Reduced serum levels of adiponectin in elderly patients with major depression

Recent studies have implicated adiponectin and other adipocytokines in brain function, particularly in processes related to memory and cognition. Blood levels of adiponectin are reduced in patients with primary cognitive disorders, such as Alzheimer's disease and mild cognitive impairment, and in adult patients with major depression. The aim of the present study is to determine serum levels of adiponectin in a sample of elderly patients with major depressive disorder (MOD) as compared to healthy older adults, and to examine the correlations between adiponectin levels and parameters indicative of mood and cognitive state. We recruited fifty-one unmedicated outpatients with late-life depression (LLD) and 47 age-matched controls in this study. The diagnosis of MDD was made according to the DSM-IV criteria, and the severity of depressive episode was determined with the 21-item Hamilton Depression Scale (HORS). Cognitive state was ascertained with the Cambridge Cognitive Test (CAMCOG) and the Mini-Mental State Examination (MMSE). Serum concentrations of adiponectin were determined using a sandwich ELISA method. Serum levels of adiponectin were significantly reduced in individuals with LLD (F = p < 0.001). Adiponectin level remained significantly reduced in after controlling for BMI index, scores on the CAMCOG, MMSE and HDRS and educational level (p < 0.001). Adiponectin levels showed a negative correlation with HORS scores (r = -0.59, p < 0.001) and BMI index (r = -0.42, p < 0.001); and showed a positive correlation with CAMCOG (r = 0.34, p < 0.01) and MMSE scores (r = 0.20, p = 0.05). The availability of circulating adiponectin is reduced in older adults with major depression, with likely implications on cognitive and mood state. Additional studies are required to determine whether this abnormality pertains to the pathophysiology of geriatric depression per se, or is a consequence of the morbid state. (C) 2012 Elsevier Ltd. All rights reserved.

Symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment: a prospective study

This study aimed to investigate the frequency of symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment, in the initial, middle and final stages of the treatment. This is a prospective exploratory quantitative study of 41 patients with head and neck cancer, undergoing radiotherapy treatment in the Oncology Outpatient Clinic of the Beneficencia Portuguese Hospital of Ribeirao Preto. Data were collected through the Beck Depression Inventory instrument, and analyzed quantitatively by means of the Statistical Package for the Social Sciences. Symptoms of dysphoria were found to increase throughout the treatment, as well as the number of patients with depression. The results show the importance for the healthcare professionals to detect the prevalence and the levels of the symptoms of depression, since these symptoms tend to increase and may lead to consequences such as a lack of adherence to treatment and a decrease in the quality of life of these patients.

Syntax of social life in postpartum depression: Mother-child interaction

Purpose: Understand the difficulties and experienced of individuals suffering from postpartum depression, related to mood disturbances, the mother-child bond and its repercussions in the meanings established for the experience of being a mother. Methods: Forty-one patients were interviewed, with ages ranging from 20 to 49 years, from a total of 106 attended at the Primary Care Unit, in the interior of the state of Parahiba, Brazil. A sample of 21 women was selected, presenting an inclusion profile, propitious to mapping postpartum depression. The eligible patients were referred by two PSF (Health Family) teams (one each from the urban and rural zones), aimed at diagnosing the psychic disturbance of the perperium. They were accompanied by a psychologist and all signed an informed consent form. A field diary supported the information recorded. Beck's Depression Inventory complemented the inclusion and follow-up of the patients. The data were analyzed statistically. Results: We confirmed the findings of the most recent studies that infant abandonment in the postpartum period occurs in situations where multiple and serious factors add up, such as misery (86.7%), little schooling (67%), lack of a support network (36.5%), estrangement of the mother's family relations (12%) and lack of paternal involvement (91.5%). Conclusion: The feeling of psyching pain and suffering, resulting from postpartum depression, is the most emphasized by women (87%) because it triggers the greatest discomfort, due to the difficulty in overcoming it.

ARE TWO ITEMS SUFFICIENT TO SCREEN FOR DEPRESSION WITHIN THE HOSPITAL CONTEXT?

