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A gender analysis of the study of pharmacotherapy of psychotic depression (STOP-PD): gender and age as predictors of response and treatment-associated changes in body mass index and metabolic measuresBACKGROUND: Gender differences exist in psychiatric disorders; however, gender has not been well studied in psychotic depression. This analysis of the largest clinical trial in psychotic depression examined the effects of age and gender on clinical characteristics and predictors of treatment outcome and treatment-associated changes in body mass index (BMI) and metabolic measures. METHOD: Secondary analyses were performed on data from 259 subjects with major depressive disorder with psychotic features (DSM-IV-TR) aged 18-93 years in the double-blind randomized controlled trial of olanzapine plus sertraline versus olanzapine plus placebo for psychotic depression (Study of Pharmacotherapy of Psychotic Depression). Sociodemographic factors, clinical characteristics, treatment outcome, and treatment-associated changes in BMI and metabolic measures were analyzed by gender and age. Subjects were enrolled from December 2002 to June 2007. RESULTS: Female gender was associated with divorced (χ(2)(1) = 5.3, P = .03) or widowed (χ(2)(1) = 8.1, P ≤ .01) marital status. Comorbid anxiety disorders were more common in women than in men (χ(2)(1) = 4.9, P = .03). Hallucinations (χ(2)(1) = 7.8, P = .005) and delusions with disorganization (t(257) = -2.10, P = .04) were significantly associated with female gender, as were higher cholesterol measures (χ(2)(1) = 7.15, P = .008). There were no significant interactions between treatment and gender in terms of change in BMI. Gender was not associated with treatment response. DISCUSSION: This study is the first analysis of gender and age as predictors of treatment outcome and treatment-associated changes in BMI and metabolic adverse effects in psychotic depression. Gender differences exist in patients with psychotic depression, most notably with regard to the presence of hallucinations. Female gender was associated with metabolic measures. Future studies with larger sample sizes may detect small gender differences in treatment outcome and treatment-associated changes in BMI and metabolic measures in psychotic depression. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00056472.
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ED Diagnosis of Acute Coronary Syndromes: No Gender-Related Difference of 'Chest Discomfort'Background: There is evidence of gender and diabetes-related differences in symptoms of ACS upon presentation to the ED: i.e., non-diabetic men typically report ‘chest pain’, whereas women and diabetics may report atypical complaints such as arm or jaw pain, nausea, etc. This may reflect differences in either ACS-related chest pain, or differences between men vs. women in the perceptionof pain. Objective:Our aim was to obtain insight into this issue by comparing the frequency of broadly defined, ‘chest-associated discomfort’ rather than ‘chest pain’ reported by men vs. women and diabetics vs. non-diabetics with MI. Methods:This is a prospective, ongoing, IRB-approved study enrolling patients presenting to an urban academic medical center with the subsequent diagnosis of NSTEMI/STEMI. After admission patients were interviewed using a focused, semi-structured format and queried as to the presence (yes/no), severity, and quality of chest discomfort–defined as any symptom referred to the thorax–upon ED presentation. Severity was scored on a scale of 1 to 10; the quality was categorized as: pressure or tightness; burning or ‘heartburn’; sharp or shooting sensation; cramping; or other. Patients were excluded if unstable or otherwise unable to give a history. Incidence of discomfort was compared in women vs. men by Fisher’s exact test, while severity was compared by t-test. Results:Interim analysis of the 81 patients enrolled to date reveals no significant gender-related differences in either the incidence (91% in females versus 94% in males: p=0.69) or severity of chest discomfort (mean score of 7.4±2.8 in females versus 7.2±2.4 in males; p=0.76). Also no significant diabetes-related difference in either the incidence (86% in diabetics vs. 95% in non-diabetics, p=0.18) or severity (6.8±2.9 in diabetics vs. 7.4±2.4 in non-diabetics, p=0.34) of chest discomfort was found. Conclusion:These preliminary results suggest that, while there may be gender or diabetes-related differences in the perception of ‘chest pain’, there is an equivalent incidence and severity of ‘chest discomfort’ in all groups. This re-enforces the importance of pursuing broad complaints of chest discomfort in the ED.
