La relación entre la transición a la menopausia y los trastornos del estado de ánimo / The relationship between menopause transition and mood disorders

Este estudio tuvo como objetivo examinar la relación entre la transición a la menopausia y los trastornos del estado de ánimo, específicamente la ansiedad y la depresión. Se llevó a cabo una revisión narrativa de la literatura relevante sobre la transición a la menopausia y los trastornos del estado de ánimo. Se revisaron estudios que se enfocaron en el impacto de los cambios hormonales durante la menopausia en el bienestar psicológico y se evaluaron diversas opciones de tratamiento para los trastornos del estado de ánimo. La disminución de los niveles hormonales de estrógenos y progesterona durante la menopausia puede llevar a diversos cambios psicológicos, como ansiedad y depresión. La terapia hormonal con estrógenos solo o en combinación con progesterona puede mejorar los síntomas depresivos en mujeres en la menopausia, pero este tratamiento no está exento de riesgos. Otros tratamientos no hormonales, como la terapia cognitivo-conductual, el ejercicio y una buena higiene del sueño, también pueden ser efectivos para manejar los trastornos del estado de ánimo. Se concluyó que existe una compleja interacción entre factores hormonales, biológicos y psicosociales para desarrollar intervenciones efectivas que mejoren el bienestar psicológico de las mujeres en la menopausia.

This study aimed to examine the relationship between menopause transition and mood disorders, specifically anxiety and depression. The authors conducted a narrative review of relevant literature on menopause transition and mood disorders. They reviewed studies that focused on the impact of hormonal changes during menopause on psychological well-being and evaluated various treatment options for mood disorders. The decline in estrogen and progesterone hormone levels during menopause can lead to various psychological changes, such as anxiety and depression. Hormonal therapy with estrogen alone or in combination with progesterone can improve depressive symptoms in menopausal women, but this treatment is not without risks. Other non-hormonal treatments, such as cognitive-behavioral therapy, exercise, and good sleep hygiene, can also be effective in managing mood disorders. The study highlights the need for recognition of the complex interplay between hormonal, biological, and psychosocial factors in developing effective interventions to improve the psychological well-being of menopausal women. Further research is needed to fully understand the potential relationship between menopause transition and mood disorders.

Perfis de jogo de crianças: adaptação do Children's Play Therapy Instrument (CPTI) / Play profiles of children: adaptation of the Children's Play Therapy Instrument (CPTI) / Perfiles de juego de niños: adaptación del Children's Play Therapy Instrument (CPTI)

O brincar e a vida infantil estão inevitavelmente entrelaçados, havendo inúmeras evidências da ação terapêutica do brinquedo para o desenvolvimento infantil e, consequentemente, para o desenrolar da Psicoterapia Psicodinâmica (PP). Para acessar o brincar de crianças de maneira objetiva durante o percurso da PP, foi desenvolvido o Children's Play Therapy Instrument (CPTI). O objetivo desse estudo foi adaptar para o português o CPTI, assim como realizar um estudo piloto para identificar evidências de validade do instrumento, através da análise de perfis de jogo de psicoterapias de três crianças, uma menina e dois meninos, com oito, sete e oito anos, diagnosticados com transtorno de adaptação, transtorno disruptivo da desregulação do humor e transtorno do espectro autista, nível 1, respectivamente. A versão em português do CPTI apresentou boa equivalência com a original e a fidedignidade interavaliadores foi alta, além de serem encontradas evidências preliminares de validade. O instrumento foi capaz de diferenciar os perfis de jogo de cada criança, descrevendo atividades de jogo condizentes com as psicopatologias analisadas. As possibilidades e limitações de utilização do instrumento foram discutidas. (AU)

Play and childhood are inevitably intertwined, with numerous indications of the therapeutic effects of play on child development and, consequently, on the progress of Psychodynamic Psychotherapy (PP). To access children's play during the course of PP, the Children's Play Therapy Instrument (CPTI) was developed. The aim of this study was to adapt the CPTI to Portuguese and to conduct a pilot study to identify validity evidence for the instrument through the analysis of play profiles of psychotherapies involving three children: one girl and two boys, aged eight, seven, and eight, respectively. They were diagnosed with adjustment disorder, disruptive mood dysregulation disorder, and autism spectrum disorder level 1. The Portuguese version of the CPTI showed good equivalence to the original, inter-rater reliability was high, and preliminary evidence of validity was found. The instrument was able to differentiate each child's play profiles, describing play activities consistent with the psychopathologies analyzed. The instrument's possibilities and limitations were discussed. (AU)

