Research in the Department of Family Medicine-Research covers a broad range of medical issues focused on family and community medicine, including headache, depression, calcium and vitamin D nutrition, obesity, women's health, and global health.
Objective: Several studies indicate that patients with primary hyperparathyroidism (PHPT) undergoing parathyroid surgery have improvement in mood and neuropsychological functioning. The current analysis aims to examine the relationship between biochemical and clinical variables and the improvement in depression scores and in specific symptoms, after parathyroidectomy.
Measurements: The Patient Health Questionnaire-9 (PHQ-9) was utilized to obtain depression scores at enrolment and 12 months after surgery. The changes in PHQ-9 were analysed and correlated with baseline clinical and biochemical parameters.
Depression is a leading cause of disability worldwide,2 and in the United States, anxiety disorders are common, affecting approximately 40 million adults every year.3 Psychotherapy approaches and medications are standard first-line treatments suggested for clinical depression and general anxiety disorders.4,5 In addition, the emerging field of nutritional psychiatry suggests a relationship between diet quality and mental health and considers the use of dietary and nutraceutical interventions to address mental disorders and to potentially improve patient outcomes.6,7 Recent research suggests that while nutritional habits, dietary patterns, and diet quality may all impact overall mental wellness, they may also be modifiable risk factors for mental disorders.6,8-10 For example, conclusions based largely on cross-sectional and longitudinal studies suggest that routine consumption of a Western-type highly processed diet increased the risk of developing symptoms associated with depression and anxiety.8 In contrast, those observational studies suggested that the risk was lower if an anti-inflammatory, Mediterranean-style diet was followed.8
The relationship between nutrition and mental health has also been discussed as bidirectional, with dietary choices not only possibly impacting mental wellness, but mental health states potentially affecting dietary habits and food choices.21,22 Specific to depression and anxiety, the role of the gut-brain axis and status of the gut microbiota has recently surfaced as a potential consideration and component for future diet-depression research studies and clinical nutrition interventions.23
In elderly patients, failure to thrive describes a state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments. Manifestations of this condition include weight loss, decreased appetite, poor nutrition, and inactivity. Four syndromes are prevalent and predictive of adverse outcomes in patients with failure to thrive: impaired physical function, malnutrition, depression, and cognitive impairment. Initial assessments should include information on physical and psychologic health, functional ability, socioenvironmental factors, and nutrition. Laboratory and radiologic evaluations initially are limited to a complete blood count, chemistry panel, thyroid-stimulating hormone level, urinalysis, and other studies that are appropriate for an individual patient. A medication review should ensure that side effects or drug interactions are not a contributing factor to failure to thrive. The impact of existing chronic diseases should be assessed. Interventions should be directed toward easily treatable causes of failure to thrive, with the goal of maintaining or improving overall functional status. Physicians should recognize the diagnosis of failure to thrive as a key decision point in the care of an elderly person. The diagnosis should prompt discussion of end-of-life care options to prevent needless interventions that may prolong suffering.
Four syndromes are prevalent and predictive of adverse outcomes in persons who may have failure to thrive: (1) impaired physical function, (2) malnutrition, (3) depression, (4) and cognitive impairment.10 A comprehensive initial assessment should include information about physical and psychologic health, functional ability, and socioenvironmental factors.
Tryptophan is an essential amino acid necessary for the synthesis of serotonin, melatonin, and niacin. Low plasma concentrations of tryptophan have been associated with clinical observations of insomnia, anxiety, and depression. 2b1af7f3a8