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1.
Braz. j. med. biol. res ; 54(1): e10285, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153507

ABSTRACT

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.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adolescent , Young Adult , Cesarean Section , Mood Disorders/epidemiology , Brazil/epidemiology , Cohort Studies
2.
Paidéia (Ribeirão Preto, Online) ; 31: e3129, 2021. tab, graf
Article in English | LILACS, INDEXPSI | ID: biblio-1351178

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anxiety , Psychological Tests , Students , Bias , Mood Disorders , Depression , Emotional Adjustment
3.
Article in English | LILACS, INDEXPSI | ID: biblio-1154972

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Child , Adolescent , Aptitude , Rorschach Test , Schizophrenia , Attention Deficit Disorder with Hyperactivity , Adaptation, Psychological , Mood Disorders , Wool Fiber , Judgment
4.
Dement. neuropsychol ; 14(3): 283-289, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133642

ABSTRACT

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.


Subject(s)
Humans , Mental Health , Anxiety , Bipolar Disorder , Mood Disorders , Depression
6.
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1127297

ABSTRACT

OBJETIVO: compreender a percepção de familiares de pacientes com diagnóstico de transtorno de humor em relação à doença, sintomas e tratamento. MÉTODO: estudo de caso qualitativo realizado com familiares de pacientes com diagnóstico de transtorno de humor em tratamento em hospital psiquiátrico. A coleta de dados ocorreu por meio de entrevistas semiestruturadas e os dados foram submetidos à análise de conteúdo. RESULTADOS: a desinformação e o estigma permeiam esse panorama, fragilizando relações, prejudicando o suporte familiar e o tratamento, que envolveu medicamentos, psicoterapia e eletroconvulsoterapia. CONCLUSÃO: os transtornos do humor, dadas sua complexidade e prevalência, necessitam ser compreendidos pela sociedade, família e profissionais. A família é afetada pelo sofrimento mental e necessita ser foco do cuidado.


OBJECTIVE: to understand the perception of family members of patients diagnosed with a mood disorder concerning the disease, its symptoms and treatment. METHOD: qualitative case study with relatives of patients diagnosed with mood disorders undergoing treatment in a psychiatric hospital. Data were collected by semi-structured interviews and analyzed by content analysis. RESULTS: misinformation and stigma permeate this panorama, weakening relationships and impairing family support and treatment, which involved medication, psychotherapy and electroconvulsive therapy. CONCLUSION: mood disorders, given their complexity and prevalence, must be understood by society, families and professionals. The family is affected by mental suffering and needs to be the focus of care.


OBJETIVO: comprender la percepción de familiares de pacientes con diagnóstico de trastorno de humor en relación a la enfermedad, síntomas y tratamiento. MÉTODO: estudio de caso cualitativo realizado con familiares de pacientes con diagnóstico de trastorno de humor en tratamiento en hospital psiquiátrico. La recolección de datos ocurrió por medio de entrevistas semiestructuradas y los datos fueron sometidos a análisis de contenido. RESULTADOS: la desinformación y el estigma permean ese panorama, debilitando las relaciones, perjudicando el soporte familiar y el tratamiento. CONCLUSION: los trastornos del humor, dada su complejidad, necesitan ser comprendidos por la sociedad, la familia y los profesionales. La familia es afectada por el sufrimiento mental y necesita ser foco del cuidado.


Subject(s)
Humans , Male , Female , Perception , Psychotherapy , Quality of Life , Signs and Symptoms , Family , Mood Disorders , Depression , Family Relations , Social Stigma , Health Services Needs and Demand
7.
Rev. colomb. psiquiatr ; 49(2): 96-101, abr.-jun. 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1115649

ABSTRACT

RESUMEN Introducción: La ideación suicida y los intentos son muy predictivos de muerte por suicidio. Además, los intentos de suicidio causan a la sociedad una carga financiera de millones de dólares. Objetivo: Establecer los factores asociados con más de un intento de suicidio registrado en 2016 en la población colombiana. Métodos: Se realizó un estudio trasversal de 18.763 reportes consignados en la base de datos del Sistema Nacional de Vigilancia en Salud Pública del Instituto Nacional de Salud de Colombia durante 2016. Resultados: Del total de reportes, 11.738 (62,6%) corresponden al sexo femenino; la media de edad fue 25,0 (IC95%, 24,9-25,2) arios; el 46% de todos los casos corresponden a personas entre 10 y 20 años. Refirieron 2 o más intentos de suicidio 5.734 (30,6%). Las prevalencias de alguna enfermedad mental y de ideación suicida persistente fueron del 48,5 y el 16,4% respectivamente. Tras realizar el ajuste mediante regresión logística, el factor más asociado con más de 1 intento suicida, fue la ideación suicida persistente: OR bruta = 5,5 (IC95%, 5,0-5,9) y ORa = 4,0 (IC95%, 3,6-4,3). Conclusiones: Los pacientes con ideación suicida persistente tienen una probabilidad 4 veces mayor de hacer 2 o más intentos suicidas. Otros factores, como el uso de arma cortopunzante como mecanismo para ejecutar el intento y el antecedente de trastorno afectivo bipolar y/o depresión, también se asociaron con más de 1 intento de suicidio.


