Kinect Adventures versus physical exercise on depressive symptoms of older adults: A pilot study / Kinect Adventures versus exercício físico sobre sintomas depressivos em idosos: Um estudo piloto

Abstract Introduction: Depressive and anxiety disorders are considered the main cause of emotional suffering and decrease of quality of life among older adults. It has been suggested that the practice of physical exercise can be a treatment option for anxiety and depression. Alternative approaches such serious games show promise for reducing depression symptoms. Objective: To compare the effect of virtual reality, in the form of commercially available interactive Kinect Adventures video games, compared to a standard physical exercise program on depressive symptoms of older adults. Method: This is a pilot study, parallel group, single-blind randomized controlled pilot trial that recruited two intervention groups: Interactive Video Game Kinect Adventures (IVG, n=8) versus usual physical exercise program (PEP, n=6). The two groups completed a seven week program with a total of fourteen 60-minute sessions divided into two sessions a week. The IVG completed individual training sessions using the Microsoft Xbox Kinect Adventures games and the PEP performed a group exercise program. Depression symptoms were measured using the Geriatric Depression Scale (GDS-15). This measure was assessed pre-intervention, post intervention and at 30-day follow-up. Results: There was a significant effect of assessment without group effect or interaction between factors, in the GDS-15 (RM-ANOVA, P < 0.0001). Both groups showed improvement in the GDS-15 post intervention assessment that was maintained after 30-day follow-up (Bonferroni post hoc test, P < 0.05). Conclusion: The results of this study suggest that both Interactive Kinect Adventures video games and physical exercise provide beneficial effects on depressive symptoms of older adults.

Resumo Introdução: Os transtornos depressivos e de ansiedade são considerados a principal causa de sofrimento emocional e diminuição da qualidade de vida de idosos. Foi sugerido que a prática de exercício físico pode ser um tratamento para depressão. Abordagens alternativas, como jogos interativos, podem reduzir sintomas depressivos. Objetivo: Comparar o efeito da realidade virtual, na forma de videogames interativos Kinect Adventures disponíveis comercialmente, em comparação com um programa de exercícios físicos padrão sobre sintomas depressivos de idosos. Método: Trata-se de um estudo piloto, grupos paralelos, experimental, controlado, randomizado, cego através de dois grupos de intervenção: Interactive Video Game Kinect Adventures (IVG, n = 8) versus programa de exercício físico (PEF, n = 6). Os dois grupos completaram um programa de sete semanas com um total de 14 sessões de 60 minutos divididas em duas sessões por semana. O IVG concluiu sessões de treinamento individuais usando os jogos Microsoft Xbox Kinect Adventures e o PEF realizou um programa de exercícios em grupo. Os sintomas de depressão foram mensurados através da Escala de Depressão Geriátrica (GDS-15). Essas medidas foram avaliadas pré-intervenção, pós-intervenção e no seguimento de 30 dias. Resultados: Houve um efeito significativo da avaliação sem efeito grupo ou interação entre fatores, no GDS-15 (RM-ANOVA, P <0,0001). Ambos os grupos apresentaram melhora na avaliação pós-intervenção GDS-15, que foi mantida após 30 dias de acompanhamento (teste post hoc de Bonferroni, P <0,05). Conclusão: Os resultados deste estudo sugerem que os jogos interativos Kinect Adventures e o exercício físico proporcionam efeitos positivos nos sintomas depressivos de idosos.

Association of G-Protein β3 Subunit C825T Polymorphism with Seasonal Variations in Mood and Behavior

OBJECTIVE: Seasonal affective disorder and seasonal changes in mood and behavior are associated with several genes that regulate circadian rhythms. In this study, we investigated the relationship between the C825T polymorphism of the G-protein β3 subunit and seasonal variations in mood and behavior in a young healthy Korean population. METHODS: A total of 507 young Korean participants were recruited through a newspaper advertisement, and their seasonality was evaluated by the Korean version of the Seasonal Pattern Assessment Questionnaire to assess the global seasonality score (GSS). We analyzed the CC, CT, and TT genotypes and their association with the GSS score and subscales. RESULTS: T allele carriers of the GNB3 C825T polymorphism were more likely to score higher on body weight and GSS. In the female group, the T allele carriers obtained significantly high total GSS and its subscale scores for mood, body weight, energy level, and appetite; however, differences in genotypes and allele carriers were also observed in the male participants. CONCLUSION: These results suggested that GNB3 C825T polymorphism plays a role in seasonal variations in mood, body weight, energy level, and appetite in a Korean population, particularly in females.

