The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study.

Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.

Pleasure: The missing link in the regulation of sleep.

Although largely unrecognized by sleep scholars, sleeping is a pleasure. This report aims first, to fill the gap: sleep, like food, water and sex, is a primary reinforcer. The levels of extracellular mesolimbic dopamine show circadian oscillations and mark the "wanting" for pro-homeostatic stimuli. Further, the dopamine levels decrease during waking and are replenished during sleep, in opposition to sleep propensity. The wanting of sleep, therefore, may explain the homeostatic and circadian regulation of sleep. Accordingly, sleep onset occurs when the displeasure of excessive waking is maximal, coinciding with the minimal levels of mesolimbic dopamine. Reciprocally, sleep ends after having replenished the limbic dopamine levels. Given the direct relation between waking and mesolimbic dopamine, sleep must serve primarily to gain an efficient waking. Pleasant sleep (i.e. emotional sleep), can only exist in animals capable of feeling emotions. Therefore, although sleep-like states have been described in invertebrates and primitive vertebrates, the association sleep-pleasure clearly marks a difference between the sleep of homeothermic vertebrates and cool blooded animals.

Coping strategies and postpartum depressive symptoms: A structural equation modelling approach.

BACKGROUND: Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks. METHODS: A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression. RESULTS: Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism. CONCLUSIONS: Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.

Mood changes after delivery: role of the serotonin transporter gene.

BACKGROUND: Polymorphic variations in the serotonin transporter gene (5-HTT) moderate the depressogenic effects of tryptophan depletion. After childbirth there is a sharp reduction in brain tryptophan availability, thus polymorphic variations in 5-HTT may play a similar role in the post-partum period. AIMS: To study the role of 5-HTT polymorphic variations in mood changes after delivery. METHOD: One thousand, eight hundred and four depression-free Spanish women were studied post-partum. We evaluated depressive symptoms at 2-3 days, 8 weeks and 32 weeks post-partum. We used diagnostic interview to confirm major depression for all probable cases. Based on two polymorphisms of 5-HTT (5-HTTLPR and STin2 VNTR), three genotype combinations were created to reflect different levels of 5-HTT expression. RESULTS: One hundred and seventy-three women (12.7%) experienced major depression during the 32-week post-partum period. Depressive symptoms were associated with the high-expression 5-HTT genotypes in a dose-response fashion at 8 weeks post-partum, but not at 32 weeks. CONCLUSIONS: High-expression 5-HTT genotypes may render women more vulnerable to depressive symptoms after childbirth.

Plan integral de prevención del tabaquismo desde los servicios de prevención: experiencia pionera en Baleares / Integral plan for prevention of tobacco smoking addiction based on the preventive medicine services: a pioneer experience inthe baleric islands

Lograr que los Servicios de Prevención de Baleares estén formados para abordar unplan integral frente al tabaquismo en su respectivas empresas con una metoldología homogénea. Personas y métodos: Partiendo de la experiencia piloto de GESMA se elabora un documento de trabajo donde se recogen las distitnas fases para conseguir la implantación de un programa integral de prevención frente al tabaquismo en la empresa. Se establece un programa formativo, con contenidos teóricos y prácticos, para todos los profesionales sanitarios de los Servicios de Prevención interasados. Finalmente se establece un sistema de tutela para la implantación del programa en las empresas. Resultados: Al programa formativo acuden 57 profesionales que representan a 27 servcios de prevención diferentes (el total de trabajadores representados es superior a 150.000, lo que supone más del 70% de los trabajadores protegidos). El número de servicios que ya han implantado el plan es de 11 (40,74 % d elos que acudieron a la formación). Está previsto que este número aumente durante este año. Conclusiones: Creemos que es importante potenciar el papel de los Servicios de Prevenicón frente al tabaquismo. Consideramos que esta actividad, pionera en España, ha resultado muy útil y que debería valorarse la posibilidad de exportaria al resto de las comunidades (AU)

