Scalco AZ, Scalco MZ, Azul JBS, Lotufo Neto F. Hypertension and depression. Clinics. 2005;60(3):241-50.Despite the high prevalence of depression and hypertension, the relationship between the two diseases has received little attention. This paper reviews the epidemiological, pathophysiological, and prognostic aspects of this association, as well as its implications for treatment. A Medline search was conducted using the following key words: depression, blood pressure, blood pressure variability, physical morbidity, hypertension, mood, stress, hypertension, antidepressive agents, and genetics, from 1980 to 2004. We found descriptions of increased prevalence of hypertension in depressed patients, increased prevalence of depression in hypertensive patients, association between depressive symptomatology and hypotension, and alteration of the circadian variation of blood pressure in depressed patients. There is considerable evidence suggesting that hyperreactivity of the sympathetic nervous system and genetic influences are the underlying mechanisms in the relationship between depression and hypertension. Depression can negatively affect the course of hypertensive illness. Additionally, the use of antidepressive agents can interfere with blood pressure control of patients with hypertension by inducing changes in blood pressure and orthostatic hypotension.Several studies have focused on the association between depression and cardiovascular diseases; however, the relationship between depression and hypertension has received less attention. Nevertheless, interactions between blood pressure (BP) and psychic factors have been observed. O'Hare observed that by asking hypertensive patients to talk about health problems or other life stresses, he could induce substantial increases in their BP, and while after resting quietly for 20 to 40 minutes, they had large drops in BP. 1 Over the next several decades, these observations were replicated many times by other investigators who also found that BP measurements by a doctor are frequently accompanied by marked increased BP and heart rate (HR). This increase (named the "white-coat" effect) is quite common and is believed to be a consequence of an anxiety response to the doctor's visit. 2 Since both hypertension and depression are highly prevalent, it is extremely important to better understand the relationship between them. METHODThis paper reviews the epidemiological, pathophysiological, and prognostic aspects of the association between hypertension and depression, as well as its implications for treatment. The method was a Medline search, which was conducted using the following key words: depression, blood pressure (BP), blood pressure variability (BPV), physical morbidity, hypertension, mood, stress, hypertension, antidepressive agents, and genetics, from 1980 to 2004. RESULTS Epidemiologics aspectsBoth hypertension and hypotension have been observed in association with depression or depressive symptoms. CLINICS 2005;60(3):241-50 Hypertension and depression Scalco AZ et al.

There is a need for clinical tools to identify cultural issues in diagnostic assessment.To assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.Mixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.Mixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.The CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.

Moderate-to-severe depression is associated with increased MSNA. Sertraline treatment reduces MSNA at rest and during mental challenge in depressed patients, which may have prognostic implications in this group.

Objective This study’s objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. Method The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians’ first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. Results Most frequently, clinicians named case-based behavioral simulations as “most helpful” and video as “least helpful” training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician’s age was associated with a preference for behavioral simulations: OR=1.05 (95% CI: 1.01–1.10; p=0.025). Conclusions Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.