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2.
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
3.
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
4.
Trends psychiatry psychother. (Impr.) ; 41(1): 9-17, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004840

ABSTRACT

Abstract Objective To explore and describe a profile of patients admitted to a psychiatric emergency facility, comparing patients with and without a recent suicide attempt in terms of their clinical characteristics and aggression. Methods This was an exploratory comparative study where patients were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Scale (OAS). Participants with a suicide attempt in the last 24 hours (SA) were compared to participants with a prior history of suicide attempt but no recent attempt (PHSA). Results 63 individuals (SA: 26; PHSA: 37) were selected. Both groups had similar demographic and clinical characteristics. The most prevalent diagnoses were mood (57.1%) and personality (50.8%) disorders. The majority of patients in both groups had a history of aggression episodes. Physical aggression in the week prior to admission was more prevalent in the PHSA group (51.4 vs. 19.2%, p = 0.017). The PHSA group also presented higher activation scores (p = 0.025), while the SA group presented higher affect scores on BPRS dimensions (p = 0.002). Conclusion The majority of individuals with a history of suicide attempt also presented a history of aggression. Inpatients with recent suicide attempt were hospitalized mainly due to the risk of suicide, while those with no recent suicide attempt were hospitalized mainly due to the risk of hetero-aggression. These findings support the hypothesis of an aggressive profile in suicidal patients and may open up a path for future research.


Resumo Objetivo Explorar e descrever o perfil de pacientes internados em uma unidade de emergência psiquiátrica, comparando os pacientes com e sem tentativa recente de suicídio em termos de suas características clínicas e agressividade. Métodos Trata-se de um estudo exploratório comparativo, onde os pacientes foram avaliados por meio da Escala Breve de Avaliação Psiquiátrica (BPRS) e da Escala de Agressividade Declarada (OAS). Os participantes com tentativa de suicídio (TS) nas últimas 24 horas foram comparados com participantes com história prévia de tentativa de suicídio, mas sem tentativa recente (HPTS). Resultados Foram selecionados 63 indivíduos (TS: 26; HPTS: 37). Ambos os grupos tinham características demográficas e clínicas semelhantes. Os diagnósticos mais prevalentes foram transtornos de humor (57,1%) e de personalidade (50,8%). A maioria dos pacientes em ambos os grupos apresentava história de agressão. A agressão física na semana anterior à internação foi mais prevalente no grupo HPTS (51,4 vs. 19,2%, p = 0,017). O grupo HPTS também apresentou maior ativação (p = 0,025), enquanto o grupo TS apresentou maior afetividade nas dimensões da BPRS (p = 0,002). Conclusão A maioria dos indivíduos com história de tentativa de suicídio também apresentou história de agressão. Os pacientes internados com tentativa recente de suicídio foram hospitalizados principalmente devido ao risco de suicídio, enquanto aqueles sem tentativa recente de suicídio foram hospitalizados principalmente devido ao risco de heteroagressão. Esses achados apoiam a hipótese de um perfil agressivo em pacientes suicidas e podem abrir caminho para pesquisas futuras.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Aggression/physiology , Mental Disorders/physiopathology , Personality Disorders/physiopathology , Personality Disorders/therapy , Suicide, Attempted/statistics & numerical data , Mood Disorders/physiopathology , Mood Disorders/therapy , Emergency Services, Psychiatric/statistics & numerical data , Hospitalization/statistics & numerical data , Mental Disorders/therapy , Middle Aged
5.
Trends psychiatry psychother. (Impr.) ; 39(3): 207-215, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-904588

ABSTRACT

Abstract Introduction The objective of this study was to conduct a review of the literature covering the use of different mindfulness-based therapy approaches in treatment of mood and anxiety disorders, including mindfulness skills and mindfulness linked to emotional regulation and fear of negative appraisal. Methods A review was conducted of literature identified by searching the scientific databases PubMed and PsycINFO with the following keywords: mindfulness, mood disorders, and anxiety disorders. The search covered the past 10 years. The search returned 532 articles, 24 were selected, their full texts were read, and 16 were included in this review. Results Six articles about mindfulness-based stress reduction, four about mindfulness-based cognitive therapy, and three about fear of negative appraisal and emotional regulation were reviewed. All of the articles covered mindfulness in relation to mood and anxiety disorders. Conclusions The literature in this field suggests that mindfulness is an effective strategy for the treatment of mood and anxiety disorders and is effective in therapy protocols with different structures including virtual modalities. Use of mindfulness in scientific models continues to expand.


