Conceptual Challenges of a Tentative Model of Stress-Induced Depression

Extent: 2p.Bernhard Baun

New developments in the management of major depressive disorder and generalized anxiety disorder: role of quetiapine

Quetiapine has demonstrated efficacy in schizophrenia, bipolar disorder and in the treatment of specific symptom clusters such as agitation and sleep problems in mood disorders. In this review, randomized controlled studies demonstrating efficacy, safety and tolerability of quetiapine in major depressive disorder (MDD) and general anxiety disorder (GAD) are evaluated. The results show that quetiapine monotherapy and quetiapine augmentation of antidepressant treatment in MDD and GAD are efficacious for short-term and maintenance treatment at a dose range between 50 and 300 mg/day. Quetiapine appears to have a specific but overall mild side-effect profile, though, some adverse effects such as sedation and somnolence may lead to withdrawal from treatment in some patients. Overall, the available evidence suggests that there is a significant role for quetiapine in the treatment of MDD and GAD

Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression

Limited data exist on concordance between patients’ and health care providers’ (HCPs) perceptions regarding symptoms of major depressive disorder (MDD) and treatment priorities, particularly across disease phases. This study examined concordance during the acute, post-acute, and remission phases of MDD. In an online survey, 2,008 patients responded based on their experience with MDD, and 1,046 HCPs responded based on their clinical experience treating patients with MDD. Questions included symptom frequency and severity, treatment priorities, and impact on psychosocial functioning. Patients reported more frequently mood, physical, and cognitive symptoms than HCPs in the post-acute and remission phases and greater impact on psychosocial functioning. Patients reported that all these symptoms require high treatment priority across the phases of MDD, generally to a greater extent than HCPs. Patients also gave high emphasis to addressing impairment in psychosocial functioning early in the treatment course. A substantial difference in the effectiveness of treating symptoms of MDD between patients and HCPs was observed. This is the first study to quantify, broadly, differences in perceptions of MDD symptom prevalence, severity, and treatment priorities across MDD phases, and the study findings highlight a need for improved communication between patients and HCPs about symptoms, their impact on psychosocial functioning, and treatment priorities across phases

Recurrence of suicidal ideation due to treatment with antidepressants in anxiety disorder: a case report

This report describes a patient suffering from panic disorder who developed repeated suicidal ideation specifically due to the treatment with Venlafaxine. A first suicide attempt years ago occurred while being treated with Venlafaxine. Subsequent treatment with SSRIs or other antidepressants involved no suicidal ideation. Re-commencement of Venlafaxine four years later immediately led to a second suicide attempt. This unwanted effect subsided immediately after switching to another SNRI (i.e. Duloxetine). The case report underlines the importance of onset of suicide risk in panic disorders due to specific antidepressants

Health Behaviors, Knowledge, Life Satisfaction, and Wellbeing in People with Mental Illness across Four Countries and Comparisons with Normative Sample

Background: People with chronic mental illness have poorer physical health and higher mortality than the general population. We investigated lifestyle factors in people with mental illness across four countries and compared with a normative sample. Design and methods: Data were collected from N=672 people (Germany, n=375; Palestine, n=192; London, n=63; Australia, n=42) with substance abuse disorder (n=224), schizophrenia (n=158), mood disorders (n=227) and somatoform disorders (n=63). The General Health Behaviour Questionnaire measured behaviours and knowledge related to nutrition, physical activity, alcohol, smoking, sleep, life satisfaction and wellbeing. The normative sample were derived from a German population (N=1,019). Data were analysed using ANOVAs and t-tests. Results: The Palestine sample did not differ from the Western samples on reported life satisfaction and wellbeing. However they reported unhealthier diets, less physical activity, and lower knowledge about the impact of diet, physical activity, smoking and sleep on health than the Western samples. Comparing the Western and normative samples, people with mental illness reported lower intake of healthy foods/drinks, higher intake of unhealthy foods, higher exercise, higher alcohol consumption, smoked less cigarettes, had less sleep and reported more sleep problems. Their knowledge was lower for nutrition, physical activity, and smoking. All participants reported lower life satisfaction and wellbeing than the normative sample (P values <0.001). Conclusions: Education on health-related lifestyle factors present important targets for primary care, quality of

Overweight and obesity at school entry among migrant and German children: a cross-sectional study

