Jean-Louis Terra

Associations Between Anxiety, Depression, and the Metabolic Syndrome

BACKGROUND There is limited evidence as to whether the metabolic syndrome (MetS) is associated with depression or anxiety and, if so, whether this association is gender-specific. This study investigated in each gender whether the MetS is associated with anxiety or depression and whether these relationships are independent of age, obesity, smoking status, socioeconomic factors, and lifestyle. METHODS Metabolic syndrome (American Heart Association/National Heart, Lung, and Blood Institute criteria), depression, and anxiety (Hospital Anxiety and Depression Scale) were assessed in 1598 subjects at risk of cardiovascular disease. RESULTS In both men and women, the MetS was associated with an increased prevalence of depression but not anxiety. The number of components of the MetS increased with increasing levels of depression but not anxiety. This association between the MetS and depressive symptoms was independent of age, smoking status, socioeconomic factors, and lifestyle. The relationship was observed across body mass index categories and was independent of anxiety. CONCLUSIONS The MetS is associated with depression and depressive symptoms but not anxiety irrespective of gender and overweight/obesity status in subjects at risk of cardiovascular disease. These findings suggest a potential importance of screening for depression in patients with the MetS.

Depressive symptoms are associated with unhealthy lifestyles in hypertensive patients with the metabolic syndrome

Objective Metabolic syndrome results from a complex interaction between lifestyle and genetic factors. Among this population, adhesion to healthy recommendations is a cornerstone of cardiovascular disease prevention. We examined the association between depression and multiple unhealthy behaviours in hypertensive patients with the metabolic syndrome. Research design and methods Eight hundred and forty consecutive hypertensive subjects with the metabolic syndrome were studied in our secondary-care centre. Separated scores reflecting unhealthy behaviours (physical inactivity, smoking and unhealthy diet) were combined to produce a global unhealthy lifestyle score. The Hospital Anxiety and Depression scale was used to assess and quantify depression. We performed a separate analysis for each sex. Results The prevalence of depression (13.0 versus 7.3%, P < 0.001) was greater in women than in men. Presence of depression was significantly associated in both men and women with unhealthy diet (in particular, excessive cholesterol and total caloric intake) but also with decreased physical activity in men and with smoking habits in women. In both sexes, the global unhealthy lifestyle score, reflecting a cluster of unhealthy behaviours, was positively correlated with the depression score. In multivariate analysis, the depression score appeared in both sexes as an independent determinant of unhealthy lifestyle. Conclusions Among hypertensive subjects with the metabolic syndrome, depressive symptoms along a continuum of severity are independently associated with multiple unhealthy lifestyles. This suggests that even minor forms of depression may impact on adhesion to health behaviours beyond major depressive symptoms and/or psychiatric condition.

Nocturnal plasma melatonin levels in schizophrenic patients

It has been suggested that melatonin may be the best peripheral index of the pineal function in humans. The development of assays for melatonin has recently made it possible to investigate pineal function in psychiatric disorders. Low nocturnal levels of melatonin have been reported in depressive patients (Wetterberg et al. 1979; Mendlewicz et al. 1980; Beck-Friis et al. 1984; Claustrat et al. 1984). Ferrier et al. (1982) detected a reduction in the 24-hr melatonin plasma level and the 24/08&r melatonin ratio in a group of 21 male chronic schizophrenic patients. In the present study, midnight plasma melatonin levels of a group of schizophrenic inpatients under medication were measured.

Left temporoparietal transcranial magnetic stimulation in treatment-resistant schizophrenia with verbal hallucinations

Left temporoparietal repetitive transcranial magnetic stimulation (rTMS) reportedly diminishes verbal hallucinations. A 21-year-old schizophrenic man, who had killed his mother in the belief that she was a demon, failed to respond to combined treatment with a variety of antipsychotic agents. His persistent hallucinations consisted of two voices (God and the Devil). As an adjunct to continued antipsychotic medication, the patient received a course of rTMS: 10 sessions of 1-Hz stimulations near Wernickes area. After rTMS, the patients hallucinations grew less intrusive and he no longer required isolation. Although the improvement could be a delayed effect of medication, further trials of rTMS in cases of this type appear justified.

No season-of-birth effect in schizophrenic patients from a tropical island in the Southern Hemisphere

The distribution of birth rates was examined in 668 schizophrenic patients born in Réunion, a tropical French island in the Southern Hemisphere, and compared with that in the general local population. We failed to observe a significant season-of-birth effect, either in the total sample of schizophrenic patients or in subgroups categorized by gender, age, or family history of schizophrenia. Seasonal factors do not appear to affect the yearly distribution of births among schizophrenic patients on Réunion Island. It is nevertheless possible that environmental factors which are seasonal in countries with more contrasting climates have a continuous effect, throughout the whole year, in subtropical areas. Conversely, these findings provide some evidence against the hypothesis that there is an age-incidence artifact in seasonal studies from countries in the Northern Hemisphere.

