Transtorno distímico: uma ilustração clínica pela perspectiva da Terapia Cognitivo-Comportamental e Terapia Cognitiva Processual / Dysthimic disorder: clinical illustration from the perspective of Cognitive- Behavioral Therapy and Processual Cognitive Therapy

O presente trabalho tem como objetivo ilustrar como a articulação entre a Terapia Cognitivo Comportamental e a Terapia Cognitiva Processual possibilita resultado satisfatório em casos de Trantorno distímico. Os estudos acerca do transtorno distímico ainda são limitados. No entanto, o caso clínico corrobora com a literatura, que aponta a importância dos psicofarmacos no tratamento dos transtornos de humor, bem como a importância da psicoterapia, inclusive em casos mais brandos, como os de distimia. A Terapia Congitivo Comportamental clássica não foi suficente para a melhora significativa da paciente, sendo necessário o acréscimo de técnicas da Tereapia Cognitiva Processual. Essa articulação das abordagens nas intervenções psicoterápicas proporcionou mudanças significativas no padrão de pensamento, sentimento e comportamento da paciente.(AU)

This paper aims to illustrate how the articulation between Cognitive-Behavioral Therapy and Cognitive Processual Therapy enables satisfactory results in cases of dysthymic disorder. Studies on dysthymic disorder are still limited. However, the clinical case corroborates the literature, which points out the importance of psychopharmaceuticals in the treatment of mood disorders, as well as the importance of psychotherapy even in milder cases such as dysthymia. The classic Cognitive-Behavioral Therapy was not enough for the patients significant improvement, and the addition of Cognitive Processual Therapy techniques was necessary. This articulation of approaches in psychotherapeutic interventions provided significant changes in the patients pattern of thinking, feeling, and behaving.(AU)

El presente trabajo pretende ilustrar cómo la articulación entre la Terapia Cognitivo Conducutal y la Terapia Cognitiva Procesal permite obtener resultados satisfactorios en casos de trastorno distímico. Los estudios sobre el trastorno distímico son todavía limitados. Sin embargo, el caso clínico corrobora la literatura, que señala la importancia de los psicofármacos en el tratamiento de los trastornos del estado de ánimo, así como la importancia de la psicoterapia, incluso en los casos más leves, como la distimia. La clásica Terapia CognitivoConductual no fue suficiente para la mejora significativa del paciente, siendo necesaria la adición de técnicas de la Terapia Cognitiva Procesal. Esta articulación de enfoques en las intervenciones psicoterapéuticas condujo a cambios significativos en el patrón de pensamiento, sentimiento y comportamiento del paciente.(AU)

Psicoterapia breve na intervenção de psicólogos e psiquiatras no Brasil: uma revisão integrativa da produção científica / Brief psychotherapy in the intervention of psychologists and psychiatrics in Brazil: an integrative review of scientific production

Historicamente, a Psicoterapia Breve (PB) teve como pressuposto teórico a Psicanálise e foi desenvolvida para atender o cenário da saúde mental. Observa-se que ao longo dos anos a técnica foi aprimorada, utilizada por diferentes profissionais e em distintos contextos. Diante disso, busca-se identificar, avaliar e sumarizar as evidências científicas disponíveis que demonstrem a caracterização da literatura científica sobre intervenções de psicólogos e psiquiatras em psicoterapias breves no Brasil. O estudo foi conduzido mediante revisão integrativa da literatura, nas seguintes bases de dados PubMed, SCOPUS, PsycINFO e Lilacs, no período compreendido entre 2010 e 2020. Foram recuperadas para análise 266 publicações. Destas, foram incluídas 22 por cumprirem os critérios de inclusão do estudo. Todas as pesquisas indicaram a participação de psicólogos nas intervenções e também intervenções de modo conjunto a psiquiatras. Há predominância do nível 6 de evidência científica. Diferentes abordagens psicológicas foram utilizadas na condução das intervenções que se efetivaram de forma individual ou grupal. A aplicação da PB é identificada em diferentes contextos, tais como: clínica, hospitais, ambiente de trabalho e sociojurídico. As pesquisas em PB buscam consolidar conhecimento sobre o processo, o curso do tratamento e resultados de intervenções psicoterápicas independente do profissional da área da saúde que conduz a intervenção. Os dados identificados possibilitam a revisão de práticas de intervenção e o avanço no conhecimento científico, importantes para subsidiar tomadas de decisão para o cuidado à saúde de indivíduos, grupos e populações.(AU)

