Síntomas depresivos en el embarazo y factores asociados, en pacientes de tres instituciones de salud de la ciudad de México

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Abstract: Background Depression is a frequent condition in pregnancy, at least as frequent as it is among non-pregnant women. Studies on its prevalence show rates from 2% to 21% of major depression and 8% to 31% of depressive symptomatology. In Mexico, a prevalence of 22% has been estimated on the basis of a self-report scale. Risk factors for depression in pregnancy include previous history of depression, parental separation during childhood, single mother-hood, not wishing to be pregnant, lack of social support and low educational attainment. Objective Due to the consequences of depression on pregnancy and to the scarce studies available in Mexico, the aim of this study was to examine the presence of depression in pregnant women as well as the risk factors associated with the latter. Material and methods Three hundred pregnant women receiving ante-natal care were interviewed in the waiting rooms of three institutions (one third level hospital, a health center and a clinic specializing in women). The instrument included a scale of depression (CES-D) and the following risk factors: previous depression symptoms, parental separation before the age of 11, possible depression and problem-atic alcohol consumption in expectant motliers parents, unplanned pregnancy and lack of social support. Results A total of 30.7% of the interviewees showed significant depressive symptomatology (CES-D > 16). Fifty-nine percent mentioned having suffered from depressive symptomatology in the past. Some degree of disability in the past month was reported by 19% of those that mentioned depression symptoms. The mean number of days they stopped performing their everyday activities was 11.21 (SD = 10.68) with a range of 1 to 30 days. Seven women (21.2%) stated that they could not engage in their activities because of their depression every single day of the past month. As for suicidal ideation at any time in their lives, the following symptoms were displayed: half said that they had thought a great deal about death, a quarter said that they had wanted to die, nearly a fifth had intended to take their own life and 7.7% had injured themselves in order to take their own lives. During the previous month, the frequency of these behaviors had considerably declined, almost to zero, and only "thinking frequently about death" was common (18%). The variables associated with depression symptoms (CES-D) were: previous symptoms of depression (t = -4-40, p > 0.000), separation from the father before the age of 11 (t = -2.68; p > 0.008), possible depression in mother (t = -3.24, p > 0.001), possible depression in father (t = -2.41, p > 0.016), problematic alcohol consumption in father (t= -2.23, p > 0.040), unplanned pregnancy (t=-2.43, p>0-015), lack of emotional social support (t = 2.87, p > 0.005) and lack of practical social support (t = 2.94, p > 0.005). The evaluation of a risk model of these factors on depressive symptomatology through logistic regression (with the step-by-step method) showed that the following variables were significant: possible depression in the mother (of the expec-tant mother) which increases the risk of displaying depression in pregnancy 0.8 times, previous depressive symptomatology, which increases it 1.08 times, lack of practical social support, which increases it 1.71 times and not having a partner, which increases it 1.51 times. Discussion and conclusions The results, as regards mental health, showed that depressive symptoms occured in nearly a third of pregnant women; this percentage is higher than the 22% found in Mexico in previous studies. Although this symptomatology does not necessarily meet the criteria for major depression, it has been considered to be of sufficient clinical importance, as it has been associated with disability, psychiatric and physical co-morbidity; demand for treat-ment for and risk of future depression and in this case, with post-partum depression. A fifth of the subjects displayed more serious symptomatology in terms of disability, as the women mentioned not being able to engage in their everyday activities, working or studying. The mean number of days in which they were unable to carry out their activities was eleven during the previous month. This data suggests that this population with greater pathology should be detected and referred for specialized mental care by antenatal care services. Suicidal ideation during the previous month decreased considerably, in comparison with that reported at any time in theit lives, which agrees with reports that state that self-damaging behaviors and suicide attempts tend to be very low during pregnancy. As for pathological antecedents, 59% considered that they had suffered from depressive symptomatology in the past, in addition to having experienced suicidal ideation to varying degrees. It is significant that nearly 8% had previously attempted suicide. Both, previous depressive symptomatology and suicidal ideation in the past, were associated with current depression symptoms in the expectant mother, as has been reported in other countries. Unplanned pregnancy was also related to depression (CES-D). As literature suggests, not wishing to be pregnant is related to this disorder and although not planning a pregnancy is not synonymous with not wishing for it, according to these data, lack of planning also increases depressive symptoms. Among childhood situations, parental separation or loss of the father before the age of 11 was a significant variable as regards symptomatology in pregnancy; this was similar to what other authors have reported. Separation from the mother was not related to these symptoms, contrary to what other studies have reported in both pregnant and non-pregnant women. Adversity in childhood in the form of parents' mental pathology or substance use has been associated with depression among the general population. The results obtained here show a significant relationship between problematic alcohol consumption in the father and possible depression in the mother or father -as perceived by the interviewee herself- and depression symptoms in the expectant mother. During pregnancy and above all, post-partum, women have a real need to receive both emotional and practical support. This study, like others showed that the lack of this support increased the risk of depression. The construction of a model with some of these variables showed that being a single or divorced mother, having had a mother who may have been depressed, having displayed depressive symptoms in the past and the lack of practical support increased the risk of depressive symptomatology. By way of a conclusion, one can say that although there are similarities between depression in pregnancy and at other moments in women's lives, its presence during this period is particu-larly important due to the new demands the woman has to cope with and the adverse effects it has on the development of pregnancy, and the high risk of experiencing depression during the post-partum. Designing intervention programs for expectant mothers could have an enormous effect on improving the mental health of mothers and their babies, a reason why it is important to take into account the risk factors described in this study.