Influenza in the Eastern Mediterranean Region

The influenza situation in the countries of the Eastern Mediterranean Region [EMR] remain stable and between moderate to low levels of activities have been observed in most of the countries

Investigando a associação entre sintomas e queixas depressivas com as estações do ano / Investigating the association between depressive symptoms and complaints in different seasons

A depressão implica diversos prejuízos na vida dos indivíduos, ocasiona desde a incapacitação para o trabalho até o prejuízo nas relações e bem estar. OBJETIVOS: Este trabalho buscou investigar se há associação entre queixas e sintomas depressivos e a estação do ano em que pacientes buscam atendimento na área da saúde mental. MÉTODO: Foi realizado estudo transversal e documental com pacientes adultos e idosos em ambulatório transdisciplinar em Porto Alegre, RS. RESULTADOS: Não foi encontrada associação entre motivo de consulta, sintomas depressivos e a estação do ano. Apesar disto, associou-se faixa etária, renda familiar, sexo e fonte de encaminhamento à busca por atendimento psicoterápico em função de patologia depressiva. CONCLUSÕES: Apesar de não ter encontrado associação entre queixa e sintomatologia depressiva e a estação do ano em que o paciente buscou atendimento, esta pesquisa levantou dados pertinentes e importantes a serem considerados em futuros estudos sobre queixas e sintomas depressivos. .

Depression involves many losses in individuals’ lives. These can vary from the incapacity to work, relationship problems and harmed well-being. This study investigated if there is association between depressive symptoms and depressive complaints and the season in which patients seek care in a mental health institution. METHOD: We conducted a cross and documentary study with adult and elderly patients in outpatient multidisciplinary clinic in Porto Alegre, RS. RESULTS: No association was found between depressive complaint and depressive symptoms with the season. Despite this, the search for psychotherapy because of depressive disorder was associated with age, family income, sex and source of referral. CONCLUSIONS: Even not having found an association between abuse and depressive symptoms with the season in which the patient sought care, this study gathered relevant and important data to consider in future studies. .

IRT Application to Verify Psychometric Properties of the Beck Depression Inventory (BDI) / Aplicación de la TRI para verificar las propriedades psicométricas del Inventario de Depresión de Beck

The aim of this study was to evaluate the performance of the Brazilian version of the Beck Depression Inventory (BDI) using Rasch-based person and item analysis. For this purpose, 271 participants were recruited, between 18 and 51 years of age (M = 23.61; SD=6.12), 187 (69%) female and 84 men, all Brazilian college students. Participants responded to the BDI on the assessment of depressive symptoms. Results suggest the adequacy of the psychometric properties of the instrument and demonstrate the Rasch model's applicability for clinical practices. Among the important tools offe -red by the Rasch model, we explore the use of the person-item map, which visually presents the intuitively understandable psychological construct along the dimensional scale of the instrument.

El objetivo de este estudio fue evaluar el desempeño de la versión brasileña del Inventario de Depresión de Beck (BDI) usando el modelo de Rasch. Para ello 271 participantes fueron reclutados, entre 18 y 51 años de edad (M = 23,61; SD = 6.12), 187 (69%) mujeres y 84 hombres, todos son estudiantes universitarios brasileños. Los participantes respondieron a la BDI sobre la evaluación de los síntomas de la depresión Los resultados sugieren la adecuación de las propiedades psicométricas del instrumento y demuestran la aplicabilidad del modelo de Rasch en prácticas clínicas. Entre las herramientas más importantes que ofrece el modelo de Rasch se explora el uso del mapa persona-artículos, que presenta visualmente la construcción psicológica intuitivamente comprensible a lo largo de la escala dimensional del instrumento.

A depressão pós-parto e a figura materna: uma análise retrospectiva e contextual / La depresión posparto y la figura materna: un análisis retrospectivo y contextual / Postpartum depression: a retrospective and contextual analysis

Este estudo, de caráter exploratório-descritivo e de abordagem qualitativa, pretendeu buscar na fala de mulheres que foram acometidas pela depressão pós-parto, vivências em relação à maternidade que tiveram com suas próprias mães, e verificar se essas vivências influenciaram no desencadeamento da depressão. Os dados foram coletados por meio de entrevistas com cinco mães e, posteriormente, analisados por meio da técnica da Análise de Conteúdo. Os resultados mostraram que a maioria das participantes demonstrou relação conflituosa com suas mães e trouxeram fortes indícios de que os modelos de mulher (lugar e papel sociais) e de maternidade vivenciados e internalizados pelas participantes do estudo tiveram influência no desencadeamento e agravamento da depressão que as acometeu após o parto. O estudo avançou neste sentido, uma vez que tais modelos maternos sempre foram relacionados ao desempenho da jovem mãe, mas não ao surgimento e desenvolvimento da depressão. Tais indícios podem, assim, fomentar novos estudos que confirmem e ampliem esse conhecimento.

