Antonio Campayo

Depressive disorder and incident diabetes mellitus: the effect of characteristics of depression.

OBJECTIVE The purpose of this study was to test the hypothesis that clinically significant depression detected in a population sample increases the risk of diabetes mellitus. The authors examined the effect of characteristics of depression frequently found in the community on the risk of incident diabetes mellitus. METHOD A large community sample of adults aged > or = 55 years (N=4,803) was assessed at baseline in a longitudinal three-wave epidemiological enquiry using a psychiatric interview and the Geriatric Mental State Schedule. Cases of depression were diagnosed according to standardized criteria, and diabetes was assessed using a risk factors questionnaire. Follow-up evaluations, conducted 2.5 and 5 years later, were completed to determine the incidence of diabetes. RESULTS At baseline, 379 case subjects with depression were identified. The risk of incident diabetes mellitus was higher among subjects with depression when compared with nondepressed subjects, and the association remained significant after controlling for potential confounders, including diabetes risk factors. The estimated rate of diabetes mellitus attributable to depression was 6.87%. An increased risk of diabetes mellitus was also associated with the following characteristics of depression: nonsevere depression, persistent depression, and untreated depression. Treatment with antidepressants was not associated with an increased risk of diabetes mellitus. CONCLUSIONS Clinically significant depression is associated with a 65% increased risk of diabetes mellitus. Characteristics of depression frequently found in the community, namely nonsevere depression, persistent depression, and untreated depression, may play a role in the development of diabetes in a predominantly elderly adult population.

Non-cognitive psychopathological symptoms associated with incident mild cognitive impairment and dementia, alzheimer’s type

Objective: To test the hypothesis that specific psychopathological non-cognitive symptoms are associated with incident mild cognitive impairment (MCI), while different symptoms are associated with incident dementia of Alzheimer’s type (DAT).Methods: A representative community sample of 4,803 individuals aged 55+ years was interviewed in a two-phase screening, in Wave I or ZARADEMP I. This is the baseline, cross-sectional study of the ZARADEMP Project, a longitudinal study to document incidence and risk factors of dementia. The main instrument for assessment of participants was the ZARADEMP Interview, which includes standardized Spanish versions of instruments such as the Mini-Mental Status Examination and the Geriatric Mental State GMS-AGECAT. Two years later, in Wave II or ZARADEMP II, the cognitively non-deteriorated elderly were reassessed in a similar, two-phase procedure. “Incident cases” of both dementia and DAT (DSM-IV-TR criteria), as well as MCI (operationally defined Petersen’s criteria) were diagnosed by a panel of psychiatrists. Statistical, logistic regression models, adjusted by age, sex and education were used to test the hypothesized association.Results: “Irritability”, “neurovegetative symptoms”, “sleep problems”, “concentration ifficulties”, “loneliness” and “subjective slowing” documented at baseline were associated with incident MCI (odds ratio, OR range 1.71-2.67). A different profile of non-cognitive symptoms was associated with incident DAT, specifically “tension” (OR= 2.45), “sleep problems” (OR= 2.81), and “observed slowing” (OR= 4.35). On the contrary, “subjective restriction of activities” seemed to be negatively associated with DAT (OR= 0.12).Conclusions: To our knowledge, this is the first report about some specific psychopathological, non-cognitive symptoms associated with incident MCI and/ or incident DAT, when controlling by each other. The psychopathological profile associated with MCI is different from the profile preceding DAT.

Depression and Incident Alzheimer Disease: The Impact of Disease Severity

OBJECTIVES To test the hypothesis that clinically significant depression (particularly severe depression) increases the risk of Alzheimers disease (AD). METHODS A longitudinal, three-wave epidemiologic study was implemented in a sample of individuals aged 55 years and older (n = 4,803) followed up at 2.5 years and 4.5 years. This was a population-based cohort drawn from the Zaragoza Dementia and Depression (ZARADEMP) Project, in Zaragoza, Spain. Participants included individuals cognitively intact at baseline (n = 3,864). The main outcome measures were depression as assessed by using the diagnostic interview Geriatric Mental State- Automated Geriatric Examination for Computer Assisted Taxonomy package; and AD diagnosed by a panel of research psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The Fine and Gray multivariate regression model was used in the analysis, accounting for mortality. RESULTS At baseline, clinically significant depression was diagnosed in 452 participants (11.7%); of these, 16.4% had severe depression. Seventy incident cases of AD were found at follow-up. Compared with nondepressed individuals, the incidence rate of AD was significantly higher in the severely depressed subjects (incidence rate ratio: 3.59 [95% confidence interval: 1.30-9.94]). A consistent, significant association was observed between severe depression at baseline and incident AD in the multivariate model (hazard ratio: 4.30 [95% CI: 1.39-13.33]). Untreated depression was associated with incident AD in the unadjusted model; however, in the final model, this association was attenuated and nonsignificant. CONCLUSIONS Severe depression increases the risk of AD, even after controlling for the competing risk of death.

