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Association between anxiety and depression symptoms with resistant hypertension and central hemodynamics: A pilot study.The hypothesis that symptoms of anxiety and depression contribute to the development of hypertension has been controversial. Rutledge and Hogan found that the risk of developing hypertension is approximately 8% higher among people with psychological distress compared to those with minimal distress. People suffering from either severe depression or anxiety were two to three times more likely to develop hypertension. The aim of the present pilot study was to compare the prevalence of anxiety and depression in patients with resistant HTN (rHTN) who underwent renal denervation (RDN) versus medical management alone. An additional aim was to assess possible associations with central hemodynamics using the cardio-ankle vascular index (CAVI). The study included 34 patients who lacked a comorbid mental health disorder, had rHTN and were a mean age of 58.3 ± 11.2 years. Twenty-four hour ambulatory blood pressure monitoring (24 hABPM) was conducted in all patients, and they were divided into the following groups: group I (n = 20) underwent RDN and group II (n = 14) was treated with medical management alone. The mean office SBP and DBP measurements for group I were 163 mmHg and 92 mmHg, respectively; for group II, they were 159 mmHg and 91 mmHg, respectively. There was no significant difference in the duration of hypertension (10.1 vs 9.4 years, p = NS) or in the familial burden. Finally, there was no difference in the number of antihypertensive medications in the two groups (5.1 vs 5.5, p = NS). The evaluation of anxiety disorder was performed with the Hospital Anxiety Depression Scale (HADS)3,4. The Beck Depression Inventory (BDΙ) was used to evaluate depression5. Both scales consist of a simple, yet reliable, self-assessment screening questionnaire. For the HADS scale, a score of ≥11 is thought to indicate a significant case of psychological morbidity. The BDI is a 21-item self-report depression inventory that measures depressive symptoms. For each item, the score ranges from 1 to 4. The total score is obtained by summing the scores on each of the 21 questions. CAVI was measured with a Vasera VS-1500 (Fukuda Denshi, Tokyo, Japan) vascular screening device. Descriptive and univariate comparisons were made using SPSS (version 20.0). Due to the low number of subjects in each group, only non-parametric tests were used (Spearman for correlations, Mann-Whitney U-test for comparison of groups and Chi square for categorized comparisons). A p-value of 0.05 was set as the cut-off for significance. The HADS and BDI scores were highly correlated in the entire group [correlation coefficient (CC) = 0.787, p = 0.0001] as well as separately in each of the two groups [group I (CC) = 0.825, p = 0.0001 and group II (CC) = 0.779, p = 0.0001, respectively]. When comparing HADS and BDI scores between the two groups, no significant difference was identified. Comparing CAVI results, CAVIR, but not CAVIL, was significantly higher in group I (p = 0.02). In group II, there seems to be a negative correlation between the CAVIR, CAVIL and HADS scores [CAVIR-HADS CC = -0.597, p = 0.024; CAVIL-HADS CC = -0.668, p = 0.009] This small pilot study showed that there is a significant correlation between the two scores in the total population; however, patients treated with RDN are not different from those with medical management alone. A negative association was also noted between the anxiety scoring scale and CAVIR and CAVIL in patients treated with medical management alone. A previous study documented a lack of difference in the prevalence of panic, anxiety and depression between patients with rHTN and non-resistant controls. In agreement with our study, the prevalence of anxiety and depression was high in the two groups of patients with rHTN; however, the RDN made no difference in the total impact of the two modalities, which is in contrast with previous results. To the best of our knowledge, this report describes the first attempt to associate the arterial stiffness using the CAVI with anxiety and depression in this population. In a previous study, there was an association between an increased arterial stiffness, autonomic disbalance and depression in a young hypertensive population. The present study is a small pilot study that highlights the higher prevalence of depression and anxiety in patients with resistant hypertension, as well as a negative association with central hemodynamics. However, because the sample is small, acquisition of a larger sample size with the continuation of this study might reveal stronger correlations in the future.
Electroconvulsive therapy in the Republic of Ireland, 1982.Electroconvulsive Therapy (ECT) is the induction of seizure activity in the brain by the passage of a small electric current between two electrodes placed on the scalp. The patient is invariably asleep under the influence of a rapidly acting anaesthetic agent. The epileptic convulsion or fit (which is an indication of satisfactory treatment effect) is modified to a series of muscular twitching by a muscle relaxant administered intravenously by the anaesthetist once the patient is asleep. The treatment procedure takes about five minutes with about an hour of sleep needed for complete recovery afterwards. The commonest indication for ECT is severe depressive illness or other serious mental disturbance where other treatments have failed or are unsuitable. A series of individual treatments. at intervals of one or more days, is commonly needed before relief of symptoms occurs. The treatment is widely acknowledged to be safe and has been in use for over forty years. With the introduction of effective antipsychotic and antidepressant drugs in the 1950s, ECT has been used less frequently and more selectively than in the past. However, there is little likelihood that ECT will be displaced by drugs or other treatments of comparable safety in the foreseeable future. Several recent studies of exceptional scientific rigour have helped to dispel residual doubts about the efficacy of ECT, although the details of the moile of action of the treatment are still not fully understood. . In recent years, ECT has attracted criticism from civil rights groups in the United States and more recently in the United Kingdom. Allegations were made of too frequent use of ECT, harmful consequences of the treatment and/or misuse of ECT to control anti-social behaviour tn detained patients. Public anxiety was not lessened by the impact ofthe popular film "One Flew Over the Cuckoo's Nest" which depicted ECT, unmodified by anaesthetics or muscle relaxants, as a barbaric and cruel treatment for the control of undesirable behaviour. Pressure from civil rights groups in Ihe U.S.A. finally led to a series of legal decisions which had the effect of prescribing the treatment or so restricting its use in certain States as to make it unavailable to patients. Anticipating similar developments on this side of the Atlantic, the Royal College of Psychiatrists commissioned a major survey by John Pippard and Les Ellam in 1981 of Electroconvulsive Treatment in Great Britain:Thls was the first such survey to include field visits to ECT clinics. These authors showed that ECT was used selectively in the United Kingdom but the authors found much to criticise in the way of obsolete equipment, poor facilities for patients, abdication of consultant responsibility (inexpert junior psychiatrists often administering the treatment) and sometimes scant regard for the privacy and feelings of patients. . The present survey was undertaken on behalf of the Irish Division of the Royal College of Psychiatrists. A major objective was to replicate (and possibly validate) the British findings and in the process to audit professional opinion and practice and to determine rates of ECT prescribing in this country. The methods used were broadly similar to those of the British survey. Rating scales andqueSlionnaires, in particular, were identical in the two studies. Thus, opinions of Irish psychiatrists were elicited by postal questionnaire, field visits were made to all ECT centres and clinics and a large sample of patients was documented prospectively over a three-month period by their psychiatrists. Statistics of ECT prescribing were collected and analysed in relation to national patterns of hospitalisation for mental illness. Finally, evidence was sought of any change in practice which might have taken place as an effect of the research.