Background: The purpose of the study was to assess the frequency and characteristics of psychological distress, even after adequate treatment, in the heterogeneous population of an endocrine outpatient clinic. Methods: 146 endocrine patients (31 males/115 females; age 39.4 ± 12.5 years), who were cured or in remission, were studied in a university endocrine outpatient clinic. Semistructured clinical interviews to assess psychiatric (Structured Clinical Interview for DSM-IV) and psychological (Diagnostic Criteria for Psychosomatic Research, DCPR) diagnoses were employed and were supplemented by self-rated instruments (the Psychosocial Index and the Medical Outcome Study short form General Health Survey) which could provide the patients’ perception of their own quality of life. Results: There were 118 patients (81%) who presented with at least 1 psychiatric (DSM-IV) or psychological (DCPR) diagnosis. The most frequent diagnostic findings were generalized anxiety disorder (29%), major depression (26%), irritable mood (46%), demoralization (34%) and persistent somatization (21%). By self-rated instruments, patients with at least 1 DSM-IV or DCPR diagnosis reported significantly more stressful life circumstances, psychological distress and an impaired quality of life compared to those who had none. Conclusions: A high prevalence of psychological distress may be encountered in the long-term follow-up of endocrine patients. A biopsychosocial consideration of the person and his/her quality of life appears to be mandatory for improving therapeutic effectiveness in endocrine disorders.

At follow-up after appropriate treatment, we documented a high prevalence of psychopathology in patients with pituitary disease, which was however, similar to that found in nonpituitary endocrine patients. This is consistent with an increasing body of literature that reports difficulties in obtaining full recovery in patients treated for endocrine disorders.

Objective: Little is known about the relationship between recent life events and onset of hyperprolactinemia, despite the well-known effect of acute psychological stress on prolactin levels in healthy subjects. Recent life events in patients with hyperprolactinemia compared with healthy controls were investigated. Design: Case-control study. Methods: Fifty-two consecutive patients with hyperprolactinemia (45 females/7 males; mean age 34.9^10.1 years, range 18-60 years) and 52 healthy subjects matched for socio-demographic variables were studied. Nineteen patients (18 females/1 male) had no pituitary tumor and were diagnosed as suffering from idiopathic hyperprolactinemia. Patients with additional pathology or with high prolactin due to medications were excluded. All patients were interviewed by Paykel Interview for Recent Life Events while on remission after surgery or pharmacological treatment. The time period considered was the year preceding the first signs of hyperprolactinemia, and the year before interview for controls. Results: Patients with hyperprolactinemia reported significantly more life events than control subjects (P , 0.001). The same significant difference compared with controls applied to patients with (n ¼ 16) and without (n ¼ 36) depression. All categories of events (except events that were likely to be under the subject's control) were significantly more frequent. There were no significant differences between patients with prolactinoma (n ¼ 33) and those with idiopathic hyperprolactinemia (n ¼ 19). Conclusions: Within the complexity of phenomena implicated in the pathogenesis of hyperprolactinemia, our findings emphasize a potential role of emotional stress in either prolactin-secreting pituitary tumors or idiopathic hyperprolactinemia. Appraisal of life stress may have implications in clinical assessment (e.g. functional hyperprolactinemia) and decisions (e.g. termination of long-term pharmacological treatment).European Journal of Endocrinology 151 61-65

Background: Scarce data are available on the influence of psychological aspects on 24-hour ambulatory blood pressure patterns either in normotensive or hypertensive subjects. This study was designed to evaluate the relationship between psychological profile and changes in daytime/nighttime blood pressure rhythm. Methods:Nocturnal dipping was defined as the night/day ratio of ambulatory mean systolic and/or diastolic blood pressure ≤0.87. Three-hundred and two outpatients (M/F = 174/128; mean age = 49.8 years, SD = 13.6; range, 16–80 years) underwent 24-hour ambulatory blood pressure monitoring. They were administered a self-rating scale, the Psychosocial Index, as an indicator of stress, psychological distress, sleep disturbances, well-being, abnormal illness behavior and quality of life. There were 242 patients taking antihypertensive medication (146 adequately controlled and 96 not controlled) and 60 who were drug free (33 never-treated hypertensive and 27 normotensive subjects). Patients were divided according to the presence (n = 125) or absence (n = 177) of night blood pressure dipping. The two groups were compared using analysis of covariance, with age as a covariate. Results: Dippers had lower (p < 0.001) nocturnal systolic and diastolic blood pressure than nondippers, and higher (p < 0.05) daytime diastolic blood pressure. Patients with nocturnal blood pressure decline had a markedly higher (p < 0.001) level of stress than nondippers. When the sample was divided according to the presence or absence of hypertension, only subjects with normalblood pressure showed nocturnal dipping associated with increased stressful life circumstances. Conclusions: Our findings indicate that dippers experience stressful life circumstances, both in terms of life events and chronic stress. Thissuggests that stress-reducing techniques may be particularly helpful in the setting of hypertension characterized by nighttime blood pressure dipping.

Result: Analysis of the population showed: Comparison of mean MADRS scores (C+L: 25. I versus C+P: 27.8) showed a significant difference in the C+L group on days 4 and 7 (C+L: 18.6 versus C+P: 21.5) and approaching significance on day I1 (C+L: 18.6 versus C+P: 17.2). On day 7, the number of patients in total remission was three-fold higher in the C+L group than in the C+L group ( 15% versus 4% p < 0.05) and two fold day 11 (29% versus 14% p < 0.05) AAer 6 weeks of treatment mean MADRS score in the C+L group was 2.5 point lower than in the C+P group (C+L: 7.6 [6.6] versus :lO.l (8.3 p = 0.09). Safety based upon clinical and laboratory parameters was satisfactory in both groups. Conclusion:This double-bind study seems conlirmed that lithium potentiates antidepressant treatment in unipolar non refratory patients with severe major depression in the first days of treatment.