Do Life Events and Social Support Vary across Depressive Disorders?

BACKGROUND: Social support and life events moderate the expression of depression though studies have shown contradictory results. The objective was to study the stressful life events and perceived social support in patients with adjustment disorder, first-episode depression, and recurrent depressive disorder (RDD). SUBJECTS AND METHODS: One hundred and forty-six patients aged 18-60 years with adjustment disorder, first-episode depression, or RDD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were evaluated using the presumptive stressful life events scale and Multidimensional Scale of Perceived Social Support. RESULTS: There was no difference in mean number of total life events and subgroups as well as perceived stress score in the past 1 year between the groups. There was no difference in the perceived social support scale total score, as well as from family and friends, across the three groups. However, the mean perceived social support from significant others in those with RDD was lower as compared to those with adjustment disorder. CONCLUSION: Stressful life events do not differ in adjustment disorder, first-episode depression, and RDD. Furthermore, the perceived social support was similar across the three groups, except for perceived social support from significant others, which was less in those with RDD.

Cognitive Behaviour Therapy for Anxiety and Depression among People Undergoing Haemodialysis: A Randomized Control Trial.

INTRODUCTION: Chronic Kidney Disease (CKD) is becoming a major public health problem worldwide. The very diagnosis of CKD brings a plethora of psychological problems that adds to the agony of the debilitating illness. Financial difficulties apart from the excruciating physical burden of the disease, owing to series of psychosocial issues. Anxiety and depression are two major concerns that to be managed effectively to sustain the life of people undergoing Haemodialysis. AIM: The study aimed at finding the effect of Cognitive Behaviour Therapy (CBT) on anxiety and depression among people undergoing haemodialysis. MATERIALS AND METHODS: An experimental approach with Randomized controlled trial design was adopted for the study. The instruments used for data collection were Background Proforma and Hospital Anxiety and Depression Scale (HADS). A total of 150 subjects undergoing haemodialysis in a tertiary care hospital of South Karnataka were screened for inclusion and exclusion criteria and 80 participants were recruited for the study. Through computerized block randomization 40 each were allotted to experimental and control groups whereas 33 and 34 respectively in both the groups completed the study. CBT, a structured individual therapy of cognitive, behavioural and didactic techniques, with 10 weekly sessions each was administered to the experimental group. Non-directed counseling, a psychological intervention with ten weekly sessions of individual counseling was given to the control group. RESULTS: The findings of the study revealed that there was a significant reduction of mean anxiety (F=76.739, p=0.001) and depression (F=57.326, p= 0.001) in the experimental group when compared with the control group. CONCLUSION: Researchers concluded that CBT can be effectively utilized for people undergoing haemodialysis in order to obtain control over their negative thoughts thereby reducing anxiety and depression.

Gender Differences in Perceived Social Support and Stressful Life Events in Depressed Patients.

OBJECTIVE: To study the gender differences in perceived social support and life events in patients with depression. METHODS: A total of 118 patients aged 18 to 60 years, with depressive disorder according to the DSM-IV-TR, were evaluated using the Multidimensional Scale of Perceived Social Support and Presumptive Stressful Life Events Scale. RESULTS: The perceived social support score was significantly higher in males than females (p < 0.001). Males perceived significantly higher social support from friends than females (p < 0.001), whereas support from significant others was higher in females. There was a higher mean number of total life events as well as specific type of life events in males that became apparent after controlling for education (p < 0.05). Financial loss or problems was the most commonly reported life event in both males and females. Work-related problems were more commonly reported by males, whereas family and marital conflict were more frequently reported by females. CONCLUSION: Perceived social support and stressful life events were higher in males with depression than females.

First evidence to show the topological change of DNA from B-dNA to Z-DNA conformation in the hippocampus of Alzheimer's brain.

Alzheimer's disease (AD) is a complex neurodegenerative disorder. Our studies for the first time showed evidence for altered DNA conformation in the hippocampus of Alzheimer's disease affected brain. The Circular dichroism spectra of severely affected AD DNA showed a typical left-handed Z-DNA conformation, whereas normal, young, and aged brain DNA have the usual B-DNA conformation. Moderately affected AD DNA has modified B-DNA conformation (probable B-Z intermediate form). The ELISA, ethidium bromide binding pattern to DNA and melting temperature (Tm) profiles also revealed the conformational transition from B to Z DNA in AD brain DNA. The altered conformation of DNA will have tremendous implications in gene expressions.

Suicide pact survivors: some observations.

