Structural changes of the frontal cortex in depressed mice are associated with decreased expression of brain-derived neurotrophic factor / 南方医科大学学报

OBJECTIVE@#To investigate the changes in gray matter volume in depressive-like mice and explore the possible mechanism.@*METHODS@#Twenty-four 6-week-old C57 mice were randomized equally into control group and model group, and the mice in the model group were subjected to chronic unpredictable mild stimulation (CUMS) for 35 days. Magnetic resonance imaging was performed to examine structural changes of the grey matter volume in depressive-like mice. The expression of brain-derived neurotrophic factor (BDNF) in the grey matter of the mice was detected using Western blotting and immunofluorescence staining.@*RESULTS@#Compared with the control mice, the mice with CUMS showed significantly decreased central walking distance in the open field test (P < 0.05) and increased immobile time in forced swimming test (P < 0.05). Magnetic resonance imaging showed that the volume of the frontal cortex was significantly decreased in CUMS mice (P < 0.001, when the mass level was greater than or equal to 10 756, the FDRc was corrected with P=0.05). Western blotting showed that the expression of mature BDNF in the frontal cortex was significantly decreased in CUMS mice (P < 0.05), and its expression began to decrease after the exposure to CUMS as shown by immunofluorescence staining. The volume of different clusters obtained by voxel-based morphometry (VBM) analysis was correlated with the expression level of mature BDNF detected by Western blotting (P < 0.05).@*CONCLUSION@#The decrease of frontal cortex volume after CUMS is related with the reduction of mature BDNF expression in the frontal cortex.

La depresión con ideas suicidas presenta disfunciones corticales prefrontales que favorecen significativamente el intento suicida / Depression with suicidal ideas presents prefrontal cortical dysfunctions that significantly favor suicidal intent

Se realiza una revisión de estudios de resonancia magnética integral y funcional, así como estudios bioquímicos en pacientes con y sin ideas suicidas. Estos estudios en pacientes con alto riesgo de suicidio presentan una disminución de volúmenes corticales en la corteza prefrontal dorso y ventrolateral. Lo importante de estos estudios es que resultan de la comparación con pacientes deprimidos con bajo riesgo de suicidio. Los estudios de resonancia magnética funcional mostraron una hipofuncionalidad del lóbulo prefrontal en los pacientes depresivos con ideas suicidas severas, que se observa como una disminución del flujo sanguíneo cerebral en las áreas lateral y ventral. Se observa una disminución del metabolismo de serotonina, en clara relación con la severidad de las ideas de muerte, también con un foco en la región lateroventral prefrontal. Dado que las funciones de la corteza prefrontal afirman al individuo en su perspectiva vital, disfunciones como las descritas debilitan la coordinación y organización del apego a la vida, quedando, por el contrario, la posibilidad de la búsqueda de la muerte. Se concluye que los pacientes depresivos con ideas suicidas tienen una alta vulnerabilidad para el intento de suicidio por la afectación de las zonas prefrontales.

A review of functional integral magnetic resonance and biochemical data from patients with and without suicidal ideation is presented. Patients with high suicidal risk show a decrease in cortical volume in ventrolateral and dorsal prefrontal cortex. These studies are compared to those of depressed patients with low suicidal risk. Functional magnetic resonance in depressed patients with severe suicidal ideation show an hypo functional prefrontal lobe, seen as a decrease in blood flow in lateral and ventral areas. There is a decrease in serotonin metabolism, clearly related to the severity of suicidal ideation, also in ventrolateral prefrontal cortex. As prefrontal cortex functions enhance vital perspectives, such dysfunctions weaken coordination and organization of attachment to life, making search for death a possibility. Authors conclude that depressed patients with suicidal ideation have a high vulnerability for suicidal intent due to changes in prefrontal areas.

Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample / Comprometimento cognitivo na enxaqueca crônica: um estudo transversal em uma amostra clínica

Abstract Cognitive impairment has been described in all phases of a migraine attack and interictally. However, the prevalence and phenotype of such impairment in chronic migraine (CM) have not yet been studied. Objectives: The aim of this study was to evaluate both the prevalence of the objective cognitive deficit in patients with CM and the factors underlying its etiology. Methods: 144 patients with CM and 44 age-matched patients with low-frequency episodic migraine (EM) (a maximum of 4 headache days per month) participated in this study. Neuropsychiatric characteristics were measured with the HADS Hospital Anxiety and Depression Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20). Results: Compared to EM, CM subjects demonstrated higher subjective and objective cognitive impairment across all tests. CM patients had 4 times higher odds of achieving a RAVLT score in the lower quartile range compared to EM (Odds Ratio [OR] 3.8; 95% confidence interval [95%CI] 1.5‒9.6; р=0.005). In the MoCA, CM patients demonstrated the most striking impairment in memory/delayed recall (65.3%), attention (46.5%), abstraction (30.6%), and language (27.1%). Chronic headache and level of education, but not gender, depression or anxiety, were independent predictors of cognitive impairment. Conclusions: Cognitive impairment is prevalent in the CM population during their mildest possible pain and may be caused by a central sensitization. Timely preventive treatment of EM is warranted.

Resumo O comprometimento cognitivo foi descrito em todas as fases de um ataque de enxaqueca, de maneira intermitente. Entretanto, a prevalência e o fenótipo desse comprometimento na enxaqueca crônica (EC) não foram estudados. Objetivos: O objetivo deste estudo foi avaliar a prevalência do déficit cognitivo objetivo em pacientes com EC e fatores subjacentes à sua etiologia. Métodos: 144 pacientes com CM e 44 pacientes pareados por idade com enxaqueca episódica (EE) de baixa frequência (máximo de 4 dias de dor de cabeça por mês) foram incluídos. As características neuropsiquiátricas foram medidas pela Hospital Anxiety and Depression Scale (HADS). A função cognitiva foi avaliada por meio da Montreal Cognitive Assessment (MoCA), o Digit Symbol Substitution Test (DSST), o Rey Auditory Verbal Learning Test (RAVLT) e o Perceived Deficits Questionnaire (PDQ-20). Resultados: Em comparação com a EE, os indivíduos com EC demonstraram um comprometimento cognitivo subjetivo e objetivo maior em todos os testes. Os pacientes com CM tiveram 4 vezes mais chances de alcançar um escore RAVLT na faixa quartil inferior, em comparação com EE (Odds Ratio [OR] 3,8; intervalo de confiança de 95% [IC95%] 1,5‒9,6; p=0,005). No MoCA, os pacientes com EC demonstraram o maior prejuízo na memória/atraso na recordação (65,3%), atenção (46,5%), abstração (30,6%) e linguagem (27,1%). Dor de cabeça crônica e nível de escolaridade, mas não o sexo, depressão ou ansiedade, foram preditores independentes de comprometimento cognitivo. Conclusões: O comprometimento cognitivo é prevalente na população com enxaqueca crônica mesmo durante uma dor muito leve e pode ser causado pela sensibilização central. O tratamento preventivo oportuno da enxaqueca episódica se faz necessário.

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.

Lipopolysaccharide-stimulated intracellular cytokines and depressive symptoms in community-dwelling older adults

Abstract Background Inflammation is involved in the pathophysiology of depression, and circulating inflammatory cytokines have been associated with depressive symptoms. However, measuring circulating cytokines have inherent methodological limitations. In vitro lipopolysaccharide (LPS)-stimulated intracellular cytokines (ICCs) overcome these limitations. Furthermore, because psychosocial and physiological stressors activate inflammatory responses and LPS-stimulated ICCs reflect the inflammatory responsivity of monocytes to such stressors, ICCs may reflect individual stress responsivity. Methods This cross-sectional study examined whether LPS-stimulated expression of ICCs in peripheral blood mononuclear cells (PBMCs) is a sensitive inflammation measure correlated with depressive symptoms in 180 community-dwelling older adults. We tested correlations of not only intracellular but also circulating inflammatory markers with depressive symptoms assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Intracellular markers included expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and both in PBMCs. Circulating markers included IL-6, TNF-α, and C-reactive protein (CRP) in plasma. Results None of the correlations were statistically significant. However, in contrast to circulating markers, the correlations of ICCs were consistently in the expected direction, i.e., higher ICC expression correlating with higher depression severity. Discussion Despite the non-significant findings, further research is required for the evaluation of LPS-stimulated ICC expression as biomarkers of depressive symptoms.

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.

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.

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.

