Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis.

BACKGROUND: Our aim was to assess differences in anxiety and depression between women with and without (controls) polycystic ovary syndrome (PCOS). METHODS: We conducted a systematic review and meta-analysis of published literature comparing women with PCOS to control groups on anxiety and depression. Electronic databases were searched up to 17 December 2010. The inverse variance method based, as appropriate, on a random- or fixed-effects model in Review Manager, Version 5 was used to analyse the data. RESULTS: Twelve comparative studies were included; all studies assessed depression (910 women with PCOS and 1347 controls) and six also assessed anxiety (208 women with PCOS and 169 controls). Analysis revealed higher depression (Z = 17.92, P < 0.00001; Hedges' g = 0.82; 95% CI 0.73-0.92) and anxiety (Z = 5.03, P < 0.00001; Hedges' g = 0.54; 95% CI 0.33-0.75) scores in the participants with, than without, PCOS. Studies controlling for BMI showed a smaller difference between women with PCOS and controls on anxiety and depression scores than studies not controlling for BMI. CONCLUSIONS: Women with PCOS on average tend to experience mildly elevated anxiety and depression, significantly more than women without PCOS. Women with PCOS with lower BMI tended to have slightly lower anxiety and depression scores, suggesting that having a lower BMI reduces anxiety and depression. Future studies might consider (i) controlling for BMI, (ii) stratifying by medication use in order to control for any anti-androgenic effects of medication and (iii) excluding women with polycystic ovaries from control groups.

Investigation of the cause of miscarriage and its influence on women's psychological distress.

OBJECTIVE: To determine whether knowledge of the possible cause of miscarriage reduces women's long term psychological distress. DESIGN: Prospective longitudinal study. SETTING: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London. METHODS: In 143 women where a routine ultrasound scan at 10-14 weeks of gestation showed an anembryonic pregnancy or fetal death, investigations were carried out to help ascertain the cause of the pregnancy loss. The participants were divided into two groups according to whether the cause was identified or not, and the psychological conditions of the two groups were compared at four weeks and four months after the diagnosis of fetal loss. MAIN OUTCOME MEASURES: Anxiety, depression, grief, self-blame, worry. RESULTS: The scores for all outcome variables were significantly lower at the four-month compared with the four-week post-miscarriage assessment. A fetal chromosomal abnormality was the most commonly identified cause of miscarriage, and this group reported significantly less self-blame than women in whom no cause was identified. There were no significant differences between the groups on any other outcome variables. CONCLUSIONS: In women with a missed miscarriage, identification of the cause of fetal loss reduces the feelings of self-blame.

Personal coping resources, responsibility, anxiety and depression after early pregnancy loss.

This cross-sectional study aimed at assessing the relationship of feeling of personal responsibility for miscarriage and personal coping resources (self-esteem and self-efficacy), with symptoms of anxiety and depression in 138 women at 19 to 400 days following the diagnosis of a missed abortion. Multiple regression analyses controlling for demographic and obstetric variables demonstrated that higher feelings of personal responsibility, and lower personal resources were significantly associated with anxiety and depression. Self-esteem had the most salient effect on women's level of affective psychopathology; higher levels of self-esteem were associated with lower anxiety and depression. Women with high levels of self-esteem also reported significantly lower feelings of personal responsibility for miscarriage than those with low levels of self-esteem. Interventions aimed at enhancing feelings of self-worth, and at altering exaggerated feelings of personal responsibility for miscarriage, could lessen the potential negative emotional impact of pregnancy loss on women.

Explained and unexplained medical symptoms in generalized anxiety and panic disorder: relationship to the somatoform disorders.

We have examined the numbers and types of symptoms in a sample of 90 patients with generalized anxiety disorder (GAD) and 77 patients with panic disorder (PD) collected from six different sites during the conduct of a multicenter clinical trial. This information was obtained utilizing the Health Questionnaire, a 47-item self-report list of medical symptoms, patterned after the Somatization Disorder section of the Diagnostic Interview Schedule. Although the patients in this sample had a wide variety of medically explained and unexplained physical symptoms, none of them qualified for a diagnosis of somatization disorder by DSM-III-R criteria. GAD and PD patients reported remarkably similar numbers of explained and unexplained medical symptoms. The panoply of somatic symptoms presented by these patients presents a formidable diagnostic challenge for clinicians. These findings suggest that the pattern of overutilization of medical services that is well documented for PD patients may also be found for GAD patients.

Serum cholesterol levels in patients with generalized anxiety disorder (GAD) and with GAD and comorbid major depression.

OBJECTIVE: To investigate risk for cardiovascular disease in patients with GAD, as well as the effects of comorbid major depression (MD). METHOD: Predrug-trial serum cholesterol and triglyceride levels were assessed in 38 patients with pure GAD and compared with those of 21 patients with mixed GAD and comorbid (MD). RESULTS: Significantly higher cholesterol and triglyceride levels were found in the GAD group. CONCLUSION: Increased noradrenergic activity may be responsible for elevations in lipid levels in patients with pure GAD.

The relationship between mood, somatization, and alexithymia in premenstrual syndrome.

To examine the relationship between mood, somatization, and alexithymia in premenstrual syndrome (PMS), 66 women with a prospectively confirmed diagnosis of PMS were compared with a group of 49 non-PMS control women on a battery of self-administered tests measuring depression, anxiety, somatization, and alexithymia. Based on their scores on the Beck Depression Inventory, the PMS patients were subdivided into a high-depression and low-depression group and compared with the non-PMS control group on all test measures. Significantly greater somatization and alexithymia were reported in the high-depression PMS group, and no differences were found on any of the test measures between the low-depression PMS and non-PMS control groups.

Coping styles in women with premenstrual syndrome.

