Meta-Analysis of the Prevalence of Major Depressive Disorder Among Older Adults With Dementia.

OBJECTIVE: Little is known about the overall prevalence of major depressive disorder (MDD) in persons with dementia (ie, "depression in dementia": DpD). The aim of this systematic review and meta-analysis was to determine the prevalence and factors associated with DpD among older adults (age range 58.7-87.8 years). The protocol was registered in the PROSPERO registry (2015:CRD42015020681). DATA SOURCES: We searched the following electronic databases: MEDLINE (1946-February 2017), Embase (1980-2017 week 5), and PsycINFO (1967-February 2017) using medical subject headings and free-text search terms for studies in the English language. STUDY SELECTION: We screened 9,421 studies, and 55 met the inclusion criteria (ie, used validated criteria for both MDD and dementia). DATA EXTRACTION: Two independent reviewers extracted data from included studies. Meta-analysis was used to determine the pooled estimates and 95% confidence intervals for the prevalence of DpD. Prevalence across dementia subtypes, study setting, diagnostic criteria, and dementia severity was compared in subgroup analyses. RESULTS: The prevalence of MDD in all-cause dementia was 15.9% (95% CI, 12.6%-20.1%). The prevalence of MDD was higher among individuals with vascular dementia (24.7%) compared to Alzheimer's disease (14.8%). Studies using the provisional diagnostic criteria for DpD reported a higher prevalence (35.6%) compared to studies using either the DSM-III-R (13.2%) or DSM-IV (17.3%) criteria. CONCLUSIONS: Depression is common among individuals with dementia, and the type of dementia and diagnostic criteria affect prevalence estimates of DpD. Further studies are required to understand factors that lead to the development of DpD and strategies to prevent and treat DpD.

Forensic psychiatric service provision in Pakistan and its challenges.

In the Islamic Republic of Pakistan the law relating to people who are mentally ill, until 2001, was set out by the Lunacy Act of 1912, which was inherited from the British colonial occupiers. In 2001 the Mental Health Ordinance 2001 took its place but only for this federal law to be superseded in April 2010 with the 18th constitutional amendment. As part of that amendment, provinces have become responsible for (psychiatric) healthcare, including mental health legislation. Forensic psychiatry is practised in Pakistan but is very much in its infancy; it needs to develop and learn from more experienced countries in Europe and North America. Cultural factors and misconceptions arising from religion can at times contribute to, or create, barriers to the implementation of forensic psychiatric services in Pakistan. This paper reviews the current state of forensic psychiatric services in Pakistan and is intended to open the debate on the challenges ahead.

Canadian Physicians' Attitudes towards Accessing Mental Health Resources.

Despite their rigorous training, studies have shown that physicians experience higher rates of mental illness, substance abuse, and suicide compared to the general population. An online questionnaire was sent to a random sample of physicians across Canada to assess physicians' knowledge of the incidence of mental illness among physicians and their attitudes towards disclosure and treatment in a hypothetical situation where one developed a mental illness. We received 139 responses reflecting mostly primary care physicians and nonsurgical specialists. The majority of respondents underestimated the incidence of mental illness in physicians. The most important factors influencing respondent's will to disclose their illness included career implications, professional integrity, and social stigma. Preference for selecting mental health treatment services, as either outpatients or inpatients, was mostly influenced by quality of care and confidentiality, with lower importance of convenience and social stigma. Results from this study suggest that the attitudes of physicians towards becoming mentally ill are complex and may be affected by the individual's previous diagnosis of mental illness and the presence of a family member with a history of mental illness. Other factors include the individual's medical specialty and level of experience. As mental illness is common among physicians, one must be conscious of these when offering treatment options.