Este estudio, de carácter exploratorio descriptivo y cualitativo, tuvo como objetivo examinar en el discurso de las mujeres que fueron afectadas por la depresión posparto, las experiencias sobre la maternidad que tuvieron con sus propias madres, y verificar si estas experiencias influyeron en el desencadenamiento de la depresión. Los datos fueron recolectados a través de entrevistas con cinco madres, y posteriormente analizados por la técnica de análisis de contenido. Los resultados indicaron que la mayoría de las participantes mostró una relación conflictiva con sus madres. Se obtuvieron fuertes evidencias de que los modelos de mujer (lugar y función social) y la maternidad experimentada e interiorizada por las participantes en el estudio fueron influyentes en el desencadenamiento y empeoramiento de la depresión después del parto. El estudio avanzó en esta dirección, ya que tales modelos maternos siempre han estado relacionados con el desempeño de la joven madre, pero no con la aparición y desarrollo de la depresión. Tales evidencias pueden, animar a la ampliación y confirmación de los resultados en futuros estudios.

This study, exploratory-descriptive and of qualitative approach, aimed to examine the discourse of women who were affected by postpartum depression in order to search for experiences about motherhood they had gone through with their own mothers and to analyze whether these experiences influenced the onset of depression. Data were collected through interviews with five mothers and subsequently analyzed by the technique of Content Analysis.The results showed that most participants displayed conflicting relationships with their mothers and provided strong evidence that models of women (place and social role) and motherhood experienced and internalized by the participants in the study were influential in triggering and worsening the depression that struck after delivery. The study made progress in this direction, since such maternal models have always been related to the performance of the young mother, but not to the emergence and development of depression. Such evidence may thus encourage further studies to confirm and extend these findings.

Scores of a web-based version of the Seasonal Pattern Assessment Questionnaire in Brazil

Seasonal affective disorder (SAD) is a proposed mental disorder still controversial. This condition is prevalent in northern latitudes, but few studies have been conducted at locations in the southern hemisphere. It is usually assessed by the Seasonal Pattern Assessment Questionnaire (SPAQ). This study aimed to evaluate, through on-line questionnaire, the hypothesis that, in the Brazilian population, latitude and longitude influence SPAQ scores. Methods: An advertisement was posted on a sleep medicine website inviting visitors to investigate seasonal patterns of behavior and mood, using a Brazilian Portuguese version of the SPAQ. The geographic coordinates of the place of residence of each respondent were analyzed as a continuous variable or distributed in quartiles of latitude and longitude. The psychometric properties of the SPAQ were assessed by reliability and factor analyses. Results: Answers from 1001 respondents out of 1045 were considered eligible. High SPAQ scores were observed in 287 respondents, equally distributed among all latitude and longitude quartiles. Data collected in different seasons and during daylight saving time did not differ significantly in any of the scores for SPAQ dimensions. No correlations between SPAQ scores and latitude or longitude were observed. Psychometric properties of the SPAQ were preserved in all geographic locations. Conclusion: The finding of similar SPAQ scores at a wide latitude range defies the concept of SAD symptoms as latitude or longitude-dependent phenomena...

A Case of Bright Light Therapy in a Treatment Resistant Patient with Major Depressive Disorder / 신경정신의학

The light therapy has been known to be effective to non-seasonal affective disorder as well as seasonal affective disorder. Although the mechanism of action of light therapy for depressive disorder has not been verified yet, its clinical application revealed similar effects like antidepressants and relatively smaller side effects. However, it is not common to apply the light therapy for treatment resistant depressive disorder. This case report indicates a robust efficacy of light therapy and its clinical usefulness, illustrating the complete remission in a treatment resistant patient with major depressive disorder after bright light therapy.

Melatonin in Psychiatric Disorders / 수면정신생리

The secretion of melatonin exhibits a circadian rhythm entrained with the sleep-wake cycle. An alteration of this secretory rhythm has been found in various psychiatric disorders. This review summarizes the regulation of melatonin and its relationship to the circadian rhythm, major depressive disorder, bipolar disorder, seasonal affective disorder, Alzheimer's disease and autism. The review also looks at the effect of melatonin and melatonin agonist on sleep and symptoms of depression, bipolar disorder and seasonal affective disorder. In Alzheimer's disease, the circadian rhythm alterations are associated with the change of melatonin levels and melatonin receptors. It has been reported that melatonin and melatonin synthetic enzyme levels decrease in autism spectrum disorder.