Resumo Introdução O objetivo deste estudo foi fazer uma revisão da literatura abrangendo o uso das diferentes abordagens da terapia baseada em mindfulness no tratamento dos transtornos de humor e ansiedade, incluindo suas habilidades e sua relação com a regulação emocional e com o medo da avaliação negativa. Métodos Uma revisão de literatura foi realizada através de busca pelas bases científicas PubMed e PsycINFO, com as seguintes palavras-chave: mindfulness, transtornos do humor e transtornos de ansiedade. A pesquisa abrangeu os últimos 10 anos. A busca resultou em 532 artigos, sendo 24 selecionados e 16 incluídos nesta revisão. Resultados Foram revisados seis artigos sobre programa de redução de estresse baseado em mindfulness, quatro artigos sobre terapia cognitiva baseada em mindfulness, e três sobre medo da avaliação negativa e regulação emocional. Todos os artigos abordaram mindfulness com relação aos transtornos de humor e ansiedade Conclusão A literatura nessa área sugere que mindfulness é uma estratégia eficaz no tratamento dos transtornos de humor e ansiedade e é eficaz no protocolo de terapia em diferentes formatos, incluindo virtual. O uso de mindfulness continua a se expandir nos modelos científicos.


Subject(s)
Humans , Anxiety Disorders/therapy , Mood Disorders/therapy , Mindfulness , Cognitive Behavioral Therapy/methods
6.
Rev. chil. pediatr ; 88(2): 294-299, abr. 2017.
Article in Spanish | LILACS | ID: biblio-844616

ABSTRACT

Las Medicinas Complementarias/alternativas (MCA) cada día son más utilizadas por los pacientes, incluidos niños y adolescentes. En Chile el Ministerio de Salud (Minsal), ha ido reconociendo y regulando alguna de ellas, aunque todavía existe gran desconocimiento sobre su efectividad y seguridad. OBJETIVO: Revisar la evidencia disponible en relación a las MCA en adolescentes con Trastorno déficit atencional/hiperactividad (TDAH) y trastornos del ánimo. METODOLOGÍA: Se realizó una búsqueda bibliográfica en PubMed de artículos de revisión del tema, publicados los últimos 10 años, con las palabras claves "Complementary/Alternative Medicine/Therapies"; "Attention deficit disorder with hyperactivity" y "Mood disorders" combinadas con "Children/Adolescents". Se complementó con otras fuentes de información consideradas relevantes. RESULTADOS: Mundialmente ha habido un aumento progresivo de publicaciones en relación a MCA. No obstante, no todos los estudios son de buena calidad metodológica, y la mayoría de los estudios en población infanto-juvenil señalan resultados inconclusos. En TDAH se han demostrado beneficios con ácidos grasos omega 3. En relación a otras MCA y TDAH, no se han demostrado efectos favorables superior al placebo. Varios estudios presentan fallas metodológicas y hacen faltan más estudios, lo cual imposibilita tener conclusiones al respecto. En trastornos del ánimo, hay varias terapias promisorias, como es el ejercicio físico, la terapia de luz, la hierba de San Juan y algunos tipo de meditación como el Mindfulness. En Chile, todavía no hay estudios en este grupo etario, siendo importante poder desarrollar líneas de investigación en esta área en virtud de la situación actual del país.