Historically, Brief Psychotherapy (BP) has Psychoanalysis as a theoretical assumption and was developed to serve the mental health center. It is observed that over the years the technique has been improved, used by different professionals and in different contexts. Therefore, it seeks to identify, assess and summarize the scientific evidence available to demonstrate the characterization of the scientific literature on interventions by psychologists and psychiatrists in brief psychotherapies in Brazil. The study was carried out through an integrative literature review, following the following databases PubMed, SCOPUS, PsycINFO and Lilacs, period not between 2010 and 2020. 266 publications were retrieved for analysis. Of these, 22 were included for meeting the study's inclusion criteria. All investigations will indicate the participation of psychologists in the intervention and also in conjunction with psychiatrists. There is a predominance of level 6 of scientific evidence. Different psychological approaches are used to conduct interventions that are carried out individually or in groups. An application of BP is identified in different contexts, such as: clinic, hospital, work environment and socio-legal. The investigations in the BP seek to consolidate knowledge about the process, or trajectory of treatment, and the results of professional psychotherapeutic interventions independent of the health area that originated the intervention. The identified data enable the review of interventions, which are important to support decision-making for the health care of individuals, groups and populations.(AU)

Históricamente, la Psicoterapia Breve (PB) tiene al Psicoanálisis como supuesto teórico y fue desarrollada para servir al centro de salud mental. Se observa que a lo largo de los años la técnica ha ido mejorando, siendo utilizada por diferentes profesionales y en diferentes contextos. Por lo tanto, busca identificar, evaluar y resumir la evidencia científica disponible para demostrar la caracterización de la literatura científica sobre intervenciones de psicólogos y psiquiatras en psicoterapias breves en Brasil. El estudio se realizó mediante una revisión integradora de la literatura, siguiendo las siguientes bases de datos PubMed, SCOPUS, PsycINFO y Lilacs, período no comprendido entre 2010 y 2020. Se recuperaron 266 publicaciones para su análisis. De estos, 22 se incluyeron por cumplir con los criterios de inclusión del estudio. Todas las investigaciones indicarán la participación de psicólogos en la intervención y también en conjunto con psiquiatras. Predomina el nivel 6 de evidencia científica. Se utilizan diferentes enfoques psicológicos para realizar intervenciones que se llevan a cabo de forma individual o en grupo. Se identifica una aplicación de PB en diferentes contextos, tales como: clínico, hospitalario, ambiente laboral y sociojurídico. Las investigaciones en el PB buscan consolidar el conocimiento sobre el proceso, o trayectoria de tratamiento, y los resultados de las intervenciones psicoterapéuticas profesionales independientes del área de salud que originó la intervención. Los datos identificados permiten la revisión de prácticas y / o intervenciones, que son importantes para apoyar la toma de decisiones para el cuidado de la salud de individuos, grupos y poblaciones.(AU)

Clinical Observation of Jiawei Xiaoyaosan in Treating Liver Depression and Spleen Deficiency Type 2 Diabetes with Emotional Disorder / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of Jiawei Xiaoyaosan for patients with anxiety and depression in type 2 diabetes with liver depression and spleen deficiency. Method:The 76 eligible patients with anxiety and depression in type 2 diabetes with liver depression and spleen deficiency were randomly divided into two groups:control group (38 cases) and treatment group (38 cases). In control group, the basic medicines metformin sustained-release tablets combined with deanxit were given; based on the treatment in control group, the patients in treatment additionally received Jiawei Xiaoyaosan. The changes of fasting plasma glucose (FPG), 2 hours postprandial blood glucose (2 hPG), haemoglobin A1c (HbA1c), fasting insulin (FINS) and serum insulin levels 30 minutes after glucose intake (30 min INS), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) and so on were observed and compared. Result:As compared with those before treatment, the levels of FPG, 2 hPG and HbA1c were decreased significantly (PPPPPPPPConclusion:Jiawei Xiaoyaosan combined with basic medication can significantly reduce depression and anxiety in patients with type 2 diabetes mellitus of liver depression and spleen deficiency, reduce blood glucose, glycosylated hemoglobin, decrease fasting insulin and increase 30 min INS level. The effect may be related to the improvement of anxiety, depression and other adverse emotions in these patients.

The epidemiological investigation of major depressive disorder and dysthymia in mosuo ethnic minority of Ninglang area, Yunnan province / 中华行为医学与脑科学杂志

Objective To explore the prevalence of depressive disorder in the Mosuo ethnic minority in Ninglang district,Yunnan Province.Methods By stratified random sampling,1 121 Mosuo subjects aged 15 or above were selected and assessed by the MINI-international neuropsychiatric interview according to the Structured Clinical Interview for DSM-V-TR Axis I Disorders-Patient Edition for mental disorders.Results The standardized time-point prevalence of major depressive disorder in Mosuo nationality was 1.74％,and 1.69％ (95 ％ CI =1.32％-2.15 ％) in males and 1.77％ (95 ％ CI =1.39％-2.15 ％) in females.There was no statistically significant difference in the prevalence of major depressive disorder between males and females (x2 =0.051,P＞0.05).The standardized time-point prevalence of dysthymic disorder in Mosuo nationality was 0.78％,and 0.66％ (95％ CI=0.54％-0.78％) in males and 0.88％ (95％ CI=0.74％-1.02％) in females (x2=1.232,P＞0.05).Those aged 40-54 years old had the highest adjusted prevalence of depressive episodes(1.48％ (95％CI=0.77％-2.18％)).Conclusion The prevalence of depressive disorder in Mosuo nationality is in a low level,and the middle-age Mosuo people has the highest time-point prevalence.