ABSTRACT Introduction: Suicidal ideation and attempts are strongly predictive of suicide deaths. Furthermore, suicide attempts exert a financial burden of millions of dollars on society. Objective: To establish the factors associated with more than one suicide attempt in the Colombian population that was reported in 2016. Methods: A cross-sectional study of 18,763 reports entered in the database of the National Public Health Surveillance of the National Institute of Health of Colombia during 2016 was performed. Results: 11,738 (62.6%) of the total number of reports were female, the mean age was 25.0 (95% CI, 24.9-25.2) years, 46% of all cases were individuals between 10- and 20-years-old; 5,734 (30.6%) reported 2 or more suicide attempts and the prevalence of a mental disorder and persistent suicidal ideation were 48.5% and 16.4%, respectively. The factor most strongly associated with more than one suicide attempt, after adjusting for logistic regression, was persistent suicide ideation with crude OR = 5.5 (95% CI, 5.0-5.9), and ORa = 4.0 (95% CI, 3.6-4.3). Conclusions: Patients with persistent suicidal ideation were 4 times more likely to have 2 or more suicide attempts. Other factors such as the use of a sharp weapon as a mechanism to perform the attempt and the history of bipolar affective disorder and/or depression were also associated with more than one suicide attempt.


Subject(s)
Humans , Female , Suicide, Attempted , Prevalence , Mental Disorders , Cross-Sectional Studies , Colombia , Mood Disorders , Depression , Suicidal Ideation
8.
Rev. Méd. Clín. Condes ; 31(2): 150-162, mar.-abr. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1223256

ABSTRACT

Los trastornos del ánimo en el adulto mayor, especialmente aquellos de inicio tardío son difíciles de diferenciar de la demencia en su etapa inicial, dado que existe un traslape sintomático. Esto puede llevar a errar o a retrasar el diagnóstico e impedir la entrega de un tratamiento adecuado. Para el diagnóstico diferencial es fundamental obtener una historia rigurosa tanto del paciente como de la familia, un examen mental y neurológico. Se complementa con un estudio neuropsicológico y con biomarcadores de demencia. Hoy en día se dispone de nuevas técnicas de diagnóstico precoz en la demencia como la volumetría de hipocampos, el PET/CT F18-FDG y PET de amiloide, beta-amiloide y proteína Tau en el LCR, entre otras, que ayudan en casos complejos de diagnóstico diferencial. Este artículo de revisión reúne elementos clínicos y estudios complementarios, con el objetivo de ayudar al psiquiatra en la tarea de diferenciar ambos cuadros.


Mood disorders in the elderly, especially those with late onset are difficult to differentiate from Dementia in its initial stage, given that there is a symptomatic overlap. This can lead to miss or delay the diagnosis and subsequently prevent an appropriate treatment. For the differential diagnosis it is essential to obtain a rigorous history of both the patient and the family, a mental and neurological examination. It is complemented with a neuropsychological assessment and with biomarkers of Dementia. Nowadays, new early diagnosis techniques are available in Dementia such as hippocampal volumetry, PET/CT F18-FDG and PET of amyloid, beta-amyloid and Tau protein in the CSF, among others, which help in complex cases of differential diagnosis. This article reviews clinical elements and complementary studies that help the psychiatrist in the task of differentiating both disorders.


Subject(s)
Humans , Mood Disorders/diagnosis , Dementia/diagnosis , Bipolar Disorder/diagnosis , Mood Disorders/diagnostic imaging , Dementia/diagnostic imaging , Depression/diagnosis , Diagnosis, Differential
9.
Rev. Méd. Clín. Condes ; 31(2): 105-113, mar.-abr. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1223378

