Neuroprogression in post-traumatic stress disorder: a systematic review

Abstract Introduction Neuroprogression has been proposed as the pathological rewiring of the brain that takes place in parallel with clinical and neurocognitive deterioration in the course of psychiatric disorders. This study aims to review the biological underpinnings and clinical outcomes related to neuroprogression in post-traumatic stress disorder (PTSD). Methods We performed a systematic review by searching PubMed, Embase, and Web of Science for articles published between January 1, 1960, and January 6, 2020. Inclusion criteria were met when articles assessed brain changes, neurocognition, functioning, inflammation, oxidative stress, and neurotrophins in patients with PTSD. Narrative review articles, case reports, and preclinical studies were excluded. Results A total of 965 abstracts were identified and 15 articles were included in our systematic review. It seems that for a subset of patients whose symptoms worsen or are maintained at a high intensity there is a progressive change in the frontal lobe, especially the prefrontal cortex, and worsening of both neurocognition (verbal memory and facial recognition) and functioning (physical, psychological, social and environmental). Conclusion Although current findings associate progressive reduction in frontal lobe size with neurocognitive impairment, further research is needed to characterize PTSD as a neuroprogressive disorder.

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life

Abstract Introduction A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. Methods The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. Results Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. Conclusions This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

COVID-19 pandemic and social distancing: economic, psychological, family, and technological effects

Abstract Introduction The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. Objective The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. Method This study is a narrative review of the literature on social isolation in the context of the COVID-19 pandemic. Results 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. Conclusions It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families.

Trauma infantil e manifestações histéricas na atualidade: uma revisão da literatura / Child trauma and hysterical manifestations today: a literature review

As reações corporais e emocionais sentidas pelos pacientes com manifestações histéricas podem atingir tamanha intensidade, a ponto de prejudicar sua vida social, familiar e laboral. O trabalho parte dos seguintes questionamentos: como são as manifestações histéricas na atualidade? Qual a compreensão sobre a histeria na literatura da área ao longo do tempo? O objetivo é descrever aspectos teóricos sobre a histeria e o trauma infantil, articulando-os com a clínica atual. Foi desenvolvida uma revisão da literatura por meio do método narrativo. Os resultados encontrados foram 106 estudos nos últimos 6 anos (Bireme e Dialnet), sendo que, de 2017 em diante, houve um decréscimo nas publicações científicas sobre o tema. Apesar de a categoria psicopatológica da histeria ter desaparecido dos manuais de transtornos mentais, na clínica atual as manifestações histéricas são facilmente confundidas com outros transtornos (depressivos, dissociativos e distúrbio borderline). As manifestações somáticas aparecem no corpo para comunicar eventos traumáticos não contidos pelo aparelho psíquico. Conclui-se que as manifestações histéricas seguem presentes nos dias de hoje, e o corpo tende a ser uma via de expressão somática. No contexto da relação entre sintomas histéricos e traumas vivenciados na infância, a psicoterapia ocupa lugar de destaque, promovendo ressignificações para tais eventos traumáticos.(AU)

The bodily and emotional reactions felt by patients with hysterical manifestations can reach such intensity as to harm their social, family and work life, causing several losses for the individual. The study starts from the following questions: how are the hysterical manifestations today? What about understanding hysteria in the literature of the area over time? The objective is to describe theoretical aspects of hysteria and childhood trauma, in conjunction with the current clinic. A literature review using the narrative method was developed. The results found were 106 studies in the last 6 years (Bireme and Dialnet), and as of 2017 there is a decrease in scientific publications on the topic. Although the psychopathological category of hysteria has disappeared from the manuals of mental disorders, nowadays in the clinic the hysterical manifestations are easily confused with other disorders (depressive, dissociative and borderline). Somatic manifestations appear in the body to communicate traumatic events not contained by the psychic apparatus. It is concluded that the hysterical manifestations are still present today, and the body tends to be an important way of expressing symptoms through the somatic path. In the context of the relationship between hysterical symptoms and childhood trauma, psychotherapy occupies a prominent place, promoting reframing for such traumatic events.(AU)

