Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review

Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

Cross-cultural adaptation of the City Birth Trauma Scale for the Brazilian context

Abstract Background Posttraumatic stress disorder consists of a set of symptoms that occurs in response to one or more traumatic events and can occur in postpartum, from traumatic situations related to the birth or to the baby's health in the first days of life. It is important tracking the presence of birth trauma, but there is not available instruments in the Brazilian context for this purpose. Objectives To present the cross-cultural adaptation of City Birth Trauma Scale (BiTS) into Brazilian portuguese. Methods Cross-cultural adaptation involved independent translations, synthesis,back-translation, and submission to the original author's appreciation. After the scale was subjected to face validity, followed by a pilot study with postpartum mothers. Results All steps were performed for the cross-cultural adaptation. Regarding face validity, items evaluated concerning different types of equivalence, presented satisfactory agreement values (≥4.20). Most of the expert's suggestions were followed, being the main ones related to adjustments in prepositions, pronouns and verbal subjects. Pilot study showed that the mothers had been able to understand and respond to the instrument without adjustments. Discussion BiTS's Brazilian version proved to be cross-culturally adapted, ensuring the possibility of intercultural data comparison from the semantic, idiomatic, cultural, and conceptual perspectives. New studies are being conducted to attest its psychometric adequacy.

Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review

Objective: The medial prefrontal cortex (mPFC) is a highly connected cortical region that acts as a hub in major large-scale brain networks. Its dysfunction is associated with a number of psychiatric disorders, such as schizophrenia, autism, depression, substance use disorder (SUD), obsessive-compulsive disorder (OCD), and anxiety disorders. Repetitive transcranial magnetic stimulation (rTMS) studies targeting the mPFC indicate that it may be a useful therapeutic resource in psychiatry due to its selective modulation of this area and connected regions. Methods: This review examines six mPFC rTMS trials selected from 697 initial search results. We discuss the main results, technical and methodological details, safety, tolerability, and localization strategies. Results: Six different protocols were identified, including inhibitory (1 Hz) and excitatory (5, 10, and 20 Hz) frequencies applied therapeutically to patient populations diagnosed with major depressive disorder, OCD, autistic spectrum disorder, SUD, specific phobia, and post-traumatic stress disorder (PTSD). In the OCD and acrophobia trials, rTMS significantly reduced symptoms compared to placebo. Conclusion: These protocols were considered safe and add interesting new evidence to the growing body of mPFC rTMS literature. However, the small number and low methodological quality of the studies indicate the need for further research.

Subjective well-being, religiosity and anxiety: a cross-sectional study applied to a sample of Brazilian medical students / Bem-estar subjetivo, religiosidade e ansiedade: um estudo transversal em uma amostra brasileira de estudantes de medicina

Abstract Objective: To assess associations between subjective well-being (SWB), religiosity, anxiety and other factors in a sample of Brazilian medical students from a public university in northeastern Brazil. Methods: The present study followed a cross-sectional, observational, analytical approach. Data were collected by administering a self-applicable questionnaire composed of questions focused on sociodemographic data and based on the Satisfaction With Life Scale (SWL), Positive Affect and Negative Affect Scale (PANAS), Penn State Worry Questionnaire (PSWQ), and the Duke Religiosity Index (DUREL). Results: The sample comprised 417 medical school students (73.54% of all the enrolled students). The medical students assessed presented a medium level of satisfaction with life, low mean positive emotion levels and high anxiety/uneasiness levels. Surprisingly, lower anxiety and intrinsic religiosity (IR) scores were associated with higher scores in the two SWB parameters (positive emotions and satisfaction with life). Furthermore, the factors leisure activities, good sleep quality, financial support, age, and gender were associated with the highest SWB scores (with emotional and cognitive components, or with only one of these two components). Conclusions: Data in the current study corroborated the negative association between SWB and anxiety; however, in opposition to the literature, they also evidenced a negative association between SWB and IR. In addition, the present research signaled the need for creating preventive intervention programs to increase SWB through positive psychological techniques and/or to decrease anxiety by applying, for instance, cognitive-behavioral therapy paradigms and/or mindfulness techniques to medical students.