ABSTRACT

INTRODUCCIÓN La comorbilidad médica en pacientes con trastornos del estado de ánimo tiende a convertirse en un problema de salud pública clínica y global cada vez más importante. Varias patologías médicas específicas están asociadas con un mayor riesgo de padecer trastornos del estado de ánimo y, por otra parte, los trastornos del estado de ánimo están asociados con un aumento de la morbilidad y mortalidad debidas a condiciones médicas comórbidas. En este artículo se revisan las comorbilidades médicas que más comúnmente se asocian a los trastornos afectivos (enfermedades cardiovasculares, obesidad y síndrome metabólico) examinando sus posibles implicaciones bidireccionales. MÉTODOS Se ha realizado una revisión no sistemática y búsqueda de la literatura científica sobre la asociación entre las tres enfermedades médicas más frecuentes en trastorno depresivo mayor y trastorno bipolar (enfermedades cardiovasculares, obesidad, síndrome metabólico) entre enero de 1995 y noviembre de 2019. RESULTADOS La evidencia sugiere que la comorbilidad entre estas tres enfermedades médicas y los trastornos del estado de ánimo es muy frecuente; la presencia de las primeras empeora significativamente el pronóstico y el manejo terapéutico de las segundas y viceversa, comparten mecanismos fisiopatológicos e implican una etiología aparentemente bidireccional. CONCLUSIONES La presencia de estas enfermedades médicas concurrentes en un individuo con un trastorno del estado de ánimo se asocia con una presentación de enfermedad más compleja. En muchos casos, estas comorbilidades pueden preceder a la aparición de los trastornos del estado de ánimo, aunque en la mayoría de los casos parecen seguir a la aparición de los trastornos del estado de ánimo. Para los profesionales, la evidencia apoya inequívocamente las recomendaciones para la vigilancia rutinaria de las comorbilidades según un enfoque multidisciplinar.


INTRODUCTION Medical comorbidity in patients with mood disorders tends to become an increasingly important clinical and global public health problem. On one hand, several specific medical pathologies are associated with an increased risk of mood disorders and on the other hand, mood disorders are associated with increased morbidity and mortality due to comorbid medical conditions. This article reviews the medical comorbidities that are most commonly associated with affective disorders (cardiovascular diseases, obesity and metabolic syndrome) examining their possible bidirectional implications. METHODS A non-systematic review about the association between the three most common medical diseases in major depressive disorder and bipolar affective disorder (cardiovascular diseases, obesity, metabolic syndrome) has been carried out from January 1995 to November 2019. RESULTS The evidence suggests that comorbidity between these three medical diseases and mood disorders is very prevalent. The presence of medical disease significantly worsens the prognosis and therapeutic management of the mood disorders and vice versa. In many cases, these comorbidities may precede the onset of mood disorders, although in most cases they appear to follow the onset of mood disorders. CONCLUSIONS the presence of these concurrent medical diseases in an individual with a mood disorder is associated with a more complex disease presentation. For professionals, the evidence unequivocally supports recommendations for routine surveillance of comorbidities according to a multidisciplinary approach.


Subject(s)
Humans , Cardiovascular Diseases/epidemiology , Health , Mood Disorders/epidemiology , Metabolic Diseases/epidemiology , Obesity/epidemiology , Bipolar Disorder/epidemiology , Cardiovascular Diseases/psychology , Comorbidity , Metabolic Syndrome/psychology , Depressive Disorder, Major/epidemiology , Obesity/psychology
10.
Rev. Méd. Clín. Condes ; 31(2): 114-121, mar.-abr. 2020. tab
Article in Spanish | LILACS | ID: biblio-1223379

ABSTRACT

Los trastornos del ánimo (uni o bipolares) constituyen un significativo problema de salud pública, tanto por su alta prevalencia como por el elevado índice de discapacidad que generan. El presente artículo aborda el problema de la resistencia a tratamiento como también las estrategias y guías clínicas para el manejo de los cuadros de mayor complejidad. Se analizan los aportes de la terapia farmacológica, de la psicoterapia y de las terapias somáticas no farmacológicas, intentando un enfoque integrativo. El equipo multidisciplinario de la Unidad de Trastornos del Ánimo del Departamento de Psiquiatría de Clínica Las Condes busca aplicar un modelo integrativo con una mirada amplia, con el objetivo de encontrar el mejor manejo para cada paciente, orientado no solo a la remisión sintomática sino también a la recuperación funcional (autonomía, calidad de vínculos, etc.), para incidir de este modo en la calidad de vida global de los pacientes.


Affective disorders (uni­ or bipolar) represent a significant public health issue, due both to its high prevalence as well as the high index of disability that they generate. This article addresses the problem of treatment resistance, as well the use of clinical guidelines and strategies for the treatment of more complex cases. We analyze the contributions of pharmacological treatments, psychotherapy and non-pharmacological somatic therapies, from an integrative point of view. The multidisciplinary team of Mood Disorders Unit at Clínica Las Condes Psychiatry Department seeks to apply a broad-view integrative model with the aim of finding the better management strategy for each patient. Our objectives are both symptomatic remission and functional recovery (autonomy, quality of affective bonds, etc.), in order to make a difference on the patients' overall quality of life.


