ABSTRACT
Em março de 2020 a situação causada pela covid-19 foi elevada à categoria de pandemia, impactando de inúmeras formas a vida em sociedade. O objetivo deste estudo foi compreender os impactos da pandemia na atuação e saúde mental do psicólogo hospitalar, profissional que atua nos espaços de saúde e tem experienciado mais de perto o sofrimento dos doentes e dos profissionais de saúde frente à covid-19. Trata-se de um estudo exploratório-descritivo com 131 psicólogos que atuam em hospitais. Os profissionais foram convidados a participar através de redes sociais e redes de contatos das pesquisadoras, utilizando-se a técnica Bola de Neve. Foram utilizados dois questionários, disponibilizados na plataforma Google Forms, um abordando os impactos da pandemia sentidos pelos profissionais e outro referente ao sofrimento psíquico. Os dados foram analisados a partir de estatísticas descritivas e inferenciais. Foram observados impactos na atuação de quase a totalidade dos participantes, constatada a necessidade de preparação dos profissionais para o novo cenário, a percepção de pouco apoio institucional e quase metade da população estudada referiu-se a sintomas de sofrimento psíquico considerável desde o início da pandemia. É fundamental dar atenção a sinais e sintomas de sofrimento psíquico, procurando evitar o adoecimento de uma categoria profissional que se encontra na linha de frente do combate aos danos psicológicos da pandemia e cuja própria saúde mental é pouco abordada na literatura.(AU)
In March 2020, the COVID-19 pandemic breakout hugely impacted life in society. This study analyzes how the pandemic impacted hospital psychologists' mental health and performance, professional who more closely experienced the suffering of patients and health professionals in this period. An exploratory and descriptive study was conducted with 131 hospital psychologists. Professionals were invited to participate through the researchers' social and contact networks using the Snowball technique. Data were collected by two questionnaires available on the Google Forms platform, one addressing the impacts felt by professionals and the other regarding psychic suffering, and analyzed by descriptive and inferential statistics. Results showed that almost all participants had their performance affected by the need to prepare for the new scenario, the perceived little institutional support. Almost half of the study sample reported considerable psychological distress symptoms since the beginning of the pandemic. Paying attention to signs and symptoms of psychic suffering is fundamental to avoid compromising a professional category that is on the front line of combating the psychological damage caused by the pandemic and whose own mental health is little addressed by the literature.(AU)
En marzo de 2020, la situación provocada por el COVID-19 se caracterizó como pandemia e impactó el mundo de diversas maneras. El objetivo de este estudio fue comprender los impactos de la pandemia en la salud mental y la actuación del psicólogo en los hospitales, uno de los profesionales que trabaja en espacios sanitarios y que ha experimentado más de cerca el sufrimiento de pacientes y profesionales sanitarios frente al COVID-19. Este es un estudio exploratorio descriptivo, realizado con 131 psicólogos que trabajan en hospitales. Los profesionales recibieron la invitación a participar a través de las redes sociales y redes de contactos de las investigadoras, mediante la técnica snowball. Se utilizaron dos cuestionarios disponibles en la plataforma Google Forms: uno sobre los impactos de la pandemia en los profesionales y el otro sobre el sufrimiento psíquico. Los datos se analizaron a partir de estadísticas descriptivas e inferenciales. Se observaron impactos en el trabajo de casi todos los participantes, la necesidad de preparación de los profesionales para este nuevo escenario, la percepción de poco apoyo institucional, y casi la mitad de la población estudiada reportaron sentir síntomas de considerable angustia psicológica desde el inicio de la pandemia. Es esencial prestar atención a los signos y síntomas del sufrimiento psíquico, buscando evitar la enfermedad de una categoría profesional que está a la vanguardia de la lucha contra el daño psicológico de la pandemia y cuya propia salud mental se aborda poco en la literatura.(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Young Adult , Psychology , Mental Health , Coronavirus Infections , Pandemics , Anxiety , Orientation , Physicians , Protective Clothing , Respiration , Respiratory Tract Infections , Safety , Attention , Set, Psychology , Social Adjustment , Social Isolation , Stress, Physiological , Stress, Psychological , Awareness , Software , Immunoglobulin M , Adaptation, Psychological , Pharmaceutical Preparations , Irritable Mood , Family , Carrier State , Epidemiologic Factors , Public Health Practice , Quarantine , Sanitation , Hygiene , Public Health , Epidemiology , Risk , Disease Outbreaks , Data Collection , Survival Rate , Mortality , Transportation of Patients , Triage , Contact Tracing , Occupational Health , Immunization , Universal Precautions , Infection Control , Immunization Programs , Infectious Disease Transmission, Professional-to-Patient , Infectious Disease Transmission, Patient-to-Professional , Coronavirus , Comprehensive Health Care , Disease Transmission, Infectious , Remote Consultation , Containment of Biohazards , Pulmonary Ventilation , Emergency Plans , Disaster Vulnerability , Declaration of Emergency , Disaster Planning , Death , Trust , Air Pollution , Ethanol , Economics , Emergencies , Emergency Services, Psychiatric , Empathy , Ethics, Professional , Professional Training , Surveillance of the Workers Health , Family Relations , Family Therapy , Resilience, Psychological , Infectious Disease Incubation Period , Fear , Epidemics , Social Networking , Binge Drinking , Epidemiological Monitoring , Personal Protective Equipment , Emotional Adjustment , Emergency Medical Dispatch , Survivorship , Family Separation , Posttraumatic Growth, Psychological , Embarrassment , Sadness , Teleworking , Physical Distancing , COVID-19 Nucleic Acid Testing , SARS-CoV-2 , Sociodemographic Factors , Suicide Prevention , Post-Acute COVID-19 Syndrome , Health Services Research , Immune System , Sleep Initiation and Maintenance Disorders , Anger , Loneliness , Masks , Mass Media , Negativism , Nurses, Male , Nursing AssessmentABSTRACT
Abstract Introduction Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Irritable Mood , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Mood Disorders/diagnosis , Problem Behavior , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Outpatient Clinics, Hospital , Irritable Mood/physiology , Reproducibility of Results , Factor Analysis, Statistical , Diagnosis, Differential , Tertiary Care CentersABSTRACT
INTRODUCCIÓN: La forma clínica de presentación más común del neuroblastoma es el de una masa abdominal, pero puede presentarse con sintomatología menos habitual, como es la crisis adrenérgica por liberación de catecolaminas. OBJETIVO: Describir una forma de presentación inusual de neuroblastoma y el amplio diagnóstico diferencial que existe en un lactante con síntomas adrenérgicos. CASO CLÍNICO: Lactante femenina de 7 semanas de vida, consultó por historia de tres semanas de sudoración e irritabilidad a lo que se asoció fiebre de 24 h de evolución y dificultad respiratoria. Al ingreso presentaba mal esta do general, irritabilidad, sudoración, enrojecimiento facial, taquipnea y palidez cutánea, taquicardia sinusal extrema e hipertensión arterial (HTA), interpretadas como sintomatología adrenérgica. Se completó el estudio con una ecografía abdominal y resonancia magnética que mostraron una gran masa retroperitoneal compatible con neuroblastoma. Las catecolaminas en sangre y en orina mostraron altos niveles de dopamina, adrenalina y noradrenalina, probablemente de origen tumoral. Se inició tratamiento antihipertensivo con fármacos alfa bloqueantes con buen control de la tensión arterial. Se resecó quirúrgicamente el tumor sin incidencias y con una adecuada recuperación posterior. La paciente presentó evolución favorable a tres años de seguimiento. CONCLUSIONES: en un lactante con sintomatología adrenérgica como irritabilidad, enrojecimiento, sudoración asociada a HTA, se debe descartar patología cardiaca, metabólica (hipoglucemia), intoxicaciones y/o patología suprarrenal. Dentro de esta última, el neuroblastoma es la primera posibilidad diagnóstica, por ser uno de los principales tumores en la infancia y aunque esta presentación no es habitual puede producir estos síntomas.