Resumo Objetivos: Avaliar associações entre bem-estar subjetivo (BES), religiosidade, ansiedade e outros fatores em uma amostra de estudantes brasileiros de medicina de uma universidade pública do nordeste do Brasil. Métodos: O presente estudo seguiu uma abordagem transversal, observacional, analítica. Os dados foram coletados por meio da aplicação de um questionário autoaplicável incluindo questões focadas em dados sociodemográficos e baseado na Escala de Satisfação com a Vida (SWL), Escala de Afeto Positivo e Afeto Negativo (PANAS), Questionário de Preocupação da Pensilvânia (PSWQ) e Índice de Religiosidade de DUKE (DUREL). Resultados: A amostra foi composta por 417 estudantes de medicina (73,54% de todos os alunos matriculados). Os estudantes avaliados apresentaram nível médio de satisfação com a vida, baixos níveis de emoções positivas e altos níveis de ansiedade/preocupação. Surpreendentemente, menor ansiedade e escores de religiosidade intrínseca (IR) foram associados com maiores pontuações nos dois parâmetros de BES (emoções positivas e satisfação com a vida). Além disso, os fatores atividades de lazer, boa qualidade do sono, apoio financeiro, idade e sexo foram associados aos maiores escores do BES (com componentes emocionais e cognitivos, ou apenas um deles). Conclusão: Os dados do presente estudo corroboraram a associação negativa entre BES e ansiedade; no entanto, contrariamente à literatura, eles também evidenciaram uma associação negativa entre BES e IR. Além disso, a presente pesquisa sinalizou a necessidade de criar programas de intervenção preventiva para aumentar o BES por meio de técnicas psicológicas positivas e/ou diminuir a ansiedade aplicando, por exemplo, paradigmas de terapia cognitivo-comportamental e/ou técnicas de mindfulness a estudantes de medicina.

Depressive symptoms in postpartum women at Family Health Units / Sintomas depressivos em puérperas atendidas em Unidades de Saúde da Família

Abstract Objectives: to identify postpartum depression among women assisted by Family Health Units (FHU). Methods: this is a cross-sectional study with a quantitative approach carried out in FHUs at the city of Vitoria de Santo Antão - PE. Fifty eight mothers constituted the sample. We used the Portuguese version of the Postpartum Depression Screening Scale - PDSS for screening. We collected data from February to April 2011. Results: we were able to demonstrate that 8.6% of participants had scores above the PDSS cut-off point. We also found an association between postpartum depression and incomplete primary education. Conclusions: although the percentage of women with postpartum depression scores is lower than values found in other national studies, the early identification of these mothers in FHU is imperative, given the harmful repercussions that depression can cause in women, as well as in physical and psychic development of the baby.

Resumo Objetivos: identificar a depressão pós-parto (DPP) entre mulheres atendidas em Unidades de Saúde da Família (USF). Métodos: trata-se de um estudo transversal, com abordagem quantitativa realizado em USF do município da Vitória de Santo Antão - PE. A amostra foi composta por 58 puérperas. O instrumento utilizado para rastreamento foi a versão em português da Postpartum Depression Screening Scale - PDSS. Os dados foram coletados no período de fevereiro a abril de 2011. Resultados: evidenciou-se que 8,6% das participantes apresentaram pontuação acima do ponto de corte da PDSS. Os quadros sugestivos de DPP apresentaram associação estatística com o ensino fundamental incompleto. Conclusões: embora o percentual de mulheres com escores sugestivos de DPP esteja abaixo do quantitativo encontrado em outros estudos nacionais, é premente que essas mães sejam identificadas precocemente nas USFs, tendo em vista as repercussões que a depressão pode acarretar para a mulher e para o desenvolvimento físico e psíquico do bebê.

A systematic review of the neural correlates of positive emotions

Objective: To conduct a systematic literature review of human studies reporting neural correlates of positive emotions. Methods: The PubMed and Web of Science databases were searched in January 2016 for scientific papers written in English. No restrictions were placed on year of publication. Results: Twenty-two articles were identified and 12 met the established criteria. Five had been published during the last 4 years. Formation and regulation of positive emotions, including happiness, are associated with significant reductions in activity in the right prefrontal cortex and bilaterally in the temporoparietal cortex, as well as with increased activity in the left prefrontal regions. They are also associated with increased activity in the cingulate gyrus, inferior and middle temporal gyri, amygdalae, and ventral striatum. Conclusion: It is too early to claim that there is an established understanding of the neuroscience of positive emotions and happiness. However, despite overlap in the brain regions involved in the formation and regulation of positive and negative emotions, we can conclude that positive emotions such as happiness activate specific brain regions.

