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Aneja J, Singh J, Udey B. Prevalence and clinical correlates of restless legs syndrome in psychiatric patients: A cross-sectional study from North India. Indian J Psychiatry 2024; 66:58-66. [PMID: 38419934 PMCID: PMC10898525 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_223_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/24/2023] [Accepted: 11/11/2023] [Indexed: 03/02/2024] Open
Abstract
Background Restless legs syndrome (RLS) is a neuro-sensorimotor disorder which is scarcely researched and is commonly missed in routine psychiatry practice. Aim To evaluate the prevalence of RLS and its correlates in patients with anxiety, depression, and somatoform disorders. Methods A cross-sectional single-center study was undertaken in patients aged 18-65 years suffering from ICD-10 (International Statistical Classification of Diseases-10th edition) diagnosis of anxiety, depressive, and somatoform disorders. RLS was evaluated by using diagnostic criteria of International Restless Legs Syndrome Study Group (IRLSSG) and severity measured on IRLSSG scale. Depression and anxiety were rated on Hamilton Depression and Anxiety Rating Scales respectively, insomnia severity measured by Insomnia Severity Index (ISI), and quality of life measured by WHO Quality of Life-Brief version (WHO-QOL BREF) scale. Serum ferritin levels were measured for evaluating iron deficiency. Results The rate of RLS was 66.7%, 50%, and 48% in patients with depressive, anxiety, and somatoform disorders, respectively, with no significant inter-group difference. Nearly one-third of patients suffered from severe to very severe symptoms of RLS, and quality of life was poorest in those with depressive disorders. RLS was significantly higher in females (P = 0.019), who were married (P = 0.040), diagnosed with severe depression (P = 0.029), and abused benzodiazepines (P = 0.045). On binary logistic regression, female gender and presence of clinical insomnia predicted occurrence of RLS. Conclusion The prevalence of RLS is very high in patients with common psychiatric disorders which is often missed. Clinical enquiry and examination for reversible causes such as iron deficiency may assist in its diagnosis and improve clinical outcome.
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Affiliation(s)
- Jitender Aneja
- Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Jawahar Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Bharat Udey
- Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab, India
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2
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Auvinen P, Koponen H, Kautiainen H, Korniloff K, Ahonen T, Vanhala M, Mäntyselkä P. A longitudinal study of restless legs symptoms among patients with depression. Nord J Psychiatry 2022; 76:584-590. [PMID: 35191781 DOI: 10.1080/08039488.2022.2038265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to analyse the relationship between depressive symptoms and clinical depression and restless legs symptoms in a longitudinal primary care setting. METHODS The prevalence of restless legs symptoms at baseline and after a six-year follow-up was studied in 474 patients with depressive symptoms and 333 population-based control subjects without depressive symptoms. Depressive symptoms at the baseline and after the six-year follow-up were evaluated with the Beck Depression Inventory (BDI) Second Edition. A psychiatric diagnosis was confirmed with a diagnostic interview (M.I.N.I.). Statistical comparisons between groups were made using analysis of variance (ANOVA) for continuous variables and a chi-square test or logistic models for categorical variables. Repeated measures were analysed using generalizing estimating equations (GEE) models. RESULTS At baseline the prevalence of restless legs symptoms was 24.3% in control subjects, 43.8% in the patients with depressive symptoms without a depression diagnosis, and 49.3% in clinically depressed patients. During the follow-up up the prevalence of restless legs symptoms declined significantly (p = 0.003). In addition to baseline restless legs symptoms, the prognostic factors for restless legs symptoms among patients with clinical depression were age and BDI score. In the control subjects, moderate and high leisure time physical activity was inversely associated with restless legs symptoms at the follow-up. CONCLUSIONS A higher level of baseline depressive symptoms was a risk factor for restless legs symptoms in patients with clinical depression. In the prevention and treatment of restless legs symptoms among the patients with depression, the priority is the effective treatment of depression.
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Affiliation(s)
- Piritta Auvinen
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
| | - Hannu Koponen
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Katariina Korniloff
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Tiina Ahonen
- Primary Health Care Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Mauno Vanhala
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
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Raatikainen I, Mäntyselkä P, Heinonen A, Vanhala M, Kautiainen H, Koponen H, Korniloff K. Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study. Nord J Psychiatry 2021; 75:356-361. [PMID: 33380252 DOI: 10.1080/08039488.2020.1862296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. METHODS A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score ≥10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. RESULTS Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (β=0.14 [95% CI: 0.02-0.26] for linearity = 0.024). CONCLUSION Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.
