Associations between Maternal and Offspring Hair Cortisol Concentrations and Child Behavioral Symptoms in Mother-Child Pairs with Perinatal Mental Disorders.

Maternal perinatal mental disorders (PMD) are associated with developmental and behavioral problems in children, probably mediated by the programming of the hypothalamic-pituitary-adrenal (HPA) axis. Increased cortisol concentrations during the antenatal and perinatal periods have been related to long-term effects on children's behavior and stress response. We aimed to investigate the association of hair cortisol concentrations (HCC) between mothers, with (n = 16) and without PMD (n = 30), and their children, aged between 18 and 48 months. Participants were evaluated with a clinical interview and questionnaires for the Depression Anxiety Stress Scale and the Child Behavior Checklist for ages 1½-5. Maternal and child HCCs were compared between the two groups. Children of the PMD group had increased symptoms of attention deficit hyperactivity disorder. A positive linear association between maternal and child HCC was observed only in the total sample of mother-child dyads and the control group. In the PMD group, children's HCCs were significantly associated with child anxiety/depression symptoms. Aggressive behavior and oppositional/defiant problems correlated significantly with children's own HCCs, and their mother's too. These findings suggest that a chronic dysregulation of maternal and child HPA axis and their associations in the PMD dyads may underlie the linkage among prolonged maternal stress, child behavioral/emotional problems and stress responses.

Association between gestational diabetes and perinatal depressive symptoms: evidence from a Greek cohort study.

Aim The aim of the present study was to assess the association of gestational diabetes mellitus (GDM) with prenatal and postnatal depressive symptoms in a sample of pregnant women in Greece. BACKGROUND: Earlier research supports a relationship between depression and diabetes, but only a few studies have examined the relationship between GDM and perinatal depressive symptomatology. METHODS: A total of 117 women in their third trimester of pregnancy participated in the study. Demographic and obstetric history data were recorded during women's third trimester of pregnancy. Depressive symptoms were assessed with the validated Greek version of the Edinburg Postnatal Depression Scale (EPDS) at two time points: on the third trimester of pregnancy and on the first week postpartum. Findings Prevalence of GDM was 14.5%. Probable diagnosis of depression occurred for 12% of the sample during the antenatal assessment and 15.1% in the postpartum assessment. In the first week postpartum, women with GDM had significantly higher postpartum (but no antenatal) EPDS scores compared with the non-GDM cohort. In conclusion, GDM appears to be associated with depressive symptoms in the first week postpartum. Clinical implications and recommendations for future research are discussed, emphasizing the importance of closely monitoring women with GDM who seem more vulnerable to developing depressive symptomatology during the postnatal period.

Birth order and memories of traumatic and family experiences in Greek patients with borderline personality disorder versus patients with other personality disorders.

The purpose of this study was to assess the possible effect of recalled traumatic experiences, perceived parental rearing styles, and family parameters on the occurrence of borderline personality disorder (BPD) versus other personality disorders (other-PDs). A total of 88 adult outpatients with personality disorders completed the Traumatic Antecedents Questionnaire and the Egna Minnen av Barndoms Uppfostran, which measures perceptions regarding parental rearing. Results indicated that incidence of traumatic childhood experiences was higher among those in the BPD group compared to those in the other-PD group. Firstborns were less likely to carry a diagnosis of BPD over other-PDs. Also, significantly more BPD compared to other-PD patients reported being the father's favorite child over siblings. Results suggest that traumatic experiences, birth order, and family interactions in the presence of siblings seem to differentially affect the formation of borderline diagnosis compared to other-PDs. Limitations and clinical implications of the study are discussed in detail.

Limited Depressive and Anxiety Symptoms Late in Pregnancy Are Not Related to Neonatal Outcomes.