Screening and diagnosing postpartum depression: when and how? / Triagem e diagnóstico de depressão pós-parto: quando e como?

Abstract Introduction: Prevalence rates of postpartum depression (PPD) vary widely, depending on the methodological parameters used in studies: differences in study populations, diagnostic methods, and postpartum time frame. There is also no consensus on the ideal time to perform screening, on whether PPD can only be diagnosed in the early postnatal period, or on how soon after a delivery depression may be related to it. Objective: To review which instruments have been used over recent years to screen and diagnose PPD and the prevailing periods of diagnosis. Methods: Only articles published within 5 years and related exclusively to screening and diagnosis were selected. The sample comprised 22 articles. Results: The Edinburgh Posnatal Depression Scale (EPDS) was the most common screening tool, used in 68% of the sample (15 articles), followed by the Beck Depression Inventory (BDI-II) (27%, 6 articles), and the Patient Health Questionnaire-9 (PHQ-9) (18%, 4 articles). Screening time frame was reported in 21/22 articles: 0 to 3 months postpartum in 9 (43%), up to 6 months in 4 (19%), and up to 12 months or more in 8 (38%). In short, 13 articles screened during the first 6 months (59%) while only 8 (36%) screened up to 1 year. Conclusion: The most frequent PPD diagnosis tool was the EPDS, but other scales were also used. The most common period for diagnosis was up to 3 months postpartum. However, some researchers diagnosed PPD 12 months or more postpartum. Greater standardization of parameters for investigation of this disease is needed.

Resumo Introdução: A prevalência de depressão pós-parto (DPP) varia consideravelmente dependendo dos parâmetros metodológicos utilizados: diferentes populações, métodos de diagnóstico e o tempo pós-parto considerado. Também não há consenso sobre o momento ideal para a triagem, se a DPP pode ser diagnosticada apenas no período puerperal, e por quanto tempo após o parto a depressão pode ser relacionada a ele. Objetivo: Revisar os instrumentos mais usados recentemente para rastreamento e diagnóstico de DPP e os períodos predominantes de diagnóstico. Métodos: Foram selecionados apenas artigos relacionados exclusivamente ao rastreio e diagnóstico publicados num período de 5 anos. A amostra incluiu 22 artigos. Resultados: A Escala de Depressão Pós-Parto de Edimburgo (EPDS) foi a ferramenta mais frequente, utilizada em 68% da amostra (15 artigos), seguida pelo Inventário de Depressão de Beck (27%, 6 artigos) e o Patient Health Questionnaire-9 (PHQ-9) (18%, 4 artigos). O tempo de rastreio foi definido em 21/22 artigos: 0-3 meses pós-parto em 9 (43%), < 6 meses em 4 (19%), e ≤ 12 meses em 8 (38%). Treze artigos selecionaram as mulheres durante os primeiros 6 meses (59%), enquanto apenas 8 (36%) o fizeram até 1 ano. Conclusão: A EPDS foi o instrumento mais utilizado para o diagnóstico de DPP, mas outras escalas também foram aplicadas. O período mais comum para o diagnóstico foi de < 3 meses pós-parto. No entanto, alguns pesquisadores consideraram o diagnóstico de PPD em ≤ 12 meses após o parto. Há necessidade de maior padronização de parâmetros em relação à investigação desta doença.

Suicídio entre Médicos e Estudantes de Medicina: Revisão de Literatura / A Review of Literature on Suicide among Doctors and Medical Students

RESUMO Objetivos O presente estudo tem como objetivo construir uma revisão integrativa de literatura sobre o suicídio em médicos e estudantes de Medicina com base em uma análise de artigos científicos sobre o tema. Métodos Foi realizada uma pesquisa nos bancos de dados PubMed, Lilacs e SciELO com os descritores “suicide”, “physicians”, “doctors” e “students” entre os anos de 2000 e 2014 em língua inglesa, alemã, portuguesa e espanhola. Resultados Os resultados indicaram que as taxas de suicídio nessa população são maiores do que as da população geral e de outros grupos acadêmicos. As principais causas apontadas nos estudos foram maior incidência de transtornos psiquiátricos, como depressão e abuso de substâncias, e sofrimento psíquico relacionados a vivências específicas da profissão, como grande carga de trabalho, privação do sono, dificuldade com pacientes, ambientes insalubres, preocupações financeiras e sobrecarga de informações. Conclusões A prevenção do suicídio é possível, porém o problema não tem recebido a atenção necessária. É preciso que haja outros estudos sobre o tema a fim de formular intervenções e políticas de prevenção e tratamento específico para essa população.

