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1.
SMAD, Rev. eletrônica saúde mental alcool drog ; 17(1): 39-47, jan.-mar. 2021. ilus
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1280639

ABSTRACT

OBJETIVO: caracterizar os idosos atendidos em um Serviço de Urgência e Emergência Psiquiátrica quanto ao perfil sociodemográfico, diagnóstico psiquiátrico, prescrição de medicamentos e conduta médica e avaliar suas associações com o sexo. MÉTODO: estudo transversal, quantitativo, em que os dados foram obtidos a partir dos prontuários de pacientes atendidos no referido serviço, entre julho/2015 e junho/2016. A variável independente foi o sexo e as dependentes foram: idade; procedência; informante; tratamento psiquiátrico anterior; diagnóstico; medicamentos prescritos e conduta. RESULTADOS: nos 152 prontuários analisados, observam-se idade prevalente entre 60 a 69 anos, maioria de mulheres, procedência do município local e comparecimento com acompanhante. Os diagnósticos prevalentes são a esquizofrenia e os transtornos mentais e comportamentais decorrentes do uso de substâncias psicoativas. As medicações prescritas com maior frequência são da classe dos antipsicóticos e anti-histamínicos, seguidas dos ansiolíticos/sedativos. O critério de Beers considera a prescrição de medicamentos do grupo dos benzodiazepínicos, antipsicóticos e anti-histamínicos inapropriada para idosos. A principal conduta foi a alta, sem encaminhamento a outro serviço. CONCLUSÃO: embora haja incentivo do Ministério da Saúde, com a criação de novas políticas de saúde mental, muitos profissionais mantêm o modelo de atendimento baseado na queixa e conduta, dificultando a reabilitação psicossocial dos pacientes.


OBJECTIVE: characterize the elderly treated in a Psychiatric Emergency and Urgency Service regarding their sociodemographic profile, psychiatric diagnosis, prescription of medication and medical conduct and evaluate their associations with sex. METHOD: a cross-sectional, quantitative study in which data was obtained from the medical records of patients seen in the referred service, between July/2015 and June/2016. The independent variable was gender and dependents were: age; origin; informant; previous psychiatric treatment; diagnosis; prescribed drugs and conduct. RESULTS: in the 152 medical records analyzed, the prevailing age is between 60 and 69 years old, most of them women, coming from the local municipality and attending with a companion. The prevalent diagnoses are schizophrenia and mental and behavioral disorders resulting from the use of psychoactive substances. The most frequently prescribed medications are in the class of antipsychotics and antihistamines, followed by anxiolytics/sedatives. Beers' criteria consider the prescription of benzodiazepine, antipsychotic and antihistamine medications inappropriate for the elderly. The main conduct was discharge, without referral to another service. CONCLUSION: although there is encouragement from the Ministry of Health, with the creation of new mental health policies, many professionals maintain the model of care based on complaint and conduct, hindering the psychosocial rehabilitation of patients.


OBJETIVO: caracterizar a los ancianos atendidos en un servicio psiquiátrico de emergencia y urgencia en relación con el perfil sociodemográfico, el diagnóstico psiquiátrico, la prescripción de medicamentos y la conducta médica; y evaluar sus asociaciones con el sexo. MÉTODO: un estudio cuantitativo y transversal en el que se obtuvieron datos de los registros médicos de los pacientes tratados en el citado servicio, del 2015 al 2016 de julio. La variable independiente era el sexo y los dependientes eran: edad, procedencia, informante, tratamiento psiquiátrico previo, diagnóstico, medicamentos recetados y conducta. RESULTADOS: de los 152 registros médicos analizados, se observa que: la edad predominante es de 60 a 69 años, la mayoría de ellos son mujeres, desde el municipio local y atendido a la atención de un acompañante. Los diagnósticos prevalentes son la esquizofrenia y los trastornos mentales y conductuales resultantes del uso de sustancias psicoactivas. Los medicamentos recetados con mayor frecuencia son la clase antipsicótica y anti-histamina, seguida de ansiolíticos/sedantes. El criterio de Beers considera que la prescripción de fármacos del grupo de benzodiazepinas, antipsicóticos y antihistaminas, es inadecuada para los ancianos. La conducta principal era alta, sin remisión a otro servicio. CONCLUSIÓN: aunque hay aliento del Ministerio de salud con la creación de nuevas políticas de salud mental, muchos profesionales mantienen el modelo de cuidado basado en la queja y la conducta, obstaculizando la rehabilitación psicosocial de los pacientes.