The Complementary/Alternative Medicine (CAM) have been increasingly used by patients such as children and adolescents. The Ministry of Health in Chile (MINSAL) has recognized and regulated some CAM, although there is still unknown their effectiveness and safety of these. OBJECTIVE: Review the available evidence regarding the use of CAM in adolescents with the attention deficit hyperactivity syndrome (ADHD) and mood disorders. METHODOLOGY: A review of the related literature about this topic on PubMed, focus on the last 10 years and using as a keywords Complementary/Alternative Medicine/Therapies, Attention deficit disorder with hyperactivity, Mood disorders, and Children/Adolescents. The revision was also complemented with other sources of information. RESULTS: Globally there has been a progressive increase in publications in relation to the CAM. However, not all studies follow a good methodology and the majority of the studies in adolescents show inconclusive results. The ADHD studies have shown benefits when using omega 3 fatty acids. Regarding other CAM and ADHD, the evidence does not show any favorable results beyond placebo. Though some of these studies have methodological mistakes or lack of enough studies, making it impossible to have conclusive. In mood disorders, there are several promising therapies, such as: physical exercise, light therapy, St. John’s Wort and some kinds of meditation like Mindfulness. In Chile, there are still no studies in this age group, which makes important the development of a line of research in this area.


Subject(s)
Humans , Adolescent , Attention Deficit Disorder with Hyperactivity/therapy , Complementary Therapies/methods , Mood Disorders/therapy , Research Design , Fatty Acids, Omega-3/administration & dosage , Chile
8.
Trends psychiatry psychother. (Impr.) ; 35(2): 134-140, 2013. tab
Article in English | LILACS | ID: lil-683361

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of a unified cognitive-behavioral therapy protocol for group treatment of patients with a range of comorbid mood and anxiety disorders. METHODS: In this open-trial study, the unified protocol was followed for the psychotherapeutic treatment of 16 patients with comorbid mood and anxiety disorders, confirmed by the Mini International Neuropsychiatric Interview. Beck Depression and Anxiety Inventories, the World Health Organization Quality of Life evaluation instrument, and the ARIZONA scale of sexual function were used to evaluate progress in patients throughout the therapeutic process. RESULTS: All patients showed unipolar depressive disorder. Comorbidity with anxiety disorders was distributed as follows: generalized anxiety disorder, 13 (81.3%); panic disorder, 3 (18.8%); social anxiety disorder, 1 (6.3%); and post-traumatic stress disorder, 1 (6.3%). Improvement was observed in the signs and symptoms of depression (F = 78.62, p < 0.001) and anxiety (F = 19.64, p < 0.001), overall quality of life (F = 39.72, p < 0.001), physical domain (F = 28.15, p < 0.001)), psychological variables (F = 9.90, p = 0.007), social functioning (F = 36.86, p < 0.001), environmental variables (F = 27.63, p < 0.001), and sexuality (F = 13.13; p < 0.005). All parameters showed highly significant correlations (p < 0.01). CONCLUSION: An effort to establish one unified treatment protocol for a whole family of emotional disorders (primarily mood and anxiety disorders) showed benefits in the field of clinical psychology and for the treatment of patients. No other data were found in the literature describing the implementation of the unified protocol in a transdiagnostic group. Our results revealed statistically significant improvement in all variables, suggesting that the protocol proposed can become an important tool to improve quality of life, sexuality, and anxiety/depression symptoms in patients with different diagnoses


