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1.
Evid. actual. práct. ambul ; 25(1): e002065, 2022. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1367549

ABSTRACT

La depresión es un trastorno del estado de ánimo que se caracteriza por la existencia de un sentimiento de tristeza lo suficientemente intenso como para interferir en el desarrollo de las actividades habituales. A partir de un caso clínico real, en el que una paciente con depresión solicita a su médico de cabecera sumar un suplemento de vitaminas a su plan terapéutico, revisamos la evidencia disponible sobre el uso de estos micronutrientes para el tratamiento de la depresión, y encontramos que no existen pruebas robustas que avalen la suplementación vitamínica en pacientes con este problema de salud. (AU)


Depression is a mood disorder characterised by the existence of a feeling of sadness intense enough to interfere with the performance of normal activities. Based on a real clinical case, in which a patient with depression asked her family doctor to add a vitamin supplement to her therapeutic plan, we reviewed the available evidence on the use of these micronutrients for the treatment of depression and found that there is no robust evidence to support vitamin supplementation in patients with this health problem. (AU)


Subject(s)
Humans , Female , Aged, 80 and over , Vitamin B Complex/therapeutic use , Vitamin D/therapeutic use , Depression/drug therapy , Folic Acid/therapeutic use , Anxiety , Exercise , Serotonin Uptake Inhibitors/therapeutic use , Depression/physiopathology , Depression/therapy , Systematic Reviews as Topic , Antidepressive Agents/therapeutic use
2.
Rev. bras. ginecol. obstet ; 43(2): 126-130, Feb. 2021. tab
Article in English | LILACS | ID: biblio-1156095

ABSTRACT

Abstract Objective The present study aimed to assess the effect of Melissa Officinalis L. (a combination of lemon balm with fennel fruit extract) compared with citalopram and placebo on the quality of life of postmenopausal women with sleep disturbance. Methods The present study is a randomized, double-blind, placebo clinical trial among 60 postmenopausal women with sleep disturbance who were referred to a university hospital from 2017 to 2019. The participants were randomized to receive M. Officinalis L. (500 mg daily), citalopram (30 mg) or placebo once daily for 8 weeks. The Menopause-Specific Quality of Life (MENQOL) questionnaire was self-completed by each participant at baseline and after 8 weeks of the intervention and was compared between groups. Results The mean for all MENQOL domain scores were significantly improved in the M. Officinalis L. group compared with citalopram and placebo (p < 0.001). The mean ± standard deviation (SD) after 8 weeks in the M. Officinalis L., citalopram and placebo groups was 2.2 ± 0.84 versus 0.56 ± 0.58 versus 0.36 ± 0.55 in the vasomotor (p < 0.001), 1.02 ± 0.6 versus 0.28 ± 0.2 versus 0.17 ± 0.1 in the psychomotor-social (p < 0.001), 0.76 ± 0.4 versus 0.25 ± 0.1 versus 0.11 ± 0.1 in the physical and 2.3 ± 1.0 versus 0.35 ± 0.5 versus 0.41 ± 0.5 in the sexual domain, respectively. Conclusions The results revealed that M. Officinalis L. may be recommended for improving the quality of life of menopausal women with sleep disturbance. Trial registration The present study was registered by the name "Comparison of the efficacy of citalopram and compound of Asperugo procumbens and foeniculum vulgare in treatment of menopausal disorders" with the code IRCT2013072714174N1 in the Iranian Registry of Clinical Trials (IRCT).


Subject(s)
Sleep Wake Disorders/drug therapy , Plant Extracts/therapeutic use , Citalopram/therapeutic use , Serotonin Uptake Inhibitors/therapeutic use , Melissa , Quality of Life , Sleep Wake Disorders/psychology , Plant Extracts/administration & dosage , Citalopram/administration & dosage , Double-Blind Method , Surveys and Questionnaires , Treatment Outcome , Serotonin Uptake Inhibitors/administration & dosage , Postmenopause , Iran , Phytotherapy , Middle Aged
4.
Arch. Clin. Psychiatry (Impr.) ; 47(1): 19-24, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088743

ABSTRACT

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


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Anxiety Disorders/complications , Panic Disorder/complications , Sleep Initiation and Maintenance Disorders/etiology , Anxiety Disorders/drug therapy , Anxiety Disorders/epidemiology , Tobacco Use Disorder/complications , Remission Induction , Case-Control Studies , Chronic Disease , Cross-Sectional Studies , Follow-Up Studies , Panic Disorder/drug therapy , Panic Disorder/epidemiology , Serotonin Uptake Inhibitors/therapeutic use , Disease-Free Survival , Serotonin and Noradrenaline Reuptake Inhibitors/therapeutic use , Sleep Initiation and Maintenance Disorders/epidemiology
5.
Article in English | LILACS | ID: biblio-1092138

ABSTRACT

ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.


RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.


Subject(s)
Humans , Female , Adolescent , Sleep Wake Disorders/diagnosis , Sleep Paralysis/complications , Sleep Paralysis/psychology , Fear/psychology , Anxiety/etiology , Anxiety/psychology , Recurrence , Sleep Wake Disorders/etiology , Social Change , Administration, Oral , Treatment Outcome , Fluvoxamine/administration & dosage , Fluvoxamine/therapeutic use , Serotonin Uptake Inhibitors/administration & dosage , Serotonin Uptake Inhibitors/therapeutic use , Sleep Paralysis/diagnosis , Sleep Paralysis/drug therapy , Diagnosis, Differential , Academic Performance/psychology , Hallucinations/etiology , Hallucinations/psychology
6.
Article in English | LILACS | ID: biblio-1057218

ABSTRACT

ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.


RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.


Subject(s)
Humans , Female , Adolescent , Sleep Wake Disorders/diagnosis , Sleep Paralysis/complications , Sleep Paralysis/psychology , Fear/psychology , Anxiety/etiology , Anxiety/psychology , Recurrence , Sleep Wake Disorders/etiology , Social Change , Administration, Oral , Treatment Outcome , Fluvoxamine/administration & dosage , Fluvoxamine/therapeutic use , Serotonin Uptake Inhibitors/administration & dosage , Serotonin Uptake Inhibitors/therapeutic use , Sleep Paralysis/diagnosis , Sleep Paralysis/drug therapy , Diagnosis, Differential , Academic Performance/psychology , Hallucinations/etiology , Hallucinations/psychology
7.
J. bras. nefrol ; 41(4): 492-500, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056600

ABSTRACT

Abstract Introduction: Intradialytic hypotension (IDH) is a major complication of hemodialysis, with a prevalence of about 25% during hemodialysis sessions, causing increased morbidity and mortality. Objective: To study the effects of sertraline to prevent IDH in hemodialysis patients. Methods: This was a double-blind, crossover clinical trial comparing the use of sertraline versus placebo to reduce intradialytic hypotension. Results: Sixteen patients completed the two phases of the study during a 12-week period. The IDH prevalence was 32%. A comparison between intradialytic interventions, intradialytic symptoms, and IDH episodes revealed no statistical difference in the reduction of IDH episodes (p = 0.207) between the two intervention groups. However, the risk of IDH interventions was 60% higher in the placebo group compared to the sertraline group, and the risk of IDH symptoms was 40% higher in the placebo group compared to the sertraline group. Survival analysis using Kaplan-Meier estimator supported the results of this study. Sertraline presented a number needed to treat (NNT) of 16.3 patients to prevent an episode from IDH intervention and 14.2 patients to prevent an episode from intradialytic symptoms. Conclusion: This study suggests that the use of sertraline may be beneficial to reduce the number of symptoms and ID interventions, although there was no statistically significant difference in the blood pressure levels.


