Ansiedad y depresión en pacientes post-COVID-19 en primer nivel de atención / Anxiety and depression in post-COVID-19 patients at the primary level of health care

Introducción: durante diciembre de 2019 se identificó en Wuhan, China, un nuevo coronavirus, denominado SARS-CoV-2 por el Comité Internacional de Taxonomía de Virus. Después de haber presentado esta enfermedad se han encontrado secuelas como ansiedad y depresión. Objetivo: determinar el nivel de ansiedad y depresión en los pacientes post-COVID-19 en primer nivel de atención. Material y métodos: estudio observacional, descriptivo, transversal, unicéntrico, homodémico, prospectivo, prolectivo. Se realizó en una Unidad de Primer Nivel de Atención del Instituto Mexicano del Seguro Social, en el periodo de enero de 2021 a enero de 2022. Se aplicó la Escala de Hamilton para la Ansiedad y el Inventario de Beck para Depresión. Se realizó un análisis estadístico en el programa SPSS 25, los datos se expresaron como media ± desviación estándar o mediana, según la distribución. Las variables cualitativas se expresaron en frecuencias y porcentajes. Resultados: el promedio de edad fue de 27 años; con predominio del sexo femenino (62.4%), presentaron depresión moderada 6%, depresión grave 1.5%, ansiedad leve 20.9% y ansiedad moderada o grave 9.8%. Conclusión: existe una asociación entre el nivel de depresión y ansiedad en los pacientes post-COVID-19, con una p significativa (AU)

Introduction: during December 2019, a new coronavirus, named SARSCoV-2, by the International Committee on Taxonomy of Viruses, was identified in Wuhan, China. After presenting with this disease, sequelae such as anxiety and depression have been found. Objective: determine the level of anxiety and depression in post-COVID-19 patients of the Family Medicine Unit No. 34. Material and methods: observational, descriptive, cross-sectional, unicentric, homodemic, prospective, prolective study. It was conducted in a first level unit of the Mexican Institute of Social Security, in the period from January 2021 to January 2022. The Hamilton Anxiety Scale and the Beck Depression Inventory were applied. Statistical analysis was performed in the SPSS 25 program, data were expressed as mean ± standard deviation or median, according to the distribution. Qualitative variables were expressed as frequencies and percentages. Results: the mean age was 27 years; with a predominance of females (62.4%), 6% presented moderate depression, 1.5% severe depression, 20.9% mild anxiety and 9.8% moderate or severe anxiety. Conclusions: there is an association between the level of depression and anxiety in post-COVID-19 patients, with a significant p (AU)

Governor vessel moxibustion combined with western medication for mild to moderate depression with kidney-yang deficiency: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the therapeutic efficacy of governor vessel moxibustion combined with fluoxetine hydrochloride capsule, simple fluoxetine hydrochloride capsule and placebo moxibustion combined with fluoxetine hydrochloride capsule for mild to moderate depression with kidney-yang deficiency.@*METHODS@#A total of 126 patients with mild to moderate depression with kidney-yang deficiency were randomized into a governor vessel moxibustion group (42 cases, 2 cases dropped off), a western medication group (42 cases, 1 case dropped off) and a placebo moxibustion group (42 cases, 1 case dropped off). The western medication group was given fluoxetine hydrochloride capsule orally, 20 mg a time, once a day. On the basis of the treatment in the western medication group, governor vessel moxibustion was applied from Dazhui (GV 14) to Yaoshu (GV 2) in the governor vessel moxibustion group, once a week; placebo moxibustion was applied in the placebo moxibustion group, once a week. Treatment of 8 weeks was required in the 3 groups. Before and after treatment, the scores of Hamilton depression scale-17 (HAMD-17), Asberg's rating scale for side effects (SERS) and TCM clinical symptom were compared, and the clinical efficacy was evaluated.@*RESULTS@#After treatment, the scores of HAMD-17, SERS and TCM clinical symptom were decreased compared before treatment in the 3 groups (P<0.05), the decrease ranges of above scores in the governor vessel moxibustion group were larger than those in the western medication group and the placebo moxibustion group (P<0.05). The total effective rate was 92.5% (37/40) in the governor vessel moxibustion group, which was higher than 75.6% (31/41) in the western medication group and 80.5% (33/41) in the placebo moxibustion group (P<0.05).@*CONCLUSION@#Governor vessel moxibustion combined with fluoxetine hydrochloride capsule can improve the degree of depression and relieve the clinical symptoms in mild to moderate depression patients with kidney-yang deficiency, the efficacy is superior to simple fluoxetine hydrochloride capsule, and can reduce the fluoxetine hydrochloride capsule-induced adverse effect to a certain extent.

