WTP is 30,000. Conclusion: A brief community pharmacist intervention addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs, respectively, when compared to usual care. Regular implementation of the community pharmacist intervention is not recommended.

Las emociones como variables relacionadas con el cambio de hábitos de salud en familiares y amigos próximos de enfermos de cáncer

Study of the changes in health habits of 105 cancer patients’ relatives and close friends after the diagnosis. The aim is to try to verify whether the knowledge of the disease has got some impact in the modification of their life styles. The emotional alterations influence in this change of behaviour has been analysed futhermore. An interview of own creation and HADS (Anxiety Hospital and Depression Scale of Zigmond and Snaith, 1983) instrument, in a Spanish and a Catalan version, were used with this aim. The results show that 21.1% of the participants presented positive changes in their health habits after the diagnosis of the relative or close friend and 11.5% showed negative changes. In relation to the role of the emotions, averages of anxiety (14,33; d.t.=4,98) and depressive (10,17; d.t.=4,93) symptoms were higher in those subjects who made negative changes than in those who did not make any change (9,32; d.t.=5,37 and 6,33; d.t.=4,64). In addition, the youngest participants, with more depressive symptoms and who visit the subject more often, are those who become more assets modifying health habits. The results suggest that emotional alterations, mainly depressive symptoms, are associated with negative change and, therefore, it would be suitable to lend some type of attention to these alterations in the population studied with the purpose of improving their present and future health

Cribatge de simptomatologia depressiva en població universitària catalana : associació amb perfil de personalitat i branca de coneixement dels estudis cursats

La simptomatologia depressiva és una problemàtica incapacitant i freqüent en la població dels països occidentalitzats, tot i que existeix notable disparitat entre les xifres aportades per diferents treballs. Al nostre entorn, a més, no ha estat estudiada en població universitària. La relació de la simptomatologia depressiva amb determinats trets de personalitat, fonamentalment el neuroticisme, ha estat reportada àmpliament en la literatura; tanmateix, no existeixen estudis recents en el nostre entorn, i també hi ha incertesa en la relació entre personalitat i tipologia d’estudis universitaris. Estudi descriptiu transversal amb una mostra de 156 estudiants de primer curs de les branques de coneixement d’enginyeries, humanitats, ciències socials i ciències de la salut de la Universitat Autònoma de Barcelona, els quals han estat avaluats amb el Beck Depression Inventary (BDI) i el test de personalitat NEO PI-R

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism.

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism. Azorin JM, Bowden CL, Garay RP, Perugi G, Vieta E, Young AH. Source Department of Psychiatry, CHU Sainte Marguerite, Marseilles, France. Abstract About half of all bipolar patients have an alcohol abuse problem at some point of their lifetime. However, only one randomized, controlled trial of pharmacotherapy (valproate) in this patient population was published as of 2006. Therefore, we reviewed clinical trials in this indication of the last four years (using mood stabilizers, atypical antipsychotics, and other drugs). Priority was given to randomized trials, comparing drugs with placebo or active comparator. Published studies were found through systematic database search (PubMed, Scirus, EMBASE, Cochrane Library, Science Direct). In these last four years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues (2008) showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use. Several other open-label trials have been generally positive and support the efficacy and tolerability of agents from different classes in this patient population. Valproate efficacy to reduce excessive alcohol consumption in bipolar patients was confirmed and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics and to improve alcohol hallucinosis. Topiramate deserves to be investigated in bipolar patients with comorbid alcoholism since this compound effectively improves physical health and quality of life of alcohol-dependent individuals. In conclusion, randomized, controlled research is still needed to provide guidelines for possible use of valproate and other agents in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence.

Comorbilidad entre los factores de ansiedad del SCARED y la sintomatología depresiva en niños de 8-12 años

El objetivo de este estudio fue examinar la comorbilidad entre los factores de ansiedad del SCARED y síntomas depresivos en niños de 8-12 años. 792 niñas y 715 niños completaron el Screen for Child Anxiety Related Emotional Disorder (SCARED), el Children’s Depression Inventory (CDI) y un cuestionario de datos sociodemográficos. El 47% de la muestra presentó síntomas ansiosos y el 11,5% presentó síntomas depresivos. La comorbilidad heterotípica fue del 82% en niños con riesgo de depresión y del 20% en niños con riesgo de ansiedad. La comorbilidad homotípica entre los factores de ansiedad fue del 87%. La comorbilidad homotípica y heterotípica fueron elevadas, su detección hará posible prevenir la continuidad de un trastorno de ansiedad y el desarrollo de depresión

Psychological and Family Factors Associated with Suicidal Ideation in Pre-Adolescents

To assess the psychological and family factors associated with suicidal ideation in preadolescent children, we studied a sample of 361 students, average age 9 years old. Twogroups were formed, on the basis of the presence (n = 34) or absence (n = 44) of suicidal ideation. Suicidal ideation was assessed with the Children’s Depression Inventory and the Children’s Depression Rating Scale-Revised. Depression, hopelessness, self-esteem, and perceived family environment were compared in both the suicidal ideation and the control groups. Students with suicidal ideation generally presented greater depressive symptoms and hopelessness, and lower self-esteem and family expressiveness, although there weredifferences both between sexes, and when the variable depression was controlled. Identifying these risk factors in pre-adolescents may have an impact on prevention of suicidal behavior at higher risk ages

Design and implementation of a leisure program to improve function and wellbeing in people with depressive disorder

Depression is a major cause of disability and disease with significant costs to the health system and for the whole society. Regarding the treatment, in recent years has questioned the effectiveness of antidepressant drugs, with a recognition that although depressive disorders tend to improve with these treatments, residual symptoms seems to be still the norm, which is associated with the risk of new episodes or relapses, and faster its appearance. Otherwise many of the specialized clinical guidelines, propose a based on stepped-care model intervention, prioritizing less intrusive actions, including low-intensity psychosocial-interventions.