Effect of group cognitive-behavior therapy intervention on dysthymic disorders in children and adolescents / 中华行为医学与脑科学杂志

Objective To explore the effect of group cognitive-behavior therapy intervention on dys-thymic disorders in children and adolescents.Methods From July 2015 to December 2017,68 cases of chil-dren and adolescents treated in Lishui Second People's Hospital were divided into two groups randomly. The study group ( 34 cases) were treated with group cognitive-behavior therapy,and the control group ( 34 cases) were treated with selective 5-hydroxytryptamine reuptake blocker ( SSRI ) . The achenbach child behavior check list(CBCL),self-rating depression scale(SDS) and self-rating anxiety scale(SAS) scores of the two groups before and after the intervention were compared.Results Before the intervention,there was no differ-ence in the score of CBCL,SDS and SAS between the study group and the control group (P>0.05). After drug treatment or cognitive-behavior therapy, the social, activity, thinking and aggressive behavior of both groups were obviously improved. The SDS and SAS scores were 43.64±4.86 and 42.27±3.74 in cognitive-be-havior therapy group,which had significant difference (P<0.05) compared with pre-intervention score of SDS (82.91±3.95) and SAS (78.61±6.28). The scores of SDS (45.61±8.03) and SAS (44.09±7.04) in treat-ment group were significantly (P<0.05) decreased compared with those before treatment (84.03±5.11 and 77.30±9.55,respectively). The satisfaction of the study group and control group was 94.1％ and 67.6％,re-spectively,and the difference was significant between the two groups(P<0.05).Conclusion The effect of cognitive-behavior therapy in children and adolescents on reducing the negative emotion is remarkable,which is equivalent to the drug treatment.The cognitive-behavior therapy in children and adolescents can be used as a auxiliary means to treat children's dysthymic disorders in clinical practice.

Korean Medication Algorithm for Depressive Disorder 2012 (III): The Subtypes of Depression / 대한정신약물학회지

OBJECTIVE: Recently, the pharmacotherapy including antidepressants in treating depression is widely used. However, as a result of newer agents that are continuously introduced, pharmacological treatment strategy is also changing. To catch up this trend, Korean Medication Algorithm Project for Depressive Disorder was developed in 2002 and revised in 2006. Since the last revision, the third revision reflected the new research result and the latest trends in the areas of pharmacological treatment. METHODS: One hundred and twenty three psychiatrists who have vast clinical experiences in depressive disorder are primarily selected then survey was sent to them via mail, 67 surveys were retried. This survey is constructed with 44 questionnaires in which contained from overall treatment strategies to treatment strategies under the specific circumstances. Each treatment strategy or treatment option is evaluated with the overall score of nine and the following 95% confidence interval result treatment option were divided into three phases of recommendation; primary, secondary, tertiary. RESULTS: For dysthymic disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) [(es)citalopram, fluoxetine, sertraline, paroxetine], serotonin-norepinephrine reuptake inhibitor (SNRI) (venlafaxine, duloxetine, milacipran), and mirtazapine, was recommended as the first line medications. For melancholic type, SSRI, SNRI, and mirtazapine were recommended as the first line medications. For atypical type and seasonal pattern, bupropion as well as SSRI, SNRI, and mirtazapine, were recommended as the first line medications. CONCLUSION: The preferences of antidepressants in experts were different according to the subtype of depression. These results suggest that clinicians have to consider the subtype of depression in the treatment of depressive disorders.

Impacto da cronicidade do transtorno distímico na qualidade de vida / Impact of dysthymic disorder cronicity on quality of life

A distimia diferencia-se da depressão por sua cronicidade e menor severidade sintomatológica. A cronicidade acarreta sérios prejuízos na rotina dos pacientes, atividades laborais, relacionamentos sociais e qualidade de vida. O objetivo deste estudo foi explorar o impacto do transtorno distímico na qualidade de vida dos pacientes. Utilizou-se uma entrevista semiestruturada com 24 pacientes distímicos, sendo os dados analisados pelo software Alceste. Neste artigo, discutiu-se a classe sobre o Tratamento da Distimia e Qualidade de Vida. Observou-se um ciclo de tristeza que interfere no dia a dia, acarretando insatisfação e frustração, retroalimentando a baixa autoestima, que induziria à continuidade dos sintomas, passando a fazer parte da experiência cotidiana do indivíduo e aparecendo, por fim, como um modo de ser. A partir desses dados, sugere-se que o transtorno possa ser interpretado por novos parâmetros, baseados na compreensão dessa sucessão de processos, que deveria ser o foco da intervenção com tais pacientes.