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Affiliation(s)
- Ilkka Raatikainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Assistive Technology Centre, Central Finland Health Care District, Jyväskylä, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mauno Vanhala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Hannu Koponen
- Old Age Psychiatry, Department of Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Katariina Korniloff
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
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4
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Xiao-Ling Q, Gang C, Bo L, Zai-Li L, Xue-Kui L, Xue L, Ming-Yu S, Yin-Zhen D, Xu C, Dian-Shuai G. Depression Is Associated With Constipation in Patients With Parkinson's Disease. Front Neurol 2021; 11:567574. [PMID: 33391144 PMCID: PMC7772414 DOI: 10.3389/fneur.2020.567574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Constipation is one of the most frequent non-motor symptoms (NMS) in Parkinson's disease (PD), causing great disturbance to patients. The present study investigated the prevalence and the clinical features of constipation in patients with PD and explored the difference between prodromal and clinical constipation of PD. Methods: A total of 186 patients with PD were recruited into this study. Subjective constipation was defined by ROME III criteria. Demographic and PD-related clinical information of the participants were collected. The PD patients were objectively assessed by a spectrum of rating scales of motor symptoms, non-motor symptoms, and quality of life. Results: In total, 51.61% (96/186) of PD patients suffer from constipation. Compared with patients without constipation, the patients with constipation were prone to have restless leg syndrome, depression, and anxiety and have higher scores of the non-motor symptoms scale. Among patients with constipation, 21.88% (21/96) patients had constipation in prodromal stage. Compared with patients with constipation in clinical stage, patients with prodromal constipation had a lower age of constipation onset (56.48 ± 9.63 and 65.26 ± 8.42, χ2 = 4.091, P < 0.001), longer timespan from constipation onset to motor symptom onset (6.62 ± 3.91 and 3.18 ± 2.13, χ2 = −3.877, P = 0.001). Patients with prodromal constipation were predominantly tremor onset (χ2 = 4.405, P = 0.044) and usually had a better quality of life [28 (14.50–37.5) and 40 (25.0–55.0), χ2 = 2.011, P = 0.046]. Depression was the only risk factor of constipation in PD patients. Body mass index, depression, and anxiety were factors that affected the life quality in patients with constipation. Conclusions: Our results supported the high incidence of constipation in patients with PD and that, in some patients, constipation occurred before the onset of motor symptoms. The specific clinical characteristics of patients with constipation and with prodromal constipation help to make early diagnosis, to discover the relationship between constipation and PD, and to further explore the pathogenesis of this degenerative disease.
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Affiliation(s)
- Qin Xiao-Ling
- Department of Neurology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Chen Gang
- Xuzhou Key Laboratory of Neurobiology, Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou, China
| | - Lu Bo
- Department of Gastroenterology, Shanghai Yangsi Hospital, Shanghai, China
| | - Li Zai-Li
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Liu Xue-Kui
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Li Xue
- Xuzhou Key Laboratory of Neurobiology, Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou, China
| | - Shi Ming-Yu
- Xuzhou Key Laboratory of Neurobiology, Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou, China
| | - Du Yin-Zhen
- Xuzhou Key Laboratory of Neurobiology, Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou, China
| | - Chen Xu
- Department of Neurology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Gao Dian-Shuai
- Xuzhou Key Laboratory of Neurobiology, Department of Neurobiology and Anatomy, Xuzhou Medical University, Xuzhou, China
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Goecke TW, Schnakenberg P, Frensch M, Chechko N. Restless Legs Syndrome During Pregnancy and 12 Weeks Postpartum and its Links to Cardiovascular Diseases, Stressful Life Events, and Psychiatric History. J Clin Med 2020; 9:E3046. [PMID: 32967350 PMCID: PMC7563656 DOI: 10.3390/jcm9093046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022] Open
Abstract
Restless legs syndrome (RLS) is highly prevalent among pregnant women. In the present study, a neurological-obstetrical sample of 561 postpartum women was retrospectively screened for RLS symptoms during pregnancy and in the first 12 weeks postpartum. The first screening took place within 1 to 6 days of delivery (T0) and the second 12 weeks after childbirth (T1). The pregnancy-related RLS prevalence rate was found to be 21% (n = 119), with the women suffering from RLS being more often affected by psychiatric history and having been more exposed to stressful life events. They were also found to have experienced baby blues more frequently shortly after childbirth. However, RLS in pregnancy did not appear to have any effect on the development of postpartum depression. Additionally, a positive trend was observed toward an association between pregnancy-related RLS and gestational diabetes and hypertension. Of the 119 women, 23 (19.3%) remained affected by RLS 12 weeks postpartum. Body mass index (BMI), weight gain, parity, childbearing history, or chronic stress exposure in pregnancy as measured by hair cortisol were not found to be linked to RLS. In summary, a comprehensive understanding of the interaction of clinical, environmental, and anamnestic factors can help shed valuable light on this pregnancy-related condition.
