The relationship between occupational burnout and work ability among firefighters: exploring the mediating effects of insomnia, depressive symptoms, loneliness and alcohol misuse.

Purpose: Firefighting is a profession associated with a high risk of elevated levels of occupational stress and burnout. The aim of this cross-sectional study was to explore the mediating effects of insomnia, depressive symptoms, loneliness and alcohol misuse in the relationship between two dimensions of burnout (i.e., exhaustion and disengagement) and work ability among firefighters. Methods: A total of 460 firefighters from various regions of Poland completed a set of self-report questionnaires to assess constructs of interest. A mediation model was constructed to verify hypothesized paths, adjusted for socio-demographic and work-related background characteristics. Model parameters were estimated using a bootstrapping procedure, with sampling set at N = 1000. Results: The proposed model explained 44% of variance in work ability. Higher levels of both exhaustion and disengagement predicted worsened work ability. When mediators were controlled for, these effects remained statistically significant. Depressive symptoms and feelings of loneliness were found to be partial mediators of the association between exhaustion and work ability, and between disengagement and work ability. The mediating effects of insomnia and alcohol misuse were non-significant. Conclusions: Interventions aimed at counteracting the decrement in work ability among firefighters should target not only occupational burnout, but also depressive symptoms and a sense of loneliness as factors mediating its detrimental effects.

Cognitive decline and dementia in women after menopause: Prevention strategies.

Worldwide, cognitive decline and dementia are becoming one of the biggest challenges for public health. The decline in cognition and the development of dementia may be caused by predisposing or trigger factors. There is no consensus over whether the drop in estrogen levels after menopause is a risk factor for cognitive decline and dementia. This article discusses the prevention of cognitive decline and dementia in women after menopause, both primary prevention (essentially pharmacological intervention) and secondary prevention (chiefly diet and weight reduction). Further study is required to clarify whether menopausal hormone therapy (MHT) has a role in dementia.

Menopause in women with schizophrenia, schizoaffective disorder and bipolar disorder.

The transition to menopause, usually occurring between the ages of 40 and 55, is a time when women are particularly vulnerable. When preexisting mental illness is present, symptoms are often amplified during this period. Moreover, women with mental illnesses experience menopausal symptoms similarly to healthy women. In this narrative review we summarize the current data regarding menopause in women with schizophrenia, schizoaffective disorder, and bipolar disorder, as well as current standards of management and care. The management of chronic disease in women suffering from severe mental illness is also considered.

Efficacy, safety and tolerability of formula-based unilateral vs bilateral electroconvulsive therapy in the treatment of major depression: A randomized open label controlled trial.

Electroconvulsive therapy (ECT) remains the most effective treatment of depression, though it is still unclear which of its type is the most beneficial. The aim of this study was to compare the formula-based right unilateral ECT (RUL) with the fronto-temporal bilateral ECT (BT), in terms of their efficacy, safety and tolerability in patients with bipolar or unipolar depression. Ninety-one patients were randomly assigned to either BT (n = 45) or RUL (n = 46) ECT. Brief pulse width (0.5 ms) and a formula-based dosing method were applied. The clinical efficacy was assessed using the Hamilton Depression Rating Scale (HDRS-21).The somatic state was monitored throughout the ECT course and cognitive examination included: general cognitive performance, executive functions, visual-spatial functions, verbal fluency, verbal memory and autobiographical memory. Efficacy outcomes were not found to be significantly different between groups when using higher doses of energy in RUL ECT. Patients in RUL group were less likely to be confused and experienced increased blood pressure. The indices of general cognitive performance and verbal auditory memory were also significantly better this group, while BT ECT did not change these functions. Both ECT types resulted in a decline in the retrieval consistency of autobiographical memory that persists for at least three months and was significantly more marked in BT group as compared to RUL. In conclusion, formula-based RUL ECT does not differ from BT in antidepressant efficacy and has an advantage in terms of safety (lower incidence of increased blood pressure and fewer disturbances of consciousness) and tolerability (impact on cognitive functions).

The use of buprenorphine in the treatment of drug-resistant depression - an overview of the studies. / Zastosowanie buprenorfiny w leczeniu depresji lekoopornej ­ przeglad wyników badan.

There is evidence that the endogenous opioid system in the brain plays an important role in mood regulation, and disturbances in its functioning may lead to the occurrence of depressive disorders. One of the drugs that affect the endogenous opioid system in the CNS is buprenorphine. The article is areview of the studies on the effectiveness of buprenorphine used as an augmentation of antidepressant treatment. The selection of articles was made by browsing the Medline and PubMed databases with the use of key words 'buprenorphine'and 'treatment of drug-resistant depression'. The analysis included thirty one studies. The results indicate that buprenorphine may be effective in drug-resistant depression in a similar manner as other augmentation strategies added to antidepressant treatment. Co-administration of buprenorphine and samidorphan may reduce the risk of addiction without losing the antidepressant effectiveness of buprenorphine. Further methodologically correct studies in this field are needed. In addition to being a partial agonist of the µ receptor, buprenorphine is also a potent antagonist of the kappa type opioid receptors. The antagonism of µ receptors alone does not cause antidepressant effects. Antagonism towards kappa receptors may cause antidepressant effects as well as reduce the severity of anhedonia. Depressed patients who do not respond to standard antidepressant treatment may have dysfunctions of the kappa receptor that are similar to opioid addicts.