Sixty-five women with a prospectively confirmed diagnosis of premenstrual syndrome (PMS) were subdivided on the basis of their scores on the Beck Depression Inventory (BDI) into high-depression and low-depression groups and compared with 49 non-PMS control women on self-administered measures of coping and anxiety. The high-depression PMS group was found to utilize significantly more avoidant coping styles in dealing with stressors independent of the premenstrual phase. Implications for treatment are discussed.

Perception of family and work environments in women with premenstrual syndrome.

Seventy-three women with a prospectively confirmed diagnosis of Premenstrual Syndrome (PMS) were compared to 50 routine gynaecological care non-PMS controls on measures of social climate/environmental stress. Tests administered included the Family Environment Scale (FES), Work Environment Scale (WES), Spielberger State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). The PMS group scored significantly higher on amount of conflict in their families as well as on emphasis on ethical and religious values but lower on direct emotional expressiveness within the family, intellectual-cultural orientation, and active-recreational orientation as compared to controls. Furthermore, the PMS group perceived having more work pressure, less autonomy on the job, and less variety in their work than controls. Overall, psychological distress was not associated with increased environmental stress either in the PMS or control groups.

Multi-component behavioral treatment of premenstrual syndrome: a case report.

A 36-year-old female was treated for severe Premenstrual Syndrome (PMS) utilizing a multi-component behavioral approach which included relaxation training, stress inoculation, assertiveness training, marital therapy, and prescribed exercise. Following nine weeks of therapy the patient reported significantly less premenstrual distress and a decrease in sick leave each month. Treatment gains were maintained at both three and nine month follow-up.

Evaluation and management of premenstrual syndrome in clinical psychiatric practice.

Premenstrual syndrome, a long-recognized entity, has been the subject of increased interest in recent years. Many women, perhaps a majority, experience some premenstrual symptoms; a minority have severe symptoms. The authors explore possible links to psychiatric disorders, outline general evaluation and management approaches, and discuss specific implications for the treatment of psychiatric patients who have a menstrually related component to their symptoms. It is hoped that a continuing understanding of this complex area may further our conceptualization and treatment of both premenstrual symptoms and psychiatric disorders.

Repeated suicide attempts by the intravenous injection of elemental mercury.

The case of a patient who repeatedly injected himself intravenously with elementary mercury in suicide attempts is presented and the toxicological effects of this chemical form and route of exposure of mercury are examined. A review of the literature reveals that elemental mercury, when injected as opposed to inhaled, causes few of the effects typical of mercurialism; pleuritic chest pain was frequently reported, whereas renal and central nervous system involvement were less common. Evidence of premorbid psychiatric disturbances was found in ten of fourteen non-cardiac catheterization exposures to intravenous elemental mercury. Findings in our patient were consistent with these observations. One additional and noteworthy finding in our case was that documented deposits of elemental mercury in the right parietal lobe of the brain did not correlate with any specific deficits on neuropsychological testing. Consultation-liaison psychiatry plays an important role in the treatment and care of these complex patients.

Pain responsivity in women with premenstrual syndrome across the menstrual cycle.

11 women with a clinical diagnosis of Premenstrual Syndrome (PMS) and 10 control women with no such diagnosis were compared on pain threshold and pain-tolerance measures in the intermenstrual and premenstrual phases of their menstrual cycles. No significant differences were found between the groups for behavioral measures of pain sensitivity. Ratings of pain intensity, however, were higher in both phases for the PMS group.

Autonomic arousal and pain sensitivity in women with premenstrual syndrome at different phases of the menstrual cycle.

Eleven women with a clinical diagnosis of premenstrual syndrome (PMS) and ten non-PMS control women were compared on physiological measures in the intermenstrual and premenstrual phases of their menstrual cycle. Heart rate (HR) and skin conductance level (SCL) were monitored during baseline conditions and in response to a stressful laboratory procedure. Analyses for HR revealed a three-way interaction (groups X phase X tests) which approached significance indicating that the PMS group was generally lower during the intermenstrual testing but was higher in the premenstrual phase. No significant differences were observed on behavioral measures (pain threshold, pain tolerance) between the groups. Pain intensity ratings were found to be overall higher in the PMS group irrespective of menstrual cycle phase. The role of cognitive-perceptual processes is discussed in the context of the acquisition and maintenance of PMS symptomatology.

Effects of familial pain models on pain complaints and coping strategies.

Recent evidence has underscored the effect of the number of parental pain models in an individual's environment on the frequency of current complaints about pain, yet little is known about the effect of number of familial pain models on other aspects of a person's pain behavior and on coping with pain. The present study assessed the effect of pain models by giving a questionnaire to 224 college students. Analysis showed that the number of familial pain models was related to the perception of pertinent secondary gains but not to the methods used to cope with pain.

An investigation of the aetiology of chronic headache. The role of headache models.

Headache sufferers (n = 30) reported significantly more immediate family members with headache, compared to controls (n = 22). Sensitivity, specificity, and efficiency analyses revealed that knowledge of family headache history has predictive value. The results are consistent with findings with other pain disorders.

Assessment and treatment of stress in myofascial pain-dysfunction syndrome: a model for analysis.

Myofascial pain dysfunction (MPD) syndrome has received widespread attention in the dental and psychological literature. The present paper considers issues concerning a stress-related muscular hyperactivity theory of MPD syndrome. A review of the empirical evidence as well as methodological problems evident in these studies has been noted. In addition, definition aspects of stress and a conceptual model of stress in clinical use is presented. A functional analysis of the problem components will help determine a proper treatment protocol for patients suffering from stress-related myofascial pain. A discussion of the conceptual model for assessment and treatment purposes is presented and its implications for future research noted.