Diagnostic criteria and prevalence of mild cognitive impairment in older adults living in the community: a systematic review and meta-analysis

Abstract Background Mild Cognitive Impairment (MCI) is a disorder in which the patient presents a cognitive decline, but without negative impact on the activities of daily living. Objective To carry out a systematic review of published studies that analyzed the prevalence of Mild Cognitive Impairment (MCI) in older adults living in the community, and the criteria used for the diagnosis of this disorder. Methods A search was carried out in May 2017 using the descriptors: "epidemiology" or "prevalence", "mild cognitive impairment", and "community" in the PubMed, PsycInfo, SciELO, Web of Science, and Scopus databases. Two independent researchers extracted and documented the data. We used a random effect model to calculate pooled prevalence of MCI for overall studies and for each subgroup divided by diagnostic criteria. Results We found initially 1996 articles, and we selected 35 studies. The prevalence of MCI in the selected studies ranged from 0.5% to 41.8%. The overall pooled prevalence of MCI was 17.3% (CI 95%, 13.8-20.8), with significant heterogeneity between estimates (I2 = 99.6%). Discussion The standardization of the diagnostic criteria for MCI, as well as the tests used in the cognitive evaluation, could allow the comparison between the studies and would be an important step in the researches of this area.

Can anxiety increase tremors in patients with Parkinson's disease? An experimental model

Abstract Background Among non-motor symptoms of Parkinson's disease (PD), anxiety occurs in up to 67% of patients. Clinically, PD patients report worsening of tremors in anxiogenic situations. Objective The aim of this study was to evaluate the association between motor symptoms and anxiety in PD patients and compare their performances with those of healthy volunteers. Methods Fifteen volunteers with PD and 15 healthy volunteers without clinically significant psychiatric disorders were evaluated. Both groups were subjected to a simulated public speaking test (SPST). The following parameters were measured: visual analog mood scale (VAMS), items related to tremors of UPDRS, bradykinesia tests, blood pressure, and heart rate. Results Results of repeated measures ANOVA indicated a significant effect on group × phase interaction (F3.7,105.6 = 2.56; p = 0.046) for VAMS anxiety factor. Regarding tremors, ANOVA indicated significant differences in group × phase interaction (F4.5,121 = 2.88; p = 0.021) and between the groups (F1,27 = 45.88, p < 0.001), with differences in the anticipatory phase, performance, and post-speech, compared with those in the baseline. There were no significant differences between the groups with regard to other factors of VAMS, physiological measurements, and bradykinesia. Discussion Worsening of tremors occurred during SPST, particularly in phases with higher anxiety scores.

Early interventions for the prevention of PTSD in adults: a systematic literature review

Abstract Background Secondary interventions are implemented within a short interval following the occurrence of traumatic events with the purpose of preventing the onset of PTSD. Objective Analyze the results of studies that assessed post-trauma interventions in adults aimed at preventing the onset of PTSD or symptoms related to PTSD. Methods We performed literature searches using the search expression [(Early intervention OR secondary prevention) AND (Post traumatic stress disorder OR PTSD)] for articles published until October 2016. Among the references found, 29 fulfilled the selection criteria established for the review. Data were divided and analyzed according to the type of intervention: pharmacological or psychological. Results Psychological measures used in the studies lack homogeneity regarding the type of intervention and the assessment of intervention outcomes. Pharmacological interventions were less frequent and findings require replication, together with an expansion in the types of substances investigated. In general, many of the studies reviewed suggest that both pharmacological and psychological interventions are effective in the prevention of PTSD. Discussion Future trials should be focused on determining the best interventions for the secondary prevention of PTSD. The combination of psychological and pharmacological interventions for post-trauma patients poses opportunities and challenges that remain unexplored.

Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): transcultural adaptation of the Brazilian version

Abstract Background DSM-5 introduced some modifications on Posttraumatic Stress Disorder (PTSD) criteria. The instruments developed for the assessment of aspects related to PTSD needed a reformulation, as was the case of the Posttraumatic Stress Disorder Checklist (PCL). Objectives To present the process of transcultural adaptation of the three forms of the PCL-5 to Brazilian Portuguese, as well as its face validity. Methods The procedure involved independent translations, a synthesis version, back translation by an independent translator, evaluation by the original author, analysis by an expert committee, and a pretesting study (10 subjects with/without experience of a traumatic situation). The last two steps formed the face validity procedure. Results The synthesis version was approved by the original author and the agreement percentage by the expert committee was excellent, with only two items showing < 90%. The pretesting study showed that the Brazilian version was well understood and linguistically and culturally accepted by the participants, which did not make significant suggestions for changes. Discussion Transcultural adaptation of the PCL-5 for Brazilian Portuguese followed a rigid and standardized procedure. Therefore, after having its face validity assessed by an expert committee and by the target population, it is apt to be used.

