Novel Loci for Adiponectin Levels and Their Influence on Type 2 Diabetes and Metabolic Traits : A Multi-Ethnic Meta-Analysis of 45,891 Individuals

J. Kaprio, S. Ripatti ja M.-L. Lokki työryhmien jäseniä.Peer reviewe

[Staging and profiling of unipolar depression]

Contains fulltext : 110312.pdf (publisher's version ) (Open Access)BACKGROUND: Not only is the heterogeneous concept of depression too comprehensive, it is also insufficiently differentiated. This serves as a barrier to scientific research and obscures the symptoms that should indicate what treatment is required. AIM: To describe an accurate model for staging and profiling depression. METHOD: We placed depressive disorders in the context of the entire course of the disorder and we regarded the course as a continuum of psychopathology. RESULTS: First of all we distinguish five stages: (1) the prodromal phase, (2) the first depressive episode, (3) residual symptoms following an episode, (4) the relapse episode and (5) the chronic and/or treatment-resistant depression. The higher the stage, the greater the need for complex and specialised treatment. As characteristics for profiling we distinguish (a) aetiological and pathophysiological variables and (b) clinical factors. The latter are the ones that mainly influence treatment from stage 2 onwards. CONCLUSION: In our article we give a tentative overview of possible characteristics for profiling. At the moment the clinical factors are the ones used most for assessment. Current research into the value of aetiological characteristics for profiling will increase the applicability of a staging and profiling model

The temporal relation between pain and depression: results from the longitudinal aging study Amsterdam

Objective: Pain and depression are both common in old age, but their (long-term) temporal relationship remains unknown. This study is designed to determine whether pain predicts the onset of depression and vice versa. Methods: This is a prospective, population-based cohort study with 12-year follow-up and 3-year intervals in the Netherlands (Longitudinal Aging Study Amsterdam). At baseline, participants were aged 55 to 85 years (n = 2028). Main measurements outcomes were incident depression defined as crossing the cutoff of 16 and showing a relevant change (>= 5 points) on the Center for Epidemiological Studies-Depression Scale among nondepressed participants and incident pain defined as a score of 2 or higher on the pain scale of the 5-item Nottingham Health Profile in pain-free participants. Multiple imputations were adopted to estimate missing values. Results: In nondepressed participants (n = 1769), a higher level of pain was predictive of incident depression in multiple extended Cox regression analyses (hazard rate [HR] = 1.13 [95% confidence interval {CI}: 1.05-1.22], p = .001), which all remained significant after correction for sociodemographic characteristics, life-style characteristics, functional limitations, and chronic diseases (HR = 1.09 [95% CI = 1.01-1.18], p = .035). In the pain-free participants (n = 1420), depressive symptoms at baseline predicted incident pain (HR = 1.02 [95% CI: 1.01-1.04], p = .006). This depression measure did not independently predicted the onset of pain in the fully adjusted models. Conclusions: As pain precedes the onset of depression, strategies to prevent depression in chronic pain patients are warranted. In contrast, no effects of depression on the development of subsequent pain were found when adjusting for covariates

Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study

Patients with Attention-Deficit/Hyperactivity disorder (ADHD) have higher smoking rates, a younger age of smoking onset, and increased difficulty to stop smoking as compared to controls. Methylphenidate induced acute effects of increased smoking in laboratory studies, but long-term effects are unknown. We studied the acute and long-term relationship between methylphenidate use and tobacco consumption and nicotine craving among ADHD patients naïve for methylphenidate (. N=325). Patients filled out the Smoking Questionnaire (SQ) at baseline, and after two-weeks and three-months of methylphenidate use. The SQ involved questions on demographics, tobacco consumption, nicotine craving, life events, psychiatric diagnoses and use of medication. At baseline, smoking prevalence of ADHD patients was twice as high (50.2%) as the national norm (25.6%; p<.001). Tobacco consumption increased with 1.3 cigarettes per day after three-months of methylphenidate use. When translated into pack years, tobacco consumption increased by about 23 packs per year. Reports of increased nicotine craving after methylphenidate, increased with 20.3% after two weeks and 29.2% after three months. Light smokers (1-12 cigarettes/day) were especially at risk for increased tobacco consumption (. p<.05). Thus although methylphenidate is the drug of choice in medical treatment for ADHD, tobacco consumption and nicotine craving increased acutely and stabilized at increased levels after three-months of methylphenidate use. Although the net effect of methylphenidate on smoking behavior and craving should be further investigated within a randomized, placebo-controlled design, the results suggest that active prevention of increased smoking is needed in patients prescribed methylphenidate. © 2012 Elsevier B.V. and ECNP

