Chronotype in bipolar disorder: an 18-month prospective study

Objective: Circadian dysregulation plays an important role in the etiology of mood disorders. Evening chronotype is frequent in these patients. However, prospective studies about the influence of chronotype on mood symptoms have reached unclear conclusions in patients with bipolar disorder (BD). The objective of this study was to investigate relationship between chronotype and prognostic factors for BD. Methods: At the baseline, 80 euthymic BD patients answered a demographic questionnaire and clinical scales to evaluate anxiety, functioning and chronotype. Circadian preference was measured using the Morningness-Eveningness Questionnaire, in which lower scores indicate eveningness. Mood episodes and hospitalizations were evaluated monthly for 18 months. Results: Among the BD patients, 14 (17.5%) were definitely morning type, 35 (43.8%), moderately morning, 27 (33.7%) intermediate (neither) and 4 (5%) moderately evening. Eveningness was associated with obesity or overweight (p = 0.03), greater anxiety (p = 0.002) and better functioning (p = 0.01), as well as with mood episodes (p = 0.04), but not with psychiatric hospitalizations (p = 0.82). This group tended toward depressive episodes (p = 0.06), but not (hypo)mania (p = 0.56). Conclusion: This study indicated that evening chronotype predicts a poor prognostic for BD. It reinforces the relevance of treating rhythm disruptions even during euthymia to improve patient quality of life and prevent mood episodes.

The association of self-reported awake bruxism with anxiety, depression, pain threshold at pressure, pain vigilance, and quality of life in patients undergoing orthodontic treatment

Abstract This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain vigilance, oral health-related quality of life (OHRQoL), and anxiety and depression symptoms in patients undergoing orthodontic treatment. Methodology This observational study followed patients who had started receiving orthodontic treatment for six months. The following variables were measured three times (at baseline, one month, and six months): pressure pain threshold (PPT) in the right and left masseter, anterior temporalis, and temporomandibular joint (TMJ), and right forearm; pain vigilance and awareness questionnaire; and shortened form of the oral health impact profile (OHIP-14). Anxiety and depression symptoms were measured using the Beck anxiety inventory and the Beck depression inventory, respectively. The patients were divided into two main groups according to the presence (n=56) and absence (n=58) of possible awake bruxism. The multi-way analysis of variance (ANOVA) was applied on the date (p=0.050). Results TMJ and/or muscle pain were not observed in both groups. Time, sex, age group, and awake bruxism did not affect the PPT in the masticatory muscles and pain vigilance (p>0.050). However, the primary effect of awake bruxism was observed when anxiety (ANOVA: F=8.61, p=0.004) and depression (ANOVA: F=6.48, p=0.012) levels were higher and the OHRQoL was lower (ANOVA: F=8.61, p=0.004). Conclusion The patients with self-reported awake bruxism undergoing an orthodontic treatment did not develop TMJ/masticatory muscle pain. The self-reported awake bruxism is associated with higher anxiety and depression levels and a poorer OHRQoL in patients during the orthodontic treatment.

Comparison of quality of life and functionality in type 2 diabetics with and without insulin

SUMMARY INTRODUCTION Type 2 diabetes mellitus compromises physical, psychological, economic, and social life. OBJECTIVES To identify and compare the quality of life, depression, functional performance, and physical activity in patients with type 2 diabetes mellitus who use insulin or not. METHODS A observational, descriptive, cross-sectional, comparative study involving 100 patients (50 use insulin and 50 do not) from a Teaching Hospital. Questionnaires used: Identification and Socioeconomic Profile; SF-36; Hospital Anxiety and Depression Scale; Visual Analogue Scale for Pain; Canadian Occupational Performance Measure, and International Physical Activity Questionnaire. RESULTS Sample composed predominantly by middle-aged, female, married, retired, and with incomplete elementary school individuals. There is impairment in all domains of quality of life, being more intense in functional capacity, physical limitations, pain, social aspects, limitation by emotional aspects, and mental health (P<0.05). There is a significant prevalence of anxiety or depressive symptoms in the groups, especially in those using insulin. However, the occurrence of the corresponding psychiatric disorders is unlikely (P<0.05). There was no significant difference in neuropathic pain between the groups (P=0.2296). Functional impairment is similar in both groups regarding self-care activities (P=0.4494) and productivity (P=0.5759), with a greater deterioration of leisure time in patients on insulin (P=0.0091). Most of them practice physical activity, predominantly walking, with no significant difference when comparing the groups (P>0.05), as well as in the other modalities. CONCLUSION Insulinized patients present greater impairment of functional capacity and socialization, as well as greater neuropathic pain, anxiety, and depressive symptoms.

