Toward a comprehensive care of HIV patients: Finding a strategy to detect depression in a Spanish HIV cohort

Depression is a common but frequently undiagnosed feature in individuals with HIV infection. To find a strategy to detect depression in a non-specialized clinical setting, the overall performance of the Hospital Anxiety and Depression Scale (HADS) and the depression identification questions proposed by the European AIDS Clinical Society (EACS) guidelines were assessed in a descriptive cross-sectional study of 113 patients with HIV infection. The clinician asked the two screening questions that were proposed under the EACS guidelines and requested patients to complete the HADS. A psychiatrist or psychologist administered semi-structured clinical interviews to yield psychiatric diagnoses of depression (gold standard). A receiver operating characteristic (ROC) analysis for the HADS-Depression (HADS-D) subscale indicated that the best sensitivity and specificity were obtained between the cut-off points of 5 and 8, and the ROC curve for the HADS-Total (HADS-T) indicated that the best cut-off points were between 12 and 14. There were no statistically significant differences in the correlations of the EACS (considering positive responses to one [A] or both questions [B]), the HADS-D ≥ 8 or the HADS-T ≥ 12 with the gold standard. The study concludes that both approaches (the two EACS questions and the HADS-D subscale) are appropriate depression-screening methods in HIV population. We believe that using the EACS-B and the HADS-D subscale in a two-step approach allows for rapid, assumable and accurate clinical diagnosis in non-psychiatric hospital settings.

Influence of depression in a sample of people with hallux valgus

Hallux valgus (HV) is a highly-prevalent forefoot deformity associated with progressive subluxation and osteoarthritis of the first metatarsophalangeal joint; it is believed to be associated with depression. The aim of the present study was to determine the association of patients with varying degrees of HV involvement to depression using the Beck Depression Inventory (BDI). The sample consisted of 102 participants (mean age: 45.1±1.6), who attended an outpatient centre where self-report data were recorded. The degree of HV deformity was determined in both feet, and the scores on the BDI were compared. A total of 38.24% of the sample had depression, with an average BDI score of 10.55±12.36 points. There was a statistically-significant association between the degree and presence of HV in both feet (P=0.0001). People with a greater degree of HV deformity in any foot also have a significant increase in depression based on BDI scores, regardless of sex.

Os recetores da melatonina como novos alvos de fármacos antidepressivos

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

Behind the Great wall : the story of the C.E.Z.M.S. work and workers in China with numerous illustrations

http://www.archive.org/details/behindthegreatw00barnuoft/

The GrEAT pack: generic electronic assistive technology environmental control system - information booklet

This is a user manual for your electronic assistive technology environmental control system trial pack or in simple words – a few bits of technology that can let you control some household appliances. This information is intended for you, your family and carers.

The Whitby life of Gregory the Great: exegesis and hagiography

The eight-century Whitby Vita Gregorii is one of the earliest examples of Anglo-Saxon hagiography, and is the earliest surviving life of Gregory the Great (590-604). The work has proved itself an anomaly in subject matter, style and approach, not least because of the writer’s apparently arbitrary insertion of an account of the retrieval of the relics of the Anglo-Saxon King Edwin (d.633). There has, however, been relatively little research on the document to date, the most recent concentrating on elements in the Gregorian material in the work. The present thesis adapts a methodology which identifies patristic exegetical themes and techniques in the Vita. That is not only in material originating from the pen of Gregory himself, which is freely quoted and cited by the writer, but also in the narrative episodes concerning the Pope. It also identifies related exegetical themes underlying the narrative of the Anglo-Saxon material in the document, and this suggests that the work is of much greater coherence then has previously been thought. In the course of the thesis some of the Vita Gregorii’s major patristic themes are compared with Bede and other insular writers in the presentation of topics that have been of considerable interest to insular historians in recent years. That is themes including: the conversion and salvation of the English people; the ideal pastor; monastic influence on formation of Episcopal spiritual authority; relations between king and bishop. The thesis also includes a re-evaluation of the possible historical context and purpose of the work, and demonstrates the value of a proper understanding of the Vita’s spiritual nature in order to achieve this. Finally the research is supported by a new structural analysis of the entire Vita Gregorii as an artefact formed within literary traditions.

