Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction / Diferenças por Sexo na Ansiedade e Depressão após Infarto Agudo do Miocárdio

Abstract Background: Among patients with heart disease, depression and anxiety disorders are highly prevalent and persistent. Both depression and anxiety play a significant role in cardiovascular disease progression and are acknowledged to be independent risk factors. However, there is very little gender-related analysis concerning cardiovascular diseases and emotional disorders. Objective: We aimed to evaluate depression and anxiety levels in patients suffering from myocardial infarction [MI] within the first month after the MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender-based differences or similarities. Methods: This survey included demographic questions, clinical characteristics, questions about cardiovascular disease risk factors and the use of the Hospital Anxiety and Depression Scale [HADS]. All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Results: It was determined that 71.4% of female and 60.4% of male patients had concomitant anxiety and/or depression symptomatology (p = 0.006). Using men as the reference point, women had an elevated risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531, p = 0.004). It was determined that male patients who developed depression were on average younger than those without depression (p = 0.005). Conclusions: Women demonstrated an elevated risk of having anxiety and/or depression disorder compared to men. Furthermore, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity was similar for women of all ages after the MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, and a higher depression score was associated with physical inactivity in women.

Resumo Fundamento: Os pacientes com doença cardíaca, depressão e transtornos de ansiedade são altamente prevalentes e persistentes. A depressão e a ansiedade desempenham um papel significativo na progressão da doença cardiovascular e são reconhecidas como fatores de risco independentes. No entanto, há muito pouca análise relacionada ao gênero em relação às doenças cardiovasculares e transtornos emocionais. Objetivo: Avaliar os níveis de depressão e ansiedade em pacientes com infarto do miocárdio (IM) no primeiro mês após o IM e avaliar a relação entre os fatores de risco para doença cardiovascular, indicadores demográficos e distúrbios emocionais, bem como determinar se existem diferenças ou semelhanças baseadas no sexo do paciente. Métodos: Esta pesquisa incluiu questões demográficas, características clínicas, questões sobre fatores de risco de doença cardiovascular e a Escala Hospitalar de Ansiedade e Depressão [HADS]. Todos os testes estatísticos foram bilaterais, e valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Determinou-se que 71,4% dos pacientes do sexo feminino e 60,4% dos pacientes do sexo masculino apresentavam sintomatologia concomitante de ansiedade e/ou depressão (p = 0,006). Utilizando os homens como o ponto de referência, as mulheres mostraram um risco elevado de apresentar qualquer distúrbio psiquiátrico (odds ratio, 2,86, p = 0,007). O escore da HADS-D foi notavelmente maior nas mulheres (8,66 ± 3,717) do que nos homens (6,87 ± 4,531, p = 0,004). Foi determinado que os pacientes do sexo masculino que desenvolveram depressão eram em média mais jovens do que aqueles sem depressão (p = 0,005). Conclusões: As mulheres demonstraram risco mais elevado de apresentar distúrbio de ansiedade e/ou depressão em comparação aos homens. Além disso, a gravidade da depressão aumentou com a idade entre os homens, enquanto o gravidade da ansiedade diminuiu. Em contraste, a gravidade da depressão e ansiedade foram semelhantes para mulheres de todas as idades após o IM. Um maior escore de depressão foi associado com diabetes e inatividade física, e o maior escore de ansiedade foi associado ao tabagismo nos homens. A hipercolesterolemia foi associada tanto aos maiores escores de ansiedade e depressão, enquanto um maior escore de depressão foi associado à inatividade física entre mulheres.

Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction.

BACKGROUND: Among patients with heart disease, depression and anxiety disorders are highly prevalent and persistent. Both depression and anxiety play a significant role in cardiovascular disease progression and are acknowledged to be independent risk factors. However, there is very little gender-related analysis concerning cardiovascular diseases and emotional disorders. OBJECTIVE: We aimed to evaluate depression and anxiety levels in patients suffering from myocardial infarction [MI] within the first month after the MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender-based differences or similarities. METHODS: This survey included demographic questions, clinical characteristics, questions about cardiovascular disease risk factors and the use of the Hospital Anxiety and Depression Scale [HADS]. All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. RESULTS: It was determined that 71.4% of female and 60.4% of male patients had concomitant anxiety and/or depression symptomatology (p = 0.006). Using men as the reference point, women had an elevated risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531, p = 0.004). It was determined that male patients who developed depression were on average younger than those without depression (p = 0.005). CONCLUSIONS: Women demonstrated an elevated risk of having anxiety and/or depression disorder compared to men. Furthermore, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity was similar for women of all ages after the MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, and a higher depression score was associated with physical inactivity in women.

ADHD - the scourge of the 21st century? / ADHD ­ plaga XXI wieku?

