Current Psychiatry Reviews - Volume 11, Issue 2, 2015

Current findings indicate that depression and suicidal ideation are prevalent in medical students. The main aim was to systematically review articles related to depression and suicidal behavior among medical students. Using MEDLINE a systematic review was made, combining the keywords “depression”, “suicide”, “suicidal ideation”, “suicidal behavior” and “AND medical students”. English and Portuguese peer-reviewed original articles published between January 2005 and June 2011 were included. From the 114 identified by systematic search, 37 articles were found after excluding studies where medical students´ reaction to patient suicide or depression was studied, studies not using a standardized depression instrument and students from other than conventional medical schools. Prevalence of depression in medical students ranged from 2.9% to 38.2%, suicidal ideation from 4.4% to 23.1% and suicidal attempts from 0.0% to 6.4%. Studies suggest that prevalence of depression is higher in female medical students, younger students and lower years in medical schools. Mixed results were found about the relationship between depression and ethnicity. Regarding suicidal behavior there were mixed results in the relationship of gender and year of medical school. No relationship was found between suicidal behavior and age, and suicidal ideation and race. Increasing awareness about the prevalence of depression, suicidal behavior and associated factors among medical students is needed. Psychoeducation on early recognition about depression and suicidal behavior and available treatment resources for students, and counteracting the stigma associated with these conditions, could prevent hazardous consequences, by promoting preventive programs and an easier and confidential access to psychiatric treatment.

Abnormal function of the hypothalamic–pituitary–adrenal (HPA) axis along with the sympathetic-adrenalmedullary (SAM) axis represents the hallmark pathological findings in non-pregnant and pregnant women exhibiting major depressive disorder (MDD). Perinatal depression is highly prevalent, with an estimated prevalence exceeding 10% in most high-income countries. Pregnant women experience more stressful life events than non-pregnant women. Pregnant women with MDD show higher baseline levels of cortisol, increased levels of proinflammatory cytokines, and higher levels of hypothalamic-pituitary peptide hormones, catecholamines, and low dehydroepiandrosterone (DHEA) levels in plasma compared to those without MDD. During pregnancy the innate immune system and placental factors play crucial roles in the development of the conceptus to its full term. These factors when altered may generate a persistent dysfunction of the HPA axis that could lead to an overt transfer of cortisol and toxicity to the fetus at the expense of reduced activity of placental 11β-hydroxysteroid dehydrogenase Type 2 (11β-HSD-2). Epigenetic modifications (DNA methylation) of gene enhancers of the glucocorticoid receptor (GR) in addition to the corticotrophin-releasing hormone (CRH) and arginine-vasopressin (AVP) among other brain and placental molecules, may significantly contribute to the expression of depression during pregnancy. Pregnant women exhibiting affective disorders have a higher risk of generating preterm babies with high rates of morbidity and mortality and negative outcomes in child development compared to pregnant women without these disorders. Affective disorders in pregnant women should be taken seriously, and therapies focused in reducing or at most preventing the deleterious effects induced by stressors should be implemented to promote the welfare of both mother and baby. The goal of this paper is to describe the modulatory role of distinct paracrine and endocrine mediators including epigenetics of hormone receptors that drive the abnormal activity of the HPA axis in perinatal depression.

Background: Antidepressant related movement disorders have been reported in individuals who are ≤ 65 years in age, but a review of such cases in individuals who are ≥ 65 years from medical literature has not yet been conducted. Objectives: To review case reports of antidepressant related movement disorders in individuals who are ≥ 65 years in age from medical literature. Methods: A systematic search of PubMed, Medline, PsychINFO, Embase and Cochrane Library was conducted through January, 31, 2014 for case reports of antidepressant related movement disorders in the elderly. Results: A total of 40 reports (43 individual cases) of movement disorders related to antidepressant use in the elderly were identified. The most common movement disorders noted in these cases were dyskinesias, myoclonus and Parkinsonism. Approximately 80% of the cases occurred in women. About 40% of the cases involved Selective Serotonin Reuptake Inhibitors (SSRIs), with paroxetine being the most commonly noted drug in this class with a total of six cases. Discontinuation of the antidepressant resulted in a resolution of the abnormal movements in a majority of the cases. Conclusions: Antidepressant related movement disorders are uncommon among older adults.

Inflammatory bowel disease (IBD) classically consists of ulcerative colitis and Crohn’s disease, which are typically characterized by progressive cyclical attacks of abdominal pain, diarrhea and fatigue. Other highly prevalent clinical features of IBD include psychiatric disorders such as mood and anxiety, which may occur in 60-80% of patients during relapse. Stressful live events seem to precipitate IBD diagnosis, and are related to a significantly increased risk of disease relapse. Alternatively, an IBD diagnosis itself is associated with an increased risk for the development of anxiety and depression. These conditions lead to significantly worsened prognosis, increased risk of relapse, increased healthcare utilization, and decreased quality of life. Risk factors known to predict anxiety and depression in patients with IBD include female gender, presence of other medical comorbidities, severe and active disease, and socioeconomic deprivation. Thus, increased clinical suspicion for comorbid mood or anxiety disorders must be made once a diagnosis of inflammatory bowel disease is established, with appropriate followup. This review summarizes the literature regarding the relationship between IBD and the development of psychiatric disorders.

We systematically examined recent publications to weigh the relative contribution of directly measured and perceived body weight on the status of emotional well-being, and to determine whether the relationship between measured body weight and emotional well-being is mediated or confounded by perceived body weight among adolescents (11-18 year old). A total of 61 papers met inclusion criteria and were included for review. Approximately, half of the studies suggested a relationship between emotional statuses and directly measured body weight; whereas, the other half did not. The presence of a relationship primarily depended on how perceived body weight was controlled for. Results were converging for studies that included both measured and perceived body weight. Irrespective of directly measured body weight, perceived weight was significantly associated with emotional health. Perceived overweight was a predominant concern among girls; whereas, perceived underweight and overweight were equally worrisome to boys. The findings also suggest a bidirectional relationship between body weight and poor emotional health. Perceived overweight predicted depressive symptoms in longitudinal studies. Meanwhile, low self-esteem aggravated the onset of obesity, and depressive symptom exacerbates an excessive increase in body weight. Programs to correct normative misperceptions and reduce stigma exposure may improve emotional well-being and ultimately lead to more effective prevention of both obesity and emotional disturbances among adolescents.