ABSTRACT Objectives This study aims to construct an integrative review of suicide among physicians and medical students based on an analysis of scientific articles on the subject. Methods A search was conducted in the PubMed, Lilacs and SciELO databases using the keywords “suicide”, “physicians”, “doctors”, and “students” between 2000 and 2014 in English, German, Portuguese, and Spanish. Results The results indicated that suicide rates in this population are higher than those of the general population and other academic groups. The main causes identified in the study were a higher incidence of psychiatric disorders such as depression and substance abuse, and psychological distress related to specific situations involved with the profession, such as high workload, sleep deprivation, difficulty with patients, unhealthy environments, financial worries, and information overload. Conclusions Suicide prevention is possible, but the problem is not receiving the necessary attention. Additional research on the subject is required to formulate policies and interventions for prevention and specific treatment for this population.

Special features of high-risk pregnancies as factors in development of mental distress: a review / Particularidades da gravidez de alto risco como fatores para o desenvolvimento de sofrimento mental

Abstract Introduction: Approximately 22% of all pregnant women are classified as having high-risk pregnancies, which may involve feelings of vulnerability because of having a high-risk pregnancy, resulting in greater exposure to stressful feelings. Objective: To review aspects of high-risk pregnancy that can have a negative impact on the these women's mental health status. Method: Original articles were identified by conducting searches of the PubMed/MEDLINE, LILACS and SciELO databases, followed by a manual search of references to select articles and additional bibliographic material. Articles from the last 22 years were included in the review (1992-2014). Results: Fifteen articles were found that specifically studied high-risk pregnancies and mental health outcomes. Women with high-risk pregnancies exhibited a significantly higher level of stress and reported negative emotions as they dealt with stress and had worse emotional status than women with normal pregnancies. Researchers found that hospitalized pregnant women had higher levels of anxiety than non-hospitalized women. Studies of women going through normal and high-risk pregnancies show that women with normal pregnancies had good self-perceived quality of life. Conclusion: Special features of high-risk pregnancies could be factors in development of mental distress, in addition to psychological and social factors. Therefore, only a biopsychosocial research study would be able to identify the factors that can affect the quality of mental health during high-risk pregnancy.

Resumo Introdução: Aproximadamente 22% de todas as mulheres grávidas são classificadas como tendo gravidezes de alto risco, podendo experimentar vulnerabilidade por esta situação. Desta forma, estão mais expostas a sentimentos de estresse. Objetivo: Revisar aspectos da gravidez de alto risco que podem ter um impacto negativo sobre o estado de saúde mental dessas mulheres. Métodos: Artigos originais foram localizados por meio de uma busca eletrônica nas bases de dados PubMed/MEDLINE, LILACS e SciELO, bem como uma busca manual de referências para selecionar artigos e material bibliográfico adicional. Foram selecionados artigos publicados nos últimos 22 anos (1992-2014). Resultados: Foram encontrados 15 artigos que estudavam especificamente gravidez de alto risco e o desfecho saúde mental. Mulheres grávidas de alto risco demonstraram um nível significativamente mais elevado de estresse e relataram emoções negativas ao lidar com o estresse; elas também apresentavam pior estado emocional quando comparadas a mulheres com gravidez normal. Os pesquisadores observaram que as mulheres grávidas internadas tinham níveis mais elevados de ansiedade do que mulheres não hospitalizadas. Outros estudos envolvendo mulheres com gestações normais e de alto risco mostram que as mulheres com uma gravidez normal têm uma boa percepção de sua qualidade de vida. Conclusões: As particularidades das gestações de alto risco, além de fatores psicológicos e sociais, podem ser fatores no desenvolvimento de transtornos mentais. Portanto, somente um estudo biopsicossocial seria capaz de identificar os fatores que podem afetar a qualidade da saúde mental durante a gravidez de alto risco.

