Severity and risk factors of depression in Alzheimer's disease

To determine the frequency, severity and risk factors of depression in Alzheimer's disease. Descriptive study. The Department of Psychiatry, Sir Ganga Ram Hospital, Lahore, from August 2007 to December 2008. Consecutive patients of Alzheimer's disease reporting to the department during the study period were included and those with extreme cognitive impairment were excluded. The cognitive status was judged by using the Mini-Mental State Examination [MMSE]. The Hamilton rating scale for depression [Ham-D] was used as a symptom checklist to diagnose major depression according to the DSM-IV criteria. Chi-square test was used to check the significance of association. There were 73 patients comprising of 34 males and 42 females. The mean age was 67.74 +/- 6.71 years; 66% were married, 14% were single and 20% were widowed; 47% had family history of depression and medical co-morbidity was observed in 48%. Based on MMSE, 31.5% had mild Alzheimer, 55.3% had moderate and 13.1% had severe Alzheimer. Judging from Hamilton rating scale, 25% patients were free from depression, 19.7% had mild depression, 27.6% had moderate depression and 27.6% were suffering from severe depression. The frequency of depression was significantly higher [p= 0.0013] among females [90%] as compared to males [55.9%]. There is a high frequency of depression among patients of Alzheimer's disease particularly among female patients. This finding is consistent with the reports from other countries

Child sexual abuse

Child sexual abuse with significant impact on victim's physical, mental and social health has now been recognized as existing on an appreciable scale worldwide. Diversity of opinions exist about the concept, types, prevalence and repercussions along with a paucity of systematic and scientific work in the developing world including Pakistan. This paper aims at reviewing the literature for clarification of concept, update of estimates and correlates, and to identify lines for future research. The literature was searched through BMJ-Medline for international data, supplemented by local data through CPSP-MEDLIP service. The search term [child sexual abuse] with associated sub-heads were used. No constraint of time period, publication type or source applied except [English Language version]. Wide variations identified in conceptual boundaries with consequent impact on prevalence estimates. Agreement found for its existence as an international problem with rates ranging from 7 percent - 36 percent for women and 3 percent - 29 percent for men. Female abused 1.5-3 times more than male with exponential high rates in age group 3-6 years and 8-11 years. In 2/3 cases the perpetrator identified belonged to nuclear or extended family. Significant association exists with early onset of psychiatric ailments like substance abuse, eating disorders, personality disorders, dissociative disorders and depression. The need for extensive research studies is immense in developing countries like Pakistan where environmental circumstances suggest its presence at rates higher than the identified elsewhere. In addition to facilitate awareness and perhaps to clarify the concept as well as the prevalence of child sexual abuse researchers need to select methodologies and instruments with international comparison in mind