Subject(s)
Humans , Male , Female , Aged , Anxiety Disorders/drug therapy , Schizophrenia/therapy , Antipsychotic Agents/therapeutic use , Anti-Anxiety Agents/therapeutic use , Mentally Ill Persons , Psychiatric Rehabilitation , Mental Disorders/therapy
2.
Arch. Clin. Psychiatry (Impr.) ; 47(1): 19-24, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088743

ABSTRACT

Abstract Background Sleep disorders are common in psychiatric diseases. Panic disorder (PD) and generalized anxiety disorder (GAD) are two major anxiety disorders that are associated with sleep disorders. Objective We hypothesized that poor sleep quality continues in PD and GAD during remission. Therefore, in this study we aimed to compare the sleep quality of patients with PD and GAD to that of healthy controls. Methods The study included patients with PD (n = 42) and GAD (n = 40) who had been in remission for at least 3 months and healthy control volunteers (n = 45). The patients were administered the Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Results The total PSQI scores of the GAD group were significantly increased in comparison to those of the PD (p = 0.009) and control (p < 0.001) groups. The rate of poor sleep quality in GAD during remission (77.5%) was greater than that of the PD (47.6%) and control (51.1%) groups (p = 0.011). Discussion GAD is a chronic and recurrent disease. In this study, it was found that the deterioration in sleep quality of patients with GAD may continue during remission. In the follow-up and treatment of patients, it is appropriate to question about sleep symptoms and to plan interventions according to these symptoms.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Anxiety Disorders/complications , Panic Disorder/complications , Sleep Initiation and Maintenance Disorders/etiology , Anxiety Disorders/drug therapy , Anxiety Disorders/epidemiology , Tobacco Use Disorder/complications , Remission Induction , Case-Control Studies , Chronic Disease , Cross-Sectional Studies , Follow-Up Studies , Panic Disorder/drug therapy , Panic Disorder/epidemiology , Serotonin Uptake Inhibitors/therapeutic use , Disease-Free Survival , Serotonin and Noradrenaline Reuptake Inhibitors/therapeutic use , Sleep Initiation and Maintenance Disorders/epidemiology
3.
Rev. bras. psiquiatr ; 41(2): 168-178, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-990820

ABSTRACT

Objective: Anxiety disorders are highly prevalent and the efficacy of the available anxiolytic drugs is less than desired. Adverse effects also compromise patient quality of life and adherence to treatment. Accumulating evidence shows that the pathophysiology of anxiety and related disorders is multifactorial, involving oxidative stress, neuroinflammation, and glutamatergic dysfunction. The aim of this review was to evaluate data from animal studies and clinical trials showing the anxiolytic effects of agents whose mechanisms of action target these multiple domains. Methods: The PubMed database was searched for multitarget agents that had been evaluated in animal models of anxiety, as well as randomized double-blind placebo-controlled clinical trials of anxiety and/or anxiety related disorders. Results: The main multitarget agents that have shown consistent anxiolytic effects in various animal models of anxiety, as well in clinical trials, are agomelatine, N-acetylcysteine (NAC), and omega-3 fatty acids. Data from clinical trials are preliminary at best, but reveal good safety profiles and tolerance to adverse effects. Conclusion: Agomelatine, NAC and omega-3 fatty acids show beneficial effects in clinical conditions where mainstream treatments are ineffective. These three multitarget agents are considered promising candidates for innovative, effective, and better-tolerated anxiolytics.


Subject(s)
Humans , Animals , Anxiety Disorders/drug therapy , Acetylcysteine/pharmacology , Anti-Anxiety Agents/pharmacology , Fatty Acids, Omega-3/pharmacology , Hypnotics and Sedatives/pharmacology , Acetamides/pharmacology , Neuroimmunomodulation/drug effects , Oxidative Stress/drug effects , Disease Models, Animal , Glutamine/drug effects
5.
Rev. eletrônica enferm ; 18: 1-10, 20160331.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-832798

ABSTRACT

Este estudo objetivoucompreender as dificuldades de pessoas com transtorno de ansiedade referente ao seguimento da terapia medicamentosa. Trata-se deestudo transversal, descritivo com abordagem qualitativa, desenvolvido em 2012 com 32 pessoas atendidas em serviço ambulatorial no interior de São Paulo - Brasil. Os dados foram coletados por entrevista semiestruturada gravada e submetidos à análise de conteúdo temática. As dificuldades para o seguimento da farmacoterapia foram representadas pelas categorias: ͞Ter conhecimento insuficiente sobre o diagnóstico e tratamento medicamentoso͟, ͞Ficar insatisfeito(a) com os efeitos do tratamento͟, ͞Desejar mais do que uma prescrição͟, ͞Apresentar temores e preocupações relacionadas ao tratamento͟e ͞Identificar impedimentos para seguir a prescrição medicamentosa͟. Este estudo identificou aspectos, passíveis de intervenção, por meio de estratégias que focalizem a escuta, educação, autonomia e habilidades com vistas à segurança no uso dos medicamentos prescritos