Increased serum levels of neuron-specific enolase in epileptic patients and after electroconvulsive therapy : a preliminary report

Serum neuron-specific enolase (NSE) levels were studied by an enzymo-immunoassay method in 2 groups of patients: a group of epileptic patients, and a group of patients with refractory major depression after electroconvulsive therapy (ECT). In patients without organic neurological disease (n = 274) the mean serum NSE level (+/- S.D.) was 8.4 +/- 3.4 micrograms/l. No correlation with sex or age was observed. No significant difference was observed between epileptic patients without seizure or major electroencephalogram (EEG) abnormality, and a reference group. Significant increases were observed in 32 samples collected from patients with interictal EEG without spikes and waves before the 7th day after a seizure, in whom mean NSE was 21.5 +/- 9.4 micrograms/l, and in 26 samples from 4 patients without seizures but with spikes and waves in the interictal EEG, whose mean NSE was 20.6 +/- 11.5 micrograms/l. The increases of serum NSE levels in epileptic patients seem therefore to be linked to seizures and/or to EEG abnormalities. The consequences of these observations for the survey of epileptic patients, and for the diagnosis of cerebral tumors (mainly neuroblastoma) or for monitoring treatment after surgical resection, are discussed. In only 1 patient out of 6, an increase in serum NSE levels was observed with a peak about 12 h after ECT. No significant correlation with the ECT features (length of seizures, one- or two-sided electrodes) was observed.

Relationship between symptoms rated with the Positive and Negative Syndrome Scale and brain measures in schizophrenia.

The Positive and Negative Syndrome Scale (PANSS) was used to rate clinical symptoms in 42 inpatients with schizophrenia before they were examined by computed tomography. Significantly higher mean size of lateral and third ventricles, and higher mean cortical atrophy were found in schizophrenic patients compared with healthy control subjects. Ventricular enlargement and cortical atrophy were significantly related to low scores on the Composite subscale of the PANSS. Positive correlations were observed mainly with negative items such as blunted affect, emotional withdrawal, difficulties in abstract thinking, passive-apathetic social withdrawal, and lack of spontaneity of conversation. Additional positive correlations were observed with two items from the General Psychopathology subscale (mannerisms and disorientation). Inverse correlations were found with most positive items. These results suggest a relationship between brain structural abnormalities and the symptomatology of schizophrenia recorded with PANSS.

Characteristics of socially withdrawn youth in France: A retrospective study:

Background: Poor social interactions have been recognized as a symptom since the beginnings of psychiatry. As far as socially withdrawn youth (SWY) are concerned, studies were mostly conducted on patients seeking care. Our psychiatric outreach team called Psymobile was able to reach SWY patients who were not seeking mental health care. Aims: To identify the clinical and socio-demographic characteristics of SWY patients referred to our Psymobile unit. Method: We carried out a retrospective study on the records of patients aged 18–34 years, who were referred to Psymobile for ‘withdrawal’, between April 2012 and December 2015. Results: In total, 66 patients were included in the study. SWY are predominantly male (80%) from large families or single-parent ones. About 42% had no prior contact with a mental health professional before being referred to Psymobile. The mean duration of withdrawal is 29 months. In all, 42% of SWY use cannabis and 73% present disorders of the sleep–wake schedule. About 71% maintain relations with their families and 73% go out occasionally. They are mostly diagnosed with schizophrenia (37%) or mood disorders (23%). Conclusion: Over one-third of Psymobile patients aged 18–34 years were referred on grounds of social withdrawal. Our data may illustrate more accurately the situation of youth social withdrawal amid the general population than data from help-seeking patients or online questionnaires.

Barriers to the Prevention of Suicide in Nursing Homes

Background: The suicide rate in older people is high. Gatekeeper training is recommended for at-risk populations in the detection and management of suicidal residents in nursing homes. Aims: This study focuses on how caregivers in nursing homes consider suicide in older people from a social perspective, and to what extent these social representations are an obstacle to the prevention of suicide. Method: This study is both observational and qualitative, and is based on semi-directed one-to-one interviews with caregivers. Results: We met with 18 caregivers from three nursing homes in 2015. We show that the social representations of caregivers working in nursing homes are essentially identical to those of the general population and those found in other studies on paramedics. Suicide is seen as an expression of autonomy, a response to the suffering associated with aging and the living conditions imposed on older people in our society, particularly in nursing homes. Limitations: Our study highlights the problems inherent to the position of caregiver, in which we can observe a conflict between professional missions and personal ideology. Conclusion: This study confirms the need to continue training on suicide prevention in nursing homes.