Severity of depression and anxiety are predictors of response to antidepressant treatment in Parkinson's disease.

BACKGROUND: Antidepressants have appeared to be more effective than placebo treatment in treating depressive syndromes in patients with Parkinson's disease (PD). OBJECTIVE: To identify factors that predict improvement in depressive symptoms during antidepressant treatment in depressed PD patients. METHODS: A secondary analysis was performed on the dataset of the Randomized Placebo-controlled Study of Antidepressants in PD (SAD-PD), in which 76 patients received active treatment with either paroxetine or venlafaxine extended release (XR), and 39 patients received placebo treatment. Backward stepwise regression analyses were conducted with change in 24-item Hamilton Depression Rating Scale (HAMD-24) score between assessments at baseline and week 12 as the main outcome measure, and sex, age, baseline HAMD-24 score, Unified Parkinson's Disease Rating Scale section III (UPDRS-III) score, Mini-Mental State Examination (MMSE), and the Clinical Anxiety Scale (CAS) as independent variables. RESULTS: In both the active treatment and placebo groups, higher baseline HAMD-24 score and lower UPDRS-III score were associated with greater reduction in HAMD-24 score. Higher anxiety scores predicted less response in the active treatment group. Higher MMSE scores predicted greater response only in the placebo-treated group. Sex and age were no predictors of response. CONCLUSIONS: Higher pre-treatment depression scores and lower pre-treatment anxiety scores are the two most important predictors for improvement during antidepressant treatment in depressed PD patients, which is in line with those found in treatment studies of depressed non-PD patients. Furthermore, our results indicate the requirement for different or more intensive treatment for depressed PD patients with more severe anxiety symptoms.

A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease.

OBJECTIVE: To evaluate the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) and a serotonin and norepinephrine reuptake inhibitor (SNRI) in the treatment of depression in Parkinson disease (PD). METHODS: A total of 115 subjects with PD were enrolled at 20 sites. Subjects were randomized to receive an SSRI (paroxetine; n = 42), an SNRI (venlafaxine extended release [XR]; n = 34), or placebo (n = 39). Subjects met DSM-IV criteria for a depressive disorder, or operationally defined subsyndromal depression, and scored >12 on the first 17 items of the Hamilton Rating Scale for Depression (HAM-D). Subjects were followed for 12 weeks (6-week dosage adjustment, 6-week maintenance). Maximum daily dosages were 40 mg for paroxetine and 225 mg for venlafaxine XR. The primary outcome measure was change in the HAM-D score from baseline to week 12. RESULTS: Treatment effects (relative to placebo), expressed as mean 12-week reductions in HAM-D score, were 6.2 points (97.5% confidence interval [CI] 2.2 to 10.3, p = 0.0007) in the paroxetine group and 4.2 points (97.5% CI 0.1 to 8.4, p = 0.02) in the venlafaxine XR group. No treatment effects were seen on motor function. CONCLUSIONS: Both paroxetine and venlafaxine XR significantly improved depression in subjects with PD. Both medications were generally safe and well tolerated and did not worsen motor function. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that paroxetine and venlafaxine XR are effective in treating depression in patients with PD.

Elaboración de un procedimiento de notificación y actuación en situaciones de embarazo y lactancia de trabajadoras expuestas a radiaciones ionizantes / Elaboration of a notice and procedure for action in situations of pregnancy and lactation of workers exposed to ionizing radiation

Los Servicios de Prevención y Física Médica elaboran un procedimiento de notificación de embarazo y lactancia para trabajadoras de un área sanitaria de la Comunidad de Madrid tomando como referencia la normativa vigente. El procedimiento comienza con la comunicación de la situación de embarazo por parte de la trabajadora expuesta a radiaciones ionizantes al Servicio de Prevención. Este Servicio solicitará al Servicio de Física Médica la información necesaria sobre el riesgo de exposición de la mujer embarazada y, si se estima procedente el cambio de puesto de trabajo, se elevará la propuesta a la dirección correspondiente. Ha de existir una coordinación total entre el Servicio de Prevención y el Servicio de Física Médica, en cuanto a las condiciones de trabajo habituales de la trabajadora gestante expuesta a radiaciones ionizantes, para poder establecer medidas preventivas,información-formación, dosimetría específica, vigilancia de la salud individualizada, adaptación/cambio de puesto si procede, que eviten posibles efectos sobre la salud del feto (AU)

Occupational Health Service and Medical Physics Service develope a procedure for notificating pregnancy and lactation for workers in a sanitary area of Madrid with current legislation. The procedure begins communicating the pregnancy of the worker exposed to ionizing radiation to the Occupational Health Service. ThisService will ask the Medical Physics Service information about the hazzard for pregnant women and, if the change of job is estimated, the proposal will be communicated to the appropriate managment. There must be a total coordination between Occupational Health Service and Medical Physics one, in terms of working conditions of pregnant worker exposed to ionizing radiation, in order to establish preventive measures, information, training, dosimetry, health monitoring, adaptation/change of the job if necessary, to avoid possible effects on fetus health (AU)

Seroprevalencia y conocimiento de vacunación en nuevos residentes / Seroprevalence and vaccines knowledge among newcomers hospital residents

Objetivo: Valorar el conocimiento de los nuevos residentes sobre su calendario vacunal, su estado serológico frente enfermedades vacunoprevenibles y la validez de la historia clínico-laboral como indicador de protección frente éstas.Método: Mediante cuestionario específico obtenemos datos sobre el conocimiento del estado e historia vacunal, y mediante serología comprobamos el estado de protección actual de 130 nuevos residentes hospitalarios.Resultados: La edad media es de 26,7 años, siendo 62% mujeres. Son españoles 82%, de Centro y Sur América 17% y un 1% europeos. El 42% desconocen su calendario vacunal. Están protegidos frente varicela 93,1% y frente a sarampión 90.8%, pero frente parotiditis y rubéola sólo presentan anticuerpos positivos el 69.2% y 61.5% respectivamente. Refieren vacunación frente hepatitis B 81.5% y están protegidos 80,8%. Refieren vacunación de hepatitis A 35% y están protegidos 52.3%. 65% nunca se vacunó de gripe.Conclusiones: Se ha objetivado un gran desconocimiento sobre vacunaciones. La protección frente parotiditis y rubéola ha resultado escasa. La cobertura vacunal frente a VHB, VHA y gripe es baja contando con que se trata ya de personal de riesgo antes de realizar este estudio. La historia clínico laboral no es congruente con los resultados serológicos en muchos casos (AU)

Objective: To evaluate knowledge about vaccines, protection against vaccine-preventable diseases and labour medical history value.Methods: We obtained data on immunization status and serum antibodies against these diseases from 130 newcomers residents to our hospital that were enrolled from May to June 2008. Results: Their mean age was 26.7 years (62% women). They are Spanish 82%, from Centre and South America 17% and 1% European. 42% of subjects don’t know their immunization schedule. 93.1% are immune against varicella and 90.8% against measles, but only 69,2% are immune against rubella and 61,5% against mumps. 81% have been vaccinated against hepatitis B and 80,8% are protected. 35% related to be vaccinated against hepatitis A, but 52.3% are protected. 65% of them never have been flu vaccinated.Conclusion: A lack of knowledge about vaccine has been found. Protection against mumps and rubella is not enough. Immunization coverage against VHB, VHA and flu is low for this biological risk population. Lot of the subjects doesn’t have a labour medical history consistent with serological results (AU)