ABSTRACT
The objective of the present study was to establish the frequency of psychiatric comorbidity in a sample of diabetic patients with symmetric distal polyneuropathy (SDPN). Sixty-five patients with type 2 diabetes mellitus were selected consecutively to participate in the study at Instituto Estadual de Diabetes e Endocrinologia. All patients were submitted to a complete clinical and psychiatric evaluation, including the Portuguese version of the structured clinical interview for DSM-IV, the Beck Depression Inventory, the Neuropathy Symptom Score, and Neuropathy Disability Score. SDPN was identified in 22 subjects (33.8 percent). Patients with and without SDPN did not differ significantly regarding sociodemographic characteristics. However, a trend toward a worse glycemic control was found in patients with SDPN in comparison to patients without SDPN (HbA1c = 8.43 ± 1.97 vs 7.48 ± 1.95; P = 0.08). Patients with SDPN exhibited axis I psychiatric disorders significantly more often than those without SDPN (especially anxiety disorders, in general (81.8 vs 60.0 percent; P = 0.01), and major depression - current episode, in particular (18.2 vs 7.7 percent; P = 0.04)). The severity of the depressive symptoms correlated positively with the severity of SDPN symptoms (r = 0.38; P = 0.006), but not with the severity of SDPN signs (r = 0.07; P = 0.56). In conclusion, the presence of SDPN seems to be associated with a trend toward glycemic control. The diagnosis of SDPN in diabetic subjects seems also to be associated with relevant psychiatric comorbidity, including anxiety and current mood disorders.
Subject(s)
Humans , Male , Female , Middle Aged , /psychology , Diabetic Neuropathies/psychology , Mental Disorders/epidemiology , Polyneuropathies/psychology , Ambulatory Care/statistics & numerical data , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Mental Disorders/diagnosis , Mental Disorders/etiology , Psychiatric Status Rating Scales/statistics & numerical data , Severity of Illness Index , Socioeconomic FactorsABSTRACT
The International Classification of Diseases, 10th edition (ICD-10) defines atypical bulimia nervosa (ABN) as an eating disorder that encompasses several different syndromes, including the DSM-IV binge eating disorder (BED). We investigated whether patients with BED can be differentiated clinically from patients with ABN who do not meet criteria for BED. Fifty-three obese patients were examined using the Structured Clinical Interview for DSM-IV and the ICD-10 criteria for eating disorders. All volunteers completed the Binge Eating Scale (BES), the Beck Depression Inventory, and the Symptom Checklist-90 (SCL-90). Individuals fulfilling criteria for both ABN and BED (N = 18), ABN without BED (N = 16), and obese controls (N = 19) were compared and contrasted. Patients with ABN and BED and patients with ABN without BED displayed similar levels of binge eating severity according to the BES (31.05 ± 7.7 and 30.05 ± 5.5, respectively), which were significantly higher than those found in the obese controls (18.32 ± 8.7; P < 0.001 and P < 0.001, respectively). When compared to patients with ABN and BED, patients with ABN without BED showed increased lifetime rates of agoraphobia (P = 0.02) and increased scores in the somatization (1.97 ± 0.85 vs 1.02 ± 0.68; P = 0.001), obsessive-compulsive (2.10 ± 1.03 vs 1.22 ± 0.88; P = 0.01), anxiety (1.70 ± 0.82 vs 1.02 ± 0.72; P = 0.02), anger (1.41 ± 1.03 vs 0.59 ± 0.54; P = 0.005) and psychoticism (1.49 ± 0.93 vs 0.75 ± 0.55; P = 0.01) dimensions of the SCL-90. The BED construct may represent a subgroup of ABN with less comorbities and associated symptoms.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Diagnostic and Statistical Manual of Mental Disorders , Feeding and Eating Disorders/psychology , Obesity/psychology , Psychiatric Status Rating Scales , Bulimia Nervosa/diagnosis , Bulimia Nervosa/psychology , Case-Control Studies , Comorbidity , Feeding and Eating Disorders/diagnosis , Obesity/diagnosis , Severity of Illness IndexABSTRACT
Investigamos a presenca de sinais neurologicos menores (SNM) em pacientes com transtorno obsessivo compulsivo (TOC), de "início precoce" e "início tardio" e sua correlaçao com características clínicas e terapêuticas. Vinte pacientes com TOC, sendo 10 de início precoce (idade média de início=11.10 anos) e 10 de início tardio (idade média de início de 41.70 anos) foram avaliados com as escalas Y-BOCS, CGI e uma escala elaborada pelos autores para avaliaçäo de SNM. Após a avaliaçäo neurológica, os pacientes foram tratados com inibidores da recaptaçäo da serotonima por 10 semanas. Dentre os 20 pacientes examinados,foram identificados um ou mais SNM em 12 (60 por cento), sendo seis pacientes pertencentes ao subgrupo de TOC de início precoce (n=10) e seis pacientes pertencentes ao subgrupo de TOC de início precoce (n=10) e seis pacientes pertencentes ao subgrupo de TOC de início tardio (n=10). Os sinais neurológicos mais comuns foram alteraçöes de fala/articulaçäo (em 36,4 por cento) e a impersistência de membros superiores (em 21,1 por cento). A presença de alteraçöes motoras as exame de SNM se correlacionou significativamente com maior gravidade das compulsöes (p=0,004). A presença de SNM näo se correlacionou com a resposta terapêutica. Concluímos que SNM säo frequentemente encontrados em pacientes com TOC, mas näo diferem em frequência entre o subgrupo de início precoce e de início tardio. A presença de SNM de motilidade se correlacionou com compulsöes mais graves
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Diagnostic Techniques, Neurological , Neurology , Obsessive-Compulsive DisorderABSTRACT
A E.C.D. e um metodo nao invasivo, usado amplamente em cardiologia, no estudo das arritmias. A eficiencia do metodo, o colocou em primeiro plano no estudo da epidemiologia da morte subita. Neste artigo, os autores analisam o seu uso, as suas indicacoes na cardiologia e na clinica medica