INTRODUCTION: The most common clinical presentation of neuroblastoma is an abdominal mass, but it can present with uncommon symptoms, such as adrenergic storm due to catecholamine release. OBJECTIVE: To describe an unusual presentation of neuroblastoma and the wide differential diagnosis that exists in an infant with adrenergic symptoms. CLINICAL CASE: A 7-week old female infant was evaluated due to a 3-week history of sweating and irritability associated with a 24-hour fever and respiratory distress. At admission, she presented poor general condition, irritability, sweating, facial redness, tachypnea and skin paleness, extreme sinus tachycardia, and high blood pressure (HBP), interpreted as adrenergic symptoms. The study was completed with abdominal ultrasound and magnetic reso nance imaging that showed a large retroperitoneal mass compatible with neuroblastoma. Plasma and urinary catecholamines tests showed high levels of dopamine, adrenaline, and noradrenaline, probably of tumor origin. We started antihypertensive treatment with alpha-blocker drugs, showing a good blood pressure control. The tumor was surgically resected without incidents and adequate subsequent recovery. The patient presented a favorable evolution after three years of follow-up. CONCLUSIONS: In an infant with adrenergic symptoms such as irritability, redness, sweating associated with HBP, it should be ruled out pathology heart or metabolic (hypoglycemia) pathology, intoxications, and/or adrenal pathology. Within this last one, neuroblastoma is the first diagnostic possibility, since it is one of the main tumors in childhood and, although this presentation is not usual, it can produce these symptoms.
Subject(s)
Humans , Female , Infant , Retroperitoneal Neoplasms/diagnosis , Sweating , Tachycardia/etiology , Catecholamines/urine , Flushing/etiology , Hypertension/etiology , Neuroblastoma/diagnosis , Retroperitoneal Neoplasms/complications , Retroperitoneal Neoplasms/urine , Tachycardia/diagnosis , Irritable Mood , Biomarkers, Tumor/urine , Diagnosis, Differential , Hypertension/diagnosis , Neuroblastoma/complications , Neuroblastoma/urineABSTRACT
El Síndrome X Frágil (SXF) es la principal causa heredada de Discapacidad intelectual (DI) y Trastorno del espectro autista (TEA). Se caracteriza por presentar un fenotipo conductual asociado a hiperactividad, déficit atencional, impulsividad, ansiedad, trastornos conductuales, espectro autista y retraso global del desarrollo. No existe actualmente un tratamiento farmacológico para el trastorno genético de base. El tratamiento farmacológico se focaliza en los síntomas que interfieren con la calidad de vida y aprendizaje, entre ellos la irritabilidad e hiperactividad. OBJETIVO: Evaluar cambios conductuales a través de la escala conductual ABC, de pacientes masculinos con diagnóstico de SXF tratados con psicoestimulantes y/o antipsicóticos en comparación a controles. MÉTODO: Se evalúa a 40 pacientes hombres con diagnóstico de SXF entre los años 2014 y 2017. Se utiliza la evaluación de la conducta mediante el puntaje en la subescala de irritabilidad e hiperactividad de la encuesta ABC-C y el registro de fármacos indicados. Se compara la sintomatología conductual en pacientes que no utilizan fármacos, aquellos que utilizan antipsicóticos, los que usan psicoestimulantes y pacientes tratados con ambos fármacos. RESULTADOS: La mediana de edad fue de 15,1 (±9,3) años. Del total de pacientes, el 42,5% reportó uso de fármacos, de éstos el 35% utilizó psicoestimulantes, 35% antipsicóticos y 30% la combinación de ambos. Se observa que solo el grupo que recibe tratamiento con psicoestimulantes y antipsicóticos en forma simultánea presenta diferencias con el subgrupo sin tratamiento farmacológico. CONCLUSIONES: En más de la mitad de nuestros pacientes se decide no utilizar tratamiento farmacológico. Sin embargo, dichos pacientes igualmente presentan sintomatología de irritabilidad e hiperactividad. Los pacientes que recibieron terapia asociada de psicoestimulantes y antipsicóticos presentan puntajes significativamente más altos en la escala de irritabilidad que aquellos que no recibieron tratamiento farmacológico. Este grupo, que constituye el 12,5% del total de la muestra, presenta un fenotipo conductual que genera mayores dificultades en la calidad de vida del paciente y su entorno.
Fragile X Syndrome (FXS) is the main inherited cause of Intellectual Disability and Autism Spectrum Disorder. It characteristically presents as a behavioral phenotype asso- ciated with hyperactivity, attention deficit, impulsivity, anxiety, behavioral disorders, autistic spectrum and global developmental delay. There is currently no pharmacological treatment for the underlying genetic disorder. Pharmacological treatment targets symptoms that interfere with quality of life and learning, including irritability and hyperactivity.OBJECTIVE: To evaluate behavioral changes through the ABC behavioral scale of male patients diagnosed with FXS treated with psychostimulants and / or antipsychotics compared to controls. METHOD: 40 male patients with a diagnosis of FXS between 2014 and 2017 were evaluated. The behavioral assessment was done by scoring the irritability and hyperactivity subscale of the ABC-C survey and by registering the prescribed drug. Behavioral symptomatology was compared in patients who do not use drugs, those who use antipsychotics, those who use psychostimulants and patients treated with both drugs. RESULTS: The median age was 15.1 (± 9.3) years. Of the total of patients, 42.5% were prescribed drugs, of these 35% used psychostimulants, 35% antipsychotics and 30% the combination of both. It was observed that the group that received treatment with both psychostimulants and antipsychotics simultaneously presented differences with the subgroup without pharmacological treatment.CONCLUSIONS: In more than half of our patients no pharmacological treatment is prescribed. However, these patients also show symptoms of irritability and hyperactivity. Patients who received associated therapy of psychostimulants and antipsychotics have significantly higher scores on the irritability scale than those who did not receive pharmacological treatment. This group, which constitutes 12.5% of the total sample, has a behavioral phenotype that generates greater difficulties in the patient's quality of life and their environment.
