Bullous hemorrhagic dermatosis (BHD) is a rare cutaneous manifestation characterized by tense hemorrhagic bullae that appear at sites distant from low molecular weight heparin (LMWH) injections, typically within seven days of exposure. As of March 2022, only 94 cases have been reported. It most commonly affects elderly males with predisposing factors for thromboembolism, such as carcinoma, and usually involves the extremities.

This case highlights the importance of maintaining a high index of suspicion for bullous hemorrhagic dermatosis (BHD) in patients receiving low molecular weight heparin, even beyond the typical 7-day window and in demographics not commonly affected. Early recognition and prompt discontinuation of the offending agent, as demonstrated in this atypical presentation involving a Filipino elderly woman with multiple comorbidities and no malignancy, can lead to favorable outcomes. Clinicians should be aware of this rare but reversible complication to avoid misdiagnosis and ensure appropriate management.

Human ; Female ; Aged: 65-79 Yrs Old ; Affect ; Aged ; Blister ; Carcinoma ; Causality ; Demography ; Diagnostic Errors ; Enoxaparin ; Extremities ; Heparin ; Heparin, Low-molecular-weight ; Index ; Injections ; Lead ; Male ; Molecular Weight ; Neoplasms ; Patients ; Research Report ; Skin Diseases ; Thromboembolism ; Women

Objective Observational studies have shown an association between Parkinson disease （PD） and mental illness， but further studies are needed to explore the causal relationship between them. This study aims to investigate such causal relationship using the method of two-sample Mendelian randomization （MR）. Methods Related data were extracted from GWAS， and summary statistics associated with PD， depression， sleep disorders， and anxiety phenotype-variants were obtained. Single nucleotide polymorphisms （SNPs） for PD were selected as instrumental variables， and MR-PRESSO was used to exclude outliers. Inverse variance weighting was used as the main method to assess causal effect estimates， and MR Egger， weighted median， simple mode， and weighted mode were used to verify the robustness of the findings. A sensitivity analysis was used to validate the reliability of the results， including the Cochran Q test， the MR-Egger intercept test， funnel plots， and the leave-one-out method. Results A total of 21 SNPs associated with PD were identified. The MR analysis showed that PD had a causal relationship with depression （OR=0.974，95%CI 0.934‒1.015， P=0.210）， sleep disorders （OR=1.056， 95%CI 0.970-1.149， P=0.211）， and anxiety （OR=0.998， 95%CI 0.996‒1.001， P=0.118）， with no statistical significance. Different MR analyses and sensitivity analyses showed that PD did not directly contribute to the development of mental illness. Conclusion There is no direct causal relationship between PD and depression/sleep disorders/anxiety. In clinical practice， healthcare professionals should pay attention to the mental health of patients with PD. Randomized controlled studies should be conducted in the future to further validate the results of this study.
Depression ; Anxiety

