Neurotrophins and neuroinflammation in fetuses exposed to maternal depression and anxiety disorders during pregnancy: a comparative study on cord blood.

In recent years, there have been changes in the approach to maternal psychiatric disorders and their effects on the fetus, with the focus redirected to the search for biological markers. Neurotrophic factors and inflammatory processes have received particular attention in the past few years. According to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the study sample (n = 136) consisted of three groups: mothers with major depressive disorder (MDD group, n = 25), mothers with anxiety disorder (AD group, n = 18), and mothers without any psychiatric disorders (not diagnosed (ND) group, n = 93). During the delivery/cesarean section, a blood sample was obtained from the umbilical cord. Serum concentrations of BDNF, NT-3, FGF2, TNF-α, and neopterin were determined by enzyme-linked immunosorbent assay (ELISA), according to the manufacturer's procedure. Clinical and biochemical characteristics were assessed. We did not find a significant difference among the three study groups with regard to BDNF, NT-3, and TNF-α levels. The ANOVA test indicated statistically significant differences in FGF2 levels and neopterin between the study groups. The newborns of mothers with AD had significantly higher FGF2 levels and significantly higher neopterin levels when compared with those of mothers with MDD and healthy mothers. The present study sheds light on the effects of higher FGF2 and neopterin levels in fetuses exposed to AD. Our results should be replicated through further prospective studies with a larger sample size.

Relationships of neutrophil-lymphocyte and platelet-lymphocyte ratios with the severity of major depression.

We aimed to evaluate the neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of inpatients and outpatients suffering from different levels of major depression. In total, 100 inpatients and 60 patients treated at an outpatient clinic were included the study. The presence of mood and anxiety disorders was identified with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version, and the Hamilton Depression Rating Scale was used to assess the severity of major depression (MD). Inpatients and outpatients with MD did not differ in NLR or PLR. The PLRs of patients who had severe major depression with psychotic features were higher than those of patients with other types of depression, but no differences in NLRs were detected across types of depression. The PLRs were higher in patients with severe levels of major depression with psychotic features than in other patients. This parameter may be more predictive than is NLR for assessing the prognosis of major depression.

Psychiatric comorbidity in women with polycystic ovary syndrome.

AIM: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder that women experience during their reproductive years and is associated with many psychiatric disorders. This study sought to determine the existence of psychiatric disorders in women with untreated PCOS. Another objective of the study was to examine whether an association exists between psychiatric disorders, insulin resistance, and body mass index. MATERIAL AND METHODS: Women who met the Rotterdam criteria for PCOS (n = 88) were included. Structured Clinical Interviews for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edn were conducted. After the psychiatric evaluations, blood samples were obtained from the participants. RESULTS: Prevalence for all comorbid psychiatric disorders was 50% (n = 44). The most common psychiatric disorder was major depression (33%), followed by generalized anxiety disorder (13.6%) and binge-eating disorder (6.8%). No significant difference in body mass index and insulin resistance index scores was found between women with and without psychiatric disorders (P > 0.05 for both comparisons). CONCLUSION: A considerable number of women with PCOS experience a psychiatric disorder during their lifetime. Clinicians should be aware that women with PCOS are at a high risk for major depression, generalized anxiety disorder, and binge-eating disorder.

Is there any difference between the early age myocardial infarction and late age myocardial infarction in terms of psychiatric morbidity in patients who have survived acute myocardial infarction?

OBJECTIVE: We aimed to compare the rates of psychiatric morbidity in patients who had early age and late age MI in patients who have survived acute myocardial infarction? METHODS: One hundred sixteen patients who were hospitalized in the coronary care unit were included in the study. Psychiatric assessment of the patients was carried out within 1-6months post-MI. Psychiatric interviews were conducted with the Structured Clinical Interview for DSM-IV (SCID-I). Also used were the Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), and Health Anxiety Inventory (HAI). RESULTS: A total of 116 patients were divided into two groups according to age as an early age myocardial infarction group (EA-MI) and a late age myocardial infarction group (LA-MI). The EA-MI group included 24 patients 45years of age and under. The LA-MI group included 92 patients over 45years of age. Current psychiatric disorders, lifetime psychiatric disorders and lifetime depressive disorders were significantly more frequent in the EA-MI group than in the LA-MI group. CONCLUSION: EA-MI patients have experienced a depressive episode prior to the onset of the MI, whereas in the LA-MI group, the patients typically experienced depressive episodes after MI. Our findings suggest that depression may increase the risk of MI at an early age.

Birth weight and preterm birth in babies of pregnant women with major depression in relation to treatment with antidepressants.