This study aimed to comprehend difficulties of people with anxiety disorder referred to follow a medication therapy. This is a cross-sectional descriptive study with a qualitative approach, developed in 2012 with 32 people attended in an ambulatory service at the interior of São Paulo state ­ Brazil. The data was collected by semi-structured interview recorded and submitted to thematic content analysis. The difficulties to follow pharmacotherapy were represented by the categories: ͞To have insufficient knowledge about the diagnosis and medication therapy͟, ͞To be unsatisfied with the treatment effects͟, ͞To wish more than a prescription͟, ͞To present fears and worries related with the treatment͟ and ͞To identify impediments to follow the medication prescription͟. This study identified aspects subject to intervention, through interventions focused in listening, education, autonomy and abilitiesfor safety in the use of prescribed medications


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Anxiety Disorders/drug therapy , Medication Adherence , Psychiatric Nursing , Psychotropic Drugs/therapeutic use , Outpatients
6.
Arq. bras. cardiol ; 104(6): 433-442, 06/2015. tab, graf
Article in English | LILACS | ID: lil-750702

ABSTRACT

Background: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. .


Fundamento: A insuficiência cardíaca (IC) é uma das principais causas de hospitalização em adultos no Brasil, no entanto a maioria dos dados disponíveis é limitada a registros unicêntricos. O registro BREATHE é o primeiro a incluir uma ampla amostra de pacientes hospitalizados com IC descompensada de diferentes regiões do Brasil. Objetivo: Descrever as características clínicas, tratamento e prognóstico intra-hospitalar de pacientes admitidos com IC aguda. Métodos: Estudo observacional tipo registro, com seguimento longitudinal. Os critérios de elegibilidade incluíram pacientes acima de 18 anos com diagnóstico definitivo de IC, admitidos em hospitais públicos ou privados. Os desfechos avaliados incluíram causas de descompensação, uso de medicações, indicadores de qualidade assistencial, perfil hemodinâmico e eventos intra-hospitalares. Resultados: O total de 1.263 pacientes (64 ± 16 anos, 60% mulheres) foi incluído a partir de 51 centros de diferentes regiões do Brasil. As comorbidades mais comuns foram hipertensão arterial (70,8%), dislipidemia (36,7%) e diabetes (34%). Em torno de 40% dos pacientes apresentavam função sistólica do ventrículo esquerdo normal e a maioria foi admitida com perfil clínico-hemodinâmico quente-úmido. Vasodilatadores e inotrópicos endovenosos foram administrados a menos de 15% da amostra estudada. Indicadores de qualidade assistencial baseados nas orientações de alta hospitalar foram atingidos em menos de 65% dos pacientes. A mortalidade intra-hospitalar afetou 12,6% do total dos pacientes incluídos. Conclusão: O estudo BREATHE demonstrou a alta mortalidade intra-hospitalar dos pacientes admitidos com IC aguda no Brasil, somada à baixa taxa de prescrição de medicamentos baseados em evidências. .


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Antipsychotic Agents/therapeutic use , Anxiety Disorders/drug therapy , Bipolar Disorder , Schizophrenia , Antipsychotic Agents/economics , Anxiety Disorders/epidemiology , Bipolar Disorder/drug therapy , Bipolar Disorder/economics , Bipolar Disorder/epidemiology , Cost-Benefit Analysis , Drug Prescriptions/statistics & numerical data , Health Care Costs , Insurance, Health/economics , Medicaid/economics , Prevalence , Schizophrenia/drug therapy , Schizophrenia/economics , Schizophrenia/epidemiology , United States/epidemiology
8.
IJRM-Iranian Journal of Reproductive Medicine. 2013; 11 (6): 495-502
in English | IMEMR | ID: emr-138384

ABSTRACT

The infertility is associated with psychological consequence including depression, and lack of self-efficacy. The aim of this study was to compare the pharmacological and no pharmacological strategies in promotion of self-efficacy of infertile women. A randomized controlled clinical trial was conducted on 89 infertile women who were recruited from Fatemeh Zahra Infertility and Reproductive Health Research Center and were randomized into three groups; cognitive behavioral therapy [CBT], antidepressant therapy with flouxetine 20 mg daily for 3 month, and a control group. All participants completed Infertility Self-efficacy Inventory [ISE] and the Beck Depression Inventory [BDI] at the beginning and end of the study. The means ISE scores among the CBT, fluoxetine, and control groups at the beginning and end of the study were 6.1 +/- 1.6 vs. 7.2 +/- 0.9, 6.4 +/- 1.4 vs. 6.9 +/- 1.3 and 6.1 +/- 1.1 vs. 5.9 +/- 1.4 respectively. Both CBT and fluoxetine increased the mean of ISE scores more than control group after intervention [p<0.0001, p=0.033; respectively], but increase in the CBT group was significantly greater than flouxetine group. Finally, there was evidence of high infertility self-efficacy for women exposed to the intervention compared with those in the control group. Also, there was an improvement in depression. Both fluoxetine and CBT decreased significantly the mean of BDI scores more than the control group; decrease in the CBT group was significantly more than that in the fluoxetine group. CBT can serve as an effective psychosocial intervention for promoting self-efficacy of infertile women


Subject(s)
Humans , Female , Male , Depressive Disorder/drug therapy , Anxiety Disorders/drug therapy , Reproductive Medicine , Fluoxetine , Psychometrics , Treatment Outcome
9.
Clinics ; 67(7): 827-830, July 2012. ilus
Article in English | LILACS | ID: lil-645458

ABSTRACT

Patients who have suffered burns frequently experience psychological consequences, among which anxiety disorders are prominent. Benzodiazepines are commonly administered to treat these symptoms. The effects of benzodiazepines on healing may not be direct but rather are modulated by alterations of the sleep architecture. This hypothesis is supported by studies that demonstrate the effects of benzodiazepines on the immune system and the inflammatory profile under both normal sleep conditions and during sleep deprivation, particularly rapid eye movement sleep deprivation.