Subject(s)
Humans , Male , Child , Adolescent , Young Adult , Antipsychotic Agents/therapeutic use , Fragile X Syndrome/psychology , Fragile X Syndrome/drug therapy , Central Nervous System Stimulants/therapeutic use , Irritable Mood , Patient Acceptance of Health Care , Surveys and Questionnaires , Checklist , Problem BehaviorABSTRACT
Resumen. La irritabilidad es un síntoma transdiagnóstico que atraviesa la barrera de las patologías internalizantes y externalizantes. Se define como un umbral bajo para experimentar la ira en respuesta a la frustración y es uno de los síntomas más comunes en niños y adolescentes. Las conductas relacionadas con la ira apropiadas para el desarrollo tienden a reflejar frustración en contextos esperados, mientras que la irritabilidad crónica es inapropiada para la situación. La presentación de la irritabilidad, crónica o episódica, es crucial para comprender su significado psicopatológico, en particular porque las estructuras de la irritabilidad episódica y crónica son separables y permanecen estables a lo largo del tiempo. Existen varios estudios acerca de la irritabilidad en patologías como trastorno afectivo bipolar y trastorno de desregulación disruptiva del estado del ánimo, en ambos casos es importante plantearse como punto de partida la identificación de la episodicidad. La irritabilidad también se encuentra presente en el trastorno de personalidad límite observándose dentro de una inestabilidad afectiva debida a una reactividad notable del estado de ánimo. Estas emociones tienen un correlato anatómico relacionado con deficiencias de los circuitos frontolímbicos. Para el manejo de la irritabilidad en las distintas patologías, la evidencia del tratamiento incluye terapia cognitivo conductual, intervención de los padres, mindfulness, pero existe una necesidad apremiante de investigación sobre el tratamiento farmacológico complementario.
Irritability is a transdiagnostic symptom that crosses the barrier between internalizing and externalizing pathologies. It is defined as a low threshold to experience anger in response to frustration and it is one of the most common symptoms in children and adolescents. Behaviors related to appropriate developmental anger tend to reflect frustration in expected contexts, while chronic irritability is inappropriate to the situation. The presentation of irritability, chronic or episodic, is crucial to understanding its psychopathological meaning, particularly because the structures of episodic and chronic irritability are separable and remain stable over time. There are several studies about irritability in pathologies such as bipolar affective disorder and disruptive mood dysregulation disorder, in both cases it is important to consider the identification of episodicity as a starting point. Irritability is also present in borderline personality disorder, where it is expressed as an affective instability due to a remarkable reactivity of the state of mind. These emotions have been anatomically related to deficiencies of the frontolimbic circuits. For the management of irritability in different patholo-gies, the evidence includes cognitive behavioral therapy, parental intervention, mindfulness, but there still is a pressing need for research on complementary pharmacological treatment.
Subject(s)
Humans , Child , Adolescent , Irritable Mood , Mental Disorders/diagnosis , Mental Disorders/psychology , Bipolar Disorder/diagnosis , Borderline Personality Disorder/diagnosis , Problem Behavior , Anger , Mental Disorders/therapyABSTRACT
INTRODUCTION: Although the rapid weight loss process is undertaken by combat sports athletes very often, the impact of this practice on cardiovascular health is not fully understood. OBJECTIVE: To verify the effects of the rapid weight loss process undertaken by combat sports athletes on hemodynamic parameters, cardiovascular autonomic modulation and mood state. METHODS: Eight male fighters (21.62±1.49 years, 71.25±3.54 kg, 1.74±0.03 cm) were assessed in the city of São Paulo. The subjects had 5.37±0.77 years of practice and were training 5.75±0.45 days per week, for 3.05±0.69 hours per day. The athletes were assessed on 2 occasions: 14 days before and 1 day before official weigh-in. Weight, height and bioimpedance were used for body composition analysis. Mood state was assessed using the Brums Mood Scale. Blood pressure was measured at rest with a digital meter. Cardiovascular autonomic modulation was obtained through an analysis of heart rate variability recorded for 25 minutes at rest. The Student's t-test for dependent samples was used for comparison between time points. Values of p<0.05 were considered significant. RESULTS: No differences in body composition were observed between the time points evaluated. After the weight loss strategy, increases in mood state parameters related to anger, vigor and fatigue categories were observed. Blood pressure did not change between the time points evaluated. However, an increase in heart rate associated with greater sympathetic modulation was observed after the weight loss strategy. There were no differences in autonomic modulation parameters representing parasympathetic activity. CONCLUSIONS: The study provided evidence of a higher cardiovascular risk in athletes as a result of this rapid weight loss practice, which is very concerning since combat sports athletes repeat this process several times during their lives. Level of Evidence IV; Study type: Case series
INTRODUÇÃO: Apesar de o processo de perda ponderal rápida ser realizado por atletas de esporte de combate com muita frequência, os impactos dessa prática sobre a saúde cardiovascular não estão totalmente esclarecidos. OBJETIVO: Verificar os efeitos do processo de perda ponderal rápida realizado pelos atletas de esportes de combate sobre parâmetros hemodinâmicos, modulação autonômica cardiovasculares estado de humor. MÉTODOS: Foram avaliados oito lutadores do sexo masculino (21,62 ± 1,49 anos, 71,25 ± 3,54 kg, 1,74±0,03 cm) na cidade de São Paulo. Os sujeitos tinham 5,37 ± 0,77 anos de prática, treinavam 5,75 ± 0,45 dias por semana, durante 3,05 ± 0,69 horas por dia. Os atletas foram avaliados em duas oportunidades: 14 dias e 1 dia antes da pesagem. Foram realizadas avaliações de massa corporal, altura e bioimpedância para análise da composição corporal. O estado de humor foi avaliado pela da escala de humor de Brums. A pressão arterial foi aferida em repouso com medidor digital. A modulação autonômica cardiovascular foi obtida pela análise de variabilidade da frequência cardíaca gravada durante 25 minutos em repouso. Para a comparação entre os momentos, foi utilizado teste t de Student para amostras dependentes. Os valores de p < 0,05 foram considerados significativos. RESULTADOS: Não foram observadas diferenças na composição corporal entre os momentos avaliados. Após a estratégia de perda ponderal, foram observados aumentos dos parâmetros de humor relacionados às categorias raiva, vigor e fadiga. A pressão arterial não se alterou entre os momentos avaliados. Entretanto, verificou-se aumento da frequência cardíaca associado à maior modulação simpática após a estratégia de perda ponderal. Os parâmetros de modulação autonômica representativos de atividade parassimpática não apresentaram diferenças. CONCLUSÕES: Houve maior risco cardiovascular nos atletas em decorrência dessa prática de perda ponderal rápida, o que é muito preocupante, tendo em vista que os atletas de esportes de combate repetem esse processo várias vezes durante a vida. Nível de Evidência IV; Tipo de estudo: Série de casos.