OBJECTIVE: It is unclear whether antidepressant treatment has a preventive effect on negative neonatal outcomes due to major depression in pregnant women. The objective of the present study was to compare women with major depression treated with antidepressants, untreated women with major depression, and healthy women during pregnancy with respect to birth weight and preterm birth. METHODS: The study sample included a total of 23 women taking antidepressant medication, 36 women who were not taking antidepressant medication for major depression during pregnancy, and 30 healthy women. Major depression was diagnosed via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS: The study groups were similar with respect to sociodemographic characteristics. Compared with infants of healthy control subjects, infants of untreated major depressed women had significantly lower birth weight and shorter gestational age at delivery. There is no significant difference between infants of major depressed women treated with antidepressants and infants of healthy subjects for these variables. CONCLUSIONS: Our results suggest that antidepressants may have beneficial effects on the risk of low birth weight and preterm birth in the infants of depressed women.

Are there any differences in psychiatric symptoms and eating attitudes between pregnant women with hyperemesis gravidarum and healthy pregnant women?

AIM: We aimed to determine the relationship between eating attitudes and psychiatric symptoms in women with hyperemesis gravidarum (HG) and to compare these women with healthy control subjects. METHODS: The study sample included 48 women with HG, and the control group had 44 pregnant women. The patients were selected from women with HG hospitalized in the obstetric inpatient clinic. All of the participants were in the first trimester of pregnancy. The participants' sociodemographic and clinical characteristics were recorded in the obstetric clinic. All of the participants completed a Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Eating Attitudes Test (EAT) and Body Image Scale (BIS). RESULTS: Women with HG were more likely to have had a history of HG during their previous pregnancy (P<0.05). There was no significant difference between the study and control groups regarding obstetric history. Women with HG were more influenced by food that induced nausea. There was no significant difference between the study and control groups for pre-pregnancy nausea, food craving and the initial BMI (P>0.05). Depression and anxiety scores were significantly higher in women with HG (P<0.05). However, there was no significant difference between the study and control groups for body image score and eating attitude test scores (P>0.05). CONCLUSION: We suggest that HG appears to be associated with depression and anxiety symptoms rather than deterioration of eating attitudes and body image. However, these results should be confirmed by prospective and clinical studies.

Body Image, Self-Esteem and Depressive Symptomatology in Women with Polycystic Ovary Syndrome.

INTRODUCTION: In the current study we aimed to determine body image, self-esteem and depressive symptomatology in women with Polycystic ovary syndrome (PCOS) and compare with healthy controls. METHOD: This study was conducted among the patients with untreated PCOS who admitted to the Outpatient Clinic of Gynecology and Obstetrics of Faculty of Medicine of Selçuk University. A total 83 consecutive women with PCOS met the criteria of present study were included in the study. Age matched healthy controls (n=64) were recruited from employees at Selçuk University Hospital. PCOS was defined according to Rotterdam criteria. After socio-demographic characteristics of the participants were recorded, Body Image Scale, Rosenberg Self-Esteem Scale and Beck Depression Inventory were completed by the participants. RESULTS: Patients with PCOS and healthy controls did not differ in some sociodemographic variables, including age, education and economic status (p>.05). Previous psychiatric history was more prevalent among the PCOS group (p<. 05). Body mass index (BMI) was ≤25 kg/m2 in both groups. BMI values in the PCOS group were significantly higher than in the controls (p<.05). BDI scores were significantly higher in the PCOS group compared to that in the healthy controls (p<.05). There was no significant difference between the PCOS group and healthy controls in BIS and RSES scores (p>.05). CONCLUSION: The present study suggests that PCOS seems to be associated with depressive symptomatology. Furthermore, rising BMI values of these women may be an indicator for the onset of PCOS. However, these results should be confirmed by prospective studies.

Do psychiatric disorders continue during pregnancy in women with hyperemesis gravidarum: a prospective study.

OBJECTIVE: We aimed to determine Axis I psychiatric disorders in women with hyperemesis gravidarum (HG) and to follow up the course of psychiatric disorder and its association with nausea and vomiting (NV) during pregnancy. METHODS: The study sample was composed of 47 patients with HG. Psychiatric interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Other psychiatric interviews were performed in the second and third trimesters. On each visit, the subjects completed the Beck Depression Inventory and the Beck Anxiety Inventory. RESULTS: The prevalence of any anxiety disorder was 25.5%, and the prevalence of any mood disorder was 14.9% in women with HG in the first trimester. Psychiatric disorders continued throughout the pregnancy in two thirds of the women who had HG and a psychiatric diagnosis. Any SCID diagnosis in the first trimester was higher in women whose NV had partially resolved than in women whose NV had fully resolved (P<.05). CONCLUSION: The present studies suggest that psychiatric disorders may play a significant role in the etiology of HG. Our findings presented a potential connection between HG and anxiety disorders and major depressive disorder. Additionally, the NV symptoms in women with HG and a psychiatric disorder may persist during pregnancy.