El juego y la vida de los niños están inevitablemente entrelazados, con numerosas evidencias de la acción terapéutica del juguete para el desarrollo infantil y, en consecuencia, para el desarrollo de la Psicoterapia Psicodinámica (PP). Para acceder de forma objetiva al juego infantil durante el transcurso de la PP, se desarrolló el Instrumento de Terapia de Juego Infantil (CPTI). El objetivo de este estudio fue adaptar el CPTI al portugués, así como realizar un estudio piloto para identificar evidencias de validez del instrumento, a través del análisis de perfiles de juego de tres psicoterapias con tres niños, se incluye una niña y dos niños de ocho, siete y ocho años, diagnosticados con trastorno de adaptación, trastorno de desregulación disruptiva del estado de ánimo y trastorno del espectro autista, nivel 1, respectivamente. El CPTI mostró una buena equivalencia con el original y la confiabilidad entre evaluadores fue alta. El instrumento logró diferenciar los perfiles de juego de cada niño, describiendo actividades de juego consistentes con las psicopatologías analizadas. Se discutieron las posibilidades y limitaciones del uso del instrumento. (AU)

Avaliação da relação entre eventos traumáticos infantis e comportamentos autolesivos em adolescentes / Evaluation of the relationship between childhood traumatic events and self-injurious behavior in adolescents / Evaluación de la relación entre eventos traumáticos infantiles y comportamiento autolesivo en adolescentes

Esta pesquisa teve como objetivo verificar a relação entre eventos traumáticos (ET) na infância e a ocorrência de comportamentos autolesivos em adolescentes. Os instrumentos utilizados foram o Questionário sobre Traumas na Infância (QUESI) e o Inventário de Autolesão Deliberada - reduzido (IAD-r). Participaram 494 estudantes do ensino médio de ambos os sexos e idade entre 15 e 18 anos (M = 16,4). Destes, 58,5% afirmaram ter sofrido abuso emocional de forma recorrente e 19,0% e 59,5% assumiram já ter sofrido abuso sexual e físico, respectivamente. Quanto à prática de autolesão, 65,0% revelaram já ter se engajado em comportamentos autolesivos. De acordo com a análise de Regressão Logística Binomial, todos os tipos de ET exibiram associação significativa com a prática de comportamentos autolesivos. A análise de moderação a respeito da interação entre a ocorrência de ET infantis e a prática de autolesão revelou ausência de moderação pelo sexo e pela idade. Porém, quanto ao abuso físico, o efeito de moderação da idade apresentou significância estatística limítrofe e indicou que os adolescentes mais novos, de 15 e 16 anos, que sofreram este tipo de abuso na infância, foram mais susceptíveis à prática autolesiva. Portanto, as altas taxas de ET e de autolesão encontradas nesta pesquisa revelam a gravidade do problema. Espera-se que esta investigação possa contribuir para a elaboração de intervenções para prevenção e controle dos fatores de risco que acometem a população infanto-juvenil.(AU)

This research aimed to verify the relationship between traumatic events (TE) in childhood and the occurrence of self-injurious behavior in adolescents. The instruments used were the Childhood Trauma Questionnaire (QUESI) and the Deliberate Self-Injury Inventory - reduced (IAD-r). The sample was composed of 494 high school students of both genders and aged between 15 and 18 years old (M = 16.4). Of those, 58.5% declared to have suffered recurring emotional abuse and 19.0% declared to have suffered sexual abuse and 59.5% physical abuse. Regarding the practice of self-harm, 65.0% reported having already engaged in self-injurious behaviors. According to the Binomial Logistic Regression analysis, all types of TE were associated with the practice of self-injurious behaviors. The moderation analysis between the occurrence of childhood TE and self-injury showed no moderation by sex or age. However, regarding physical abuse, the moderating effect of age showed borderline statistical significance and indicated that younger adolescents, 15 and 16 years old, who suffered this type of abuse in childhood, were more susceptible to self-injurious behavior. Therefore, the high rates of TE and self-injury found in this research reveal the seriousness of the problem. It is hoped for this investigation to contribute to the development of interventions to prevent and control risk factors that affect children and adolescents.(AU)

Esta investigación tuvo como objetivo verificar la relación entre eventos traumáticos (ET) en la infancia y la ocurrencia de conductas autolesivas en adolescentes. Los instrumentos utilizados fueron el Cuestionario de Trauma Infantil (QUESI) y el Inventario de Autolesiones Deliberadas -reducido (IAD-r). Participaron 494 estudiantes de la secundaria, de ambos sexos y con edades entre 15 y 18 años (M = 16,4). De estos, el 58,5% afirmaron haber sufrido maltrato emocional de forma recurrente, el 19,0% dijeron haber sufrido maltrato sexual y el 59,5%, maltrato físico. En cuanto a la práctica de la autolesión, el 65,0% informaron haber realizado conductas autolesivas. El análisis de Regresión Logística Binomial mostró que todos los tipos de ET tuvieron una asociación significativa con la práctica de conductas autolesivas. El análisis de la moderación respecto a la interacción entre la ocurrencia de ET infantil y la práctica de la autolesión reveló una ausencia de moderación por sexo o edad. En cuanto al maltrato físico, el efecto moderador de la edad mostró una significación estadística marginal e indicó que los adolescentes más jóvenes, de 15 y 16 años, que sufrieron este tipo de maltrato en la infancia, son más susceptibles a la práctica de autolesiones. Por lo tanto, las altas tasas de ET y autolesiones encontradas en esta investigación revelan la gravedad del problema. Se espera que esta investigación contribuya con el desarrollo de intervenciones para la prevención y control de los factores de riesgo que afectan a niños y adolescentes.(AU)