Dysthymia is differentiated from depression by its chronicity and less symptomatic severity. Chronicity causes severe harm in the routine of patients, work activities, social relationships and quality of life. The aim of this study was to explore the impact of dysthymic disorder on patients' quality of life. A semi-structured interview was held with 24 dysthymic patients and the data were analyzed by the Alceste software. In this article, the lexical class in the Treatment of dysthymia and Quality of Life was discussed. There was a cycle: sadness that interferes with day-to-day life, causing frustration and dissatisfaction, with feedback to low self-esteem, which would lead to continuity of symptoms, becoming part of the individual's everyday experience, and finally, appearing to be a way of being. From these data, it is suggested that the disorder may be interpreted by new parameters, based on the understanding of this succession of processes, which should be the focus of intervention in these patients.

A related study of the level of hypersensitive C-reactive protein and the heart rate variability in patients with dysthymic disorder / 中华行为医学与脑科学杂志

ObjectiveTo investigate the hypersensitive C-reactive protein(hs-CRP),level in serum and the heart rate variability(HRV) in patients with dysthymic disorder,and explore the possible psychological and physiological mechanisms.MethodsPHI and short-term HRV were measured in 42 patients with dysthymic disorder( DD group),33 patients with major depressive disorder ( MD group)and 30 heathy controls( NC group),fasting blood samples were also analyzed with high-sensitivity C-reactive protein (hs-CRP).Results ( 1 ) DD group gained higher score in the somatization,anxiety,psychopathic deviate and hypomania than the MD group(P＜0.05 or P ＜ 0.01 ).(2)The standard deviation of differences between the consecutive RR intervals (SDNN),the percentage value of consecutive RR intervals that differ more than 50 ms(PNN50) and the high frequency band(HF) of DD group were lower significantly than MD and NC groups,the low frequency band(LF),and the ratio of LF to HF power(LF/HF) and hs-CRP level were higher than other two groups (P ＜ 0.05 or P＜0.01 ).(3)The somatization and anxiety were correlated with SDNN,the very low frequency band(VLF),LF and hs-CRP level ( r=-0.27,-0.29,r=0.38,0.33,r=0.41,0.31,r=0.34,0.23,P＜0.05 or P＜0.01).(4)The hs-CRP level in serum were correlated with SDNN,the root mean square of successive RR intervals (RMSSD),the standard deviation of differences between the consecutive RR intervals ( SDSD),VLF,LF,HF and LF/HF ( r =- 0.47,- 0.45,- 0.45,0.26,0.46,-0.51,0.10,P ＜ 0.05 or P ＜ 0.01 ).ConclusionThe patients with dysthymic disorder have significant somatization and anxiety,the personality character was mainly resulting in reducing HRV,which is related with the increasing serum hs-CRP level.

The influence of the comorbidity between depression and alcohol use disorder on suicidal behaviors in the São Paulo Epidemiologic Catchment Area Study, Brazil / Influência da comorbidade entre depressão e transtornos por uso de álcool nos comportamentos suicidas no Estudo de Área de Captação de São Paulo, Brasil

OBJECTIVE: To investigate in a community sample the association of suicide-related cognitions and behaviors ("thoughts of death", "desire for death", "suicidal thoughts", and "suicidal attempts") with the comorbidity of depressive disorders (major depressive episode or dysthymia) and alcohol or substance use disorders. METHOD: The sample was 1464 subjects interviewed in their homes using the Composite International Diagnostic Interview to generate DSM-III-R diagnosis. Descriptive statistics depicted the prevalence of suicide-related cognitions and behaviors by socio-demographic variables and diagnoses considered (major depressive episode, dysthymia, alcohol or substance use disorders). We performed a multivariate logistic regression analysis to estimate the effect of comorbid major depressive episode/dysthymia and alcohol or substance use disorders on each of the suicide-related cognitions and behaviors. RESULTS: The presence of major depressive episode and dysthymia was significantly associated with suicide-related cognitions and behaviors. In the regression models, suicide-related cognitions and behaviors were predicted by major depressive episode (OR = range 2.3-9.2) and dysthymia (OR = range 5.1-32.6), even in the presence of alcohol use disorders (OR = range 2.3-4.0) or alcohol or substance use disorders (OR = range 2.7-2.8). The interaction effect was observed between major depressive episode and alcohol use disorders, as well as between dysthymia and gender. Substance use disorders were excluded from most of the models. CONCLUSION: Presence of major depressive episode and dysthymia influences suicide-related cognitions and behaviors, independently of the presence of alcohol or substance use disorders. However, alcohol use disorders and gender interact with depressive disorders, displaying a differential effect on suicide-related cognitions and behaviors.