Objective To investigate the association between sleep behaviors （including bedtime， sleep quality， and nap duration） and academic performance among college students， as well as the regulatory effect of test anxiety and exercise habit on the association between sleep and academic performance. Methods A questionnaire survey was conducted to collect data. The grade of compulsory courses （with higher grades indicating better academic performance） was used as an ordinal dependent variable. All independent variables were coded by levels： for bedtime during exam and non-exam periods， higher levels indicated later bedtimes； for anxiety during the exam period， higher levels indicated more severe anxiety； for sleep quality during both exam and non-exam periods， higher levels indicated better sleep quality； for nap duration， higher levels indicated longer naps. Exercise habit was treated as a binary variable （yes/no）. Ordinal logistic regression （proportional odds model） was used for multivariable analysis， and OR and 95%CIwere calculated. In addition， sex-stratified models were established to investigate sex differences in the associations between these factors and academic performance. Results A total of 1 221 college students were included， among whom male students accounted for 33.7%. After controlling for confounding factors， bedtime during the exam period was significantly positively associated with the grade of compulsory courses， indicating that later bedtime was associated with a greater likelihood of achieving a higher grade （OR=1.32，95%CI 1.08‒1.62， P=0.007）. Sex was also an independent predictive factor， and the OR of achieving a higher grade in female students was 2.4 times that in male students （OR=2.41， 95%CI 1.90‒3.06， P<0.001）. Sleep quality during the exam period （OR=1.18，95%CI 0.99‒1.42， P=0.070） and exercise habit （OR=1.24， 95%CI 0.99‒1.55， P=0.064） showed marginally significant associations with grade. In contrast， bedtime during the non-exam period， nap duration， anxiety during the exam period， and self-rated sleep quality during the non-exam period showed no statistical significance （all P>0.05）. Sex-stratified analysis showed that among the male students， later bedtime during the exam period was associated with a greater likelihood of achieving a higher grade （OR=1.48， 95%CI 1.05‒2.09， P=0.025）， whereas higher anxiety during the exam period was associated with a lower likelihood （OR=0.79，95%CI 0.63‒0.98， P=0.032）； among the female students， better sleep quality during the exam period was associated with a greater likelihood of achieving a higher grade （OR=1.27， 95%CI 1.02‒1.57， P=0.033）， and bedtime during the exam period showed a positive association with academic performance， but without statistical significance （OR=1.25，95%CI 0.96‒1.62，P=0.091）. Conclusion The association between sleep behaviors and academic performance among college students varies with academic period and sex. Later bedtime during the exam period is associated with better academic performance， but this effect is observed only among male students. In addition， the academic performance of male students is negatively affected by test anxiety， whereas the academic performance of female students is positively associated with subjective sleep quality. Future interventions aimed at improving academic health should consider sex-specific strategies.
Anxiety ; Exercise

BACKGROUND

Anxiety and depression are prevalent during pregnancy. There is significant evidence that antenatal anxiety and depression are risk factors for adverse maternal and neonatal outcomes.

OBJECTIVE

This study aims to determine the prevalence of anxiety and depression among pregnant women who undergo ultrasonographic detection of structural fetal anomalies in the Department of Maternal and Fetal Medicine of University of the Philippines–Philippine General Hospital, Manila, Philippines, for a 13-month period.

METHODS

The study utilized a comparative cross-sectional study design comparing those who underwent congenital anomaly scan (CAS) with those who just underwent routine biometry. There were 177 research respondents for each group. The Filipino version of the Hospital Anxiety and Depression Scale (HADS-P) was used. The psychiatric interview was based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V) particularly on the Major Depressive DIsorder and the Generalized Anxiety Disorder.

RESULTS

The results showed that the mean pre-diagnostics anxiety score of women who underwent CAS was significantly higher than the mean pre-diagnostics anxiety score of women who had biometry. The mean post-diagnostics depression score of women who underwent CAS was significantly higher than the mean post-diagnostics depression score of women who had biometry. However, all pregnant women had normal HADS-P score before and after CAS and biometry. Psychiatric evaluation showed that none was diagnosed to have generalized anxiety disorder or major depression in the conduct of the diagnostic tests.

CONCLUSION

This study indicates that generalized anxiety and depression among pregnant patients subjected to routine biometry and congenital scan were not problems in this tertiary hospital. Knowledge of CAS and awareness of risk factors for congenital anomalies are important for providing care and counseling pregnant women.

Human ; Anxiety ; Depression

BACKGROUND AND OBJECTIVES

Depression and anxiety are common among patients with cardiovascular disease. With increased stress from the ongoing pandemic, it is important to evaluate these conditions. Hence, this study aimed to identify the prevalence of depression and anxiety among outpatient consults via telemedicine through the HADS-P questionnaire and to compare the clinical and socioeconomic profile of patients with HADS-P score of >/=11.

METHODS

This is a cross-sectional descriptive study including participants, outpatients in the cardiology clinic through an online survey regarding their socioeconomic demographic profile and the HADS-P questionnaire. Patients with scores of >/=11 for anxiety or depression were identified and the two groups were compared using a chi-square test analysis.