Trastorno por Déficit de Atención e Hiperactividad (TDHA) y trastornos del estado del ánimo en estudiantes de medicina humana peruanos: una prueba piloto a nivel nacional / Attention Deficit Hyperactivity Disorder (ADHD) and mood disorders in Peruvian human medicine students: a nationwide pilot test

Introducción: el Trastorno por Déficit de Atención con Hiperactividad, también conocido por sus siglas TDAH, es considerado como un trastorno del neurodesarrollo. Diversos estudios reportan que la persistencia de los síntomas durante la adultez se da en el 50-70% de niños con TDAH. Respecto del área académica, la literatura menciona que esta patología en la población universitaria oscila entre un 10 a 25% de estudiantes, en particular los de Medicina Humana. Materiales y métodos: estudio piloto con diseño Cross-sectional, para explorar las variables mencionadas en los estudiantes de todo el territorio peruano se agruparon los departamentos en cinco macro regiones, se utilizaron los cuestionarios ASRS V1.1 y DASS-21. Resultados: se contó muestra total de 250 participantes para la prueba piloto (50 por cada macro región), respecto del TDAH, 33,6% presentó resultados sugestivos. La prevalencia de trastornos del estado anímico fue del 81,6%, dentro de ellos la ansiedad fue más prevalente (70,4%), seguido por la depresión (62,8%) y el estrés (57,6%). Se encontró asociación entre el TDAH y los siguientes: trastorno anímico (PR=1,3 IC(95%) ), depresión (PR=1,51 IC(95%) ), ansiedad (PR=1,47 IC(95%) ) y estrés (PR=1,87 IC(95%) ). Conclusiones: el presente estudio piloto nos ha permitido probar satisfactoriamente el desempeño del instrumento y la técnica propuesta por el diseño metodológico en el estudio primario, confirmado con la obtención de cifras estimadas coherentes con lo descrito por la literatura, y confirmando la asociación entre las variables de interés.

Introduction: Attention Deficit Hyperactivity Disorder, also known by its acronym ADHD, is considered a neurodevelopmental disorder. Several studies report that the persistence of symptoms during adulthood occurs in 50-70% of children with ADHD. Regarding the academic area, the literature mentions that this pathology in the university population ranges from 10 to 25% of students, in particular those of human medicine. Materials and methods: pilot study with Cross-sectional design, to explore the variables mentioned in students from all over the Peruvian territory, the departments were grouped into 5 macro regions, the ASRS V1.1 and DASS-21 questionnaires were used. Results: a total sample of 250 participants was counted for the pilot test (50 for each macro region), regarding ADHD, 33.6% presented suggestive results. The prevalence of mood disorders was 81.6%, among them, anxiety was more prevalent (70.4%), followed by depression (62.8%) and stress (57.6%). An association was found between ADHD and the following: Mood disorder (PR=1.3 CI (95%) ). Depression (PR=1.51 CI (95%) ). Anxiety (PR=1.47 CI (95%) ). and Stress (PR=1.87 CI (95%) ). Conclusions: the present pilot study has allowed us to satisfactorily test the performance of the instrument and the technique proposed by the methodological design in the primary study, confirmed by obtaining estimated figures consistent with what is described in the literature, and confirming the association between the variables of interest.

Estados afectivos de adolescentes gestantes al asistir al control prenatal en una institución de primer nivel de atención / Affective States of Adolescent Pregnant Women Who Attended Prenatal Control in a First-Level Care Institution

Introducción: El embarazo perturba a las adolescentes en diferentes grados, tanto emocionales como psicosociales. El control prenatal ha sido reconocido como una estrategia para reducir la morbilidad y mortalidad materno perinatal. Aún más importante es conseguir que las adolescentes embarazadas acudan a los servicios y tengan buenas experiencias, para que asuman conductas saludables. Objetivo: Describir estados afectivos de las adolescentes gestantes en el momento que asisten al control prenatal en una institución de primer nivel de atención, en el municipio Malambo, departamento del Atlántico. Métodos: Estudio cualitativo, descriptivo y exploratorio. Se realizaron entrevistas semiestructuradas, además se creó un grupo focal de 15 adolescentes. La información fue transcrita para luego proceder al análisis de los datos. Se establecieron los códigos en categorías que emergieron de lo expresado por las gestantes sobre su experiencia en el control prenatal. Resultados: Algunas gestantes asistían al control prenatal puesto que encontraban apoyo, confianza, información, conocimiento y recomendaciones; describieron agrado al poder decir lo que piensan y sienten, además de esclarecer dudas sobre su gestación. Conclusiones: Las gestantes adolescentes al momento de asistir al control prenatal experimentaron una serie de sentimientos, pensamientos y emociones (pena, miedo, incertidumbre y desagrado); además, reconocieron el control prenatal como un elemento valioso para lograr el bienestar propio y el de su hijo, emergiendo sentimientos de felicidad y responsabilidad(AU)