BACKGROUND: Overweight and obesity have become a global epidemic and are increasing rapidly in both childhood and adolescence. Obesity is linked both to socioeconomic status and to ethnicity among adults. It is unclear whether similar associations exist in childhood. The aim of the present study was to assess differences in overweight and obesity in migrant and German children at school entry. METHODS: The body mass index (BMI) was calculated for 525 children attending the 2002 compulsory pre-school medical examinations in 12 schools in Bielefeld, Germany. We applied international BMI cut off points for overweight and obesity by sex and age. The migration status of children was based on sociodemographic data obtained from parents who were interviewed separately. RESULTS: The overall prevalence of overweight in children aged 6–7 was 11.9% (overweight incl. obesity), the obesity prevalence was 2.5%. The prevalence of overweight and obesity was higher for migrant children (14.7% and 3.1%) than for German children (9.1% and 1.9%). When stratified by parental social status, migrant children had a significantly higher prevalence of overweight than German children in the highest social class. (27.6% vs. 10.0%, p = 0.032) Regression models including country/region and socioeconomic status as independent variables indicated similar results. The patterns of overweight among migrant children differed only slightly depending on duration of stay of their family in Germany. CONCLUSION: Our data indicate that children from ethnic minorities in Germany are more frequently overweight or obese than German children. Social class as well as family duration of stay after immigration influence the pattern of overweight and obesity in children at school entry

Working with community to improve dementia outcomes

Aims & Rationale/Objectives: To describe general practitioner (GP) and community dementia literacy and how this knowledge may be used to reduce dementia risk factors and provide a timely diagnosis that can improve quality of life. Methods: A review of published literature on community dementia literacy provides a background for this study where adult patients and GPs respond to questionnaires exploring their roles in diagnosis and prevention of dementia. Principal findings: Most people (61) associate dementia with memory loss and 46 consider there is a stigma to the diagnosis. They learn about dementia from acquaintances (31) and the media (33) but seldom from their doctor (1). However, they expect their doctor to know about dementia and provide help should they be diagnosed with the condition. Many (37) have memory concerns but only 6 were offered a memory test, despite 52 being receptive to having one. Most people (78) want to learn more about preventing dementia and 93 would like to be told the diagnosis should they have the condition. Implications: Health literacy can assist help seeking behavior. However, many health professionals feel nothing can be done for people with dementia despite strong evidence that referral too support agencies can improve quality of life. Healthy ageing benefits from reduction of risk factors for illness such as diabetes and heart disease. Although dementia shares many similar risk factors, unlike these treatable conditions, dementia once started does not stop. Effective prevention must start early as the disease may begin many years before symptoms appear

The impact of non-compliance with the therapeutic regimen on the development of stroke among hypertensive men and women in Gaza, Palestine.

Objective: Hypertension and stroke are 2 major public health problems worldwide. Several biological and non-biological risk factors for stroke have been identified in the past. Little is known regarding risk factors for stroke among the Arabic population in Gaza. To identify potential risk factors we investigated compliance with the therapeutic regimen and life style factors which may increase the risk for stroke. Methods: To research this study question, a pair matched case control study was conducted in Gaza Strip (Shefa Hospital, Nasser Hospital, Khan Younis Hospital, and related primary health care clinics) in 2001 (from January through to December) among 112 patients, who had been hospitalized for acute stroke and history of hypertension, and 224 controls with history of hypertension from primary health care clinics. Results: Conditional logistic regression models show significant associations between stroke and medication not taking as prescribed (odds ratio (OR)= 6.07; 95% confidence interval (CI)= 1.53, 24.07), using excessive salt at meals (OR= 4.51; 95% CI= 2.05, 9.90), eating diet high in fat (OR= 4.67; 95% CI= 2.09, 10.40), and high levels of stress (OR= 2.77; 95% CI= 1.43, 5.38). No significant association between smoking and the development of stroke (OR= 2.12; 95 CI 0.82, 5.51) was found. Regular physical exercise was a protective factor (OR= 0.26; 95% CI= 0.12, 0.57). Conclusion: Our results on risk factors for stroke confirm several other studies. In future programs on health promotion among hypertensive men and women in Gaza these modifiable risk factors could be addressed by health education strategies

Bilateral Electroconvulsive Therapy For Post-Traumatic Stress Disorder Comorbid to Depression

DergiPark: 1020975tmsjAims: We aim to present a patient who was suffering from treatment-resistant depression along with psychotic features and comorbid post-traumatic stress disorder and was treated by bilateral electroconvulsive therapy. Case Report: A 58-year-old female patient was transferred to the University Hospital Münster with the diagnosis of treatment-refractory depression with psychotic features and post-traumatic stress disorder. The patient was non-responsive to unilateral electroconvulsive therapy and multiple antidepressant agents during several inpatient treatments. After initiating bilateral electroconvulsive therapy, the patient’s symptoms improved significantly. Conclusion: After ruling out conventional treatment algorithms for psychotic depression comorbid to post-traumatic stress disorder, physicians can consider bilateral electroconvulsive therapy to treat complicated cases

Suicide Rates and Antidepressant Prescribing: A Casual or Causal Relationship?

Baune and Hay discuss the strengths and limitations of an ecological study that found an inverse correlation between suicide rates and fluoxetine prescriptions