Twenty-five years since the identification of the first SCA gene: history, clinical features and perspectives for SCA1 / Vinte e cinco anos desde a identificação do primeiro gene das SCAs: história, aspectos clínicos e perspectivas para a SCA1

ABSTRACT Spinocerebellar ataxias (SCA) are a clinically and genetically heterogeneous group of monogenic diseases that share ataxia and autosomal dominant inheritance as the core features. An important proportion of SCAs are caused by CAG trinucleotide repeat expansions in the coding region of different genes. In addition to genetic heterogeneity, clinical features transcend motor symptoms, including cognitive, electrophysiological and imaging aspects. Despite all the progress in the past 25 years, the mechanisms that determine how neuronal death is mediated by these unstable expansions are still unclear. The aim of this article is to review, from an historical point of view, the first CAG-related ataxia to be genetically described: SCA 1.

RESUMO As ataxias espinocerebelares (SCA) são um grupo clínico e geneticamente heterogêneo de doenças monogênicas que compartilham ataxia e herança autossômica dominante como características principais. Uma proporção importante de SCAs é causada por expansões de repetição de trinucleotídeos CAG na região de codificação de diferentes genes. Além da heterogeneidade genética, os aspectos clínicos transcendem os sintomas motores, incluindo aspectos cognitivos, eletrofisiológicos e de imagem. Apesar de todo o progresso feito nos últimos 25 anos, os mecanismos que determinam como se dá a morte neuronal mediada por essas expansões instáveis ainda não estão claros. O objetivo deste artigo é revisar, de um ponto de vista histórico, a primeira ataxia geneticamente relacionada com o CAG descrita: SCA 1.

Funcionamiento cognitivo en adultos mayores: rol de la reserva cognitiva, apoyo social y depresión / Cognitive reserve, depression and social support. Analysis of 206 older adults

Background: Cognitive reserve (CR) is a protective factor in aging. Depression and perceived social support are associated with cognitive performance in older adults. However, their role in the relationship between CR and cognitive functioning is less clear. Aim: To determine the relationship between CR and cognitive functioning and whether this relationship is mediated by depression and moderated by social support. Material and Methods: CR, depression, perceived social support, and cognitive functioning scales were applied to a convenience sample of 206 older adults, aged 69 ± 1 years (77% women). Structural equation analysis and moderate mediation analysis were performed. Results: There was a direct effect of CR in cognitive functioning (β = 0.223, p = 0.005), which was not mediated by depression (β = 0.040, p = 0.096). High CR scores were associated with lower depression scores (β = −0.203, p = 0.002). Higher depression scores were associated with worse cognitive functioning (β = −0.168, p = 0.040). The effect of CR on depression was moderated by social support (β = −0.161, p = 0.032) controlling for income and age. Conclusions: The relationship between CR and cognition in older adults allows an early assessment of cognitive dysfunction risk. Depression is an independent risk factor for cognitive functioning. Social support protects individuals with high CR from developing depression.

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.

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.

Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study

Objective: To prospectively evaluate depressive symptoms, nutritional status, and quality of life (QoL) and search for possible associations in patients with end-stage renal disease undergoing hemodialysis. Methods: A cohort study of 104 adult patients with end-stage renal disease undergoing hemodialysis was conducted. Anthropometric, clinical, and biochemical variables were evaluated after a midweek hemodialysis session. The participants’ body composition was assessed by direct segmental multi-frequency bioimpedance analysis. The WHOQOL-Bref questionnaire was used to evaluate QoL. Participants were separated into two groups - depressive symptoms and no depressive symptoms - at inclusion and evaluated annually for 2 years thereafter using the Beck Depression Inventory. Survival analysis used the Kaplan-Meier method and Cox regression analysis for the goodness of fit of associated factors. All-cause mortality was the outcome of interest. Results: Participants’ mean age was 55.3±15.6 years, 60% were male, and the median time on hemodialysis was 17.5 (8.0-36.8) months. Thirty-two patients had depressive symptoms and a significantly lower QoL compared with the 72 patients in the no depressive symptoms group. The fitted outcome model showed that lean body mass had a protective effect against all-cause mortality (hazard ratio [HR] = 0.89; 95%CI 0.80-0.99; p = 0.038). Conclusion: Depressive symptoms were highly prevalent in the cohort, and correlated with the physical and psychological components of the QoL life questionnaire, as well as with C-reactive protein and phosphorus levels. Lean body mass was protective for the assessed outcome.

