Encephale
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Major depressive disorder is associated with several biological abnormalities. Among them, sleep disturbances and alterations of hypothalamic structures and cortisol system have been largely studied. Most studies have found a relationship between depression and alteration of sleep. Electroencephalic sleep profiles during depression demonstrate abnormalities of sleep continuity, reduction of slow waves sleep and REM pressure (27). The cortisol system, investigated by the Dexamethasone Suppression Test (DST), is abnormal in about an half of the depressed subjects. We confirm a cortisol escape from suppression by dexamethasone (21). A complex dysregulation of the Hypothalamic Pituitary Adrenal axis (HPA) is thought to explain this escape (15, 33). The HPA has been first involved in the theory of stress. There are two ways to study this. First by looking at early adversities and genetic susceptibility to stress, and second by studying acute stressors and depressive reactions (8). The sensitization model postulated that the acute abnormalities of depression may leave biological scares. Those scares could make people more vulnerable to latter depressive triggers (34). We could then suppose that biological correlates of depression become more severe during the course of the illness. The present study further examines relationships between DST, polysomnography and some clinical and epidemiological characteristics of the depressive illness. We tried to examine if there were increasing biological disturbances during the course of the illness. We also examined the effect of the history of illness on the psychosocial stressors, and the effects of those stressors on the biological correlates of depression. ⋯ This study does not support the view that the biological correlates of depression are worsening with the course of the illness. We found only correlation between age of onset and DST, but a possible confounding effect of age cannot formerly be excluded. The impact of psychosocial stressors on the biological correlates of depression was minimal. The only significant correlation found was between awakening and psychosocial stressors. We found no correlation between psychosocial stressors and the course of depression. Those results do not support the view of sensitization of the illness, but it should be remember that evaluation of psychosocial stressors by item 216 of the SADS was probably not a sufficient sensitive measure. We suggest thus that the impact of the history of depression on biological correlates of depression is not very strong. An alternative explanation of the lack of correlation found is that we used inaccurate measurement of the course of depression. For example, we had no evaluation of the quality of remission between different episodes of depression and of subsyndromic depression. Recent works show the importance of this (6, 9). The major limitations of this work were the retrospective character of the study and the low precision of the evaluation of psychosocial stressors used.
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Assessment of para-suicidal patients is one of the main tasks for the practitioner in an emergency unit. There are now any characteristics known as suicide risk factors, like drug or alcohol abuse, past history of suicides in the family, or psychiatric disorder. However though these characteristics are useful to define high-risk populations, they are not always relevant in personal assessment. ⋯ However, some aspects are still missing in this study: we did not compare any sub-score with other well-known scales, assessing depression or hopelessness. On the other hand, we couldn't obtain prospective data on all the patients after their parasuicide. The following steps will be to carry on with these studies, as well as with the replication of our results on larger samples.
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Randomized Controlled Trial Clinical Trial
[Detection, prevention and treatment of postpartum depression: a controlled study of 859 patients].
This study evaluated the clinical effectiveness of a programme aimed at detecting, preventing and treating postpartum depression. The French version of the EPDS was used to measure the intensity of postpartum blues on a sample of 859 women, during their stay at the obstetrical clinic. Subjects under treatment for psychological problems were excluded from the study. ⋯ A clearly therapeutic response to treatment was observed in the treated group with a mean reduction in HDRS score of 9.5 (DS = 6.7) from baseline. The improvement in the women in the treated group, as measured by the mean HDRS scores was statistically greater than that in the control group (m = 5.35, SD = 3.5 vs m = 15.8, SD = 4.6, t = 8.24, dl = 52, p < 0.0001). Our results indicate that a program based on an intervention at obstetrical clinics and on home visits is efficacious and well accepted for prevention, detection and treatment of postpartum depression.
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Case Reports
[Value of a consultation center and crisis intervention in addressing psychiatric disorders in the perinatal period].
The Psychiatry department of the University Hospital Centre of Lille has developed, over the last 10 years, a treatment network for psychiatric disorders during pregnancy or in the post-partum period. There are liaison consultations in the maternity department, screening and management of psychopathological disorders in the perinatal period, training of midwives, support of patients seeking genetic counselling, collaboration with teams providing "medically-assisted procreation", etc. For severe disorders of the post-partum period (severe depression, serious alteration of mother-child interaction, puerperal psychosis), the Psychiatry department has a specialized unit where 3 "mother-child" groups can be admitted. ⋯ Obviously, it is precisely this dimension of the crisis which makes the other types of management temporarily unsuitable. This new working framework, with the simple possibility of admitting women and interacting with them in a crisis situation, with the aid of the competence of "mother-child" teams, most often seems to allow an alternative to hospitalization in the Psychiatry department, at the same time keeping up quality management of problems linked to the pregnancy or post-partum period. The specificity of the CIU, with its project of taking the special psychiatric vulnerability of pregnancy into account, makes sure that the psychopathological aspects of the crisis situation and the physiological aspects of adaptation reactions to the perinatal period are not neglected, but that are respected by this type of interaction/intervention.