Comparação entre variáveis psicossociais e de desempenho funcional em um grupo de pacientes com lombalgia crônica / Comparison of psycho-social and functional performance variables in a group of chronic low back pain patients

JUSTIFICATIVA E OBJETIVOS: A dor lombar é um dos principais problemas do aparelho musculoesquelético e gera alto custo para o sistema de saúde. Independente da etiologia, os portadores de dor lombar crônica tendem a reduzir sua rotina de atividades físicas, o que compromete o condicionamento físico e o estado de humor. Portanto, estabelecer a relação entre as variáveis envolvidas na etiologia da lombalgia prejudiciais ao desempenho entre os seus portadores se faz necessário. O objetivo deste estudo foi comparar a distância percorrida no teste de caminhada de seis minutos (TC6) e as variáveis psicossociais: percepção de humor e nível de incapacidade entre portadores de dor lombar crônica e sujeitos saudáveis. MÉTODO: Estudo observacional transversal cuja amostra foi composta por voluntários de ambos os sexos, sedentários, com idade entre 30 e 58 anos, dividida em grupo controle (GC) e grupo lombar (GL). Os voluntários responderam a uma bateria de questionários: a saber, o Índice de Incapacidade de Oswestry e a Escala de Humor de Brunel para determinação do nível de incapacidade e da percepção de humor, respectivamente. Em seguida, realizaram o TC6. RESULTADOS: O GL (25,44 ± 14,3%) apresentou níveis de incapacidade significativamente maiores que o GC (1,25 ± 2,1%). Também se observou que o GL apresentou níveis de tensão, fadiga e confusão mental significativamente mais alto que o GC. CONCLUSÃO: Portadores de dor lombar crônica não apresentaram diferença, em relação aos seus pares livres de dor, no desempenho do TC6, no estado de humor de depressão, de raiva e de vigor. Contudo, apresentaram maiores níveis de incapacidade e piores índices no estado de humor de fadiga, de tensão e de confusão mental.

BACKGROUND AND OBJECTIVES: Low back pain is a major musculoskeletal system problem and generates high costs for the health system. Regardless of etiology, chronic low back pain patients tend to decrease their physical activities routine, thus impairing fitness and mood. So, it is necessary to establish the relationship among variables involved in the etiology of low back pain, which are noxious for patients' performance. This study aimed at comparing the distance covered during a six-minute walking test (6MWT) and the following psycho-social variables: mood perception and level of disability between chronic low back pain and healthy individuals. METHOD: This was an observational transversal study with volunteers of both genders, sedentary, aged between 30 and 58 years, who were divided in control group (CG) and low back pain group (LG). Volunteers answered a battery of questionnaires, as follows: Oswestry Disability Index and Brunel Mood Scale to determine the level of disability and mood perception, respectively. Then, volunteers made 6MWT. RESULTS: LG (25.44 ± 14.3%) had significantly higher levels of disability as compared to CG (1.25 ± 2.1%). It was also observed that LG had significantly higher levels of stress, fatigue and mental confusion as compared to CG. CONCLUSION: Low back pain patients were no different from their pain-free peers in the 6MWT performance, in depression, anger and vigor mood state. However, they presented higher levels of disability and poorer indices of fatigue, stress and mental confusion mood states.

Association of the RORA Gene Polymorphism and Seasonal Variations in Mood and Behavior / 수면정신생리

OBJECTIVES: Several evidence has been suggested that the circadian gene variants contribute to the pathogenesis of seasonal affective disorder. In this study, we aimed to investigate the polymorphism in RORA (Retinoid-related orphan receptor A) gene in relation to seasonal variations among healthy young adults in Seoul, Korea. METHODS: A total of 507 young healthy adult subjects were recruited by advertisement. Seasonal variations were assessed by the Seasonality Pattern Assessment Questionnaire (SPAQ). Single-nucleotide polymorphism in the RORA rs11071547 gene was genotyped by PCR in 507 individuals. Considering summer type as confounding factor, we conducted analysis 478 subjects except 29 subjects of summer type. The Chi-square test was conducted to compare differences between groups of seasonals and non-seasonals. Association between genotypes and Global Seasonality Score (GSS) were tested using ANCOVA (Analysis of covariance). RESULTS: In this sample, the prevalence of SAD was 12.1% (winter type 9.3%, summer type 2.8%). There is no significant difference in genotyping distribution of RORA rs11071547 between groups of seasonals and non-seasonals. Global seasonality score (GSS) and scores of all subscales except body weight and appetite were not significantly different between the group with C allele homozygote and the group with T allele homozygote and heterozygote (p-value 0.138). Scores of body weight and appetite were significantly higher in group with C allele homozygotes. CONCLUSION: These results suggest that RORA gene polymorphism play a role in seasonal variations in appetite and body weight and is associated with susceptibility to seasonal affective disorder in some degree in the population studied.