INTRODUCCIÓN: A pesar de que el proceso de pérdida ponderal rápida sea realizado por atletas de deporte de combate con mucha frecuencia, los impactos de esta práctica sobre la salud cardiovascular no están totalmente aclarados. OBJETIVO: Verificar los efectos del proceso de pérdida ponderal rápida realizado por los atletas de deportes de combate sobre parámetros hemodinámicos, modulación autonómica cardiovascular y el estado de humor. MÉTODOS: Se evaluaron 8 luchadores del sexo masculino (21,62±1,49 años, 71,25±3,54 kg, 1,74±0,03 cm) en la ciudad de São Paulo. Los sujetos tenían 5,37±0,77 años de práctica, entrenaban 5,75±0,45 días a la semana, durante 3,05±0,69 horas al día. Los atletas fueron evaluados en dos oportunidades: 14 días y 1 día antes del pesaje. Se realizaron evaluaciones de masa corporal, altura y bioimpedancia para análisis de la composición corporal. El estado de humor fue evaluado a través de la escala de humor de Brums. La presión arterial se midió en reposo con medidor digital. La modulación autonómica cardiovascular fue obtenida a través del análisis de variabilidad de la frecuencia cardíaca grabada durante 25 minutos en reposo. Para la comparación entre los momentos, se utilizó la prueba t de Student para muestras dependientes. Los valores de p <0,05 se consideraron significativos. RESULTADOS: No se observaron diferencias en la composición corporal entre los momentos evaluados. Después de la estrategia de pérdida ponderal, se observaron aumentos en los parámetros de humor relacionados con las categorías rabia, vigor y fatiga. La presión arterial no se alteró entre los momentos evaluados. Sin embargo, se observó un aumento en la frecuencia cardíaca asociado a la mayor modulación simpática después de la estrategia de pérdida ponderal. Los parámetros de modulación autonómica representativos de actividad parasimpática no presentaron diferencias. CONCLUSIONES: Hubo mayor riesgo cardiovascular en los atletas como consecuencia de esta práctica de pérdida ponderal rápida, lo que es muy preocupante, teniendo en cuenta que los atletas de deportes de combate repiten este proceso varias veces durante su vida. Nivel de Evidencia: IV. Tipo de estudio: Serie de casos.
Subject(s)
Humans , Male , Middle Aged , Sympathetic Nervous System , Weight Loss , Martial Arts , Competitive Behavior , Athletes/psychology , Heart Rate , Water-Electrolyte Imbalance , Irritable Mood , Anthropometry/methods , Risk Factors , Dehydration/etiologyABSTRACT
Abstract Objective To describe the cross-cultural adaptation of the Anger Rumination Scale (ARS) for use in Brazil. Methods The cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. Results A final Brazilian version of the instrument (ARS-Brazil) was defined and is presented. Pretest results revealed that the instrument was generally well understood by adults as well as indicated a few modifications that were included in the final version presented here. Conclusion The Brazilian Portuguese version of the ARS seems to be very similar to the original ARS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of rumination symptoms of anger and irritability for adults in community, clinical, and research settings.
Resumo Objetivo Descrever a adaptação transcultural da Escala de Ruminação de Raiva (Anger Rumination Scale, ARS) para uso no Brasil. Método A adaptação transcultural seguiu um processo de quatro etapas baseado em literatura especializada: 1) investigação da equivalência conceitual e dos itens; 2) tradução e retrotradução; 3) pré-teste; e 4) investigação da equivalência operacional. Resultados Uma versão final brasileira do instrumento, denominada ARS-Brasil, foi obtida e é apresentada. Os resultados do pré-teste demonstraram que a escala foi predominantemente bem entendida entre adultos, e indicaram algumas modificações que foram incluídas na versão final. Conclusão A versão da ARS adaptada para o português brasileiro mostra-se muito similar à versão original da ARS no que diz respeito à equivalência conceitual e dos itens, semântica e equivalência operacional, sugerindo que futuros estudos transculturais poderiam se beneficiar desta primeira versão. Como resultado, um novo instrumento está agora disponível para a avaliação de sintomas de ruminação da raiva e da irritabilidade para adultos, em contextos comunitário, clínico e de pesquisa.
Subject(s)
Humans , Male , Female , Adult , Psychological Tests , Rumination, Cognitive , Anger , Translating , Irritable Mood , Cross-Cultural ComparisonABSTRACT
<p><b>INTRODUCTION</b>This study aimed to determine the sleep patterns and dysfunctions in children with learning problems in comparison against a local population-based sample.</p><p><b>MATERIALS AND METHODS</b>Parents of 200 children with learning problems and 372 parents of a local population-based sample of typically developing (TD) children were recruited to complete a questionnaire on their child's sleep patterns and sleep problems. The Children's Sleep Habits Questionnaire (CSHQ) is a validated parent-reported sleep screening questionnaire that contains 54 items identifying sleep behaviours in children.</p><p><b>RESULTS</b>The mean age of the sample was 4.2 years (SD: 1.4; range, 2 to 6 years). Sleep duration was similar between the 2 groups. The difference in mean CSHQ subscale scores between children with learning problems and TD children was significant for sleep-disordered breathing (1.3 vs 1.2,= 0.001). Among children with learning problems, 36.5% snored (vs 26.6% of TD children), 30.5% had noisy breathing (vs 18.8%), and 9.0% (vs 4.6%) experienced difficulty breathing 2 or more times a week. Children with learning problems woke up in a more irritable mood (= 0.01), had more difficulty in getting out of bed (<0.001), and took a longer time to be alert (<0.001). They exhibited fewer behaviours of daytime drowsiness (= 0.009). Among this group of children, 15.0% of parents reported that their child had a sleep problem compared to 9.0% in the TD group.</p><p><b>CONCLUSION</b>Sleep breathing disorders and symptoms of morning sleepiness are more prevalent in children with learning problems. Symptoms of daytime lethargy are similar between the 2 groups. We suggest that a simple outpatient screening targeted at these problems be instituted in the initial workup of any child with learning difficulties.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Case-Control Studies , Comorbidity , Irritable Mood , Learning Disabilities , Epidemiology , Prevalence , Singapore , Epidemiology , Sleep , Sleep Apnea Syndromes , Epidemiology , Sleep Hygiene , Sleep Wake Disorders , Epidemiology , Snoring , EpidemiologyABSTRACT
O Transtorno de Oposição e Desafio (TOD) é definido por um padrão recorrente de comportamento desafiante, desobediente e hostil com início na infância e adolescência e caracteriza-se por uma alta taxa de comorbidades. Estudos longitudinais apontam o TOD na infância como um dos principais preditores de psicopatologia na idade adulta. Uma possível explicação para a grande heterogeneidade de comorbidades e trajetórias longitudinais é de que o diagnóstico de TOD abrange distintas dimensões de sintomas, cada qual com seu desfecho. O primeiro objetivo desta tese foi a validação das distintas dimensões do TOD em uma amostra comunitária Brasileira composta de 2512 sujeitos. Através de análise fatorial confirmatória, demonstramos que o modelo que melhor representa a heterogeneidade do TOD é composto por três dimensões: a dimensão "argumentative/defiant" que está associada com transtorno de déficit de atenção/hiperatividade (TDAH); a dimensão "vindictiveness" que possui associação com transtorno de conduta (TC); e a dimensão "angry/irritable mood" onde predominam as associações com transtornos depressivos e de ansiedade. O objetivo seguinte foi investigar o papel da dimensão irritável na classificação nosológica dos transtornos mentais na infância e adolescência. A apresentação da irritabilidade é um aspecto crucial: irritabilidade crônica caracterizada por baixa tolerância à frustração e frequentes explosões de raiva, que é distinta da apresentação episódica, associada ao diagnóstico Transtorno de Humor Bipolar (TB). "Severe mood dysregulation", "disruptive mood dysregulation disorder", ou dimensão irritável do TOD são formas distintas de classificar o fenótipo de irritabilidade crônica. Entretanto, independente da classificação utilizada, a alta taxa de comorbidades é invariavelmente o denominador comum em estudos sobre irritabilidade. Neste sentido, examinamos o impacto da irritabilidade como uma dimensão subjacente a vários transtornos. Para tanto, avaliamos o...
