Patients' perceptions of stigma at the start of treatment influence their subsequent treatment behavior. Stigma is an appropriate target for intervention aimed at improving treatment adherence and outcomes.

Perceived stigma associated with mental illness and individuals' views about the illness play an important role in adherence to treatment for depression. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.

There is increasing evidence for an important role of adverse early experience on the development of major psychiatric disorders in adulthood. Corticotropinreleasing factor (CRF), an endogenous neuropeptide, is the primary physiological regulator of the mammalian stress response. Grown nonhuman primates who were exposed as infants to adverse early rearing conditions were studied to determine if long-term alterations of CRF neuronal systems had occurred following the early stressor. In comparison to monkeys reared by mothers foraging under predictable conditions, infant monkeys raised by mothers foraging under unpredictable conditions exhibited persistently elevated cerebrospinal fluid (CSF) concentrations of CRF. Because hyperactivity of CRF-releasing neurons has been implicated in the pathophysiology of certain human affective and anxiety disorders, the present finding provides a potential neurobiological mechanism by which early-life stressors may contribute to adult psychopathology.Considerable evidence from genetic, neurochemical, pharmacological, and neuroanatomical studies obtained over the past three decades supports a biological basis for many of the major neuropsychiatric disorders (1). Prior to the modern era of biological psychiatry, psychoanalytic theory pioneered by Freud prevailed. Freud's theories emphasized the importance of early rearing conflicts in the pathogenesis of adult psychopathology (2). More recent studies indicate that psychosocial factors, including abuse and neglect in early life as well as untoward life events in adulthood, contribute to the development of mood and anxiety disorders (3, 4). An integration of biological and developmental approaches may illuminate further the role of adverse early life experience on subsequent neurodevelopment. Using random-assignment study designs, nonhuman primate models of psychopathology, produced by an unpredictable early rearing environment, provide for the experimental exclusion of genetic influences on development, a strategy rarely feasible in humans (5-9).The present study presents evidence for persistent hyperactivity of corticotropin-releasing factor (CRF)-releasing neurons in the central nervous system (CNS) of grown nonhuman primates who, as infants, were reared by mothers exposed to environmental unpredictability. A neurochemically based hypothesis is proposed whereby emotionally adverse early experiences may antecede psychiatric disorders through the induction of persistently elevated neuronal release of CRF.The CRF-containing parvocellular neurons of the hypothalamic paraventricular nucleus (PVN) represent the cephalicThe publication costs of this article were defrayed in part by page charge payment. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. §1734 solely to indicate this fact. component of the hypothalamic-pituitary-adrenal (HPA) axis, which serves as the primary endocrine response of mammalian organisms to stress (10-12). Hypothalamic CRF release increases HPA axis activity by ...

Depression is well established as a prevalent mental health problem for people with ESRD and is associated with morbidity and mortality. However, depression in this population remains difficult to assess and is undertreated. Current estimates suggest a 20 to 30% prevalence of depression that meets diagnostic criteria in this population. The extent of other psychopathology in patients with ESRD is largely unknown. The aim of this study was to expand the research on psychiatric complications of ESRD and examine the prevalence of a broad range of psychopathology in an urban hemodialysis center and their impact on quality of life. With the use of a clinician-administered semistructured interview in this randomly selected sample of 70 predominately black patients, >70% were found to have a psychiatric diagnosis. Twenty-nine percent had a current depressive disorder: 20% had major depression, and 9% had a diagnosis of dysthymia or depression not otherwise specified. Twenty-seven percent had a current major anxiety disorder. A current substance abuse diagnosis was found in 19%, and 10% had a psychotic disorder. The mean Beck Depression Inventory score was 12.1 ؎ 9.8. Only 13% reported being in current treatment by a mental health provider, and only 5% reported being prescribed psychiatric medication by their physician. A total of 7.1% had compound depression or depression coexistent with another psychiatric disorder. The construct of depression was also disentangled from the somatic effects of poor medical health by demonstrating a unique relationship between depressive affect and depression diagnosis, independent of health status. This study also suggests the utility of cognitive variables as a meaningful way of understanding the differences between patients who have ESRD with clinical depression or other diagnoses and those who have no psychiatric comorbidity. The findings of both concurrent and isolated anxiety suggest that the prevalence of psychopathology in patients with ESRD might be higher than previously expected, and the disorders may need to be treated independently. In addition, the data suggest that cognitive behavioral therapeutic techniques may be especially advantageous in this population of patients who are treated with many medications.