Subject(s)
Humans , Practice Guidelines as Topic , Mood Disorders/therapy , Psychotherapy/methods , Bipolar Disorder/therapy , Remission Induction , Mood Disorders/drug therapy , Recovery of Function , Depression/therapy , Antidepressive Agents/therapeutic use
11.
Rev. Méd. Clín. Condes ; 31(2): 122-129, mar.-abr. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1223502

ABSTRACT

La relación entre función tiroidea y trastornos del ánimo se ha observado desde hace más de 50 años. Las hormonas tiroideas, actúan en el cerebro modulando génicamente proteínas asociadas a la fisiopatología de los trastornos del ánimo y potenciando los sistemas de neurotransmisión serotoninérgica y noradrenérgica. En el tratamiento de un episodio depresivo, la normalización de hormonas tiroideas es fundamental, y debe realizarse en todo paciente con sintomatología anímica, especialmente en aquellos con respuestas insuficientes a tratamiento, que requieren niveles de hormonas más estrictos que lo recomendado para población general. En pacientes eutiroideos, la potenciación con triyodotironina ha sido probada, pero también se ha utilizado T4 en altas dosis en casos resistentes, en que se postula que pudiese existir un estado de resistencia a hormonas tiroideas, no reflejado en los niveles hormonales periféricos evaluados rutinariamente. Las enzimas deiodasas, el receptor de hormona tiroidea, y el transportador de hormona tiroidea en la barrera hematoencefálica son blancos a investigar. Los objetivos de la presente revisión son ofrecer orientaciones respecto del uso de hormonas tiroideas en pacientes con trastornos del ánimo, una puesta al día sobre la relación entre hormonas tiroídeas y sistema nervioso central, y las interacciones entre psicofármacos y función tiroidea.


The relationship between thyroid function and mood disorders has been observed for more than 50 years. Thyroid hormones act in the brain genetically modulating proteins associated with the pathophysiology of mood disorders and potentiating the serotonergic and noradrenergic neurotransmission systems. In the treatment of a depressive episode, the normalization of thyroid hormones is essential, and should be performed in all patients with mood symptoms, especially in those with insufficient responses to treatment, which require more stringent hormone levels than recommended for the general population. In euthyroid patients, potentiation with triiodothyronine has been proven, but T4 has also been used in high doses in resistant cases, in which it is postulated that there might be a state of resistance to thyroid hormones, not reflected in the peripheral hormonal levels evaluated routinely. The enzymes deiodasas, the thyroid hormone receptor, and the thyroid hormone transporter in the blood brain barrier are white to investigate. The objectives of this review are to provide guidance regarding the use of thyroid hormones in patients with mood disorders, an update on the relationship between thyroid hormones and central nervous system, and the interactions between psychoactive drugs and thyroid function.


Subject(s)
Humans , Thyroid Diseases/psychology , Thyroid Diseases/epidemiology , Mood Disorders/psychology , Mood Disorders/epidemiology , Thyroid Diseases/drug therapy , Thyroid Gland/physiopathology , Thyroid Hormones/therapeutic use , Bipolar Disorder , Mood Disorders/drug therapy , Depression , Antidepressive Agents/therapeutic use
12.
Rev. Méd. Clín. Condes ; 31(2): 174-182, mar.-abr. 2020. tab
Article in Spanish | LILACS | ID: biblio-1223625

ABSTRACT

La comorbilidad entre trastornos del ánimo (TA) y trastornos por uso de sustancias (TUS) es frecuente, empeora el pronóstico de ambos cuadros y dificulta su tratamiento. El reconocimiento y manejo de síntomas anímicos en usuarios de sustancias significa un desafío en la práctica clínica. Si bien existen los trastornos anímicos secundarios a la patología por consumo, la evidencia muestra que la mayor parte de las veces en que ambas patologías coexisten, el trastorno anímico es primario, por lo tanto, el uso de sustancias activo no debiese impedir un tratamiento oportuno del TA, sin descuidar el manejo específico del uso de sustancias, ya que el tratamiento del cuadro afectivo por sí sólo no resuelve el TUS. Existe acuerdo en la necesidad de realizar un tratamiento integrado de ambos trastornos, que incorpore intervenciones farmacológicas y psicoterapéuticas ya validadas para el tratamiento de ambos trastornos por separado, y especialmente aquellas que han mostrado efectividad en la comorbilidad. El tratamiento debe tener un enfoque en la recuperación, que promueva la adherencia y reinserción social. Se requiere mayor investigación sobre el pronóstico y el tratamiento de la comorbilidad entre Trastorno anímicos y por uso de sustancias, y el fortalecimiento de la red de salud general y salud mental en la pesquisa y manejo de estos cuadros.


