Association Between Chromosome 9p21 Variants and the Ankle-Brachial Index Identified by a Meta-Analysis of 21 Genome-Wide Association Studies

Genetic determinants of peripheral arterial disease (PAD) remain largely unknown. To identify genetic variants associated with the ankle-brachial index (ABI), a noninvasive measure of PAD, we conducted a meta-analysis of genome-wide association study data from 21 population-based cohorts

To stop or not to stop psychotropic medication; a protocol for an umbrella review on stakeholder perspectives

The intervention of deprescribing psychotropic medication appears to have been an overlooked aspect of pharmacotherapy for a long time. Rather recently, an attention shift has taken place, as evidenced by the publication of not only new guidelines but also systematic reviews of qualitative data from stakeholders on the process of decision making. Our aim is to synthesize qualitative research literature in order to explore factors influencing the decision to dis-/continue the use of several types of psychotropic medication from the perspectives of patients, relatives and healthcare professionals

Feasibility and Effectiveness of Memory Specificity Training in Depressed Outpatients: A Pilot Study

Background: Research has shown that depressed patients suffer from reduced autobiographical memory specificity (rAMS). This cognitive phenomenon is associated with the maintenance and recurrence of depressive symptoms. Objectives: This pilot study aims to investigate the feasibility and effectiveness of a relatively new group-based intervention (Memory Specificity Training; MeST) that aims to reduce rAMS in an outpatient setting. Methods: Twenty-six depressed outpatients received MeST during the waiting period prior to psychotherapy. The Client Satisfaction Questionnaire (CSQ-8) was used to measure client satisfaction after the training. The Autobiographical Memory Test (AMT) was used to measure memory specificity before and after the training. Depressive symptoms were measured using the Beck Depression Inventory (BDI-II) and the Montgomery Asberg Depression Rating Scale (MADRS), before and after the training, and at a 3-month follow-up. Results: Participants as well as trainers were positive about the use of MeST. Participants also showed an increase in memory specificity and a decrease in depressive symptoms. Conclusions: This study suggests that MeST is feasible in an outpatient setting, that it increases autobiographical memory specificity and that it may decrease depressive symptoms. A randomized controlled trial is recommended to examine MeST and its effects on autobiographical memory specificity, depressive symptoms and depressive relapse more extensively

Anxiety and new onset of cardiovascular disease: critical review and meta-analysis

Background Anxiety has been associated with new-onset cardiovascular disease (CVD), but the quality of this relationship is unclear. Only if anxiety is a causal, independent cardiovascular risk factor might it be a target for CVD prevention. Aims To determine and examine the independent association and causality between anxiety and incident CVD. Method PubMed, EMBASE and PsycINFO databases were searched up to October 2013. A review of Hill's criteria for causality and random effects meta-analysis were conducted of prospective, population-based studies examining anxiety and incident CVD in people free from CVD at baseline. Results The meta-analysis comprised 37 papers (n = 1 565 699). The follow-up ranged from 1 to 24 years. Anxiety was associated with a 52% increased incidence of CVD (hazard ratio = 1.52, 95% CI 1.36–1.71). The risk seemed independent of traditional risk factors and depression. The evaluation of Hill's criteria largely argued in favour of causality. Conclusions Anxiety may be of interest for CVD prevention. Future research should examine biological and behavioural underpinnings of the association in order to identify targets for intervention

The bidirectional relationship between anxiety disorders and alcohol use disorders in adults:Findings from a longitudinal population-based study