Introduction: Pregnancy affects adolescents at different degrees, both emotionally and psychosocially. Prenatal care has been recognized as a strategy for reducing maternal and perinatal morbidity and mortality. Even more important is to achieve that pregnant adolescents attend services and have good experiences, in order for them to assume healthy behaviors. Objective: To describe the affective states of pregnant adolescents at the time they attend prenatal care in a first-level care institution from Malambo Municipality, Atlántico Department, Colombia. Methods: Qualitative, descriptive and exploratory study. Semistructured interviews were conducted and a focus group of fifteen adolescents was created. The information was transcribed, and then data analysis was carried out. The codes were established according to categories that emerged from what was expressed by the pregnant women about their prenatal care experience. Results: Some pregnant women attended prenatal control since they found support, confidence, information, knowledge and recommendations; they described pleasure in being able to express what they think and feel, in addition to clarifying doubts about their pregnancy. Conclusions: Adolescent pregnant women, at the time of attending prenatal control, experienced a series of feelings, thoughts and emotions (grief, fear, uncertainty and displeasure); in addition, they recognized prenatal control as a valuable element to achieve their own and their child's wellbeing, with emerging feelings of happiness and responsibility(AU)

Diagnóstico de enfermería del estado emocional en pacientes con insuficiencia renal crónica durante su tratamiento / Nursing diagnosis of the emotional state in patients with chronic renal insufficiency during their treatment

La insuficiencia renal crónica (IRC) provoca cambios bruscos en la vida del individuo, como el desarrollo de trastornos emocionales que pueden conllevar a cuadros de ansiedad, depresión y estrés; afectando su estado emocional. Objetivo: Validar los instrumentos para analizar la influencia de la hemodiálisis en el estado emocional. Materiales y métodos: La investigación fue de diseño transversal con análisis descriptivo no experimental, modalidad cuali-cuantitativo. Los instrumentos utilizados fueron diseñados y validados por juicio de expertos y analizados estadísticamente con alfa de Cronbach, se empleó una prueba piloto compuesta por 15 personas con insuficiencia renal crónica para la validación de los instrumentos. Resultados: El instrumento cuantitativo presentó un coeficiente de fiabilidad de 0.75 en alfa de Cronbach y el instrumento cualitativo de acuerdo a la rúbrica de los expertos obtuvo un promedio de confiabilidad de 96; por lo que los instrumentos son aprobados y pueden aplicarse con resultados confiables. Conclusión: Los instrumentos tienen una validez, pertinencia y coherencia, adecuados para trabajar en la recolección de datos para determinar el estado emocional de los pacientes sometidos a hemodiálisis. El estudio estableció las asociaciones entre las variables de acuerdo a las etapas de la enfermedad será la predisposición a trastornos del estado de ánimo. Los resultados obtenidos validan la utilidad científica y la efectividad de los instrumentos diseñado(AU)

Chronic renal failure (CRF) causes sudden changes in the individual's life, such as the development of emotional disorders that can lead to anxiety, depression and stress; affecting your emotional state. Objective: To validate the instruments to analyze the influence of hemodialysis on the emotional state. Materials and methods: The research was of a cross-sectional design with non-experimental descriptive analysis, qualitative-quantitative modality. The instruments used were designed and validated by expert judgment and statistically analyzed with Cronbach's alpha. A pilot test consisting of 15 people with chronic renal failure was used to validate the instruments. Results: The quantitative instrument presented a reliability coefficient of 0.75 in Cronbach's alpha and the qualitative instrument, according to the experts' rubric, obtained a reliability average of 96; so the instruments are approved and can be applied with reliable results. Conclusion: The instruments have validity, relevance and coherence, adequate to work on data collection to determine the emotional state of patients undergoing hemodialysis. The study established the associations between the variables according to the stages of the disease will be the predisposition to mood disorders. The results obtained validate the scientific usefulness and effectiveness of the instruments designed(AU)

Validación de instrumentos para evaluar la calidad de vida del adulto mayor con insuficiencia renal crónica / Validation of instruments to assess the quality of life of the elderly with chronic renal insufficiency

La insuficiencia renal crónica afecta a toda una población adulta e influye en su calidad de vida. En el Ecuador se reporta que más del 65% de pacientes con hipertensión y diabetes progresan con insuficiencia renal. Objetivo: Validar los instrumentos para evaluar la influencia de la hemodiálisis en la calidad de vida del adulto mayor con insuficiencia renal crónica, Unidad Dialysis Center. Materiales y métodos: La investigación tuvo un enfoque cuali-cuantitativo, diseño no experimental, descriptivo de corte transversal. Se realizó una prueba piloto con los instrumentos a validarse en una muestra conformada por 15 adultos mayores que se encuentran en tratamiento sustitutivo de hemodiálisis. Resultados: El instrumento cuantitativo o encuesta obtuvo un coeficiente de confiabilidad (Alfa de Cronbach) de 0.80 y la entrevista o instrumento cualitativo, una puntuación de 95 según la rúbrica de los expertos, por lo que los instrumentos fueron aprobados y es confiable su aplicación para responder a los objetivos planteados en la investigación. Conclusiones: Con los resultados obtenidos por el plan piloto realizado, se identifica una influencia considerable de la insuficiencia renal crónica en la calidad de vida, comprende repercusiones a nivel emocional desarrollando depresión. Los datos obtenidos validan la efectividad de los instrumentos para el estudio(AU)