BACKGROUND: Prior studies have reported inconsistent findings regarding the link between antenatal depressive and anxiety symptomatology, with neonatal outcomes. OBJECTIVES: The aim of the present study was to assess the possible association of prenatal depressive and anxiety symptoms, in the third trimester of pregnancy, with perinatal outcomes (birth weight of the newborn, Apgar score and the newborn's admission in neonatal intensive care unit) in a sample of pregnant women, in Greece. PATIENTS AND METHODS: A total of 117 women from Athens, during the 32(nd) to 35(th) week of pregnancy, participated in the study. Demographic and obstetric history data, as well as neonatal outcomes, were recorded. Three self-administered psychometric scales (Beck depression inventory (BDI), Edinburg postnatal depression scale (EPDS) and beck anxiety inventory (BAI)) were used to evaluate in detail the prenatal depressive and anxiety symptoms. Descriptive statistics, Spearman's Rho coefficients, Mann-Whitney U and Kruskal-Wallis testes were applied to analyze the data. RESULTS: On the basis of BDI, 81.1% of the sample showed minimal, 15.4% mild, 2.6% moderate and 0.9% severe depressive symptoms, respectively. Furthermore, 80.3% of the participants, scored on EPDS below the cut-off point for a likely diagnosis of depression. According to BAI scale, 43.6% showed minimal, 42.7% women mild, 10.3% moderate and 3.4% severe anxiety symptoms. No statistically significant correlations were found between depressive and anxiety symptoms and neonatal outcomes (birth weight, Apgar score and admission in neonatal intensive care unit). CONCLUSIONS: Limited levels of prenatal depressive and anxiety symptoms do not seem to be associated with neonatal outcomes. In clinical practice, pregnant women, who suffer from low levels of prenatal depressive and anxiety symptoms, may be reassured, in respect of the adverse outcomes of these mood symptoms on the neonate.

Vasomotor and depression symptoms may be associated with different sleep disturbance patterns in postmenopausal women.

OBJECTIVE: This study aims to explore the association of vasomotor symptoms (VMS) and depression symptoms with different symptoms of subjective sleep disturbance in postmenopausal women. METHODS: This is a cross-sectional study of 163 postmenopausal women (not taking hormone therapy) attending a university menopause clinic. Measures included the Athens Insomnia Scale, Greene Climacteric Scale, and Symptom Checklist-90-Revised depression subscale. Covariate-adjusted ordinal logistic regression was used to investigate the association of VMS and depression with each item of the Athens Insomnia Scale. RESULTS: Controlling for confounding factors, we found VMS to be significantly associated with awakenings during the night (odds ratio [OR], 1.85; P < 0.001), overall quality of sleep (OR, 2.00; P < 0.001), well-being during the day (OR, 1.63; P = 0.008), functioning capacity during the day (OR, 1.72; P = 0.01), and sleepiness during the day (OR, 1.66; P = 0.03); whereas we found Symptom Checklist-90-Revised depression subscale scores to be associated with sleep induction (OR, 2.09; P < 0.001), final awakening earlier than desired (OR, 2.21; P < 0.001), total sleep duration (OR, 1.62; P = 0.01), overall quality of sleep (OR, 1.64; P = 0.009), well-being during the day (OR, 1.67; P = 0.006), functioning capacity during the day (OR, 1.68; P = 0.01), and sleepiness during the day (OR, 1.57; P = 0.04). CONCLUSIONS: VMS and depression symptoms are associated with different patterns of sleep disturbance. Although both symptoms are related to sleep quality, daytime functioning, and daytime well-being, depression is uniquely associated with difficulty falling asleep and waking up earlier than desired, whereas VMS are related to frequent awakenings during sleep. The findings are limited by the cross-sectional design and relatively small sample size of the study. Recommendations for future research are discussed to guide this line of inquiry and to gain a better understanding of the complex relationship between climacteric and mood symptoms and their contribution to the development of sleep disturbances during menopause.

Comorbid attention-deficit/hyperactivity disorder in adult psychiatric outpatients with depressive or anxiety disorders.

BACKGROUND: There are very few studies reporting on the prevalence and the contribution of not previously diagnosed ADHD in the clinical picture of other psychiatric disorders. The aim of our study is to determine the prevalence and clinical correlates of comorbid attention deficit/hyperactivity disorder (ADHD) in adult psychiatric outpatients with depressive or anxiety disorders. METHODS: During a 6-month period, 114 outpatients with depressive or anxiety disorders were evaluated for ADHD diagnosis. Assessment included interviews with both patient and relatives/friends and the use of a daily diary. Moreover, the patients completed the self-report scales Beck Depression Inventory (BDI), Spielberger's Anxiety Inventory (STAI), and the Symptom Checklist-90-R Rating Scale (SCL-90-R). RESULTS: A total of 22 out of 114 patients (19.3%) received an ADHD diagnosis for the first time in their life. Comorbid ADHD compared to non ADHD patients scored significantly higher (p < 0.05) for depression (BDI), state and trait anxiety (STAI) and in the following SCL-90-R factors: Positive Symptoms Distressing Index, Positive Symptoms Index, Somatization, Obsessive Compulsive, Depression, Anxiety, and Hostility. CONCLUSIONS: ADHD might go unrecognized among psychiatric outpatients. Patients with depressive or anxiety disorder reporting more severe symptomatology should be carefully screened for possible comorbid adult ADHD.

Phantom breast syndrome: The effect of in situ breast carcinoma.