RESUMO INTRODUÇÃO Diabetes mellitus tipo 2 compromete física, psicológica, econômica e socialmente. OBJETIVOS Identificar e comparar qualidade de vida, depressão, desempenho funcional e exercício físico em pacientes com diabetes mellitus tipo 2 insulinizados ou não. MÉTODOS Estudo individuado, observacional, descritivo, transversal, comparativo envolvendo 100 pacientes (50 utilizam insulina e 50 não) em um hospital escola. Instrumentos utilizados: Ficha de Identificação e Perfil Socioeconômico; SF-36; Escala Hospitalar de Ansiedade e Depressão; Escala Visual Analógica de Dor; Medida Canadense de Desempenho Ocupacional e Questionário Internacional de Atividade Física. RESULTADOS Amostra composta, predominantemente, por indivíduos de meia-idade, sexo feminino, casados, ensino fundamental incompleto e aposentados. Há comprometimento de todos os domínios da qualidade de vida, sendo mais intenso nos insulinizados em capacidade funcional, limitação por aspectos físicos, dor, aspectos sociais, limitação por aspectos emocionais e saúde mental (P<0,05). Importante prevalência de sintomas ansiosos ou depressivos nos grupos, principalmente nos em uso de insulina, porém a ocorrência dos transtornos psiquiátricos correspondentes é improvável (P<0,05). Não houve diferença significativa da DNP entre os grupos (P=0,2296). O prejuízo da funcionalidade é semelhante em relação a atividades de autocuidado (P=0,4494) e produtividade (P=0,5759) nos dois grupos, havendo maior deterioração do lazer em usuários de insulina (P=0,0091). A maioria pratica atividade física, tendo a caminhada a maior adesão, sem diferença significativa ao comparar os grupos (P>0,05), repetindo-se nas demais modalidades. CONCLUSÃO Pacientes insulinizados apresentaram maior prejuízo da capacidade funcional e na socialização, assim como referem maiores dores neuropáticas e sintomas ansiosos e depressivos.

Propiedades psicométricas del Cuestionario de ansiedad social para adultos (CASO) en Perú / Psychometric properties of the Social Anxiety Questionnaire for Adults (SAQ) in Peru

Resumen La investigación sobre la evaluación de la ansiedad social en Iberoamérica es escasa. En los últimos años se ha informado sobre las características psicométricas del "Cuestionario de ansiedad social para adultos" (CASO) en distintos países iberoamericanos, excepto Perú. El objetivo de este estudio fue analizar las pruebas de validez basadas en el constructo, las pruebas de validez basadas en la relación con otras variables de tipo convergente y la fiabilidad del CASO, utilizando una muestra no clínica de 3064 peruanos. El análisis factorial confirmatorio comprobó que el modelo de cinco factores relacionados se ajustaba mejor a los datos que el modelo jerárquico y se halló que el modelo unifactorial no tenía un buen ajuste. Las correlaciones entre los factores del CASO (de .608 a .709) indicaron que cada uno de ellos evalúa aspectos específicos del constructo y aportan, a su vez, a la medición global del mismo. Los coeficientes de fiabilidad fueron de aceptables a muy buenos (.78( (( .85, .75( (( .83). La alta correlación (r= .69) con la subescala de Ansiedad de la "Escala de ansiedad social de Liebowitz, versión de autoinforme" (LSAS-SR), apoya su relación con la variable convergente. Estas adecuadas características psicométricas del CASO respaldan su utilización con población peruana.

Abstract Research on the assessment of social anxiety in Ibero-America is scarce. In recent years, the psychometric characteristics of the Social Anxiety Questionnaire for adults (SAQ) have been reported in different Ibero-American countries except Peru. The aim of this study was to analyze the construct and the convergent validity, and the reliability of the SAQ, using a non-clinical sample of 3064 Peruvians. The confirmatory factorial analysis showed that the model of five-related factors was better adjusted to the data than the hierarchical model, and that the unifactorial model did not have a good fit. The correlations between their factors (from .608 to .709) indicate that each of them evaluates specific aspects of the construct and also contribute to the overall measurement of it. The reliability coefficients were from acceptable to very good (.78( (( .85, .75( (( .83). The high correlation (r= .69) with the Anxiety subscale of the "Liebowitz Social Anxiety Scale-Self-Report version" (LSAS-SR) supports its convergent validity. These appropriate psychometric characteristics of the questionnaire support its use with the Peruvian population.

An easy and reliable way to prevent electrocardiographic deteriorations of patients undergoing off-pump coronary artery bypass surgery: preoperative anxiolytic treatment

Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.