Incidence and associated factors with traumatic childbirth in postpartum Brazilian woman / Incidencia y factores asociados con el parto traumático en mujer brasileña en el posparto

Childbirth may be a traumatic experience for some women. This observational study aimed to describe the incidence of traumatic childbirth in two regional maternity services in Brazil. In addition, the study intended to determine characteristics that are associated with traumatic childbirth. A total of 328 women were interviewed, up to 72 hours postpartum, between July and November 2010. Women were screened for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMI-IV) criteria for traumatic event using the item A of SCID-I interview for PTSD. Socio-demographic and obstetrical variables, pain score, previous trauma and dissociative experiences in women with and without traumatic childbirth were compared. A total of 53 (16.2%) of the sample fulfilled the criteria for a traumatic event. It observed that some socio-demographic and obstetrical variables may be considered as associated with traumatic childbirth, such as an intermediate level of schooling, high risk pregnancy, obstetrical complications during pregnancy, primiparity, a high pain score, forceps, episiotomy, prematurity, obstetrical complications at birth or with the baby, baby needing hospital care, dissociative experience peripartum, no satisfaction with maternity care, not being well informed of the progress of labor and previous trauma related to urban violence, sexual abuse or domestic violence. Childbirth may be a traumatic event for Brazilian. In this sample traumatic childbirth was associated with pain, previous trauma, dissociative experiences and some socio-demographic and obstetrical variables. Traumatic childbirth constitutes an important mental health problem and need more attention from health.

El parto puede ser una experiencia traumática para algunas mujeres. Este estudio observacional tuvo como objetivo describir la incidencia del parto traumático en dos servicios regionales de maternidad en Brasil. Además, el estudio pretendía determinar las características asociadas con el parto traumático. Un total de 328 mujeres fueron entrevistadas, hasta 72 horas después del parto, entre julio y noviembre de 2010. Las mujeres fueron seleccionadas para el Manual Diagnóstico y Estadístico de los Trastornos Mentales, Cuarta Edición (DSMI-IV) para el evento traumático utilizando el ítem A de SCID- entrevisto para estrés postraumático. Se compararon variables sociodemográficas y obstétricas, puntuación de dolor, trauma previo y experiencias disociativas en mujeres con y sin parto traumático. Un total de 53 (16,2%) de la muestra cumplieron los criterios para un evento traumático. Se observó que algunas variables sociodemográficas y obstétricas pueden considerarse asociadas con el parto traumático, como un nivel intermedio de escolaridad, un embarazo de alto riesgo, las complicaciones obstétricas durante el embarazo, la primiparidad, un alto puntaje de dolor, fórceps, episiotomía, prematuridad, obstetricia Lactancia que necesita atención hospitalaria, experiencia disociativa periparto, ausencia de satisfacción con la atención de maternidad, no estar bien informado sobre el progreso del parto y trauma previo relacionado con la violencia urbana, el abuso sexual o la violencia doméstica. El parto puede ser un evento traumático para el brasileño. En esta muestra el parto traumático se asoció con dolor, traumatismo previo, experiencias disociativas y algunas variables sociodemográficas y obstétricas. El parto traumático constituye un importante problema de salud mental y necesita más atención de la salud

Folie à deux (transtorno delirante induzido) / Folie à deux (induced delusional disorder)

RESUMO Folie à deux, ou transtorno delirante induzido, é uma síndrome rara caracterizada por transferência de delírios de um sujeito considerado primariamente psicótico para um ou mais sujeitos considerados secundários em relação à origem do delírio. Apesar de ser um diagnóstico considerado raro, e até por isso esquecido nos tratados psiquiátricos atuais, nosso artigo descreve um caso de folie à deux entre mãe (sujeito delirante primário) e filha (paciente previamente saudável e secundariamente psicótica) que teve sucesso terapêutico e evolução muito favorável. Apesar de nosso caso ter tido evolução favorável, há relatos na literatura de desfechos trágicos como infanticídio. Além disso, nosso artigo chama atenção para alguns aspectos importantes. Primeiro, quadros de folie à deux podem ocorrer em muitas situações, e não só em confinamentos, diferentemente do que os sistemas classificatórios atuais tendem a fazer. Igualmente, não são tão raros como se supõe. Por último, os clínicos devem estar atentos a possíveis problemas psiquiátricos não reconhecidos no indivíduo considerado secundário.

ABSTRACT Folie à deux, or induced delusional disorder, is a rare syndrome characterized by transfer of delusions from a primary subject to one or more secondary subjects. Though a diagnosis considered rare and even so forgotten in current psychiatric treated our article describes a case of folie à deux between mother (primary delusional subject) and daughter (previously healthy and secondary psychotic subject) had therapeutic success and evolution very favorable. Although our case had favorable development, there are reports in the literature tragic outcomes as infanticide. In addition, our article draws attention to some important aspects. First, folie à deux frames can occur in many situations and not only in feedlots, unlike the current classification systems tend to do. Also, they are not as rare as it is supposed. Finally, clinicians should be alert to possible psychiatric problems not recognized in the individual considered secondary.