Chronic renal failure affects an entire adult population and influences their quality of life. In Ecuador it is reported that more than 65% of patients with hypertension and diabetes progress to kidney failure. Objective: To validate the instruments to evaluate the influence of hemodialysis on the quality of life of the elderly with chronic renal failure, Dialysis Center Unit. Materials and methods: The research had a qualitative-quantitative approach, non-experimental, descriptive cross-sectional design. A pilot test was carried out with the instruments to be validated in a sample made up of 15 older adults who are on hemodialysis replacement therapy. Results: The quantitative instrument or survey obtained a reliability coefficient (Cronbach's Alpha) of 0.80 and the interview or qualitative instrument, a score of 95 according to the experts' rubric, so the instruments were approved and their application is reliable for respond to the objectives set out in the research. Conclusions: With the results obtained by the pilot plan carried out, a considerable influence of chronic renal failure on quality of life is identified, including repercussions at an emotional level, developing depression. The data obtained validate the effectiveness of the instruments for the study(AU)

Contemporary prevalence and predictors of anxiety among patients living with HIVAIDS in Ghana

Objectives: To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana. Design: The study employed a cross-sectional design. Setting: The study was conducted in the outpatient HIV clinic of a tertiary hospital. Participants: Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study. Interventions: Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors. Main outcome measure: Proportion of PLWHA who had HADS score of ≥8 Results: Overall prevalence of anxiety was 61.0% (95%CI: 56.6 ­ 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 ­ 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 ­ 2.38) and depression (aOR: 13.62, 95%CI: 7.91 ­ 23.45) were independently associated with anxiety. Conclusion: In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety

Differences in non-suicidal self-injury behaviors between only-child and non-only-child adolescents with mood disorders: a cross-sectional study / 中国当代儿科杂志

OBJECTIVES@#To investigate the differences in non-suicidal self-injury (NSSI) behaviors between only-child and non-only-child adolescents with mood disorders.@*METHODS@#A three-stage sampling method was used to perform a cross-sectional survey of 529 adolescents, aged 12-18 years, who had mood disorders and NSSI behaviors. These adolescents were sampled from the outpatient service of 20 mental hospitals in 9 provinces of China from August to November 2020. A self-made questionnaire was used to collect general demographic data. The Functional Assessment of Self-Mutilation, Beck Scale for Suicide Ideation, Kessler Psychological Distress Scale, Stress Mindset Measure-General, Multidimensional Scale of Perceived Social Support, Multidimensional Students' Life Satisfaction Scales, and Rosenberg Self-Esteem Scale were used to collect the information on self-injury behaviors and psychological factors in these adolescents.@*RESULTS@#A total of 529 adolescents with mood disorders and NSSI behaviors were surveyed, among whom 375 were only-child adolescents and 154 were non-only-child adolescents. Compared with the non-only-child group, the only-child group had a significantly higher total score of Functional Assessment of Self-Mutilation (P<0.05) .The type and frequency of self-injury in the only-child group were significantly higher than those in the non-only-child group (P<0.05). Psychological analysis showed that compared with the non-only-child group, the only-child group had a significantly lower score of self-esteem (P<0.05) and significantly higher scores of psychological distress and depressive symptoms (P<0.05). The multiple linear regression analysis showed that the score of suicidal ideation was positively correlated with the frequency of NSSI behaviors in both only-child and non-only-child adolescents with mood disorders (P<0.05); in the only-child adolescents, the level of self-esteem was negatively correlated with the frequency of NSSI behaviors (P<0.05), and the score of stress perception was positively correlated with the frequency of NSSI behaviors (P<0.05); in the non-only-child adolescents, the score of anxious emotion was positively correlated with the frequency of NSSI behaviors (P<0.05).@*CONCLUSIONS@#Among the adolescents with mood disorders and NSSI behaviors, the only-child adolescents tend to have a higher frequency of self-injury and poorer mental health, and therefore, the only-child adolescents with mood disorders and NSSI behaviors need more attention.

Cerebellar cognitive affective syndrome due to cerebellar atrophy: case report / Síndrome cerebelar cognitivo-afetiva secundária à atrofia cerebelar: relato de caso

Cerebellar atrophy is a rare and challenging disease with few descriptions in the medical literature. Motor impairment is mild, but behavioral and linguistic alterations stand out, in what is known as the cerebellar cognitive affective syndrome secondary to cerebellar atrophy. We report the case of an older woman with early-onset (age 45) signs and symptoms of this syndrome, including impairment of executive functions and visuospatial cognition, personality changes, and language deficits, who was followed at a geriatric medical center for 14 years. Neuropsychological, imaging, and behavioral aspects during this period are discussed in light of scientific evidence. This case report contributes to the scientific literature by describing the progression of the signs and symptoms of cerebellar atrophy over the years, which can help guide medical management and support advice for patients and their families.