Currently, attention deficit hyperactivity disorder (ADHD) is intensively studied by world medical community, its understanding expands, for example, it has now been diagnosed not only in children but also in adults. On the other hand, ADHD raises a number of discussions on the need of its treatment and, if there is a need, how it shall be treated, it is doubtful whether this disorder overall exists, because its "morphological component" has not been identified so far, and all the symptoms of ADHD, including anxiety, concentration difficulties, motor hyperactivity, cognitive disorders or social disadaptation, can be found in a number of mental disorders and somatic diseases. Modern attention, emotional and behavioral changes can be considered as a result of changing human social portrait. Those who question ADHD existence argue that this disorder is likely temperament and parenting matter, rather than the illness, and that the diagnosis and treatment of this illness can be a matter invented by doctors and pharmacists, the aim of which is to tame individuals disregarding public standards of conduct and get the maximum profit from medicines in the treatment of this illness. Due to the fact that ADHD is diagnosed more often, it is even called the twenty-first-century scourge. In this article we will review the historical aspect of formation of ADHD diagnosis, illness etiology, comorbidity with other mental and somatic diseases as well as treatment necessity and opportunities, paying attention to adult ADHD as well.

Patient satisfaction with primary healthcare services: are there any links with patients' symptoms of anxiety and depression?

BACKGROUND: The aim of our study was to determine the association of anxiety and depression symptoms, as well as the main socio-demographic factors, with patients' satisfaction with primary healthcare services. METHODS: The respondents were asked to fill out an anonymous questionnaire that included information on the patients' gender, age, place of residence, education, ethnicity, the type of clinic they visited and the presence of chronic diseases. Patient satisfaction was evaluated by using a short version of the Patient Satisfaction Questionnaire. We also used the Hospital Anxiety and Depression Scale. RESULTS: Poor evaluations of primary healthcare services were more characteristic of males, older patients, those living in district centres and villages, individuals with lower (secondary or lower) education levels, respondents of Russian ethnicity (compared to Lithuanian), patients with chronic diseases and higher anxiety and depression symptom scores. In the final regression analysis, better satisfaction with primary healthcare services was observed in respondents who were less depressed, of Polish ethnicity and who were living in a city rather than a village. CONCLUSIONS: Being more depressed or anxious, living in the district centre or countryside related to patients' worse satisfaction with primary healthcare services. The results of nationality of patients and their satisfaction are ambiguous. The is strong correlation between the symptoms of depression and anxiety.

[Parameters of ante-mortem delirium]. / Parametry przedsmiertnego majaczenia.

OBJECTIVES: The aim of this study was to investigate the parameters of ante-mortem delirium of the patients in a closed psychiatric institution and to compare them with the ante-mortem psychopathology of the medical patients. METHODS: There were 139 medical records of the patients analyzed, who died during the period of 1997-2003 at the in-patient psychiatric institution. The diagnoses were recorded according to the International Classification of Diseases, 10th Revision (ICD-10) criteria. Patients' data included age, gender, previous psychiatric disorders, current somatic and psychiatric morbidity, and comorbidity. RESULTS: The incidence of delirium was 83.7%. The delirium group included more elder, male persons who were more likely to have dementia and less inclined to depression. Surprisingly the incidence of delirium among non-dementia men was quite high--76.9%, as compared to non-dementia women--23.1% (P = 0.008). The duration of delirium differed from 1 to 1335 days. Longer delirium was observed among elder than 75 years (87.7, SD 183.9 vs 52.6, SD 121.4 days; P = 0.019) and dementia (8.6, SD 173.6 vs 13.5, SD 11.6 days; P < 0.001) patients, but did not differ in gender groups. CONCLUSIONS: Ante-mortem delirium occurred more commonly in more elder and demented patients The duration of ante-mortem delirium was shorter in younger and non-dementia patients. Patients of the psychiatric institution tend to have longer deliriums than medical patients. The patients with depression and the history of alcohol abuse were not likely to get ante-mortem delirium. Before death in many persons hyperactive and mixed delirium transformed into hypoactive.

Delirium: its historical evolution and current interpretation.

Delirium was one of the first mental disorders ever to be described, though it remains an elusive concept to this day. Historically, delirium has developed from the prototype of acute confusion with psychomotor agitation. It was thought to be caused by the withdrawal of substance dependence or severe somatic diseases accompanying by fever; however only in the 20th century, it was concluded that delirium and similar states manifest themselves as a consciousness disorder, and is not a specific state of somatic diseases. Four core features defines delirium at present: a disturbance of consciousness, a disturbance of cognition, limited course and external causation. However, these features do not include common manifestations of delirium in elderly patients with dementia; therefore the concept of delirium should be revised and corrected.