OBJETIVO: Avaliar a eficácia de um protocolo unificado de terapia cognitivo-comportamental para tratamento em grupo de pacientes com diferentes transtornos de humor e ansiedade comórbidos. MÉTODOS: Neste estudo aberto, o protocolo unificado foi seguido no tratamento psicoterápico de 16 pacientes com transtornos de humor e ansiedade comórbidos, confirmados pelo Mini International Neuropsychiatric Interview. Os Inventários de Depressão e Ansiedade de Beck, o instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde e a escala ARIZONA de função sexual foram utilizados para avaliar o progresso em pacientes ao longo de todo o processo terapêutico. RESULTADOS: Todos os pacientes tinham transtorno depressivo unipolar. A comorbidade com transtornos de ansiedade apresentou a seguinte distribuição: transtorno de ansiedade generalizada, 13 (81,3%); transtorno do pânico, 3 (18,8%); fobia social, 1 (6,3%); e transtorno do estresse pós-traumático, 1 (6,3%). Foi observada melhora nos sinais e sintomas de depressão (F = 78,62, p < 0,001) e ansiedade (F = 19,64, p < 0,001), na qualidade de vida geral (F = 39,72, p < 0,001), no domínio físico (F = 28,15, p < 0,001)), em variáveis psicológicas (F = 9,90, p = 0,007), funcionamento social (F = 36,86, p < 0,001), variáveis ambientais (F = 27,63, p < 0,001) e sexualidade (F = 13,13; p < 0,005). Todos os parâmetros demonstraram correlações altamente significativas (p < 0,01). CONCLUSÃO: O esforço para estabelecer um protocolo unificado de tratamento para toda uma família de transtornos emocionais (especialmente humor e ansiedade) mostrou benefícios na área da psicologia clínica e no tratamento dos pacientes. Não foram encontrados outros dados na literatura descrevendo a implementação do protocolo unificado em um grupo transdiagnóstico. Nossos resultados revelaram uma melhora estatisticamente significativa em todas as variáveis, sugerindo que o protocolo proposto pode se tornar uma ferramenta importante para melhorar qualidade de vida, sexualidade e sintomas de ansiedade/depressão em pacientes com diferentes diagnósticos


Subject(s)
Humans , Anxiety/complications , Outcome and Process Assessment, Health Care/standards , Clinical Protocols/standards , Mood Disorders/diagnosis , Anxiety/therapy , Outcome and Process Assessment, Health Care/methods , Mood Disorders/therapy
9.
Rev. bras. psiquiatr ; 35(supl.1): S32-S39, 2013. tab, graf
Article in English | LILACS | ID: lil-687951

ABSTRACT

Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.


Subject(s)
Adolescent , Child , Humans , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Bipolar Disorder/diagnosis , Irritable Mood , Mood Disorders/diagnosis , Anger , Attention Deficit and Disruptive Behavior Disorders/therapy , Bipolar Disorder/therapy , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Irritable Mood/drug effects , Mood Disorders/therapy , Psychiatric Status Rating Scales
10.
Rev. bras. psiquiatr ; 35(supl.1): S22-S31, 2013. tab, graf
Article in English | LILACS | ID: lil-687953

ABSTRACT

The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.


Subject(s)
Adolescent , Child , Humans , Bipolar Disorder , Depression , Mood Disorders , Bipolar Disorder/diagnosis , Bipolar Disorder/therapy , Diagnostic and Statistical Manual of Mental Disorders , Depression/diagnosis , Depression/therapy , Mood Disorders/diagnosis , Mood Disorders/therapy , Psychotherapy , Psychotropic Drugs/adverse effects , Psychotropic Drugs/therapeutic use
11.
São Paulo; s.n; 20 jan. 2012. 62 p. tab, graf.
Non-conventional in Portuguese | LILACS, AHM-Producao, SMS-SP, CAMPOLIMPO-Producao, SMS-SP, SMS-SP | ID: lil-642626

ABSTRACT

Este estudo tem como objetivo geral realizar uma análise do perfil das práticas do emprego de lítio para tratamento de transtornos do humor bipolar por psiquiatras da rede pública de saúde a partir de uma revisão bibliográfica sobre aspectos práticos do uso desse fármaco. Após aplicação de um questionário (Apêndice 1), elaborado pelos pesquisadores, dirigido a psiquiatras da rede pública de saúde, na zona sul da cidade de São Paulo, região do Campo Limpo, foi obtido um perfil das práticas utilizadas no emprego de lítio. Com base numa revisão bibliográfica a respeito do uso de carbonato de lítio no tratamento de transtornos do humor, discuti-se o perfil das práticas utilizadas no emprego do lítio, assim como: indicações; terapêutica; modo de usar; farmacocinética clínica; efeitos colaterais; sinais clínicos de intoxicação; monitoração sérica do lítio; concentrações terapêuticas; contra-indicações; exames complementares. O sucesso da litoterapia depende de avaliações clínicas adequadas e muito precisas por parte do profissional de saúde. Identificar as dificuldades na prática desses profissionais em relação ao uso do lítio pode contribuir, não somente aos profissionais, mas aos gerenciadores do sistema de saúde para estabelecer estratégias que possam melhorar essa terapêutica possibilitando benefícios aos pacientes e a sistema de saúde.


