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QUESTIONS OF THE WEEK BETWEEN
APRIL, 2006 and JUNE, 2006 |
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une 26, 2006
Q "What
is the current thinking about diabetes and depression...especially among
children?."
A
Please review the following: "Depressive symptoms are common among children and
adolescents with type 1 diabetes...evidence of depressive symptoms in 15% of the
young diabetics in their study.
The Children's Depression Inventory, a 27-item self-report questionnaire, was
used to assess depressive symptoms - with a score of 13 or higher indicating
elevated depressive symptoms. Parents of the children also completed the
Children's Depression Inventory, with regard to their children. A parent score
of 17 or higher indicated elevated depressive symptoms in the youth.
The investigators also used the Diabetes Family Conflict Scale to examine
diabetes-specific family conflict across 19 diabetes management tasks, and the
Diabetes Family Responsibility Questionnaire was used to evaluate family
responsibility for diabetes tasks.
15.2% of the young diabetic had symptoms of depression. Higher levels of
patient-reported rates of diabetes-specific family conflict (p = 0.001);
youth-reported negative affect (p = 0.03); and parent-reported diabetes-specific
burden (p = 0.03) were significant predictors of higher scores on the Children's
Depression Inventory.
There was also significant correlation between parent and youth reports of
youth-depressive symptoms. Overall, 83% of parent-youth pairs agreed about
whether depressive symptoms were present or not."
Diabetes Care 2006;29:1389-1391..
June 19, 2006
Q "I
heard that premature babies may have behavioral problems later. Is there any
truth to that?."
A
You may wish to seek out the original article that,
in part, says: "At 3 years of age, children born very prematurely are at
increased risk for behavioral problems compared with their term counterparts and
sociodemographic factors appear to influence the risk of such problems in very
preterm infants.
The current findings "should encourage the early detection of behavioral
difficulties to reduce their consequences on the well-being and social
adaptation of the children. Major neonatal cerebral lesions detected by
ultrasound, hospitalization within the last year, poor health, and psychomotor
delay were all risk factors for behavioral problems among very preterm children.
Likewise, a high birth order, young maternal age, and low maternal education
also predicted such problems. Very preterm birth was significantly associated
with overall behavioral difficulty, hyperactivity, conduct problems, and peer
problems. In addition, a near-significant association with emotional symptoms
was seen. It is important to know whether children born very prematurely are at
risk of behavioral problems early in life to deal with and prevent the effects
of these problems at school age," the researchers conclude."
Pediatrics
2006;117:1996-2005.
June 12, 2006
Q "Can
hypnosis or biofeedback help with irritable bowel syndrome."
A
"Symptom severity and quality of life improve substantially with nurse-directed
gut-directed hypnotherapy for patients with irritable bowel syndrome (IBS).
Patients recorded IBS symptoms for 7 days prior to intervention. Abdominal pain
was reported in 61%, altered bowel habits in 37.5% and abdominal distention or
bloating in 6.5%.
There was a statistically significant improvement in severity of symptoms after
nurse-led gut-directed hypnotherapy. Significant improvements were reported for
six of the eight items on the quality of life questionnaire, including emotional
status, mental health, sleep, physical function, energy and social interaction.
...response to hypnotherapy was greatest in the women who reported the highest
scores on abdominal pain and distention at enrollment.
"it could also be argued that nursing support itself might contribute to a
reduction in anxiety in this patient group...Clearly, further controlled
clinical trials are needed in this field, despite the ethical and practical
difficulties this would imply."
J Clin Nursing 2006;15:678-684.
June 5, 2006
Q "What
about eating disorders in pregnant women...that can't be good."
A "The risk
of postpartum depression is higher among women with binge eating disorder or
bulimia nervosa. Symptoms of depression during pregnancy, "baby blues," and
postpartum depression were higher among women with eating disorders.
Specifically bulimia nervosa and binge-eating disorder were strongly associated
with postpartum depression.
In fact, "women with eating disorders appear to be at as much, if not greater,
risk for developing depression during pregnancy or postpartum as are women with
a history of major depressive disorder."
After correcting for lifetime major depression, postpartum depression scores
correlated with concern over mistakes and doubts about one's abilities.
Among individuals who reported symptoms of postpartum depression...the severity
of these symptoms may be accounted for by specific aspects of perfectionism,
primarily concern over making mistakes.
Physicians to ask pregnant patients about their histories of eating disorders
and assess the features of perfectionism, since these traits help "to identify
at-risk individuals, and facilitate primary prevention of postpartum depression.
Given the significant impact that postpartum depression can have on the health
of both mothers and their offspring, as well as the effectiveness of treatment,
early detection and treatment appear invaluable."
Int J Eat Disord 2006;39:202-211.
May 29, 2006
Q
"Medication has not helped my irritable bowel syndrome. Are there techniques
other than medicine that might help me?"