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Affiliation(s)
- Tamme W. Goecke
- Department of Gynecology and Obstetrics, Medical Faculty, Uniklinik RWTH Aachen University, 52074 Aachen, Germany;
- Department of Obstetrics, RoMed Hospital Rosenheim, 83022 Rosenheim, Germany
| | - Patricia Schnakenberg
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany;
| | - Markus Frensch
- Klinikum Mutterhaus der Borromäerinnen gGmbH, Abteilung für Gynäkologie u. Geburtshilfe, Feldstraße 16, 54290 Trier, Germany;
| | - Natalia Chechko
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, 52074 Aachen, Germany;
- Jülich Aachen Research Alliance (JARA)–Translational Brain Medicine, 52066 Aachen, Germany
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6
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Auvinen P, Koponen H, Kautiainen H, Korniloff K, Ahonen T, Vanhala M, Mäntyselkä P. The influence of restless legs symptoms on musculoskeletal pain in depression. Scand J Pain 2020; 20:603-610. [PMID: 32106087 DOI: 10.1515/sjpain-2019-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/17/2020] [Indexed: 11/15/2022]
Abstract
Background and aims Restless legs syndrome is a sensorimotor disorder associated with mental health conditions notably depression. Restless legs symptoms and depression are commonly associated with pain. The study investigated the influence of restless legs symptoms on musculoskeletal pain in patients with depression or with increased depressive symptoms. Methods A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in patients with depressive symptoms (n = 695) and controls without a psychiatric diagnosis (n = 410) by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory and the psychiatric diagnosis was confirmed by means of a diagnostic interview (MINI). The prevalence and intensity of musculoskeletal pain was captured with form-based questions. A single-question screen for restless legs symptoms was applied. Results There was a significant difference in the prevalence of continuous widespread musculoskeletal pain between the three study groups: the controls 4.6% (95% CI: 2.8-7.1), the patients with symptoms of depression without a diagnosis 16.0% (11.7-21.1), and the patients with diagnosed depression 22.1% (18.3-23.3) (p = 0.006 after being adjusted for age, sex, smoking, use of alcohol, education years, body mass index, use of antidepressants, and physical activity, after multiple corrections, all groups were significantly different from each other). Compared with those not having restless legs symptoms, subjects with restless legs symptoms had more often continuous widespread musculoskeletal pain in the control subjects (p = 0.001; 2.3% vs. 10.5%) and in the patients with depressive symptoms without a depression diagnosis (p = 0.024; 9.1 vs. 18.7%) but not in those with diagnosed depression (p = 0.98; 19.5 vs. 19.4%). The restless legs symptoms were associated with the intensity of pain in all groups (p < 0.001). Conclusions Restless legs symptoms were related to continuous widespread musculoskeletal pain in subjects without depressive symptoms and in patients with depressive symptoms without a depression diagnosis. Pain intensity was higher in the subjects with restless legs symptoms regardless of depressive symtoms or depression. Implications Clinical management of pain in patients with restless legs symptoms should include an increased focus on the prevention and treatment of either conditions.
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Affiliation(s)
- Piritta Auvinen
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Primary Health Care Unit, Kuopio, Finland, Phone: +358407063831
| | - Hannu Koponen
- University of Helsinki and Helsinki University Hospital; Psychiatry, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Katariina Korniloff
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Tiina Ahonen
- Primary Health Care Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Mauno Vanhala
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
| | - Pekka Mäntyselkä
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
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7
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Zhuang S, Na M, Winkelman JW, Ba D, Liu CF, Liu G, Gao X. Association of Restless Legs Syndrome With Risk of Suicide and Self-harm. JAMA Netw Open 2019; 2:e199966. [PMID: 31441941 PMCID: PMC6714009 DOI: 10.1001/jamanetworkopen.2019.9966] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. OBJECTIVE To investigate the association between RLS and risk of suicide and self-harm. DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. EXPOSURE Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. MAIN OUTCOMES AND MEASURES Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. RESULTS Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5%) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95% CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95% CI, 2.17-7.92). CONCLUSIONS AND RELEVANCE Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.