Novel insights into the role of the GABAB receptor in depression and anxiety

The GABAB receptor is a functional heterodimer comprising the GABAB1 and GABAB2 subunits, with the GABAB1 subunit displaying two major isoforms, GABAB(1a) and GABAB(1b). Preclinical findings have strongly implicated the GABAB receptor in stress-related psychiatric disorders, however, the precise contribution of the GABAB receptor in depression and anxiety disorders remains unknown. Emerging data suggest that the interaction between adverse environmental conditions, such as early life stress, and a specific genetic composition can increase the risk to develop psychiatric disorders in adulthood. This thesis investigated the role of the GABAB receptor alone or in combination with early-life stress (maternal separation), in modulating antidepressant like and anxiety-related behaviours. Pharmacological blockade of the GABAB receptor with CGP52432 had antidepressant-like behavioural effects. Moreover, mice lacking the GABAB(1b) receptor subunit isoform exhibited antidepressant-like behaviours in adulthood but anxiety-like behaviour in early-life. In response to maternal separation, GABAB(1a)-/- mice exhibited early-life stress-induced anhedonia, a core symptom of depression, while GABAB(1b)-/- mice exhibited a more resilient phenotype. Moreover, when compared with wildtype or GABAB(1a)-/- mice, GABAB(1b)-/- mice that underwent maternal separation exhibited enhanced stressinduced neuronal activation in the hippocampus and in the nucleus accumbens (NAcc), a critical area for anhedonia thus suggesting that enhanced stress-induced neuronal activation in the hippocampus and NAcc in GABAB(1b)-/- mice may be important for their antidepressant-like phenotype and their resilience to stress-induced anhedonia. Pharmacological blockade of GABAB receptor and GABAB(1b) receptor subunit isoform loss of function increased adult hippocampal cell proliferation, thus suggesting that increased hippocampal neurogenesis could be a potential mechanism for the antidepressant-like effects of GABAB receptor antagonists and GABAB(1b) receptor subunit isoform disruption. Finally, this thesis investigated whether the expression of several genes involved in hippocampal neurogenesis or the antidepressant response were altered in the mouse hippocampus following chronic treatment with a GABAB receptor antagonist.

Depression and 'crises of meaninglessness' in the political-economic theology of the money-God

The thesis starts with a historical analysis of the development of depression as a concept. Through this inquiry, the controversies behind the apparent consensus about depression’s etiology and treatment are illuminated, suggesting that the understanding of the climbing rates of depression in contemporary Western civilization is still up for grabs. That’s what the thesis sets out to investigate. In order to accomplish this aim, the study builds upon the classical accounts of Georg Simmel, Émile Durkheim and the more contemporary ideas of Dany-Robert Dufour, in dialogue with an array of supplementary theoretical sources. Navigating through this ‘sea’ of extraordinary and different theories, a new avenue of reflections arises, contributing for the sophistication of the questions made about the phenomenon of depression’s rates. The fundamental argument emerging from this theoretical undertaking is that ‘crises of meaninglessness’ that pervade the collective body of Western contemporary societies have, as one of its consequences, the expansion of depression rates. Meaninglessness in contemporary times is the primary object of investigation of the thesis. The concept, in the context of this study, is not understood as merely an effect of the historical decline of shared social norms due to processes of individualization. Rather, it is claimed, it originates from and is reinforced by the ‘political-economic theology of neo-liberalism’ which becomes virtually generalized in the West, erecting money as a God. The study concludes that by undermining culturally established values, ideals, institutions and principles that may block the dissemination of commodities this new transcendence has been challenging the task of signifying life, potentializing – among other subjective difficulties – the diffusion of depression.

Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes.

BACKGROUND: Coronary artery bypass grafting (CABG) is often used to treat patients with significant coronary heart disease (CHD). To date, multiple longitudinal and cross-sectional studies have examined the association between depression and CABG outcomes. Although this relationship is well established, the mechanism underlying this relationship remains unclear. The purpose of this study was twofold. First, we compared three markers of autonomic nervous system (ANS) function in four groups of patients: 1) Patients with coronary heart disease and depression (CHD/Dep), 2) Patients without CHD but with depression (NonCHD/Dep), 3) Patients with CHD but without depression (CHD/NonDep), and 4) Patients without CHD and depression (NonCHD/NonDep). Second, we investigated the impact of depression and autonomic nervous system activity on CABG outcomes. METHODS: Patients were screened to determine whether they met some of the study's inclusion or exclusion criteria. ANS function (i.e., heart rate, heart rate variability, and plasma norepinephrine levels) were measured. Chi-square and one-way analysis of variance were performed to evaluate group differences across demographic, medical variables, and indicators of ANS function. Logistic regression and multiple regression analyses were used to assess impact of depression and autonomic nervous system activity on CABG outcomes. RESULTS: The results of the study provide some support to suggest that depressed patients with CHD have greater ANS dysregulation compared to those with only CHD or depression. Furthermore, independent predictors of in-hospital length of stay and non-routine discharge included having a diagnosis of depression and CHD, elevated heart rate, and low heart rate variability. CONCLUSIONS: The current study presents evidence to support the hypothesis that ANS dysregulation might be one of the underlying mechanisms that links depression to cardiovascular CABG surgery outcomes. Thus, future studies should focus on developing and testing interventions that targets modifying ANS dysregulation, which may lead to improved patient outcomes.

