Psychiatric disorders after deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a systematic review

ABSTRACT Objective To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease. Methods Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library. Results Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases. Conclusion More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.

Caracterização do perfil comportamental e de competência social de indivíduos com a síndrome del22q11.2 / Characterization of behavior profile and social competence of individuals with the del22q11.2 syndrome

Resumo:OBJETIVO:caracterizar os problemas comportamentais e de competência social de indivíduos com a síndrome del22q11.2 e compará-los com indivíduos com desenvolvimento típico, segundo informação dos pais.MÉTODOS:participaram desta pesquisa 24 pais de indivíduos de ambos os gêneros, entre seis e 18 anos, sendo 12 indivíduos com a síndrome del22q11.2 (grupo amostral) e 12 indivíduos com desenvolvimento típico (grupo controle). Foi aplicado o inventário comportamental "Child Behavior Checklist (CBCL)".RESULTADOS:oito dos 12 indivíduos com a síndrome foram classificados como "clínico" nas escalas de comportamento e Problemas Internalizantes; cinco dos 12 indivíduos do grupo amostral foram classificados como "clínico" quanto às escalas de comportamento e Problemas Externalizantes. Nas habilidades de competência social, dez dos 12 indivíduos do grupo amostral foram classificados como "clínico".CONCLUSÃO:indivíduos com diagnóstico da síndrome del22q11.2 apresentaram, segundo opinião dos pais, problemas comportamentais e de competência social, em diferentes graus de comprometimento. Quando realizada a comparação entre os grupos pode-se observar diferenças estatisticamente significantes em variáveis dos comportamentos externalizantes e dos comportamentos internalizantes. Desta forma, concluí-se que o grupo amostral apresenta comportamentos mais alterados quando comparados ao grupo controle.

Abstract:PURPOSE:to characterize the behavioral problems and social competence of individuals with del22q11.2 syndrome and compare them with typically developing individuals, according to information from parents.METHODS:participated in this study 24 parents of individuals of both sexes between 6 and 18 years, being 12 individuals with the syndrome del22q11.2 (sample group) and 12 individuals with typically developing (control group). The behavioral inventory "Child Behavior Checklist (CBCL)" was applied.RESULTS:eight of the twelve patients with the syndrome were classified as "clinical" as the scales of behavior and Internalizing Problems. Five of the twelve individuals of sample group were "clinical" as the scales of behavior and Externalizing Problems. The skills of social competence, ten of the twelve individuals sample group were "clinical".CONCLUSION:individuals with the diagnostic of the del22q11.2 syndrome, according with opinion their parents present behavioral and social problems in different degrees of commitment. Comparing the groups, was observed statistically significant differences in variables of externalizing and internalizing behaviors. Therefore, we conclude that the sample group presents more abnormal behavior compared to the control group.

Medical Care Expenditure in Suicides From Non-illness-related Causes / 예방의학회지

OBJECTIVES: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. METHODS: Suicides motivated by non-illness-related factors were identified using the investigator's note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. RESULTS: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. CONCLUSIONS: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Correlation between behavioural and psychological symptoms and cerebra white matter lesions in patients with Alzheimer's disease / 国际脑血管病杂志

Objective To investigate the correlation between behavioural and psychological symptoms and cerebral white matter lesions (WMLs) in patients with Alzheimer's disease (AD). Methods Sixty patients with AD aged more than 60 years (AD group) and 40 age-, sex-matched subjects with normal cognitive function (control group) were recruited. data of cerebral CT were analyzed blindly. The sum of WMLs in 8 regions, such as bilateral frontal region, parieto-occipital region, temporal region, and subtentorial region, etc were used as the total score of WMLs, and the cerebrovascular lesions revealed on CT were detected. The AD group was assessed with the Neuropsychiatric Inventory (NPI). Results There were significant differences in total WML score (1. 450 ±2. 310 vs. 9. 640 ± 1. 566, P =0. 000), left frontal WMLs (0. 340 ± 0. 340 vs. 1. 720 ± 0. 248, P = 0. 001), fight frontal WMLs (0. 310 ±0. 560 vs. 1. 680 ±0. 312, P =0. 001), left parieto-occipital WMLs (0. 240 ±0. 360 vs. 1. 550 ±0. 244, P =0. 012), right parieto-oecipital WMLs (0. 140 ±0. 230 vs. 1. 450 ± 0. 231, P = 0. 006) and cerebrovascular lesions (0. 120 ± 0. 330 vs. 2. 230 ± 0. 378, P = 0. 002) hetwsen the AD group and the control group. Spearman correlation analysis showed that NPI was correlated with the total WML score (rs =0. 487, P = 0. 016), left frontal WMLs (rs =0. 490, P = 0. 014), right frontal WMLs (rs = 0. 502, P = 0. 014), left parieto-occipital WMLs (rs =0. 507, P =0. 012) and right parieto-occipital WMLs (rs =0. 521, P = 0. 014), and it was not correlated with the cerebrovascular lesions (rs = 0. 132, P = 0. 590).Conclusions WMLs and cerebrovascular lesions are essential in the onset of AD and disease development. WMLs are closely correlated with the behavioural and psychological symptoms in patients with AD.

