580 research outputs found
La dépression, maladie de société ? : les études soulignent une augmentation du phénomène en Suisse et ailleurs
No full textDepuis le début des années 70, l'Organisation mondiale de la santé estime que la dépression est le principal trouble mental dans le monde et que les choses iront en s'aggravant à l'avenir. Elle considère également que seule la moitié des dépressifs sont diagnostiqués et traités. Les études récentes mettent généralement en évidence une augmentation du taux de dépression en Suisse comme dans les autres sociétés développées. Aujourd'hui, le coût social de la dépression semble aussi lourd que celui des maladies cardiovasculaires. Mais il faut faire deux remarques. D'abord, il y a dans nos sociétés une attention à la souffrance psychique qui n'existait pas il y a encore trente ans. Ensuite, il faut savoir quelle définition on retient de la dépression, ce que l'on compte et ce qui compte. Le Bloc-notes a rencontré trois spécialistes de la question aux Hospices: François Ansermet, Jacques Laget et Martin Preisig. [Chiffres et points de repères. La dépression chez les adolescents. La dépression chez les enfants.] <Auteur
Eye Gaze and Turn Taking in Aphasia Patients
No full textIn every conversation you have, there is an unspoken code – a set of social rules that guide you. When to stop talking, where to look, when to listen and when to talk
Aphasia and dialogue: What eye movements reveal about the processing of cospeech gestures and the prediction of turn transitions
No full textTwo intriguing aspects of human communication are the occurrence of co-speech gestures and the alternating exchange of speech acts through turn-taking. The present thesis aimed to investigate both aspects by means of eye movement recordings in patients with poststroke aphasia. In particular, it was assessed whether patients’ linguistic deficits lead to
altered visual processing of co-speech gestures and whether aphasic impairments have an impact on the capability to predict turn transitions.
The findings obtained from two studies imply that co-speech gesture processing is not affected in aphasic patients. On the contrary, we found that patients benefit from multimodal information provided through the congruent presentation of speech and co-speech gestures. However, aphasic patients’ focused less on the visual speech component (i.e.,
fewer fixations on the speaker’s face). This could be an indicator for a general deficit to integrate audio-visual information causing aphasic patients to avoid interference between the visual and the acoustic speech signal. In a third study, we addressed the frequency and the precise timing of eye movements in relation to the turn transitions between speaking actors. Patients with aphasia shifted their gaze less frequently according to the flow of the conversation, although there was no difference with regard to the timing of their gaze shifts.
In this study, we could further show that higher lexico-syntactic processing demands lead to a reduced gaze shift probability in aphasic patients. This finding might imply that patients miss more opportunities to make their own verbal contributions when talking to their family
members.
Future studies should target gesture processing and turn-taking capabilities in aphasic patients during face-to-face interaction. This is important in order to verify if the presented findings can be generalized to patients’ everyday life
WHEN THE HEART ACHES: ATYPICAL FEATURES IN DEPRESSION ARE A HALLMARK OF AN INCREASED CARDIO-METABOLIC RISK
No full textLa dépression et les maladies cardiovasculaires représentent deux enjeux majeurs de santé publique en raison du grand nombre de personnes atteintes et de leur impact sur la qualité de vie. Ces troubles coexistent chez les mêmes individus plus souvent que ce que le hasard voudrait, pourtant les mécanismes qui sous-tendent cette association ne sont que peu compris. Compte tenu de l'hétérogénéité de la dépression, l’évaluation détaillée des symptômes, de la temporalité et des sous-types de la dépression semble être une piste vers une meilleure compréhension de ces mécanismes. Dans ce contexte, les objectifs de ce travail étaient (1) d’examiner l’effet des différents sous-types de dépression sur les facteurs de risque cardio-vasculaires métaboliques et
(2) d’évaluer la mortalité associée à différentes caractéristiques de la dépression. Parmi les habitants de Lausanne âgés de 35 à 66 ans, un échantillon randomisé de 3719 personnes (étude PsyCoLaus) a accepté de se soumettre à des investigations physiques et psychiatriques étendues, cela à deux reprises à cinq ans d’intervalle. Des modèles linéaires généralisés ont permis d’analyser ces données. Les participants ayant présenté une dépression atypique au début de l’étude prenaient plus de poids, augmentaient plus leur tour de taille, et présentaient un taux plus élevé d’obésité et de syndrome métabolique à la fin du suivi que les participants sans dépression, indépendamment d’un grand nombre de facteurs confondants. Ce même groupe de participants a aussi présenté une plus grande augmentation de sa glycémie à jeûn, indépendamment de sa prise de poids. Enfin, les sujets qui présentaient une dépression lors de la première investigation étaient plus à risque de décéder durant les cinq années du suivi que les autres. Ces résultats soulignent la nécessité pour le chercheur comme pour le clinicien, d'évaluer en détail les divers aspects de la dépression, en particulier les caractéristiques atypiques, et de considérer leurs possibles conséquences métaboliques.
