Does Maternal Depression Predict Young Children’s Executive Function? – a 4-Year Longitudinal Study.

Does maternal depression predict young children’s executive function? – a 4-year longitudinal study.

Filed under: Depression Treatment

J Child Psychol Psychiatry. 2012 Nov 22;
Hughes C, Roman G, Hart MJ, Ensor R

Background:? Building on reports that parental maltreatment and neglect adversely affect young children’s executive function (EF), this longitudinal study examined whether exposure to a more common risk factor, mothers’ depressive symptoms, predicted individual differences in EF at school-age. Methods:? We followed up at age 6 a socially diverse sample of 126 children (78 boys, 48 girls) for whom direct observations of mother-child interactions have been shown to predict gains in EF between the ages of 2 and 4. We used an EF latent factor based on scores from three tasks (Beads, Day/Night, Tower of London) that tapped working memory, inhibitory control and planning, as well as a latent growth model of mothers’ Beck Depression Inventory factor scores at four time-points, and included age 6 verbal ability as a covariate in all analyses. Results:? The intercept and slope for mothers’ depressive symptoms each predicted unique variance in EF at age 6; these predictive effects remained significant when we also included: (a) age 2 working memory, (b) maternal education and (c) direct observations of maternal positive control at ages 2 and 6. Conclusion:? Our findings suggest that early exposure to mothers’ depressive symptoms adversely affects children’s developing EF, and that the chronicity of this exposure may matter.
HubMed – depression

Pharmacogenomics of opioids and perioperative pain management.

Filed under: Depression Treatment

Pharmacogenomics. 2012 Nov; 13(15): 1719-40
Sadhasivam S, Chidambaran V

Inadequate pain relief and adverse effects from analgesics remain common in children and adults during the perioperative period. Opioids are the most commonly used analgesics in children and adults to treat perioperative pain. Narrow therapeutic index and a large interpatient variability in response to opioids are clinically significant, with inadequate pain relief at one end of the spectrum and serious side effects, such as respiratory depression and excessive sedation due to relative overdosing, at the other end. Personalizing analgesia during the perioperative period attempts to maximize pain relief while minimizing adverse events from therapy. While various factors influence response to treatment among surgical patients, age, sex, race and pharmacogenetic differences appear to play major roles in predicting outcome. Genetic factors include a subset of genes that modulate the proteins involved in pain perception, pain pathway, analgesic metabolism (pharmacokinetics), transport and receptor signaling (pharmacodynamics). While results from adult genetic studies can provide direction for pediatric studies, they have limited direct applicability, as children’s genetic predispositions to analgesic response may be influenced by developmental and behavioral components, altered sensitivity to analgesics and variation in gene-expression patterns. We have reviewed the available evidence on improving and personalizing pain management with opioids and the significance of individualizing analgesia, in order to maximize analgesic effect with minimal adverse effects with opioids. While the early evidence on individual genotype associations with pain, analgesia and opioid adverse outcome are promising, the large amount of conflicting data in the literature suggests that there is a need for larger and more robust studies with appropriate population stratification and consideration of nongenetic and other genetic risk factors. Although the clinical evidence and the prospect of being able to provide point-of-care genotyping to enable clinicians to deliver personalized analgesia for individual patients is still not available, positioning our research to identify all possible major genetic and nongenetic risk factors of an individual patient, advancing less expensive point-of-care genotyping technology and developing easy-to-use personalized clinical decision algorithms will help us to improve current clinical and economic outcomes associated with pain and opioid pain management.
HubMed – depression

Prevalence, clinical associations, and impact of intimate partner violence among HIV-infected gay and bisexual men: a population-based study.

Filed under: Depression Treatment

HIV Med. 2012 Nov 21;
Siemieniuk R, Miller P, Woodman K, Ko K, Krentz H, Gill M

OBJECTIVES: Intimate partner violence (IPV) is a risk factor for HIV infection. Little is known, however, about the prevalence, clinical associations, and impact of IPV among patients living with HIV. METHODS: HIV-infected gay and bisexual men in Southern Alberta, Canada were screened for IPV between May 2009 and December 2011. The associations with IPV of sociodemographic factors, psychological factors, clinical status, and HIV-related and HIV-unrelated hospitalizations, data for which were obtained from a regional database, were evaluated using Poisson regression. RESULTS: Of 687 gay and bisexual patients, 22.4% had experienced one or several types of IPV. Patients disclosing IPV were more likely to be Aboriginal [adjusted prevalence ratio (APR)?=?2.48; 95% confidence interval (CI) 1.18-5.20], to be younger (APR/year?=?0.97; 95% CI 0.95-0.99), to be victims of childhood abuse (APR?=?4.27; 95% CI 2.84-6.41), to be smokers (APR?=?2.53; 95% CI 1.59-4.00), to have had depression prior to HIV diagnosis (APR?=?1.87; 95% CI 1.10-3.16), to use ongoing psychiatric resources (APR?=?3.53; 95% CI 2.05-6.10), to have recently participated in unprotected sex (APR?=?2.29; 95% CI 1.10-4.77), and to have poor or fair vs. very good or excellent health-related quality of life (APR?=?2.91; 95% CI 1.57-5.39). IPV was also associated with a higher rate of clinically relevant interruptions in care (APR?=?1.95; 95% CI 1.23-3.08), a higher incidence of AIDS among patients presenting early to care (CD4 count ??200 cells/?L; APR?=?2.06; 95% CI 1.15-3.69), and an increased rate of HIV-related hospitalizations [relative risk (RR)?=?1.55; 95% CI 0.99-2.33], especially after HIV diagnosis was established (RR?=?2.46; 95% CI 1.51-3.99). CONCLUSIONS: The prevalence of IPV is high among HIV-infected gay and bisexual men and is associated with poor social, psychiatric, and medical outcomes. IPV is an under-recognized social determinant of health in this community that may be amenable to meaningful clinical interventions.
HubMed – depression

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