Therapeutic effects of Tongdu Qishen acupuncture combined with traditional Chinese medicine decoction on post-stroke depression in 31 patients / 中国基层医药

Objective:To investigate the clinical effects of Tongdu Qishen acupuncture combined with traditional Chinese medicine decoction on post-stroke depression in patients. Methods:Sixty-two patients with post-stroke depression who received treatment in Zhongda Hospital of Southeast University from October 2020 to April 2022 were included in this study. They were randomly treated either with traditional Chinese medicine decoction (control group, n = 31) or Tongdu Qishen acupuncture combined with traditional Chinese medicine decoction (combined group, n = 31) based on routine medication. All patients were treated for 4 weeks. Depressive state, neurological function, and activities of daily living were compared between the two groups. Results:Before treatment, there were no significant differences in the Hamilton Depression Scale (HAMD) score, National Institutes of Health Stroke Scale (NIHSS) score, and Barthel index between the two groups (all P > 0.05). After 4 weeks of treatment, the HAMD and NIHSS scores in the control group were (13.88 ± 3.92) points and (8.56 ± 1.82) points, respectively, and they were (8.72 ± 2.48) points and (6.67 ± 1.14) points in the combined group. There were significant differences in HAMD and NIHSS scores between the two groups ( t = 2.14, 2.43, both P < 0.05). The Barthel index in the combined group was (69.53 ± 13.29) points, which was significantly higher than (62.34 ± 15.67) points in the control group ( t = 2.23, P < 0.05). Conclusion:Tongdu Qishen acupuncture combined with traditional Chinese medicine decoction can reduce depressive symptoms and improve neurological function and activities of daily living in patients with post-stroke depression. The combined therapy has obvious efficacy in the treatment of post-stroke depression.

An interprofessional interventional approach to improve the mental well-being of medical students for better academic performances

Background: Medical students are the future doctors who are the primary caregivers for the society. High level of stress can obstruct the learning of medical students by impairing their concentration, problem solving, and decision-making skills. Improving mental well-being of medical students will ensure community safety. The stakeholders need to realize positive role of mental well-being on academic performance of students. This will not only benefit the students as well as the society as a whole. Aim and Objective: The present study was innovatively planned to determine the impact of the motivational sessions on relieving perceived stress and anxiety of the students along-with impact of such sessions on motivation for learning. Materials and Methods: An interventional cross-sectional study was designed for 2nd year MBBS students. A module comprising of eight sessions for improving mental well-being of undergraduate students was designed by an interprofessional team comprising a medical teacher, clinical phycologist, psychiatrist, and medical students. The pre-validated scales used were Hamilton Anxiety Rating Scale (HAM-A) to assess anxiety level, Perceived Stress Scale to assess perceived stress, and Motivated Strategies for Learning Questionnaire to measure the types of learning strategies and academic motivation of college students. Results: About 64% (n = 46) of the participants were male and 36% (n = 26) were female students. The present study showed no significant association between the gender and stress. It was seen that number of students with high perceived stress before the session were reduced by as much as 72.41% and that of students with highest motivation for learning strategies doubled from 18 to 36 (100% improvement).The difference in means of HAM-A scores in post-test and pre-tests is highly significant (P = 0.01). The students were very much satisfied with the mode and content of the module. They expressed that these sessions made them feel thought of and cared for. Conclusion: It is strongly recommended to apply this interprofessional interventional approach to improve the mental well-being of medical students for better academic performances.

White matter hyperintensities on magnetic resonance imaging among elderly depressed patients and its association with the severity of depression and cognition

Introduction: Depression in the elderly can have a different pathophysiology and clinical profile, and studies have shown pathological changes in the brain on radio imaging. The present study aimed to find out the association of white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) with the severity of illness and cognition in elderly depressed patients. Methodology: This cross-sectional study included 68 elderly (>60 years of age) depressed patients who had undergone MRI at a tertiary care center, and based on the severity of WMH, they were divided into two groups: no or slight WMH group and moderate or severe WMH group. The severity of depression was assessed using the Hamilton Depression Rating Scale (HAM-D) scale, and neuropsychological assessments were made for testing attention, concentration and executive function. Results: HAM?D scores were found significantly higher in patients with moderate?to?severe WMH groups (22.6 ± 5.2) compared to those with no or slight WMH (16.3 ± 4.2). The cognitive performance evaluated by backward digit span test, Trail making Test A and B, and Color Stroop test was significantly poor in the moderate?to?severe WMH group. Conclusion: Elderly depressed patients having a greater WMH had more severe depression and poor cognitive performance, especially psychomotor and executive functioning. WMH could be a potential marker for the severity of illness and cognition in depression in elderly persons.