Resumo Introdução: A hipotensão intradialítica (HID) é uma das principais complicações da hemodiálise, com uma prevalência de cerca de 25% durante as sessões de hemodiálise, causando aumento da morbimortalidade. Objetivo: Estudar os efeitos da sertralina na prevenção da HID em pacientes em hemodiálise. Métodos: Este foi um ensaio clínico duplo-cego, cruzado, comparando o uso de sertralina versus placebo para reduzir a hipotensão intradialítica. Resultados: Dezesseis pacientes completaram as duas fases do estudo durante um período de 12 semanas. A prevalência de HID foi de 32%. Uma comparação entre intervenções intradialíticas, sintomas intradialíticos (ID) e episódios de HID não revelou diferença estatística na redução dos episódios de HID (p = 0,207) entre os dois grupos de intervenção. No entanto, o risco de intervenções para HID foi 60% maior no grupo placebo em comparação com o grupo Sertralina, e o risco de sintomas ID foi 40% maior no grupo placebo em comparação com o grupo Sertralina. A análise de sobrevida utilizando o estimador de Kaplan-Meier corroborou os resultados deste estudo. A sertralina apresentou um número necessário para tratar (NNT) de 16,3 pacientes para prevenir um episódio de intervenção de HID e 14,2 pacientes para prevenir um episódio de sintomas intradialíticos. Conclusão: Este estudo sugere que o uso de sertralina pode ser benéfico para reduzir o número de sintomas e intervenções de HID, embora não tenha havido diferença estatisticamente significante nos níveis pressóricos.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Renal Dialysis/adverse effects , Serotonin Uptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Renal Insufficiency/therapy , Hypotension/physiopathology , Placebos/administration & dosage , Blood Pressure/drug effects , Blood Pressure/physiology , Double-Blind Method , Prevalence , Renal Dialysis/mortality , Cross-Over Studies , Renal Insufficiency/complications , Hypotension/prevention & control , Hypotension/epidemiology
8.
Int. braz. j. urol ; 45(6): 1209-1215, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056348

ABSTRACT

ABSTRACT Purpose: To compare the efficacy and safety of available selective serotonin reuptake inhibitors (SSRIs) in order to find the most effective drug with the least number of side effects in treatment of premature ejaculation (PE). Materials and Methods: This study was a randomized clinical trial. Four hundred and eighty patients with PE in the 4 groups referred to Imam Reza hospital Tehran, Iran from July 2018 to February 2019 were enrolled in the study. The patients received sertraline 50mg, fluoxetine 20mg, paroxetine 20mg and citalopram 20mg, every 12 hours daily. The intravaginal ejaculatory latency time (IELT) before treatment, fourth and eighth weeks after treatment was recorded by the patient's wife with a stopwatch. Results: Mean IELT before, 4 and 8 weeks after treatment in four groups were: sertraline 69.4±54.3, 353.5±190.4, 376.3±143.5; fluoxetine 75.5±64.3, 255.4±168.2, 314.8±190.4; paroxetine 71.5±69.1, 320.7±198.3, 379.9±154.3; citalopram 90.39±79.3, 279.9±192.1, 282.5±171.1 seconds, respectively. The ejaculation time significantly increased in all groups (p <0.05), but there was no significant difference between the groups (P=0.75). Also, there was no significant difference in drugs side effects between groups (p >0.05). The most common side effects were drowsiness and dyspepsia, which were not severe enough to cause discontinuation of the drug. Conclusions: All available SSRIs were effective and usually had no serious complications. In patients who did not respond to any of these drugs, other SSRI drugs could be used as a salvage therapy.


Subject(s)
Humans , Male , Adult , Aged , Young Adult , Citalopram/therapeutic use , Fluoxetine/therapeutic use , Serotonin Uptake Inhibitors/therapeutic use , Paroxetine/therapeutic use , Sertraline/therapeutic use , Premature Ejaculation/drug therapy , Reaction Time/drug effects , Time Factors , Treatment Outcome , Ejaculation/drug effects , Middle Aged
9.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(3): 323-328, set. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058703

ABSTRACT

RESUMEN Los trastornos vestibulares funcionales se constituyen como una de las causas más frecuentes de consulta por vértigo y trastornos del equilibrio. El mareo postural perceptual persistente (MPPP) es un síndrome recientemente definido, enmarcado en la categoría de síndromes vestibulares crónicos, que agrupa trastornos vestibulares funcionales crónicos como el vértigo postural fóbico, el malestar con el movimiento espacial, el vértigo visual y el mareo subjetivo crónico. El MPPP se manifiesta por síntomas de mareo, inestabilidad y/o vértigo no rotatorio, persistentes, exacerbados por cambios posturales, movimientos y exposición a distintos estímulos visuales. El tratamiento de este cuadro es más sencillo de lo que parece, basado en psicoeducación efectiva respecto a la patología como primer abordaje, adicionando o no rehabilitación vestibular, uso de inhibidores selectivos de la recaptación de serotonina y/o terapia cognitivo conductual. Se presentan dos casos clínicos de pacientes diagnosticados con MPPP y su respuesta a tratamiento.