The effects of physical activity on anxiety, depression, and quality of life in elderly people living in the community / Efeitos da atividade física sobre ansiedade, depressão e qualidade de vida em idosos da comunidade

Abstract Introduction: Health problems may negatively affect the psychological and physical aspects of life, influencing the quality of life of older adults. The objective of this study was to analyze the effects of physical activity on quality of life, anxiety, and depression in the elderly population. Methods: We performed a cross-sectional study of 200 elderly people of both genders. Subjects were divided into two groups: one with 100 senior citizens engaged in physical activities in a social center for the elderly; and another composed of 100 subjects who lived in the community but were not engaged in physical activities. The instruments used to assess physical activities, quality of life, and anxiety and depression were, respectively: the modified Baecke questionnaire; the 36-Item Short Form Health Survey (SF-36); and the Hospital Anxiety and Depression Scale (HADS). The data were analyzed using the Student's t test, Pearson's r, and analysis of variance (ANOVA), with odds ratio and a 5% significance level (p<0.05). Results: We observed that the active group showed higher scores of physical activity and quality of life. Conversely, the sedentary group revealed higher scores of anxiety and depression. Data assessment revealed a strong correlation between the domains quality of life, level of vitality, and mental health (r=0.77). The prevalence ratio showed that physical activity is a protective factor against anxiety and depression in the elderly. Conclusion: The findings suggest a correlation between low levels of physical activity and symptoms of anxiety and depression in the elderly living in the community.

Resumo Introdução: Problemas de saúde podem afetar negativamente nos aspectos físicos e psicológicos, influenciando a qualidade de vida dos idosos. O objetivo deste estudo foi analisar os efeitos da atividade física sobre a qualidade de vida, ansiedade e depressão na população idosa. Métodos: Foi realizado estudo transversal com 200 idosos de ambos os sexos, divididos em dois grupos: um grupo com 100 idosos envolvidos em atividades físicas do centro social para idosos; outro composto por 100 sujeitos que viviam na comunidade, mas não estavam envolvidos em atividades físicas. Os instrumentos utilizados para avaliação das atividades físicas, qualidade de vida, ansiedade e depressão foram, respectivamente: o questionário de Baecke modificado; o Questionário de Qualidade de Vida (SF-36); e a Escala Hospitalar de Ansiedade e Depressão (HADS). Os dados foram analisados por testes t de Student, Pearson (r) e análise de variância (ANOVA), com odds ratio e nível de significância de 5% (p<0,05). Resultados: Observamos que o grupo ativo apresentou maiores escores de atividade física e qualidade de vida. Por outro lado, o grupo sedentário revelou maiores escores de ansiedade e depressão. A avaliação dos dados revelou uma forte correlação entre os domínios qualidade de vida, nível de vitalidade e saúde mental (r=0,77). A razão de prevalência mostrou que a atividade física é fator de proteção contra ansiedade e depressão em idosos. Conclusão: Os achados sugerem uma correlação entre baixos níveis de atividade física e sintomas de ansiedade e depressão em idosos que vivem na comunidade.

The positive impact of physical activity on the reduction of anxiety scores: a pilot study

SUMMARY OBJECTIVES: To compare anxiety scores between physical activity practitioners and sedentary, men and women and to relate them to physical activity frequency and age. METHODS: In this cross-sectional study, a sample of 256 regular aerobic physical activity practitioners was compared to a sample of 256 sedentary individuals (control group). Anxiety scores were quantified by Anxiety Inventory Spielberger State-Trait (STAI). The scores of the groups were compared using the Student t-test and chi-square test for parametric and non-parametric data, respectively. The correlation between scores of different variables was performed using the Pearson test. RESULTS: There was a significant difference between the average anxiety scores (p <0.001) and the chi-square test proved there is a higher prevalence of severe anxiety (p <0.001) in the sedentary group. Age did not correlate with worse anxiety scores (p <0.05). Comparing by gender, women had a higher prevalence of intense anxiety. CONCLUSIONS: Individuals who engage in regular physical activity have lower levels of anxiety, and both sexes are benefited with the anxiolytic potential of physical activity. Therefore, this study proved that the Roman poet Juvenal was right, and his expression "Mens sana in corpore sano," could also be interpreted in the opposite direction, i.e., a healthy body correlates with a healthy mind.

RESUMO OBJETIVOS: Comparar escores de ansiedade entre praticantes de atividade física e sedentários, entre homens e mulheres e relacioná-los com frequência de atividade física e idade. MÉTODOS: Amostra de 256 praticantes de atividade física aeróbica regular foi comparada à amostra de 256 sedentários (grupo controle). Escores de ansiedade foram quantificados por meio do Inventário de Ansiedade Estado-Traço de Spielberger (Idate). Os escores dos grupos foram comparados por meio dos testes t de Student e qui-quadrado para dados paramétricos e não paramétricos, respectivamente. A correlação entre escores de diferentes variáveis foi realizada pelo teste de Pearson. RESULTADOS: Houve diferença significativa entre os escores médios de ansiedade (p < 0,001) e o teste qui-quadrado comprovou haver maior prevalência de escores de ansiedade intensa (p < 0,001) no grupo de sedentários. Idade não se correlacionou com piores escores de ansiedade (p < 0,05). Em relação ao sexo, mulheres apresentaram maior prevalência de escores de ansiedade intensa. CONCLUSÕES: Praticantes de atividade física possuem menores escores de ansiedade e ambos os sexos se beneficiam com o potencial ansiolítico da prática de atividade física. Portanto, foi comprovado que a máxima de Juvenal, Mens sana in corpore sano, também pode ser interpretada em sentido inverso, em que um corpo são se correlaciona com uma mente sã.