Depresión en adultos de 60 a 75 años en San Lorenzo, Valle, marzo 2011 / Depression in adults aged 60-75 years in San Lorenzo, Valle, March 2011

La depresión es la enfermedad psiquiatrica mas frecuente en ancianos en países en desarrollo, es la responsable del sufrimiento del anciano y de incrementar la prevalencia de la mala evolución de las complicaciones médicas. Objetivo: calcular la tasa de prevalencia de depresión y algunos factores asociados en la población adulta de 60-75 años de edad en San Lorenzo, Departamento de Valle, marzo 2011. Metodología: tipo de estudio: se realizo un estudio descriptivo de corte transversal. La población de estudio estaba distribuida 4, 423 casas y 11 barrios y 11 colonias que forman la ciudad de San Lorenzo, Departamento de Valle el tamaño de la muestra fue de casas. El Método el muestreo utilizado por conglomerado; una vez seleccionados los barrios se utilizo el sistema estratificado por adecuación para elegir un numero de casas por barrio para este fin se utilizo la tabla de numeros aleatorios. Procedimiento: previo consentimiento informado, los adultos respondieron cuatro cuestionarios que fueron: Escala de Depresión Geriátrica Yesavage en su versión completa de de 30 items. Esta escala es la unica validada en atención primaria siendo diseñada exclusivamente para este grupo de edad. Tiene una sensibilidad de un 84% y especialidad de un 95%. la Puntuación de clasificación es: 0-10, normal; 11-15, depresión leve; 15 depresión establecida. La escala de Katz, es la valoración funcional de las actividades basicas de la vida diaria (ADV) a niveles elementales de función física. La escala de Pfeiffer, diseñada para detectar la posible existencia de deterioro congnitivo. el cuestionario de carácter general para información sobre datos demográficos y factores de riesgo. Resultados: La prevalencia de depresión fue de 177 (52.5%);

Efecto de la variación estacional en el estado de ánimo de adolescentes, estudio prospectivo, Santiago / Relationship between the seasonal variation and the mood of adolescents: prospective study

Introducción: El Trastorno Afectivo Estacional (TAE) es caracterizado por síntomas depresivos que se manifiestan recurrentemente durante el invierno y ceden espontáneamente en primavera-verano. Existen pocos estudios sobre TAE en niños y adolescentes. Objetivo: Estudiar la relación entre la variación estacional” y el estado de ánimo en adolescentes. Metodología: Se realizó un estudio de cohorte prospectivo a 220 estudiantes de 1° Medio a 4° Medio de dos colegios de la Región Metropolitana de diferente nivel socioeconómico, elegidos al azar. A los estudiantes se les aplicó en invierno y en primavera 2008, Cuestionario de Depresión Infantil (CDI) y Cuestionario de Evaluación de Perfil Estacional versión para niños y adolescentes (SPAQ-CA). Resultados: La prevalencia de “Sospecha de Depresión”(SD) fue mayor en invierno(20 por ciento) que en primavera(13 por ciento) (p<0,01). La “Autopercepción de tener Problemas con la Variación Estacional” (APPVE) no varió significativamente entre los periodos encuestados. La APPVE fue 2,8 veces más frecuente en mujeres que en hombres(p<0,01). Se encontró una correlación positiva entre SD y APPVE, solo en invierno. Conclusión: En una misma población de adolescentes hay variación en el autoreporte de SD según la estación del año, siendo significativamente mayor en invierno. La variación estacional influye en el ánimo de los adolescentes encuestados, especialmente en mujeres, siguiendo el patrón descrito en la literatura.

Background: Seasonal affective disorder (SAD) is characterized by depressive symptoms that appear repeatedly in the winter and subside spontaneously in Spring-summer. There are few studies of SAD in children and adolescents. Objective: To study the relationship between the seasonal variation (SV) and the mood of adolescents. Methodology: A prospective cohort study of 220 high school students from two randomly chosen schools of different socioeconomic status in the metropolitan area of Santiago was conducted. Students were surveyed in winter and spring 2008 with the Childhood Depression Inventory (CDI) and Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA). Results: The prevalence of suspected depression (SD) was higher in winter (20 percent) than in spring (13 percent) (p <0.01). The perception of problems with seasonal variation (PPSV) did not differ significantly between surveys. The PPSV was 2.8 times higher in women than in men (p <0.01). We found a positive correlation between SD and PPSV only in winter. Conclusion: There is SV in adolescent self-reported SD, being higher in woman, following the pattern described in the literature.