Objective: to determine the ability of the reduced form of a screening instrument, the Patient Health Questionnaire-2 (PHQ-2), to assess the presence of depressive disorders in patients admitted to a general hospital. Method: A sample of 227 patients admitted to the clinical wards of a Brazilian general university hospital were assessed with Module A of the Diagnostic Structured Interview for the DSM-IV (SCID-IV) and filled out the PHQ-9 and PHQ-2. Results: The PHQ-2 demonstrated an area under the ROC curve of 0.89 (p < 0.0001), with a cutoff point of three or more being the one that best equilibrated the sensitivity (0.86) and specificity (0.75) values. The agreement index between the PHQ-2 and module A of SCID-W was 78.4% and the Kappa value was 0.51. Regarding reliability, the Cronbach alpha value obtained was 0.64 and the intraclass correlation coefficient was 0.52. Conclusion: PHQ-2 proved to be an instrument with good psychometric properties comparable to those of PHQ-9, being superior to the latter regarding the rate of false-positive results. In addition, it is a brief instrument that elicits little resistance on the part of the patient, being inexpensive and requiring little time, thus being of important help to the treatment teams for the detection of depressive disorder, being suitable for incorporation into hospital admission protocols and thus possibly favoring more immediate interventions. (Int'l J. Psychiatry in Medicine 2012;44:141-148)

AN EVALUATION OF ANXIETY AND DEPRESSION SYMPTOMS IN FIBROMYALGIA

The objective of this study was to identify the frequency of anxiety and depression symptoms by verifying the association between anxiety traits, current depression and anxiety symptoms in fibromyalgia patients. Interviews were performed with 60 subjects diagnosed with fibromyalgia at the Rheumatology Outpatient Clinic at Universidade Federal de Sergipe between August 2007 and March 2008, in which two questionnaires were administered: the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). The frequency of anxiety and depression symptoms was, respectively, 50% and 86% for individuals with fibromyalgia, and the mean trait-anxiety score was 59.38. An association was observed between trait and state anxiety. Anxiety and depression were frequent symptoms among patients with fibromyalgia. However, anxiety appeared as a secondary symptom to depression, appearing in a more severe form, and, therefore, this comorbidity should be more valued and studied.

Treatment-resistant depression increases health costs and resource utilization

Objective: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impact. The impact of MDD and Treatment-Resistant Depression (TRD+) within the Brazilian health system is largely unknown. The goal of this study was to compare resource utilization and costs of care for treatment-resistant MDD relative to non-treatment-resistant depression (TRD-). Methods: We retrospectively analyzed the records of 212 patients who had been diagnosed with MDD according to the ICD-10 criteria. Specific criteria were used to identify patients with TRD+. Resource utilization was estimated, and the consumption of medication was annualized. We obtained information on medical visits, procedures, hospitalizations, emergency department visits and medication use related or not to MDD. Results: The sample consisted of 90 TRD+ and 122 TRD-patients. TRD+ patients used significantly more resources from the psychiatric service, but not from non-psychiatric clinics, compared to TRD-patients. Furthermore, TRD+ patients were significantly more likely to require hospitalizations. Overall, TRD+ patients imposed significantly higher (81.5%) annual costs compared to TRD-patients (R$ 5,520.85; US$ 3,075.34 vs. R$ 3,042.14; US$ 1,694.60). These findings demonstrate the burden of MDD, and especially of TRD+ patients, to the tertiary public health system. Our study should raise awareness of the impact of TRD+ and should be considered by policy makers when implementing public mental health initiatives.

Maternal Depression, Behavioral Profile and School Performance in School-Age Children

The aim of this study was to compare behavioral profile and school performance of school-age children living with a mother who presents clinical history of recurrent depression, diagnosed according to CID-10 criteria in order to verify the influences of such adversity. Thirty-eight mother-child dyads were evaluated using tests, interviews and questionnaires. Approximately two-thirds of the children presented behavioral and school performance difficulties with predominance of emotional and relationship problems, and impairment in the three areas of school performance which were assessed (writing, arithmetic and reading). Such difficulties may be associated with the negative impact of maternal depression. One-third of the children did not present difficulties, which suggests the use of protective mechanisms. The study highlights the importance of considering differences in children's profiles for the planning of mental health practices.

