Is hyperglycemia associated with anxious-depressive symptoms? An Italian study in primary care setting

Background: Recent researches exploring the relationship between impaired glucidic tolerance, hyperglycemia or frank type II diabetes mellitus and symptoms of anxiety and depression, mostly conducted on in-patients or highly selected samples and on foreign populations, have reported conflicting results. Nevertheless, these medical and mental conditions are often comorbid in clinical practice. Chronic and systemic inflammation could represent the trait d\'union between these conditions. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients. The aims of this research was to measure the association between hyperglycemia and symptoms of anxiety and/or depression in out-patients, and to fill the lack of studies on comorbidity between depression and anxiety disorders and medical conditions in Primary Care services. Method: The present was a cross-sectional study. We evaluated all consecutive patients undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics medication; psychosis (schizophrenia, schizoaffective, bipolar, organic, or tall as psychotic disorder by DSM IV-TR) or major depression; pregnancy; previous stroke or heart attack; type I diabetes mellitus. The psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Blood Glucose measurements (BM) in the last 6 months were considered in our analysis. Hyperglycemia cutoff: blood glucose N100 mg/dl. The statistical analysis was performed using STATA with multiple linear regressions. Results: 209 subjects were recruited in our study (84 men and 125 women). Of those, 48 (22.9%) were affected by hyperglycemia: 22 were men and 26 women. Hyperglycemia was related to HADS-D score in the men sample (β = .44, p = .01). No association was found between hyperglycemia and HADS-A, either in men or in women. Conclusion: The presence of hyperglycemia, well-known cardiovascular risk factor, may have a clinical value in predicting the presence of depressive symptoms, especially in men. Further studies should examine whether our results are generalizable to other populations and whether they are applicable to clinical depression. Molecular researches could focus on clarifying the pathophysiological reasons for such association, also exploring reasons for sex differences

Apple or pear? A cross sectional study on the association between body shape and symptoms of anxiety and depression in primary care female patients

INTRODUCTION - "Apple" body shape (Waist-to-Hip Ratio, WHR>1) is a documented risk factor for cardiovascular diseases, the first cause of morbility and mortality in Western societies. Mental disorders, especially anxiety and depression, are also related to cardiovascular diseases with accumulating evidence that these conditions have in common a dysregulation of inflammatory pathways. Nevertheless, joint assessment of WHR and symptoms of anxiety and depression has not been reported commonly so far. AIM - To explore the association between WHR and symptoms of anxiety and depression in a female primary care sample. METHODS - Cross-sectional design. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy Practice. Exclusion criteria: age 80; use of antidepressants or antipsychotics; previous stroke or heart attack; obesity due to hereditary. Psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Statistical analysis was performed using STATA. RESULTS - 125 women were assessed. WHR was inversely associated to HADS-Anxiety subscale score (β=-5.28, p=.02) e HADS-Depression subscale score(β=-4.02, p=.04) in the 40-60 years’ subgroup. In particular, WC was positively related to HADS-A (β=13.39, p=.02) e HADS-D (β=10.38, p=.03) while HC was inversely associated to HADS-A (β=-11.3, p=.01) and HADS-D (β=-8.6, p=.03). No associations were found in older groups. CONCLUSION - 'Pear” body shape (WHR<1), with a peripheral distribution of fat, is inversely associated to symptoms of anxiety and depression in women aged 40 to 60. The post-menopausal transition to the 'apple” model, with a central fat distribution, could explain the lack of correlations in women >60 years

Association between symptoms of anxiety and depression and BMI in Primary Care patients: a cross sectional study

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominaladiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation

Association between anxiety and depressive symptoms with metabolic syndrome in primary care: Results of an Italian cross-sectional study involving outpatients

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominal adiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation

Role of the equilibrium size of Kadanoff blocks in the loop-expansion technique

A method developed by the present authors in a previous paper [Phys. Rev. E 57, 2594 (1998)] leads to the introduction of the equilibrium size of the Kadanoff blocks as a useful tool to approach the critical properties of the φ4 model. The present paper aims to elucidate the role of the equilibrium size of the Kadanoff blocks in the loop-expansion technique currently used in the field-theoretic renormalization. While the standard results are readily obtained, aspects emerge that help clarify the true nature of the smallness parameter in the loop-expansion technique

Treatment of postprandial hypotension in the elderly

Food intake induces splanchnic vasodilation lasting for at least one hour, which can precipitate in postprandial hypotension, if systolic arterial blood pressure falls by more than 20 mmHg. Postprandial hypotension has a high prevalence in the elderly, above all in subjects receiving hypotensive drugs or in those with disorders of the autonomic nervous system. In our total case series of 567 subjects, the prevalence of postprandial hypotension evaluated by 24-hr blood pressure recording, was 14.5 %, increasing to 28 % in the oldest group. Since relevant cerebral ischemic symptoms may become manifest, a correct diagnosis of the disorder and both pharmacological and non-pharmacological therapeutical approaches are of great importance for the wellbeing of old patients

The choice and the change of the allocated primary mental health professional in community-based mental health services: A focus-group qualitative study

Objectives It is generally agreed that it is important to take into consideration users' preferences in the choice of their allocated primary mental health professional (PMHP). Our aim was to explore experiences of users, care givers and psychiatrists on users' initial choice and request of change the PMHP in Community Mental Health Services (CMHSs). Methods Three focus groups were conducted in March-May 2017 in two CMHSs in Modena, Northern Italy. Transcripts were analyzed using MaxQda 11. Results Six users, 7 psychiatrists and 5 care givers were enrolled. Casual or fixed allocation is commonly performed (so-called “fixed rota”). Lack of empathy and a bad therapeutic relationship seem to be the most important reasons to change the PMHP. Conclusions Neither users nor professionals are generally involved in the initial choice of the PMHP. The availability of evidence-based guidelines for managing users' request to choose/change the PHMP may improve quality of care