Psychosocial assessment among ophthalmic patients attending tertiary eye care centre during the lockdown in times of COVID-19 pandemic

Purpose: The coronavirus disease (COVID?19) pandemic continues to play havoc in our lives. During the first “ lockdown” in 2020, we were keen on assessing the anxiety levels of patients who sought ophthalmic care despite the lockdown. Public health actions, such as social distancing, were necessary to reduce the spread of COVID?19. As a result, most people felt isolated and lonely, thereby causing increased levels of stress and anxiety in them. We aimed to assess the anxiety levels using the Hamilton Anxiety Scale and personality assessment using the 57?point Eysenck’s Personality Inventory (EPI) questionnaire among patients visiting a tertiary eye care hospital during the lockdown period. Methods: Consecutive patients attending an ophthalmic tertiary care hospital during the COVID?19 pandemic and lockdown were approached to be a part of this prospective cross?sectional survey. Results: In total, 1,088 responses were analyzed during the 2?month study period with the mean age being 45.7 + 16.9 years. The majority had completed graduation (78%) with 15 years or more of formal education. The purpose of the visit was an emergency consultation in 42% (n = 455), a review appointment in 42% (n = 457), and the remaining (16%, n = 176) came for a routine consultation. The majority of the patients (>90%) did not report experiencing any of the 14 sets of symptoms. A mild level of anxiety was noted in 1,086 (>99%) respondents, whereas only 2 (<1%) respondents showed mild–moderate levels of anxiety. Financial concerns such as affordability of medications (6% vs. 3%, P = 0.05) and fear of losing their job (16% vs. 11%, P = 0.02) were significantly more in those experiencing any anxiety compared to those with no anxiety. Conclusion: Our study revealed that patients visiting a tertiary ophthalmic center during lockdown were graduates, sought eye consultation primarily for emergency or a review, and had no major anxiety symptoms. In those with anxiety, the affordability of medicines and loss of jobs were the main concerns.

Statistical Validation of LENS: A Smartphone-based Empty Nest Syndrome Screening and Monitoring Biomarker Tool

Background: Empty Nest Syndrome (ENS) is a complex grief state, observed in the affected parents when their children leave home. Studies show ENS may progress to clinical-grade depression and anxiety if left uncared for. Methodology: In this double-blind case-control cross-sectional study, 80 subjects are recruited by a panel of psychologists and psychiatrists. Subjects are divided into two equal groups – case (with ENS symptoms) and control (without symptoms). Three instruments are applied – a) ENS interpretation by the psychologists based on the symptoms, b) Lyfas smartphone-based biomedical application to capture the cardiovascular optical biomarkers (COB) from the index finger non-invasively with the help of arterial photoplethysmography technique, and c) Hamilton’s depression scales (HAM-D), which psychiatrists have used to check the mental health of the subjects. The COB (e.g., SD1/SD2, LF/HF, HRVScore, and ENERGY) and a set of physical parameters (e.g., Body mass index or BMI, Heart rate or HR, Systolic blood pressure or SBP, Diastolic blood pressure or DBP, Glycosylated hemoglobin or HbA1c, Cholesterol, Triglyceride, Thyroid-stimulating hormone or TSH, Estradiol or E2, and Testosterone or TST) consist the independent variables, while ENS scores interpreted by the psychologists and HAM-D scores interpreted by the psychiatrists are the dependent variables. Spearman’s rank correlation and Bland Altman’s reliability tests are performed to mine the significant independent variables and reliability of Lyfas ENS (LENS) application. Results: The study observes that SD1/SD2, LF/HF, HRVScore, ENERGY, DBP, BMI, HR, HbA1c, TSH, and Estradiol have significant roles in ENS. Bland Altman's reliability measure shows that LENS (novel instrument under trial) has a high agreement of 92.85% and 93.86%, respectively with ENS scoring done by senior psychologists (champion instrument1) and HAM-D grading performed by psychiatrists (champion instrument2). Conclusions: LENS can be used as a clinical-graded pocket application for screening and monitoring ENS.