Symptomatic differences and symptoms stability in unipolar and bipolar depression. Medical charts review in 99 inpatients. / Obraz psychopatologiczny i powtarzalnosc wystepowania objawów w chorobie afektywnej jednobiegunowej i chorobie afektywnej dwubiegunowej. Analiza dokumentacji 99 pacjentów.

OBJECTIVES: Misdiagnosis of bipolar disorder may result in a non-optimal treatment, higher servicecosts and increase in the patient's suffering and risk of suicidal behavior. Lack of clinically approved and suitable for widely use biomarkers of BD led clinicians to focus on clinical course and symptomatology of depression in BD. The aim of this study was the retrospective evaluation of symptomatic differences and symptoms stability between MDD and BD patients during three subsequent depressive episodes in the inpatient setting. METHODS: Retrospective chart review of 99 patients with diagnosis of MDD and BD during three subsequent depressive episodes. Chi-squared test and logistic regression was used to analyze the symptomatic profile. Cohen's kappa value used to estimate symptoms stability. RESULTS: Statistical differences were observed in the case of 7 out of 22 depressive symptoms. Somatization (pain and non-pain complains), psychomotor agitation and pathological guilt were more frequent in MDD patients. Anhedonia, attention deficit, and suicidal ideation were more frequent in BD group. In MDD group relatively highest symptom stability was observed for somatization, middle insomnia, early wakening, and attention deficit. In BD group relatively highest symptom stability was observed for delusions, somatization (pain and non-pain complains), initial and middle insomnia, memory disturbance, psychomotor retardation, and pathological guilt. CONCLUSIONS: The observed symptomatic differences may be an additional factor of MDD/DB differential diagnosis. Lower than previously reported symptoms stability highlights the need to evaluate more than one depressive episode in differential diagnosis.

The effect of vitamin D3 deficiency on the severity of depressive symptoms. Overview of current research. / Wplyw niedoboru witaminy D3 na poziom nasilenia objawów depresyjnych. Przeglad aktualnych badan.

Traditional methods of depression treatment with the use of pharmacotherapy with antidepressants have limited effectiveness. Biological, psychological and environmental causes of depressive disorders are known, but pathophysiology of depression has not been fully explained. Many factors and mechanisms play role in the pathophysiology of depression, one of which may be vitamin D3 deficiency. Deficiency or border level of vitamin D3 is fairly common in the general population and may occur even in one billion people globally. Epidemiological studies show that vitamin D3 or its metabolites do not reach an optimal level in most adults. Even lower than the optimal level may cause clinical symptoms and be one of the risk factors for depression. In the population of patients suffering from depressive disorders deficiency or insufficiency of vitamin D3 occur more frequently than in the general population. The use of vitamin D3in patients with depression may have antidepressant effect. Continuous supplementation may also reduce the risk of recurrence. This article is a review of literature on the possible impact of vitamin D3 deficiency on the prevalence of depression and antidepressant effect of the supplementation. Selection of articles was made by searching the Medline and PubMed databases using specific keywords: depression, vitamin D3 deficiency. Previous studies on the use of vitamin D3 and its role in prevention and treatment of depressive disorders included too small number of people to clearly assess the effectiveness and safety of supplementation used as adjunctive therapy to antidepressants, as well as and dose range which should be used.

Efficacy and safety of antidepressant's use in the treatment of depressive episodes in bipolar disorder - review of research.

The use of antidepressants in treatment of depression in course of bipolar disorders (BD) is controversial. In case of no improvement during monotherapy with mood stabilizer, the use of antidepressants is often necessary. The safety of this group (in context of phase change, mixed states and rapid cycling) is essential and is the subject of many research. In the paper, the authors review the literature concerning efficacy and safety of use of antidepressants in the treatment of affective disorders and long-term impact on the course of the disease. Selection of articles have been made by searching the Medline and Pubmed databases using keywords: antidepressant drugs, bipolar depression, bipolar disorder, efficacy, safety, mania, hypomania. The risk of mania is greater in bipolar disorder type I, than in type II or during treatment with Tricyclic antidepressants (TCAs) and treatment with venlafaxine. The use of SSRIs and bupropion is associated with a relatively small increase of phase change risk. There are different opinions concerning recommended duration of antidepressant treatment. Generally antidepressant use should end after 2-3 months of remission, the risk of recurrence of depression after discontinuation of antidepressants is, however, higher than in case of continuation. In BD type II or BD spectrum, antidepressant monotherapy is allowed in severe depression. In bipolar disorder type I and in case of phase change after antidepressants use in the past, use of antidepressants should be very cautious. Antidepressants are contraindicated in rapid cycling and in mixed episodes. Further work is needed to evaluate the efficacy and safety of antidepressants use.