Subject(s)
Animals , Humans , Mice , Rats , Anti-Anxiety Agents/adverse effects , Burns/psychology , Midazolam/adverse effects , Wound Healing/drug effects , Anxiety Disorders/drug therapy , Anxiety Disorders/immunology , Burns/immunology , Sleep Deprivation/drug therapy , Sleep Deprivation/immunology , Stress, Psychological/drug therapy , Stress, Psychological/immunology , Wound Healing/immunology , Wound Healing/physiology
11.
Rev. bras. psiquiatr ; 34(supl.1): 104-110, June 2012. tab
Article in English | LILACS | ID: lil-638691

ABSTRACT

OBJECTIVES: To review and describe studies of the non-psychotomimetic constituent of Cannabis sativa, cannabidiol (CBD), as an anxiolytic drug and discuss its possible mechanisms of action. METHOD: The articles selected for the review were identified through searches in English, Portuguese, and Spanish in the electronic databases ISI Web of Knowledge, SciELO, PubMed, and PsycINFO, combining the search terms "cannabidiol and anxiolytic", "cannabidiol and anxiolytic-like", and "cannabidiol and anxiety". The reference lists of the publications included, review articles, and book chapters were handsearched for additional references. Experimental animal and human studies were included, with no time restraints. RESULTS: Studies using animal models of anxiety and involving healthy volunteers clearly suggest an anxiolytic-like effect of CBD. Moreover, CBD was shown to reduce anxiety in patients with social anxiety disorder. CONCLUSION: Future clinical trials involving patients with different anxiety disorders are warranted, especially of panic disorder, obsessive-compulsive disorder, social anxiety disorder, and post-traumatic stress disorders. The adequate therapeutic window of CBD and the precise mechanisms involved in its anxiolytic action remain to be determined.


OBJETIVOS: Revisar e descrever os estudos do constituinte não psicotomimético da Cannabis sativa, o canabidiol (CBD), como ansiolítico e discutir seus possíveis mecanismos de ação. MÉTODO: Os artigos selecionados para a presente revisão foram identificados por meio de busca eletrônica em inglês, português e espanhol nos bancos de dados ISI Web of Knowledge, SciELO, PubMed e PsycINFO e combinando os termos "canabidiol e ansiolíticos", "canabidiol e semelhante ao ansiolítico" e "canabidiol e ansiedade". Foram também revisadas as listas de referências dos artigos incluídos, de revisões da literatura e de capítulos de livro. Incluímos trabalhos experimentais em humanos e em animais, sem limite de tempo. RESULTADOS: Estudos com modelos animais de ansiedade e envolvendo voluntários saudáveis sugerem claramente que o CBD possui efeitos ansiolíticos. Além disso, o CBD mostrou-se capaz de reduzir a ansiedade em pacientes com transtorno de ansiedade social. CONCLUSÃO: Futuros ensaios clínicos com pacientes portadores de diferentes transtornos de ansiedade, em especial pacientes com transtorno do pânico, obsessivo-compulsivo, ansiedade social e estresse pós-traumático, são oportunos. Além disso, ainda é necessário determinar a adequada faixa terapêutica do CBD e os exatos mecanismos envolvidos nessa ação ansiolítica.


Subject(s)
Animals , Humans , Anti-Anxiety Agents/therapeutic use , Anxiety Disorders/drug therapy , Cannabidiol/therapeutic use , Cannabis/chemistry , Disease Models, Animal
12.
Rev. bras. psiquiatr ; 33(3): 292-302, Sept. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-609087