Quality of life among patients with age-related severe macular degeneration assessed using the NEI-VFQ, HADS-A, HADS-D and SF-36 tests. A cross-sectional study

ABSTRACT BACKGROUND: Exudative age-related macular degeneration (e-AMD) may cause severe central vision loss. Patients with e-AMD can experience difficulties in daily basic activities and suffer from psychological problems. Our aim was to assess quality of life (QoL) and anxiety and depression status among patients with e-AMD. DESIGN AND SETTING: Cross-sectional study in a state university. METHODS: We included 200 e-AMD patients and 120 age and gender-matched controls. We assessed QoL using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and the Short Form (SF)-36 test; and anxiety and depression status using the Hospital Anxiety Depression Scales A and D (HADS-A and HADS-D). RESULTS: The mean ages in the e-AMD and control groups were 68.40 ± 9.8 and 66.31 ± 8.98, respectively. Visual acuity among e-AMD patients was 0.37 ± 0.31 and 0.39 ± 0.32 in the right and left eyes, respectively. The e-AMD patients performed significantly worse than the controls in NEI-VFQ-25 (P < 0.05 for all items). The proportions of e-AMD patients scoring higher than the cutoffs in HADS-A and HADS-D were significantly higher than among the controls (41.5% versus 12.5% and 63.5% versus 27.5%; P < 0.001). The e-AMD patients had significantly lower mean scores than the controls for each of the SF-36 QoL items (P < 0.001). The NEI-VFQ-25 scores were significantly lower among patients with bilateral e-AMD than among those with unilateral disease (P < 0.05 for all). The HADS scores were positively correlated with duration of e-AMD and patient age, but negatively with vision levels (P < 0.05 for all items). CONCLUSION: The e-AMD patients had higher depression and anxiety scores and lower QoL scores.

Obstructive sleep apnea and quality of life in elderly patients with a pacemaker / Apneia obstrutiva do sono e qualidade de vida em idosos portadores de marca-passo

ABSTRACT Objective: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. Methods: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. Results: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). Conclusions: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.

RESUMO Objetivo: Avaliar a qualidade de vida em idosos portadores de marca-passo e apneia obstrutiva do sono (AOS). Métodos: Estudo de corte transversal com idosos (idade ≥ 60 anos) portadores de marca-passo cardíaco. A variável dependente foi qualidade de vida, avaliada por meio do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Dados sociodemográficos e clínicos foram analisados como variáveis independentes, entre os quais ansiedade e depressão (por meio da Hospital Anxiety and Depression Scale), assim como presença de AOS (definida como um índice de apneia-hipopneia ≥ 15 eventos/h). Pacientes com déficits cognitivos/neurológicos ou descompensação cardíaca foram excluídos. Resultados: A amostra foi composta por 72 pacientes, 17 dos quais (23,6%) apresentaram AOS - 9 homens (52,9%). A média de idade foi de 72,3 ± 9,3 anos. Não houve associações de presença de AOS com sexo (p = 0,132), idade (p = 0,294) e índice de massa corpórea (p = 0,790). Não foram observadas diferenças dos domínios do SF-36 entre os grupos com e sem AOS. Em relação à ansiedade, 14 pacientes (19,4%) apresentaram sintomas moderados ou graves, dos quais apenas 3 (21,4%) tinham AOS (p = 0,89 vs. sem AOS). No tocante à depressão, 12 pacientes (16,6%) apresentaram sintomas moderados ou graves, dos quais 2 (16,6%) tinham AOS (p = 0,73 vs. sem AOS). Conclusões: Nesta amostra em idosos portadores de marca-passo, a presença de AOS não foi associada a qualidade de vida e sintomas de ansiedade e depressão.

Intermittent hypoxia, brain glyoxalase-1 and glutathione reductase-1, and anxiety-like behavior in mice

Objective: Sleep apnea has been associated with anxiety, but the mechanisms of the sleep apnea-anxiety relationship are unresolved. Sleep apnea causes oxidative stress, which might enhance anxiety-like behavior in rodents. To clarify the apnea-anxiety connection, we tested the effect of intermittent hypoxia, a model of sleep apnea, on the anxiety behavior of mice. Methods: The rodents were exposed daily to 480 one-minute cycles of intermittent hypoxia to a nadir of 7±1% inspiratory oxygen fraction or to a sham procedure with room air. After 7 days, the mice from both groups were placed in an elevated plus maze and were video recorded for 10 min to allow analysis of latency, frequency, and duration in open and closed arms. Glyoxalase-1 (Glo1) and glutathione reductase-1 (GR1) were measured in the cerebral cortex, hippocampus, and striatum by Western blotting. Results: Compared to controls, the intermittent hypoxia group displayed less anxiety-like behavior, perceived by a statistically significant increase in the number of entries and total time spent in open arms. A higher expression of GR1 in the cortex was also observed. Conclusion: The lack of a clear anxiety response as an outcome of intermittent hypoxia exposure suggests the existence of additional layers in the anxiety mechanism in sleep apnea, possibly represented by sleepiness and irreversible neuronal damage.