Subject(s)
Humans , Lithium Carbonate/therapeutic use , Lithium/therapeutic use , Bipolar Disorder/therapy , Mood Disorders/therapy
12.
São Paulo; s.n; 20 jan. 2012. 62 p. tab, graf.
Non-conventional in Portuguese | LILACS, ColecionaSUS, AHM-Producao, SMS-SP, CAMPOLIMPO-Producao, SMS-SP, SMS-SP | ID: biblio-937361

ABSTRACT

Este estudo tem como objetivo geral realizar uma análise do perfil das práticas do emprego de lítio para tratamento de transtornos do humor bipolar por psiquiatras da rede pública de saúde a partir de uma revisão bibliográfica sobre aspectos práticos do uso desse fármaco. Após aplicação de um questionário (Apêndice 1), elaborado pelos pesquisadores, dirigido a psiquiatras da rede pública de saúde, na zona sul da cidade de São Paulo, região do Campo Limpo, foi obtido um perfil das práticas utilizadas no emprego de lítio. Com base numa revisão bibliográfica a respeito do uso de carbonato de lítio no tratamento de transtornos do humor, discuti-se o perfil das práticas utilizadas no emprego do lítio, assim como: indicações; terapêutica; modo de usar; farmacocinética clínica; efeitos colaterais; sinais clínicos de intoxicação; monitoração sérica do lítio; concentrações terapêuticas; contra-indicações; exames complementares. O sucesso da litoterapia depende de avaliações clínicas adequadas e muito precisas por parte do profissional de saúde. Identificar as dificuldades na prática desses profissionais em relação ao uso do lítio pode contribuir, não somente aos profissionais, mas aos gerenciadores do sistema de saúde para estabelecer estratégias que possam melhorar essa terapêutica possibilitando benefícios aos pacientes e a sistema de saúde.


Subject(s)
Humans , Bipolar Disorder/therapy , Lithium Carbonate/therapeutic use , Lithium/therapeutic use , Mood Disorders/therapy
13.
Clinics ; 67(1): 3-9, 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-610617

ABSTRACT

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5 percent); those with substance abuse disorders alone had the lowest (40 percent); and those with both disorders had an intermediate rate of adherence (50 percent). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6 percent and 72.9 percent, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.


Subject(s)
Adolescent , Child , Female , Humans , Male , Young Adult , Child Abuse/psychology , Homeless Youth/psychology , Mood Disorders/psychology , Patient Compliance/psychology , Substance-Related Disorders/psychology , Brazil , Crime Victims/psychology , Epidemiologic Methods , Family , Mental Disorders/diagnosis , Mental Disorders/therapy , Mood Disorders/therapy , Patient Compliance/statistics & numerical data , Substance-Related Disorders/therapy , Time Factors
14.
J. pediatr. (Rio J.) ; 87(5): 373-381, set.-out. 2011.
Article in Portuguese | LILACS | ID: lil-604427

ABSTRACT

OBJETIVOS: Revisar aspectos epidemiológicos e etiológicos do diagnóstico e tratamento dos transtornos do humor em crianças e adolescentes, com foco em conteúdos essenciais para médicos pediatras. FONTES DOS DADOS: Revisão da literatura no banco de dados da MEDLINE. Utilização das recomendações da quarta edição do texto revisado do Manual Diagnóstico e Estatístico de Transtornos Mentais da Associação Americana de Psiquiatria. Análise crítica dos atuais critérios diagnósticos e teorias científicas sobre etiologia dos transtornos do humor. SÍNTESE DOS DADOS: Foram identificadas opiniões discordantes e congruentes sobre a efetividade de se utilizar os mesmos critérios atualmente listados no Manual Diagnóstico e Estatístico de Transtornos Mentais para diagnóstico de transtornos do humor em adultos, adolescentes e crianças. Embora esse tópico tenha sido muito debatido na literatura dos últimos 10 anos, a percepção é de que uma porcentagem significativa de casos continuam sendo subdiagnosticados devido à utilização dos mesmos critérios independente da faixa etária. Os diversos estudos epidemiológicos realizados na população infantil fundamentam-se nesses critérios para cálculos de prevalência, o que tornam duvidosos os números atualmente publicados. Embora a neurociência tenha alcançado grandes avanços no conhecimento dessas patologias, ainda é necessário um melhor entendimento sobre como os fatores genéticos e ambientais interagem e influenciam a origem, gravidade e resposta ao tratamento. CONCLUSÕES: Os transtornos do humor são patologias de alta prevalência na infância e adolescência, com grande impacto na vida dos portadores no longo prazo. Constatamos a necessidade de aprimorar os critérios diagnósticos, adequando-os à população infantil, com objetivo de facilitar ao clínico, particularmente ao pediatra, diagnóstico e intervenção precoce. Avanços na área de epigenética podem colaborar para o desenvolvimento de outras abordagens preventivas, diagnósticas e terapêuticas.