Diagnosing social anxiety in Parkinson's disease: characteristics and frequencies according to two diagnostic criteria

Abstract Background: Studies found inconsistent frequencies of social anxiety disorder (SAD) in Parkinson's disease (PD) (9.7%-50%). Previous reports did not test the impact of applying DSM-IV restrictive criteria that recommends the exclusion of secondary cases when diagnosing SAD in PD. Objective: Our aim is to estimate the frequency of social anxiety according to DSM-IV criteria and according to an inclusive broader approach. Methods: One hundred and ten PD patients were assessed for the presence of SAD using SCID-I, diagnosis of social anxiety were determined according to two different criteria: following and not following DSM-IV recommendation for exclusion of cases though to be secondary to a general medical condition. Results: SAD was present in 34 (31%) of patients, but 17 (15.5%) were secondary to a general medical condition. Patients with SAD were significantly younger, had earlier disease onset, had more severe PD symptoms, and were more frequently depressed. There was no difference in demographic and clinical features between primary and secondary SAD. Discussion: We conclude that the use of different diagnostic criteria may have a massive impact in the estimation of frequency of SAD in PD.

Empatia e reconhecimento de expressões faciais de emoções básicas e complexas em estudantes de Medicina / Empathy and facial expression recognition of basic and complex emotions in medical students

RESUMO Objetivo Avaliar a empatia e a capacidade de reconhecimento de emoções básicas e complexas e suas correlações em estudantes de Medicina. Métodos O desenho do estudo foi transversal. Foram avaliados 86 alunos do 3º e 4º ano do curso de Medicina de uma faculdade de Medicina do interior do estado de São Paulo com os seguintes instrumentos: (i) escala Jefferson de empatia, (ii) tarefa de Reconhecimento de Expressões Faciais de emoções básicas (REF) e (iii) Reading the mind in the eyes test (RMEt). Resultados A média geral de acertos no REF foi 15,6 (DP: ±2,3). Houve diferença estatisticamente significante no número de acertos da emoção tristeza no sexo feminino comparado com o masculino (t84 = 2,30; p = 0,02). Em relação ao RMEt, a média geral de acertos foi de 26,5 (DP: ±3,3) com diferença estatisticamente significante entre os gêneros com maior número de acertos entre as estudantes do sexo feminino (t84 = 3,43; p < 0,01). O escore total médio na escala de empatia foi 121,3 (DP: ±9,8). Houve correlação positiva fraca entre o escore total da escala de empatia e o número de acertos para a emoção tristeza (r = 0,29; p < 0,01). Conclusão O número de acertos para a emoção tristeza no REF e o escore total do RMEt foi maior no sexo feminino comparado com sexo masculino. Além disso, a empatia parece estar diretamente relacionada com a capacidade de reconhecer a emoção tristeza. Outros estudos parecem pertinentes para avaliar de forma mais profunda aspectos de empatia e reconhecimento de expressões faciais da emoção em estudantes de medicina.

ABSTRACT Objective The aim was to evaluate empathy and facial expression recognition of basic and complex emotions and their correlations in medical students. Methods A cross-sectional study was performed in a medical school of the state of São Paulo. We evaluated 86 third and fourth year medical students with the following instruments: (i) Jefferson Scale of Empathy, (ii) Facial Expression Recognition of basic emotions task (REF) and (iii) Reading the Mind in the Eyes test (RMEt). Results The overall mean score in the REF was 15.6 (SD: ±2.3). There was a statistical significant difference in the number of correct responses in sadness emotion in female gender compared to male (t84 = 2.30; p = 0.02). Regarding RMEt, the overall mean score was 26.5 (SD: ±3.3) with statistically significant difference between genders with higher number of correct responses among female students (t84 = 3.43; p < 0.01). The mean score on the empathy scale was 121.3 (SD: ±9.8). There was significant weak positive correlation between the total score of empathy scale and the recognition of sadness facial emotion (r = 0.29; p < 0.01). Conclusion The number of correct responses to sadness emotion in the REF and the total score of RMEt was higher in female students compared to male. In addition, empathy seems to be directly related to the ability to recognize sadness. Other studies are needed to provide a deeper understanding of empathy and facial emotion recognition in medical students.