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Affiliation(s)
- Sheng Zhuang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Muzi Na
- Department of Nutritional Sciences, Pennsylvania State University, State College, University Park
| | - John W. Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Djibril Ba
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, State College, University Park
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Brietzke E, Vazquez GH, Kang MJY, Soares CN. Pharmacological treatment for insomnia in patients with major depressive disorder. Expert Opin Pharmacother 2019; 20:1341-1349. [PMID: 31046480 DOI: 10.1080/14656566.2019.1614562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Insomnia in Major Depressive Disorder (MDD) is highly prevalent and associated with increased suffering and functional impairment. Effective, evidence-based treatments for insomnia in MDD are an unmet need in clinical practice. AREAS COVERED Herein, the authors provide a review of the clinical correlates, putative neurobiological mechanisms and treatment options for the management of insomnia in individuals with MDD. EXPERT OPINION Sleep disturbances in MDD should be recognized as at least one of the following: (1) a domain of depressive psychopathology; (2) a consequence of rhythm disruptions; (3) a manifestation of comorbidities of sleep disturbances; (4) a manifestation of the influence of sex hormones in the brain in MDD; (5) a general medical comorbidity; and (6) a side effect of antidepressant medications. Assessment of insomnia in clinical practices is routinely performed with the use of non-structured interviews. Other methods such as standardized questionnaires and sleep diaries, along with complementary methods such as actigraphy and polysomnography are more scarcely applied. Smartphones and personal devices offer a promising strategy with the use of passive, long lasting, and ecologically valid assessments despite the lack of studies specifically targeting insomnia in individuals with MDD. New therapeutic approaches are essential, including novel targets such as orexins/hypocretins and the endocannabinoid system.
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Affiliation(s)
- Elisa Brietzke
- a Department of Psychiatry , Queen's University School of Medicine , Kingston , ON , Canada.,b Mood Disorders Outpatient Unit, Department of Psychiatry , Providence Care Hospital , Kingston , ON , Canada
| | - Gustavo H Vazquez
- a Department of Psychiatry , Queen's University School of Medicine , Kingston , ON , Canada.,b Mood Disorders Outpatient Unit, Department of Psychiatry , Providence Care Hospital , Kingston , ON , Canada
| | - Melody J Y Kang
- c Center of Neuroscience Studies (CNS) , Queen's University , Kingston , ON , Canada
| | - Claudio N Soares
- a Department of Psychiatry , Queen's University School of Medicine , Kingston , ON , Canada.,b Mood Disorders Outpatient Unit, Department of Psychiatry , Providence Care Hospital , Kingston , ON , Canada.,c Center of Neuroscience Studies (CNS) , Queen's University , Kingston , ON , Canada
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Kotiaho S, Korniloff K, Vanhala M, Kautiainen H, Koponen H, Ahonen T, Mäntyselkä P. Psychiatric diagnosis in primary care patients with increased depressive symptoms. Nord J Psychiatry 2019; 73:195-199. [PMID: 30929594 DOI: 10.1080/08039488.2019.1584240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Screening of depression has been recommended in primary care and Beck's 21-item Depression Inventory (BDI-21) is a commonly used tool for screening. Depression has been shown to be frequently accompanied by comorbidities. AIMS This study aimed to analyze the characteristics, psychiatric diagnoses, and psychiatric comorbidity of primary care patients who have been screened for depression and referred to a depression nurse. METHODS The study subjects were primary care patients aged ≥ 35 years with depressive symptoms (BDI-21 > 9). Their psychiatric diagnosis were based on a diagnostic interview (Mini-International Neuropsychiatric Interview; M.I.N.I.) conducted by a trained study nurse. RESULTS Of the 705 study subjects, 617 (87.5%) had at least one and 66.1% had at least two psychiatric diagnoses. The most common diagnosis was depression (63.4%). The next most common diagnoses were generalized anxiety disorder (GAD) (48.1%) and panic disorder (22.8%). Only 8.8% of the study subjects had depression without other psychiatric disorders. Ten percent of the subjects had both depression and a generalized anxiety disorder (GAD). Also other psychiatric comorbidities were common. Age was inversely associated with the psychiatric diagnosis in the M.I.N.I. CONCLUSIONS This study suggests that most of the primary care patients with increased depressive symptoms have a psychiatric disorder. Although depression is the most common diagnosis, there are several other concurrent psychiatric comorbidities. Therefore, diagnostic assessment of primary care patients with a screening score over 9 in the BDI-21 should be reconsidered.