ABSTRACT Functional vestibular disorders are one of the most frequent causes of consultation due to vertigo and balance disorders. Persistent postural-perceptual dizziness (PPPD) is a recently defined syndrome, categorized as a chronic vestibular syndrome, that includes functional vestibular disorders such as phobic postural vertigo, space-motion discomfort, visual vertigo and chronic subjective dizziness. PPPD manifests with dizziness, unsteadiness and/or non-spinning vertigo, which are persistent, exacerbated by postural changes, movements and exposure to various visual stimuli. PPPD treatment is simpler than it may seem initially. It is based on effective psychoeducation related to the pathology in the first place, followed, or not, by vestibular rehabilitation, use of selective serotonin reuptake inhibitors and/or cognitive behavioral therapy. We present two clinical cases of patients diagnosed with PPPD and their response to treatment.


Subject(s)
Humans , Male , Female , Middle Aged , Dizziness/diagnosis , Dizziness/therapy , Posture , Visual Perception , Cognitive Behavioral Therapy , Vestibular Diseases , Chronic Disease , Serotonin Uptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Dizziness/physiopathology
13.
Int. braz. j. urol ; 43(3): 496-504, May.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-840849

ABSTRACT

ABSTRACT Objective To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE). Materials and Methods Between May 2009 and November 2012, this open-label, randomized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 μg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All patients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments using Fisher’s exact test. Results One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vitamin B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment. Conclusions Amoxapine may be an effective, safe and well-tolerated therapy for RE.


Subject(s)
Humans , Male , Adult , Sexual Dysfunction, Physiological/drug therapy , Vitamin B 12/therapeutic use , Vitamin B Complex/therapeutic use , Serotonin Uptake Inhibitors/therapeutic use , Ejaculation , Amoxapine/therapeutic use , Vitamin B 12/adverse effects , Vitamin B 12 Deficiency , Treatment Outcome , Cross-Over Studies , Amoxapine/adverse effects , Middle Aged
14.
Rev. bras. psiquiatr ; 37(4): 334-342, Oct.-Dec. 2015. tab
Article in English | LILACS | ID: lil-770002

ABSTRACT

Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.


Subject(s)
Female , Humans , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Obsessive-Compulsive Disorder/drug therapy , Pregnancy Complications/drug therapy , Pregnancy/drug effects , Serotonin Uptake Inhibitors/therapeutic use , Abnormalities, Drug-Induced , Fetus/drug effects , Meta-Analysis as Topic , Pregnancy Complications/psychology , Risk Assessment , Treatment Outcome
15.
Dental press j. orthod. (Impr.) ; 20(4): 68-75, July-Aug. 2015. tab, ilus
Article in English | LILACS | ID: lil-757428

ABSTRACT

OBJECTIVE: The aim of this study was to compare the cephalometric pattern of children with and without adenoid obstruction.METHODS: The sample comprised 100 children aged between four and 14 years old, both males and females, subjected to cephalometric examination for sagittal and vertical skeletal analysis. The sample also underwent nasofiberendoscopic examination intended to objectively assess the degree of adenoid obstruction.RESULTS: The individuals presented tendencies towards vertical craniofacial growth, convex profile and mandibular retrusion. However, there were no differences between obstructive and non-obstructive patients concerning all cephalometric variables. Correlations between skeletal parameters and the percentage of adenoid obstruction were either low or not significant.CONCLUSIONS: Results suggest that specific craniofacial patterns, such as Class II and hyperdivergency, might not be associated with adenoid hypertrophy.


OBJETIVO: a presente pesquisa teve como objetivo comparar o padrão cefalométrico de crianças com e sem obstrução adenoidiana.MÉTODOS: a amostra consistiu de 100 crianças, com idades entre 4 e 14 anos, de ambos os sexos, submetidas a exames cefalométricos para a avaliação de variáveis cefalométricas horizontais e verticais. A amostra também foi submetida à nasofibroendoscopia, por meio da qual o grau de obstrução adenoidiana foi objetivamente aferido.RESULTADOS: os pacientes avaliados demonstraram tendência ao crescimento vertical acentuado, ao perfil convexo e à retrusão mandibular. No entanto, não houve diferenças entre pacientes portadores e não portadores de obstrução, em relação a todas as variáveis cefalométricas. As correlações estabelecidas entre os parâmetros esqueléticos e os percentuais de hipertrofia foram baixas ou não significativas.CONCLUSÕES: os resultados sugerem que padrões faciais específicos, tais como Classe II e hiperdivergência, parecem não estar associados à hipertrofia adenoideana.