Two types of irritable bowel syndrome: pathophysiologic and pharmacological considerations / Dos tipos del síndrome de intestino irritable: consideraciones patofisiológicas and farmacológicas

The investigation performed in 18 diarrheid and 24 spastic patients showed adrenal glands hyperactivity in the former and hypoactivity in the latter. The central noradrenergic system was unresponsive to glucose in both groups: probably due to glucose-insulin failure to rise in diarrheics, whereas a hyperactive parasympathetic system may have been resposible in spactics. Diarrheics had the lowest sigmoidal tone with rectal hyperactivity and the highest plasma catecholamines + cortisol + glucose + insulin values. Spastic patients, in turn, had the highest sigmoidal tone and the lowest catecholamine values. Plasma glucose, insulin, platelet serotocin and sigmoidal tone rose in spactics, after glucose ingestion, but failed to do so in diarrheics. Further, in spactic patients, sigmoidal tone correlated positively with platelet serotonin and negatively with noradrenaline. The clonidine test showed hyperresponsivenes of growth hormone, cortisol and diastolic blood pressure in diarrheics, compared to a normal response in spastics, alpha-adrenergic antagonists suppressed diarrhea and renal hiperactivity. Alpha adrenergic agonists (wich also deplete plattelet-and myentericplexa serotonin) reduced signoidal tone to zero, increased rectal activity and provoked diarrhea. These findings suggest that peripheral sympathetic activity (prevalent in diarrheics) and hyperparasympathetic activity (prevalent in spactics) trigger these physiological disorders by respectively suppressing and reinforcing the serotonin-plexa level functioning

Clonidine treatment of acute pancreatitis: report of five cases

Reportamos cinco casos consecutivos de pacientes con pancreatitis aguda, resistente a la terapia convencional, quienes mejoraron dramáticamente con clonidina. Todos los pacientes presentaban niveles plasmáticos muy elevados de noradrenalina, adrenalina y cortisol (indicadores biológicos de estrés, los cuales cayeron bruscamente en cuanto se inició tratamiento con clonidina. Cuando se les practicó el test de clonidina, todos los pacientes tuvieron una hiper-respuesta, lo cual es compatible con situaciones de desadaptación al estrés