The effects of maternal major depression, generalized anxiety disorder, and panic disorder on birth weight and gestational age: a comparative study.

OBJECTIVE: The present study comparatively examined the impact of maternal major depression, generalized anxiety disorder and panic disorder on gestational age and birth weight. METHODS: A total of 90 women (24 subjects with major depression, 19 subjects with panic disorder, 22 subjects with generalized anxiety disorder, and 25 healthy subjects) in the perinatal period who were admitted to three hospitals were included in the study. Psychiatric diagnoses were determined by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The birth weight and gestational age of the subjects in each groups were compared with one-way analysis of variance (ANOVA). RESULTS: There were significant differences among the study groups for birth weight and gestational age (P<0.001 for both variables). These parameters were significantly lower in the subjects with major depression (P=0.021 and P=0.015, respectively) and panic disorder (P<0.001 for both variables) compared to healthy controls. Compared with major depression, panic disorder was associated more negatively with birth weight (P=0.036). CONCLUSION: Major depression, and especially panic disorder, may negatively affect the gestational length and birth weight.

Biological correlates of major depression and generalized anxiety disorder in women with polycystic ovary syndrome.

OBJECTIVE: We aimed to compare the levels of serum androgens in women with polycystic ovary syndrome (PCOS) who had a diagnosis of only major depressive disorder (MDD), only generalized anxiety disorder (GAD) or who had no psychiatric disorder, as determined by a structured clinical interview. Another objective of the study was to examine whether an association exists between these psychiatric diagnoses and insulin resistance or body mass index via a comparison among the study groups in terms of these parameters. METHOD: This study was performed between March 2011 and February 2012. A total of 73 patients were included in the study. The study sample consisted of three groups: PCOS patients with only major depressive disorder (n=23), PCOS patients with only generalized anxiety disorder (n=20), and PCOS patients without any diagnosed psychiatric disorders (not diagnosed - ND group, n=30). RESULTS: Significant difference was found among the three groups with regard to the serum levels of 17-OHP and DHEAS. When multiple comparisons were performed among the groups, 17-OHP levels were significantly higher in the MDD group than in the ND group. DHEAS levels were significantly higher in the MDD group and the GAD group than in the ND group. CONCLUSION: The present study suggests that MDD and GAD appear to be associated with higher DHEAS levels.

Is maternal depressive symptomatology effective on success of exclusive breastfeeding during postpartum 6 weeks?

AIM: The aim of this prospective study was to examine the relationship between success of exclusive breastfeeding and postpartum depressive symptomatology. Our hypothesis was that mothers with depressive symptoms initially fail exclusive breastfeeding. SUBJECTS AND METHODS: One hundred ninety-seven mothers were enrolled in the study. The participants were interviewed twice. The first visit was within the first 48 hours after birth. The Edinburgh Postnatal Depression Scale (EPDS) was completed by the participants. The second interview was performed at 6 weeks. Participants answered questions regarding methods of breastfeeding for 6 weeks, any methodological problems, and nipple pain. The EPDS was again completed by the participants at 6 weeks. All newborns were term infants. RESULTS: All the participants were divided into two groups: exclusive breastfeeding and mixed-feeding (partial breastfeeding and/or bottle feeding). Both groups were compared in terms of features, such as mode of delivery, parity, prevalence of depressive symptomatology (at 48 hours and 6 weeks), and delayed onset of lactation within the first 48 hours. Statistical significance was found for only three variables: delayed onset of lactation within the first 48 hours, gestational age, and the problems related to breastfeeding methods. CONCLUSIONS: Clinicians should pay special attention to any lactation difficulty during the first week postpartum. Early lactation difficulties are associated with greater risk of early termination of breastfeeding and lower breastfeeding success.

Does a non-destructive earthquake cause posttraumatic stress disorder? A cross-sectional study.

This study evaluated the prevalence and symptoms of posttraumatic stress disorder (PTSD) among adolescents who experienced non-destructive, moderate magnitude earthquake. Four hundred and fifty students (214 girls and 236 boys between the ages of 12-14) were selected from secondary schools located within Konya province in Turkey, 6 months after the earthquake. They were chosen to participate in this cross-sectional study by simple random sampling. The students were evaluated by the child posttraumatic stress reaction index. Of all the students, we found that 3.5% had very severe, 20.8% had severe, 28.4% had moderate and 20% had mild symptoms of PTSD and that 24.3% had probable PTSD diagnoses. The most common PTSD symptoms were trauma-related fears, social avoidance, emotional detachment and the concentration difficulty. Limitations and implications for research studies are included in the discussion.