Efficacy of combined fluoxetine and aniracetam tablets in the treatment of senile depression and its effects on serum total bile acid and norepinephrine levels / 中国基层医药

Objective:To investigate the efficacy of combined fluoxetine and aniracetam tablets in the treatment of senile depression and its effects on serum total bile acid (TBA) and norepinephrine (NE) levels.Methods:A total of 100 older adult patients with depression who received treatment in Heze Medical College from January 2019 to December 2019 were included in this study. They were randomly assigned to receive either fluoxetine tablets alone (control group, n = 50) or fluoxetine and aniracetam tablets (study group, n = 50). All patients received two months of treatment. Clinical efficacy, scores of the Hamilton Rating Scale for Anxiety (HAMA) and the Hamilton Rating Scale for Depression (HAMD), adverse reactions, and serum TBA and NE levels were compared between the two groups. Results:Total response rate was significantly higher in the study group than in the control group [96.0% (48/50) vs. 84.0% (42/50), χ2 = 4.00, P = 0.045]. HAMD and HAMA scores post-treatment in the study group were (5.85 ± 1.81) points and (4.81 ± 1.57) points, respectively, which were significantly lower than those in the control group [(11.65 ± 2.65) points, (10.85 ± 2.84) points, t = 10.84, P < 0.001; t = 11.16, P < 0.001). Serum NE level was significantly higher in the study group than in the control group [(138.68 ± 16.35) ng/L vs. (127.17 ± 14.34) ng/L, t = 3.17, P = 0.002]. There were no significant differences in serum TBA level [(5.85 ± 0.63) μmol/L vs. (5.91 ± 0.65) μmol/L] and the incidence of adverse reactions (8.00% vs. 6.00%) between the study and control groups ( t = 0.39, P = 0.692; χ2 = 0.15, P = 0.695). Conclusion:The combined therapy of fluoxetine and aniracetam tablets for the treatment of senile depression is safe and highly effective, does not affect metabolic function and thereby deserves clinical application.

Effects of repetitive transcranial magnetic stimulation combined with oral paroxetine on cognitive status and activities of daily living in older adult patients with severe depression / 中国基层医药

Objective:To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with oral paroxetine in the treatment of older adult patients with severe depression and its effects on the scores of the Hamilton Rating Scale for Depression (HAMD), the Mini-Mental State Examination (MMSE), and Activities of Daily Living (ADL).Methods:A total of 192 older adult patients with severe depression who received treatment in Shaoxing 7 th People's Hospital from January 2018 to December 2019 were included in this study. They were randomly assigned to receive either oral paroxetine (control group, n = 96) or rTMS + oral paroxetine (observation group, n = 96). All patients received 1 month of treatment. Clinical efficacy was compared between the two groups. HAMD, MMSE, and ADL scores pre- and post-treatment and the incidence of adverse events during the treatment were compared between the two groups. Results:Total response rate was significantly higher in the observation group than in the control group [96.88% (93/96) vs. 89.58% (86/96), χ2 = 4.04, P < 0.05]. HAMD scores post-treatment were significantly lower in the observation group than in the control group [(6.43 ± 2.33) points vs. (11.32 ± 2.02) points, t = 15.53, P < 0.05]. MMSE and ADL scores post-treatment in the observation group were (29.13 ± 3.01) points and (71.52 ± 5.32) points, respectively, which were significantly higher than those in the control group [(24.65 ± 2.79) points, (69.65 ± 5.17) points, t = 10.69, 2.47, P < 0.05]. There was no significant difference in the incidence of adverse events between the two groups ( P > 0.05). Conclusion:The combined therapy of rTMS and oral paroxetine is highly effective on severe depression in older adult patients. It can improve cognitive function and the activities of life living.