RESULTS

One hundred and twelve patients were recruited. Majority were females, with a partner, unemployed and living below the poverty line. The most common cardiovascular condition was ischemic heart disease and most patients were at least functional class II. The measured prevalence of probable anxiety and depression were 22% and 8%, respectively. A significant difference between the presence of both anxiety and depression was seen in participants with no partners; and for depression alone, in employed participants.

CONCLUSION

Anxiety and depression are common in this sample population. HADS-P is a simple way of screening patients for these conditions so that holistic care may be instituted and appropriate referrals for psychological intervention may be done.

Human ; Anxiety ; Depression ; Telemedicine

Objective To investigate the state of anxiety and depression in patients with Parkinson disease due to high-altitude exposure in Tibet， China and its impact on quality of life. Methods A total of 93 patients with Parkinson disease who attended Tibet Autonomous Region People’s Hospital from February 2023 to November 2024 were enrolled， and basic information and assessment scales were collected. The Unified Parkinson’s Disease Rating Scale Part Ⅲ （UPDRS-Ⅲ） and Hoehn-Yahr （H-Y） stage were used to evaluate disease severity； Parkinson’s Disease Quality of Life Questionnaire （PDQ-39） was used to evaluate the quality of life of patients； the diagnostic criteria for depression and anxiety in Parkinson disease were used for the diagnosis of depression and anxiety in patients with Parkinson disease； Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used to assess the severity of depression and anxiety. Results Among the 93 patients with Parkinson disease， the prevalence rates of depression and anxiety were 59.1% and 44.1%， respectively. There were significant differences between the depression group and the non-depression group in the somatization， despair， cognitive impairment， block factor， and day-night changes of anxiety， but there were no significant differences in sleep disorders and body weight between the two groups. The depression group had significantly higher PDQ-39 scores than the non-depression group， and the anxiety group had significantly higher PDQ-39 scores than the non-anxiety group. Depressive state was negatively correlated with folate and was positively correlated with blood homocysteine. Anxiety state was positively correlated with H-Y stage and UPDRS Ⅲ score. Conclusion There are relatively high prevalence rates of depression and anxiety in patients with Parkinson disease in Tibetan plateau area， which significantly affects the quality of life of patients.
Parkinson Disease ; Depression ; Anxiety

Objective To investigate the effect of Baduanjin on mood and sleep quality in patients with mild to moderate Parkinson disease （PD） and related mechanisms. Methods A total of 110 patients with Hoehn-Yahr stage 1-3 stable PD were randomly divided into Baduanjin group and control group， with 55 patients in each group. The patients in the Baduanjin group received Baduanjin exercise for 30 minutes each time， 5 days a week for 12 weeks， and those in the control group did not do any exercise. Motor function， anxiety and depression mood， and sleep quality were assessed before exercise and after exercise for 12 weeks. Results Compared with the control group， the Baduanjin group had significant improvements in UPDRS-Ⅲ score and 6-minute walk test results. There was a significant difference in Berg Balance Scale in terms of the interaction between time and intervention. There were significant differences between the two groups in HAMA14，HAMD24，and PSQI scores. Conclusions Baduanjin can improve mood and sleep quality in patients with mild to moderate PD.
Parkinson Disease ; Anxiety ; Depression

BACKGROUND AND OBJECTIVE

Primary care nurses serve as the gatekeeper of the health system. They could be psychologically affected in times of health crisis such as the COVID-19 pandemic. This study aimed to assess their perceived anxiety, depression, and resilience while working in the rural health units in Samar Province.

METHODS

A cross-sectional design was employed involving 188 primary care nurses who were working in rural health units (RHUs) in Samar province. They were selected through stratified random sampling technique. Anxiety and depression levels were assessed using the 21-item Depression Anxiety Stress Scale (DASS-21). Resilience level was assessed using 18-item Resilience Scale. Pearson’s r moment correlation and logistic regression analysis were used to determine associated factors with mental health.