The Oppositional Defiant Disorder (ODD) is defined as a pattern of disobedient, hostile and defiant behavior beginning in childhood or adolescence and often accompanied by a wide range of comorbidities. Longitudinal studies support ODD as a predictor of psychopathology in adulthood. A potential explanation for such heterogeneity of comorbidities and longitudinal trajectories is that ODD diagnosis encompasses distinct clusters of symptoms, each with its outcome. The first aim of this work was the validation of ODD dimensions in a Brazilian community sample of 2512 subjects. Confirmatory factorial analysis showed that the best model for ODD comprised three dimensions: an "argumentative/defiant" dimension, which associates with attention deficit/hyperactivity disorder (ADHD); a "vindictiveness" dimension, which associates with conduct disorder (CD); and an "angry/irritable" dimension where emotional disorders such as depression and anxiety are the most common associations. The next step was the investigation of the role of the irritable dimension of oppositionality in diagnostic classifications of childhood mental disorders. The pattern of irritability is a crucial point: its chronic presentation as easy annoyance and frequent temper outbursts should be differentiated from the episodic course of irritability associated with the specific diagnosis of Bipolar Disorder (BD). "Severe mood dysregulation", "disruptive mood dysregulation disorder", and the irritable dimension of oppositionality are different ways to classify the chronic irritability phenotype. However, regardless of the classification, the high rate of comorbidities is invariably the common denominator in studies of irritability. Therefore, we examined the impact of irritability as a dimension cutting across multiple settings: individuals without any diagnosis, subjects with ADHD, and also those with emotional disorders. For that we used two samples, one from Brazil, with 2.512 subjects, and one...
Subject(s)
Humans , Child , Adolescent , Affective Symptoms , Attention Deficit and Disruptive Behavior Disorders , Epidemiologic Studies , Irritable Mood , Mood Disorders , Comorbidity , Emotions , Multifactorial InheritanceABSTRACT
OBJECTIVES: We compared the clinical presentations of manic and depressive episodes and the treatment response among children and adolescents with bipolar disorder (BD) types I and II and BD not otherwise specified (NOS). METHODS: The sample consisted of 66 patients, aged between 6 and 18 years, who were admitted for BD to a 20-bed child and adolescent psychiatric ward in a university hospital located in Seoul, Korea. RESULTS: Patients with BD type I were more likely to have lower intelligence quotients and exhibit violent behaviors during manic episodes than patients with BD type II or BD NOS and to show better treatment responses during manic episodes than patients with BD NOS. Patients with BD NOS were more likely to have an irritable mood rather than a euphoric mood during the manic phase than patients with BD type I or II and to exhibit violent behaviors during the depressive phase and chronic course than patients with BD type II. CONCLUSION: Pediatric BD patients are heterogeneous with respect to their clinical characteristics. Implications for the usefulness of the current diagnostic subtype categories should be investigated in future studies.
Subject(s)
Adolescent , Child , Humans , Bipolar Disorder , Inpatients , Intelligence , Irritable Mood , Korea , SeoulABSTRACT
O atual reconhecimento de que os transtornos mentais são resultados de interações entre aspectos biológicos e ambientais que ocorrem ao longo do desenvolvimento baliza a relevância das apresentações clínicas durante a infância e adolescência. O presente artigo tem por objetivo prover uma atualização em transtornos de humor em crianças e adolescentes. Para tanto, abordaremos aspectos específicos de desenvolvimento nos transtornos de humor enfatizando como a identificação precoce e a terapêutica adequada podem potencialmente modificar alterações a longo prazo. O processo diagnóstico dos transtornos de humor em crianças e adolescentes possui peculiaridades próprias da idade que necessitam ser contempladas durante a avaliação. Isso é especialmente importante na diferenciação dos transtornos depressivos e do transtorno de humor bipolar, o que constitui hoje um dos focos de maior estudo na área. Em relação ao tratamento, hoje dispomos de inúmeros métodos terapêuticos, como a psicoeducação, a terapia de orientação psicodinâmica, a terapia cognitivo-comportamental e a terapia farmacológica, além da inclusão familiar como importante recurso na determinação do sucesso terapêutico. Uma escolha terapêutica acertada depende de um processo diagnóstico criterioso e visa proporcionar para a criança e o adolescente com transtorno de humor recursos para seu desenvolvimento pessoal e sua participação social na família e na escola.(AU)
The current recognition that mental disorders are the result of interactions between biological and environmental aspects that occur throughout development goal relevance of clinical presentations during childhood and adolescence. This article aims to provide an update on mood disorders in children and adolescents. To do so, we discuss specific aspects of the development of mood disorders emphasizing how early identification and appropriate therapy can potentially modify long-term changes. The diagnostic process of mood disorders in children and adolescents age has its own peculiarities that need to be addressed during the evaluation. This is especially important in the differentiation of depressive disorders and bipolar disorder, which is now a focus of further study in the area. Regarding treatment, we now have numerous therapeutic methods, such as psycho-education, psychodynamic orientation therapy, cognitive behavioural therapy and drug therapy, as well as family inclusion as an important feature in determining therapeutic success. A therapeutic right choice depends on a careful diagnostic process and aims to provide for the child and adolescent with mood disorder resources for personal development and social participation in family and school.(AU)
Subject(s)
Adolescent , Child Development , Depression , Irritable MoodABSTRACT
El propósito de este estudio fue comparar la frecuencia de alteraciones del estado de ánimo de los trabajadores masculinos y femeninos maduros. También se intentó demostrar la relación de los síntomas con algunos aspectos psicológicos como la autoestima de los voluntarios (AE), la satisfacción marital (SM) y las actitudes hacia la sexualidad (AHS). Materiales y métodos: En un diseño transversal, se determina la frecuencia de la depresión, la ansiedad, los síntomas no específicos de la depresión (SNED), MS, y los sentimientos de síndrome del nido vacío (SSNV) en 103 hombres y 129 mujeres de 40 a 64 años de edad. Depresión, los SNED y la ansiedad fueron evaluados según los criterios DSM-III-R calificados con la prueba de Bech-Rafaelsen Hamilton. La AE se evaluó con la prueba Coopersmith, AHS y SSNV con un cuestionario previamente validado y SM con la prueba de selección De Weiss. Las mujeres se dividieron en función de su último período menstrual en pre, peri y postmenopáusicas. Resultados: Los resultados demostraron que el SSNV fue más frecuente en mujeres que en varones (p = 0,03). Las mujeres perimenopáusicas tuvieron mayor frecuencia de depresión, ansiedad y SNED que los hombres y las mujeres pre y posmenopáusicas. La AE fue asociada positivamente con alteraciones del estado de ánimo en el trabajo masculino y femenino. En los hombres, la MS estuvo significativamente asociada con SSNV y con la depresión y los SNED en las mujeres perimenopáusicas. Conclusiones: Llegamos a la conclusión de que las alteraciones del estado de ánimo son más frecuentes en las mujeres que en los hombres maduros. También hemos demostrado que en las mujeres maduras una pobre AE podría ser un factor de riesgo para el desarrollo de problemas del estado de ánimo. En ambos, hombres maduros y mujeres posmenopáusicas, la MS juega un papel importante en la aparición de SSNV.