Happiness and health in psychiatry: what are their implications?

Happiness is a lasting state and is associated with the absence of negative emotions, the presence of positive emotions, life satisfaction, social engagement and objectives in life. Researchers have demonstrated the benefits of happiness in many aspects of life, but few studies have been conducted within psychiatry. Objectives: To develop a critical literature review of studies on happiness and health in order to bring some further and useful information to psychiatry updating the article “Happiness: a review” published in 2007 in Revista de Psiquiatria Clínica. Methods: Computational searching was undertaken of digital data basis (PubMed and SciELO) using the keywords “happiness” and “health”. One hundred twenty-seven papers published between 2004 and 2014 were found, but only 76 had the keywords in the title or abstract and with this were selected. Results: Personality traits, such as self-direction; being married; being involved in physical and leisure activities; higher educational backgrounds and intelligence quotient; religiosity, volunteering and altruism; good physical and mental health; were positively related to happiness. Discussion: Analysis of the concept of happiness and its associated emotions may be more complex than describing the symptoms of psychiatric disorders. Despite this, the study of happiness brings several positive implications for psychiatry...

Instrumentos de avaliação do vínculo entre mãe e bebê / Mother-child bonding assessment tools

Objetivo: Identificar os instrumentos utilizados na avaliação do vínculo entre mãe e bebê com até um ano de vida, descrevê-los e fornecer informações sobre suas medidas de confiabilidade, validade e adaptação para o contexto brasileiro. Fonte de dados: Trata-se de um estudo de revisão integrativa realizado com base nas publicações contidas nas bases de dados PUBMED, LILACS, ScienceDirect, PsycINFO e CINAHL. Utilizaram-se os descritores mother-child relations e mother infant relationship, e as expressões validity, reliability e scale. Selecionaram-se 23 pesquisas, que foram lidas em sua integralidade. Síntese dos dados: Foram identificados 13 instrumentos de avaliação do apego entre mãe e bebê: sete escalas, três questionários, dois inventários e um método de observação. Do total de ferramentas analisadas, o Prenatal Attachment Inventory apresentou maior validade e confiabilidade para analisar a relação entre a mãe e o feto durante a gestação. Quanto ao período puerperal, foram encontrados melhores coeficientes de consistência interna para o Maternal Attachment Inventory e o Postpartum Bonding Questionnaire. Além disso, esse último revelou elevada sensibilidade para identificar disfunções leves e graves nas relações afetivas entre mãe e bebê. Conclusões: Verificou-se que a maioria dos instrumentos é confiável para estudar o fenômeno em questão. Contudo, foram evidenciadas limitações com relação à validade de construto e de critério. Ademais, apenas dois estão traduzidos e adaptados para a população de mulheres e crianças brasileiras, sendo portanto uma lacuna encontrada na produção científica nessa área...

Objective: To identify and describe research tools used to evaluate bonding between mother and child up to one year of age, as well as to provide information on reliability and validity measures related to these tools. Data source: Research studies available on PUBMED, LILACS, ScienceDirect, PsycINFO and CINAHL databases with the following descriptors: mother-child relations and mother infant relationship, as well as the expressions validity, reliability and scale. Data synthesis: 23 research studies were selected and fully analyzed. Thirteen evaluation research tools were identified concerning mother and child attachment: seven scales, three questionnaires, two inventories and one observation method. From all tools analyzed, the Prenatal Attachment Inventory presented the higher validity and reliability measures to assess mother and fetus relation during pregnancy. Concerning the puerperal period, better consistency coefficients were found for Maternal Attachment Inventory and Postpartum Bonding Questionnaire. Besides, the last one revealed a higher sensibility to identify amenable and severe disorders in the affective relations between mother and child. Conclusions: The majority of research tools are reliable to study the phenomenon presented, although there are some limitations regarding the construct and criterion related to validity. In addition to this, only two of them are translated into Portuguese and adapted to women and children populations in Brazil, being a decisive gap to scientific production in this area...