Comorbidity between Mood Disorders (MD) and Substance Use Disorders (SUD) are common and it worsens the prognosis of both conditions. The recognition and management of mood symptoms in SUD patients is a usual challenge in clinical practice. As opposed to the usual belief, most mood disorders in TUS patients are primary disorders and therefore the use of active substances should not prevent timely treatment of MD, without neglecting the specific management of substance use, since that the treatment of the affective condition alone does not resolve your SUD. There is agreement on the need to perform an integrated treatment of both disorders, which incorporates pharmacological and psychotherapeutic interventions already validated for the treatment of both disorders, and especially those that have shown effectiveness in comorbidity. Treatment should have a focus on recovery, which promotes adherence and social reintegration. More research is required on the prognosis and treatment of comorbidity between mood and substance use disorders, and the strengthening of the general health and mental health network in the research and management of these conditions.


Subject(s)
Humans , Mood Disorders/epidemiology , Substance-Related Disorders/epidemiology , Diagnosis, Dual (Psychiatry) , Mood Disorders/diagnosis , Mood Disorders/therapy , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy
13.
Säo Paulo med. j ; 138(2): 167-170, Mar.-Apr. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139672

ABSTRACT

ABSTRACT Our aim was to analyze hospitalization due to affective disorders in Brazil from 2003 to 2017 and the possible association with economic indicators during crises. We used data on hospitalizations due to affective disorders within the Brazilian National Health System, obtained from DATASUS; data on health-related behavior (television-viewing and physical activity) from the VIGITEL database; and economic data from the World Bank database. We found that the numbers of hospitalizations increased one year after the 2009 crisis and one year after the 2016 crisis. Negative changes in health-related behavior also followed changes in the numbers of hospitalizations due to affective disorders.


Subject(s)
Humans , Health Behavior , Mood Disorders/epidemiology , Hospitalization/statistics & numerical data , Brazil/epidemiology , Cross-Sectional Studies , Databases, Factual
15.
Ciênc. cuid. saúde ; 19: e50354, 20200000.
Article in Portuguese | LILACS, BDENF | ID: biblio-1122153

ABSTRACT

Objective: to estimate the prevalence of factors associated with mental disorders present in users of a psychosocial care center. Method: retrospective documentary study with a quantitative approach. Data were collected from 824 patient records between May and July 2019. A descriptive analysis was performed and the data were presented in the form of absolute and relative frequency, using tabulation, considering p <0.05. Results: there was a greater prevalence of mood disorders in 48.1% of users, stress-related neurotic disorders and somatoform disorders in 18.1%. The sex variable was associated with the diagnosis of mental disorder (p <0.001), and patients under the age of 20 years had a greater prevalence of child and adolescent disorders (35.7%) and mood disorders (32.6%) compared to the other age groups analyzed. Retirees had a higher prevalence of mood disorders (50.7%) and somatoform disorders, where as workers had a higher prevalence (65.7%) of mood disorders. Conclusion: this study will contribute to the planning of actions and permanent education by managers, together with mental health workers, in order to develop different strategies considering differences between sex, age and occupation in relation to the various types of mental disorders verified in the participants of this research.


Objetivo: estimar a prevalência de fatores associados aos transtornos mentais apresentados por usuários de um centro de atenção psicossocial. Método: estudo retrospectivo documental de abordagem quantitativa. Os dados foram coletados em 824prontuários de pacientes entre maio e julho de 2019. Realizou-se análise descritiva e os dados foram apresentados sob forma de frequência absoluta e relativa, utilizando tabulação, considerando p<0, 05.Resultados:verificou-se maior prevalência de transtornos de humor em 48,1% dos usuários, de transtornos neuróticos relacionados ao estresse e transtornos somatoformes em 18,1% deles. A variável sexo associou-se com diagnóstico de transtorno mental (p<0,001), aqueles com idade inferior a 20 anos apresentaram maior prevalência de transtorno infantil e da adolescência (35,7%) e prevalência de transtornos de humor (32,6%) se comparados com as demais faixas etárias analisadas. Aposentados apresentaram maior prevalência de transtornos de humor (50,7%) e transtornos somatoformes; os pacientes trabalhadores apresentaram maior prevalência (65,7%) de transtornos do humor. Conclusão: este estudo contribuirá para o planejamento de ações e de educação permanente por parte de gestores, em conjunto com trabalhadores da saúde mental, de forma a elaborar estratégias diferenciadas considerando diferenças entre sexo, idade e ocupação em relação aos vários tipos de transtornos mentais verificados nos participantes desta pesquisa


Subject(s)
Humans , Male , Female , Psychiatric Rehabilitation , Mental Disorders , Somatoform Disorders , Mental Health , Mood Disorders , Mental Health Services , Neurotic Disorders
16.
Article in Chinese | WPRIM | ID: wpr-879792

