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The purpose of this paper is to assess the prevalence and nature of presentation of unipolar depression in individuals with Prader-Willi syndrome (PWS).

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2009) checklist for systematic reviews was followed where possible.

Seven studies were included in the qualitative synthesis from a total of 261 records identified. The quality of the studies was then assessed: scores for each study design ranged from between 3 and 6 of a possible score total of 6. The frequency of depression ranged between studies from 4 to 22 per cent. four studies showed over 50 per cent of patients appeared to suffer from psychotic symptoms. Low mood, anhedonia and irritability were described as features of depression, although no fixed pattern of psychopathology arose from across the studies (excluding psychosis). This review has provided evidence to suggest that depression is a frequent occurrence in the PWS population. One study found that the incidence of depression differed between the genetic subtypes, raising questions regarding the relationship between genotype and behavioural phenotypes. A high proportion of individuals with depression suffered from psychotic symptoms.

The small number of heterogeneous studies included in this study precluded meta-analysis of the results. This highlights the need for further original research in this field.

An increased awareness of the frequency of depressive symptoms within the PWS population will aid in the timely diagnosis and management of the disorder which will reduce psychiatric morbidity. The noted high proportion of psychotic symptoms associated with depression should raise the index of suspicion with clinicians and aid appropriate management decisions.

This review has provided preliminary evidence for the nature of presentation of unipolar depression in PWS. It has highlighted the possibility of an increased propensity towards depression with psychotic symptoms. There is some suggestion of a differing presentation and course of unipolar depression between the common genetic subtypes of PWS which warrants further investigation.

The purpose of this paper is to assess the prevalence and nature of presentation of unipolar depression in individuals with Down syndrome (DS).

The PRISMA (2009) checklist for systematic review was followed where possible.

Eight studies were included in the qualitative synthesis from a total of 634 records identified. The quality of the studies was then assessed: the studies all scored either 5 or 6 out of 6. The incidence of depression ranged between studies from 5 to 13 per cent. It was found that depression is more common in DS than the general intellectual disability population; this on a background of mental ill health of all causes being less common in DS. It was suggested that, excluding organic disorders, depression is the most common psychiatric problem in DS. In terms of the nature of depression, the evidence was less clear. Various “vegetative” and biological symptoms were observed, with no fixed pattern. There was evidence for withdrawal symptoms and psychosis.

The small number of studies included in this review, and their heterogeneity, highlights the need for further original research in this field.

An increased awareness of the frequency of depression in individuals with DS will aid in a timely diagnosis, therefore reduce psychiatric morbidity. Clinicians should be aware of the varied presentation, with no clear clinical picture, in order to maintain a high index of suspicion in an individual presenting with “atypical” symptoms.

This review has provided preliminary evidence that depression may be the most commonly experienced psychiatric disorder in DS.

Depressive disorders are a focus of growing social and economic concern. While antidepressant medications are widely accepted, they are ineffective for nearly 40% of users, and cause numerous adverse drug reactions. The pharmacogenomics of depression attempts to better understand the role of genetic variation in antidepressant metabolism in the hope of improving drug efficacy and tolerability. However, the development and delivery of genome‐based antidepressants face many hurdles. In this paper we provide an overview of the potential impact of the pharmacogenomics of depression on public mental health care by focusing on the social and ethical issues at stake. These include questions about genetic testing, informed consent, drug access, and market fragmentation. We end the paper with a brief discussion of the wider context and how the pharmacogenomics of depression relates to broader trends in psychiatry and biomedicine.

Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from schizophrenia with affective features has led to a third category of patients often loosely labeled as schizoaffective. Research in schizophrenia has attempted to render the presence or absence of negative symptoms and their relation to etiology and prognosis more explicit. A dichotomous population is a recurring theme in experimental paradigms. Thus, schizophrenia is defined as process or reactive, deficit or non-deficit and by the presence or absence of affective symptoms. Laboratory tests confirm the clinical impression showing conflicting responses to dexamethasone suppression and clearly defined differences in autonomic responsiveness, but their patho-physiological significance eludes mainstream theory. Added to this is the difficulty in agreeing to what exactly constitutes useful clinical features differentiating, for example, negative symptoms of a true deficit syndrome from features of depression. Two recent papers proposed that the general and specific cognitive features of schizophrenia and major depression result from a monoamine-cholinergic imbalance, the former due to a relative muscarinic receptor hypofunction and the latter, in contrast, to a muscarinic hypersensitivity exacerbated by monoamine depletion. Further development of these ideas will provide pharmacological principles for what is currently an incomplete and largely, descriptive nosology of psychosis. It will propose a dimensional view of affective and negative symptoms based on relative muscarinic integrity and is supported by several exciting intracellular signaling and gene expression studies. Bipolar disorder manifests both muscarinic and dopaminergic hypersensitivity. The greater the imbalance between these two receptor signaling systems, the more the clinical picture will resemble schizophrenia with bizarre, incongruent delusions and increasingly disorganized thought. The capacity for affective expression, by definition a non-deficit syndrome, will remain contingent on the degree of preservation of muscarinic signaling, which itself may be unstable and vary between trait and state examinations. At the extreme end of muscarinic impairment, a deficit schizophrenia subpopulation is proposed with a primary and fixed muscarinic receptor hypofunction.