Changes of skin lesion, anxiety and depression in patients with facial hormone-dependent dermatitis before and after treatment / 中华医学美学美容杂志

Objective:To observe the changes of skin lesion, anxiety and depression in patients with facial hormone-dependent dermatitis before and after treatment.Methods:Ninty-two cases of hormone-dependent dermatitis were collected from October 2014 to December 2020 in the Department of Dermatology, the First People＇s Hospital of Changshu, Jiangsu province, including 24 males and 68 females, aged 18 to 52 (31±10) years. The skin lesions and subjective symptoms changes were compared 2 weeks and 4 weeks after treatment. Depression and anxiety changes were compared before and after treatment with Hamilton depression scale and Hamilton anxiety scale. Telephone follow-up was conducted 4 weeks and 8 weeks after treatment.Results:The skin lesions and subjective symptoms of the 92 cases were improved in different degrees after 2 weeks and 4 weeks treatment, and the effective rates were 52.17% (48 cases) and 88.04% (81 cases) respectively, and the difference was statistically significant ( Z=-9.24, P<0.01). The depression scores (16.89±4.53) before treatment were significantly higher than those after treatment (4.38±2.10), and the difference was statistically significant ( t=35.79, P<0.01). 28 cases (30.43%) had clinically significant depression symptoms before treatment, and none after treatment. The difference was statistically significant ( Z=-5.39, P<0.01). The scores of anxiety (14.39±3.97) before treatment were significantly higher than those after treatment (4.46±1.67). and the difference was statistically significant ( t= 28.87, P<0.01). 50 cases (54.35%) had clinically significant anxiety symptoms before treatment, and none after treatment. The difference was statistically significant ( Z=-7.07, P=<0.01). The total scores of Hamilton depression scale were positively correlated with course of disease before and after treatment ( r=0.27, P<0.05; r=0.22, P<0.05). The total scores of Hamilton anxiety scale were positively correlated with course of disease before and after treatment ( r=0.29, P<0.01; r=0.35, P<0.01). They were followed up by telephone 4 weeks and 8 weeks after the end of treatment, and there was no relapse. Conclusions:Facial hormone-dependent dermatitis can affect appearance, leading to depression and anxiety, and early and full treatment can achieve satisfactory results.

Effects of structured group psychotherapy on symptoms and social function of patients with mild to moderate depression / 中国基层医药

Objective:To investigate the effects of structured group psychotherapy on symptoms and social function of patients with mild to moderate depression.Methods:Sixty patients with mild to moderate depression who received treatment in Department of Psychiatry of the Third People's Hospital of Yongkang from June 2019 to May 2020 were included in this study. They were randomly assigned to receive either conventional antidepressants ( n = 30, control group) or conventional antidepressants combined with structured group psychotherapy ( n = 30, observation group). The Self-rating Anxiety Scale, Self-rating Depression Scale Hamilton Anxiety Scale, Hamilton Depression Scale and the Simplified Coping Style Questionnaire were used to compare the anxiety state, depression state and coping style between the two groups. Results:Self-rating Anxiety Scale, Self-rating Depression Scale, Hamilton Anxiety Scale, Hamilton Depression Scale and Simplified Coping Style Questionnaire scores in the observation group were (44.21 ± 4.15) points, (45.28 ± 5.16) points, (12.41 ± 2.16) points, (9.75 ± 2.83) points, and (10.35 ± 2.23) points, respectively, which were significantly lower than those in the control group [(51.14 ± 4.39) points, (53.64 ± 5.31) points, (16.73 ± 2.54) points, (14.18 ± 2.72) points, (14.73 ± 2.54) points, t = 6.283, 6.184, 7.097, 6.182, 7.375, all P < 0.001]. Simplified Coping Style Questionnaire score in the observation group was significantly higher than that in the control group [(31.42 ± 4.43) points vs. (24.16 ± 4.27) points, t = 7.432, P < 0.001]. Conclusion:Structured group psychotherapy combined with conventional antidepressant therapy for treatment of mild to moderate depression can greatly reduce the symptoms of anxiety and depression and improve the coping style.

Structural Differences of Depression for Patients with Parkinson's Disease Using Hamilton Depression Scale / 中国康复理论与实践

Objective:To explore the structural differences and the trend in series scores of Hamilton Depression Scale (HAMD) in patients with Parkinson's disease (PD). Methods:From June, 2017 to March, 2018, 168 PD patients from Beijing Tiantan Hospital were reviewed. Their genders, ages, courses of disease, Hamilton Depression Scale (HAMD) scores, unified Parkinson's disease rating scale III (UPDRS III) scores，Hoehn-Yahr stage and Mini-Mental State Examination (MMSE) scores, the most improvement ratios by PD drug and other clinical data were collected. The patients were divided into non-depression group (n = 61), mild depression group (n = 68) and moderate depression group (n = 39) according to the HAMD scores. The series scores of HAMD among the groups were compared. Results:The factor scores all increased with depression exacerbating (F > 10.546, P < 0.001), except day and night change in the mild depression group, while the proportion of anxiety/somatization score decreased, and the proportion of cognitive disorder and retardant scores increased. Conclusion:The depression structure changes in PD patients with depression exacerbating, which means decrease of anxiety/somatization and increase of cognitive disorder and retardant.