Papel de los estrógenos en el sistema nervioso central y su implicancia en los trastornos psiquiátricos: segunda parte / Role of estrogens in the central nervous system and their Implication for psychiatric disorders: second part

En esta segunda parte del trabajo se focaliza en cómo los estrógenos, con sus diferentes concentraciones a lo largo de las distintas etapas de la vida, por su presencia o ausencia, vulnerabilizan a padecer determinadas patologías neuropsiquiátricas, así como también protegen de algunas otras. En este sentido, se considera que la patología de la mujer debería incluir profundos conocimientos sobre la implicancia que las hormonas sexuales tienen en el desarrollo de determinadas enfermedades neuropsiquiátricas. Se relevan también otros estudios sobre la administración de terapia hormonal de reemplazo, ya que son los procesos neurodegenerativos, como la enfermedad de Alzheimer, los que mayor lugar han tenido entre las investigaciones de las últimas décadas. Allí los resultados se vislumbran promisorios, pues la administración de estrógenos inmediatamente después de la menopausia revela tener efecto en la prevención del desarrollo de estos procesos, lo que no ocurre una vez iniciados los procesos neurodegenerativos. Se incluyen, a su vez, otros trabajos en otras patologías psiquiátricas, en donde se ha evaluado la eficacia de la prescripción de estrógenos, como ser en determinadas formas de depresión mayor (como coadyuvante), con buenos resultados. A pesar de los avances en el campo de la neurociencia y la influencia que ésta ha tenido en el conocimiento de las enfermedades psiquiátricas, es necesario proseguir con las investigaciones en donde se incluyan nuevos fármacos, como ser hormonas sexuales y SERMs, que seguramente traerán aportes promisorios en determinadas patologías neuropsiquiátricas.

The second part of the article focuses on estrogens, with their varying concentrations, throughout the different stages of life, which, whether by their presence or absence, predispose to suffering from certain neuropsychiatric diseases, just as they protect the individual from some others. In this sense, it is considered that female pathology should involve a deep knowledge on the impact that sexual hormones have on the development of certain neuropsychiatric diseases. The article also includes other studies on the administration of hormone replacement therapy, since it is neurodegenerative processes, such as Alzheimer's Disease, which occupied a leading place in investigations during the past decades. In such investigations, outcomes seem to be promising, since the administration of estrogens right after menopause demonstrates to have an impact on preventing the development of these processes, which does not occur once neurodegenerative processes have started. Also included are other investigations conducted on other psychiatric pathologies, in which the efficacy of prescribing estrogens, such as for certain forms of major depression (as adjunctive therapy) are evaluated, with positive results. Despite the advances in neuroscience and its influence on the knowledge of psychiatric diseases, it is necessary to continue preforming investigations that include new pharmacological drugs, such as sexual hormones and SERMs, which will possibly bring about promissory contributions to certain neuropsychiatric diseases.

Estacionalidad en admisiones hospitalarias por Trastorno Bipolar en Santa María, Córdoba, Argentina / Seasonal pattern in hospital admissions due to bipolar disorder in Santa María, Córdoba, Argentina

Introducción: el objetivo del trabajo es establecer si existe un patrón de estacionalidad en las internaciones hospitalarias por trastorno bipolar en el Hospital Colonia Santa María, Córdoba, Argentina, entre los años 2000 y 2003. Materiales y métodos: se tomaron los episodios afectivos internados con diagnóstico de trastorno bipolar (CIE-IO) durante el período y se analizaron las historias clínicas según los criterios del DSM-IV. Se incluyeron las internaciones de toda la historia patobiográfica del individuo. Resultados: se incluyeron 84 episodios afectivos: 43 maníacos (51%), 20 depresivos (24%), 15 mixtos (18%) y 6 hipomaníacos (7%). Se encontró una asociación estadísticamente significativa (p<0,001) entre episodios afectivos del trastorno bipolar y estación del año, con un patrón estacional de manía-hipomanía en verano y depresión en invierno. Los episodios mixtos presentan pico en verano pero se distribuyen más uniformemente en el año. Conclusiones: existe estacionalidad en las internaciones por trastorno bipolar.

Introduction: The purpose of this research is to establish if there is a seasonal pattern in hospitalizations due to affective episodes of bipolar disorder in Hospital Colonia Santa Maria, Córdoba, Argentina, between 2000-2003. Materials and methods: The affective episodes considered were those which required patient hospitalization with bipolar disorder diagnosis (ICD-I0). Medical histories were analyzed subsequently, according to the DSM-IV criteria. The episodes considered were those with hospitalization during all the pathobiographical history of the patient. Outcome: 84 affective episodes were considered. 43 were maniac (51 %), 20 were depressive (24%), 15 were mixed (18%) and 6 were hypomaniac (7%). A statistically significant association was found (p<0,00l) between affective episodes of bipolar disorder and the season of the year, with a seasonal pattern of mania-hypomania in summer and depression in winter. Mixed episodes were distributed more consistently in the year with a peak in summer. Conclusion: In this research a relationship is established between bipolar disorder and seasonal nature in hospitalizations.