ABSTRACT

INTRODUÇÃO: O transtorno de ansiedade social (TAS) é o transtorno de ansiedade mais comum, freqüentemente sem remissões, sendo comumente associado com importante prejuízo funcional e psicossocial. A Associação Médica Brasileira (AMB), através do "Projeto Diretrizes", busca desenvolver consensos de diagnóstico e tratamento para as doenças mais comuns. O objetivo deste trabalho é apresentar os achados mais relevantes das diretrizes relativas ao tratamento do TAS, servindo de referência para o médico generalista e especialista. MÉTODO: O método utilizado foi o proposto pela AMB. A busca foi realizada nas bases de dados do MEDLINE (PubMed), Scopus, Web of Science e Lilacs, entre 1980 e 2010. A estratégia utilizada baseou-se em perguntas estruturadas na forma P.I.C.O (acrônimo das iniciais "paciente ou população"; "intervenção, indicador ou exposição"; "controle ou comparação" e; "outcome ou desfecho"). RESULTADOS: Estudos evidenciam que o tratamento farmacológico de primeira linha para adultos e crianças são os inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina, enquanto que a terapia cognitivo-comportamental é apontada como melhor tratamento psicoterápico. Além disso, algumas comorbidades psiquiátricas foram associadas a uma pior evolução do TAS. CONCLUSÕES: Apesar da alta prevalência, o TAS acaba por não receber a devida atenção e tratamento. A melhor escolha para o tratamento de adultos é a associação psicoterapia cognitivo-comportamental com inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina. Outras opções como benzodiazepínicos ou inibidores da monoamino-oxidase devem ser usados como segunda e terceira opção respectivamente.


INTRODUCTION: Social anxiety disorder (SAD) is the most common anxiety disorder, usually with no remission, and is commonly associated with significant functional and psychosocial impairment. The Brazilian Medical Association (BMA), with the project named Diretrizes (Guidelines, in English), seeks to develop consensus for the diagnosis and treatment of common diseases. The aim of this article is to present the most important findings of the guidelines on the treatment of SAD, serving as a reference for the general practitioner and specialist. METHOD: The method used was proposed by the BMA. The search was conducted in the databases of MEDLINE (PubMed), Scopus, Web of Science and LILACS, between 1980 and 2010. The strategy used was based on structured questions as PICO (acronym formed by the initials of "patient or population", "intervention, display or exhibition", "control or comparison" and "outcome"). RESULTS: Studies show that the first-line pharmacological treatment for adults and children are serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, whereas cognitive-behavioral therapy is considered the best psychotherapeutic treatment. Moreover, some psychiatric comorbidities were associated with a worse outcome of SAD. CONCLUSIONS: Despite its high prevalence, SAD does not receive adequate attention and treatment. The best choice for the treatment of adults is a combination of cognitive-behavioral psychotherapy with serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors. Other options as benzodiazepines or monoamine oxidase inhibitors must be used as second and third choices, respectively.


Subject(s)
Adolescent , Adult , Child , Humans , Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Practice Guidelines as Topic , Phobic Disorders/therapy , Anxiety Disorders/diagnosis , Anxiety Disorders/drug therapy , Brazil , Combined Modality Therapy/methods , Phobic Disorders/diagnosis , Phobic Disorders/drug therapy , Serotonin Uptake Inhibitors/therapeutic use
14.
Rev. bras. psiquiatr ; 33(1): 55-58, Mar. 2011. graf, tab
Article in English | LILACS | ID: lil-584097

ABSTRACT

OBJECTIVE: Methylphenidate hydrochloride is the most widely used medication for treatment and management of attention-deficit hyperactivity disorder. However, the chronic effects of methylphenidate hydrochloride on anxiety- and depressive-like rat behaviors remain poorly investigated. In this context, the present study evaluated the effects of treatment with methylphenidate hydrochloride on anxiety- and depressive-like behaviors using young and adult rats during the light and the dark cycle. METHOD: Male Wistar rats (25 or 60 days old) received a once-daily (in either the light or dark cycle) methylphenidate hydrochloride (2mg/kg) or saline intraperitoneal injection for 28 days. We performed elevated plus maze and forced swimming test two hours after the last injection. RESULTS: The light/dark cycle was a significant factor in the anxiety-like behaviors; however, no significant interaction between all three factors (cycle, age and methylphenidate hydrochloride) was found. Nevertheless, we observed a nominally significant interaction between the light/ dark cycle and age in the forced swimming test. CONCLUSION: Our results have shown that age and the light/dark cycle are more significant modulators of anxiety- and depressive-like behaviors than methylphenidate hydrochloride treatment.


OBJETIVO: Hidrocloridrato de metilfenidato é a medicação preferida para o tratamento e manutenção do transtorno de atenção e hiperatividade. No entanto, os efeitos do tratamento crônico com hidrocloridrato de metilfenidato em diferentes idades e ciclos sobre o comportamento relacionado à ansiedade e à depressão ainda não está claro. Neste contexto, o presente estudo teve como objetivo avaliar os efeitos do tratamento com hidrocloridrato de metilfenidato sobre o comportamento relacionado à ansiedade e à depressão em diferentes idades e no ciclo claro e escuro. MÉTODO: Foram utilizados ratos Wistar machos jovens e adultos que receberam uma vez ao dia (ciclo claro e escuro) hidrocloridrato de metilfenidato (2mg/kg) ou salina com injeção intraperitoneal, durante 28 dias. Após duas horas da última injeção, os animais foram submetidos ao testes de labirinto em cruz elevada e natação forçada. RESULTADOS: A fase do ciclo claro e escuro foi um fator significativo para o comportamento relacionado à ansiedade. Além disso, não houve interação significativa entre os ciclos claro e escuro, idade e metilfenidato no comportamento relacionado à ansiedade e à depressão, mas foi observada uma interação significativa entre ciclo claro e escuro e idade no teste de natação forçada. CONCLUSÃO: Nossos resultados mostraram que a idade e o ciclo claro e escuro são moduladores significativos de ambos os comportamentos quanto do tratamento com hidrocloridrato de metilfenidato.