OBJETIVO: Investigar, numa amostra comunitária, a associação entre cognições e comportamentos relacionados ao suicídio ("pensamentos de morte", "desejo de morte", "pensamentos suicidas", e "tentativas de suicídio") e a comorbidade entre transtornos depressivos (episódio depressivo maior ou distimia) e transtornos por uso de álcool ou substâncias. MÉTODO: 1.464 sujeitos foram entrevistados em seus domicílios com o CIDI para gerar diagnósticos DSM-III-R. Estatística descritiva demonstrou a prevalência de cognições e comportamentos relacionados ao suicídio pelas variáveis sociodemográficas e diagnósticos considerados (episódio depressivo maior, distimia, transtornos por uso de álcool ou substâncias). Realizamos também análises de regressão logística multivariada para estimar o efeito da comorbidade entre episódio depressivo maior/distimia e transtornos por uso de álcool ou substâncias em cognições e comportamentos relacionados ao suicídio. RESULTADOS: A presença de episódio depressivo maior e distimia foi significativamente associada a cognições e comportamentos relacionados ao suicídio. Em modelos de regressão multivariada, os preditores de cognições e comportamentos relacionados ao suicídio foram episódio depressivo maior (OR range = 2,3-9,2) e distimia (OR range = 5,1-32,6) mesmo na presença de transtornos por uso de álcool (OR range = 2,3-4,0) ou transtornos por uso de substâncias (OR range = 2,7-2,8). O efeito de interação foi observado entre episódio depressivo maior e transtornos por uso de álcool, bem como entre gênero e distimia. Transtornos por uso de álcool foi excluído da maioria dos modelos. CONCLUSÃO: A presença de episódio depressivo maior e distimia influencia os CCS, independentemente da presença de transtornos por uso de álcool ou substâncias. Contudo, transtornos por uso de álcool e gênero interagem com os transtornos depressivos, demonstrando um efeito diferencial em cognições e comportamentos relacionados ao suicídio.

Correlatos del maltrato físico en la infancia en mujeres adultas con trastorno distímico o depresión mayor / Correlates of childhood physical maltreatment in adult women with dysthymic disorder or major depression

Epidemiologic studies have found that childhood physical maltreatment affects 31% and 21% of males and females, respectively, and almost one half of cases correspond to severe physical abuse. A recent study carried out in population from four representative regions of our country found that 14% to 21% of adolescents reported a history of physical abuse during childhood. Childhood maltreatment experiences have been found to be associated to development of psychopathology during childhood. In regard to mood disorders, interest has been focused on the relationship between depression and sexual abuse. An explanation to this situation is that both conditions predominantly affect women while physical abuse is more frequent among men. However, physical abuse produces more negative consequences on women's health; severe physical abuse equally affects men and women; moreover, child physical abuse has been significantly associated with depression only in women. The experiences of adverse events during childhood also seem to be associated with dysthymic disorder, a depressive condition of lower symptomatic severity but longer duration than major depression. Nevertheless, data about childhood physical abuse among patients with dysthymic disorder are scarce. One study found that physical and sexual abuses were significantly more frequent among dysthymic and depressed patients in comparison with control subjects. This finding suggests an association between physical abuse and both acute and chronic forms of depression. On the basis of this knowledge, the aims of this study were: a) to determine and compare the frequency of childhood physical abuse among women with major depression or dysthymic disorder in a community mental health centre; b) to determine psychiatric comorbidity in relation to the history of physical abuse; and c) to compare the severity of depressive symptoms and suicide risk between depressed patients (major depression or dysthymic disorder) with or without a history of childhood physical maltreatment. Subjects were recruited from the population seeking psychiatric attention in a community mental health centre. To be included, patients were required to be females, 18-65 years old, literate, meet DSM IV criteria for major depressive disorder or dysthymic disorder, and give their written informed consent. All patients were assessed with the Mini International Neuropsychiatric Interview, the Beck Depression Inventory and the Childhood Physical Maltreatment Index. This self-report instrument was developed as part of the study. It consists of five questions and it showed satisfactory psychometric properties (e. g., inter-item score correlations .54-.67, item-total score correlations .78-.85 and Cronbach's alpha = .88). Eighty patients were studied: 42 with major depression (MD) and 38 with dysthymic disorder (DD). Patients with MD were not significantly different from DD subjects in age (38.0±11.3 vs. 39.8±12.9, respectively; t = -.64, gl 78, p = .52), civil status (64.2% vs 55.2% living with a partner; x² = .67, gl 1, p = .49), education years (9.5±3.2 vs. 10.3±3.1, respectively; t = -1.1, gl 78, p = .25) and occupation (50% vs. 60% dedicated to housework; x² = .89, gl 1, p = .37). Seventy six percent of patients reported a history of childhood physical abuse; there were no significant differences between MD and DD patients (75% vs. 72%, respectively). However, severity of maltreatment showed a tendency to be significantly higher among MD patients (4.88 [DE 4.81] vs. 3.18 [DE 3.10]; t = 1.8, gl 78, p= 07). Women with a history of physical abuse obtained significantly higher scores on depression than patients without it. This association was not dependent on diagnosis. In contrast, suicide risk was not significantly different between patients with or without child physical abuse. The number of comorbid psychiatric disorders showed a marginal association with the history of physical abuse (1.2 -DE 1.0] vs. 0.78 -DE 0.91], t= -1.6, gl 78, p=.09). According to these results, three out of four women with major depression or dysthymic disorder suffered from physical abuse during childhood. This proportion is notably higher than the one found in general population, and it also differs from the prevalence rate reported in previous studies with depressed patients. In one study where authors examined 1019 patients admitted in a psychiatric hospital, they identified a history of child physical abuse in 12.3% and 8.3% of MD and DD patients, respectively. Later, a rate of 16% and 29% among MD and DD patients was reported. More recently, an epidemiologic study found a rate of 40.3% among women with major depression. The disparity in the reported prevalence rates might have several explanations. Some studies have used definitions of childhood physical maltreatment which seem to correspond to a severe form. For example, in one study it was defined as the experience of being hit hard or often enough to leave bruises, draw blood, or require medical attention. Another one included some other aggressive behaviors (being pushed, grabbed or shoved), but they were not considered as maltreatment if they had had a low frequency. The inclusion of these behaviors, which could be classified as <