Pituitary volume and the effects of phototherapy in patients with seasonal winter depression: a controlled study

OBJECTIVES: Our aims were to investigate the pituitary volume in patients with seasonal winter depression and healthy volunteers in winter and summer, and to assess the effects of phototherapy in these patients. METHOD: The pituitary volume of 12 patients with winter depression and 12 healthy controls, paired according gender, age and menstrual cycle, were obtained from magnetic resonance imaging in winter and summer. Eight patients were submitted to phototherapy (10000 vs. 2500 lux) in a double-blind crossover fashion during the winter, and reassessed (symptoms and magnetic resonance imaging) after treatment. RESULTS: There were no significant differences in pituitary volume between controls and patients in winter or summer. Exposure to phototherapy (10000 lux) decreased the depressive symptoms (p = 0.004), but the glandular volume did not change (p = 0.5). However, the pituitary volume in winter showed a positive correlation with the severity of depression in these patients (r = 0.69, p = 0.04). CONCLUSIONS: The results suggest that neither winter depression nor the change of seasons is associated with significant change in the pituitary volume. Despite the fact that this study was performed in a tropical area, phototherapy with 10000 lux showed to be an efficient treatment in this SAD patients sample.

OBJETIVOS: Nossos objetivos foram investigar o volume da pituitária em pacientes com depressão sazonal de inverno e controles sadios, no inverno e verão, e avaliar os efeitos da fototerapia nesses pacientes. MÉTODO: O volume da pituitária de 12 pacientes com depressão de inverno e 12 controles sadios, pareados quanto ao gênero, idade e fase do ciclo menstrual, foi examinado por meio de imagem por ressonância magnética no inverno e verão. Oito pacientes foram submetidos à fototerapia (10.000 vs 2.500 lux) de forma duplo-cega e cruzada durante o inverno e reavaliados (sintomas e imagem por ressonância magnética) após o tratamento. RESULTADOS: Não houve diferença significativa no volume da pituitária entre controles e pacientes, no inverno e verão. A fototerapia (10.000 lux) reduziu os sintomas depressivos (p = 0,004), mas não alterou o volume glandular (p = 0,5). Contudo, o volume da pituitária, no inverno, mostrou uma correlação positiva com a gravidade da depressão nesses pacientes (r = 0,69, p = 0,04). CONCLUSÕES: Os resultados sugerem que nem a depressão de inverno, nem a mudança das estações estão associadas com a mudança significativa do volume da pituitária. Apesar do fato deste estudo ter sido realizado em uma região tropical, a fototerapia com 10.000 lux mostrou-se um tratamento eficaz nesta amostra.

Análisis de ruptura del vínculo de pareja después de veinte o más años de convivencia / Analysis of the break of the link of couple after twenty or more years of living together

El presente trabajo tienen como objetivo primordial analizar el proceso por el que atraviesan los adultos, mayores de 50 años que, después de veinte o mas años de convivencia, rompen ese vínculo por decisión en común o unilateralmente, y deben enfrentarse a esta realidad, tanto en los aspectos fisicos, como en los psíquicos y sociales. La interpretación de los recolectado mediante entrevistas y encuestas, como el análisis de la Escala de Bienestar Psicologico (de Riff), nos ha permitido tener un acercamiento a esta situación propia de fines de siglo pasado y del presente. Tratamos de reflejar las experiencias de un grupo de hombres y mujeres de la ciudad de Córdoba, mostrando, desde una perspectiva sistémica, una modalidad de enfrentar las crisis que en algunos casos se manifestaron y manifestan, siendo las problemáticas o los desencadenantes más señaladas: la falta de comunicación, los intereses diferentes, escasas propuestas en común. la ausencia de los hijos en el hogar y la jubilación, particularmente masculina.

Superposição entre depressão atípica, doença afetiva sazonal e síndrome da fadiga crônica / Overlap between atypical depression, seasonal affective disorder and chronic fatigue syndrome

OBJETIVO: Foram revisados estudos que descrevem que as alterações na função do eixo hipotálamo-hipófise-adrenal são relacionadas com o estado psicopatológico em depressão. Além da depressão melancólica, uma série de condições podem ser associadas à hiperativação prolongada do eixo hipotálamo-pituitária-adrenal. Um outro grupo de psicopatologias é caracterizado por hipoativação do mesmo eixo com redução crônica na secreção do fator de liberação de corticotrofina. Pacientes com depressão atípica, doença afetiva sazonal e síndrome da fadiga crônica estão inclusos nesta categoria. MÉTODO: Foram revisados os dados da literatura que incluem a interseção entre estes descritores, resumidos e discutidos os principais e recentes achados. RESULTADOS: Muitos estudos têm enfatizado que estes quadros se sobrepõem biologicamente, demonstrando hipofunção no sistema relacionado ao fator de liberação de corticotrofina. CONCLUSÕES: Na prática clínica, os pacientes frequentemente se apresentam de forma intermediária entre a fadiga e a depressão atípica crônica e/ou a depressão sazonal. Isto enfatiza o potencial biológico comum que fundamenta o grupo de sintomas não somente entre depressão (atípica e sazonal) e a síndrome da fadiga crônica e as condições caracterizadas por alterações no eixo hipotálamo-pituitária-adrenal, principalmente hipofunção e, em particular, diminuição da atividade do fator de liberação de corticotrofina.

