BackgroundHow subjective social status is associated with childhood abuse and affective temperament in the mechanism of depressive symptom exacerbation remains unknown. In this study, we investigated how the complex effects of subjective social status, childhood abuse, and affective temperament influence depressive symptoms in adulthood.MethodsSelf-report questionnaires were distributed to 853 adult volunteers between January and August 2014. Of them, 404 people gave full consent and returned complete anonymous responses. The following five questionnaires were analyzed: demographic information, Patient Health Questionnaire-9, subjective social status, Child Abuse and Trauma Scale, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego autoquestionnaire. The associations between the scores were analyzed by structural equation modeling. This study was conducted with approval from the ethics committees of Tokyo Medical University and Hokkaido University Hospital.ResultsCovariance structure analysis demonstrated that childhood abuse and subjective social status did not have a direct effect on adulthood depressive symptoms. Childhood abuse had direct effects on subjective social status and affective temperament and childhood abuse indirectly affected adulthood depressive symptoms through subjective social status and affective temperament. Subjective social status also affected depressive symptoms through an effect on affective temperament. This model explained 43% of the variability in depressive symptoms and the fitness of this model was good.ConclusionRegarding childhood abuse and adulthood depressive symptoms, subjective social status as well as affective temperament may be mediators. The results of this study are expected to contribute to the elucidation of the mechanism of depression.
A 19-year-old woman suffered from severe excessive daytime sleepiness accompanied with long sleep episodes both in the daytime and nighttime and frequent episodes of cataplexy shortly after the removal of craniopharyngioma in the intrasellar space. Multiple sleep latency test showed a typical finding of narcolepsy, and cerebrospinal fluid orexin concentration was below the narcolepsy cut-off value. MRI-tractography showed a clear lack of neuronal fiber connections from the hypothalamus to the frontal lobe. SPECT using 123 I-IMP showed frontal hypoperfusion. These connection damages could have been responsible for the occurrence of narcolepsy-like symptoms and long daytime sleep episodes in this case.
Determinations of subjective daytime sleepiness among patients with periodic limb movements during sleep (PLMS), and of the cut‐off level of periodic limb movement index (PLMI) for starting treatment have been inconclusive. This retrospective study was set out to clarify these issues by investigating the relationship between subjective sleepiness measure and PLMI as well as other demographic variables both before and after starting the treatment. Firstly, we investigated factors associated with excessive daytime sleepiness (Epworth sleepiness scale: ESS ≥ 11) in untreated 74 PLMS patients (42 men, 32 women) using multiple logistic regression analysis. Secondly, in 34 patients treated with pramipexole (PPX), a dopamine agonist, the cut‐off PLMI for predicting treatment effectiveness on subjective sleepiness (≥median reduction rate of ESS: 18%) was evaluated using the receiver operating characteristic (ROC) curve. As a result, PLMI and age positively correlated (r = 0.46, P < 0.0001), but age showed very small but significantly negative correlation with excessive daytime sleepiness (odds ratio = 0.96, 95% confidence interval = 0.93–0.99, P < 0.05) in untreated PLMS patients. Moreover, the optimal cut‐off PLMI for predicting a substantial improvement in subjective daytime sleepiness was 31.35/h on ROC analysis among the patients who received the treatment with PPX. Although clear relationship between PLMI and subjective sleepiness severity was not observed, the present study indicated that a PLMI ≥ 31.35/h may become an indication for starting treatment so as to improve daytime sleepiness.
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