Background: Anxiety disorders (AD) and alcohol use disorder (AUD) frequently co-occur, but the temporal order of the association is unclear. We have determined the association between AD and the presence and first-onset of AUD, and vice versa. Methods: Data were used from n = 6.646 participants and four measurement waves (baseline, 3-, 6- and 9-years) of the Netherlands Mental Health Survey and Incidence Study 2 (NEMESIS-2), a cohort study of the Dutch general population aged 18–64 years. AD and AUD were assessed with the Composite International Diagnostic Interview 3.0. Multilevel logistic autoregressive models were controlled for previous-wave AD or AUD, sociodemographics (Model 1), smoking and clinical factors (Model 2). Results: People with AUD had a higher risk of present (OR = 1.65, 95 % CI 1.11–2.43; Model 2) and first-onset (OR = 2.03, 95 % CI 1.17–3.51; Model 2) AD in 3-years follow-up intervals than people without AUD. Vice versa, people with AD also had a higher sociodemographics-adjusted risk of present and first-onset AUD over 3-years follow-up intervals, but these associations attenuated into insignificance after adjustment for smoking and clinical variables. Limitations For statistical power reasons we were not able to analyze 9-year follow-up data or distinguish between AD and AUD types. Conclusions: Our results indicate a bidirectional relationship between AD and AUD; especially those with severe AD (medication use, comorbid depression) are at risk of developing AUD. Health care professionals should focus on prevention of AD in AUD patients and prevention of AUD in patients with (more severe) AD. Further research should investigate the mechanisms underlying the observed associations

Consensus on discontinuation of psychotropic medication; a Delphi study

There is an urgent need for practical recommendations to empower rational discontinuation care based on shared-decision making. Ideally, these recommendations help to answer the question how psychotropic medication can be best discontinued, taking into account the needs of patients and relatives, as well as the risk of recurrence or withdrawal symptoms. In this study we aim to collect expert-based judgments and to identify consensus on the best practices with respect to the discontinuation of psychotropics. The expert panel will include individuals with lived experience (patients, relatives) as well as health care professionals deprescribing psychotropic medication (e.g. pharmacists, general practitioners, psychiatrists, nurse practitioners)

Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey

Aims The association between antidepressant use and risk of cardiovascular disease (CVD) remains controversial, particu-larly in initially healthy samples. Given that antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are now prescribed not only for depression, but also for a wide range of conditions, this issue has relevance to the general population. We assessed the association between antidepressant medication use and future risk of CVD in a representative sample of community-dwelling adults without known CVD. Methods and results A prospective cohort study of 14 784 adults (aged 52.4+11.9 years, 43.9 % males) without a known history of CVD was drawn from the Scottish Health Surveys. Of these study participants, 4.9 % reported the use of antidepressant medication. Incident CVD events (comprising CVD death, non-fatal myocardial infarction, coronary surgical pro-cedures, stroke, and heart failure) over 8-year follow-up were ascertained by a linkage to national registers;

Associations between life stress and subclinical cardiovascular disease are partly mediated by depressive and anxiety symptoms

AbstractBackgroundStress experienced during childhood or adulthood has been associated with cardiovascular disease (CVD), but it is not clear whether associations are already prevalent on a subclinical cardiovascular level. This study investigates associations between indicators of life stress and subclinical CVD, and whether these are mediated by depression and anxiety.MethodsSubjects were 650 participants of the Netherlands Study of Depression and Anxiety, aged 20–66years, with or without (27.5%) depressive and anxiety disorders. Life stress included childhood trauma, negative life events and recently experienced daily hassles or job strain. Subclinical CVD was measured as 1) carotid atherosclerosis (intima–media thickness and the presence of plaques) using B-mode ultrasonography, and 2) central arterial stiffness (heart rate normalized augmentation index) using calibrated radial applanation tonometry.ResultsIncreased central arterial stiffness was shown in subjects who had experienced childhood trauma (per SD increase: β=.07; p=.01), or reported recently experienced daily hassles (per SD increase: β=.06; p=.02), negative life events (per SD increase: β=.05; p=.03), or job strain (high versus low: β=.09; p=.01). Associations between life stress and arterial stiffness appeared to be partly mediated by severity of depressive and anxiety symptoms. No significant associations were found for childhood life events, nor between indicators of life stress and carotid atherosclerosis.ConclusionsChildhood trauma and recent life stress were associated with increased central arterial stiffness. This suggests that life stress – partly via depression and anxiety – might enhance the development and progression of CVD