RESULTS

Twenty (20) nurses experienced anxiety and five of them reported depression. Work experience is associated with depression [Exp(B) = 3.753; 95% CI (1.121 – 12.563)]. Overall, nurses reported high resilience level. Anxiety and depression are significantly and negatively associated with resilience.

CONCLUSION

Primary care nurses experience depression and anxiety during COVID-19 pandemic. Work experience is associated to their levels of depression. Moreover, nurses reported high levels of resilience. The higher the levels of anxiety and depression, the lower is their resilience.

Anxiety ; Depression ; Resilience, Psychological

BACKGROUND

Polypharmacy in patients with chronic disease such as Migraine Headache poses potential harm in patients such that psychological distress may come in. In relation to psychological distress, Migraine Headache patients with multiple drug use are at increased risk of anxiety and depression.

OBJECTIVES

The main objective of the study is to determine the association between anxiety and depression to polypharmacy in migraine headache patients by using the data in the PNA One Headache Database.

METHODOLOGY

We utilized the data obtained from the Philippine Neurological Association One (PNA-1) Headache Database from 2021 to 2024 and determine the association between Anxiety and Depression to Polypharmacy in patients with Migraine.

RESULTS AND DISCUSSION

The number of medications taken by patients does not significantly differ across depression and anxiety levels, indicating that polypharmacy has no impact on patient’s depression and anxiety. However, the study found that patients with anxiety have more tendency to report more severe headache.

CONCLUSION

The study highlights that participants, primarily middle-aged women, experience chronic headaches with high pain severity, often lasting for hours. Educational attainment may influence headache management compliance with a large proportion having only elementary education. Headache onset typically begins in early adulthood, and medication effectiveness often diminishes over time suggesting potential tolerance issues. Anxiety is associated with reporting of increased headache severity while depression does not significantly impact headache characteristics or polypharmacy. The findings emphasize the need for targeted interventions and revised treatment strategies to improve headache management outcomes.

Human ; Anxiety ; Depression ; Headache ; Migraine Disorders ; Polypharmacy

BACKGROUND

Hypertension is a significant global health issue linked to high mortality and morbidity rates. It contributes not only to organ damage but also to psychological disorders such as anxiety and depression. Despite the rise in hypertensive patients experiencing these mental health issues, evidence remains insufficient.

OBJECTIVE

This systematic review and meta-analysis aimed to assess the prevalence of anxiety and depression among hypertensive patients.

METHODS

Observational studies published between 2020 and 2024 were sourced from PubMed, The Cochrane Library, and Google Scholar. The Newcastle-Ottawa Scale, adapted for cross-sectional studies, was utilized to evaluate study quality. A random-effects model was employed for meta-analysis to estimate the prevalence rates of anxiety and depression, alongside subgroup and sensitivity analyses to identify sources of heterogeneity.

RESULTS

Fifteen studies were included, with 14 eligible for quantitative analysis. The findings indicated a prevalence rate of 35% for depression (95% CI: 26%-44%) and 41% for anxiety (95% CI: 4%-78%) among hypertensive patients. Significant heterogeneity was observed in the studies (I²=98.3% for depression, I²=99.9% for anxiety). Subgroup analyses highlighted variability in assessment scales (p < 0.001), but not by region or population source. No publication bias was identified (p = 0.663 for depression, p = 0.710 for anxiety). Factors associated with depression included uncontrolled hypertension, female gender, marital status, and social support, while anxiety was linked to similar factors plus concerns about hypertension complications.

CONCLUSION

Depression and anxiety prevalence among hypertensive patients ranges from 30-42%. Uncontrolled hypertension and social support significantly impact mental health, with major barriers to psychiatric care compliance including economic constraints, lack of education, and comorbidities.

Human ; Hypertension ; Depression ; Anxiety ; Prevalence