ABSTRACT

OBJECTIVE@#To study the changes in metabolic markers and clinical outcome after treatment with different drug regimens in children with bipolar affective disorder.@*METHODS@#A retrospective analysis was performed on the medical data of 220 children with bipolar affective disorder who attended the hospital from January 2017 to January 2020. According to the treatment method, 112 children treated with atypical antipsychotic drugs alone were enrolled as the control group, and 108 children treated with atypical antipsychotic drugs combined with mood stabilizer were enrolled as the study group. The two groups were compared in terms of baseline data, changes in related metabolic markers[fasting insulin (FIN), glycosylated hemoglobin (HbAlc), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] after treatment, incidence rate of metabolic syndrome, and clinical outcome.@*RESULTS@#There were no significant differences in the baseline data including age, sex, and course of disease between the two groups (@*CONCLUSIONS@#Atypical antipsychotic drugs combined with mood stabilizer in the treatment of bipolar disorder in children have little effect on the level of metabolic markers, and the curative effect is significant.


Subject(s)
Antipsychotic Agents/therapeutic use , Biomarkers/blood , Bipolar Disorder/drug therapy , Child , Cholesterol, HDL , Humans , Mood Disorders , Retrospective Studies , Triglycerides
17.
Rev. enferm. UERJ ; 27: e43934, jan.-dez. 2019. ilus
Article in Portuguese | LILACS, BDENF | ID: biblio-1097673

ABSTRACT

Objetivo: identificar os determinantes sociais de saúde dos pacientes com transtorno afetivo bipolar (TAB), sua distribuição espacial e a adesão ao tratamento. Métodos: estudo descritivo e transversal, com amostragem não probabilística, realizado no Centro de Atenção Psicossocial de Divinópolis/Minas Gerais, no período de fevereiro/2017 a fevereiro/2018 com 35 pacientes diagnosticados com TAB, submetidos a um questionário, escala clínica e telefonemas. Análise estatística realizada através de técnicas univariadas e multivariadas. Estudo aprovado por Comitê de Ética em Pesquisa. Resultados: a maioria da população estudada apresentou predição positiva à adesão ao tratamento, que se associou ao sexo, idade, estilo de vida saudável, apoio de redes sociais e comunitárias, saneamento básico, acesso a serviços sociais de saúde e benefício do governo. Conclusão: a adesão ao tratamento é um produto da interação entre as dimensões relacionadas ao paciente, ao serviço de saúde, aos fatores socioeconômicos e à terapêutica proposta.


Objective: to identify the health social determinants of patients with bipolar affective disorder (BAD), their spatial distribution and treatment adherence. Methods: a descriptive and cross-sectional study with non-probabilistic sampling, carried out at the Psychosocial Care Center of Divinópolis/Minas Gerais, from February/2017 to February/2018 with 35 patients diagnosed with BAD, submitted to a questionnaire, clinical scale and phone calls. Analysis performed through univariate and multivariate techniques. Study approved by the Research Ethics Committee. Results: most of the population studied had a positive prediction for treatment adherence, which was associated with gender, age, healthy lifestyle, support from social and community networks, basic sanitation, access to social health services and government benefit. Conclusion: adherence to treatment is a product of the interaction between the dimensions related to the patient, the health service, the socioeconomic factors and the proposed therapy.


Objetivo: identificar los determinantes sociales de la salud de pacientes con trastorno afectivo bipolar (TAB), su distribución espacial y la adherencia al tratamiento. Métodos: estudio descriptivo y transversal con muestreo no probabilístico, realizado en el Centro de Atención Psicosocial de Divinópolis/Minas Gerais, de febrero/2017 a febrero/2018 con 35 pacientes diagnosticados de TAB, sometidos a un cuestionario, escala clínica y llamadas telefónicas. Análisis realizado a través de técnicas univariadas y multivariadas. Estudio aprobado por Comité de Ética en Investigación. Resultados: La mayoría de la población estudiada tenía una predicción positiva para la adherencia al tratamiento, que se asoció con el género, la edad, el estilo de vida saludable, el apoyo de las redes sociales y comunitarias, el saneamiento básico, el acceso a los servicios de salud social y los beneficios del gobierno. Conclusión: la adherencia al tratamiento es producto de la interacción entre las dimensiones relacionadas con el paciente, el servicio de salud, los factores socioeconómicos y la terapia propuesta.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Socioeconomic Factors , Bipolar Disorder/diagnosis , Bipolar Disorder/therapy , Demography , Social Determinants of Health , Treatment Adherence and Compliance , Bipolar Disorder/prevention & control , Bipolar Disorder/psychology , Cross-Sectional Studies , Mood Disorders , Health Services Accessibility
18.
Arq. gastroenterol ; 56(4): 351-356, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055176