Perinatal and early life factors associated with symptoms of depression in Brazilian children

Background: Few studies have been conducted on the association between perinatal and early life factors with childhood depression and results are conflicting. Our aim was to estimate the prevalence and perinatal and early life factors associated with symptoms of depression in children aged 7 to 11 years from two Brazilian birth cohorts. Methods: The study was conducted on 1444 children whose data were collected at birth and at school age, in 1994 and 2004/2005 in Ribeirao Preto, where they were aged 10-11 years and in 1997/98 and 2005/06 in Sao Luis, where children were aged 7-9 years. Depressive symptoms were investigated with the Child Depression Inventory (CDI), categorized as yes (score >= 20) and no (score < 20). Adjusted and non-adjusted prevalence ratios (PR) were estimated by Poisson regression with robust estimation of the standard errors. Results: The prevalence of depressive symptoms was 3.9% (95% CI = 2.5-5.4) in Ribeirao Preto and 13.7% (95% CI = 11.0-16.4) in Sao Luis. In the adjusted analysis, in Ribeirao Preto, low birth weight (PR = 3.98; 95% CI = 1.72-9.23), skilled and semi-skilled manual occupation (PR = 5.30; 95% CI = 1.14-24.76) and unskilled manual occupation and unemployment (PR = 6.65; 95% CI = 1.16-38.03) of the household head were risk factors for depressive symptoms. In Sao Luis, maternal schooling of 0-4 years (PR = 2.39; 95% CI = 1.31-4.34) and of 5 to 8 years (PR = 1.80; 95% CI = 1.08-3.01), and paternal age < 20 years (PR = 1.92; 95% CI = 1.02-3.61), were independent risk factors for depressive symptoms. Conclusions: The prevalence of depressive symptoms was much higher in the less developed city, Sao Luis, than in the more developed city, Ribeirao Preto, and than those reported in several international studies. Low socioeconomic level was associated with depressive symptoms in both cohorts. Low paternal age was a risk factor for depressive symptoms in the less developed city, Sao Luis, whereas low birth weight was a risk factor for depressive symptoms in the more developed city, Ribeirao Preto.

Does ragging play a role in medical student depression - Cause or effect?

Background: Medical students experience a lot of stress what may contribute to symptoms of depression. In this study we set out to look at the environmental factors which may be contributing in one medical school in Brazil. Methods: We assessed depressive symptoms using Beck's Depression Inventory in 465 and 267 medical students in 2001 and 2006 respectively. We explored possible social and environmental causes using qualitative data. Results: Nearly 15% scored above the cut off for depression in both the samples. Males in the pre-clinical stage in 2006 showed an increase in depressive symptoms than males in the same cycle in 2001 (aOR = 7.36 [95% CI = 0.85-63.5] p = 0.07). Qualitative data confirmed that factors such as ragging and low social involvement were correlated with depressive symptoms in pre-clinical stage males. Limitations: The sample size was small both for quantitative and qualitative aspects of the study. Conclusions: It appears that ragging plays an important role in the genesis of depressive symptoms in medical students. (C) 2012 Elsevier B.V. All rights reserved.

Relations between Depression, Alcohol and Gender in the Metropolitan Region of Sao Paulo, Brazil

As part of the GENACIS project, this paper sought to assess the prevalence of depression in an urban sample in the city of Sao Paulo, Brazil, as well as the association between depression and alcohol abuse according to gender. To achieve this, an epidemiological survey was conducted using a stratified probability sample, including 2,083 adults. CIDI SF was used to identify depression. The Rao Scott test and multivariate logistic regression were used for statistical analysis. The response rate was 74.9%. Females (58.3%) under 40 years of age (52%) were predominant. The prevalence of depression was 28.3% for women and 12.7% for men. Most men declared being drinkers (61.1%) in the last year. Depression was associated with an alcohol drinking pattern, mostly binge drinking, in addition to the occurrence of problems derived from alcohol use. Most women declared being abstainers (69.5%). Depression was associated with cohabiting with spouses with alcohol-related problems. Results reveal that the association between depression and alcohol consumption is distinct between genders.

Circulating Glial-derived neurotrophic factor is reduced in late-life depression

Background: The Glial Cell-line derived neurotrophic factor (GDNF) is part of the TGF-beta superfamily and is abundantly expressed in the central nervous system. Changes in GDNF homeostasis have been reported in affective disorders. Aim: To assess serum GDNF concentration in elderly subjects with late-life depression, before antidepressant treatment, as compared to healthy elderly controls. Methods: Thirty-four elderly subjects with major depression and 37 age and gender-matched healthy elderly controls were included in this study. Diagnosis of major depression was ascertained by the SCID interview for DSM-IV and the severity of depressive symptoms was assessed by the Hamilton Depression Rating Scale (HDRS-21). Serum GDNF concentration were determined by sandwich ELISA. Results: Patients with major depression showed a significant reduction in GDNF levels as compared to healthy elderly controls (p < 0.001). Also, GDNF level was negatively correlated with HDRS-21 scores (r = -0.343, p = 0.003). Discussion: Our data provide evidence that GDNF may be a state marker of depressive episode in older adults. Changes in the homeostatic control of GDNF production may be a target to development of new antidepressant strategies. (C) 2011 Elsevier Ltd. All rights reserved.