Las reacciones corporales y emocionales que sienten los pacientes con manifestaciones histéricas pueden alcanzar tal intensidad como para dañar su vida social, familiar y laboral, causando varias pérdidas para el individuo. El estudio parte de las siguientes preguntas: ¿Cómo son hoy las manifestaciones histéricas? ¿Cuál es la comprensión de la histeria en la literatura de la zona a lo largo del tiempo? El objetivo es describir aspectos teóricos de la histeria y el trauma infantil, en conjunto con la clínica actual. Se ha elaborado una revisión de la literatura utilizando el método narrativo. Los resultados encontrados fueron 106 estudios en los últimos 6 años (Bireme y Dialnet), y a partir de 2017 hubo una disminución en las publicaciones científicas sobre el tema. Aunque la categoría psicopatológica de histeria ha desaparecido de los manuales de trastornos mentales, hoy en día en la clínica las manifestaciones histéricas se confunden fácilmente con otros trastornos (depresivo, disociativo y borderline). Las manifestaciones somáticas aparecen en el cuerpo para comunicar eventos traumáticos no contenidos por el aparato psíquico. Se concluye que las manifestaciones histéricas todavía están presentes hoy en día, y el cuerpo tiende a ser una forma importante de expresar los síntomas a través de las vías somáticas. En el contexto de la relación entre los síntomas histéricos y el trauma vivido en la infancia, la psicoterapia ocupa un lugar destacado, promoviendo replanteamiento para tales eventos traumáticos.(AU)

Indicações de tratamento psicoterápico individual no Transtorno de Estresse Pós-Traumático / Indications of individual psychotherapeutic treatment in Posttraumatic Stress Disorder

O objetivo deste estudo foi revisar as principais recomendações de tratamento psicoterápico individual em adultos para o Transtorno de Estresse Pós-Traumático (TEPT), permitindo uma melhor avaliação clínica para a adequação do mesmo de acordo com as características do paciente. A revisão foi realizada na base de dados PubMed com estudos de revisão e recomendações reconhecidas internacionalmente. São descritas as abordagens psicoterápicas individuais e seus níveis de evidência. A descrição é complementada com uma avaliação clínica para auxiliar o terapeuta na escolha entre as possíveis intervenções psicoterápicas para o TEPT. Visto que vários tratamentos psicológicos são eficazes para adultos com TEPT, esta revisão pode ser um guia na decisão terapêutica usando parâmetros clínicos e de evidência científica.(AU)

The purpose of the study was to review the main individual psychotherapeutic treatment recommendations for Post-traumatic Stress Disorder (PTSD), aiming a better clinical assessment of its adequacy according to the patient characteristics. The review was conducted on the PubMed database with study reviews and internationally recognized guidelines. We describe the individual psychotherapeutic approaches and their levels of evidence. The description is supplemented by a clinical evaluation to assist the therapist in choosing among the possible psychotherapeutic interventions for PTSD. Since various psychological treatments are effective for adults with PTSD, this review may be a guide to the therapeutic decision using clinical and scientific evidence parameters.(AU)

Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia / Fatores de risco para multirresistência bacteriana em pneumonias adquiridas no hospital não associadas à ventilação mecânica

OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP. .

OBJETIVO: Identificar fatores de risco para o desenvolvimento de pneumonia adquirida no hospital (PAH), não associada à ventilação mecânica e causada por bactérias multirresistentes (MR). MÉTODOS: Estudo de coorte observacional retrospectivo, conduzido ao longo de três anos em um hospital universitário terciário. Incluímos apenas pacientes sem ventilação mecânica, com diagnóstico de PAH e com cultura bacteriana positiva. Variáveis categóricas foram comparadas por meio do teste do qui-quadrado. A análise de regressão logística foi usada para determinar os fatores de risco para PAH causada por bactérias MR. RESULTADOS: Dos 140 pacientes diagnosticados com PAH, 59 (42,1%) apresentavam infecção por cepas MR. As taxas de mortalidade nos pacientes com cepas de Staphylococcus aureus resistentes e sensíveis à meticilina, respectivamente, foram de 45,9% e 50,0% (p = 0,763). As taxas de mortalidade nos pacientes com PAH causada por bacilos gram-negativos MR e não MR, respectivamente, foram de 45,8% e 38,3% (p = 0,527). Na análise univariada, os fatores associados com cepas MR foram DPOC, insuficiência cardíaca crônica, insuficiência renal crônica, diálise, cateterismo urinário, infecções extrapulmonares e uso de antimicrobianos nos 10 dias anteriores ao diagnóstico de PAH. Na análise multivariada, o uso de antimicrobianos nos 10 dias anteriores ao diagnóstico foi o único fator preditor independente de cepas MR (OR = 3,45; IC95%: 1,56-7,61; p = 0,002). CONCLUSÕES: Neste estudo unicêntrico, o uso de antimicrobianos de largo espectro 10 dias antes do diagnóstico de PAH foi o único preditor independente da presença de bactérias MR em pacientes ...

Biomarkers in community-acquired pneumonia: A state-of-the-art review

Community-acquired pneumonia (CAP) exhibits mortality rates, between 20% and 50% in severe cases. Biomarkers are useful tools for searching for antibiotic therapy modifications and for CAP diagnosis, prognosis and follow-up treatment. This non-systematic state-of-the-art review presents the biological and clinical features of biomarkers in CAP patients, including procalcitonin, C-reactive protein, copeptin, pro-ANP (atrial natriuretic peptide), adrenomedullin, cortisol and D-dimers.

