Current Psychiatry Reviews - Volume 7, Issue 2, 2011

Objective: To review recent data on six previously-identified genetic associations with depression, focusing upon issues of samples and instruments, in order to clarify the roles of these genetic variables in depression. Methods: Search the literature from the last four years, tabulate studies and examine the presence of any recent trends. Results: At least one previously-identified genetic association with depression is subject to the confounding effects of agerelated dementia, and some others do not have recent supportive data that connect them to depression. In addition, over 300 other genetic factors have recently been identified to have associations with depression. Recent findings regarding one particular polymorphism (the ss 5-HTTLPR) suggest that the “causal” connection between some genes and depression may be via sensitivity to environmental stressors rather than as a result of the genetic predisposition per se. Conclusion: Recent genetic association studies of depression appear to suggest that some of the six previously-identified polymorphisms are not consistently related to depression, and that at least one major “causal” genetic variable may act via increased environmental sensitivity.

Research examining the role of several factors associated with body size estimation is reviewed. Methodological techniques and issues related to measuring body size estimation are described. Several factors associated with body size estimation are reviewed including eating disorders, obesity, weight loss, hunger/satiety, restrained eating, mood, depression, body regions, age, childhood sexual abuse, menstrual cycle, media influences, and gender. Of these factors, the role of eating disorders, obesity, weight loss, restrained eating, depression, body regions, age, and media influences has, to varying extent, been clarified. The role of hunger/satiety, mood, childhood sexual abuse, menstrual cycle, and gender is still not clearly understood and await further research. Differing methodological techniques account for much of the inconsistency in findings. Methodological shortcomings in measuring body size estimation are reviewed and recommendations for dealing with these issues are detailed.

Introduction: Depression is a mental disorder that is common and chronic, especially if it is initially undertreated. It is now widely recognized that primary care providers have an important role to play in the detection and treatment of depression. However, ensuring quality depression care remains a challenge. Quality indicators for the treatment of depression can help monitor the treatment received by people suffering from depression in primary care and guide improvements needed in that sector. Objectives: To systematically review indicators used to measure the quality of depression treatment in primary care and explore factors leading to divergent results. Method: The literature on the quality of depression treatment was reviewed using “360search”, a federated search engine for searching across multiple databases from a single interface. Databases searched included Pubmed, Embase and PsycINFO and keywords were depression, depressive disorder, quality, treatment, indicator, adequacy, adherence, concordance, clinical guideline and guideline. Additional articles were also identified through a manual search of the reference section of retrieved articles. Results: Though mostly based on recommendations from clinical practice guidelines, a great variety of indicators were observed. Most studies used rudimentary indicators to measure the quality of depression treatment, especially for psychotherapy. Studies also differed greatly with respect to the methods used, thus limiting the comparability of results. However, whatever the chosen method, most studies reveal that a large proportion of people with depression do not receive minimally adequate treatment in primary care settings. Conclusion: The implications of these findings and future research directions are discussed.

Debates about EBs (gambling, Internet use, shopping, working, exercising, eating, video game playing and sex) have gained momentum among researchers, clinicians, and the media. Controversy exists in the scientific literature about whether EBs are primary psychiatric disorders and, if so, where they fit into current and emerging diagnostic classification systems. The lack of consensus and associated confusion was the impetus for this systematic review. The key search terms were: abuse/misuse, dependence, addiction, impulse control, compulsivity, pathological, and excessive, in combination with: buying/shopping, work, gaming/video games, exercise, Internet, sex, eating, and gambling. 361 articles were analyzed according to their conceptualization. In total, 47% adopted an addiction conceptualization, 9% adopted an impulse control conceptualization, and 2% an obsessive compulsive spectrum conceptualization. Alternative or blended conceptualizations were utilized by 27% and 16% did not specify a particular conceptualization. The findings were also broken down by excessive behaviour. Almost half of the articles were review articles (49%), 34% were empirical articles, and the remaining 17% were commentaries. There was a general lack of agreement regarding conceptualization and a lack of consistency in nomenclature, definitions, and use of language. The addiction conceptualization was most prevalent consistent with the common use of the term behavioural addiction, and in line with proposed changes to the DSM-5.

Functional somatic syndromes (FSS) are defined by a constellation of symptoms for which after thorough medical examination no structural pathology and no proportional tissue abnormalities can be identified. Pathophysiology of these syndromes has remained elusive and treatment options are limited. Current research efforts acknowledge the importance of stress as a potential risk factor in the manifestation and maintenance of FSS. A substantial body of research has focused on psychological stress factors as well as alterations of the endocrine stress system (the hypothalamicpituitary- adrenal, HPA axis, in particular), the immune system, and the autonomic nervous system (ANS). Dysregulation of these systems might explain some of the symptoms of FSS. In this review, we describe studies reporting stress-related findings in three of the most prevalent and well-described FSS, i.e. chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and fibromyalgia syndrome (FMS). Psychobiological processes which seem to play a role in the translation of stress into functional symptoms and syndromes are discussed.