ABSTRACT

ABSTRACT BACKGROUND: Physical activity in daily life and exercise capacity have not been assessed in patients with Crohn's disease to date. OBJECTIVE: To evaluate the physical activity in daily life, exercise capacity, quality of life, and prevalence of mood disorders in patients with moderate-to-severe Crohn's disease on infliximab-induced remission and the possible associations among variables. METHODS: A cross-sectional preliminary study was conducted. Twenty-six patients with Crohn's disease and 20 controls were selected. Participants underwent evaluation of physical activity in daily life (triaxial accelerometer), exercise capacity (shuttle walk test), handgrip strength, quality of life, and presence of mood disorders. RESULTS: The number of steps taken (7446±3081 vs 7898±2487), active time (80.6±42 vs 89.7±24.3min), shuttle walk test distance [665 (405) vs 710 (409) m] and handgrip strength [31 (15) vs 29 (20) kgf did not show any difference between the patients with Crohn's disease and the controls. The time spent lying down [95.8 (68.8) vs 60.9 (74.7) min] was greater and some domains of the quality of life were superior in the patients with Crohn's disease. No correlation was observed between the physical activity in daily life and quality of life or presence of mood disorders in patients with Crohn's disease. CONCLUSION: Patients with Crohn's disease on infliximab-induced remission, despite to more time spent lying down, they have the same level of physical activity in daily life and exercise capacity min compared with the controls.


RESUMO CONTEXTO: A atividade física na vida diária e a capacidade de exercício não tem sido avaliada em pacientes com doença de Crohn. OBJETIVO: Avaliar a atividade física na vida diária, capacidade de exercício, qualidade de vida e distúrbios de humor em pacientes com doença de Crohn moderada-grave em remissão induzida pelo infliximabe, e as possíveis associações entre essas variáveis. MÉTODOS: Este foi um estudo preliminar transversal, envolvendo 26 pacientes com doença de Crohn e 20 controles. Os participantes realizaram as seguintes avaliações: atividade física na vida diária por meio de um acelerômetro triaxial, capacidade de exercício (teste de Shuttle), força de preensão palmar, qualidade de vida e distúrbios do humor. RESULTADOS: O número de passos registrados (7446±3081 vs 7898±2487), o tempo ativo (80,6±42,0 vs 89,7±24,3min), a distância caminhada no teste de Shuttle 665 (405) vs 710 (409) m, e a força de preensão manual 31(15) vs 29 (20) kgf não mostraram diferenças entre os pacientes com doença de Crohn e os controles, respectivamente. O tempo gasto na posição deitada 95.8 (68.8) vs 60.9 (74.7) min, e alguns domínios da qualidade de vida foram maiores nos pacientes com doença de Crohn. Nenhuma correlação foi observada entre a atividade física na vida diária e a qualidade de vida ou distúrbios do humor nos pacientes com doença de Crohn. CONCLUSÃO: Pacientes com doença de Crohn em remissão induzida por infliximabe, apesar de passarem mais tempo deitados, apresentam mesmo nível de atividade física e capacidade de exercício quando comparados aos controles.


Subject(s)
Humans , Male , Female , Adult , Quality of Life , Gastrointestinal Agents/administration & dosage , Exercise/psychology , Crohn Disease/psychology , Crohn Disease/drug therapy , Mood Disorders/psychology , Infliximab/administration & dosage , Severity of Illness Index , Crohn Disease/radiotherapy , Case-Control Studies , Prevalence , Cross-Sectional Studies , Exercise Tolerance
19.
Arq. gastroenterol ; 56(4): 357-360, Oct.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1055175

ABSTRACT

ABSTRACT BACKGROUND: Non-alcoholic fatty liver disease is characterized by deposition of lipids in the hepatic parenchyma exceeding 5% of liver weight in the absence of other conditions, such as viral or alcoholic hepatitis and metabolic disease. Non-alcoholic fatty liver disease is the most common form of chronic liver disease in several countries. In addition to liver complications, recent studies have shown a relation between liver fat and sarcopenia. OBJECTIVE: Determine the association between sarcopenia and the severity of non-alcoholic hepatic steatosis diagnosed by abdominal ultrasonography. METHODS: A clinical, cross-sectional study was conducted with a sample of male and female adults (18 to 70 years of age) submitted to ultrasonography for the investigation of non-alcoholic hepatic steatosis. Evaluations were also performed for the determination of upper and lower limb muscle strength. Data analysis was performed with the aid of the SPSS 22.0 program and involved ANCOVA and the Bonferroni post hoc test, with P-value <0.05 considered indicative of statistical significance. RESULTS: One hundred two patients were submitted to abdominal ultrasonography, 57.8% of whom presented some degree of non-alcoholic hepatic steatosis. The presence and degree of fatty liver infiltration were significantly associated with the sarcopenic index, determined by the ratio between upper and lower limb strength and BMI (P=0.009 and post-test P=0.028 for upper limbs; P=0.006 and post-test P=0.013 for lower limbs). CONCLUSION: In the present study, an association was found between the sarcopenic index and non-alcoholic hepatic steatosis, with an inversely proportional relation between this index and the severity of fatty infiltration. This finding offers further evidence of the metabolic interaction of the liver, adipose tissue and muscle.