Relação entre ansiedade e modulação autonômica cardíaca / Relationship between anxiety and autonomic heart modulation

A ansiedade é caracterizada pelo sentimento de tensão, nervosismo, apreensão e preocupação que pode alterar a modulação do sistema nervoso autônomo sobre a condução elétrica ligada ao coração, determinando a intensidade nos batimentos cardíacos modificando a variabilidade da frequência cardíaca que é um importante indicador de condições normais e patológicas. Assim, o objetivo do estudo foi analisar a relação existente entre a ansiedade e o processo de regulação autonômica cardíaca. Este estudo trata-se de uma revisão integrativa desenvolvido por meio de buscas nas bases de dados da Lilacs, Medline e SciELO, com os descritores em ciências da saúde e operador booleano: ansiedade AND frequência cardíaca e, ansiedade AND sistema nervoso autônomo. A busca foi realizada durante o mês de setembro de 2017, sendo incluídos artigos disponíveis na íntegra; em português e inglês e; publicados nos últimos 06 anos. Excluiu-se artigos que não fossem originais, teses, dissertações e monografias. Obteve-se um total de 10 artigos, nos quais observou-se que a ansiedade altera a resposta autonômica, assim quando o corpo entra em tensão, aumenta-se a frequência cardíaca, o predomínio do sistema simpático e no relaxamento ocorre o domínio parassimpático. Assim indivíduos portadores de ansiedade apresentam menor variação na frequência cardíaca e possuem uma capacidade menor de interação social. Com isto, evidencia-se uma baixa adaptação do sistema nervoso autônomo em casos de ansiedade, sendo que a variabilidade da frequência cardíaca encontra-se reduzida; condição esta que pode ser classificada como patológica.

The anxiety is characterized by the sensation of tension, nervousness, apprehension and worry that can alter the modulation of autonomic nervous system on the electrical conduction linked to the heart, determining the intensity in the heart beats modifying the heart rate variability, which is an important indicator of conditions normal and pathological. Thus, the study objective is to analyze the relationship between anxiety and the process of autonomic cardiac regulation. This study is an integrative review developed through searches in the databases of Lilacs, Medline and SciELO, with the descriptors in health sciences and boolean operator: anxiety AND heart rate and anxiety AND autonomic nervous system. The search was performed during the month of September of 2017, being included articles available in full; in Portuguese and English and; published in the last 6 years. Was excluded articles that were not original, theses, dissertations and monographs. Was obtained a total of 10 articles, in which it was observed that anxiety alters the autonomic response, so when the body is in tension, increases your heart rate, the predominance of the sympathetic system and in the relaxation occurs the domain of the parasympathetic. Thus, individuals with anxiety present lower variation in heart rate and have a lower capacity for social interaction. With this, it is evident a low adaptation of the autonomic nervous system in cases of anxiety, being that the variability of the heart rate is reduced; condition that can be classified as pathological.

Doença inflamatória do intestino: impacto no score da qualidade de vida, depressão e ansiedade em pacientes atendidos em um centro de atendimento terciário no Brasil / Inflammatory bowel disease: impact on scores of quality of life, depression and anxiety in patients attending a tertiary care center in brazil

ABSTRACT BACKGROUND: Inflammatory bowel disease frequently affects patients at working age, compromising their quality of life in several levels: physical, psychological, familial and social. Few studies have evaluated the impact of Inflammatory bowel disease on quality of life, anxiety and depression in Brazilian patients. OBJECTIVE: Evaluate quality of life and its correlation with psychological aspects of patients with inflammatory bowel disease through the Inflammatory Bowel Disease Questionnaire and Hospital Anxiety and Depression Scale. METHODS: Cross-sectional study; Inflammatory Bowel Disease Questionnaire, Short Form-36 and Hospital Anxiety and Depression Scale were applied to consecutive outpatients in a tertiary referral center for inflammatory bowel disease. Harvey-Bradshaw Index and Truelove scores were used to evaluate Crohn's disease and ulcerative colitis activity. Sample calculation: 113 patients for a significance level of 5%, power of 90% and a correlation coefficient of at least 0.3 between scales. Statistical analysis: Student-t test, Pearson and Spearman correlations. RESULTS: One hundred twenty patients participated in the study; mean age: 41.7 years; female: 58.3%; Crohn's Disease: 69 patients. No low scores for quality of life were found across the four Inflammatory Bowel Disease Questionnaire domains; the Short Form-36 showed low scores in physical limitations (47.2±42.4) and emotional aspects (49.8±43.4); Hospital Anxiety and Depression Scale score presented a mean of 9.5±2.7 for anxiety and 8.7±2.0 for depression. Quality of life was decreased and Hospital Anxiety and Depression Scale did show increased indices of anxiety and depression, in both diseases only when clinically active. CONCLUSION: Inflammatory Bowel Disease Questionnaire and Hospital Anxiety and Depression Scale showed that outpatients of a tertiary care center for inflammatory bowel disease in Brazil presented good quality of life. The worst quality of life was associated with the intensity of the disease activity.

