Hedonic and Behavioral Deficits Associated With Apathy in Parkinson’s Disease: Potential Treatment Implications.

Hedonic and behavioral deficits associated with apathy in Parkinson’s disease: Potential treatment implications.

Mov Disord. 2013 May 27;
Jordan LL, Zahodne LB, Okun MS, Bowers D

BACKGROUND: Many individuals with Parkinson’s disease (PD) experience apathy independent of depression. METHODS: In this study, we examined hedonic and behavioral deficits related to apathy in 50 patients with PD and 42 healthy older adults who completed standardized measures. RESULTS: Regression analyses revealed that apathy was associated with anticipatory, but not consummatory, anhedonia and reduced goal-directed behavior, independent of PD diagnosis, age, education, and depressive symptoms. CONCLUSIONS: These findings suggest that apathy is characterized by deficits in anticipatory pleasure and behavioral drive rather than consummatory pleasure or reward responsiveness. Therefore, PD patients with apathy would likely benefit from psychotherapeutic treatment that encourages structured, goal-directed plans for pleasurable events and stimulation that provide adaptive hedonic effects. In addition, given the proposed shared mechanism of dopamine depletion within the ventral striatum in apathy and anticipatory anhedonia, future trials of dopamine-eliciting activities (eg, exercise and other nonpharmacologic methods) appear to be warranted to improve these symptoms in patients with PD. © 2013 Movement Disorder Society. HubMed – depression


Does hospital admission risk for depression vary across social groups? A population-based register study of 231,629 middle-aged Finns.

Soc Psychiatry Psychiatr Epidemiol. 2013 May 28;
Moustgaard H, Joutsenniemi K, Martikainen P

PURPOSE: Evidence on social differentials in depression outcomes remains inconsistent. We assess social predictors of psychiatric admission for depression in a community setting. METHODS: A register-based 14 % sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression and psychiatric comorbidity, using register data on psychiatric hospital care and medication purchases in 1996-1997. Those with inpatient treatment for unipolar depression (n = 846), those with antidepressant treatment (n = 8,754), and those with neither (n = 222,029) were followed for psychiatric admission with a diagnosis of unipolar depression in 1998-2003. Differentials in admission rates by socioeconomic position, employment status, and living arrangements were studied using Cox proportional hazards modelling. RESULTS: Among those with prior inpatient or antidepressant treatment, the material aspects of socioeconomic position increased admission risk for depression by 20-40 %, even after controlling for baseline depression severity and psychiatric comorbidities, whereas education and occupational social class were unrelated to admission risk. Among inpatients, also having no partner, and among antidepressant users, being previously married and living without co-resident children increased admission risk. However, among inpatients few excess risks reached statistical significance. Among those with no inpatient or antidepressant treatment, all measures of low social position and not living with a partner predicted admission, and the factors had more predictive power in admission than among those with prior treatment. CONCLUSIONS: Further studies should disentangle the mechanisms behind the higher admission risk among those with fewer economic resources and no co-resident partner. HubMed – depression


Physical and Mental Health, Anxiety and Depressive Symptoms in Caregivers of Patients in Vegetative State and Minimally Conscious State.

Clin Psychol Psychother. 2013 May 27;
Pagani M, Giovannetti AM, Covelli V, Sattin D, Raggi A, Leonardi M

Caregivers of patients in vegetative state and minimally conscious state play a crucial role in the process of taking care and, as previous studies reported, they can suffer of high burden and negative health outcomes. The aim of this national cross-sectional study was to assess whether physical and mental health of caregivers, considering gender differences, is related to the presence of depressive symptoms, anxiety, age and patient’s disease duration. Four-hundred and eighteen caregivers, 294 women and 124 men, completed the State Trait Anxiety Inventory-Y, Beck Depression Inventory, second version and Short Form-12. Hierarchical multiple regression analyses were performed to evaluate to which extent depressive and anxiety symptoms predict physical and mental health. Men reported higher levels of mental health state, whereas physical health was not different across gender. High levels of anxiety symptoms were associated to negative mental health outcomes in both genders, whereas depressive symptoms were found to impact on female’s mental and physical health only. A comprehensive and cost-effective screening of anxiety and depressive symptoms may help to identify determinants of health worsening in order to plan, when necessary, caregivers’ support. Copyright © 2013 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGES: Female caregivers of patients in vegetative state and minimally conscious state have poorer levels of mental health, whereas physical health is similar to men’s.Anxiety symptoms are related to negative mental health outcomes in both male and female caregivers, whereas depressive symptoms are found to impact on female mental and physical health only.It is essential to consider and assess depressive and anxiety symptoms as they may contribute to caregivers’ health worsening. This knowledge can lead to plan more comprehensive and tailored caregivers’ supports and a better care for patients. HubMed – depression


[Potentially inappropriate medication in elderly primary care patients : A retrospective, longitudinal analysis.]

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013 May 29;
Zimmermann T, Kaduszkiewicz H, van den Bussche H, Schön G, Brettschneider C, König HH, Wiese B, Bickel H, Mösch E, Luppa M, Riedel-Heller S, Werle J, Weyerer S, Fuchs A, Pentzek M, Hänisch B, Maier W, Scherer M, Jessen F,

BACKGROUND: Elderly people are often burdened by several diseases. This accounts for a higher medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of potentially inappropriate medication (PIM) over a period 4.5 years in a cohort of patients aged 75 years or more. METHODS: Data were collected from the prospective, multicenter, observational study “German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe),” initially enrolling 3,327 patients. We investigated the prevalence of PIM by checking medications during visits to patients’ homes. Furthermore, we analyzed the use of individual PIM agents over time. RESULTS: At baseline, we found a PIM prevalence of 29?% according to the PRISCUS list, which decreased to 25.0?% 4.5 years later (?(2): 7.87, p?=?0.004). The Beers list yielded a prevalence of 21?% at baseline, decreasing after 4.5 years to 17.1?% (?(2): 10.77, p?=?0.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM. CONCLUSION: Our results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects. HubMed – depression



New treatment for depression – One in ten people suffer from depression but not all respond to traditional treatments such as anti-depressants. The London Psychiatry Centre are using a new…