A atrofia cerebelar é uma doença rara, desafiadora e com poucas descrições na literatura médica. O prejuízo motor é discreto, mas as alterações comportamentais e de linguagem se destacam, caracterizando a síndrome cognitivo-afetiva cerebelar secundária à atrofia cerebelar. Apresentamos o relato de caso de uma paciente idosa, que apresentou sinais e sintomas dessa síndrome precocemente (aos 45 anos de idade) ­ tais como déficits na função executiva, prejuízo visuoespacial, alterações de personalidade e déficits de linguagem ­ e foi acompanhada em um centro médico geriátrico por um período de 14 anos. Aspectos neuropsicológicos, de imagem e comportamentais durante esse período são comentados à luz das evidências científicas. O caso relatado contribui com a literatura científica ao descrever a evolução dos sinais e sintomas da atrofia cerebelar ao longo dos anos, balizando as condutas médicas e amparando as orientações ao paciente e seus familiares.

O efeito da competição sobre o estado de humor de jovens atletas de jiu-jitsu / The effect of competition on the mood state of young jiu-jitsu athletes

O Jiu-Jitsu é considerado um excelente exercício físico que pode ser realizado em todas as faixas etárias, aperfeiçoando os componentes físicos do corpo, assim como os aspectos sociais e emocionais de seus praticantes. No intuito de entender como uma luta de Jiu-Jitsu influencia no estado de humor dos seus praticantes, surge o objetivo deste estudo, que foi verificar os efeitos de uma competição sobre o estado de humor de jovens atletas de jiu-jitsu. Após os critérios de inclusão, o grupo do estudo foi composto por 12 atletas com idade entre 15 e 17 anos, do sexo masculino, praticantes de jiu-jitsu. A coleta de dados foi realizada na semifinal de um campeonato na cidade de Chapecó - SC. Os estados de humor dos atletas foram avaliados por meio da Escala de Humor de Brunel (BRUMS), em três momentos distintos identificados em controle, pré-luta e pós-luta. Para análise dos dados, os valores foram avaliados de maneira descritiva e inferencial. Após a análise de normalidade com os testes de Shapiro-Wilk, optou-se pelos testes de Anova de medidas repetidas e de Friedman com o Post Hoc de Bonferroni. Observou-se que no grupo vencedor houve aumento na fadiga pós luta (p<0,001), enquanto no grupo perdedor ocorreu aumento nos valores de depressão (p<0,001), raiva (p<0,001), fadiga (p<0,001) e diminuição do vigor (p=0,013) pós competição em relação aos valores controle e pré. Portanto, no grupo estudado a vitória ou a derrota influenciou o estado de humor dos atletas participantes, sendo que a derrota exprimiu relação com o aumento de sentimentos negativos como a depressão, a raiva e a fadig

Jiu-Jitsu is considered an excellent physical exercise that can be performed in all age groups, acting and perfecting the physical components of the body, as well as the social and emotional aspects of its practitioners. In order to understand how a Jiu-Jitsu fight influences the mood of its practitioners, the objective of this study arises, which was to verify the effects of a competition on the mood of young jiu-jitsu athletes. After the inclusion criteria, the study group was composed of 12 male athletes aged between 15 and 17 years old, jiu-jitsu practitioners. Data collection was carried out in the semifinal of a championship in the city of Chapecó - SC. The athletes' mood states were assessed using the Brunel Mood Scale (BRUMS), in three distinct moments identified in control, pre-fight and post-fight. For data analysis, the values were assessed in a descriptive and inferential manner. After the analysis of normality with the Shapiro-Wilk tests, we opted for the Anova tests of repeated measures and the Friedman tests with the Bonferroni Post Hoc. It was observed that in the winning group there was an increase in post-fight fatigue (p <0.001). While in the losing group there was an increase in the values of depression (p <0.001), anger (p <0.001), fatigue (p <0.001) and a decrease in vigor (p = 0.013) after competition in relation to the control and pre values. Therefore, in the studied group, victory or defeat influenced the mood of the participating athletes, and the defeat expressed a relationship with the increase in negative feelings such as depression, anger and fatigue.