Somatic and psychiatric comorbidity in the general elderly population: Results from the ZARADEMP Project

OBJECTIVE In a representative sample of the elderly population in a southern European city, we tested the hypothesis that there is an association between general somatic and general psychiatric morbidity. METHODS A stratified random sample of 4803 individuals aged > or =55 years was selected for the baseline study in the ZARADEMP Project. The elderly were assessed with standardized Spanish versions of instruments, including the Geriatric Mental State (GMS)-AGECAT. Psychiatric cases were diagnosed according to GMS-AGECAT criteria, and somatic morbidity was documented with the EURODEM Risk Factors Questionnaire. RESULTS General comorbidity clustered in 19.9% of the elderly when hypertension was removed from the somatic conditions category, with 33.5% of the sample remaining free from both somatic and psychiatric illnesses. General comorbidity was associated with age, female gender, and limited education, but did not increase systematically with age. The frequency of psychiatric illness was higher among the somatic cases than among noncases, and the frequency of somatic morbidity among the psychiatric cases was higher than among noncases. This association between somatic and psychiatric morbidity remained statistically significant after controlling for age, gender, and education [odds ratio (OR)=1.61; confidence interval (CI)=1.38-1.88]. Most somatic categories were associated with psychiatric illness, but after adjusting for demographic variables and individual somatic illnesses, the association remained statistically significant only for cerebrovascular accidents (CVAs) (OR=1.47; CI=1.09-1.98) and thyroid disease (OR=1.67; CI=1.10-2.54). CONCLUSION This is the first study to document that there is a positive and statistically significant association between general somatic morbidity and general psychiatric morbidity in the (predominantly) elderly population. CVAs and thyroid disease may have more weight in this association.

Somatic and psychiatric co-morbidity in Primary Care patients in Spain

Background:There is limited information on the subject of co-morbidity of general medical conditions (GMCs) and general psychiatric disturbance in primary care (PC). Methods: A representative sample (n = 1559) of adult PC patients was examined in a two-phase screening. Standardized screening instruments were used, including the Stan- dardized Polyvalent Psychiatric Interview (SPPI). ICD-10 research criteria were used for psychiatric diagnosis, and ICPC-2 for medical diagnosis. Results: Most co-morbidity cases had depressive (120 cases, 28.1%) or anxiety/neurot- ic disorders (217 cases, 50.9%). In support of the working hypothesis, the proportion of patients with several medical diagnoses was significantly higher among the cases, and logistic regression showed that the probability of being a psychiatric case increased with each medical diagnosis done by the primary care physician (OR = 2.46; IC 1.66-3.66, p < 0.001). Moderate/severe cases were significantly more frequent among the depressed group (91 cases, 75.9%), but were also common in the anxiety/neurosis group (52 cases, 24%), the between groups differences in disability being non-significant. The distribution of both affective and neurotic disorders by specific ICPC-2 categories suggests preferen- tial associations. Conclusion: In PC, the probability of having a co-morbid psychiatric diagnosis dou- bles with each medical diagnosis. Anxiety/neurotic disorders, and not only depressive dis- orders, are relevant co-morbid psychiatric categories in this setting.

A new autopsy interview for the assessment of factors potentially related to death in depressed medical patients.

