Menstruation-Related Hypersomnia Treated with Hormonal Contraception: Case Report and Review of Literature.

Menstrual-related hypersomnia (MRH) is a rare disorder consisting of recurrent hypersomnia that is temporally linked with menses. An unusual case of an 18-yearold female with repeated episodes of hypersomnia was referred to a psychiatrist and a neurologist. A review of the literature was done so that an accurate diagnosis could be made, thereby enabling the development of an appropriate treatment plan. Making an effective diagnosis was a challenge because of the similarity of the symptoms of MRH with other psychiatric disorders. As additional clinical features were identified and treatments were ruled ineffective, further diagnoses were proposed. The patient's symptoms ceased with oral contraceptive treatment. Hormones play a role in the menstrual cycle and frequently affect behavior (such as sleep patterns). This case underlines the importance of multidisciplinary evaluation and treatment in unusual cases. The potential role of hormone fluctuation in patients with psychiatric conditions should be considered when diagnosing and treating those who are unresponsive to traditional pharmacological treatments.

Effectiveness of the Engagement and Counseling for Latinos (ECLA) intervention in low-income Latinos.

BACKGROUND: Persistent disparities in access and quality of mental health care for Latinos indicate a need for evidence-based, culturally adapted, and outside-the-clinic-walls treatments. OBJECTIVE: Evaluate treatment effectiveness of telephone (ECLA-T) or face-to-face (ECLA-F) delivery of a 6-8 session cognitive behavioral therapy and care management intervention for low-income Latinos, as compared to usual care for depression. DESIGN: Multisite randomized controlled trial. SETTING: Eight community health clinics in Boston, Massachusetts and San Juan, Puerto Rico. PARTICIPANTS: 257 Latino patients recruited from primary care between May 2011 and September 2012. MAIN OUTCOME MEASURES: The primary outcome was severity of depression, assessed with the Patient Health Questionnaire-9 and the Hopkins Symptom Checklist-20. The secondary outcome was functioning over the previous 30 days, measured using the World Health Organization Disability Assessment Schedule (WHO-DAS 2.0). RESULTS: Both telephone and face-to-face versions of the Engagement and Counseling for Latinos (ECLA) were more effective than usual care. The effect sizes of both intervention conditions on Patient Health Questionnaire-9 were moderate when combined data from both sites are analyzed (0.56 and 0.64 for face-to-face and telephone, respectively). Similarly, effect sizes of ECLA-F and ECLA-T on the Hopkins Symptom Checklist were quite large in the Boston site (0.64 and 0.73. respectively) but not in Puerto Rico (0.10 and 0.03). CONCLUSIONS AND RELEVANCE: The intervention appears to help Latino patients reduce depressive symptoms and improve functioning. Of particular importance is the higher treatment initiation for the telephone versus face-to-face intervention (89.7% vs. 78.8%), which suggests that telephone-based care may improve access and quality of care.

Risk of serotonin syndrome with complementary and alternative medicines: importance to child and adolescent psychiatry.

OBJECTIVES: Evaluate how child and adolescent psychiatrists rate themselves regarding their knowledge and clinical skills in assessing interactions between non-prescribed complementary and alternative medicines (CAM) and prescribed medications. METHODOLOGY: A brief questionnaire about the practice of asking patients about CAM use was given to child and adolescent psychiatrists. RESULTS: The questionnaire was completed by 20 child and adolescent psychiatrists. Only 35% of the sample stated that they always asked about CAM use although 55% stated that they aware of the importance of prescribed drug interactions with CAM. Of the sample, 90% stated that they could recognize serotonin syndrome, but only 65% answered correctly to the description of the syndrome. Given a list of possible CAM that could interact with prescribed drugs to produce serotonin syndrome, only 10% identified all the drugs correctly. CONCLUSION: CAM training should be included in training programs and in continued education curriculums for practicing child psychiatrists.

Depressive symptoms and risk factors among perimenopausal women.

BACKGROUND: Several studies indicate that approximately 4.6% of the Puerto Rican Population has been affected by depression at some time in their life. Perimenopausal women have been one of the most frequently mentioned population in scientific literature prone to develop depression. Sociodemographic factors along with medical history have been hypothesized to be associated with the development of depression. This study has the purpose to know the prevalence of depressive symptoms in a sample of women age 40 to 55 years attending a gynecological outpatient clinic in the Medical Sciences Campus of the University of Puerto Rico. We also want to identify sociodemographic risk factors that can predispose these women to develop depressive symptoms. METHOD: A cross sectional study was done during the months of June 2000 thru December 2000. Female subjects age 40 to 55 selected by availability. The Zung Self-Rating Depression Scale (1995 Spanish Version) and a questionnaire were administered to each subject. Results. The overall prevalence of depressive symptoms in this sample of 64 women was 39.1%. Among the variables considered as possible associated risk factors for the development of depressive symptoms, educational level, prior visit to a mental health professional or a spiritual guide, and prior diagnosis of depression and antidepressant use were of statistical significance. DISCUSSION: A high prevalence of depressive symptoms was found in this sample. As reported in other studies, higher educational level is a protective factor against depression. Contrary of other studies, no association is found between depression and other sociodemographic and medial factors.