Prevalência e seguimento de exame citopatológico de colo uterino com atipias em células escamosas de origem indeterminada em um hospital universitário brasileiro / Prevalence and follow-up of pap smear with atypical squamous cells of undetermined origin at a teaching hospital in Brazil

Introdução: O câncer cervical é uma neoplasia maligna com possibilidade de prevenção.Rastreamento adequado pode reduzir morbimortalidade.Objetivo: Verificar a evolução clínica em pacientes com citopatológico de colo uterino com atipias em células escamosas de origem indeterminada (ASC-US ).Método: Coorte retrospectiva em pacientes com ASC-US do Ambulatório de Ginecologia do Hospital de Clínicas de Porto Alegre. Acompanhamento por 3 anos e seguimento com citologia e/ou histologia. Análise: Statistical Package for Social Sciences (dados descritivos e associações). Variáveis quantitativas com distribuição simétrica: média e desvio-padrão. Variáveis qualitativas: percentuais; aprovação do Grupo de Pesquisa ePós-graduação do Hospital de Clínicas de Porto Alegre (07-286).Resultados: Amostra de 320 casos. Média de idade das pacientes: 41,3 anos. Não houve associação com tabagismo e ASC-US , lesão intraepitelial escamosa de baixo grau (LSIL) ou lesão intraepitelial escamosa de alto grau (HSIL) (22,8 versus 20,5%; odds ratio = 0,87; intervalo de confiança de 95% 0,38-1,99; p=0,751). Das pacientes com ASC-US , 87,2% fizeram colposcopia imediata; 104 resultaram em alterações menores e quatro em maiores à colposcopia, embora 85 pacientes tenham realizado biópsias.A histologia mostrou: 7,5% de neoplasia intraepitelial 1; 2,1%, neoplasia intraepitelial 2/3; e 0,9%, carcinoma. Um total de 12,5% fez algum tipo de tratamento cirúrgico,sendo este excisão eletrocirúrgica com alça até histerectomia.

Ao final do estudo, 77,5% tiveram citopatológico normal como desfecho; 20,3% tiveram ASC-US persistente ouLSIL; 1,3%, HSIL; e 0,9%, carcinoma.Conclusões: O percentual de citopatológicos com ASC-US era esperado e foi adequado.A maioria dos exames teve um acompanhamento citológico normal, mas tivemos um número muito elevado de biópsias em pacientes com colposcopias com alterações menores. A taxa de evolução para lesões de alto grau e câncer não foi desprezível,alertando para necessidade de acompanhamento na presença de ASC-US.

Background: Cervical cancer is a preventable malignant neoplasia. Adequate screening may reduce mortality and morbidity.Aims: To investigate the clinical outcome in patients with pap smears showing atypical squamous cells of undetermined origin (ASC-US ).Methods: Retrospective cohort study involving patients with ASC-US seen at the GynecologyOutpatient Clinic of Hospital de Clínicas de Porto Alegre. Three-year follow-up and monitoring based on cytological or histological tests. Analysis: Statistical Package for the Social Sciences (descriptive data and associations). Quantitative variables with symmetric distribution: mean and standard deviation. Qualitative variables: percentage; approval of the Research and Graduate Study Program of Hospital de Clínicas de Porto Alegre (07-286).Results: Our sample included 320 cases. Patients’ mean age: 41.3 years. There was no association with smoking and ASC-US , low squamous intraepithelial lesion (LSIL), or high squamous intraepitheliallesion (HSIL) (22.8 versus 20.5%, odds ratio = 0.87, 95% confidence interval 0.38-1.99, p = 0.751).Of the patients with ASC-US , 87.2% had immediate colposcopy, 104 had minor changes and four had major changes on colposcopy, although 85 patients underwent biopsies. Histology showed:7.5% of intraepithelial neoplasia 1; 2.1% of intraepithelial neoplasia 2/3; and 0.9% of carcinoma.A total of 12.5% patients underwent surgical treatment consisting of loop electrosurgical excision procedure followed by hysterectomy. At the end of the study, 77.5% had normal pap smear; 20.3% had persistent ASC-US or LSIL; 1.3% had HSIL; and 0.9% had carcinoma.Conclusions: The percentage of pap smears with ASC-US was expected and adequate. Most tests had normal results during the follow-up, but there was a very large number of biopsies in patients with minor changes on colposcopy. The rate of progression to high-grade lesions and cancer was not negligible, prompting the need for monitoring the presence of ASC-US.