Criterion validity of an Attention Deficit Hyperactivity Disorder (ADHD) screening list for screening ADHD in older adults aged 60-94 years

Objective: To identify Attention Deficit Hyperactivity disorder (ADHD) in older adults, a validated screener is needed. This study evaluates the reliability and criterion validity of an ADHD screener for younger adults on its usefulness in a population-based sample of older adults. Methods: Data were collected as a side study in the Longitudinal Aging Study Amsterdam. In a two-phase design the validity of the screener was tested against a structured diagnostic interview (DIVA 2.0). In Phase 1, 1,494 respondents (60-94 years) were assessed with the ADHD screener. In Phase 2, 231 respondents participated in the diagnostic interview. Results: Internal consistency (Cronbach's a) and reliability (ICC) of the screener were 0.71 and 0.56, respectively. The area under the curve was 0.82. The optimal cut-point was found at 2 (sensitivity: 0.80; specificity: 0.77; PPV: 0.13; NPV: 0.99). Conclusion: Despite its low ICC, the ADHD screener may serve as a useful contribution to measure ADHD in the older population. © 2013 American Association for Geriatric Psychiatry

A study on symptom profiles of late-life depression: the influence of vascular, degenerative and inflammatory risk-indicators.

Contains fulltext : 48809.pdf (publisher's version ) (Closed access)BACKGROUND: If specific symptom profiles of depressive disorders in the elderly are related to a specific etiology, this could have implications for everyday clinical practice. We hypothesized that a "motivational" profile, with symptoms such as psychomotor change, loss of interest and loss of energy, could clinically separate patients with predominantly vascular or degenerative risk indicators from patients with inflammatory risk indicators. METHODS: A total of 4051 subjects participated in a study on mental health problems in community-dwelling elderly. Information on psychiatric symptoms, demographic and medical status, previous history and family history was obtained. We distinguished three subgroups according to predominant somatic risk-indicators; vascular, degenerative and inflammatory groups. RESULTS: Motivational symptoms were associated with vascular or degenerative risk-indicators for depression; psychomotor change with both indicators; loss of energy with vascular, though also with the inflammatory indicator, and thinking/concentration disturbance with the degenerative indicator. The so-called mood symptoms of depression, especially thoughts of death, were more strongly related with the inflammatory risk-indicator. Melancholic symptoms like appetite and sleep disturbances were more strongly associated with the inflammatory risk-indicator. LIMITATIONS: Etiological classification was not confirmed by additional investigations such as laboratory findings or MRI brain scans. CONCLUSION: This study showed that in patients with a late-life depression specific symptoms of the depressive disorder may reflect the predominant underlying pathogenic mechanism

Cardiac disease, depressive symptoms, and incident stroke in an elderly population.

Item does not contain fulltextCONTEXT: Previous research suggests that depression is a risk factor for stroke. However, the reliability of much research is limited by the lack of documentation on the presence of preexistent cardiovascular disease and by the use of limited measures of depression or stroke. OBJECTIVES: To test the hypotheses that (1) clinically relevant depressive symptoms are an independent risk factor of incident stroke in cardiac and noncardiac patients and (2) more chronic and severe depressive symptoms are associated with incident stroke. DESIGN: A cohort of elderly Dutch people (aged > or = 55 years) was followed up for 9 years in the Longitudinal Aging Study Amsterdam (baseline measurements were taken in 1992 or 1993, and the study concluded in 2001 or 2002, respectively). SETTING: General community. PARTICIPANTS: Randomly selected population-based sample (N = 2965) without a history of stroke. MAIN OUTCOME MEASURES: The study end point was a first stroke (nonfatal or fatal). Depression was measured using the National Institute of Mental Health Diagnostic Interview Schedule and the Center for Epidemiological Studies-Depression Scale. Multivariate Cox proportional hazards regression analyses of stroke incidence were performed. The association of the chronicity and severity of depressive symptoms was studied in extended models with time-dependent variables. RESULTS: The sample's mean (SD) age was 70.5 (8.7) years, 52.1% were women, and the mean (SD) follow-up was 7.7 (3.1) years. Inclusion of an interaction between cardiac disease and clinically relevant depressive symptoms improved the model for stroke (P = .03). In participants with preexistent cardiac disease, but not in participants without cardiac disease, clinically relevant depressive symptoms at baseline (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.17-4.09) and the severity (range, 0-60; HR, 1.08; 95% CI, 1.02-1.13) and chronicity (HR, 3.51; 95% CI, 1.13-10.93) of symptoms during follow-up were associated with stroke. CONCLUSIONS: Preexistent cardiac disease moderates the association between depressive symptoms and incident stroke. In cardiac patients, baseline depressive symptoms and both the severity and chronicity of symptoms during follow-up are associated with incident stroke