Delirium como fator de risco para demência em idosos: uma atualização / Delirium as risk factor for dementia in older adults: an update

RESUMO Objetivo Realizar uma revisão atualizada dos estudos que avaliaram o delirium como fator de risco para o desenvolvimento de demência em idosos. Métodos A revisão foi realizada utilizando-se a base de dados do PubMed, com o seguinte cruzamento de descritores: risk factors and (delirium or acute confusional state) and dementia. Apenas estudos do tipo coorte publicados entre janeiro de 2000 a maio de 2015 foram considerados. Resultados Foram selecionados oito estudos de acordo com os critérios de inclusão e exclusão. Todos os estudos apontaram para um aumento do risco de demência ou declínio cognitivo após a ocorrência de delirium, apesar das diferenças entre os estudos em relação à causa do delirium. Conclusões Os estudos atuais apontam para uma clara associação entre delirium e aumento do risco de demência. Dessa forma, psiquiatras e médicos generalistas precisam ficar atentos aos indícios de declínio cognitivo após a ocorrência do delirium em idosos.

ABSTRACT Objective To perform an update review of the studies that evaluated delirium as a risk factor for developing dementia in older adults. Methods A review was performed using PubMed database, crossing the following descriptors: risk factors and (delirium or acute confusional state) and dementia. Only cohort studies published from January 2000 to May 2015 were considered. Results We selected eight studies according to the inclusion and exclusion criteria. All studies pointed to an increased risk of dementia or cognitive decline after the occurrence of delirium, despite the differences between the studies in relation to the cause of delirium. Conclusions Recent studies indicate a clear association between delirium and increased risk of dementia. Therefore, the psychiatrists and general practitioners need to pay attention to the evidence of cognitive decline after the occurrence of delirium in older adults.

Depression increases in patients with Parkinson?s disease according to the increasing severity of the cognitive impairment / Em pacientes com doença de Parkinson, a depressão aumenta de acordo com o aumento da gravidade do comprometimento cognitivo

Objective : To test the hypothesis that severity of cognitive impairment modifies the association between depression and Parkinson’s disease (PD). Method : One-phase population-based door-to-door surveys. This is a secondary analysis of 1,451 people aged 65 years and older with cognitive impairment living in defined catchment areas. Depression was estimated according to ICD-10, self-reported PD, disability according to WHODAS-II and cognitive status according to the CSI-D. Results : The mean age of the sample was 79.3 years old and most (69%) were women. Of the total sample, 16.1% had depression and it was significantly higher among participants with PD. There was an increase on the ORs of the association between depression and PD with decreased scores in the cognitive test (Adjusted OR from 0.98 to 8.04). Conclusion : The association between depression and PD increases with the severity of the cognitive impairment. .

Objetivo : Testar a hipótese que a gravidade do prejuízo cognitivo modifica a associação entre depressão e doença de Parkinson (DP). Método : Estudo populacional através da análise secundária de 1.451 pessoas com idade maior ou igual a 65 anos com prejuízo cognitivo que residiam em áreas de abrangência definidas. A depressão foi estimada de acordo com a CID-10, auto-relato de DP, incapacidade conforme a WHODAS-II e nível cognitvo de acordo com a CSI-D. Resultado : A média de idade foi 79,3 anos, predominaram as mulheres (69%). Do total de indivíduos, 16,1% tinham depressão, significantemente maior entre os participantes com DP. Houve aumento gradativo na OR relativa à associação entre depressão e DP com a diminuição do escore no teste cognitivo (OR ajustado variou de 0,98 a 8,04). Conclusão : A associação entre depressão e DP parece aumentar com a gravidade do prejuízo cognitivo. .