Use of psychotropic medications during pregnancy: perception of teratogenic risk among physicians in two Latin American countries

Objective: Pregnant women and their health care professionals commonly believe that use of medications during pregnancy may be harmful to the unborn fetus. The objective of this study was to evaluate the risk perception of psychotropic drug use in pregnancy among physicians in different medical specialties. Method: This was a convenience survey conducted at outpatient clinics in the cities of Recife, Brazil, and La Plata, Bahía Blanca, and Buenos Aires, Argentina. Physicians who agreed to participate were asked to rate their perception of teratogenic risk among different classes of drugs, which included antidepressants, antipsychotics, anticonvulsants, and benzodiazepines. Results: Two hundred and thirty-eight physicians completed the survey (response rate, 98%). These included psychiatrists, obstetricians, neurologists, cardiologists, gastroenterologists, and general practitioners. Among different specialties, a minority of psychiatrists perceived psychotropic drugs to be highly teratogenic (antidepressants, 12.5%; antipsychotics, 15%; benzodiazepines, 25%) as compared with other specialties (p < 0.003 for each drug class). There was no difference in perceived risk of antiepileptic drugs among specialties, including psychiatrists. Conclusion: The risk associated with use of psychotropic drugs in pregnancy was overestimated by physicians of all medical specialties, except psychiatry. All physicians should be aware of the safety/risk of psychotropic agents in pregnancy, as they may be required to give advice and/or prescribe these drugs to pregnant women. .

Pain and associated factors in depressed and non depressed puerperal women / Dor e fatores associados em puérperas deprimidas e não deprimidas

BACKGROUND AND OBJECTIVES: Physical pain during puerperium is in general caused by musculoskeletal changes inherent to gestation; however, its clinical progression may be changed by mood disorders. This study aimed at evaluating the association between pain and postpartum depression. METHODS: Participated in the study 80 women at 2 to 30 weeks postpartum. Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale. Pain intensity was evaluated with the analog visual scale, while the Nordic Musculoskeletal Questionnaire was used for pain location. RESULTS: Univariate analysis has shown that postpartum depression was associated to more severe pain (p<0.001), to constant mood changes (p=0.001), to early sexual initiation (p<0.05) and to a larger number of people living together (p<0.05). Chest was the most common painful site referred by depressed puerperal women (p=0.01). Logistic regression analysis has shown that moderate to severe pain was a strong predictor of postpartum depression (OR=4.6; confidence interval 95%: 1.5-13.9). CONCLUSION: Moderate to severe pain increases the probability of puerperal women developing postpartum depressive symptoms. .

JUSTIFICATIVA E OBJETIVOS: A dor física no período puerperal em geral decorre das alterações musculoesqueléticas inerentes à gestação, contudo seu curso clínico pode ser alterado na presença dos transtornos de humor. O objetivo deste estudo foi verificar a associação entre dor e depressão pós-parto. MÉTODOS: Foram entrevistadas 80 mulheres em pós-parto de 2 a 30 semanas. Os sintomas depressivos foram rastreados através da Escala de Depressão Pós-natal de Edimburgo. A intensidade da dor foi avaliada, por meio da escala analógica visual, enquanto o Questionário Nórdico de Sintomas Osteomusculares foi empregado na localização da dor. RESULTADOS: A análise univariada mostrou que a depressão pós-parto esteve associada à dor de maior intensidade (p<0,001), a alterações constantes de humor (p=0,001), à iniciação sexual precoce (p<0,05) e ao consumo de álcool (p<0,05). Percepção dolorosa de maior intensidade foi associada a um relacionamento conjugal ruim (p<0,05) e a um maior número pessoas em coabitação (p<0,05). A região torácica foi o local de dor mais apontado pelas puérperas deprimidas (p=0,01). A análise de regressão logística revelou que dor referida de moderada a intensa foi um forte fator preditor de depressão pós-parto (OR=4,6; intervalo de confiança de 95%:1,5-13,9). CONCLUSÃO: Dor de intensidade moderada a intensa aumenta a probabilidade de mulheres desenvolverem sintomas depressivos no pós-parto. .