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Affiliation(s)
- Satu Kotiaho
- a School of Medicine, General Practice , University of Eastern Finland , Kuopio , Finland.,b Saarikka Primary Health Care Public Utility , Saarijärvi , Finland
| | - Katariina Korniloff
- c School of Health and Social Studies , JAMK University of Applied Sciences , Jyväskylä , Finland
| | - Mauno Vanhala
- a School of Medicine, General Practice , University of Eastern Finland , Kuopio , Finland
| | - Hannu Kautiainen
- d Faculty of Sport and Health Sciences , University of Jyväskylä , Jyväskylä , Finland.,e Primary Health Care Unit , Kuopio University Hospital , Kuopio , Finland
| | | | - Tiina Ahonen
- g Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Pekka Mäntyselkä
- a School of Medicine, General Practice , University of Eastern Finland , Kuopio , Finland.,d Faculty of Sport and Health Sciences , University of Jyväskylä , Jyväskylä , Finland
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10
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Thunander Sundbom L, Hedborg K. Association between prescribed antidepressants and other prescribed drugs differ by gender: a nationwide register-based study in Sweden. Nord J Psychiatry 2019; 73:73-79. [PMID: 30661437 DOI: 10.1080/08039488.2018.1536766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND People with depression are prescribed more drugs than people in general, partly due to comorbidity with other conditions. However, little research has been done on depression-related drug use from a gender perspective. AIM Examine the association between antidepressants, other types of prescribed drugs, and polypharmacy, by gender. METHODS Data on drugs dispensed October to December 2016 to all Swedish citizens aged 18-84 years were collected from the Swedish prescribed drug register. Logistic regression analyses were performed to examine the associations between antidepressants and other drugs, by gender. RESULTS For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, blood, nervous system, analgesics, and polypharmacy. However, for women, but not men, associations were also found for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones. CONCLUSIONS Associations were found between antidepressants and many other types of drugs for both men and women; indicating comorbidity between depression and other conditions. Further, some of the associations between antidepressants and other drugs were found to be specific among women. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, comorbidity impairs the possibility of recovery; in the somatic condition as well as the depression. Thus, physicians need to be aware that the association between antidepressants and other types of drugs are more common among women than men.
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Affiliation(s)
- Lena Thunander Sundbom
- a Faculty of Health and Occupational Studies, Department of Health and Caring Sciences , University of Gävle , Gävle , Sweden.,b Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy , Uppsala University , Uppsala , Sweden
| | - Kerstin Hedborg
- a Faculty of Health and Occupational Studies, Department of Health and Caring Sciences , University of Gävle , Gävle , Sweden
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Auvinen P, Mäntyselkä P, Koponen H, Kautiainen H, Korniloff K, Ahonen T, Vanhala M. Elevation of tumor necrosis factor alpha levels is associated with restless legs symptoms in clinically depressed patients. J Psychosom Res 2018; 115:1-5. [PMID: 30470307 DOI: 10.1016/j.jpsychores.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Restless legs syndrome is a sensorimotor disorder associated with several mental illnesses particularly depression. METHODS A cross-sectional study of primary care patients. The prevalence of restless legs symptoms was studied in 706 patients with depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the BDI and the psychiatric diagnosis was confirmed by means of a diagnostic interview (M.I.N.I.). The subjects with elevated depressive symptoms were divided into two groups subjects with depressive symptoms with and without clinical depression. RESULTS The prevalence of restless legs symptoms was 24.8% in the controls, 50.0% in the patients with clinical depression and 42.4% in the patients with depressive symptoms. CRP value was significantly higher (p = .003) in the clinically depressed patients than in the other groups. There was a higher concentration of TNF-α in the subjects with restless legs symptoms (7.4 ng/l ± 3.2) compared with the subjects without symptoms (6.7 ng/l ± 2.3)(p < .001). There was a significant difference in the TNF-α levels between the subjects with and without restless legs symptoms in the depression group (p < .001) and among the patients with depressive symptoms but no a depression diagnosis (p = .022). In these groups, restless legs symptoms were associated with elevated levels of TNF-α. CONCLUSIONS TNF-α level was associated with restless legs symptoms only among subjects with depressive symptoms whether they had clinical depression or not. We suggest that TNF-α could be an underlying factor between restless legs symptoms and comorbidities.
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Affiliation(s)
- Piritta Auvinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Koponen
- University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Katariina Korniloff
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Tiina Ahonen
- Primary Health Care Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Mauno Vanhala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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