Los profesionales de la salud y la prevención de la violencia doméstica contra la mujer / Role of health professionals in the prevention of domestic violence against women

Domestic violence against women is an important public health problem that cannot be ignored. Health professionals need to take part in the prevention, detection and treatment processes, acting in a coordinate way with other professionals and institutions. This paper analyzes the consequences of domestic violence against women, and underscores the fact that health professionals are part of the social circle surrounding the victims, playing an important role in its detection and prevention. Several response strategies from the health services are examined and, finally, the paper considers screening as a mechanism for early detection of domestic violence, paying special attention to the important controversies that surround this issue.

Behavioral problems and tobacco use among adolescents in Chile / Los problemas conductuales y el tabaquismo en adolescentes en Chile

OBJECTIVE: To examine the association between behavioral problems and tobacco smoking among adolescent students in Chile. METHODS: Data were drawn from a study that included questionnaire surveys of 46 907 school-attending adolescents in all 13 of the administrative regions of Chile. Assessments were based on an adapted, Spanish-language version of the Drug Use Screening Inventory. The conditional form of the logistic regression model was used for analysis, with matching of students on individual schools, and with further statistical adjustments for sex, age, and selected risk factors. RESULTS: The prevalence of tobacco smoking among the adolescents was very high across all of Chile, with a level between 56 percent and 65 percent in each of the 13 regions. The estimated odds of tobacco use in youths at the highest level of behavioral problems was about twice that for youths at the lowest levels, both before and after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family attention, and mental health. CONCLUSIONS: These findings help to complement and complete the evidence of prior studies on tobacco smoking among adolescents with behavior problems, including recent research on Central American youths. Although the magnitude of observed associations in Chile was not as great as that for the associations found in Central America, both the strength of these associations and their statistical significance were observed throughout Chile. This is the first study in Chile on potentially causal relationships such as these.

Objetivo. Examinar la asociación entre los problemas conductuales y el tabaquismo en estudiantes adolescentes en Chile. Métodos. Se obtuvieron datos mediante un estudio en el que se encuestó a un total de 46 907 estudiantes adolescentes en todas las 13 regiones administrativas de Chile. Las valoraciones se basaron en una adaptación en lengua española del instrumento Drug Use Screening Inventory. Se aplicó un modelo de regresión logística condicional para efectuar el análisis; los estudiantes fueron pareados por escuelas individuales y se hicieron ajustes en función del sexo, la edad y algunos factores de riesgo. Resultados. La prevalencia de tabaquismo entre los adolescentes fue muy elevada en todo el territorio de Chile, con cifras que oscilaron entre 56% y 65% en cada una de sus 13 regiones. Las posibilidades estimadas de tabaquismo entre los jóvenes con los problemas conductuales más graves fueron alrededor del doble de las observadas entre los que tenían los problemas conductuales más leves, tanto antes y después de hacer ajustes en función del sexo, la edad, la falta de participación en actividades de recreo, el grado de irritabilidad y la magnitud de los problemas de orden escolar, familiar y de salud mental. Conclusiones. Estos resultados ayudan a complementar y completar los datos aportados por estudios anteriores sobre el tabaquismo en adolescentes con problemas de conducta, incluidos algunos estudios recientes centrados en la juventud centroamericana. Aunque la magnitud de las asociaciones observadas en Chile fue menor que la de las asociaciones encontradas en Centroamérica, tanto la fuerza de estas asociaciones como su significación estadística se constataron en todo Chile. Este estudio es el primero realizado en Chile con el fin de explorar la posible existencia de relaciones causales como las aquí descritas

Caracterización sociofamiliar en un grupo de pacientes alcohólicos

RESUMEN: En 1994, en ocasión de realizar una caracterización sociofamiliar en 60 alchólicos notificados por sus médicos de familias al Departamento de Trabajo Social del Policlínico Docente "Ramiro Bentancourt" de Palma Soriano, se encontró que las cuestiones psicológicas relacionadas con el "sentirse bien" y con "el gusto" fueron los principales motivos que llevaron a estas personas a ingerir bebidas alcohólicas, y que la depresión y la ansiedad constituyeron las principales vivencias psíquicas experimentadas. Predominaron las familias de tipo antagónicas; las tensiones y dificultades, los hurtos hogareños y la violencia con las esposas se constataron como las fundamentales repercusiones familiares, y entre las repercusiones sociales se destacaron las riñas, los hurtos y los escándalos públicos.

SUMMARY: In 1994, when the sociofamilial characterization of 60 alcoholics reported by their family physicians to the Social Work Department of the "Ramiro Betancourt" Teaching Polyclinic, in Palma Soriano, was made, it was found that the psychological aspects connected with "feeling good" and "pleasure" were the main reasons that led these persons to drink alcoholic beverages. It was also observed that depression and anxiety were the most frequent mental disorders. The antagonistic families predominated. Tensions, difficulties, home thefts, and violence with wives were among the fundamental family repercussions. Quarrels, robberies and public scandals were the most important social repercussions.