Association between quality of life and clinical symptoms in patients with the first-episode depression / 西安交通大学学报(医学版)

【Objective】 To study the relationship between quality of life and clinical symptoms of patients with the first-episode depression. 【Methods】 The untreated patients (n=36) with the first-episode depression and the depression patients (n=71) on drug treatment were included according to the strict screening and exclusion criteria. Subjects in control group (n=59), who matched in age, gender and education, were included according to the corresponding enrollment criteria. World Health Organization Quality of Life—Brief (WHOQOL-BREF) and The Social Adaptation Self-evaluation Scale (SASS) were used to evaluate all the subjects. The Hamilton Depression Rating Scale (HAMD), The Hamilton Anxiety Scale (HAMA) and Montgomery-Asberg Depression Rating Scale (MADRS) were used to evaluate the depressive patients. 【Results】 There was no significant difference in age or education level between all the groups. The quality of life was significantly lower in the first group and the treatment group than in the control group; no significant difference was found between patients in the two depression groups. Correlation analysis showed that the total scores of physiology, environment and quality of life in the first group and the treatment group were negatively correlated with HAMD, HAMA and MADRS. SASS was positively correlated with the total scores of physiology, psychology, environment and quality of life. 【Conclusion】 The quality of life and social adaptation of patients with the first-episode depression and those with depression after treatment were significantly reduced. More serious depression symptoms are linked to the worse quality of life, while better social adaptation is linked to the better quality of life.

Mild and moderate postpartum depression treated with acupuncture of / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect on mild and moderate postpartum depression treated with acupuncture of @*METHODS@#A total of 116 patients with mild and moderate postpartum depression were divided into an acupuncture group (103 cases) and a non-acupuncture group (13 cases) according to treatment regimen provided. In the acupuncture group, acupuncture of @*RESULTS@#The total effective rate of the acupuncture A group was 100.0% (31/31), better than 76.9% (10/13) in the non-acupuncture group and 58.1% in the acupuncture B group (18/31) (@*CONCLUSION@#Acupuncture of

A Study to Assess Depression among Cancer Patients at Our Tertiary Care Hospital Ajmer: An Hospital Based Study

Background: Individuals and families who face a diagnosis ofcancer will experience varying levels of stress and emotionalupset. Depression in patients with cancer not only affects thepatients themselves but also features a major negative impacton their families.Aims & Objectives: The aim of this study to assess theassociation between demographic data and level of depressionamong cancer patient admitted at our tertiary care hospitalAjmer.Material and Methods: This descriptive survey approach, 50samples by using structured interview technique (Hamiltondepression rating scale) employed by convenience samplingtechnique.Results: Consistent with Hamilton depression rating scale,level of depression 20 (40%) are in mild depression, 17 (34%)are in Moderate depression, 12 (24%) are in normal stage and1 (2%) are in severe depression. Nobody in very severedepression. No association between demographic variables.Conclusion: The most outcome of the study that some cancerpatients are always in depression. Any interventional programor awareness program on depression will help the cancerpatients to attenuate Depression and that they will developcertain coping strategies.

Association of SIRT1 gene with major depression and its clinical features / 上海交通大学学报（医学版）

Objective:To explore the relationship between rs3758391 polymorphism of SIRT1 gene and depressive symptoms, and to further understand the role of SIRT1 gene in major depressive disorder. Methods:A total of 323 patients with major depressive disorder were retrospectively collected from the Jinhua Second Hospital, Wenzhou Kangning Hospital and Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine. A total of 347 healthy subjects were also recruited. Depressive symptoms were evaluated by using the Hamilton Depression Scale (HAMD), and rs3758391 polymorphism was genotyped by using the TaqMan SNP genotyping Assay. The effect of rs3758391 polymorphism on the expression of SIRT1 mRNA in brain was analyzed by BRAINEAS database, and the difference of depressive symptom severity among three genotypes at rs3758391 polymorphism was compared by multivariate analysis of variance. Results:The frequencies of C and T alleles of rs3758391 polymorphism in SIRT1 gene were 18.7% and 81.3% in the case group, and 14.3% and 85.7% in the control group, respectively. The allelic distribution frequencies between the two groups were significantly different (χ2=4.86, P=0.03). There were significant differences in mood, cognitive impairment and HAMD scores among patients with different genotypes of rs3758391 polymorphism (P<0.05). The results of eQTL analysis showed that rs3758391 polymorphism was significantly correlated with the expression of SIRT1 gene in occipital cortex (OCTX) (P=0.003). Conclusion:rs3758391 polymorphism of SIRT1 gene may be a risk factor for major depressive disorder in Chinese Han population, and is associated with the severity of depressive symptoms, especially with emotional symptoms and cognitive impairment.