OBJECTIVES: To review epidemiological and etiologic aspects of diagnosis and treatment of mood disorders (MDs) in children and adolescents, with a focus on essential information for pediatricians. SOURCES: A literature search on MEDLINE, a review of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition (text revision) (DSM-IV-TR), and a critical analysis of current diagnostic criteria and scientific evidence regarding the etiology of mood disorders were performed. SUMMARY OF THE FINDINGS: We identified diverging opinions for and against the proposition of using the same criteria used for adults, as listed in the DSM-IV-TR, for diagnosing mood disorders in children and adolescents. Although there has been much debate in the literature on this topic in the last decade, there remains a concern that there may be a significant under-diagnosis of cases due to differing methods. Several epidemiological studies conducted in pediatric populations using different criteria and methods make it difficult to interpret the data currently published. Although the field of neurosciences has achieved major advances in understanding these pathologies, additional investigations are needed to gain a clearer picture of how genetic and environmental factors interact and influence the origin and severity of the disease and the patient’s response to treatment. CONCLUSIONS: MDs have a high prevalence in childhood and adolescence and have major long-term impacts on sufferer’s lives. There is a need to improve diagnostic criteria, adapting them for the pediatric population, with the objective of making it simpler for clinicians, particularly pediatricians, to make diagnoses and initiate early intervention. Advances in the area of epigenetics may aid in the development of new preventative, diagnostic, and therapeutic approaches.


Subject(s)
Adolescent , Child , Humans , Mood Disorders , Pediatrics/education , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Early Diagnosis , Mood Disorders/diagnosis , Mood Disorders/epidemiology , Mood Disorders/etiology , Mood Disorders/therapy
15.
Rev. chil. neuro-psiquiatr ; 49(3): 265-272, 2011. ilus
Article in Spanish | LILACS | ID: lil-608779

ABSTRACT

Objetivo: Describir las características de la prescripción del reposo médico de causa psiquiátrica en un servicio de atención especializado. Métodos: Se registraron las atenciones psiquiátricas y las licencias médicas emitidas en un período de 3 meses (julio a septiembre 2009). Resultados: En el período se realizaron 3.105 consultas psiquiátricas, indicándose licencia médica en 399 atenciones (12,7 por ciento). Se eliminaron 16 y se trabajó con 383 licencias. De estas, 184 (48 por ciento) fueron 1° licencia en el período, 190 (49,6 por ciento) fueron prórroga de anterior y 9 (2,3 por ciento) fueron repetición de reposo. El número de pacientes beneficiados con la indicación de reposo fue de 228 (12 por ciento). Los trastornos del ánimo dieron cuenta de un 78,1 por ciento de las licencias y se prescribieron más frecuentemente en mujeres (68,9 por ciento). La duración total del reposo fue 25,5 +/- 20 días y la mediana fue 15. Discusión: En un servicio especializado de Psiquiatría las atenciones generaron 12,7 por ciento de prescripción de licencias médicas. La gravedad de los casos puede explicar la alta frecuencia de prórrogas y repetición de licencias. Los trastornos del ánimo son los diagnósticos más frecuentemente consignados como causa de la licencia médica. Este trabajo aporta datos técnicos sobre el uso y características de la licencia médica psiquiátrica en Chile.