Desigualdades en la continuidad de la atención ambulatoria de población desplazada en Colombia 2012-2013 / Inequalities in the continuity of outpatient care to displaced population in Colombia, 2012 - 2013

RESUMEN Objetivo Establecer desigualdades en la continuidad de la atención ambulatoria de la población desplazada con diagnóstico de depresión. Métodos Estudio transversal a partir del registro clínico, del periodo entre el 1 de junio de 2012 y 30 de junio de 2013, sobre las personas con diagnóstico de depresión y clasificadas según desplazamiento. Se usó el odds ratio para la asociación entre tipo de población y control profesional ambulatorio, ajustado por sexo, edad, afiliación y región. Resultados Sobre 74 713 registros: 3 149 de desplazados y 71 564 no desplazados; se encontró 24 % más atención ambulatoria en los no desplazados (OR: 1,24 p<0.001; IC 1,10-1,39), la ventaja fue mayor al ajustar por afiliación al sistema. En el grupo de desplazados se encontró mayor atención ambulatoria en los hombres frente a las mujeres (OR: 1,40 p<0.001 IC: 1,08-1,83). Fue mayor también la desventaja para aquellas, con respecto a mujeres no desplazadas (OR: 1,26 p<0.001 IC: 1,10-1,44). Si bien estos resultados se obtuvieron en la atención de depresión leve y moderada, no en grave, la primera fue diagnosticada en el 92 % de las personas. Discusión El registro de prestaciones demostró desigualdades en la continuidad de la atención ambulatoria y aunque su calidad ha mejorado, su cobertura todavía es incompleta. En el primer año con plan único del Sistema de Salud, parece que las coberturas no lograron por sí solas evitar diferencias en la atención de la población desplazada. Se necesita mejorar el registro y la interoperabilidad, para políticas de salud con enfoque de equidad.(AU)

ABSTRACT Objective To establish inequalities in the continuity of outpatient care to displaced population diagnosed with depression. Methods A cross-sectional study, based on clinical records, was performed during the period between June 1, 2012 and June 30, 2013, on population diagnosed with depression and reduced to displaced population. The odds ratio was used to associate the type of population with the outpatient care control by professionals, adjusted by sex, age, affiliation and region. Results The following information was obtained from 74 713 records: 3 149 related to displaced population and 71 564 to non-displaced population; non-displaced population had 24 % more ambulatory care (OR: 1.24 p<0.001; CI 1.10 to 1.39), and the advantage was greater when adjusting the information to data, based on affiliation to the health system. In the displaced population group, men had greater rates of outpatient care compared to women (OR:1.40 p<0.001 CI: 1.08 to 1.83). The disadvantage was also high for non-displaced women (OR:1.26 p<0.001 CI: 1.10 to 1.44). Although these results were obtained for outpatient care in mild and moderate depressive patients, severe depression was excluded; the first type of depression was diagnosed in 92 % of people. Discussion The performance record showed inequalities in the continuity of outpatient care and, despite the improvement of quality, its coverage is still incomplete. During the first year of the unified plan for the Health System, apparently, the coverage has not achieved to avoid by itself differences in care of displaced population. Improvement of records and interoperability is necessary for designing health policies with an equitable approach.(AU)

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.

Cognition and functioning in bipolar depression

Objectives: Depressive symptoms are associated with worse outcomes in patients with bipolar disorder (BD). However, scarce data are available regarding neurocognitive profiles across different areas of functioning among BD patients with moderate and severe depression. Our objective was to assess cognition and global functioning in a group of patients with bipolar depression. Methods: Data were available for 100 patients with bipolar depression (78% female) and 70 controls (64% female) paired by age and education level. Cognitive function was assessed with a neuropsychological test battery. Functioning was assessed with the Functioning Assessment Short Test. Results: In patients, severe depression was associated with poorer cognitive performance on measures of executive function. Patients with severe depression showed worse global functioning than those with moderate depression (z = 2.54, p = 0.011). In patients with severe depression, lower global functioning was associated with lower scores in working memory (r = -0.200, p = 0.010), and executive function (r = -0.210, p = 0.007; and r = 0.293, p < 0.001). Conclusion: Our findings suggest cognitive impairment and global functioning impairment are associated with the severity of depressive symptoms in bipolar depression. Intensive treatment of depressive symptoms in patients with BD is crucial to improve cognitive functioning and, consequently, functional outcomes.