RESUMO CONTEXTO: A doença inflamatória do intestino afeta frequentemente os pacientes em idade de trabalho, comprometendo a qualidade de vida em vários níveis: físico, psicológico, familiar e social. Poucos estudos avaliaram o impacto da doença inflamatória do intestino na qualidade de vida, ansiedade e depressão em pacientes brasileiros. OBJETIVO: Avaliar a qualidade de vida e sua correlação com os aspectos psicológicos dos pacientes com doença inflamatória intestinal através do Questionário da Doença Inflamatória do Intestino e da Escala de Ansiedade e Depressão Hospitalar. MÉTODOS: Foi realizado um estudo transversal, com uma amostra de pacientes consecutivos, nos quais foram aplicados os questionários de perguntas fechadas sobre Qualidade de Vida através dos questionários: Inflammatory Bowel Disease Questionnaire, Short Form Health Survey 36; e ansiedade e depressão: Hospital Anxiety and Depression em suas versões validadas para a língua portuguesa praticada no Brasil. Foram aplicados em pacientes ambulatoriais consecutivos em um centro de referência terciária para doença inflamatória intestinal. Os índices Harvey-Bradshaw Index e Truelove foram utilizados para avaliar a doença de Crohn e a atividade da colite ulcerativa. Cálculo da amostra: 113 pacientes para um nível de significância de 5%, força de 90% e um coeficiente de correlação de pelo menos 0,3 entre as escalas. Análise estatística: teste Student-t, correlações Pearson e Spearman. RESULTADOS: Cento e vinte pacientes participaram do estudo; idade média: 41,7 anos; feminino: 58,3%; doença de Crohn: 69 pacientes. Não foram encontrados escores baixos para a qualidade de vida nos quatro domínios do questionário da Inflammatory Bowel Disease; O Short-Form-36 mostrou baixa pontuação em limitações físicas (47,2±42,4) e aspectos emocionais (49,8±43,4); O índice da escala Hospital Anxiety and Depression apresentou uma média de 9,5±2,7 para ansiedade e 8,7±2,0 para depressão. A qualidade de vida foi diminuída e a Hospital Anxiety and Depression mostrou índices aumentados de ansiedade e depressão, em ambas as doenças somente quando clinicamente ativo. CONCLUSÃO: O questionário da Inflammatory Bowel Disease e a Escala de Hospital Anxiety and Depression mostraram que os pacientes ambulatoriais de um centro de cuidados terciários para doença inflamatória do intestino no Brasil apresentaram boa qualidade de vida. A pior qualidade de vida foi associada à intensidade da atividade da doença.

The effect of resistance training on the anxiety symptoms and quality of life in elderly people with Parkinson's disease: a randomized controlled trial / O efeito do treinamento resistido sobre sintomas de ansiedade e qualidade de vida em idosos com doença de Parkinson's: ensaio randomizado controlado

ABSTRACT Objective: To assess the effects of resistance training on the anxiety symptoms and quality of life in patients with Parkinson's disease. Methods: Thirty-five elderly patients were randomly divided into two groups: 17 patients in the control group and 18 in the intervention group. All patients maintained standard pharmacological treatment for Parkinson's disease, but the intervention group participated in a 24-week resistance training program. The anxiety symptoms were assessed through the Beck's Anxiety Inventory, and quality of life by the Parkinson's Disease Questionnaire-39. Results: There was a significant reduction in anxiety level and increase in quality of life after 24 weeks of resistance training. Conclusion: The results of the present study indicate that resistance training is an effective intervention in the reduction of anxiety symptoms and improves the quality of life in elderly people with Parkinson's disease.

RESUMO Objetivo: avaliar os efeitos do treinamento resistido nos sintomas de ansiedade e na qualidade de vida em pacientes com doença de Parkinson. Métodos: Trinta e cinco pacientes idosos foram divididos randomicamente em dois grupos: 17 indivíduos no grupo controle e 18 no grupo de intervenção. Todos os sujeitos mantiveram o tratamento farmacológico padrão para a doença de Parkinson, mas o grupo de intervenção participou de um programa de treinamento resistido de 24 semanas. Os sintomas de ansiedade foram avaliados através do inventário de ansiedade de Beck e a qualidade de vida pelo questionário da doença de Parkinson-39. Resultados: Houve redução significativa no nível de ansiedade e melhora da qualidade de vida após 24 semanas de treinamento resistido. Conclusão: Os resultados do presente estudo indicam que o treinamento resistido é uma intervenção efetiva na redução dos sintomas de ansiedade e melhora a qualidade de vida em idosos com doença de Parkinson.