Objectives: To characterize sick leaves prescription in a specialized psychiatric service. Methods: We recorded all of psychiatric attentions as well as all of sick-leaves prescribed during a three months period (July to September, 2009). Results: 3,105 attentions were done, whit a 12,7 percent (399 attentions) of them resulting in a sick-leave prescription, corresponding to 228 out-patients. We discarded 16 sick-leaves because incomplete information. 184 (48 percent) sick-leaves were prescribed in a first visit, 190 (49,6 percent) were a prolongation of a previous sick-leave prescription, and 9 (2,3 percent) were prescribed after a working period posterior to a previous rest. Affective disorder were the most frequent diagnosis observed in sick-leave prescription (78,1 percent), being more frequent in women (68,9). The mean of rest was 25,5 +/- 20 days with a median of 15 days. Discussion: A 12,7 percent of psychiatric attention generated a sick-leave prescription. Severity of disorders seen in a specialized psychiatric service could explain this finding. Our results confirm Affective Disorders are the principal cause of sick-leave prescription. This study add technical knowledge about feature and uses of psychiatric sick-leaves in Chile.


Subject(s)
Humans , Male , Adult , Female , Absenteeism , Sick Leave/statistics & numerical data , Mental Health Services/statistics & numerical data , Mental Disorders/epidemiology , Mental Disorders/therapy , Age and Sex Distribution , Ambulatory Care , Chile , Psychiatry/statistics & numerical data , Rest , Anxiety Disorders/epidemiology , Anxiety Disorders/therapy , Mood Disorders/epidemiology , Mood Disorders/therapy
16.
Psicofarmacologia (B. Aires) ; 10(62): 9-20, jun. 2010. ilus
Article in Spanish | LILACS | ID: lil-582229

ABSTRACT

La profusa información y postulaciones etiológicas relacionadas con el autismo optimizan su utilidad cuando resultan coherentes entre sí y pueden ser contrastadas con modelos de normalidad. Se trata de una difícil tarea que en los últimos tiempos es abordada con creciente rigurosidad y compromiso. El aporte que la Psicofarmacología puede constituir como parte del tratamiento requiere su contextualización en esta vasta, compleja y dinámica red de hallazgos y teorizaciones.


The abundant information and etiological propositions related with autism optimize its utility when there turns to be coherence between them, and when they can be compared against normality models. It is a difficult task which in recent times has been dealt with increasing thoroughness and commitment. The contribution that Psychopharmacology may constitute as part of the treatment of autism makes it necessary to contextualize it within the vast, complex and dynamic network of findings and theorizations.


Subject(s)
Humans , Medication Therapy Management , Anti-Anxiety Agents/pharmacokinetics , Anti-Anxiety Agents , Early Diagnosis , Serotonin Uptake Inhibitors/therapeutic use , Pharmacokinetics , Patient Care Planning/classification , Autistic Disorder/etiology , Autistic Disorder/therapy , Mood Disorders/therapy
17.
Journal of Research in Medical Sciences. 2010; 34 (1): 75-78
in Persian | IMEMR | ID: emr-108614

ABSTRACT

Conversion disorder is a type of disturbance in physical functions that does not conform to anatomical and physiological functions of central or peripheral nervous system. Being more common among adolescents, this disorder occurs following stress and results in disturbed organic functioning. Despite the high prevalence of its classic picture, this disorder also creates various uncommon clinical pictures and is often associated with the diagnosis of mood disorders, anxiety disorders and schizophrenia. The reported case was an example of conversion disorder associated with mood disorder presenting with severe elbow and finger contractions of the left side that occurred following trauma to the same hand and was associated with mood swings, aggression and suicidal ideas. All symptoms improved following electroconvulsive therapy. In patients with physical symptoms and signs, looking for personal and social factors is very important. Moreover, evaluation of other concurrent psychiatric disorders and their treatment is worthwhile


