COURSE and RISK FACTORS of FUNCTIONAL IMPAIRMENT in SUBTHRESHOLD DEPRESSION and ANXIETY.
COURSE AND RISK FACTORS OF FUNCTIONAL IMPAIRMENT IN SUBTHRESHOLD DEPRESSION AND ANXIETY.
Filed under: Depression Treatment
Depress Anxiety. 2012 Nov 16;
Karsten J, Penninx BW, Verboom CE, Nolen WA, Hartman CA
BACKGROUND: Although persons with subthreshold depression or anxiety are known to be at risk for full-syndromal disorders, little is known about their functioning over time. In this study, we investigate the functional impairment of persons with subthreshold depression or anxiety over time, compared to that of controls. Furthermore, we evaluate which illness, personal, and environmental risk factors influence its course. METHODS: Data come from the Netherlands Study of Depression and Anxiety (N = 1,266, aged 18-65). Linear mixed models were used to identify predictors of functional impairment at baseline, 1-, and 2-year follow-up. Risk factors were evaluated in their overall effect on functioning and on change in functioning over time, and whether they differed for respondents with and without subthreshold depression or anxiety. RESULTS: Functional impairment in subthreshold respondents improved over time, but remained much higher than in controls. Prior anxiety disorder, high neuroticism, low conscientiousness, more somatic conditions, and more childhood trauma all predicted greater functional impairment. Older age predicted lower functioning only in subthreshold respondents, while the effect of neuroticism was stronger in subthreshold respondents relative to controls. CONCLUSIONS: Functional impairment in subthreshold respondents improved over time, but remained elevated compared to that of controls. Given continuously elevated levels of impairment, preventive interventions should be focused on persons with subthreshold symptoms; in particular those with prior anxiety disorder, high neuroticism, low conscientiousness, somatic conditions, or childhood trauma.
HubMed – depression
Medical complications, clinical findings, and educational outcomes in adults with Noonan syndrome.
Filed under: Depression Treatment
Am J Med Genet A. 2012 Nov 19;
Smpokou P, Tworog-Dube E, Kucherlapati RS, Roberts AE
Noonan syndrome (NS) is a heterogeneous developmental disorder caused by missense mutations in genes involved in the Ras/MAPK signaling pathway, a major mediator of early and late developmental processes. The diagnosis of NS is made on clinical grounds with molecular confirmation of a mutation found in 63% of cases. Key clinical features include short stature, cardiac defects, developmental delay, lymphatic dysplasias, bleeding tendency, and a constellation of distinctive facial features and physical exam findings. The prevalence of medical issues or the development of new ones in adults with NS is not well-studied. This cross-sectional study reports on the prevalence of clinical conditions and their ages of onset in a cohort of 35 adolescents and adults with NS aged 16-68 years old (mean age 28 years). In this cohort, 34 of 35 subjects (97%) had had full PTPN11 sequencing; 37% were PTPN11 positive, 23% were SOS1 positive, and 3% were BRAF positive. Mean adult height in both men and women was at the 3rd-10th centile. The most prevalent clinical findings in this cohort included pulmonary valve stenosis (71%), easy bruising (63%), GERD (60%), constipation (51%), scoliosis (54%), chronic joint pain (54%), lymphedema (49%), depression (49%), anxiety (49%), Chiari malformation (20%), and osteopenia/osteoporosis (14%). In summary, adults with NS are affected by multi-organ morbidity and require special medical management aimed towards the most prevalent and serious known medical complications. Larger studies characterizing the clinical conditions found in NS adults are needed to provide potential genotype-phenotype correlations that may aid in clinical management. © 2012 Wiley Periodicals, Inc.
HubMed – depression
Tricyclic antidepressant use and risk of fractures: A meta-analysis of cohort and case-control studies.
Filed under: Depression Treatment
J Bone Miner Res. 2012 Nov 19;
Wu Q, Qu W, Crowell MD, Hentz JG, Frey KA
Because studies of the association between tricyclic antidepressant (TCA) treatment and risk of fracture have shown inconsistent findings, we sought to assess whether people who take TCAs are at increased risk of fracture. Relevant studies published by June 2012 were identified through database search of Scopus, MEDLINE, EMBASE, PsycINFO, ISI Web of Science, WorldCat Dissertations and Theses from their inception, and manual searching of reference lists. Only original studies that examined the association between TCA treatment and risk of fracture were included. Two investigators independently conducted literature searches, study selection, study appraisal, and data abstraction using a standardized protocol. Disagreements were resolved by consensus. Twelve studies met inclusion criteria. Because of the heterogeneity of these studies, random-effects models were used to pool estimates of effect. Overall, TCA use was associated with significantly increased fracture risk (relative risk [RR], 1.45; 95% confidence interval [CI], 1.31-1.60; P<.001). Increased fracture risk associated with TCA use was also observed in studies that adjusted for bone mineral density (RR, 1.54 [95% CI, 1.24-1.90]; P<.001) or depression (RR, 1.49 [95% CI, 1.28-1.67]; P<.001). Strength of association with TCA exposure duration ?6 weeks (RR, 1.13 [95% CI, 1.00-1.28]) was substantially weaker than association with TCA exposure duration <6 weeks (RR, 2.40 [95% CI, 1.41-4.08]). Prior TCA exposure had no significant effect on fracture risk (RR, 1.04 [95% CI, 0.86-1.26]; P=.70). After accounting for publication bias, we found the overall association between TCA use and fracture risk to be slightly weaker (RR, 1.36 [95% CI, 1.24-1.50]) but still significant (P<.001). Findings of this meta-analysis indicate that treatment with TCAs may convey an increased risk of fracture, independent of depression and bone mineral density. © 2012 American Society for Bone and Mineral Research. HubMed – depression
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