Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51 percent) patients did not have any psychiatric diagnosis, while 44 (49 percent) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1 percent) had a current mental disorder, out of which 22 (84.6 percent) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

Psychosis during peginterferon-alpha2a and ribavirin therapy: case report

Pegylated Interferon-alpha, combined with ribavirin, gives high sustained virological response in patients with hepatitis C virus, an important public health problem and one of the most frequent chronic infectious diseases worldwide. Though it has therapeutic benefits, treatment with IFN-alpha may be complicated by various side effects, especially symptoms of major depression and acute mania. Psychosis is a rare side effect, and its management usually includes discontinuation of IFN-alpha. We report a case of psychotic disorder that occurred during therapy with pegylated Interferon-alpha given associated with ribavirin. After good response to psychiatric treatment, it became possible to finish the anti-viral therapy.

Validade da escala hospitalar de ansiedade e depressão em pacientes com dor crônica / Validity of the hospital anxiety and depression scale in patients with chronic pain

JUSTIFICATIVA E OBJETIVOS: Diversos estudos sugerem forte associação entre a ansiedade e a depressão com dor crônica, o que pode ser evidenciado pela utilização de escalas padronizadas para a detecção desses sintomas. O objetivo deste estudo foi estimar a sensibilidade e a especificidade da Escala Hospitalar de Ansiedade e Depressão (HAD), em pacientes portadores de síndromes dolorosas crônicas acompanhados no Centro de Dor do Hospital Universitário Professor Edgard Santos. MÉTODO: Foi realizado um estudo descritivo transversal em pacientes que procuraram o Centro de Dor entre março de 2002 e julho de 2003, que constou de entrevistas utilizando a Escala HAD e o M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTADOS: Foram avaliados 91 pacientes. A utilização da HAD evidenciou que 61 pacientes (67 por cento) apresentaram ansiedade e 42 pacientes (46,2 por cento) apresentaram depressão. Os resultados da HAD mostraram que dos pacientes deprimidos, 38 (90,5 por cento) eram também ansiosos; enquanto dos ansiosos, 38 (62,3 por cento) também estavam deprimidos, sendo esta uma associação considerada como significativa pela análise estatística (p < 0,001). O M.I.N.I. PLUS revelou 40,7 por cento de transtorno do humor atual e 47,3 por cento de transtorno de ansiedade. Quanto à sensibilidade e a especificidade da HAD foram encontrados os seguintes resultados: sensibilidade 73,3 por cento para depressão e 91,7 por cento para ansiedade. Especificidade 67,2 por cento para depressão e 41,8 por cento para ansiedade. CONCLUSÕES: A escala HAD mostrou boa sensibilidade para avaliar sintomas de ansiedade e depressão, porém não evidenciou boa especificidade para diagnósticos de depressão e ansiedade.

BACKGROUND AND OBJECTIVES: Several studies suggest a strong association between anxiety and depression with chronic pain. That can be demonstrated using standard scales to detect these symptoms. The objective of this study was to determine sensibility and specificity of the Hospital Anxiety and Depression Scale (HAD) in patients with chronic pain syndromes followed at the Pain Center of the Hospital Universitário Professor Edgard Santos. METHODS: A transversal, descriptive study was conducted with patients who sought to the Pain Center between March 2002 and July 2003. It was composed of interviews using the HAD Scale and the M.I.N.I. International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTS: Ninety-one patients were evaluated. The HAD demonstrated that 61 patients (67 percent) presented anxiety, while 42 patients (46.2 percent) presented depression. HAD results showed that among patients with depression, 38 (90.5 percent) also had anxiety; while among those with anxiety, 38 (62.3 percent) also had depression. Statistical analysis showed that this association was statistically significant (p < 0.001). M.I.N.I. PLUS revealed an incidence of 40.7 percent in current mood changes and 47.3 percent of anxiety. As for HAD's sensibility and specificity, we found the following results: sensibility of 73.3 percent for depression and 91.7 percent for anxiety, and a specificity of 67.2 percent for depression and 41.8 percent for anxiety. CONCLUSIONS: The HAD scale showed good sensibility to evaluate anxiety and depression symptoms, but did not demonstrate good specificity for the diagnosis of depression and anxiety.

JUSTIFICATIVA Y OBJETIVOS: Diversos estudios sugieren una fuerte asociación entre la ansiedad y la depresión con dolor crónico, lo que puede ser evidenciado por la utilización de escalas estandarizadas para la detección de esos síntomas. El objetivo de este estudio fue el de estimar la sensibilidad y la especificidad de la Escala Hospitalaria de Ansiedad y Depresión (HAD), en pacientes portadores de síndromes dolorosos crónicos con seguimiento por parte del Centro de Dolor del Hospital Universitario Profesor Edgard Santos. MÉTODO: Fue realizado un estudio descriptivo transversal en pacientes que se personaron en el Centro de dolor entre marzo de 2002 y julio de 2003, que constó de entrevistas utilizando la Escala HAD y el M.I.N.I International Neuropsychiatric Interview Brazilian Version 5.0.0 (M.I.N.I. PLUS). RESULTADOS: Fueron evaluados 91 pacientes. La utilización de la HAD evidenció que 61 pacientes (67 por ciento) presentaron ansiedad y 42 pacientes (46,2 por ciento) presentaron depresión. Los resultados de la HAD mostraron que de los pacientes deprimidos, 38 (90,5 por ciento) eran también ansiosos; mientras que de los ansiosos, 38 (62,3 por ciento) también estaban deprimidos, siendo esa una asociación considerada como significativa por el análisis estadístico (p < 0,001). El M.I.N.I. PLUS reveló un 40,7 por ciento de trastorno del humor actual y un 47,3 por ciento de trastorno de ansiedad. En cuanto a la sensibilidad y a la especificidad de la HAD, se encontraron los siguientes resultados: sensibilidad 73,3 por ciento para la depresión y 91,7 por ciento para la ansiedad. Especificidad 67,2 por ciento para la depresión y 41,8 por ciento para la ansiedad. CONCLUSIONES: La escala HAD mostró un buen nivel de sensibilidad para evaluar síntomas de ansiedad y depresión, sin embargo, no mostró una buena especificidad para diagnósticos de depresión y ansiedad.