Comparing the effectiveness of the unified protocol in combination with an additional mindfulness treatment to the unified protocol alone as treatment for adolescents diagnosed with emotional disorders

Abstract Objective Many adolescents suffer from depressive and anxiety disorders simultaneously and current treatment methods do not put enough emphasis on comorbidity of these disorders. The unified protocol for treating emotional disorders in adolescents is a transdiagnostic therapy which targets mutual fundamental factors. Therefore, the current study aims to compare the effectiveness of the unified protocol alone with the unified protocol combined with mindfulness as an additional treatment in adolescents suffering from emotional disorders. Method A quasi-experimental study was conducted with adolescents. The participants had been diagnosed with emotional disorders and were divided into a control group (15 participants) and an experimental group (16 participants). Both groups were offered 14 sessions of therapy. They were assessed at pre-test, post-test, and two-month follow-up. Scales used in the study included the Child Behavior Checklist (CBCL), the Children's Depression Inventory (CDI), and the Youth Anxiety Measure for DSM-5 (YAM-5). Results The results showed that both of the treatment methods effectively reduced adolescents' emotional problems, but improvements were more significant in the group administered the additional mindfulness program. Among the variables assessed, non-phobic anxiety disorders and depression improved more than specific phobia and behavioral problems. Between-subjects (Group) partial etas for non-phobic anxiety, depression, specific phobia, and behavioral problems were 0.67, 0.50, 0.23, and 0.16, respectively. Conclusion According to the findings of this study, additional treatment methods such as mindfulness could increase the effectiveness of the unified transdiagnostic protocol for adolescents (UP-A). The therapeutic implications are discussed.

Birth by cesarean section and mood disorders among adolescents of a birth cohort study in northern Brazil

The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and "mood disorder" construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.

Personality Impairment in Children and Adolescents with ADHD / Comprometimento da Personalidade em Crianças e Adolescentes com TDAH / Deterioro de la Personalidad en Niños y Adolescentes con TDAH

Abstract Attention deficit hyperactivity disorder in children and adolescents manifests itself in a heterogeneous manner as regards personality aspects. This study aimed to evaluate, by using the Ego Impairment Index, the personality functioning characteristics of children and adolescents between 9 and 15 years old (to be completed), diagnosed with the disorder (clinical group) and compare them with a non-clinical group. The groups included 42 participants each. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version was used for diagnosis, and the Rorschach Performance Assessment System (R-PAS) was utilized for personality traits. When compared to their peers, the participants in the clinical group showed ability to discern adaptive behaviors through proper judgment, difficulty in keeping thinking and reasoning processes stable, a negative view of themselves and others, in addition to difficulty in establishing cooperative relationships.

Resumo O transtorno da falta de atenção com hiperatividade em crianças e adolescentes manifesta-se de forma heterogênea com relação aos aspectos de personalidade. O presente estudo teve por objetivo avaliar, por meio do Índice de Enfraquecimento do Ego, características do funcionamento da personalidade de crianças e adolescentes, entre 9 e 15 anos incompletos, com o diagnóstico do transtorno (grupo clínico) e compará-las com um grupo não-clínico. Os grupos contemplaram 42 participantes cada. Utilizou-se para o diagnóstico a entrevista Kiddie-Sads Referente ao Momento Presente e ao Longo da Vida, e o Sistema de Avaliação por Performance no Rorschach (R-PAS) para as características de personalidade. Os participantes do grupo clínico, quando comparados com seus pares, mostraram capacidade de discernir comportamentos adaptativos por meio de julgamento adequado, dificuldade em manter estáveis os processos de pensamento e raciocínio, visão negativa de si próprios e dos demais, dificuldade para estabelecer relacionamentos cooperativos.

Resumen El trastorno por déficit de atención con hiperactividad es uno de los más encontrados entre las patologías infantiles y se manifiesta de forma no homogénea con relación a los aspectos de personalidad. Este estudio comparó a través de lo Índice de Enflaquecimiento del Ego características de personalidad de niños y adolescentes entre 9 y 15 años incompletos con diagnóstico con un grupo de mismo sexo y edad sin diagnóstico. Cada grupo estaba compuesto por 42 participantes. Se utilizó la entrevista Kiddie-Sads sobre el momento presente y al largo de la vida para el diagnóstico y el Sistema de Evaluación por Performance en el Rorschach (R-PAS), para las características de personalidad. El grupo clínico mostró capacidad para discernir conductas adaptativas a través del juicio adecuado, dificultad para mantener estables los procesos de pensamiento y razonamiento, visión negativa de sí mismos y de los demás, dificultad para establecer relaciones de cooperación.

Typological Profiles of Depression of College Students: Latent Classes and Controlling for Response Bias of the Baptista Depression Short-Scale (EBADEP-short) / Perfis Tipológicos de Depressão de Universitários: Classes Latentes e Controle de Viés de Resposta da Escala Reduzida Baptista de Depressão - (EBADEP-short) / Tipología de la Depresión de Estudiantes Universitarios: Clases Latentes y Control del Sesgo de Respuesta de la Escala Reducida Baptista de Depresión (EBADEP-short)

Abstract Response styles and non-linearity might reduce the validity of scores on depression inventories. To address both issues, we explored the latent class structure of the Baptista's Depression Scale (EBADEP), and the influence of extreme response bias. In total, 1,137 Brazilian college students (M = 26 years, SD = 7.3) participated in this study. Taxometric analysis yielded ambiguous results, without clear support for either a dimensional or a categorical representation of the data. We found three latent classes: one comprising participants with a tendency to endorse items about sadness, angst, pessimism, and low self-efficacy; another with individuals scoring low on all symptoms; and a third with intermediate scores. We found no relationship between the composition of latent classes and extreme response. Participants who reported having received a diagnostic of depression were more likely to belong to the first latent class. These findings validate the clinical usefulness of a latent class structure for the EBADEP.