OBJECTIVE: We reviewed previous studies that have described an association between abnormal functioning of the hypothalamic-pituitary-adrenal axis and depression. In addition to melancholic depression, a spectrum of conditions may be associated with increased and prolonged activation of the hypothalamic-pituitary-adrenal axis. In contrast another group of states is characterized by hypoactivation of the stress system, rather than sustained activation, in which chronically reduced secretion of corticotropin releasing factor may result in pathological hypoarousal and an enhanced hypothalamic-pituitary-adrenal negative feedback. Patients with atypical depression, seasonal affective disorder and chronic fatigue syndrome fall in this category. METHOD: The literature data on the overlap between the key-words were reviewed, summarized and discussed. RESULTS: Many studies suggest that these conditions themselves overlap biologically, showing hypofunction of central corticotropin releasing factor neuronal systems. CONCLUSIONS: Therefore, in the real world of clinical practice, patients often present in a grey area between classical idiopathic fatigue and early chronic atypical depression and/or seasonal depression. This underscores the potential common biological links underpinning common sympton clusters not only between depression (atypical and seasonal) and chronic fatigue syndrome, but also other conditions characterized by the hypothalamic-pituitary-adrenal axis mainly diminished the corticotropin realising factor activity.

Effect of Dawn Simulation on Difficulty Awakening in the Morning and Daytime Sleepiness in Adolescents with Delayed Sleep Phase Syndrome / 신경정신의학

OBJECTIVES: Delayed sleep phase syndrome (DSPS) is characterized by difficulties in falling asleep and waking up at a desired time. Dawn simulation is a technique using a light that gradually increases in intensity before awakening in the morning, to imitate a natural sunrise. It has been found to be effective in decreasing both morning drowsiness and difficulty in awakening as well as treating symptoms of seasonal affective disorder. The aim of this study was to determine whether dawn simulation is helpful in decreasing difficulty in morning awakening and daytime sleepiness in adolescents with DSPS. METHODS: Twelve adolescents with DSPS participated in a 2-week dawn simulation trial. Each subject self-assessed level of difficulty in awakening, morning drowsiness and daytime sleepiness during a 2-week baseline period and a following 2-week trial period with dawn simulator. Subjects used Stanford Sleepiness Scale (SSS) for measuring morning drowsiness and Epworth Sleepiness Scale (ESS) for measuring daytime sleepiness. Difficulty in awakening was assessed by a single-item questionnaire. RESULTS: Dawn simulation trial decreased morning drowsiness (p=0.016) and daytime sleepiness (p=0.013) significantly compared to baseline. It also seemed to improve difficulty in awakening, but the effect was not statistically significant (p=0.092). CONCLUSION: Dawn simulation may help waking up in the morning and may improve daytime functioning by deceasing both morning drowsiness and daytime sleepiness in adolescents with DSPS.

Depresión y estacionalidad: presentación de un caso con síntomas de verano e invierno / Seasonal variation and depression: a case with summer and winter symptoms

It has been mentioned that seasonal depression posses a clinical profile which is different depending on the season of the year it manifests. This way, the seasonal depressions in winter experiment more frequently atypical symptoms, with an increase of appetite, cravings for carbohydrates, increase in weight and hipersomnia, while the summer depressions show vegetative syndromes similar to traditional endogens states with a decrease of appetite and insomnia. There is a description of a clinical case of a woman who has presented depressive states in summer and also in winter of the same year, showing in both periods the symptomatology described before. The hypothesis proposed is that the clinical characteristics depend on the more or less amount of light associated with these stations, which together with the more or less amount of solar energy modify the clinical curse of the seasonal depression syndrome.

Se ha mencionado que las depresiones estacionales poseen un perfil clínico diferente según la estación del año en que se manifiesten. De este modo, las depresiones estaciónales de invierno experimentan mayor frecuencia de síntomas atípicos con aumento del apetito, antojo por carbohidratos, aumento de peso e hipersomnia, mientras que las depresiones de verano muestran una clínica de síntomas vegetativos semejantes a los cuadros endógenos tradicionales con disminución del apetito e insomnio. Se describe un caso clínico de una mujer que presentó cuadros depresivos tanto en verano como en invierno en un mismo año calendario, mostrando en ambos períodos la sintomatología descrita. Se plantea la hipótesis que las características clínicas dependen de la mayor o menor cantidad de luz en estas estaciones, las que junto a la mayor o menor cantidad de energía solar modifican el curso clínico de los trastornos depresivos estacionales.