De acuerdo con estudios epidemiológicos en México, 18% de los adultos y de 14 a 21% de los adolescentes afirman haber recibido golpes durante su niñez por parte de alguno de sus padres. Las experiencias de maltrato en la infancia se han asociado con el desarrollo de psicopatología en la edad adulta. Sin embargo, en el caso particular de la depresión mayor, el interés se ha concentrado en la relación existente con la historia de abuso sexual. Uno de los argumentos que se han planteado es que ambas condiciones son más frecuentes en la mujer, mientras que el maltrato físico lo es en hombres. No obstante, el abuso físico tiene más consecuencias negativas en la salud de las mujeres. Se ha identificado que no existen diferencias significativas entre las mujeres adultas con historia de abuso sexual y aquéllas con antecedente de abuso físico, con respecto a los síntomas físicos y psicológicos que experimentan. Además, la historia de maltrato físico se asocia significativamente con la presencia de depresión sólo en las mujeres. En conjunto, esta información sugiere que el maltrato físico puede cumplir un papel más importante del que se ha pensado en el desarrollo de la depresión. La experiencia de eventos adversos en la infancia también parece asociarse con el curso y pronóstico del trastorno distímico, aunque la información con respecto a este trastorno es escasa. Por lo anterior, en el presente trabajo nos propusimos: a) determinar y comparar la frecuencia del maltrato físico en la infancia en mujeres con trastorno depresivo mayor y trastorno distímico en un centro comunitario de salud mental; b) determinar la comorbilidad psiquiátrica asociada con la historia de maltrato físico; y c) comparar la gravedad de la sintomatología depresiva y del riesgo suicida en función de la historia de maltrato físico y el diagnóstico. Se estudiaron mujeres, de 18 a 65 años de edad, alfabetas, con diagnóstico de trastorno depresivo mayor o trastorno distímico (DSM-IV) y que aceptaran participar otorgando su consentimiento informado por escrito. Las participantes fueron evaluadas con la Mini Entrevista Neuropsiquiátrica y respondieron el Inventario de Depresión de Beck (IDB) y el Índice de Maltrato Físico Infantil (IMFI). El IMFI es un instrumento autoaplicable que se desarrolló como parte de la investigación. Inicialmente se elaboraron 59 reactivos sobre experiencias de maltrato en la infancia, los cuales fueron clasificados por cuatro jueces clínicos. Cinco reactivos se clasificaron como maltrato físico por tres de los cuatro jueces, por lo que éstos se emplearon para conformar el IMFI. El instrumento mostró propiedades psicométricas satisfactorias: coeficientes de correlación elevados entre los reactivos y la suma total, un alto coeficiente de confiabilidad, y en el análisis factorial produjo un solo componente que explicaba casi 70% de la varianza. Participaron en la investigación ochenta mujeres, 42 con trastorno depresivo mayor (TDM) y 38 con trastorno distímico (TD). El 75 y 72%, respectivamente, reportaron una historia positiva de maltrato físico. La intensidad del maltrato experimentado mostró una tendencia a ser significativamente mayor entre las mujeres con TDM (4.88 [DE 4.81] vs. 3.18 [DE 3.10]; t=1.8, gl 78, p=.07). Las mujeres con historia de maltrato físico obtuvieron calificaciones significativamente más elevadas en el IDB en comparación con las que no lo habían sufrido. Este resultado fue independiente del diagnóstico. En contraste, el riesgo suicida no varió significativamente en función de la historia de maltrato físico. Las pacientes con historia de maltrato físico tendieron a presentar un mayor número de trastornos psiquiátricos comórbidos. En este mismo grupo, la gravedad de la sintomatología depresiva se relacionó significativamente con la gravedad del maltrato (r=0.27, p=.03). Los resultados muestran que aproximadamente tres de cada cuatro mujeres con TDM o TD experimentaron maltrato físico en la infancia. Éste se asocia, además, con una mayor gravedad de los síntomas depresivos y posiblemente con una mayor comorbilidad psiquiátrica. La elevada proporción de mujeres con TDM o TD con una historia de maltrato contrasta con los datos obtenidos en estudios previos. El origen de la discrepancia puede estar, al menos en parte, en la definición empleada, ya que en este estudio se usó una definición más estricta que incluye el maltrato considerado <