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Depression and cardiovascular diseases represent two major issues of public health due to the large number of people affected and their heavy consequences on quality of life. They are known to coexist in the same individuals more frequently than what would be expected by chance, but the mechanisms underlying this association still need to be elucidated. Given the heterogeneity of depression, studying symptoms, courses or subtypes in detail rather than depression as a whole is likely to be a more promising approach to better understand these mechanisms. Accordingly, the aims the present work were to (1) assess the prospective associations between depression subtypes at baseline and the subsequent changes in metabolic cardio-vascular risk factors, and (2) determine the association of clinical and course characteristics of depressive disorders with all- cause mortality over a 5-year follow-up period. A randomly selected sample of 3719 persons aged 35 to 66 years from the population of Lausanne (PsyCoLaus) agreed to participate in thorough physical and psychiatric assessments at baseline and, five years later, at a follow-up visit. Generalized linear models were used. Participants with the atypical subtype of depression at baseline, compared to the never depressed, presented a higher increase of body mass index, waist, as well as a higher incidence of obesity and metabolic syndrome after five years, independently of a large range of known possible confounders. This same group had also a higher increase of fasting plasma glucose. Moreover, survival analyses showed that participants with a current episode of depression at baseline were at a higher risk of dying during the five following years than the never depressed. These results emphasize the need for assessing in detail the various characteristics of depression, in particular the atypical subtype, in research as well as in clinical settings and to consider their metabolic consequences
Anxiety Disorders are Associated with Low Socioeconomic Status in Women but Not in Men
No full textObjectives We investigated to what extent the lifetime prevalence of anxiety disorders relates to negative economic changes, taking important lifestyle factors and unexpected life events into consideration. Methods We included 3,695 participants recruited in the city of Lausanne (Switzerland), from the population-based CoLaus/PsyCoLaus study. The association between anxiety disorders, lifestyle factors, and life events related to income was investigated using binary logistic regression analyses correcting for demographic and clinical confounders. Results Compared with men, women with anxiety disorders showed a significantly lower socioeconomic status (Mann-Whitney U = 56,318; p < .001) and reported a higher negative impact of substantial reduction of income (Mann-Whitney U = 68,531; p = .024). When performing adjusted analyses, low socioeconomic status (odd ratio, 0.87; p = .001) and negative impact of reduction of income (odd ratio, 1.01; p = .004) were associated significantly with anxiety disorders in women but not in men. Conclusion Our results suggest that anxiety disorders aggravate already existing gender differences in economic conditions, and that women with anxiety need additional support to attain socioeconomic security similar to that of men
PSYCHIATRIC COMORBID TIES, ANTECEDENTS AND RISK FACTORS OF MOOD DISORDERS
No full textContexte: Les troubles de l'humeur sont l'une des causes majeures de la morbidité au niveau mondial, en raison du nombre élevé de personnes affectées et des conséquences néfastes sur leur qualité de vie. Le développement naturel, qui concerne les deux sous-types majeurs des troubles de l'humeur, le trouble dépressif majeur (TDM) et le trouble bipolaire (TBP), doit encore être davantage élucidé. En plus, vue la complexité du TDM par rapport à sa présentation symptomatique, son développement et sa réponse au traitement pharmacologique, diviser ce trouble en plusieurs sous-types plus homogènes pourrait mieux nous renseigner sur les mécanismes