Abnormal resting state corticolimbic blood flow in depressed unmedicated patients with major depression: A 15O-H2O PET study

We investigated the differences in the resting state corticolimbic blood flow between 20 unmedicated depressed patients and 21 healthy comparisons. Resting state cerebral blood flow (CBF) was measured with H215O PET. Anatomical MRI scans were performed on an Elscint 1.9 T Prestige system for PET-MRI coregistration. Significant changes in cerebral blood flow indicating neural activity were detected using an ROI-free image subtraction strategy. In addition, the resting blood flow in patients was correlated with the severity of depression as measured by HAM-D scores. Depressed patients showed decreases in blood flow in right anterior cingulate (Brodmann areas 24 and 32) and increased blood flow in left and right posterior cingulate (Brodmann areas 23, 29, 30), left parahippocampal gyrus (Brodmann area 36), and right caudate compared with healthy volunteers. The severity of depression was inversely correlated with the left middle and inferior frontal gyri (Brodmann areas 9 and 47) and right medial frontal gyrus (Brodmann area 10) and right anterior cingulate (Brodmann areas 24, 32) blood flow, and directly correlated with the right thalamus blood flow. These findings support previous reports of abnormalities in the resting state blood flow in the limbic-frontal structures in depressed patients compared to healthy volunteers. Hum Brain Mapp, 2012. (C) 2011 Wiley Periodicals, Inc.

Depression, fatigue, and health-related quality of life in head and neck cancer patients: a prospective pilot study

To assess the prevalence of depression and fatigue symptoms in head and neck cancer patients during radiotherapy treatment and relate them symptoms with these patients' quality of life. This is a prospective study. The Beck Depression Inventory (BDI), Piper Fatigue Scale-revised and Functional Assessment Cancer Therapy Head and Neck (FACT-H&N) were applied to 41 head and neck cancer patients at three times: at the start of treatment (T1), approximately 15 days after the start of treatment (T2) and at the end of treatment (T3), approximately 30 days after the start of the radiotherapy. The mean BDI and PIPER increased during the radiotherapy treatment. BDI scores did not demonstrate the presence of depression, although the number of symptoms increased, and the presence of fatigue rose as treatment advanced. The mean FACT H&N decreased in the middle and at the end of treatment, indicating worsening in these patients' Quality of Life. Depression and fatigue symptoms increased during radiotherapy treatment, while QoL levels decreased. This demonstrates that these symptoms are strongly correlated and that their presence negatively influenced QoL. At the start of treatment, nurses need to advise patients and plan care, offering interventions to decrease these symptoms and improve QoL.

Validation of the Brazilian Portuguese version of the Beck Depression Inventory-II in a community sample

Background: The Beck Depression Inventory (BDI) is used worldwide for detecting depressive symptoms. This questionnaire has been revised (1996) to match the DSM-IV criteria for a major depressive episode. We assessed the reliability and the validity of the Brazilian Portuguese version of the BDI-II for non-clinical adults. Methods: The questionnaire was applied to 60 college students on two occasions. Afterwards, 182 community-dwelling adults completed the BDI-II, the Self-Report Questionnaire, and the K10 Scale. Trained psychiatrists performed face-to-face interviews with the respondents using the Structured Clinical Interview (SCID-I), the Montgomery-angstrom sberg Depression Scale, and the Hamilton Anxiety Scale. Descriptive analysis, signal detection analysis (Receiver Operating Characteristics), correlation analysis, and discriminant function analysis were performed to investigate the psychometric properties of the BDI-II. Results: The intraclass correlation coefficient of the BDI-II was 0.89, and the Cronbach's alpha coefficient of internal consistency was 0.93. Taking the SCID as the gold standard, the cut-off point of 10/11 was the best threshold for detecting depression, yielding a sensitivity of 70% and a specificity of 87%. The concurrent validity (a correlation of 0.63-0.93 with scales applied simultaneously) and the predictive ability of the severity level (over 65% correct classification) were acceptable. Conclusion: The BDI-II is reliable and valid for measuring depressive symptomatology among Portuguese-speaking Brazilian non-clinical populations.

Determination of Opiates in Whole Blood and Vitreous Humor: A Study of the Matrix Effect and an Experimental Design to Optimize Conditions for the Enzymatic Hydrolysis of Glucuronides

Faculty of Medicine University of Sao Paulo