Depressive symptoms and associated factors in medical interns at a tertiary hospital.

BACKGROUND: It is known that medical doctors suffer from increased rates of depression with medical interns being most at risk. Despite this, little is known about the prevalence of depression in interns in South Africa. OBJECTIVES: This study aimed to assess the prevalence of depressive symptoms in interns employed at Groote Schuur Hospital, a tertiary hospital in the Western Cape. METHOD: The study was a cross-sectional study. All 91 interns were invited to participate in the study and consenting interns were required to complete a demographic and related questionnaire and the Beck Depression Inventory 2 (BDI-2). RESULTS: Fifty-four (59.3%) of all invited interns participated in the study. Twenty-two interns (40.7%) reported a BDI-2 score of 14 or greater, indicating at least mild self-reported symptoms of depression. Features associated with a BDI-2 score of 14 or greater, included female gender, a previous diagnosis of depression, seeing a psychotherapist and previously being on antidepressant medication during internship. Other features also significantly associated with higher BDI-2 scores included suicidal ideation, thoughts of emigration, wanting to leave medicine and using substances to cope. The most significant associated feature of high BDI-2 scores was a subjective feeling of being 'burnt out'. CONCLUSION: Interns had a higher prevalence of depressive symptoms when compared to the general population. The feeling of being 'burnt out' was the most significant factor associated with the severity of depressive symptoms. It is imperative that the mental health of both medical students and newly qualified doctors be prioritised, supported and monitored.

Paradoxical facilitation of working memory after basolateral amygdala damage.

Working memory is a vital cognitive capacity without which meaningful thinking and logical reasoning would be impossible. Working memory is integrally dependent upon prefrontal cortex and it has been suggested that voluntary control of working memory, enabling sustained emotion inhibition, was the crucial step in the evolution of modern humans. Consistent with this, recent fMRI studies suggest that working memory performance depends upon the capacity of prefrontal cortex to suppress bottom-up amygdala signals during emotional arousal. However fMRI is not well-suited to definitively resolve questions of causality. Moreover, the amygdala is neither structurally or functionally homogenous and fMRI studies do not resolve which amygdala sub-regions interfere with working memory. Lesion studies on the other hand can contribute unique causal evidence on aspects of brain-behaviour phenomena fMRI cannot "see". To address these questions we investigated working memory performance in three adult female subjects with bilateral basolateral amygdala calcification consequent to Urbach-Wiethe Disease and ten healthy controls. Amygdala lesion extent and functionality was determined by structural and functional MRI methods. Working memory performance was assessed using the Wechsler Adult Intelligence Scale-III digit span forward task. State and trait anxiety measures to control for possible emotional differences between patient and control groups were administered. Structural MRI showed bilateral selective basolateral amygdala damage in the three Urbach-Wiethe Disease subjects and fMRI confirmed intact functionality in the remaining amygdala sub-regions. The three Urbach-Wiethe Disease subjects showed significant working memory facilitation relative to controls. Control measures showed no group anxiety differences. Results are provisionally interpreted in terms of a 'cooperation through competition' networks model that may account for the observed paradoxical functional facilitation effect.

The neuropsychiatry and neuropsychology of lipoid proteinosis.

Lipoid proteinosis is a rare hereditary disease which often results in bilateral calcifications in the medial temporal region. Thirty-four adults living with lipoid proteinosis (>10% of the world population) were extensively assessed with standardized neuropsychiatric and neuropsychological measures. Of these, 27 patients representing a homogenous group living in the Northern Cape were matched with 47 controls. Subjects with lipoid proteinosis had a high incidence of neuropsychiatric disorders and performed poorly on facial recognition of positive and negative emotions and on many neuropsychological measures. These findings are consistent with involvement of the medial temporal areas in cognitive and emotive processing.