Hippocampus shape analysis and late-life depression.

Major depression in the elderly is associated with brain structural changes and vascular lesions. Changes in the subcortical regions of the limbic system have also been noted. Studies examining hippocampus volumetric differences in depression have shown variable results, possibly due to any volume differences being secondary to local shape changes rather than differences in the overall volume. Shape analysis offers the potential to detect such changes. The present study applied spherical harmonic (SPHARM) shape analysis to the left and right hippocampi of 61 elderly subjects with major depression and 43 non-depressed elderly subjects. Statistical models controlling for age, sex, and total cerebral volume showed a significant reduction in depressed compared with control subjects in the left hippocampus (F(1,103) = 5.26; p = 0.0240) but not right hippocampus volume (F(1,103) = 0.41; p = 0.5213). Shape analysis showed significant differences in the mid-body of the left (but not the right) hippocampus between depressed and controls. When the depressed group was dichotomized into those whose depression was remitted at time of imaging and those who were unremitted, the shape comparison showed remitted subjects to be indistinguishable from controls (both sides) while the unremitted subjects differed in the midbody and the lateral side near the head. Hippocampal volume showed no difference between controls and remitted subjects but nonremitted subjects had significantly smaller left hippocampal volumes with no significant group differences in the right hippocampus. These findings may provide support to other reports of neurogenic effects of antidepressants and their relation to successful treatment for depressive symptoms.

Revisiting the monoamine hypothesis of depression: a new perspective.

As the incidence of depression increases, depression continues to inflict additional suffering to individuals and societies and better therapies are needed. Based on magnetic resonance spectroscopy and laboratory findings, gamma aminobutyric acid (GABA) may be intimately involved in the pathophysiology of depression. The isoelectric point of GABA (pI = 7.3) closely approximates the pH of cerebral spinal fluid (CSF). This may not be a trivial observation as it may explain preliminary spectrophotometric, enzymatic, and HPLC data that monoamine oxidase (MAO) deaminates GABA. Although MAO is known to deaminate substrates such as catecholamines, indoleamines, and long chain aliphatic amines all of which contain a lipophilic moiety, there is very good evidence to predict that a low concentration of a very lipophilic microspecies of GABA is present when GABA pI = pH as in the CSF. Inhibiting deamination of this microspecies of GABA could explain the well-established successful treatment of refractory depression with MAO inhibitors (MAOI) when other antidepressants that target exclusively levels of monoamines fail. If further experimental work can confirm these preliminary findings, physicians may consider revisiting the use of MAOI for the treatment of non-intractable depression because the potential benefits of increasing GABA as well as the monoamines may outweigh the risks associated with MAOI therapy.