Comorbidades entre dependência química, distimia, HIV e HCV: relato de caso / Comorbidity between addiction, dysthymia, HIV and HCV: case report

INTRODUÇÃO: A comorbidade entre dependência química e doenças infectocontagiosas é bem conhecida, assim como a relação entre transtornos de humor e uso de substâncias. Entretanto, o transtorno distímico nestes pacientes recebe pouca atenção. Em parte, isso se justifica porque a realização do diagnóstico de distimia é mais difícil do que de outros transtornos do humor em razão do tempo de abstinência (2 anos) necessário para o diagnóstico, tendo em vista que toxicodependentes apresentam diversas recaídas durante o curso de suas vidas. As infecções pelos vírus HIV e HCV, frequentemente associadas ao consumo injetável de substâncias, contribuem para alterações do estado mental e o próprio tratamento pode causar diversas flutuações no humor. RELATO DE CASO: O paciente é um homem de 40 anos de idade que apresenta comorbidade entre dependência química (heroína e álcool) e distimia, complicada por recaídas, consumo injetável e status sorológico positivo aos vírus HIV-1 e HCV. CONCLUSÃO: Pacientes dependentes químicos com comorbidades psiquiátricas e infectocontagiosas são desafiadores no que tange diagnóstico, tratamento e definição de abordagens terapêuticas para os diferentes problemas apresentados. Investigar e abordar adequadamente, entretanto, traz diversos benefícios na qualidade de vida do indivíduo afetado, assim como potenciais benefícios financeiros.

BACKGROUND: Comorbidity between chemical dependence and infectious diseases is well known, as is the relationship between mood disorders and substance misuse. Nevertheless, dysthymia in these patients is not well explored. That is partly justified since the diagnoses of dysthymia is more difficult than other mood disorders due to the abstinence time (2 years) required for the diagnoses, and since addiction patients present several relapses during the course of their lifetimes. HIV and HCV infections, frequently associated to intravenous (IV) drug use, contribute to mental status deterioration and the treatment for such conditions can cause fluctuations on mood. CASE REPORT: A 40 years old patient with comorbidity between chemical dependence (heroin and alcohol) and dysthymia, complicated by relapses, IV drug use and serological status positive to HIV-1 and HCV. CONCLUSION: Addiction patients with psychiatric and infectious comorbidity are challenging to diagnose, treat and define therapeutical approaches to the different conditions. Proper clinical investigation and approach leads to benefits in health quality and potential financial benefits.

Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 2ª parte: tratamento de manutenção do transtorno depressivo maior e tratamento dos transtornos depressivos crônicos e das depressões subliminares / World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders, part 2: maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions

Estas diretrizes práticas para o tratamento biológico de transtornos depressivos unipolares foram desenvolvidas por uma Força-Tarefa internacional da Federação Mundial de Sociedades de Psiquiatria Biológica (WFSBP). O objetivo ao desenvolver tais diretrizes foi rever sistematicamente todas as evidências existentes referentes ao tratamento de transtornos depressivos unipolares e produzir uma série de recomendações práticas com significado clínico e científico, baseadas nas evidências existentes. Têm como objetivo seu uso por todos os médicos que atendam e tratem pacientes com essas afecções. Os dados usados para o desenvolvimento das diretrizes foram extraídos primariamente de várias diretrizes e painéis nacionais de tratamento para transtornos depressivos, bem como de metanálises e revisões sobre a eficácia dos antidepressivos e outras intervenções de tratamento biológico identificadas por uma busca no banco de dados MEDLINE e Cochrane Library. A literatura identificada foi avaliada quanto à força das evidências sobre sua eficácia e, então, categorizada em quatro níveis de evidências (A a D). Esta primeira parte das diretrizes abrange definição, classificação, epidemiologia e evolução dos transtornos depressivos unipolares, bem como tratamento das fases aguda e de manutenção. As diretrizes se referem primariamente ao tratamento biológico (incluindo antidepressivos, outros medicamentos psicofarmacológicos e hormonais, eletroconvulsoterapia, fototerapia, estratégias terapêuticas complementares e novas) de adultos jovens e também, embora em menor grau, de crianças, adolescentes e adultos idosos.