Analysis on sleep quality and characteristics of depression patients with different degrees of anxiety / 上海交通大学学报（医学版）

Objective: To compare the sleep quality of depressive patients with and without anxiety symptoms. Methods: Hamilton Depression Scale-17 (HAMD-17), Hamilton Anxiety Scale (HAMA) and Pittsburgh Sleep Quality Index Scale (PSQI) were used to assess the level of patients' depression, anxiety and sleep quality. The HAMA scores of patients ranged from 0 to 6 were in the anxiety-free group, 7 to 13 in the anxiety-prone group, and 14 or more in the anxiety group. Results: The PSQI scores of the group with anxiety were higher than those of anxiety-prone group and anxiety-free group (both P=0.000). Partial correlation analysis showed that, after controlling HAMD-17 scores, the correlation between HAMA scores and PSQI scores reduced gradually with the increase of anxiety level. The multiple linear regression analysis showed that sleep disorder was still an independent risk factor for depression after controlling HAMA score. Sleep latency, sleep time, hypnotics and daytime dysfunction were independent predictive factors of HAMD-17 score (all P<0.05). Conclusion: In patients with depressive disorder, the severity of sleep disorder increases with the increase of anxiety level. In the case of comorbidity anxiety, sleep disorder is still an independent risk factor for depressive disorder, and the relationship between depressive symptoms and sleep disorder indicators of different dimensions suggests that sleep disorder plays a comprehensive role in the pathogenesis of depressive disorder.

Mood versus energy/activity symptoms in bipolar disorder: which cluster of Hamilton Depression Rating Scale better distinguishes between mania, depression, and euthymia? / Sintomas de humor versus sintomas de energia/atividade no transtorno bipolar: qual grupo da Escala de Depressão de Hamilton distingue melhor entre mania, depressão e eutimia?

Abstract Introduction Although bipolar disorder (BD) is traditionally included among mood disorders, some authors believe that changes in energy and motor activity, rather than mood changes, represent the true cardinal symptoms in mania and depression. The aim of the current study was to identify which cluster of the Hamilton Depression Rating Scale (HAM-D) better distinguishes between mania, depression and euthymia. Method A group of 106 patients with BD were followed for 13 years and repeatedly assessed with the HAM-D as well as with other clinical scales. To perform a comparison, HAM-D items were classified according to clinical criteria into three clusters: energy/activity symptoms, mood symptoms, and other symptoms. Item response theory (IRT) analyses were performed to provide a test information curve for those three clusters. We measured the prevalence of one cluster of symptoms over the other two throughout the latent trait. Results Considering HAM-D items individually, the IRT analysis revealed that there was a mixture of mood and energy/activity symptoms among the most discriminative items, both in depression and in euthymia. However, in mania, only energy/activity symptoms - i.e., general somatic symptoms and retardation - were among the most informative items. Considering the classification of items, both in depression as in mania, the energy/activity cluster was more informative than the mood cluster according to the IRT analysis. Conclusion Our data reinforce the view of hyperactivity and motor retardation as cardinal changes of mania and depression, respectively.

Resumo Introdução Embora o transtorno bipolar (TB) seja tradicionalmente incluído entre os transtornos do humor, alguns autores acreditam que as alterações na energia e na atividade motora, em vez das alterações no humor, representam os verdadeiros sintomas cardinais na mania e na depressão. O objetivo do presente estudo foi identificar qual grupo da Escala de Depressão de Hamilton (HAM-D) distingue melhor entre mania, depressão e eutimia. Método Um grupo de 106 pacientes com TB foram acompanhados por 13 anos e avaliados repetidamente com a HAM-D e com outras escalas clínicas. Para realizar uma comparação, os itens da HAM-D foram classificados de acordo com critérios clínicos em três grupos: sintomas de energia/atividade, sintomas de humor e outros sintomas. Foram realizadas análises da teoria da resposta ao item (TRI) para fornecer uma curva de informações de teste para esses três grupos. Medimos a prevalência de um grupo de sintomas em comparação aos outros dois através do traço latente. Resultados Considerando os itens da HAM-D individualmente, a análise da TRI revelou que havia uma mistura de sintomas de humor e de energia/atividade entre os itens mais discriminativos, tanto na depressão quanto na eutimia. No entanto, na mania, apenas os sintomas de energia/atividade - ou seja, sintomas somáticos gerais e retardo - estavam entre os itens mais informativos. Considerando a classificação dos itens, tanto na depressão quanto na mania, o grupo energia/atividade foi mais informativo que o grupo humor, de acordo com a análise da TRI. Conclusão Nossos dados reforçam a visão da hiperatividade e do retardo motor como as alterações cardinais de mania e depressão, respectivamente.