A
"Four sessions of cognitive behavioral therapy, combined with a take-home
workbook, result in a greater than 70% improvement in symptoms of irritable
bowel syndrome (IBS) compared with patients relegated to a waiting list...59
patients with IBS to one of three treatment arms. Patients in one arm received
ten sessions of standard cognitive behavioral therapy. Patients in a second arm
received four sessions of minimal contact cognitive therapy and were given a
self-help workbook to take home. Patients in a third arm were placed on a
waiting list. The team conducted follow-up visits to evaluate symptoms at four
and ten weeks.
Patients were taught how to manage fear, worry and anxiety, stressors which
aggravate symptoms. At the end of the study period, IBS symptoms had improved
approximately 73% in patients who received cognitive therapy, while patients
wait-listed had no improvement. Pain relief was also reported in approximately
73% in both cognitive therapy arms compared with 11.8% of wait-listed patients.
Gastrointestinal symptoms improved by 63.6% and 68.4% in those on the four-week
and ten-week sessions, respectively.
Patients who received minimal contact cognitive therapy reported significant
improvements in quality of life, and unlike those who received ten weeks of
therapy. Those who received the ten-week course have merely maintained their
gains.
Minimal contact cognitive therapy was two-and-a-half times as efficient as the
ten-week standard course, with a 60% lower demand on therapists. Short-course
therapy was about five times as efficient in a cost-effectiveness analysis."
May 22, 2006
Q
"I heard on the news that Botox cures depression. Is that true?"
A
This is the study to which you are likely referring. There are many
questions as to whether Botox or the person's concept of their cosmetic
appearance influenced the depression, but for now, you be the judge: "Botulinum
toxin A injections can treat major depression, according to the results of a
small case series reported in the May issue of Dermatologic Surgery.
"Major depression is a common and serious disease that may be resistant to
routine pharmacologic and psychotherapeutic treatment approaches. There is a
body of evidence that suggests that the facial expression of emotion may play a
causal role in the subjective experience of emotion....small open pilot trial to
determine whether inhibiting the expression of facial frowning commonly
associated with depression could help ameliorate depressive symptoms."
A total of 10 patients who met Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, criteria for ongoing major depression refractory to
pharmacologic or psychotherapeutic treatment were evaluated with the Beck
Depression Inventory II (BDI-II) before receiving botulinum toxin A to their
glabellar frown lines.
Two months later, all patients were reevaluated clinically and with the BDI-II.
Nine of 10 patients were no longer depressed, and the 10th patient had an
improvement in mood.
...the report must be considered anecdotal because there were no appropriate
controls. Other methodological weaknesses including limited follow-up, lack of
randomization, the absence of blind evaluation, the small number of individuals
studied, and self-report of depressive symptoms with potential for secondary
gain."
Dermatologic Surg. 2006;32:645-650.
May 15, 2006
Q "Whatever
happened to old Type A personality and heart disease. Anything new?"
A "People
with coronary heart disease and a type D personality -- that is, a propensity to
experience negative feelings -- are at considerably elevated risk of cardiac
events.
Type D personality was associated with a 3-fold increased risk of new cardiac
events -- death, myocardial infarction or invasive treatment -- in cardiac
patients, and this association could not be explained away by temporary changes
in psychological stress levels."
Type-D, is characterized not only by chronic negative emotions but also by the
tendency to inhibit self-expression while avoiding possible negative reactions
from others. Type-D patients perceive many types of social interaction as
stressful and tend to hide their true feelings; this may result in the
under-reporting of stress-related health problems."
Compared to non-type D personality, type D personality conferred an odds ratio
of 4.84 for death or infarction, independently of disease severity.
Independent predictors of major adverse cardiac events were a left ventricular
ejection fraction of 40% or less, no treatment with coronary artery bypass
grafting and type D personality whereas psychological stress was marginally
significant (odds ratio, 2.01; p = 0.054).
We need to look beyond acute factors such as stress and to include more chronic
factors such as type D to develop successful intervention strategies for
high-risk patients."
Am J Cardiol 2006;97:970-973.
May 8, 2006
Q "Our
little boy has headaches. We think that this is severely complicating his
development. His pediatrician thinks that it is no big deal."
A
"Frequent or severe headaches in childhood are
associated with notable pain, mental health issues, and functional limitations.
Headaches are common among children and adolescents, particularly migraine and
tension-type headaches. They contribute to missed school days, affect children's
peer and family relationships, and significantly impact children's quality of
life, often times into adulthood.
Approximately 6.7% of the children experienced frequent or severe headaches
during the previous 12 months. Children with frequent or severe headaches tended
to be older, white non-Hispanic, and living in or near poverty. Compared to
children without frequent or severe headaches, those with headaches were 3.2
times more likely to have a high level of difficulties.
Those with headaches were more likely to have a high level of emotional
symptoms, conduct problems, hyperactivity-inattention ,and peer problems.
High levels of impairments were 2.7 times more likely in children with frequent
or severe headaches, which suggested potential mental health issues. Children
with frequent or severe headaches were significantly more likely than children
without frequent or severe headaches to be upset or distressed by their
difficulties and to have these difficulties interfere with home life,
friendships, classroom learning, and leisure activities a medium amount or a
great deal.