Phantom breast syndrome (PBS) represents the experience of the continued presence of the breast, after mastectomy. Our aim was to assess PBS appearance by means of a structured questionnaire and to look into possible associations to disease and treatment parameters, in 105 women with breast cancer treated by mastectomy. PBS was recorded in 22.9% of the patients. In the majority of cases phantom experience had the size (88.9%), shape (76.5%) and weight (64.7%) of the normal breast and was localised in the entire breast (50%). Concerning disease parameters, no association with primary tumour size (T) or lymph node status was detected, but interestingly, in situ breast cancer (DCIS) was found to be more frequently associated with PBS, compared with invasive tumours. No significant associations of PBS with previous sensory experiences of the breast, radiotherapy or systemic treatment were assessed. The results are interpreted within the frame of Melzack's theory of a neuromatrix, assuming that PBS represents the continued existence, even after amputation, of a sensory engram of the breast. The absence of infiltration in primary tumour histology, probably through an unknown pathophysiological mechanism, might play a role for the significantly higher incidence of PBS in women undergoing mastectomy for DCIS.

Psychiatric manifestations preceding fetal death in antiphospholipid syndrome.

OBJECTIVES: Antiphosholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of thrombotic events, pregnancy morbidity and antiphospholipid antibodies. The objective of this report is to sensitize mental health professionals to the psychiatric manifestations of APS during pregnancy. To our knowledge, this is the first report on this matter. CASE SUMMARY: A 34-year-old pregnant woman, with no previous medical, obstetrical or psychiatric history, at the 18th week of pregnancy, acutely developed depressed mood, feelings of anxiety and insomnia with a strong premonition that "the fetus would die." Actual fetal loss ensued a few days later. During induced labor, the patient had an agitated delirium. Symptoms of depression, slowed mentation and apprehension persisted for at least 2 months after fetal demise and required pharmacological treatment. APS diagnosis was established based on clinical events and persistent findings of antiphosholipid antibodies as well as multiple high-density foci in the subcortical white matter of the frontal lobes in brain magnetic resonance imaging. CONCLUSIONS: Psychiatric symptomatology, as well as a premonitory sense of upcoming loss of pregnancy, preceded actual fetal loss and APS diagnosis in the presented case, indicating that psychiatric symptoms may present during pregnancy, perhaps as an early sign.

Additive effect of depressed mood and vasomotor symptoms on postmenopausal insomnia.

OBJECTIVE: The aim of this study was to investigate the role of vasomotor and mood symptoms on insomnia in postmenopausal women. METHODS: One hundred sixty-three postmenopausal women, not receiving hormone therapy, attending a menopause clinic at the University of Athens, Greece, were included in this cross-sectional study. Climacteric symptoms were assessed by Greene's scale, whereas psychological morbidity was measured by Zung Self-Assessment Depression Scale, Symptom Checklist-90-R, and Athens Insomnia Scale. RESULTS: Vasomotor symptoms were significantly associated with insomnia (P = 0.001). When depressive symptomatology was added to the logistic regression analysis, the predictive ability of the model was significantly improved as defined by the increase in the log likelihood (P < 0.001) and the increase in the area under the receiver operating characteristic curve. CONCLUSIONS: Insomnia in postmenopausal women attending a menopause clinic is related both to the effects of vasomotor symptoms and depressive symptomatology. Mood symptoms seem to affect sleep independently of vasomotor symptoms, suggesting that depression should be carefully assessed and treated in postmenopausal women with insomnia.

Depressive symptomatology correlates with phantom breast syndrome in mastectomized women.

OBJECTIVE: Phantom breast syndrome (PBS) after mastectomy has been hypothesized to represent a complex psychological reaction to mastectomy, but psychological studies concerning PBS are few and inconclusive. This study aimed to assess possible correlations of PBS to current psychopathology and personality dimensions, as well as to examine subjectively experienced provoking and relieving factors for the experience of PBS. METHOD: A total of 105 women who had undergone modified radical mastectomy were interviewed by a structured questionnaire after breast surgery. Moreover, they completed a set of self-administered psychometric scales consisting of Symptom Checklist-90-R, Eysenck personality questionnaire, Zung depression scale, State-Trait Anxiety Inventory and Whiteley Index of hypochondriasis. RESULTS: PBS was experienced by 24 women (22.9%). The majority of them thought that PBS did not interfere with their everyday life. Women with PBS scored significantly higher on the Zung depression scale. Multiple logistic regression analysis revealed that women aged more than 66 years were 82% less likely to have PBS compared to those aged less than 51 years. CONCLUSION: These findings provide evidence that PBS is associated with higher scores of depressive symptomatology and younger age. The nature of such an association remains unclear and calls for further investigation.