OBJECTIVE To assess the relationship between depression and anxiety and Parkinson’s disease (PD). BACKGROUND Many people with PD suffer from depression and anxiety prior to the onset of motor symptoms. Studies suggest these psychiatric conditions may be risk factors for PD or prodromal non-motor symptoms. METHODS Using a population-based approach in three California counties, we recruited 371 incident PD cases, 402 population and 115 sibling controls. We recorded self-reports of lifetime depression/anxiety diagnoses and use of psychotropic medications. We adjusted for age, race, sex, pack-years of smoking, and education, and also conducted analyses after excluding (lagging) both diagnoses and medication use first occurring within 2, 5, 10, and 20 years of the index/diagnosis date. RESULTS Cases were more likely to have received a diagnosis of depression or anxiety at any time prior to index date (OR 1.42, 95% CI 1.01, 2.00), but were not more likely to have been both diagnosed and treated (OR 1.11, 95% CI 0.77, 1.60). Male PD patients received diagnoses combined with treatment more often than population controls within 5 years of PD diagnosis (OR 2.21, 95% CI 1.21, 4.04; 2 year lag: OR 2.44, 95% CI 1.29, 4.61; 5 year lag: OR 1.67, 95% CI 0.80, 3.49). We did not see any differences for females. Results for cases compared to sibling controls were similar to those for population controls. CONCLUSION These results suggest that depression and anxiety may be early symptoms during the prodromal phase of PD.

Patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome have high rates of psychiatric illness. The effective management of these psychiatric conditions can improve a patient's quality of life and may improve antiretroviral adherence. Care providers for patients with HIV infection frequently encounter clinical situations in which psychotropic medications are needed or are being used. Those clinical situations require familiarity with the broad category of medications termed "psychotropic." That familiarity should include a basic understanding of indications, adverse effects, and drug interactions. In particular, it is very important to recognize the many potential interactions based on cytochrome P450 metabolism, which is common to many psychotropics, the protease inhibitors, and the nonnucleoside reverse-transcriptase inhibitors. In a brief review of the use of psychotropic medications in patients with HIV infection, we discuss indications, adverse effects, and drug interactions for commonly used antidepressants, mood stabilizers, anxiolytics, antipsychotics, psychostimulants, and drugs of abuse.Patients with AIDS are at higher risk for mental illness than the general population. Prevalences for major depression among patients with HIV infection only and patients with AIDS have been estimated to be between 15% and 40%, far above the prevalence for the general population [1]. Additionally, mental illness places patients at risk for contracting HIV infection. In a study of 671 patients at the Baltimore City Health Department Sexually Transmitted Disease clinic, a diagnosis of depression was associated with behaviors placing one at risk for HIV infection [2]. That 3%-23% of adults with severe mental illness are HIV infected, compared with 0.6% of the population in the United States, is likely related to such highrisk behavior [3]. Mental illness also impacts a patient's ability to adhere to complicated antiretroviral regimens [4]. Treatment of comorbid mental illness in HIV-infected patients, however, can improve adherence to HAART regimens [5].Psychiatric disorders are under-recognized and under-treated in patients with chronic medical illness. In 1996, an epidemiologic study examined a representative sample of 2864 patients receiving medical care for HIV infection [6]. In addition to finding a 12-month prevalence of nearly 50% for psychiatric illness, 27.2% of all HIV-infected patients receiving medical care were taking a psychotropic drug. Antidepressants were the most common (20.9% of all patients), followed by anxiolytics (16.7%), antipsychotics (4.7%), and psychostimulants (3%). Over one-half of the patients reporting a major depressive disorder were not treated with antidepressants [7].We will discuss the indications and uses of psychotropic medications (antidepressants, anxiolytics, mood stabilizers, antipsychotics, psychostimulants, and drugs of abuse) in the HIV clinic. Our goal is to promote the rational treatment of psychiatric disorders in HIV-infected patien...

Objective: To complete a systematic review of the literature addressing major depression in resident physicians. Methods: In 2013, the authors completed a systematic review of articles addressing major depression in physicians in United States residency programs. The following keywords were used: anxiety, stress, and mood, medical residents or interns, physician residents, graduate medical education, depression, stress or anxiety, and suicide. Results: The prevalence of depression in resident physicians is higher than that of the general population. Many sociodemographic and residency-associated factors have been studied in their relation to resident physician depression. Only physical health, an unhappy childhood, and stress at work were found to have association with depression, while the amount of call, lifestyle, age, income, and season of the year were not associated with depression. Other factors had an equivocal relationship. Depression in resident physicians is associated with medical errors, decreased ability to handle work-related stress, leaves of absence, discontinuation of medical training, disruption in personal lives, and suicide. Intervention with treatment for depression, using a low-cost, confidential, off-campus program, was successful. However, physicians may hesitate to seek treatment for mental illness because of the professional consequences, such as difficulty with medical licensing, hospital privileges, and malpractice insurance. Conclusions: Major depression is common in resident physicians in the United States. It has a negative impact on the lives of the doctors and the patients whom they treat. There appear to be effective ways of assisting residents with major depression available to training programs. Keywords