Findings of multidimensional instruments for determining psychopathology in diabetic and non-diabetic hemodialysis patients.

OBJECTIVE: The aim of this study was to expand the research on psychiatric complications of end-stage renal disease (ESRD), as well as to examine the prevalence of a broad range of psychopathology in diabetic and non-diabetic hemodialysis (HD) patients. METHODS: One hundred nineteen HD patients were invited to enter the cross-sectional study. To assess quality of life, quality of sleep, mental status and depression and anxiety symptoms, the 36-item Short Form, Pittsburgh Sleep Quality Index (PSQI), Mini-Mental State Examination and Hospital Anxiety and Depression Scale, respectively, were used. RESULTS: The mean age of all patients was 56.9±16.1 years; 54 (45.4%) were female. In the diabetic patients group, 84.8% of the patients had low MCS scores, and 89.2% patients had low PCS scores; 73.9% were poor sleepers; 63.0% had cognitive decline; 62.0% patients were depressive symptoms; and 28.3%had symptoms of anxiety. When comparing the diabetic and non-diabetic patients, the diabetic patients had lower role-emotional, sleep duration, and sleep efficiency scores. CONCLUSIONS: Incorporating a standard assessment and, eventually, treatment of psychopathologic symptoms into the care provided to diabetic and hemodialysis patients might improve quality of life and sleep, depressive symptoms and, reduce mortality risk.

Are sleep and life quality of family caregivers affected as much as those of hemodialysis patients?

OBJECTIVE: The purpose of this study was to determine and compare the quality of sleep, quality of life, and anxiety and depression symptoms reported by hemodialysis (HD) patients and family caregivers of HD patients. METHODS: The study included 142 pairs of HD patients and their caregivers. To assess quality of sleep, quality of life, and anxiety and depressive symptoms, the 36-item Short Form, Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale, respectively, were used. RESULTS: For the patients, 73.9% were poor sleepers. Low Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were found in 89.1% and 76.3% of HD patients, respectively. For the caregivers, 88% were poor sleepers. Low PCS and MCS scores were found in 62% and 70.4% of the caregivers, respectively. Mean PSQI scores, subjective sleep quality scores, sleep latency, sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction scores of the caregivers were significantly higher than the scores of the HD patients (P<.001). CONCLUSIONS: Caregivers of dialysis patients experience adverse effects on their quality of sleep and quality of life. Educational, social, and psychological support interventions should be considered to improve their ability to cope.

Varenicline-induced psychotic depressive episode in a patient with bipolar disorder.

Varenicline is a relatively novel medication for smoking cessation. Increased neuropsychiatric symptoms have been reported with its use and it is listed among drugs with a black box warning. History of a psychiatric diagnosis is suggested to be a vulnerability factor for the development of some psychiatric side effects with its use. However, empirical evidence to support this point is very limited. Here, we report the case of a bipolar patient who developed a depressive episode with psychotic features immediately after varenicline use. Clinicians should be careful about the varenicline-induced neuropsychiatric effects. Healthcare professionals can provide an important role in helping to prevent and manage worsening psychiatric symptoms.

Black hairy tongue associated with olanzapine treatment: a case report.

Olanzapine is an atypical antipsychotic drug approved for acute and long-term treatment of bipolar disorder. Although relatively safe as compared to other classical antipsychotic medications, there are a number of uncommon adverse effects of olanzapine such as oral cavity lesions. In addition to the relatively common side effect of dry mouth, several articles have reported an association between olanzapine treatment and the development of oral lesions such as apthous stomatitis, pharyngitis, glossitis and oral ulceration. Although there are several cases in which the tongue was affected in conjunction with stomatitis or pharyngitis, we could not find a case report indicating a direct relationship between olanzapine use and a tongue lesion. We present here the case of a patient with bipolar disorder, who developed recurrent black hairy tongue on two different occasions following the addition of olanzapine to lithium treatment. In the present case, xerostomia (dry mouth), which is an adverse reaction of both olanzapine and lithium, may have played a role in the development of black hairy tongue. All agents with a possible side effect of xerostomia may predispose patients to black hairy tongue, especially when they are administered in combination. To preclude the development of this complication with such drugs, extra time and effort should be given to improving oral hygiene.