一项产后及儿童发育期父亲抑郁症的前瞻性人群研究

Background:Depression is common and frequently affects mothers and fathers of young children. Postnatal depression in mothers affects the quality of maternal care, and can lead to disturbances in their children’s social, behavioural, cognitive, and physical development. However, the effect of depression in fathers during the early years of a child’s life has received little attention. Methods: As part of a large, population- based study of childhood, we assessed the presence of depressive symptoms in mothers (n=13 351) and fathers (n=12 884) 8 weeks after the birth of their child with the Edinburgh postnatal depression scale (EPDS). Fathers were reassessed at 21 months. We identified any subsequent development of behavioural and emotional problems in their children (n=10 024) at age 3.5 years with maternal reports on the Rutter revised preschool scales. Findings: Information was available for 8431 fathers, 11 833 mothers, and 10 024 children. Depression in fathers during the postnatal period was associated with adverse emotional and behavioural outcomes in children aged 3.5 years (adjusted odds ratio 2.09, 95% CI 1.42- 3.08), and an increased risk of conduct problems in boys (2.66, 1.67- 4.25). These effects remained even after controlling for maternal postnatal depression and later paternal depression. Interpretation: Our findings indicate that paternal depression has a specific and persisting detrimental effect on their children’s early behavioural and emotional development.

A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry

There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.

Validation of a Swahili version of the World Health Organization 5-item well-being index among adults living with HIV and epilepsy in rural coastal Kenya

Objective:The purpose of this study was to evaluate the psychometric properties of the World Health Organization’s five item well-being index(WHO-5)when administered to adults living with HIV or epilepsy in a rural setting at the coast of Kenya.Methods:A case control study design was conducted among 230 adults aged 18-50 years,who comprised 147 cases(63 living with epilepsy and 84 living with HIV)and 83 healthy controls.The participants were administered to a faceto-face interview during which they completed the Swahili version of WHO-5 well-being index,the Major Depression Inventory(MDI)and responded to some items on their socio-demographic characteristics.Analysis to assess internal consistency,construct validity,discriminant validity,and convergent validity of the Swahili version of WHO-5 well-being index was conducted.A multivariate regression was carried out to assess the association between psychological wellbeing(assessed using Swahili version of WHO-5 well-being index)and having a chronic illness(HIV or epilepsy).Results:The Swahili version of WHO-5 well-being index demonstrated good internal consistency with Cronbach alpha ranges of 0.86-0.88 among the three study groups.The tool had good discriminant validity.A one factor structure of the tool was obtained from confirmatory factor analysis(overall Comparative Fit Index=1.00,Tuckler Lewis Index=1.01,Root Mean Square of Error Approximation=0.00).Living with HIV or epilepsy in comparison to being a healthy control was significantly associated with greater odds of having sub-optimal psychological wellbeing.Conclusion:Our findings demonstrate that the Swahili version of WHO-5 well-being index has good psychometric properties and is appropriate for use to evaluate psychological well-being among adults living with chronic conditions such as HIV or epilepsy from a rural low resource setting in Kenya.Given its brevity and ease of use,the Swahili version of WHO-5 well-being index could potentially be used by lay workers and other paraprofessional to monitor psychological well-being among chronically ill adults in resource poor settings.

儿童和青少年进食障碍

进食障碍是一组疾病，是与饮食、保持体型、体重相关的不良观念伴随的行为，包括节食、暴饮暴食、锻炼过度、呕吐和使用泻药。尽管男性青少年和成人也有发生，但是进食障碍在青少年女性中更常见（图1）。进食障碍患者有高致死率和致残率，但是广泛证据显示，许多患者要么没有就诊，要么没有接受治疗。最近的指南强调了针对儿童和青少年进食障碍进行早期干预的重要性；为了达到更好的治疗效果，治疗开始得越早越好。

儿童与青少年抑郁症的治疗 多数选择性5-羟色胺再摄取抑制剂不再被推荐

多数选择性5-羟色胺再摄取抑制剂不再被推荐

基于脑成像的心境障碍精准生物标志物

陈润森及同事认为,识别生物标志物有助于早期诊断和更好的治疗心境障碍。心境障碍已成为一个全球公共卫生问题。该疾病在人的一生中具有高发病率、慢性和复发性等特点,并且会导致死亡率增加1-3。同时,心境障碍作为终身复发性疾病,会导致个人丧失一定工作生产能力并增加社会医疗保健压力,给社会造成了沉重的经济负担4。因此,早期诊断与有效的治疗非常关键。