sous-jacents à leur émergence. Buts et méthode : Les buts de ce travail étaient de : 1) évaluer simultanément les associations entre des facteurs de risque potentiels, soit des facteurs sociodémographiques, de style de vie, environnementaux, psychologiques, inflammatoires et cardio-métaboliques, et l'incidence des sous-types du TDM parmi des adultes de la population générale suivis sur une période de plus de 5 ans (n = 1524, moyenne d'âge 51.4 ans); et 2) identifier les troubles comorbides et les précurseurs des TBP et du TDM sur un échantillon d'enfants de parents avec un TDM ou un TBP suivis pendant plus de 13 ans (n = 449, moyenne d'âge au début de l'étude 10.1 ans). Résultats : 1) Les sous-types du TDM dans la population générale étaient prédits par des combinaisons de caractéristiques partiellement différentes, suggérant que ces sous-types diffèrent non seulement dans leur présentation clinique mais aussi dans les facteurs qui contribuent à leur développement. 2) Les épisodes (hypo)maniaques et du TDM chez les enfants de parents avec un trouble de l'humeur étaient associés avec des comorbidités psychiatriques similaires, mais comportaient des précurseurs psychiatriques différents. Ces résultats suggèrent des cheminements pathogéniques distincts qui conduisent aux deux sous-types majeurs des troubles de l'humeur. Conclusion : Dans l'ensemble, ces résultats soulignent le besoin de différencier entre les catégories de troubles de l'humeur sous forme de sous-types plus homogènes, ce qui pourrait contribuer au perfectionnement de stratégies de détection précoce et à la prévention primaire et secondaire de leur développement.
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Background: Mood disorders are one of the leading causes of the global burden of disease, due to the large number of people affected and to their heavy conséquences on quality of life. The natural development, leading to the two major subtypes of mood disorders, major depressive disorder (MDD) and bipolar disorders (BPD), still needs to be efucidated. Moreover, given that MDD is a complex illness with regard to its symptom manifestations, course and response to pharmacological treatment, dividing this disorder into more homogeneous subtypes may shed more light on the mechanisms underlying its emergence. Aims and methods: Accordingly, the aims of the present work were to: 1) simultaneously assess the associations of a comprehensive array of potential socio-demographic, lifestyle, environmental, psychological, inflammatory and cardio-metabolic risk factors with the incidence of the subtypes of MDD in midlife during a more than 5-yearfollow-up in the général population (n = 1524, mean âge 51.4 years), and 2) to identify lifetime comorbid disorders and antecedents of either BPD or MDD in a more than 13 year follow- up study of the offspring (n = 449, mean âge at study intake 10.1 years) of parents with both MDD and BPD. Results: 1) MDD subtypes in the général population were predicted by partially distinct combinations of baseline characteristics suggesting that these subtypes not only differ in their clinical manifestations but also in factors that contribute to their development. 2) (Hypo)manic episodes and MDD in offspring of parents with mood disorders were associated with similar psychiatrie comorbid lifetime conditions but with différent psychiatrie antecedents. These findings further support differential pathogenic pathways leading to the two major types of mood disorders. Conclusions: Taken together, the results emphasize the need to differentiate the heterogeneous category of mood disorders into more homogeneous subtypes: that may contribute to refining stratégies for early détection and primary or secondary prévention of mood disorders
Genomewide association scan of suicidal thoughts and behaviour in major depression