Subject(s)
Animals , Male , Rats , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents/therapeutic use , Anxiety Disorders/drug therapy , Depressive Disorder/drug therapy , Methylphenidate/therapeutic use , Photoperiod , Age Factors , Anxiety Disorders/psychology , Attention Deficit Disorder with Hyperactivity/drug therapy , Depressive Disorder/psychology , Rats, Wistar
15.
Rev. bras. psiquiatr ; 32(4): 429-436, dez. 2010. ilus, tab
Article in Portuguese | LILACS | ID: lil-573852

ABSTRACT

OBJETIVO: Revisar os estudos clínicos controlados sobre a efetividade de plantas medicinais/fitoterápicos no transtorno de ansiedade generalizada. MÉTODO: Realizou-se uma busca (Medline, Web of Science, SciELO, Biblioteca Cochrane) por artigos originais utilizando as palavras ["plant OR phytomed* OR extract OR herbal OR medicinal (OR specific name plants)"] AND ("anxie* OR anxioly* OR tranquil* OR GAD"), delimitada a "human OR clinical trial OR randomized controlled trial OR meta-analysis OR review" e à língua inglesa. Os critérios de inclusão foram: estudos randomizados, comparativos e duplo-cegos. RESULTADOS: Foram selecionados sete dos 267 artigos encontrados. O Piper methysticum (kava-kava) foi o fitoterápico mais estudado, sendo sugerido um efeito ansiolítico. Entretanto, a maioria destes estudos incluiu outros transtornos de ansiedade e os dois estudos com transtorno de ansiedade generalizada apresentaram resultados contraditórios. Estudos isolados envolvendo Ginkgo biloba, Galphimia glauca, Matricaria recutita (camomila), Passiflora incarnata e Valeriana officinalis indicaram potencial efeito ansiolítico no transtorno de ansiedade generalizada. A Ginkgo biloba e a Matricaria recutita apresentaram um effect size ('d' de Cohen = 0,47 e 0,87) similar ou superior ao dos ansiolíticos atuais (0,17-0,38). Não foram localizados estudos com outras plantas. CONCLUSÃO: Apesar do potencial terapêutico dos fitoterápicos no transtorno de ansiedade generalizada, poucos ensaios clínicos controlados foram identificados, com a maioria apresentando limitações metodológicas.


OBJECTIVE: This work aimed to identify controlled trials, which evaluated effectiveness of herbal medicines in subjects suffering generalized anxiety disorder. METHOD: Controlled studies (randomized, comparative with placebo and/or standard drug, double-blind) were sought through electronic and hand-searches. The word strategy used "plant OR phytomed* OR extract OR herbal OR medicinal (OR specific name plants)" e "anxie* OR anxioly* OR tranquil* OR GAD", limited to "human OR clinical trial OR randomized controlled trial OR meta-analysis OR review". The search was restricted to English language. RESULTS: Piper methysticum presented an unequivocal anxiolytic effect, but most studies also included patients with other anxiety disorders (e.g. phobias). Isolated studies with Ginkgo biloba, Galphimia glauca, Matricaria recutita, Passiflora incarnata and Valeriana officinalis showed a potential use for anxious diseases. Despite this low number of studies, Ginkgo biloba and Matricaria recutita showed an effect size (Cohen's d = 0.47 to 0.87) similar or higher to standard anxiolytics drugs (benzodiazepines, buspirone and antidepressants - 0.17 to 0.38). No additional study with other plants was found. CONCLUSION: Despite the therapeutic potential of medicinal plants in generalized anxiety disorder, very few controlled trials assessing herbal medicines in generalized anxiety disorder were found. Additionally, these studies present serious flaw design.


Subject(s)
Humans , Anxiety Disorders/drug therapy , Biomedical Research , Phytotherapy , Plant Extracts/therapeutic use , Plant Preparations/therapeutic use , Plants, Medicinal/chemistry , Double-Blind Method , Placebos , Randomized Controlled Trials as Topic
16.
Rev. bras. psiquiatr ; 32(supl.1): 57-514, maio 2010. ilus, tab
Article in Portuguese | LILACS | ID: lil-547317

