Psicopatología como red causal compleja de síntomas interactivos / Psychopathology as a complex network of causally interacting symptoms

Resumen El modelo de la psicopatología como red de síntomas propone centrarse en las interacciones dinámicas y causales entre los síntomas constitutivos del problema clínico. La idea principal es que la activación de un síntoma clínico lleva a la activación de otro síntoma vecino. Las conexiones entre ellos pueden ser biológicas, psicológicas o sociales. Los trastornos mentales son concebidos como estados estables alternativos de redes de síntomas fuertemente conectados. Esto permite un modelo explicativo común para todos los trastornos mentales, un modelo integral de psicopatología. A pesar del éxito de este nuevo camino metodológico, la mayoría de la información relevante se encuentra publicada en inglés. En este artículo, se presenta, en idioma español, la teoría de la psicopatología como red de síntomas y su modelo, su relevancia para la investigación, docencia y práctica clínica de la psicología y la psiquiatría, a los fines de incrementar su difusión y diseminación.

Abstract Over the past years, psychopathology has frequently been represented as a complex system, where psychiatric symptoms are causally interconnected in a network architecture. The network theory of psychopathology has led to more than 300 novel publications, academic courses, methodology for estimating novel models, and freely available software. However, despite the success of this novel research avenue, all relevant information has mostly been published in English. This paper translates the network theory of psychopathology and its model, together with its relevance for research and clinical practice of psychology and psychiatry, to the Spanish language. To serve the dissemination of this theory, this paper serves as an introductory paper for Spanish scholars, for example, as a starting point to learn more about the approach or for academic courses. The main idea of the network theory of psychopathology is that the activation of one clinical symptom in the network leads to the activation of a neighboring symptom. If symptoms are strongly connected with each other, for example, excessive worry and insomnia, they are more likely to be in the same state, meaning that if a person faces a stressful life event such as losing one's job, the activation of the symptom excessive worry will increase the probability they will also suffer from insomnia. In this way, a whole symptom activation pattern develops from which mental disorders emerge. Mental disorders are conceived as stable states of strongly connected symptom networks, allowing for a common explanatory model for multiple mental disorders, thereby providing a comprehensive model of psychopathology. Traditional representations of mental disorders conceptualize symptoms as merely passive indicators of latent, underlying mental disorders which act as common causes for patients' symptomatology. The network theory of psychopathology flips the explanatory and statistical model: instead of focusing on one underlying cause or underlying causes, it proposes to study the direct interactions between these symptoms. This imposes two important implications for the conceptualization of mental disorders. First, symptoms are no longer statistically exchangeable since every symptom can have a different role in the onset and development of psychopathology. Some symptoms can be more important than others in keeping the whole system "stuck" in a disordered state. Second, comorbidity is conceptualized as clustering symptoms which are connected to each other via certain "bridge symptoms". Bridge symptoms are symptoms which are attributed to two (or more) mental disorders, such as Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). If a person suffers from symptoms of MDD, such as loss of motivation and depressed mood, this can lead to the activation of bridge symptoms such as fatigue and concentration problems, which by themselves lead to the activation of GAD symptoms such as irritability and excessive worry.

Prevalence of psychiatric symptoms and associated factors in the adult population from the area affected by the tailings dam rupture - Brumadinho Health Project / Prevalência de sintomas psiquiátricos e seus fatores associados na população adulta da área atingida pelo rompimento da barragem de rejeitos: Projeto Saúde Brumadinho

ABSTRACT: Objective: To examine the prevalence of psychiatric symptoms and associated factors in the adult population of Brumadinho (MG), after the dam collapse. Methods: We included 2,740 participants with information about symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, thoughts of death/self-harm, and poor sleep quality collected in 2021. Prevalence values of all conditions were estimated to compare the prevalence of psychiatric symptoms with the participants' sociodemographic characteristics and place of residence. Pearson's c2 test was used, with Rao Scott's correction. Crude and adjusted logistic regressions estimated odds ratios and 95% confidence intervals to assess the association between psychiatric symptoms and participants' characteristics. Results: The most common condition was depressive symptoms (29.3%), followed by post-traumatic stress symptoms (22.9%) and anxious symptoms (18.9%). Regarding the association between participants' characteristics in the adjusted analysis, being a female and living in a mining area was positively associated with symptoms of PTSD, depression, anxiety, thoughts of death/self-harm, and poor sleep quality. A positive association was also found between high school education and post-traumatic stress symptoms. In contrast a negative association was found between being aged ≥60 years and symptoms of PTSD, depression, and anxiety. Conclusion: High prevalence values were found for all psychiatric symptoms after the dam failure in Brumadinho. Being a female, living in the mining area, being ≥60 years old, and having an educational level were all associated with the psychiatric symptoms investigated.

RESUMO: Objetivo: Examinar a prevalência dos sintomas psiquiátricos e seus fatores associados na população adulta de Brumadinho (MG), após o rompimento da barragem. Métodos: Foram incluídos 2.740 participantes com informações coletadas em 2021 sobre os sintomas de estresse pós-traumático (TEPT), depressão, ansiedade, ideias de morte/automutilação e pior qualidade do sono. Estimaram-se as prevalências de todas as condições. Para a comparação das prevalências dos sintomas psiquiátricos e as características sociodemográficas e local de moradia, empregou-se o teste χ2 de Pearson, com correção de Rao-Scott. Regressões logísticas brutas e ajustadas estimaram os odds ratios e intervalos de confiança de 95%, permitindo a avaliação da associação entre os sintomas psiquiátricos e as características dos participantes. Resultados: Os sintomas depressivos foram a condição mais prevalente (29,3%), seguidos pelos sintomas de TEPT (22,9%) e sintomas ansiosos (18,9%). Com relação à investigação da associação entre as características dos participantes na análise ajustada, observou-se que o sexo feminino e os moradores da área de mineração apresentaram relação positiva com os sintomas de TEPT, depressivos, ansiosos, ideia de morte e pior qualidade de sono. Também se encontraram associação positiva entre a escolaridade de nível médio e os sintomas de TEPT e associação negativa entre aqueles com ≥60 anos e os sintomas de TEPT, depressivos e ansiosos. Conclusão: Altas prevalências foram encontradas para todos os sintomas psiquiátricos após a ruptura da barragem em Brumadinho. Sexo feminino, local de moradia na área de mineração, ≥60 anos e escolaridade foram associados aos sintomas psiquiátricos investigados.