No full textBACKGROUND: Suicidal behaviour can be conceptualised as a continuum from suicidal ideation, to suicidal attempts to completed suicide. In this study we identify genes contributing to suicidal behaviour in the depression study RADIANT. METHODOLOGY/PRINCIPAL FINDINGS: A quantitative suicidality score was composed of two items from the SCAN interview. In addition, the 251 depression cases with a history of serious suicide attempts were classified to form a discrete trait. The quantitative trait was correlated with younger onset of depression and number of episodes of depression, but not with gender. A genome-wide association study of 2,023 depression cases was performed to identify genes that may contribute to suicidal behaviour. Two Munich depression studies were used as replication cohorts to test the most strongly associated SNPs. No SNP was associated at genome-wide significance level. For the quantitative trait, evidence of association was detected at GFRA1, a receptor for the neurotrophin GDRA (p = 2e-06). For the discrete trait of suicide attempt, SNPs in KIAA1244 and RGS18 attained p-values of <5e-6. None of these SNPs showed evidence for replication in the additional cohorts tested. Candidate gene analysis provided some support for a polymorphism in NTRK2, which was previously associated with suicidality. CONCLUSIONS/SIGNIFICANCE: This study provides a genome-wide assessment of possible genetic contribution to suicidal behaviour in depression but indicates a genetic architecture of multiple genes with small effects. Large cohorts will be required to dissect this further.Alexandra Schosser, Amy W. Butler, Marcus Ising, Nader Perroud, Rudolf Uher, Mandy Y. Ng, Sarah Cohen-Woods, Nick Craddock, Michael J. Owen, Ania Korszun, Lisa Jones, Ian Jones, Michael Gill, John P. Rice, Wolfgang Maier, Ole Mors, Marcella Rietschel, Susanne Lucae, Elisabeth B. Binder, Martin Preisig, Julia Perry, Federica Tozzi, Pierandrea Muglia, Katherine J. Aitchison, Gerome Breen, Ian W. Craig, Anne E. Farmer, Bertram Müller-Myhsok, Peter McGuffin and Cathryn M. Lewi
Mental disorders among cardiac disease patients in a Palestinian population
No full textMental disorders and cardiovascular diseases (CVDs) are among the leading contributors to the global burden of disease, making them a major public health problem. Mental disorders and CVDs are common conditions, which very often co-occur, and influence each other’s etiology. Individuals with cardiac diseases experience higher rates of mental disorders such as depression, anxiety and posttraumatic stress disorder (PTSD) than the general population. Likewise, these mental illnesses are associated with both onset and progression of cardiac diseases. A growing body of evidence has documented the independent association between depression and onset of cardiac disease, morbidity and mortality. There is also compelling evidence that the co-occurrence of depression and cardiac disease leads to worse health-related quality of life (HRQL). However, less is known about the influence of anxiety and PTSD on cardiac outcomes and HRQL. The American Heart Association (AHA) has recommended routine depression screening in cardiac patients and guidelines for cardiac rehabilitation (CR) include that attention is paid to the diagnosis and treatment of mental disorders, yet the uptake of these recommendations remains limited. This situation is expected to be aggravated in low-income countries (LICs) like Palestine, which is affected by the political conflict and rates of CVDs and mental disorders are on a rapid rise. However, mental disorders are stigmatized, and thus not recognized nor treated. The evidence base to promote mental health services is currently lacking. This is the first contribution to assess the relationship between mental disorders and cardiac diseases in Palestine.
This PhD project the “CARMEN Study” was carried out in collaboration between Swiss Tropical and Public Health Institute, (Swiss TPH) and An-Najah National University. The following dissertation is based on three interrelated studies and sought to study the epidemiology and contributions of depression, anxiety, PTSD among cardiac diseases in a population-based sample of Palestinian adults. This dissertation provides evidence to fill the knowledge gaps to inform treatment and guide optimum management of these comorbid conditions.