Subject(s)
Humans , Conversion Disorder/therapy , Mood Disorders/therapy
18.
IJMS-Iranian Journal of Medical Sciences. 2009; 34 (1): 72-75
in English | IMEMR | ID: emr-91307

ABSTRACT

Rheumatoid arthritis is a chronic systemic inflammatory disease that affects approximately 0.5-1% of the world population. The current approach to this disease is to start an intensive treatment without delay once the disease has developed. Various studies in the literature have shown that combination of disease modifying antirheumatic drugs such as sulfasalazine and chloroquine offers a more advantageous treatment. Although these drugs may cause central nervous system adverse effects such as serious psychiatric problems including mania and psychosis, these symptoms have been reported to occur only infrequently. The present case study reports a female patient who was hospitalized due to bipolar affective disorder-mixed episode. She had been receiving 250 mg/day chloroquine for 9 months for rheumatoid arthritis without exhibiting any adverse psychiatric effects. However, upon receiving a combination of 250 mg/day chloroquine and 2 gr/day sulfasalazine, she developed serious psychiatric symptoms


Subject(s)
Humans , Female , Chloroquine/adverse effects , Arthritis, Rheumatoid/drug therapy , Mood Disorders/etiology , Antirheumatic Agents , Bipolar Disorder , Psychotic Disorders , Affective Disorders, Psychotic , Mood Disorders/diagnosis , Mood Disorders/therapy , Central Nervous System/drug effects
19.
Article in Korean | WPRIM | ID: wpr-181026

ABSTRACT

OBJECTIVES: This study was performed to examine medical care utilization of psychiatric patients and to explore patients' characteristics associated with extended hospitalization. METHODS: Data were extracted from information of Korean Health Insurance Review and Assessment Service. All data associated with admission and outpatient clinic visit were analysed by patient characteristics. We selected first psychiatric admission patients who diagnosed mental and behavioral disorders due to use of alcohol (main disease code: F10), schizophrenia and related disorders (F20-29) and mood disorders (F30~33) from January to June 2005. We analysed status of admission, mean length of stay, regular access to outpatient clinic and rates of extended hospitalization during 3 years. Bivariate and multivariate analyses were conducted to identify factors associated with extended hospitalization. RESULTS: The number of psychiatric patients during the first six month of 2005 was 30,678. The mean length of stay was longest for schizophrenia and related disorders but shortest for mood disorders. Patients who experienced an extended hospitalization were 18.8% of total subjects. An extended hospitalization was more common in schizophrenia and related disorders than other diagnostic groups. The factors associated with the extended hospitalization were age, sex, diagnostic group, type of insurance and medical care utilization groups. CONCLUSIONS: The study indicates the problem of an extended hospitalization for psychiatric patients in Korea. It is suggested that variations in rates of extended hospitalization among medical care utilization group may need an active early intervention system in psychiatric treatment service. Particular attention needs to be devoted to planning and funding for reducing extended hospitalization.


Subject(s)
Adult , Alcoholism/therapy , Confidence Intervals , Female , Hospitalization/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Mental Disorders , Mental Health Services/statistics & numerical data , Middle Aged , Mood Disorders/therapy , Multivariate Analysis , Odds Ratio , Psychometrics , Psychotic Disorders/therapy , Republic of Korea , Schizophrenia/therapy , Time Factors , Young Adult
20.
Article in English | IMSEAR | ID: sea-157968

ABSTRACT

Pathological laughing and crying (PLC) is a disorder of emotional expression, accompanying various neurological and neuropsychiatric conditions. It causes significant distress and impairment in social and occupational functioning. It remains largely unrecognized in clinical settings and requires differentiation from other affective disorders. Validated instruments are available to aid in improving recognition of this disorder. Its pathophysiology is poorly understood. Antidepressants, dopaminergic and other newer agents have been reported to show varying levels of treatment success. This review describes the clinical features. pathophysiology and various treatment approaches available for PLC.


Subject(s)
Crying/physiology , Crying/psychology , Crying/therapy , Humans , Laughter/physiology , Laughter/psychology , Laughter/therapy , Mood Disorders/physiopathology , Mood Disorders/psychology , Mood Disorders/therapy , Prevalence
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