Objectives: The purpose of this study was to compare the frequencies of mood alterations of mature male and female workers. Also we aimed to demonstrate the relationship of symptoms with some psychological aspects such as volunteer's self-esteem (SE), marital satisfaction (MS) and attitudes toward sexuality (ATS). Materials and methods: In a cross-sectional design, we determine the frequencies of depression, anxiety, non-specific symptoms of depression (NSSD), MS, and the feelings of empty nest syndrome (FENS) in 103 males and 129 females from 40 to 64 years of age. Depression, NSSD and anxiety were evaluated according to DSMIII-R criteria and scored with the Hamilton Bech-Rafaelsen test. SE was evaluated with the Coopersmith test, ATS and FENS with a previously validated questionnaire, and MS with the Pick De Weiss test. Women were divided according to their last menstrual period in pre- peri- and postmenopausal. Results: The results demonstrated that FENS were more frequent in females than in males (p=0.03). Perimenopausal women had higher frequencies of depression, anxiety, and NSSD than males and pre- and postmenopausal females did. SE was positively associated with mood alterations in both male and female labors. In males, MS was significant associated with FENS; and with depression and NSSD in perimenopausal females. Conclusions: We concluded that mood alterations are more frequent in mature females than in males. Also we demonstrated that in mature females poor SE could be a risk factor to development mood problems. In both mature male and postmenopausal females, MS plays an important role in the appearance of FENS.
Subject(s)
Humans , Male , Female , Middle Aged , Reproduction , Sex Factors , Affect , Occupational Groups/psychology , Anxiety/epidemiology , Personal Satisfaction , Self Concept , Irritable Mood , Anthropometry , Surveys and Questionnaires , Risk Factors , Depression/epidemiologyABSTRACT
Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.
Subject(s)
Adolescent , Child , Humans , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Bipolar Disorder/diagnosis , Irritable Mood , Mood Disorders/diagnosis , Anger , Attention Deficit and Disruptive Behavior Disorders/therapy , Bipolar Disorder/therapy , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Irritable Mood/drug effects , Mood Disorders/therapy , Psychiatric Status Rating ScalesABSTRACT
Objective: To describe the cross-cultural adaptation of the Affective Reactivity Index (ARI) to Brazilian Portuguese and to investigate preliminary psychometric properties of the adapted version. Methods: Cross-cultural adaptation was based on the investigation of the theoretical and operational equivalences of the original ARI in the Brazilian context, followed by a process of translation, back-translation, and review by a committee of experts. Data analysis was carried out in a community sample of 133 schoolchildren aged 8 to 17 years to investigate the following characteristics of the ARI: 1) factor structure; 2) internal consistency; 3) construct validity comparing differential relationships between irritability and anxiety dimensions and impairment; and 4) item response theory (IRT) parameters. Results: A final Brazilian Portuguese version of the instrument was defined and is presented. Internal consistency was good, and our analysis supported the original single-factor structure of the ARI. Correlations of the ARI with distress-related anxiety dimensions were higher than with phobic-related anxiety dimensions, supporting its construct validity. In addition, higher ARI scores were associated with higher irritability-related impairment. IRT analysis underscored frequency of loss of temper as essential to inform about pathological states of irritability. Conclusion: The Brazilian Portuguese version of the ARI seems to be very similar to the original instrument in terms of conceptual, item, semantic, and operational equivalence. Our preliminary analysis replicates and extends previous evidence confirming promising psychometric properties for the ARI.
Objetivo: Descrever a adaptação transcultural do Affective Reactivity Index (ARI) para o português do Brasil e investigar propriedades psicométricas preliminares da versão adaptada. Método: A adaptação transcultural foi baseada na investigação das equivalências teórica e operacional da versão original do ARI no contexto brasileiro, seguida do processo de tradução, retrotradução e revisão por comitê de especialistas. A análise dos dados foi realizada em uma amostra comunitária de 133 escolares com idade entre 8 e 17 anos para investigar as seguintes características do ARI: 1) estrutura fatorial; 2) consistência interna; 3) validade do construto, comparando as relações diferenciais entre irritabilidade e as dimensões de ansiedade e prejuízo; e 4) parâmetros de teoria da resposta ao item (TRI). Resultados: Uma versão final em português do Brasil do instrumento foi definida e é apresentada. A consistência interna foi boa, e nossa análise confirmou a estrutura unifatorial original do ARI. As correlações do ARI com as dimensões de ansiedade relacionadas a sofrimento foram maiores do que com as dimensões de ansiedade relacionadas a fobias, reforçando a validade do construto. Além disso, escores mais altos no ARI foram associados a maior prejuízo relacionado à irritabilidade. A análise do TRI enfatizou a frequência de perda de controle como essencial para determinar estados patológicos de irritabilidade. Conclusão: A versão em português do Brasil do ARI parece ser muito semelhante ao instrumento original em termos de equivalência conceitual, de itens, semântica e operacional. Nossa análise preliminar reproduz e estende evidências anteriores que confirmam propriedades psicométricas promissoras para o ARI.
Subject(s)
Humans , Male , Female , Child , Adolescent , Irritable Mood/ethics , Psychometrics/standards , Mental Disorders/diagnosis , Anxiety/complications , Validation Studies as Topic , Psychometrics/methodsABSTRACT
O objetivo do estudo foi estimar a frequência e os fatores associados à ocorrência de eventos adversos pós-vacinação contra a influenza pandêmica A (H1N1) 2009 em crianças com idade entre seis meses e dois anos. Participaram do estudo 156 crianças. Modelos multivariados de regressão de Cox foram construídos para avaliar a associação independente de cada covariável e a queixa de pelo menos um evento adverso. A força da associação foi medida pela hazard ratio e seus respectivos intervalos de 95% de confiança. Após a primeira dose, foi relatado algum tipo de evento adverso por 40,3% dos participantes e, após a segunda, por 35,5%. Os eventos sistêmicos foram mais frequentes que os locais, destaque para irritabilidade, diarreia e febre. As incidências de eventos adversos, no geral e sistêmicos, após a primeira dose, foram maiores nas crianças com doença concomitante/alergia em relação àquelas sem o agravo (HR = 3,43; IC95%: 1,34-8,77 e HR = 2,76; IC95%: 1,11-6,89). A maioria dos eventos foi de intensidade leve. Febre alta, vômito e diarreia motivaram a busca por serviços de saúde.