Study I used a cross-sectional design to investigate the prevalence of depression and anxiety symptoms among Palestinian cardiac patients. Among the 1022 patients assessed, 54% were categorized as having severe depressive symptoms, while 19% exhibited severe anxiety symptoms. The study also found PTSD symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration to be independently associated factors with both depressive and anxiety symptoms. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience and were more prevalent among females and less educated patients.
Study II revealed that women were more likely to suffer from depression than men (28.7% vs. 18.8%). When assessing which characteristics mediate the effect of gender on depression using structural equation modeling (SEM), our results showed that there was no direct effect of gender on depression; however, indirect effects showed that female gender was associated with lower resilience, self-esteem and quality of life, education, prevalence of smoking and physical activity and higher PTSD symptoms, comorbidities, somatic symptoms and smoking.
Study III found 27% of the overall sample at baseline exhibits moderate-to-high PTSD symptoms and at one year follow-up, patients with PTSD reported an approximate 20% lower HRQL. In addition, when assessing the longitudinal association of PTSD with HRQL after one year, the findings suggest this relationship was largely mediated by depression and anxiety.
The overall conclusions drawn from this thesis support the essential need for integrating mental health care into CR in Palestine from disease onset and onwards, considering the alarming rates of depression and anxiety symptoms in this Palestinian patient population. Depression, anxiety and PTSD should be considered important risk factors for cardiac diseases as much as other traditional cardiac risk factors. To deliver effective treatments for depression, anxiety and PTSD, assessment of the impact of psychological interventions on cardiac outcomes is needed. For clinical practice, future research should apply a more holistic approach in treating both physical and psychological recovery among cardiac patients. Finally, our findings can be considered as first steps to the translational approach of innovation, validation and application, where we can use the current cardiac sample as an entry door to pursue family members of diseased patients whom also could be at risk of onset and progression of cardiac diseases. This could potentially lead to a national mental health program that could be generalizable to similar health care systems in the Middle East region
Role of sex and gender-related variables in development of metabolic syndrome: A prospective cohort study
No full textIntroduction: The burden of metabolic syndrome (MetS) and its components has been increasing mainly amongst male individuals. Nevertheless, clinical outcomes related to MetS (i.e., cardiovascular diseases), are worse among female individuals. Whether these sex differences in the components and sequalae of MetS are influenced by gender (i.e., psycho-socio-cultural factors)) is a matter of debate. Therefore, the purpose of this study was to determine the association between gender-related factors and the development of MetS, and to assess if the magnitude of the associations vary by sex. Method: Data from the Colaus/PsyColaus study, a prospective population-based cohort of 6,734 middle-aged participants in Lausanne (Switzerland) (2003-2006) were used. The primary endpoint was the development of MetS as defined by the Adult Treatment Panel III of the National Cholesterol Education Program. Multivariable models were estimated using logistic regression to assess the association between gender-related factors and the development of MetS. Two-way interactions between sex, age and gender-related factors were also tested. Results: Among 5,195 participants without MetS (mean age=51.3 ± 10.6, 56.1 % females), 27.9 % developed MetS during a mean follow-up of 10.9 years. Female sex (OR:0.48, 95 %CI:0.41-0.55) was associated with decreased risk of developing MetS. Conversely, older age, educational attainment less than university, and low income were associated with an increased risk of developing MetS. Statistically significant interaction between sex and strata of age, education, income, smoking, and employment were identified showing that the reduced risk of MetS in female individuals was attenuated in the lowest education, income, and advanced age strata. However, females who smoke and reported being employed demonstrated a decreased risk of MetS compared to males. Conversely smoking and unemployment were significant risk factors for MetS development among male adults. Conclusions: Gender-related factors such as income level and educational attainment play a greater role in the development of MetS in female than individuals. These factors represent novel modifiable targets for implementation of sex- and gender-specific strategies to achieve health equity for all people
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