Subject(s)
Animals , Male , Anxiety, Separation/therapy , Behavior, Animal/drug effects , Clomipramine/therapeutic use , Clorazepate Dipotassium/therapeutic use , Dogs , Anti-Anxiety Agents/administration & dosage , Anti-Anxiety Agents/therapeutic use , Clorazepate Dipotassium/administration & dosage , Serotonin Uptake Inhibitors/therapeutic use
16.
Braz. j. otorhinolaryngol. (Impr.) ; 81(3): 276-282, May-Jun/2015. tab
Article in English | LILACS | ID: lil-751906

ABSTRACT

INTRODUCTION: Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety. OBJECTIVE: To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness. METHODS: statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness. RESULTS: 81 patients, average age: 50.06 ± 12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%), body movements (52%), and sleep deprivation (38%). The most prevalent comorbidities were hypercholesterolemia (31%), migraine headaches (26%), carbohydrate metabolism disorders (22%) and cervical syndrome (21%). DHI, State-Trait Anxiety Inventory - Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p < 0.05) when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors. CONCLUSION: Persistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment. .


INTRODUÇÃO: A denominação tontura postural-perceptual persistente (TPPP) é atribuida à tontura que se mantém por mais de 3 meses em pacientes, sem que exista justificativa clínica para a sua persistência. A maioria dos pacientes possui perfil ansioso ou experimenta alto grau de ansiedade no início dos sintomas. O padrão de resposta motora apresenta-se alterado, com hipervigilância e hipersensibilidade a estímulos visuais e de movimento. OBJETIVO: Avaliar as características clínicas de pacientes com diagnóstico de TPPP. MÉTODO: Análise dos aspectos clínicos de pacientes do ambulatório de TPPP e quantificação do perfil ansioso ou depressivo. RESULTADOS: Foram avaliados 81 pacientes, com média de idade de 50,06 ± 12,16 anos; relação mulher/homem de 5,7/1; principais gatilhos para tontura: estímulos visuais (74%), movimentos corporais (52%) e privação de sono (38%). As comorbidades mais prevalentes foram hipercolesterolemia (31%), migrânea (26%), distúrbios do metabolismo do açúcar (22%) e síndrome cervical (21%). Os questionários DHI, STAI-Traço, Beck para depressão e HADS foram estatisticamente diferentes (P < 0,05) entre pacientes e controles. 68% de melhora clínica com o uso de inibidores da recaptação da serotonina. CONCLUSÃO: TPPP acomete principalmente as mulheres, sendo alta a associação com distúrbios metabólicos e migrânea. Os questionários auxiliam na identificação da predisposição à TPPP. Há bom prognóstico com o tratamento adequado. .


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Dizziness/physiopathology , Vertigo/physiopathology , Age Factors , Comorbidity , Dizziness/diagnosis , Dizziness/drug therapy , Postural Balance , Serotonin Uptake Inhibitors/therapeutic use , Sex Factors , Surveys and Questionnaires , Vertigo/diagnosis , Vertigo/drug therapy , Vestibular Diseases/physiopathology , Vestibular Diseases/psychology
18.
J. bras. med ; 102(6)dez. 2014. graf, ilus, tab, mapas
Article in Portuguese | LILACS | ID: lil-737128

ABSTRACT

A fibromialgia (FM) é uma síndrome de dor difusa crônica acompanhada de sintomas somáticos, tais como fadiga, transtornos do humor, do sono e da cognição. Em uma abordagem prática do paciente com FM, além das medidas não farmacológicas, cada sintoma pode ser tratado com medicamento específico. O objetivo deste artigo é prover revisão atualizada da literatura sobre os principais medicamentos atualmente disponíveis no Brasil para o tratamento da FM em adultos. O sucesso terapêutico da FM depende, essencialmente, do uso racional de medicamentos voltados para os sintomas refratários às medidas não farmacológicas.


Fibromyalgia (FM) is the chronic widespread pain syndrome associated with fatigue, mood, sleep and cognitive disorders. Besides non-pharmacological approach, each symptom should be treated with a specific drug. The goal of this study is to provide up-to-date literature review on main aspects of adult FM drugs available for use in Brazil. Treatment success in FM depends essentially on using drugs based on symptoms that are not responsive to non-pharmacological approach.