Psychopathological profile and quality of life of patients with oral lichen planus

Abstract Objectives Oral lichen planus (OLP) is a chronic, multifocal, sometimes painful, inflammatory disease of the oral mucosa. OLP can predispose development of psycho-emotional disorders. Until now, the relationship between the severity of lichen planus and the psychological profile of patients (psychological well-being, perceived stress and pain coping strategies) has never been studied. Material and Methods Study was conducted on 42 OLP patients. Number of sites involved, severity and activity score of OLP were evaluated. Psychological tests were used to evaluate patients' psycho-emotional condition. The mean duration time of symptomatic OLP was 43 months. Results We detected that the longer the duration of subjective symptoms, the poorer the quality of life and the higher the level of perceived stress (PSS). Also, the higher the PSS results, the greater the anxiety and depression on Hospital Anxiety and Depression Scale (HADS). Likewise, higher level of depression in HADS was strongly correlated with worse quality of life. (p≤0.05). Conclusions In this study, we detected a relationship between duration of the disease, level of perceived stress and quality of life. The longer the disease lasts, the higher it tends to catastrophize. This may influence development or increase of the anxiety and depression and may decrease patients' quality of life.

Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical trial

Abstract The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

Trait vs. state anxiety in different threatening situations / Ansiedade traço versus ansiedade estado em diferentes situações de ameaça

Abstract Objective Anxiety as a uni- or multidimensional construct has been under discussion. The unidimensional approach assumes that there is a general trait anxiety, which predisposes the individuals to increases in state anxiety in various threatening situations. In this case, there should be a correlation between state and trait anxiety in any situation of threat. Therefore, the aim of this study was to investigate the correlation between trait and state anxiety in participants exposed to two different anxiogenic situations: interpersonal threat (Video-Monitored Stroop Test - VMST) and physical threat (third molar extraction - TME). Methods Participants with various levels of trait anxiety (general trait: State-Trait Anxiety Inventory - STAI, Hospital Anxiety and Depression Scale; specific trait: Social Phobia Inventory, Dental Anxiety Scale) had their anxious state evaluated (STAI, self-evaluation of tension level, heart rate, electromyogram activity) before, during and after the VMST or the TME. Results In VMST, trait anxiety correlated to state anxiety (psychological parameters) in all test phases. However, in TME, the only trait measurement that correlated to state anxiety (psychological parameters) was the Dental Anxiety Scale. Conclusion Trait anxiety correlates positively to state anxiety in situations of interpersonal threat, but not of physical threat.

Resumo Objetivo A ansiedade como um construto uni ou multidimensional tem estado em discussão. A abordagem unidimensional presume que há uma ansiedade-traço geral, a qual predispõe o indivíduo a aumentar a ansiedade-estado em situações de ameaça. Neste caso, deveria existir uma correlação entre estado e traço ansioso em diferentes situações ameaçadoras. Portanto, o objetivo deste estudo foi avaliar a correlação entre ansiedade-traço e ansiedade-estado em participantes que foram expostos a duas situações ansiogênicas diferentes: ameaça interpessoal (Teste de Stroop Monitorado por Vídeo - TSMV) e ameaça física (exodontia do terceiro molar - ETM). Métodos Participantes com vários níveis de ansiedade-traço (traço geral: Inventário de Ansiedade Traço-Estado - IDATE; Escala Hospitalar de Ansiedade e Depressão; traço específico: Inventário de Fobia Social, Escala de Ansiedade Dental de Corah) tiveram seus estados ansiosos avaliados (IDATE, escala analógica de tensão, frequência cardíaca, eletromiografia) antes, durante e depois do TSMV ou da ETM. Resultados No TSMV, a ansiedade-traço correlacionou-se com a ansiedade-estado (parâmetros psicológicos) em todas as fases do teste. Entretanto, na ETM, a única medida de traço que se correlacionou com a ansiedade-estado (parâmetros psicológicos) foi a Escala de Ansiedade Dental de Corah. Conclusão A ansiedade-traço correlaciona-se positivamente com a ansiedade-estado em situações de ameaça interpessoal, mas não de ameaça física.