The aim of this study was to estimate the frequency of adverse events following vaccination against pandemic influenza A (H1N1) 2009 and associated factors in children from six months to two years of age (n = 156). Multivariate Cox regression was used to assess the independent associations between covariates and complaints of at least one adverse event. Strength of association was measured by hazard ratios and respective 95% confidence intervals. Following the first dose, 40.3% of parents reported one or more adverse events in their children, compared to 35.5% after the second dose. Systemic adverse events, specifically irritation, diarrhea, and fever, were more frequent than local reactions at the vaccination site. Incidence rates for adverse events in general and systemic reactions following the first dose were higher in children with concomitant illness or allergies (HR = 3.43, 95%CI: 1.34-8.77 and HR = 2.76, 95%CI: 1.11-6.89). Most events were mild. Cases of high fever, vomiting, and diarrhea prompted parents to seek care for their children at health services.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Influenza A Virus, H1N1 Subtype/immunology , Influenza Vaccines/adverse effects , Influenza, Human/prevention & control , Age Distribution , Adverse Drug Reaction Reporting Systems/statistics & numerical data , Brazil/epidemiology , Diarrhea/etiology , Epidemiologic Methods , Fever/chemically induced , Irritable Mood , Influenza Vaccines/administration & dosage , Influenza, Human/epidemiology , Influenza, Human/immunology , Pandemics , Sex Distribution , Third-Party ConsentABSTRACT
Scurvy is a condition caused by a lack of vitamin C [ascorbic acid] in the diet. It is extremely rare in industrialized societies but still exists in higher risk groups including economically disadvantaged populations with poor nutrition. We are reporting a case of 4 year old Asad who presented to our department with this condition
Subject(s)
Humans , Male , Ascorbic Acid Deficiency/complications , Malnutrition , Pallor/etiology , Irritable Mood , Gingival Hemorrhage , FeverABSTRACT
Objetivo Avaliar a autopercepcão do estado de saúde de adolescentes em confronto com a lei, obter informações relativas ao relacionamento desses adolescentes e a instituição destinada a oferecer atividades socioeducacionais e propor urna intervenção de reintegração social. Métodos Estudo qualiquantitativo incluindo um estudo transversal e uma observação de processo entre fevereiro e julho de 2006 com 51 adolescentes em confronto com a lei, atendidos no Centro de Desenvolvimento Social de Ceilándia (CDSC), Distrito Federal, Brasil. Jovens de 14 a 19 anos completaram questionários auto-respondíveis contendo variáveis sócio-demográficas e variáveis referentes ao estado de saúde. Durante a coleta de dados foram feitas observações sobre a opinião dos profissionais, dos pais e dos adolescentes, utilizando-se um diário de campo a fim de entedendermos a relação entre instituição, cuidadores e usuários do referido Centro. Resultados 78,4 por cento dos entrevistados referiram estado de saúde muito bom ou bom. No entanto, 70,6 por cento dos jovens referiram algum agravo á saúde. Irritabilidade fácil foi o agravo mais referido (25,5 por cento), seguido por problemas para dormir (19,6 por cento), dificuldade de concentração (13,7 por cento) e alergia (13,7 por cento). Os dados qualitativos sugeriram possível desconfiança mutua entre usuários e profissionais do CDSC e os adolescentes nele atendidos. Conclusão Os resultados sugerem alta prevalência de sintomas de depressão. É possível que a irritabilidade fácil esteja relacionada á delinqüência na amostra, no entanto, essa relação não foi investigada, merecendo pesquisas futuras para subsidiar políticas públicas em países da América Latina, onde a violência juvenil tornou-se um problema de saúde pública.
Objective Evaluating self-perception regarding health status in adolescents released on parole and observing the attitudes of professionals, parents or guardians and the adolescents themselves. Methods This was quali-quantitative research lasting from February to July 2006 which included a cross-sectional and observational study using a sample of 51 adolescents in conflict with the law who had been released on parole and who were attending a Social Development Centre in Ceilândia (SDCC), Distrito Federal, Brazil. Adolescents aged 14 to 19 completed self-administered questionnaires covering sociodemographic and health status-related variables. Process observation was also conducted so as to obtain qualitative information concerned with the relationship between adolescents and the professionals in charge to provide socio-educational measures in the aforementioned Centre. Results It was found that 78.4 percent of the interviewees mentioned good or very good health status; however, 76.6 percent of the sample mentioned at least one health problem. Becoming easily irritated (anger) was the most referred to health problem, followed by sleeping problems (19.6 percent), poor concentration (13.7 percent) and allergy (13.7 percent). Observation suggested that adolescents and parents had a poor relationship with the professionals in charge of caring for them. Conclusion The results suggested a high prevalence for symptoms of depression. Easy irritability may have been related to delinquency in the sample; however, such association was not investigated and deserves future research to develop appropriate public policy in Brazil and other Latin-American countries as violence becomes a public health problem in the region.
Objetivo Evaluar la percepción del estado de salud de los adolescentes en conflicto con la ley, la información relativa a la relación de estos adolescentes con la institución diseñada para ofrecer actividades socio-educativas, y proponer una intervención para su reintegración social. Métodos Estudio cuali-cuantitativo incluyendo un estudio de corte transversal y la observación de un proceso entre febrero y julio de 2006 con 51 adolescentes en conflicto con la ley, al que asistieron el Centro de Desarrollo Social Ceilândia, Distrito Federal, Brasil. Jóvenes de 14 a 19 años completaron los cuestionarios que contienen las variables socio-demográficas de auto-respuesta y las variables relacionadas con el estado de salud. Durante la recolección de datos, se hicieron observaciones sobre la opinión de los profesionales, padres y adolescentes, utilizando un diario para entender la relación entre las instituciones, los médicos y los usuarios del Centro. Resultados Aproximadamente el 78,4 por ciento de los encuestados informó un estado de salud muy buena o buena. Sin embargo, cuando se le preguntó acerca de las enfermedades específicas, el 70,6 por ciento de los jóvenes reportaron algunos daños a la salud. Irritabilidad fácil fue la afección más frecuentemente mencionada (25,5 por ciento), seguido de los problemas del sueño (19,6 por ciento), dificultad para concentrarse (13,7 por ciento) y alergia (13,7 por ciento). Los datos cualitativos sugieren desconfianza recíproca entre los usuarios y profesionales del Centro de Desarrollo Social y los adolescentes tratados en él. Conclusión Los resultados sugieren una alta prevalencia de síntomas depresivos. Es posible que la irritabilidad fácil esté relacionada con la delincuencia en la muestra, sin embargo, esta relación no se ha investigado y merece más investigación para apoyar las políticas públicas en Brasil y otros países de América Latina, donde la violencia juvenil se ha convertido en un problema de salud pública.