These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of the complete spectrum of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into four levels of evidence (A-D). The first part of these WFSBP guidelines on unipolar depressive disorders covered the acute and continuation treatment of major depressive disorder (Bauer et al., 2002). This second part of the guidelines covers the management of the maintenance-phase treatment of major depressive disorder, as well as the treatment of chronic and subthreshold depressive disorders (dysthymic disorder, double depression, minor depressive disorder and recurrent brief depression). These guidelines are primarily concerned with thebiological treatment (including antidepressants, lithium, other psychopharmacological and hormonal medications, and electroconvulsive therapy) of young adults and also, albeit to a lesser extent, children, adolescents and older adults.

Pharmacological Treatments for Dysthymic Disorder and Atypical Depression

OBJECTIVES: The diagnosis of depression is based on a highly variable set of symptoms. Therefore, depression should not be viewed as a single disease, but a heterogenous syndrome comprised of different pathophysiologies. There are several subtypes of depression which were already incorporated in DSM-IV. This article provides a systematic review of pharmacological treatments of two recognized subtypes of depression-dysthymic disorder and atypical depression. METHODS: Systematic search of relevant literatures on dysthymic disorder and atypical depression was performed by proposed search strategy of the Clinical Research Center for Depression of Korean Health 21 R&D Project. All identified literatures were carefully reviewed and classified according to SIGN grading system and summarized in a narrative manner. RESULT: For the treatment of dysthymic disorder and atypical depression, selective serotonin reuptake inhibitors(SSRIs) and moclobemide have more evidence than the other antidepressants. SSRIs and moclobemide showed superior tolerability than tricyclic antidepressants. CONCLUSION: The authors proposed treatment recommendations for dysthymic disorder and atypical depression by the methods of evidence-based medicine(EBM). However, guideline developing methods of EBM also have several inevitable limitations. Therefore, in the absence of clear and significant differences in efficacy, the choice of medication must be individualized for a particular patient based on psychiatrist's own clinical decision.

The Comparison of the Neurocognitive Functions between Dysthymic Disorder and Major Depressive Disorder

Neurocognitive research focusing on cognitive deficits in Depression has resulted in several important but yet potentially contradictory findings. Much literature documents the presence of significant neurocognitive impairments in depressive patients. Studies have shown that dysthymic disorder patients demonstrate a diffuse pattern of cognitive impairment which is frequently indistinguishable from that of focal braindamaged patients. Some reports have suggested that there is a focal pattern of deficit, such as anterior cingulate dysfunction, frontal lobe impairment, or dysfunction of the temporal-limbic cortex. The aim of this study is to evaluate the neurocognitive functions in dysthymic disorder patients, and to compare the functions with those of major depressive disorder patients. The subjects are 17 dysthymic disorder patients. And their neurocognitive functions are compared with those of 23 major depressive episode patients. Patients with a history of neurologic disease, alcohol dependence, substance abuse and mental retardation are excluded. They are assessed with a part of Vienna Test System which is computerized neurocognitive function tests and can evaluate attention, eductive ability, reproductive ability, visuoperceptual analysis, vigilance, visual immediate memory, the speed of information-processing, judgement, and fine motor coordinations. There are no other specific difference between two groups, except the result of cognitrone test. This study provides information about the neurocognitive functions and some difference between major depressive disorder patients and carefully diagnosed dysthymic disorder patients.

A Controlled Study of Personality Characteristics and Personality Disorders of Patients with Major Depression and Dysthymic Disorders in Remission / 中国临床心理学杂志

Objestive:To explore the personality traits of patients with major depression and dysthymic disorder in remission and to determine the difference of dimension ,trait level ,model of personality and personality disorder between depressive and normal subjects.Methods: major depression patients( MDD, n =58) and dysthymic disorder patients(DD, n =57) in remission and controls( n =115) were assessed with Revised NEO Personality Inventory(NEO-PI-R) and Personality Diagnostic Questionnaire( PDQ +4 ) .Results:The mean scores of Extroversion and Conscientiousness of five-factor personality model of NEO-PI-R in MDD and DD were significantly lower than those of normal group. The scores of Neuroticism of DD were significantly higher than those of MDD. The scores of Agreeableness of MDD were significantly higher than those of normal groups;The difference of thirty traits personality model had statistical significance between depressives and normal subjects. The scores of Anxiety(N1) and Self-Consciousness(N4)of DD were significantly higher than those of MDD. The scores of Activity(E4) and Trust(A1)of DD were significantly lower than those of MDD;The mean scores of 7 subscales of PDQ +4 in depression group were significantly higher than those of normal group . The scores of Schizotypal personality disorder of DD were significantly higher than those of MDD, The scores of Hysteria personality disorder of DD were significantly higher than those of normal group.Conclusion: The major depressive and dysthymic disorder patients in remission showed the differences of dimension ,trait level ,and model of personality.The personality disorder of DD was more than those of MDD.