THE GREAT RUSSIAN PIANO TRADITION: SELECTED REPERTOIRE BY TCHAIKOVSKY, RACHMANINOFF AND PROKOFIEV

This dissertation explores representative piano music by three great Russian composers: Tchaikovsky, Rachmaninoff and Prokofiev. The areas of research include: 1) the short character piece; 2) the Russian piano transcription tradition; 3) the concerto and sonata cycle; 4) extra-musical imagery; 5) the influence of popular and dance music of the period. Perhaps the most important result of this research is learning how the art of incorporating a singing quality at the piano stands at the center of Russian pianistic heritage. The first recital features compositions by Sergei Prokofiev. The Seventh Sonata exhibits rebellious, uncompromisingly dissonant treatment of its musical content. Ten Pieces from “Cinderella” shows an ascetic approach to piano texture - a common characteristic in Prokofiev’s late works. The Third Concerto is Prokofiev’s masterpiece in the genre. One of the 20th century’s most performed concerti, it overflows with pianistic challenges. For my second dissertation recital, I have chosen Peter Ilich Tchaikovsky’s The Seasons. These short character pieces were inspired by literary sources. The text portrays Russian rural life, nature, moments of intimate reflection, and imaginary experiences and impressions. Tchaikovsky’s gift as a melodist and remarkable musical individualist is represented in his two Nocturnes as well as in the Nutcracker Suite, masterfully transcribed by Mikhail Pletnev. The final program features Sergei Rachmaninoff’s Ten Preludes, Op. 23, regarded as a culmination of the turn-of-the-century grand Russian pianistic style. The Fantasy Pieces helped establish Rachmaninoff’s reputation as a pianist-composer, a profoundly lyrical poet of the piano. The three Rachmaninoff transcriptions, the Minuet, the Hopak and the Polka de W.R. preserve the spirit of the Golden Era’s musical salon. These pieces were written to delight and dazzle audiences with their bold character, musical taste, virtuosic tricks and technical finesse. The three recitals comprising this dissertation were presented in Gildenhorn Recital at the University of Maryland School of Music on November 13, 2010, April 11, 2011 and February 27, 2012. The recitals were recorded on compact discs and are archived within the Digital Repository at the University of Maryland (DRUM).

Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan.

Diagnosis and treatment of comorbid neuropsychiatric illness is often a secondary focus of treatment in individuals with autism spectrum disorder (ASD), given that substantial impairment may be caused by core symptoms of ASD itself. However, psychiatric comorbidities, including depressive disorders, are common and frequently result in additional functional impairment, treatment costs, and burden on caregivers. Clinicians may struggle to appropriately diagnose depression in ASD due to communication deficits, atypical presentation of depression in ASD, and lack of standardized diagnostic tools. Specific risk and resilience factors for depression in ASD across the lifespan, including level of functioning, age, family history, and coping style, have been suggested, but require further study. Treatment with medications or psychotherapy may be beneficial, though more research is required to establish guidelines for management of symptoms. This review will describe typical presentations of depression in individuals with ASD, review current information on the prevalence, assessment, and treatment of comorbid depression in individuals with ASD, and identify important research gaps.

THE GREAT RUSSIAN PIANO TRADITION: SELECTED REPERTOIRE BY TCHAIKOVSKY, RACHMANINOFF AND PROKOFIEV

This dissertation explores representative piano music by three great Russian composers: Tchaikovsky, Rachmaninoff and Prokofiev. The areas of research include: 1) the short character piece; 2) the Russian piano transcription tradition; 3) the concerto and sonata cycle; 4) extra-musical imagery; 5) the influence of popular and dance music of the period. Perhaps the most important result of this research is learning how the art of incorporating a singing quality at the piano stands at the center of Russian pianistic heritage. The first recital features compositions by Sergei Prokofiev. The Seventh Sonata exhibits rebellious, uncompromisingly dissonant treatment of its musical content. Ten Pieces from "Cinderella" shows an ascetic approach to piano texture - a common characteristic in Prokofiev's late works. The Third Concerto is Prokofiev's masterpiece in the genre. One of the 20th century's most performed concerti, it overflows with pianistic challenges. For my second dissertation recital, I have chosen Peter Ilich Tchaikovsky's The Seasons. These short character pieces were inspired by literary sources. The text portrays Russian rural life, nature, moments of intimate reflection, and imaginary experiences and impressions. Tchaikovsky's gift as a melodist and remarkable musical individualist is represented in his two Nocturnes as well as in the Nutcracker Suite, masterfully transcribed by Mikhail Pletnev. The final program features Sergei Rachmaninoff's Ten Preludes, Op. 23, regarded as a culmination of the turn-of-the-century grand Russian pianistic style. The Fantasy Pieces helped establish Rachmaninoff's reputation as a pianist-composer, a profoundly lyrical poet of the piano. The three Rachmaninoff transcriptions, the Minuet, the Hopak and the Polka de W.R. preserve the spirit of the Golden Era's musical salon. These pieces were written to delight and dazzle audiences with their bold character, musical taste, virtuosic tricks and technical finesse. The three recitals comprising this dissertation were presented in Gildenhorn Recital at the University of Maryland School of Music on November 13, 2010, April 11, 2011 and February 27, 2012. The recitals were recorded on compact discs and are archived within the Digital Repository at the University of Maryland (DRUM).