Overall, 82.2% of children with frequent or severe headaches and 77.6% of those
without frequent or severe headaches had visited a general doctor during the
previous 12 months. Children with frequent or severe headaches were also
significantly more likely to have visited a mental health professional or a
general doctor in the previous year for an emotional or behavioral problem."
Pediatrics 2006;117:1729-1734.
May 1, 2006
Q
"Is it common for people to be depressed after a heart attack?"
A
"Compared with other age and gender groups, women no
older than 60 years of age are at increased risk for depressive symptoms after
acute MI.
In the community setting, depression is known to be especially prevalent among
younger women, and that depressive symptoms often arise after MI. However, it
was unclear if younger women hospitalized for acute MI were increased risk for
depressive symptoms.
Depression, which was assessed during hospitalization, was defined as a score of
at least 10 on the Primary Care Evaluation of Mental Disorders Brief Patient
Health Questionnaire (PHQ).
The average PHQ score for patients 60 years of age or younger was 6.4,
significantly higher than the 5.0 score seen in older patients (p < 0.001).
Also, women had a mean score of 6.8, while men had a score of 5.2 (p < 0.001).
Thus, the highest average PHQ score, 8.2, was seen in younger women.
Forty percent of younger women had depression, the report indicates. The rate in
younger men, 22%, was just slightly higher than the rate in older women, 21%.
Older men had the lowest prevalence of depression, 15%.
Compared with older men, younger women were 3.1-times more likely to have
depression, the results of multivariate analysis showed.
"lthough the reasons for these differences need further study, based on our
results, clinicians should be aware that younger women have a high
susceptibility for being depressed after acute MI. Depression screening should
be particularly aggressive in younger female patients with acute MI."
Arch Intern Med 2006;166:876-883.
April 10, 2006
Q
"Women get depressed after having babies...do they then get depressed at
menopausee?"
A
You might find this helpful: "Women with no history
of depression are at increased risk of developing depressive symptoms when they
enter perimenopause...
The transition
to menopause is often considered a high-risk period for depressive symptoms, yet
scientific evidence supporting this association is lacking.
In an 8-year,
longitudinal study... risk factors (were examined) for depressed mood in 231
women who were about to enter menopause. All of the women had no history of
depression at enrollment. The Center for Epidemiological Studies of Depression (CED-D)
scale was used to assess depressive symptoms during follow-up.
The risk of a high CES-D score (at least 16) was 4.29-fold greater during the
menopausal transition than during the premenopausal phase, the report indicates
(p < 0.001). Similarly, the menopausal transition was tied to a 2.5-fold
increased risk of being diagnosed with a depressive disorder (p = 0.01).
After adjusting for smoking, BMI, health status, and other factors, increased
levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), as
well as increased variability of estradiol were significantly associated with a
high CES-D score.
In a similar longitudinal study...menopausal group was twice as likely to
experience significant depressive symptoms than was the premenopausal group. A
slightly higher risk was noted in menopausal women who reported vasomotor
symptoms.
Despite the fact that most women do not develop depression during the menopausal
transition, the current study suggests that, relative to women who remain
premenopausal, similarly aged women who begin the transition to menopause appear
to be at an increased risk for first onset of depression ven in the absence of a
history of depression."
Arch Gen Psychiatry 2006;63:375-382,385-390.
April 3, 2006
Q
"I am confused. Is asthma a stress-related disease or not?"
A
It is a respiratory disease, but stress has an important role. Please read this:
"It is known that stress exacerbates the symptoms of asthma in children, but the
mechanism underlying this phenomenon has been unknown. Now, researchers in
Canada have discovered that stressful experiences diminish the gene expression
of receptors that regulate airway responsiveness and inflammation. In general,
children with asthma expressed higher levels of beta-2-adrenergic receptor and
glucocorticoid receptor mRNA than did healthy children. However, the researchers
found that asthmatic children exposed to chronic stress, such as abrasive family
relationships or an unstable home environment, expressed less beta-2-adrenergic
receptor mRNA than those not exposed to chronic stress, whereas healthy children
expressed more.
Major life events alone did not affect mRNA expression in either group of
children. But in children with asthma who experienced a major life event in the
previous 3 months along with chronic stress, the expression of beta-2-adrenergic
receptor mRNA decreased 9.5-fold and expression of glucocorticoid receptor mRNA
decreased 5.5-fold. In healthy children, this pattern was reversed and was
weaker. This decrease in receptor mRNA could also diminish patients' sensitivity
to beta-agonist and glucocorticoid medications.
Collectively, these findings suggest that in children and adolescents with
asthma, the quality of home life and family relationships are important
determinants of health and well-being and appear to have stronger effects than
other life domains, such as academics and peer relationships."
Proc Natl Acad Sci USA 2006;103:5496-5501.
Past
Questions of the Week are available through the
educational resources
of the website. If you would like to submit your own question for consideration
as a public Question of the Week, please contact the practice.
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