Safety and Acceptability of Practice-Nurse-Managed Care of Depression in Patients With Diabetes or Heart Disease in the Australian TrueBlue Study.

Safety and acceptability of practice-nurse-managed care of depression in patients with diabetes or heart disease in the Australian TrueBlue study.

BMJ Open. 2013; 3(4):
Schlicht K, Morgan MA, Fuller J, Coates MJ, Dunbar JA

To determine the safety and acceptability of the TrueBlue model of nurse-managed care in the primary healthcare setting.A mixed methods study involving clinical record audit, focus groups and nurse interviews as a companion study investigating the processes used in the TrueBlue randomised trial.Australian general practices involved in the TrueBlue trial.Five practice nurses and five general practitioners (GPs) who had experienced nurse-managed care planning following the TrueBlue model of collaborative care.The practice nurse acted as case manager, providing screening and protocol-management of depression and diabetes, coronary heart disease or both.Proportion of patients provided with stepped care when needed, identification and response to suicide risk and acceptability of the model to practice nurses and GPs.Almost half the patients received stepped care when indicated. All patients who indicated suicidal ideations were identified and action taken. Practice nurses and GPs acknowledged the advantages of the TrueBlue care-plan template and protocol-driven care, and the importance of peer support for the nurse in their enhanced role.Practice nurses were able to identify, assess and manage mental-health risk in patients with diabetes or heart disease. HubMed – depression

Developmental regression, depression, and psychosocial stress in an adolescent with down syndrome.

J Dev Behav Pediatr. 2013 Apr; 34(3): 216-8
Stein DS, Munir KM, Karweck AJ, Davidson EJ, Stein MT

CASE:: Kristen is a 13-year-old girl with Down syndrome (DS) who was seen urgently with concerns of cognitive and developmental regression including loss of language, social, and toileting skills. The evaluation in the DS clinic focused on potential medical diagnoses including atlantoaxial joint instability, vitamin deficiency, obstructive sleep apnea (OSA), and seizures. A comprehensive medical evaluation yielded only a finding of moderate OSA. A reactive depression was considered in association with several psychosocial factors including moving homes, entering puberty/onset of menses, and classroom change from an integrated setting to a self-contained classroom comprising unfamiliar peers with behavior challenges.Urgent referrals for psychological and psychiatric evaluations were initiated. Neuropsychological testing did not suggest true regression in cognitive, language, and academic skills, although decreases in motivation and performance were noted with a reaction to stress and multiple environmental changes as a potential causative factor. Psychiatry consultation supported this finding in that psychosocial stress temporally correlated with Kristen’s regression in skills.Working collaboratively, the team determined that Kristen’s presentation was consistent with a reactive form of depression (DSM-IV-TR: depressive disorder, not otherwise specified). Kristen’s presentation was exacerbated by salient environmental stress and sleep apnea, rather than a cognitive regression associated with a medical cause. Treatment consisted of an antidepressant medication, continuous positive airway pressure for OSA, and increased psychosocial supports. Her school initiated a change in classroom placement. With this multimodal approach to evaluation and intervention, Kristen steadily improved and she returned to her baseline function. HubMed – depression

Tourette Syndrome and Risk of Depression: A Population-Based Cohort Study in Taiwan.

J Dev Behav Pediatr. 2013 Apr; 34(3): 181-185
Chou IC, Lin HC, Lin CC, Sung FC, Kao CH

OBJECTIVE:: The temporal relationship between Tourette syndrome (TS) and depression is unclear. This cohort study evaluates the relationship between TS and depression in Taiwan. METHODS:: Claims data from the Taiwan National Health Insurance database were used to conduct retrospective cohort analyses. The study cohort contained 1337 TS patients who were frequency matched by sex, age, urbanization of residence area, parental occupation, and baseline year with 10 individuals without TS. Cox’s proportional hazard regression analysis was conducted to estimate the effects of TS on depression risk. RESULTS:: In patients with TS, the risk of developing depression was significantly higher than in patients without TS (p value for log-rank test < .0001). After adjusting for potential confounding, the TS cohort was 4.85 times more likely to develop depression than the control cohort (HR = 4.85, 95% CI = 3.46-6.79). CONCLUSIONS:: In Taiwan, patients with TS have a higher risk of developing depression. The findings of this study are compatible with studies from other countries. This study could provide an evidence to inform the prognosis for a child with TS. The mechanism between TS and increased depression risk requires further investigation. HubMed – depression

Royal dynasties as human inbreeding laboratories: the Habsburgs.

Heredity (Edinb). 2013 Apr 10;
Ceballos FC, Alvarez G

The European royal dynasties of the Early Modern Age provide a useful framework for human inbreeding research. In this article, consanguineous marriage, inbreeding depression and the purging of deleterious alleles within a consanguineous population are investigated in the Habsburgs, a royal dynasty with a long history of consanguinity over generations. Genealogical information from a number of historical sources was used to compute kinship and inbreeding coefficients for the Habsburgs. The marriages contracted by the Habsburgs from 1450 to 1750 presented an extremely high mean kinship (0.0628±0.009), which was the result of the matrimonial policy conducted by the dynasty to establish political alliances through marriage. A strong inbreeding depression for both infant and child survival was detected in the progeny of 71 Habsburg marriages in the period 1450-1800. The inbreeding load for child survival experienced a pronounced decrease from 3.98±0.87 in the period 1450-1600 to 0.93±0.62 in the period 1600-1800, but temporal changes in the inbreeding depression for infant survival were not detected. Such a reduction of inbreeding depression for child survival in a relatively small number of generations could be caused by elimination of deleterious alleles of a large effect according with predictions from purging models. The differential purging of the infant and child inbreeding loads suggest that the genetic basis of inbreeding depression was probably very different for infant and child survival in the Habsburg lineage. Our findings provide empirical support that human inbreeding depression for some fitness components might be purged by selection within consanguineous populations.Heredity advance online publication, 10 April 2013; doi:10.1038/hdy.2013.25. HubMed – depression