This study tests the reliability and validity of the Bio-Psycho-Social Autopsy (BPSA), a new interview to assess physical, psychopathological, and social factors potentially related to mortality in depressed medical patients. The authors completed special procedures to provide support for the face and content validity of the interview. They built the psychopathological and social sections on the Standardized Polyvalent Psychiatric Interview (SPPI) but gave self-neglect special emphasis. They tested the BPSA on close relatives of 48 deceased patients, both depressed and nondepressed. They calculated interrater reliability coefficients and took preliminary steps to document the construct validity by means of epidemiological and clinical variables. Interrater reliability coefficients were acceptable (M κ = 0.82). In support of the construct validity, a multivariate analysis showed that BPSA items in the psychopathological section were able to differentiate the expected direction between deceased patients who were depressed and nondepressed. Therefore, the authors considered the BPSA interview to be a reliable assessment of factors potentially associated with death in depressed medical patients, and data presented support the validity of the psychopathological section.

Innovative methods in teaching psychiatry to medical students

Background and Objectives: To test the conjecture that the innovative method to teach psychosomatic psychiatry previously reported will be confirmed as bene- ficial in the training of medical students in the field of general psychiatry. Methods: The emphasis in this course is placed on the discussion of clinical cases, bed- side clinical teaching, and a research-oriented part. The “Innovative Teaching Plan” (ITP) is intended to train student-leaders to guide small groups (SG) of students. The results of an intensive clerkship on bedside teaching are also studied. Trainee performance was assessed by the marks in the final examination, and a reliable and valid tool, the Medical Tea ching Quality Questionnaire (MTQQ) was used to document trainee satisfaction. The results of five academic courses are presented in this report. Results : External experts consulted assured that the content of the course was adequate. Eight hundred and thirty eight medical students have completed the learning course in the study period, and 418 (one of the two groups) completed the evaluation with the MTQQ. Most items related to the students’ satisfaction were rated “high” or “very high”, in- cluding the items asking about the usefulness of the course for physicians, the quality of the teaching methods and the bedside teaching. In relation to innovation, the discussion of clinical cases in small groups was also very satisfactory and the “enhancement of a re- searcher’s mind” was rated “high” or “very high” by 1/3rd of medical students. The utili- ty of the yearly evaluation of the quality of teaching methods was supported by results showing that items scored not favourably in the initial evaluation were considerably im- proved in the follow-up evaluations, when modifications in the method were introduced. Conclusions: Good performance and high satisfaction of medical students was docu- mented in a course on general psychiatry. Lessons may be drawn to inform about efficient and effective ways of teaching and learning this subject

The state of the art in European liaison psychiatry and psychosomatics

The 11th meeting of the European Association for authorized guideline for liaison psychiatry of the Dutch Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) was held in Zaragoza, Spain, from June 25 to June 28, 2008. This was the second time that Spain had played host to the EACLPP meeting which was held in collaboration with the meeting of the Spanish Psychosomatic Medicine Association (SEMP) and the European Conference on Psychosomatic Research (ECPR). The conference was very well attended by delegates from Europe, the USA, and other countries. The meeting also coincided with the EXPO International Exhibition, and it was a great opportunity to visit Zaragoza and combine research with culture. Unfortunately, because of the success of EXPO 2008, there were some initial problems with hotel accommodation but these were resolved quickly. We are convinced that most people agreed it was worth the effort and the meeting was probably one of the best attended of all the European psychosomatic and liaison psychiatry meetings. A central issue of the conference was holistic medicine, both from the clinical and the research perspectives. The “psychosomatic” humanistic views were obvious in the presentations, as was the empirical philosophy, which was used in an attempt to find “evidence-based” foundations for our practice. Interactivity was promoted through “meet the expert” discussions, round tables, debates, workshops and symposia, following the tradition of recent years in our meetings. Recent advances were presented, and the range of topics covered gave an idea of the contemporary scope in the field. One of the most important topics covered was delirium. This included issues of clinical guidelines, new neuroleptics, the importance of cytokines in the pathogenesis or collaborative treatment issues. One of the highlights of the meeting was the intervention by Prof. Robinson, from Iowa, USA, who gave a presentation of new data related to the prevention of post-stroke depression and the reduction of mortality by means of antidepressant treatment. The current state of liaison psychiatry in Europe was discussed once again in Zaragoza, but the president of the American Academy of Psychosomatic Medicine, Dr. C. Alter, also informed the conference about new developments in the US. Dr. A. Leentjens, President of the EACLPP, presented the recently