ABSTRACT

OBJETIVO: Este artigo revisa o sistema endocanabinoide e as respectivas estratégias de intervenções farmacológicas. MÉTODO: Realizou-se uma revisão da literatura sobre o sistema endocanabinoide e a sua farmacologia, considerando-se artigos originais ou de revisão escritos em inglês. DISCUSSÃO: Canabinoides são um grupo de compostos presentes na Cannabis Sativa (maconha), a exemplo do Δ9-tetraidrocanabinol e seus análogos sintéticos. Estudos sobre o seu perfil farmacológico levaram à descoberta do sistema endocanabinoide do cérebro de mamíferos. Este sistema é composto por pelo menos dois receptores acoplados a uma proteína G, CB1 e CB2, pelos seus ligantes endógenos (endocanabinoides; a exemplo da anandamida e do 2-araquidonoil glicerol) e pelas enzimas responsáveis por sintetizá-los e metabolizá-los. Os endocanabinoides representam uma classe de mensageiros neurais que são sintetizados sob demanda e liberados de neurônios pós-sinápticos para restringir a liberação de neurotransmissores clássicos de terminais pré-sinápticos. Esta sinalização retrógrada modula uma diversidade de funções cerebrais, incluindo ansiedade, medo e humor, em que a ativação de receptores CB1 pode exercer efeitos dos tipos ansiolítico e antidepressivo em estudos préclínicos. CONCLUSÃO: Experimentos com modelos animais sugerem que drogas que facilitam a ação dos endocanabinoides podem representar uma nova estratégia para o tratamento de transtornos de ansiedade e depressão.


OBJECTIVE: The present review provides a brief introduction into the endocannabinoid system and discusses main strategies of pharmacological interventions. METHOD: We have reviewed the literature relating to the endocannabinoid system and its pharmacology; both original and review articles written in English were considered. DISCUSSION: Cannabinoids are a group of compounds present in Cannabis Sativa (hemp), such as Δ9-tetrahydrocannabinol, and their synthetic analogues. Research on their pharmacological profile led to the discovery of the endocannabinoid system in the mammalian brain. This system comprises at least two G-protein coupled receptors, CB1 and CB2, their endogenous ligands (endocannabinoids; e.g. the fatty acid derivatives anandamide and 2-arachydonoyl glycerol), and the enzymes responsible for endocannabinoid synthesis and catabolism. Endocannabinoids represent a class of neuromessengers, which are synthesized on demand and released from post-synaptic neurons to restrain the release of classical neurotransmitters from pre-synaptic terminals.This retrograde signalling modulates a variety of brain functions, including anxiety, fear and mood, whereby activation of CB1 receptors was shown to exert anxiolytic-and antidepressant-like effects in preclinical studies. CONCLUSION: Animal experiments suggest that drugs promoting endocannabinoid action may represent a novel strategy for the treatment of depression and anxiety disorders.


Subject(s)
Animals , Humans , Anxiety Disorders/drug therapy , Cannabinoid Receptor Modulators/therapeutic use , Depression/drug therapy , Endocannabinoids , Anxiety Disorders/metabolism , Cannabinoid Receptor Agonists , Cannabinoid Receptor Antagonists , Cannabinoid Receptor Modulators/metabolism , Depression/metabolism , Receptors, Cannabinoid/metabolism , Signal Transduction/drug effects
17.
Bahrain Medical Bulletin. 2010; 32 (1): 7-10
in English | IMEMR | ID: emr-93029

ABSTRACT

The aim of the study was to evaluate the prevalence of generalized anxiety disorder and depression and their treatment in a cross national sample of primary care patients. Four primary health care facilities in four Governorates, in the Kingdom of Bahrain. Design: Clinical Survey. Four primary health care facilities in four Governorates participated in one stage screening process to identify prevalence of generalized anxiety disorder and depression. Structured diagnostic interviews among 300 consecutive attendees in one day was used. The Mini International Neuro psychiatric Investigation [MINI] was used as screening tool. The association of depression and anxiety with factors such as age, sex, education and employment were evaluated. Generalized anxiety disorders prevalence rate was 52 [17.3], life time depression was 58 [19.3%] and current depression was 17 [5.6%]. Only 22 [7.3%] of the sample had either anxiety or depression in the past, of whom 41% received treatment. None of the examined factors was significantly linked to anxiety or depression. This study shows that generalized anxiety disorder and major depressive episode are very common among primary care attendees. Thus, primary care physicians should be alerted of this fact. A multifaceted program should be adopted for the detection and management of GAD and depression


Subject(s)
Humans , Male , Female , Adult , Anxiety Disorders/drug therapy , Depression/epidemiology , Depression/drug therapy , Primary Health Care , Prevalence
18.
Article in English | IMSEAR | ID: sea-46836

ABSTRACT

Ocimumn sanctum, an Indian medicinal plant, has been on trial for its role in generalized anxiety disorder (GAD) in hospital based clinical set-up. Hamilton's brief psychiatric rating scale (BPRS) and thorough clinical investigations were used to screen the subjects. Thirty-five subjects (21 male and 14 female; average age 38.4 years) were medicated with the plant extract in a fixed dose regime (500 mg/capsule, twice daily, p.o. after meal). They were thoroughly investigated clinically and using standard questionnaires based on different psychological rating scale at baseline (day 0), mid-term (day 30) and final (day 60). The observations exhibited that, O. sanctum significantly (p<0.001) attenuated generalized anxiety disorders and also attenuated its correlated stress and depression. It further significantly (p<0.001) improved the willingness to adjustment and attention in human. Therefore, it may be concluded that O. sanctum may be useful in the treatment of GAD in human and may be a promising anxiolytic agent in near future.