The genomic profile of bipolar disorder and schizophrenia overlap and both have a common dopaminergic intracellular signaling which is hypersensitive to various stressors. It is proposed that the concomitant muscarinic receptor upregulation differentiates the syndromes, being marked in bipolar disorder and rather less so in schizophrenia. From a behavioral point of view non-deficit syndromes and bipolar disorder appear most proximate and could be reclassified as a spectrum of affective psychosis or schizoaffective disorders. Because of a profound malfunction of the muscarinic receptor, the deficit subgroup cannot express a comparable stress response. None -theless, a convergent principle of psychotic features across psychiatric disorders is a relative monoaminergic-muscarinic imbalance in signal transduction.

This paper aims to identify psychosocial, demographic and health risk factors associated with depression in older people.

A correlational study with 281 independent and autonomous persons of the community over 60 years old from Bogotá was conducted. The three instruments used to measure the variables included in the data analyses were Demographic and Health Data Questionnaire, Short version of 15 items of Geriatric Depression Scale (GDS) and Montreal Cognitive Assessment Test (MoCA).

Fifteen percent of the participants presented depression. Depression was associated with different demographic, low social support and health factors in this population group and was particularly high in women. Being a woman with poor social support networks and a previous history of depressive episodes should be considered as determining factors within a clinical risk profile for depression in older adulthood. It is essential to design prevention strategies focused on women and on the development of better social support in old age.

Depression is a prevalent and highly disabling disease, when it is suffered by an older person it is associated with higher mortality, functional dependence, poor physical health, worse quality of life indicators and psychological well-being. In the elderly, the clinical diagnosis of depression is difficult, as it has a high comorbidity and is often confused with other health conditions prevalent during older adulthood.

This paper explores the evidence on risk and vulnerability to depression of older people, looking at the complex interplay between physical ill health, disability, loss of intimates and social relationships, loneliness and depression, and the resources and protective factors at individual, social and community level that either buffer risk or promote psychological well‐being. It concludes, with Blazer (2000), that effective strategies for the prevention, treatment and management of depression must ‘proceed across multiple domains simultaneously’, and address social, environmental and economic as well as medico‐biological factors if interventions are to prove effective in this greatly neglected field. Action at government level to address social inequalities throughout the life course would also have a significant protective impact on mental well‐being in old age.

Alcohol misuse and mental health problems in parents are both known to contribute to impaired outcomes in children, although little is known about the specific parenting behaviours that might be affected. Mental health problems in parents who misuse alcohol may impact parenting in specific ways, and these may be different for mothers and for fathers. The purpose of this paper is to make a preliminary investigation of alcohol misuse and mental health problems in mothers, and explore ways in which these might affect their parenting.

Semi-structured interviews were carried out with professionals involved in services for mothers who misuse alcohol, including those working in addiction psychiatry, in primary care, and in the provision of parenting services. These interviews were then examined using thematic analysis.

Themes emerged including specific mental health problems (depression, anxiety and personality disorders), and related issues, such as self-medication. Particularly relevant for mothers were post-natal depression, the effect on maternal alcohol misuse and mental health when children are removed, the role of domestic violence, and the importance for identification of home visits by services. Different types of alcohol misuse were linked to different mental states and different parenting behaviours in parents. Findings in the general parenting and substance misuse literature were confirmed, and a new addition was that expressed emotion may play a role in families where mothers misuse alcohol.

The findings increased the understanding of the relationships between maternal alcohol misuse, mental health issues and parenting, raising several new points for consideration.

The purpose of this paper is to compare predictors of receipt of recommended first‐line pharmacotherapy in three generational cohorts of patients with new episode depression.

This retrospective database cohort study included adolescent, adult and senior Quebec Public Prescription Drug Insurance Plan beneficiaries with new episode depression, who were diagnosed by primary care physicians or psychiatrists (October 2000 to March 2001) and received pharmacotherapy. Receipt of recommended first‐line pharmacotherapy, based on the first psychoactive medication dispensed following the depression diagnosis, was defined according to Canadian guidelines.

Receipt of first‐line pharmacotherapy was documented in 52 percent, 71 percent and 50 percent of adolescents, adults and seniors, respectively. Among adolescents and seniors, diagnosis by a psychiatrist was associated with a lower likelihood of receipt of recommended pharmacotherapy. Adolescent females and senior males were more likely and adults with comorbidity were less likely to receive recommended pharmacotherapy. For all age groups, having a physician who both diagnosed the depression and prescribed the initial pharmacotherapy was associated with an increased likelihood of receiving recommended pharmacotherapy. Relational continuity of care influenced receipt of recommended first‐line pharmacotherapy. Gender differences in treatment were found in adolescents and seniors.

This paper identifies predictors of receipt of recommended first‐line pharmacotherapy in three generational cohorts of patients with new episode depression.