Subject(s)
Humans , Fibromyalgia/drug therapy , Tramadol/therapeutic use , Serotonin/therapeutic use , Serotonin Uptake Inhibitors/therapeutic use , Acetaminophen/therapeutic use , Monoamine Oxidase Inhibitors/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use
19.
Clinics ; 69(11): 710-713, 11/2014. tab
Article in English | LILACS | ID: lil-731109

ABSTRACT

OBJECTIVES: Serotonin plays a central role in ejaculation and selective serotonin reuptake inhibitors have been successfully used to treat premature ejaculation. Here, we evaluated the relationship between a polymorphism in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and the response of patients with premature ejaculation to SSRI medication. METHODS: Sixty-nine premature ejaculation patients were treated with 20 mg/d paroxetine for three months. The Intravaginal Ejaculatory Latency Time and International Index of Erectile Function scores were compared with baseline values. The patients were scored as having responded to therapy when a 2-fold or greater increase was observed in Intravaginal Ejaculatory Latency Time compared with baseline values after three months. Three genotypes of 5-HTTLPR were studied: LL, LS and SS. The appropriateness of the allele frequencies in 5-HTTLPR were analyzed according to Hardy-Weinberg equilibrium using the χ2-test. RESULTS: The short (S) allele of 5-HTTLPR was significantly more frequent in responders than in nonresponders (p<0.05). Out of the 69 total PE patients, 41 patients (59%) responded to therapy. There was no significant difference in the International Index of Erectile Function score at the end of therapy between the responder and nonresponder groups. The frequencies of the L allele and S allele were 20% and 39%, respectively, in the responder group (p<0.05). CONCLUSION: We conclude that premature ejaculation patients with the SS genotype respond well to selective serotonin reuptake inhibitor therapy. Further studies with large patient groups are necessary to confirm this conclusion. .


Subject(s)
Adult , Humans , Male , Middle Aged , Young Adult , Polymorphism, Genetic , Paroxetine/therapeutic use , Premature Ejaculation/drug therapy , Serotonin Plasma Membrane Transport Proteins/genetics , Serotonin Uptake Inhibitors/therapeutic use , Gene Frequency , Genetic Association Studies , Genotype , Polymerase Chain Reaction , Premature Ejaculation/genetics , Time Factors , Treatment Outcome
20.
Braz. j. med. biol. res ; 46(3): 318-326, 15/mar. 2013. tab
Article in English | LILACS | ID: lil-670901

ABSTRACT

The aim of this study was to compare the effectiveness of attribution retraining group therapy (ARGT) with selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). Subjects were sequentially recruited and randomized into two groups, one receiving ARGT (n = 63) and the other SSRIs (n = 66) for 8 weeks. Fifty-four ARGT outpatients with MDD (n = 19), GAD (n = 19), and OCD (n = 16) and 55 SSRI outpatients with MDD (n = 19), GAD (n = 19), and OCD (n = 17) completed the study. All subjects were assessed using the Hamilton Depression Scale and Hamilton Anxiety Scale before and after treatment. The 10-item Yale-Brown Obsessive Compulsive Scale was employed only for OCD subjects. Plasma levels of serotonin, norepinephrine, cortisol, and adrenocorticotropic hormone were also measured at baseline and 8 weeks after completion of treatment. Symptom scores were significantly reduced (P < 0.001) in both the ARGT and SSRI groups at the end of treatment. However, MDD, GAD and OCD patients in the ARGT group had significantly lower plasma cortisol concentrations compared to baseline (P < 0.05), whereas MDD and OCD patients receiving SSRIs showed significantly increased plasma levels of serotonin (P < 0.05). These findings suggest that ARGT may modulate plasma cortisol levels and affect the hypothalamus-pituitary-adrenal axis as opposed to SSRIs, which may up-regulate plasma serotonin levels via a different pathway to produce an overall improvement in the clinical condition of the patients.


Subject(s)
Adult , Female , Humans , Male , Anxiety Disorders/therapy , Depressive Disorder, Major/therapy , Obsessive-Compulsive Disorder/therapy , Psychotherapy, Group , Serotonin Uptake Inhibitors/therapeutic use , Combined Modality Therapy , Psychiatric Status Rating Scales
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