Subject(s)
Adolescent , Adult , Anxiety Disorders/drug therapy , Female , Humans , Male , Middle Aged , Ocimum , Phytotherapy , Plant Extracts/therapeutic use , Plant Leaves , Treatment Outcome , Young Adult
19.
Rev. bras. psiquiatr ; 30(1): 7-11, mar. 2008. ilus, tab
Article in English | LILACS | ID: lil-482120

ABSTRACT

OBJECTIVES: To assess the prevalence and sociodemographic characteristics associated with benzodiazepine use among community-dwelling older adults. METHOD: 1606 subjects, aged > 60 years, corresponding to 92 percent of the residents of Bambuí city, participated in this study. The information about medication use was obtained by means of a standard interview and the review of medication packaging. Substances were classified using the Anatomical Therapeutic Chemical Index. RESULTS: The prevalence of benzodiazepine current use was 21.7 percent (26.7 percent among females and 14.0 percent among males). From these, 68.7 percent had been taking the medication for over one year, 31.3 percent for over five years and 53.2 percent were using long half-life benzodiazepines. The medication most frequently used was bromazepam (35.6 percent), followed by diazepam (22.5 percent), clonazepam (12.6 percent) and lorazepam (7.8 percent). After adjustment for confounders, female gender (RP = 1.93; CI95 percent = 1.51-2.46) was the only sociodemographic characteristic found to be independently associated with substance consumption. CONCLUSIONS: The prevalence of benzodiazepine use in the study population was high, but within the variation observed in developed countries. Chronic use of benzodiazepines and long half-life medications predominated.


OBJETIVOS: Determinar a prevalência e características sociodemográficas associadas ao uso de benzodiazepínicos entre idosos residentes na comunidade. MÉTODO: Participaram deste estudo transversal 1.606 indivíduos, que correspondem a 92 por cento do total de residentes na cidade de Bambuí-MG com idade > 60 anos. As informações sobre uso de medicamentos foram obtidas por meio de entrevista padronizada e verificação da embalagem. A classificação do princípio ativo foi baseada no Anatomical Therapeutic Chemical Index. RESULTADOS: A prevalência do uso de benzodiazepínicos foi de 21,7 por cento (26,7 por cento entre as mulheres e 14,0 por cento entre os homens); 68,7 por cento faziam uso do medicamento há pelo menos um ano, 31,3 por cento há pelo menos cinco anos e 53,2 por cento faziam uso de benzodiazepínicos de meia-vida longa. O medicamento de uso mais comum foi o bromazepam (35,6 por cento), seguido pelo diazepam (22,5 por cento), clonazepam (12,6 por cento) e lorazepam (7,8 por cento). Após ajuste para variáveis de confusão, sexo feminino foi o único fator independentemente associado ao uso de benzodiazepínico (RP = 1,93; IC95 por cento = 1,51-2,46). CONCLUSÕES: A prevalência do consumo de benzodiazepínicos na população estudada foi alta, mas dentro da variação observada em países desenvolvidos. O uso crônico e o uso de benzodiazepínicos de meia-vida longa foi predominante.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anti-Anxiety Agents/therapeutic use , Anxiety Disorders/drug therapy , Benzodiazepines/therapeutic use , Substance Abuse Detection/statistics & numerical data , Substance-Related Disorders/epidemiology , Age Distribution , Anti-Anxiety Agents/adverse effects , Benzodiazepines/adverse effects , Brazil/epidemiology , Cross-Sectional Studies , Drug Prescriptions , Geriatric Assessment , Pharmacoepidemiology , Risk Factors , Socioeconomic Factors
20.
Acta méd. (Porto Alegre) ; 29: 267-276, 2008.
Article in Portuguese | LILACS | ID: lil-510224

ABSTRACT

Este artigo tem como objetivo revisar o diagnóstico e tratamento do transtorno de ansiedade no idoso, apresentando as diversas peculiaridades desta faixa etária nesta patologia. Com o estabelecimento do processo de envelhecimento da população brasileira, urge uma necessidade de novos estudos voltados para a terceira idade, buscando uma maior compreensão desta última etapa do ciclo da vida e a mobilização de serviços e tratamentos voltados especificamente para os idosos. Tendo em vista a ansiedade como uma patologia comum na terceira idade, de extrema importância por elevar a morbimortalidade e por ser comumente subdiagnosticada, os autores se propõem a revisar conceitos diagnósticos e a a apresentar as melhores formas de tratamento.


Subject(s)
Aged , Psychotherapy , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/drug therapy , Anxiety Disorders/therapy
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