Influence of body posture on the association between postpartum depression and pain / Influência do tipo postural na associação entre depressão pós-parto e dor

OBJECTIVE: To determine the association between postpartum depression (PPD), intensification of back pain and exacerbation of changes in postural alignment intrinsic to puerperium. METHODS: Eighty women at 2 to 30 weeks postpartum were included in the study according to the following criteria: literate mothers, gestation of 34 to 42 weeks, and healthy live-born infants. All mothers agreed to participate in the study. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Pain was assessed using a visual analogue scale (VAS) and the Nordic Musculoskeletal Questionnaire (NMQ), and posture, using real time naturalistic observation. RESULTS: There was a statistically significant association between PPD and pain intensity (p = 0.002). The upper back was the most frequent pain site among depressed women, both before (p = 0.04) and after delivery (p = 0.01). There were no associations between PPD and type of posture (p = 0.328). However, pain intensity was greater among depressed women in the swayback group (p < 0.001). CONCLUSION: The intensification of puerperal pain is closely associated with PPD. Our results suggest that back pain may be both a risk factor and a comorbidity of PPD among puerperal women and that pain and type of posture are interdependent. .

OBJETIVO: Verificar a associação entre depressão pós-parto (DPP), intensificação do quadro álgico na região posterior do tronco e exacerbação das alterações no alinhamento postural intrínsecas ao puerpério. MÉTODOS: Foram selecionadas 80 mulheres em pós-parto de 2 a 30 semanas, de acordo com os seguintes critérios: mães alfabetizadas; gestação entre 34 e 42 semanas; parição de bebê saudável e vivo. Todas as mães concordaram em participar da pesquisa. Os sintomas depressivos foram rastreados através da Escala de Depressão Pós-natal de Edimburgo (EDPE). A avaliação da dor ocorreu através de uma escala visual analógica (EVA) e do Questionário Nórdico de Sintomas Osteomusculares (QNSO). Para avaliação postural, empregou-se observação naturalística em tempo real. RESULTADOS: Foi verificada associação estatisticamente significativa entre DPP e maior intensidade de dor referida (p = 0,002). A região dorsal foi o sítio doloroso mais apontado pelas puérperas deprimidas, tanto no período pré-puerperal (p = 0,04), quanto no puerpério (p = 0,01). Não houve associação estatística entre DPP e tipo postural (p = 0,328). No entanto, a intensidade da dor foi maior entre as mulheres deprimidas no grupo com postura desleixada (swayback) (p < 0,001). CONCLUSÃO: A intensificação do quadro álgico puerperal associa-se fortemente à DPP. Nas puérperas deste estudo, a dor na região dorsal aparentemente se comportou tanto como um fator de risco quanto como uma comorbidade de DPP. Admite-se que existe uma relação de interdependência entre dor e tipo postural. .

A supergeneralização da memória autobiográfica nos transtornos depressivos / Overgeneral autobiographical memory in depressive disorders

Este artigo tem como objetivo revisar estudos que possuíram como temática a relação entre o fenômeno da supergeneralização da memória autobiográfica e os transtornos depressivos. Tal característica tem chamado a atenção por sua relação com uma pobre habilidade de resolução de problemas e imaginação do futuro, bem como pela manutenção e pior prognóstico da depressão. Para o acesso das informações, foi realizada uma busca sistematizada nos bancos de dados LILACS, SciELO, MEDLINE, IBECS e nas bases de ciências da saúde do Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), com foco em artigos publicados entre 2000 e 2010, usando os seguintes descritores: memória autobiográfica, supergeneralização da memória autobiográfica e memória autobiográfica e depressão, em português; e autobiographical memory, overgeneral autobiographical memory e autobiographical memory and depression em inglês. Após a aplicação dos critérios de exclusão, 27 estudos foram revisados. A supergeneralização tem sido investigada em diversos transtornos depressivos. Entretanto, mais estudos longitudinais são necessários para fundamentar tal característica cognitiva como um aspecto relevante na anamnese e no tratamento de distúrbios do humor.

This article aims to review studies focusing on the relationship between overgeneral autobiographical memory and depressive disorders. Such characteristic has attracted attention because of its relationship with a poor ability to solve problems and to imagine the future, as well as with the maintenance and a poor prognosis of depression. Data were collected through a systematic search on LILACS, SciELO, MEDLINE, and IBECS databases, and also on the health sciences records of Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), a Brazilian journal database, focusing on articles published between 2000 and 2010. The following keywords were used: memória autobiográfica, supergeneralização da memória autobiográfica, and memória autobiográfica e depressão in Portuguese; and autobiographical memory, overgeneral autobiographical memory, and autobiographical memory and depression in English. Following application of exclusion criteria, a total of 27 studies were reviewed. Overgeneral autobiographical memory has been investigated in several depressive disorders. However, further longitudinal studies are required to confirm the relevant role of this cognitive characteristic in anamnesis and in the treatment of mood disorders.