A double-blind randomized placebo-controlled study of low dose mirtazapine once daily in patients of major depressive disorders on escitalopram

Background: The SSRIs being used as 1st line therapy in treatment of depression have delayed therapeutic effect which makes the patient vulnerable to an increased risk of suicide and decreased adherence to the treatment and will prematurely discontinue the therapy. The present study was conducted to evaluate if low dose mirtazapine-escitalopram combination therapy has any add on benefit over monotherapy with escitalopram.Methods: In a single-centered, comparative study involving patients with depression attending the out-patient after screening and exclusion, 60 eligible patients were randomly assigned to receive tablet mirtazapine 7.5 mg plus tablet escitalopram 10 mg intervention or tablet escitalopram 10 mg plus placebo intervention in a double-blind 6-week treatment phase. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS) score from baseline. Participants were evaluated at baseline, 1st, 2nd,4th and 6th week. Results were analyzed using Chi-Square test for adverse effects and independent t-test analysis for efficacy parameter.Results: In the analysis of results at 6th week the numbers of patients achieved remission in mirtazapine group are more with a p-value of 0.018 which is significant and the numbers of responders in mirtazapine group are also more which is statistically significant on chi-square test. There is no significant difference was observed between the two groups with reference to occurrence of adverse effect.Conclusions: Adding low dose mirtazapine has an added benefit in terms of efficacy and getting remission early with more number of responders in the treatment of major depression.

Prevalencia de depresión en embarazadas que asisten al control prenatal en el Centro Integral de Salud de Jicarito, Francisco Morazán, Honduras, octubre a diciembre 2018 / Prevalence of depression in pregnant women attending prenatal control at the Jicarito Comprehensive Health Center, Francisco Morazán, Honduras, October to December 2018

OBJETIVO. Determinar la prevalencia de depresión en embarazadas que asistieron al control prenatal al Centro Integral de Salud de Jicarito, San Antonio de Oriente, Francisco Morazán, Honduras, octubre a diciembre 2018 METODOLOGÍA: Estudio descriptivo de corte transversal en Centro Integral de Salud de Jicarito, de septiembre a diciembre del 2018, a través de encuesta, expediente clínico y test de Hamilton. Sé aplicó a 86 embarazadas que acudieron a control prenatal, previo consentimiento informado; el test de Hamilton fue aplicado por un psicólogo, mientras que la recolección de datos y tabulación de información realizados por el investigador. RESULTADOS: La prevalencia de depresión fue de 25 (29 %), edad de 20 a 36 años 20 (80%), del área rural 17 (68%), escolaridad secundaria 14 (56%), unión libre 17 (68%), nivel socioeconómico pobre 12 (48%) antecedente familiar de depresión 8 (32%), primer embarazo en 11, (44%),no usaban ningún método de planificación familiar 20, (80%), no planearon su embarazo 13 (52%), depresión mayor 7 (28 %), el síntoma más frecuente fue insomnio tardío en 21 (84 %), el menos frecuente idea de suicidio en 2 (8%), se presentaron en primer trimestre del embarazo en 16 (64%). CONCLUSIONES: De las 86 embarazadas encuestadas, la mayoría no presentó depresión y el tipo de depresión más frecuente era menor. La mayoría de los casos se presentó en: edad reproductiva sin riesgo, del área rural, educación secundaria, era su primer o segundo embarazo, no planeado, no usaban un método anticonceptivo, unión libre, nivel socioeconómico pobre y antecedente familiar de depresión. Los síntomas más frecuentes fueron insomnio tardío e insomnio intermedio, síntomas gastrointestinales y menos frecuentes: ideas de suicidio, se presentaron más en el primer y segundo trimestre del embarazo