Variables associated with health-related quality of life in a Brazilian sample of patients from a tertiary outpatient clinic for depression and anxiety disorders / Variáveis associadas à qualidade de vida em uma amostra de pacientes de um serviço ambulatorial terciário para transtornos de ansiedade e depressão

Introduction: Health-related quality of life (HRQOL) assessment tools have been broadly used in the medical context. These tools are used to measure the subjective impact of the disease on patients. The objective of this study was to evaluate the variables associated with HRQOL in a Brazilian sample of patients followed up in a tertiary outpatient clinic for depression and anxiety disorders. Method: Cross-sectional study. Independent variables were those included in a sociodemographic questionnaire and the Hospital Anxiety and Depression Scale (HADS) scores. Dependent variables were those included in the short version of the World Health Organization Quality of Life (WHOQOL-BREF) and the scores for its subdomains (overall quality of life and general health, physical health, psychological health, social relationships, and environment). A multiple linear regression analysis was used to find the variables independently associated with each outcome. Results: Seventy-five adult patients were evaluated. After multiple linear regression analysis, the HADS scores were associated with all outcomes, except social relationships (p = 0.08). Female gender was associated with poor total scores, as well as psychological health and environment. Unemployment was associated with poor physical health. Conclusion: Identifying the factors associated with HRQOL and recognizing that depression and anxiety are major factors are essential to improve the care of patients.

Introdução: Instrumentos para avaliar qualidade de vida relacionada à saúde têm sido amplamente utilizados no contexto médico, visando mensurar o impacto da doença de uma perspectiva subjetiva e relevante ao paciente. O objetivo desse estudo foi identificar variáveis associadas à qualidade de vida em uma amostra de pacientes acompanhados em um ambulatório terciário para transtornos de ansiedade e depressão. Métodos: Estudo transversal. As variáveis independentes incluíram dados de um questionário sociodemográfico e pontuação na Escala Hospitalar de Ansiedade e Depressão (HADS). Variáveis dependentes: pontuação total na escala breve de qualidade de vida da Organização Mundial de Saúde (WHOQOL-Bref) e cada um de seus subdomínios (geral, físico, psicológico, social e ambiental). Regressão linear múltipla foi aplicada para identificar as variáveis preditoras associadas de forma independente a cada uma das variáveis dependentes. Resultados: Setenta e cinco pacientes adultos foram avaliados. Após análise de regressão linear múltipla, pontuação na HADS esteve associada com todos os desfechos analisados, exceto para o subdomínio social (p = 0,08). Sexo feminino esteve negativamente associado com a pontuação total da WHOQOL-Bref e com os subdomínios psicológico e ambiental. Desemprego esteve associado com o subdomínio físico. Conclusão: A identificação de fatores associados à qualidade de vida relacionada à saúde e o reconhecimento de que a depressão e a ansiedade são variáveis fundamentais são essenciais para uma melhor assistência aos pacientes.

Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury

Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points. .

Personality changes and return to work after severe traumatic brain injury: a prospective study

Objective: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. Methods: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. Results: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). Conclusions: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition. .

SPECT and PET Imaging in epilepsy: principles and clinical applications

Functional neuroimaging with single photon emission computed tomography (SPECT) and positron emission tomography (PET) has documented several perfusion, metabolic and neurochemical dysfunctions in a variety of neurological conditions. In the presurgical workup of medically intractable epilepsies, a group of investigations is included to ascertain the lacalization of the epileptogenic zone. The aim of the present study is to review the principles and revelant investigations about the application of SPECT and PET to the epilepsies. We reviewed the physiological aspects of cerebral blood flow during seizures, pharmacological characteriristics of radiopharmaceuticals, and clinical applications of SPECT in the investigation of epileptic seizures, and provided a review of the main clinical contributions of PET in epilepsy. SPECT and PET have an important and complementary role in the presurgical evaluation as well as in pathophysiological researchs about epilepsy. Both may evaluate the ictal and interictal states of cerebral functions, playing a particular role in those patients who present with inconclusive studies of both Magnetic Resonance Imaging and the Video - EEG monitoring. Additionally, they may avoid or guide invasive neurophysiological studies, and help suggest the localization of the epileptogenic zone in those cases with extensive or multiple lesions

Tratamento farmacológico das psicoses na epilepsia / Pharmacological treatment of psychosis in epilepsy

A epilepsia é uma das causas mais comuns de incapacidade funcional. Comorbidades psiquiátricas, como as psicoses, estão freqüentemente associadas à epilepsia. Psicoses na epilepsia (PNE) requerem tratamento farmacológico mais cuidadoso, levando-se em conta a propensão dos antipsicóticos (AP) em provocar crises convulsivas e o risco de interação farmacocinética com as drogas antiepilépticas (DAE). Após uma breve descrição da classificação e das principais características clínicas das PNE, foram discutidos alguns aspectos gerais do tratamento farmacológico das PNE e o uso de AP típicos e atípicos, destacando seu potencial para diminuir o limiar epileptogênico (LE), bem como possíveis interações AP/DAE. Os AP atípicos, à exceção da clozapina, demonstraram exercer menor influência sobre o LE. Quanto às interações farmacocinéticas, as principais DAE estiveram relacionadas com um aumento importante do metabolismo dos AP. Portanto, apesar do risco para convulsões por AP ser dose-dependente, doses mais elevadas de AP podem ser necessárias no tratamento das PNE.