Subject(s)
Adolescent , Female , Humans , Male , Young Adult , Psychology, Adolescent , Attitude , Depression , Health Status , Juvenile Delinquency/psychology , Self Concept , Brazil , Cross-Sectional Studies , Interpersonal Relations , Irritable Mood , Surveys and Questionnaires , Social Class , Socioeconomic FactorsABSTRACT
Objetivo: Demostrar la influencia sobre las molestias emocionales y físicas (beneficios no anticonceptivos) experimentadas durante el primer año de uso de un anticonceptivo oral combinado (AOC) que contiene 0,02 mg de etinilestradiol (EE) y 2 mg de acetato de clormadinona (ACM) administrado en un régimen de 24 + 4 días de placebo. Diseño del estudio: Análisis adicional de las sensaciones subjetivas registradas en los diarios de 1665 participantes de un estudio de Fase III multicéntrico, no controlado, de administración múltiple, después de 13 ciclos de EE/ACM en un régimen de administración de 24 + 4 días, publicado previamente. Resultados: Se informó de menor frecuencia de molestias emocionales y físicas en el ciclo de medicación 13 en comparación con los datos en la admisión y en el ciclo 1. La incidencia de ánimo depresivo se redujo en 84,5 por ciento y 72,2 por ciento respectivamente, y la irritabilidad en 87,3 por ciento y 66,0 por ciento. Las cefaleas se redujeron en 75,5 por ciento y 74,7 por ciento, las molestias mamarias en 77,1 por ciento y 66,1 por ciento, y la dismenorrea preexistente en 77,9 por ciento y 67,6 por ciento respectivamente. El abandono prematuro del estudio a causa de las molestias fue marginal, y el perfil del sangrado fue aceptable. Conclusiones: Un AOC de baja dosis que contiene 0,02 mg de EE + 2 mg de ACM, administrado en un régimen de 24 + 4 días, reduce significativamente la mayor parte de las molestias emocionales y físicas que se presentan durante los ciclos espontáneos de las mujeres, y se combina con un adecuado perfil de sangrado.
Objective: To demonstrate the influence on physical and psychological complaints during the first year of intake of the combined oral contraceptive (COC) 0.02 mg ethinylestradiol (EE)/2 mg chlormadinone acetate (CMA), administered in a regimen of 24 days of CMA/EE intake followed by 4 days of placebo intake. Study design: The subjective feelings of non-contraceptive benefits registered in women's diaries of 1,665 subjects participating in a multicentre, uncontrolled, multiadministration, Phase III trial, published elsewhere, were analyzed post-hoc after 13 cycles intake of EE/CMA in a 24 +4 days intake regimen. Results: Emotional complaints were reported less frequently at medication cycle 13 compared with admission and cycle 1. Depressive mood was reduced by 84.5 percent and 72.2 percent, irritability by 87.3 percent and 66.0 percent; physical complaints were also reduced: headaches by 75.5 percent and 74.7 percent, breast discomfort by 77.1 percent and 66.1 percent; pre-existing dysmenorrhea by 77.9 percent and 67.6 percent. Premature termination due to complaints was only marginal, the bleeding profile was accepted. Conclusions: The low-dose COC, 0.02 mg EE/2 mg CMA, administered in a 24 +4 day regimen, reduces significantly most of the emotional and physical complaints occurring during spontaneous cycles of women, combined with an adequate bleeding profile.
Subject(s)
Humans , Adolescent , Adult , Female , Chlormadinone Acetate/administration & dosage , Contraceptives, Oral, Combined/administration & dosage , Menstrual Cycle , Ethinyl Estradiol/administration & dosage , Headache/prevention & control , Dose-Response Relationship, Drug , Depression/prevention & control , Dysmenorrhea/prevention & control , Fatigue/prevention & control , Irritable Mood , Uterine Hemorrhage/prevention & control , Multicenter Studies as Topic , Placebos , Menstruation Disturbances/prevention & controlABSTRACT
OBJECTIVE: Despite the relevance of irritability emotions to the treatment, prognosis and classification of psychiatric disorders, the neurobiological basis of this emotional state has been rarely investigated to date. We assessed the brain circuitry underlying personal script-driven irritability in healthy subjects (n = 11) using functional magnetic resonance imaging. METHOD: Blood oxygen level-dependent signal changes were recorded during auditory presentation of personal scripts of irritability in contrast to scripts of happiness or neutral emotional content. Self-rated emotional measurements and skin conductance recordings were also obtained. Images were acquired using a 1,5T magnetic resonance scanner. Brain activation maps were constructed from individual images, and between-condition differences in the mean power of experimental response were identified by using cluster-wise nonparametric tests. RESULTS: Compared to neutral scripts, increased blood oxygen level-dependent signal during irritability scripts was detected in the left subgenual anterior cingulate cortex, and in the left medial, anterolateral and posterolateral dorsal prefrontal cortex (cluster-wise p-value < 0.05). While the involvement of the subgenual cingulate and dorsal anterolateral prefrontal cortices was unique to the irritability state, increased blood oxygen level-dependent signal in dorsomedial and dorsal posterolateral prefrontal regions were also present during happiness induction. CONCLUSION: Irritability induction is associated with functional changes in a limited set of brain regions previously implicated in the mediation of emotional states. Changes in prefrontal and cingulate areas may be related to effortful cognitive control aspects that gain salience during the emergence of irritability.
OBJETIVO: Apesar da relevância de emoções de irritabilidade para o tratamento, prognóstico e classificação dos transtornos psiquiátricos, as bases neurobiológicas deste tipo de estado emocional foram raramente investigadas até hoje. Este estudo avaliou os circuitos cerebrais subjacentes à irritabilidade induzida por scripts pessoais em voluntários saudáveis (n = 11) usando ressonância magnética funcional. MÉTODO: Mudanças no sinal dependente do nível de oxigenação sanguínea (blood-oxygen level dependent signal) foram registradas durante a apresentação por via auditiva de scripts pessoais de irritabilidade em contraste com scripts de felicidade ou de conteúdo emocional neutro. Escores em escalas de autoavaliação emocional e medidas de condutância da pele também foram obtidos. A aquisição de imagens foi realizada em aparelho de ressonância magnética de 1,5 T. Os mapas de ativação cerebral foram construídos a partir das imagens individuais, e as diferenças entre as condições experimentais foram investigadas utilizando testes não-paramétricos baseados em permutações. RESULTADOS: Em comparação com scripts neutros, a apresentação de scripts de irritabilidade levou a aumentos de sinal dependente do nível de oxigenação sanguínea na porção subgenual do giro do cíngulo anterior esquerdo e nas porções medial, ântero-lateral e póstero-lateral do córtex pré-frontal dorsal (cluster-wise p-valor < 0,05). Enquanto o envolvimento do cíngulo anterior subgenual e do córtex pré-frontal dorsal antero-lateral surgiu apenas em associação com o estado de irritabilidade, aumentos do sinal dependente do nível de oxigenação sanguínea nas porções dorso-medial e dorsal póstero-lateral do córtex pré-frontal também estiveram presentes durante indução de felicidade. CONCLUSÃO: Indução de irritabilidade está associada a mudanças de atividade funcional num conjunto restrito de regiões cerebrais previamente implicadas na mediação de estados emocionais. Mudanças na atividade...