Interviews with seven survivors of four suicide pact paris are examined. In the majority of cases the instigator is more likely to be the male member of the pair. Absence of past suicidal behaviour, and some socio-cultural aspects surround the Indian pact member, in comparison with the West. The existing legal provisions relating to criminal liability for complicity in suicide of another person are summarized. The role and attitude of the Indian Penal Code in dealing with suicide pact survivors is discussed.

Criminalizing suicide attempts: can it be a deterrent?

Suicidal behaviour constitutes a serious public as well as mental health problem all over the world. Many developed countries have done away with the legal provision of punishing attempted suicides. However, in India this continues to be a punishable offence under the Indian Penal Code (1833). This review discusses the various issues related to criminalizing suicide and their implications.

Dowry death: implications of law.

The giving of dowry on marriage is a widespread custom in India, but the attitude of society towards this practice is neither uniform nor consistent. 'Dowry death' is the result of a unique form of violence suffered by Indian women. The existing legal provisions relating to dowry and dowry deaths are summarized, and the role of the Indian Penal Code is discussed. Case reports are presented.

Sleep problems in preschool and school aged rural Indian children.

We assessed 513 children (2-6 y = 252; 7-12 y = 261) who visited the pediatric outpatient of a rural medical college hospital, for sleep problems using BEARS tool. Sleep problems detected in the BEARS domains for preschool (2-6 years, n=252) and school children (7-12 years, n=261) were as follows: bedtime problems (33.3%vs 14.9% P< 0.001), excessive daytime sleepiness (32.5%vs 1.9% P<0.001), awakening during night (25%vs 11.87% P< 0.001), regularity and duration of sleep (19.84% vs 4.98% P< 0.001), and sleep disordered breathing (4.8% vs 5% , P=0.1). We conclude that sleep problems are common among rural Indian children and should be routinely screened for during health visits.

The noncompliant patient in psychiatry: the case for and against covert/surreptitious medication.

Nonadherence to treatment continues to be one of psychiatry's greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients' family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal and ethical issues of a patient's competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious administration can be seen as a breach of trust by the doctor or by family members who administer the drugs. Covert medication contravenes contemporary ethical practice. Legally, treatment without consent is permissible only where common law or statute provides such authority. The practice of covert administration of medication is not specifically covered in the mental health legislation in developing countries. Many of the current dilemmas in this area have come to public attention because of two important developments in medical ethics and the law - the increasing importance accorded to respect for autonomy and loss of the parens patriae jurisdiction of the courts [parens patriae means 'parent of the country'; it permitted a court to consent or refuse treatment on behalf of an 'incapacity', or alternatively to appoint a guardian with such powers].

Suicidal behaviour among terminally ill cancer patients in India.

BACKGROUND: Passive suicidal thoughts are relatively common in patients with terminal cancer. There is a need for more information about the factors that influence these patients to desire death. AIM: To examine the prevalence of suicidal ideation among terminally ill cancer patients. METHODS: Fifty-four terminally ill inpatients (27 men and 27 women) from the palliative care unit of the Oncology department of Kasturba Hospital, Manipal were evaluated on various rating scales for depression, hopelessness and suicidal ideation, and the correlation of suicidal ideation with medical symptoms such as pain, as well as awareness of the diagnosis and understanding of the illness. RESULTS: Most patients (79.7%) denied having suicidal thoughts or wishing for an early death; only 9.2% had severe suicidal ideation. Two patients (3.8%) with severe suicidal ideation had a past history of major depression. Factors such as the presence of pain, awareness of the diagnosis and understanding of the illness contributed to depressive mood states. CONCLUSION: Suicidal ideation and a desire for death appear to be linked exclusively to the presence of a mental disorder. In addition, poor pain control, and awareness of the diagnosis may also contribute to suicidal ideation.

Suicide attempters in a general hospital unit in India: their socio-demographic and clinical profile--emphasis on cross-cultural aspects.

The number of suicide attempts in developing countries has been increasing progressively, as in the West. It is important to note that much of the data on suicidal behaviour is based on information obtained from developed Western societies. All such data need to be evaluated within their specific cultural context as well as cross-culturally. The present study explored the various socio-demographic, clinical characteristics of suicide attempters in a general hospital unit in India. There were certain findings that contrasted markedly with those observed in the West. Male suicides tended to predominate here, as in many Indian studies. None of them were living alone, separated or deserted by their partner. Some suicide attempters continued to live with their extended family. There was virtually no alcohol consumption by female suicide attempters. The commonest agents used were organophosphates and other household poisons. Several cross-cultural variations in the suicidal act emerged compared to the West. The 'suicide potential' in the Indian culture is discussed.