Aims: To achieve that the Preventive Medicine Services in the Balearic islands may be fully and correctly trained in implementing an integrated plan against tobacco addiction intheir respective enterprises applying a homogeneous methodology. Subjects and methods: Based on the GESMA (Gestión Sanitaria de Mallorca, Mallorca Health Care Management) pilot experience, a working document has been prepared that conjoins and summarises the various phaes for achieving the implementation of an integrated prevention programme against tobaco smoking addiction at the workplace. A training programme with theoretical and practical curricula is established for all health care professionals working in the interested Preventive Medicine Services. Finally, a tutorship system is proposed formimplementing this programme in the various enterprises. Resutls: The activities of the training programme were attended by 57 health care professionals representing 27 independent Preventive Medicine Services (encompassing over 150.000 workers or over 70% of all protected workers). The number of Servies having already implemented the Plan is 11 (40,74%) of those attending the training programme); it is foreseen that this number will increase during the present year. Conclusions; We believe it is important to enhace the role of Preventive Medicien Services against tobacco smoking addiction. We hold that this activity, a pioneer one in Spian, has been quite useful, and that the posibility should be seriously considered to export it to the remainder of the Autonomous Communities in Spain (AU)

Uso de los antidepresivos en el tratamiento del insomnio / Use of antidepressants in the treatment of insomnia

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Calidad de vida de los pacientes con narcolepsia y sus consecuencias psicosociales / Quality of life in patients with narcolepsy and their psychosocial consequences

Los estudios realizados hasta ahora han demostrado que el síndrome narcolepsia-cataplejia menoscaba la calidad de vida de las personas que lo padecen. Entre sus repercusiones destacan alteraciones psicopatológicas, principalmente síntomas depresivos recurrentes y cambios en la personalidad respecto a la personalidad premórbida. En cuanto a la vida de relación de los pacientes, se observan: disminución del rendimiento escolar y laboral, mayor riesgo de padecer accidentes laborales, de tráfico y domésticos y mayores dificultades en sus relaciones sociales. Hemos evaluado una muestra clínica formada por todos los pacientes con narcolepsia tratados en la consulta de sueño de Psiquiatría del Hospital "Son Dureta" de Palma de Mallorca, observando que tanto los problemas de adaptación psicosocial como los trastornos psicopatológicos que padecen son similares a los de los pacientes con narcolepsia de otras latitudes geográficas. Las causas de estas alteraciones son los principales síntomas de la enfermedad, fundamentalmente la somnolencia diurna. El mejor conocimiento de los trastornos de sueño, dirigido a un diagnóstico más rápido de la enfermedad, y la utilización de fármacos más efectivos en el control de los síntomas, parecen ser los puntos clave para mejorar la calidad de vida de los pacientes con narcolepsia (AU)

[Epidemiologic study of myotonic dystrophy on the island of Mallorca]. / Estudio epidemiológico de la distrofia miotónica en la isla de Mallorca.

Myotonic dystrophy (MD) or Steinert's disease is the most frequent hereditary myopathy in the adult. The aim of this study was to determine the rate of prevalence of MD on the island of Mallorca. Patients diagnosed with MD were studied in all public and private surgeries and centres able to diagnose this disease on the island of Mallorca. Therefore, this study included the whole population of Mallorca (551,129 inhabitants). A total of 60 cases were studied representing a prevalence rate of 110 cases per one million inhabitants. The patients were further classified according to the existence of family history and were geographically located into the different towns. The prevalence rate found was much higher than that described in the literature which oscillates between 30 and 50 cases per million inhabitants. Furthermore, there was a concentration of cases in 10 of the 52 towns of the island with the presence of 2 cases in 6 being significant. The rate of prevalence of the disease in the city of Palma (295,136 inhabitants) representing more than half of the population of the island was very similar (120 per million) to that found for the population as a whole.