Symptoms of anxiety and depression are related to cardiovascular responses to active, but not passive, coping tasks

Objective: Anxiety and depression have been linked to blunted blood pressure (BP) and heart rate (HR) reactions to mental stress tests; however, most studies have not included indices of underlying hemodynamics nor multiple stress tasks. This study sought to examine the relationships of anxiety and depression with hemodynamic responses to acute active and passive coping tasks. Methods: A total of 104 participants completed the Hospital Anxiety and Depression Scales and mental arithmetic, speech, and cold pressor tasks while BP, HR, total peripheral resistance, and cardiac output (CO) were assessed. Results: After adjustment for traditional risk factors and baseline cardiovascular activity, depression scores were negatively associated with systolic BP, HR, and CO responses to the mental arithmetic task, while anxiety scores were inversely related to the systolic BP response to mental arithmetic. Conclusion: High anxiety or depression scores appear to be associated with blunted cardiac reactions to mental arithmetic (an active coping task), but not to the cold pressor test or speech tasks. Future research should further examine potential mechanisms and longitudinal pathways relating depression and anxiety to cardiovascular reactivity. Clinical trial registration number: TCTR20160208004

Lifestyle Intervention on Metabolic Syndrome and its Impact on Quality of Life: A Randomized Controlled Trial / Intervenção de Estilo de Vida na Síndrome Metabólica e seu Impacto na Qualidade de Vida: Um Estudo Controlado Randomizado

Abstract Background: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays. Objective: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS. Methods: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months. Results: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention. Conclusion: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship.

Resumo Fundamento: Programas de intervenção em estilo de vida podem reduzir a prevalência de síndrome metabólica (SM) e, portanto, diminuir o risco de doença cardíaca, um dos principais problemas de saúde pública da atualidade. Objetivo: Comparar os efeitos de três tipos de abordagem para programas de mudança no estilo de vida visando à redução dos parâmetros metabólicos, assim como identificar seu impacto na qualidade de vida (QV) de indivíduos com SM. Métodos: Estudo randomizado controlado incluindo 72 indivíduos com SM com idade de 30 a 59 anos, que foram randomizados em três grupos de intervenção multidisciplinar [Intervenção Padrão (IP) - grupo controle; Intervenção em Grupo (IG); e Intervenção Individual (II)] por 12 semanas. O desfecho primário foi a mudança nos parâmetros metabólicos, e o secundário, a melhora nas medidas de QV em três momentos: condição basal, aos 3 e aos 9 meses. Resultados: As intervenções IG e II resultaram em uma significativa redução em índice de massa corporal, circunferência abdominal e pressão arterial sistólica, e em melhoras da QV aos 3 meses, embora significativamente associadas com o domínio 'capacidade funcional'. Tais mudanças, entretanto, não permaneceram 6 meses após o final da intervenção. Depressão e ansiedade associaram-se significativamente com pior QV, embora sem efeito na resposta à intervenção. Conclusão: A intervenção multidisciplinar, em especial em grupo, pode ser uma estratégia efetiva e economicamente possível para controlar os parâmetros metabólicos de SM e melhorar a QV quando comparada à IP, mesmo em uma relação de dose-efeito.

Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study / Desequilíbrio na proporção salivar diurna de testosterona/cortisol em homens com apneia obstrutiva do sono grave: um estudo observacional

ABSTRACT INTRODUCTION: The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients. OBJECTIVE: The purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C). METHODS: Ten subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities. RESULTS AND CONCLUSION: The main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients.

Resumo Introdução: A relação complexa entre os distúrbios do sono e os hormônios pode levar a alterações na produção de cortisol e testosterona em pacientes com Apneia obstrutiva do sono (AOS). Objetivo: O objetivo deste estudo foi determinar as curvas diurnas de testosterona e cortisol livres na saliva e sua proporção (razão T/C). Método: Dez indivíduos recém-diagnosticados com AOS com base na avaliação por polissonografia noturna e sonolência diurna excessiva e sete controles pareados foram recrutados, consecutivamente. Cortisol e testosterona foram medidos em amostras de saliva coletadas ao acordar, ao meio-dia e à noite. A avaliação psicométrica dos distúrbios de ansiedade/depressão e função sexual mencionados foi realizada para detectar a presença de comorbidades neuropsicológicas. Resultados: O achado principal foi que os indivíduos com AOS apresentam hipocortisolismo ao acordar e uma redução significante na concentração de testosterona à noite, em comparação com o grupo controle, que manteve a variação fisiológica diurna de testosterona e cortisol com concentrações hormonais mais elevadas pela manhã e concentrações mais baixas durante a noite. O uso de dados de várias mensurações diurnas, em vez de uma única mensuração, permitiu detectar as alterações na razão T/C de sinais opostos no início e no final do dia: os indivíduos com AOS apresentaram razão T/C maior que os controles na parte da manhã, enquanto que a razão T/C foi significantemente inferior à dos controles durante a noite. Conclusão: Os desequilíbrios no balanço anabólico-catabólico diurno sugerem que a AOS está associada a uma desregulação dos eixos hipotálamo-hipófise-adrenal e hipotálamo-hipófise-gonadal, potencialmente a causa subjacente de algumas das comorbidades neuropsicológicas observadas em pacientes com AOS.