RESUMO CONTEXTO: A doença hepática gordura não-alcoólica caracteriza-se pela deposição de lipídios no parênquima hepático, excedendo 5% do peso do fígado na ausência de outras afecções como hepatites virais, alcoólicas ou doenças metabólicas. A doença hepática gordura não-alcoólica tem sido observada como a forma mais comum de doença hepática crônica em diversos países. Além das complicações hepáticas, estudos recentes têm demonstrado a relação entre a presença de gordura hepática e a sarcopenia. OBJETIVO: Determinar a associação entre a sarcopenia e a gravidade da esteatose hepática não-alcoólica diagnosticada pela ultrassonografia abdominal. MÉTODOS: Estudo clínico e transversal com amostra de pacientes de ambos os sexos, de 18 a 70 anos de idade, diagnosticados como portadores ou não de esteatose hepática não-alcoólica pela ultrassonografia e submetidos à avaliação da força muscular dos membros superiores e inferiores. Os dados foram inseridos no programa estatístico SPSS 22.0, analisados através do teste ANCOVA e pós-teste de Bonferroni, sendo considerado significante P<0,05. RESULTADOS: Foram avaliados pela ultrassonografia abdominal 102 pacientes e destes, 57,8% apresentaram algum grau de esteatose hepática não-alcoólica. A presença e os graus da infiltração gordurosa no fígado tiveram associação estatisticamente significativa com o índice sarcopênico, determinado pela razão entre força muscular dos membros superiores e inferiores e o IMC (P=0,009 e pós-teste P=0,028 MMSS; P=0,006 e pós-teste P=0,013 MMII). CONCLUSÃO: Observou-se associação entre o índice sarcopênico e a presença de esteatose hepática não-alcoólica, com relação inversamente proporcional entre esse índice e a gravidade da infiltração gordurosa, reforçando a interação do eixo metabólico entre fígado, tecido adiposo e músculo.


Subject(s)
Humans , Male , Female , Adult , Quality of Life/psychology , Gastrointestinal Agents/administration & dosage , Exercise/psychology , Crohn Disease/psychology , Crohn Disease/drug therapy , Mood Disorders/diagnosis , Severity of Illness Index , Crohn Disease/parasitology , Case-Control Studies , Prevalence , Cross-Sectional Studies , Exercise Tolerance , Infliximab/administration & dosage
20.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(5): 428-432, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1039099

ABSTRACT

Objective: Fibromyalgia (FM) patients have higher rates of depression and anxiety disorders than healthy controls. Affective temperament features are subclinical manifestations of mood disorders. Our aim was to evaluate the affective temperaments of FM patients and investigate their association with depression and anxiety levels and clinical findings. Methods: This cross-sectional study included FM patients and healthy controls. The Hospital Anxiety and Depression Scale (HADS) was used to determine patient anxiety and depression levels, and the Temperament Scale of Memphis, Pisa and San Diego, self-administered version was applied to assess affective temperaments in all subjects. Disease severity was assessed in FM patients with the Fibromyalgia Criteria and Severity Scales and the Fibromyalgia Impact Questionnaire (FIQ). Differences between groups were evaluated using Student's t-tests. Correlations among parameters were performed. Results: This study involved 38 patients with FM (30 female) and 30 healthy controls (25 female). Depressive, anxious and cyclothymic temperaments were significantly higher in FM patients than healthy controls. Statistically significant positive correlations were found between HADS depression score and all temperaments except hyperthymic, as well as between HADS anxiety score and cyclothymic and anxious temperaments. HADS depression and anxiety scores were correlated with symptom severity. We found a higher risk of depression and anxiety among FM patients with higher FIQ scores. Conclusion: This study is the first to evaluate affective temperament features of FM patients. Evaluating temperamental traits in FM patients may help clinicians determine which patients are at risk for depression and anxiety disorders.


Subject(s)
Humans , Male , Female , Adult , Anxiety Disorders/psychology , Temperament , Fibromyalgia/psychology , Mood Disorders/psychology , Depressive Disorder/psychology , Personality Inventory , Psychiatric Status Rating Scales , Severity of Illness Index , Case-Control Studies , Pilot Projects , Cross-Sectional Studies , Surveys and Questionnaires , Statistics, Nonparametric , Affective Symptoms/psychology , Middle Aged
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