Resumo Respostas extremas e ausência de linearidade podem reduzir a validade de escores de depressão. Para abordar esse problema, este estudo teve por objetivo explorar a estrutura de classes latentes da Escala Baptista de Depressão (EBADEP) e a influência do viés de respostas extremas. Participaram 1.137 estudantes universitários brasileiros (M = 26 anos, DP = 7,3). A análise taxométrica indicou resultados ambíguos, sem um ajuste explicitamente melhor para uma estrutura dimensional ou categórica. Foram identificadas três classes latentes: a primeira, composta de participantes que tenderam a endossar itens de tristeza, angústia, negativismo e baixa autoeficácia; a segunda, de indivíduos com níveis baixos de sintomas; a terceira, com escores intermediários nos itens. Não foram encontradas relação entre as classes latentes e o estilo de respostas extremas. Participantes que relataram um diagnóstico de depressão apresentaram maior probabilidade de pertencer à primeira classe latente. Os resultados evidenciam a utilidade clínica da estrutura de classes latentes para a EBADEP.

Resumen Las respuestas extremas y la falta de linealidad pueden reducir la validez de los escores de depresión. Al abordar este problema, este estudio pretende explorar la estructura de clases latentes de la Escala de Depresión Baptista (EBADEP) y la influencia del sesgo de respuesta extremo. Participaron 1.137 universitarios brasileños (M = 26 años, DE = 7,3). El análisis taxométrico indicó resultados ambiguos, sin un ajuste explícitamente mejor para una estructura dimensional o categórica. Se identificaron tres clases latentes: la primera, compuesta por participantes que tendían a obtener altas puntuaciones en los ítems tristeza, angustia, negativismo y baja autoeficacia; la segunda, de individuos con bajos niveles de síntomas; y la tercera, con puntuaciones intermedias en los ítems. No se encontró relación entre las clases latentes y el estilo de respuestas extremas. Los participantes que informaron estar con diagnóstico de depresión tenían más probabilidades de pertenecer a la primera clase latente. Los resultados muestran la utilidad clínica de la estructura de clases latente para EBADEP.

Differentiating irritable mood and disruptive behavior in adults

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.

A closer look at the epidemiology of schizophrenia and common mental disorders in Brazil / Um olhar mais atento à epidemiologia da esquizofrenia e de transtornos mentais comuns no Brasil

ABSTRACT. Schizophrenia and common mental disorders are noteworthy social and economic concern worldwide. Epidemiologic studies on the impact of specific mental disorders in emerging countries are scarce. Objectives: We aimed to characterize the demographic, social, and economic burden of schizophrenia and common mental disorders patients in the health system in Brazil. Methods: Data on these conditions in Brazil between 2008 and 2019 were collected through the website of the Departamento de Informática do Sistema Único de Saúde (Information Technology Department of the Unified Health System - DATASUS) maintained by the Brazilian Ministry of Health. Mean annual hospital admissions were 154,009.67, and cumulative incidence of 77.44 admissions per 100,000 inhabitants. Results: Average annual hospital expenses were US$ 67,216,056.04, with an average admission cost of US$ 432.58. The most affected age groups were older adults albeit younger individuals showed a trend towards increase of occurrences in recent years. There were a higher number of admissions in men compared to women. Conclusions: We consider the results obtained important to assist in evaluating and guiding public policies regarding the prevention and treatment in health systems.

RESUMO. A esquizofrenia e os transtornos mentais comuns são uma preocupação social e econômica notável em todo o mundo. Estudos epidemiológicos sobre o impacto de transtornos mentais específicos em países emergentes são escassos. Objetivos: Nosso objetivo foi caracterizar a carga demográfica, social e econômica de pacientes com esquizofrenia e transtornos mentais comuns no sistema de saúde no Brasil. Métodos: Os dados sobre essas condições no Brasil entre 2008 e 2019 foram coletados por meio do site do Departamento de Informática do Sistema Único de Saúde (DATASUS), mantido pelo Ministério da Saúde do Brasil. As internações hospitalares anuais médias foram de 154.009,67, e a incidência acumulada de 77,44 internações por 100.000 habitantes. Resultados: As despesas hospitalares médias anuais foram de US$ 67.216.056,04, com um custo médio de internação de US$ 432,58. As faixas etárias mais afetadas foram os adultos mais velhos, embora os mais jovens tenham demonstrado tendência a aumento de ocorrências nos últimos anos. Houve um número maior de admissões entre os homens em comparação às mulheres. Conclusões: Consideramos importantes os resultados obtidos para auxiliar na avaliação e orientação de políticas públicas de prevenção e tratamento nos sistemas de saúde.