BackgroundDepression is common in Parkinson’s disease (PD), and has a significant impact on the functional level of those affected. It is well studied in Western populations but data from Asia is limited. This study aims to estimate the prevalence of depression among PD patients attending a tertiary care outpatient clinic in Sri Lanka and identify potential risk factors.MethodsOne hundred and four consecutive idiopathic PD patients as defined by the United Kingdom Parkinson’s Disease Society Brain Bank Diagnostic Criteria were recruited to the study. An interviewer administered questionnaire, the Hoehn-Yahr staging scale and the Schwab-England Activities of Daily Living Scale (SEADL) were used for assessment. Depression was diagnosed through a semi-structured clinical interview based on DSM-IV-TR criteria and all subjects were rated with the Montgomery-Asberg Depression Rating Scale (MADRS).ResultsThe prevalence of depression in the study population was 37.5%. Among the depressed 12 (30.8%) had mild depression, 21 (53.8%) moderate depression and 6 (15.4%) had severe depression. Depression was significantly associated with the stage of PD, functional impairment, civil status, educational level, caregiver dependence and concomitant diabetes mellitus.ConclusionA significant proportion of PD patients suffers from depression. The prevalence rate of depression in the sample was similar to that reported in previous studies. Depression in PD is significantly associated with functional impairment.
While there is little role for antipsychotic monotherapy in OCD, there is growing evidence in support of adjunctive antipsychotics in OCD refractory to serotonin-reuptake inhibitors (SRIs). Further controlled trials are warranted. Particular subgroups of OCD patients, notably those with comorbid tic disorder and those with schizotypal personality disorder, have been shown to respond more robustly to augmentation strategies in some trials of both typical and atypical antipsychotics. Dopaminergic mediation with or without a moderating effect on serotonergic systems is likely to be important in the pharmacodynamic mechanisms of action of antipsychotic-SRI combinations in OCD.
Background Worldwide, the incidence and prevalence of dementia is currently increasing. Dementia is associated with significant disability due to cognitive impairment, and sufferers often become dependent on their carers. Close family members often provide care for persons suffering from dementia, particularly in the developing world. This care-burden is associated with many consequences such as carer depression, elder abuse and premature placement of the patients in institutions. The consequences of care-burden have not been studied in depth in Sri Lanka. A better understanding of care-burden would be helpful to develop interventions to support carers as well as minimise the economic burden to the state. Objectives The objectives of this study were to describe the level of care-burden in carers of patients with dementia, and to explore possible associations between the care-burden and other variables such as sociodemographic factors and psychiatric morbidity. Method A total of 77 carers were included in the study. The locally adapted and translated Zarit Burden Interview (ZBI) was used to assess for care-burden, and participants were also clinically assessed for the presence of depression based on the Diagnostic and Statistical Manual-version IV (DSM IV) criteria for a major depressive episode. Socio-demographic details were gathered via a questionnaire. Conclusion Over one quarter of carers were experiencing a moderate to severe level of care-burden, and almost half reported mild to moderate care-burden. The level of burden increased significantly with increasing age, and a proportion of participants were also depressed. Further large scale, population based research is needed in Sri Lanka, to explore these associations further.
The MADRS has diagnostic utility in major depression in PD. The 3-factor structure of MADRS may help to understand the different dimensions of major depression and identify distinct symptom subgroups in this population.
While there is little role for antipsychotic monotherapy in OCD, there is growing evidence in support of adjunctive antipsychotics in OCD refractory to serotonin-reuptake inhibitors (SRIs). Further controlled trials are warranted. Particular subgroups of OCD patients, notably those with comorbid tic disorder and those with schizotypal personality disorder, have been shown to respond more robustly to augmentation strategies in some trials of both typical and atypical antipsychotics. Dopaminergic mediation with or without a moderating effect on serotonergic systems is likely to be important in the pharmacodynamic mechanisms of action of antipsychotic-SRI combinations in OCD.
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