Neuroimaging in specific phobia disorder: a systematic review of the literature / Neuroimagem do transtorno de fobia específica: uma revisão sistemática da literatura

OBJECTIVE: Specific phobia (SP) is characterized by irrational fear associated with avoidance of specific stimuli. In recent years, neuroimaging techniques have been used in an attempt to better understand the neurobiology of anxiety disorders. The objective of this study was to perform a systematic review of articles that used neuroimaging techniques to study SP. METHOD:A literature search was conducted through electronic databases, using the keywords: imaging, neuroimaging, PET, spectroscopy, functional magnetic resonance, structural magnetic resonance, SPECT, MRI, DTI, and tractography, combined with simple phobia and specific phobia. One-hundred fifteen articles were found, of which 38 were selected for the present review. From these, 24 used fMRI, 11 used PET, 1 used SPECT, 2 used structural MRI, and none used spectroscopy. RESULT: The search showed that studies in this area were published recently and that the neuroanatomic substrate of SP has not yet been consolidated. CONCLUSION: In spite of methodological differences among studies, results converge to a greater activation in the insula, anterior cingulate cortex, amygdala, and prefrontal and orbitofrontal cortex of patients exposed to phobia-related situations compared to controls. These findings support the hypotheses of the hyperactivation of a neuroanatomic structural network involved in SP.

A Fobia Específica (SP do inglês) é caracterizada por medos irracionais associados à evitação de estímulos específicos. Nos últimos anos, técnicas de neuroimagem vêm sendo empregadas na tentativa de melhor compreender a neurobiologia dos transtornos de ansiedade. O objetivo do presente estudo é realizar uma revisão sistemática dos artigos que utilizaram neuroimagem para estudar a SP. A busca na literatura foi realizada por intermédio de indexadores eletrônicos, utilizando-se as palavras-chave: imaging, neuroimaging, PET, spectroscopy, functional magnetic ressonance, structural magnetic ressonance, SPECT, MRI, DTI e tractography, cruzadas individualmente com os termos simple phobia e specific phobia. Foram encontrados 115 artigos, sendo 38 deles selecionados para a presente revisão. Desses, 24 usaram fMRI, 11 usaram PET, 1 usou SPECT, 2 usaram MRI estrutural e nenhum artigo de espectroscopia. Verifica-se que os estudos na área foram publicados recentemente e que, até o momento, o substrato neuroanatômico deste transtorno não está consolidado. Apesar das diferenças metodológicas entre os estudos, os resultados convergem para maior ativação na ínsula, cíngulo anterior, amídala e córtex préfrontal e orbitofrontal dos pacientes expostos a situações phobia related quando comparados aos controles. Esses achados reforçam hipóteses a respeito da hiperativação de uma determinada rede de estruturas neuroanatômicas envolvidas no transtorno de SP.

Diretrizes da Associação Médica Brasileira para o diagnóstico e diagnóstico diferencial do transtorno de ansiedade social / Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder

OBJETIVO: O transtorno de ansiedade social é o transtorno de ansiedade mais comum, apresenta curso crônico, frequentemente sem remissões, sendo comumente associado com importante prejuízo funcional e comprometimento psicossocial. A Associação Médica Brasileira, por meio do projeto "Diretrizes", busca desenvolver consensos de diagnóstico e tratamento para as doenças mais comuns. O objetivo deste trabalho é apresentar os achados mais relevantes das diretrizes da Associação Médica Brasileira relativas ao diagnóstico e diagnóstico diferencial do transtorno de ansiedade social. MÉTODO: O método utilizado foi o proposto pela Associação Médica Brasileira para o projeto Diretrizes. A busca foi realizada nas bases de dados do Medline (PubMed), Scopus, Web of Science e Lilacs, sem limite de tempo. A estratégia utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (acrônimo das iniciais "paciente ou população"; "intervenção, indicador ou exposição"; "controle ou comparação" e; "outcome ou desfecho"). RESULTADOS: São apresentados dados relativos a manifestações clínicas, prejuízos e implicações, diferenças entre os subtipos generalizado e circunscrito, e impacto com depressão, abuso e dependência de drogas e outros transtornos de ansiedade. Além disso, foram realizadas discussões acerca dos principais diagnósticos diferenciais. CONCLUSÃO: As diretrizes propõem-se a servir de referência para o médico generalista e especialista, auxiliando e facilitando o diagnóstico do transtorno de ansiedade social.

OBJECTIVE: Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending"). RESULTS: We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION: The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.