Anxiety and depression symptoms in Brazilian sexual minority ecstasy and LSD users / Sintomas de ansiedade e depressão em brasileiros não heterossexuais usuários de ecstasy e LSD

Abstract Background This study examined drug use patterns and psychiatric symptoms of anxiety and depression among young Brazilian sexual minority ecstasy and LSD users and compared findings with those reported for their heterosexual peers. Method This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not on treatment for alcohol and drug abuse. Results Of the 240 subjects enrolled (mean age: 22.9±4.5 years), 28.7% were gay or bisexuals. Multivariate regression analysis showed that the prevalence of depression symptoms in the past 12 months in the sexual minority group was 37% higher than among heterosexuals (prevalence ratio [PR]=1.79; 95% confidence interval [95%CI] 1.03-3.11; p=0.037). Conclusion Strategies should be developed to assess and address individual needs and treatment approaches should be tailored to address depressive symptoms in young, sexual minority club drug users.

Resumo Introdução Este estudo examinou os padrões de uso de drogas e os sintomas psiquiátricos de ansiedade e depressão entre brasileiros não heterossexuais usuários de ecstasy e/ou LSD e comparou os achados com aqueles relatados por seus pares heterossexuais. Método Este estudo transversal empregou amostragens direcionadas e abordagens de mapeamento etnográfico através de entrevistas presenciais realizadas em bares e festivais de música eletrônica usando uma versão adaptada e semiestruturada do questionário de Avaliação Global de Necessidades Individuais. A amostra incluiu 240 adultos jovens do sexo masculino e feminino que haviam usado ecstasy e/ou LSD nos 90 dias anteriores à entrevista e que não estavam em tratamento para abuso de álcool e drogas. Resultados Dos 240 sujeitos incluídos (idade média: 22,9±4,5 anos), 28,7% eram homossexuais ou bissexuais. A análise de regressão multivariada mostrou que a prevalência de sintomas de depressão nos últimos 12 meses no grupo não heterossexual foi 37% superior à dos heterossexuais [razão de prevalência (RP) = 1,79; intervalo de confiança de 95% (IC95%) 1.03-3.11; p=0,037]. Conclusão Estratégias devem ser desenvolvidas para avaliar e abordar as necessidades individuais, e as abordagens de tratamento devem ser adaptadas para sintomas depressivos em usuários de drogas jovens e não heterossexuais.

Estructura de la sintomatología psiquiátrica según el SRQ-18 en pacientes ambulatorios con trastornos mentales evaluados en un hospital general de Lima / Structure of psychiatric symptoms according to the SRQ-18 in outpatients with mental disorders assessed in a general hospital in Lima

Objetivos: describir la estructura de la sintomatología psiquiátrica evaluada mediante el instrumento SRQ-18 enpacientes ambulatorios con trastornos mentales de un hospital general de Lima. Métodos: Utilizando un registrode datos demográficos y clínicos de 210 pacientes de consultorio externo de psiquiatría del Hospital CayetanoHeredia (Lima, Perú), se exploraron los vínculos entre síntomas psiquiátricos del cuestionario SRQ-18 mediantecorrelaciones tetracóricas graficadas a través de redes generadas con el programa NodeXL...

Objectives: to describe the structure of psychiatric symptomatology evaluated through SRQ-18 in outpatients withmental disorders in a general hospital in Lima. Methods: Using the demographic and clinical information from filesof 210 psychiatric out-patients in the Hospital Cayetano Heredia (Lima, Peru), the connections between psychiatricsymptoms of SRQ-18 questionnaire evaluated by means of tetrachoric correlations were graphically representedin a network generated with the NodeXL program...

Encefalitis por anticuerpos contra el receptor NMDA en tres pacientes pediátricos no asociados a tumor / Anti-NMDA receptor encephalitis in three pediatric patients without associated tumor

La encefalitis asociada a anticuerpos contra el receptor N metil D aspartato (anti-R NMDA) fue descrita por primera vez en 2005. Hoy en día es la segunda causa de encefalitis autoinmune en la población pediátrica. A diferencia de la presentación en adultos, en niños la encefalitis anti-R NMDA se asocia en menor escala a tumores y los trastornos de movimiento son más comunes. Aquí presentamos tres casos en niños, con un rango de edad entre 3 y 7 años. Las discinesias fueron el síntoma de presentación en el primer caso, y no se evidenciaron síntomas psiquiátricos. La paciente posteriormente desarrolló un estatus convulsivo y deterioro de conciencia, con alteraciones del lenguaje. El segundo caso, luego de un periodo prodrómico, desarrolló cambios comportamentales, discinesias, disautonomía, estatus convulsivo y deterioro de conciencia. En ambos casos el desenlace fue favorable con el tratamiento y en el seguimiento ambos pacientes se encontraron con buena clase funcional. Se concluye que una alta sospecha diagnóstica que permita la instauración de un tratamiento adecuado y oportuno lleva a una recuperación funcional en el tiempo, y requiere el apoyo de un equipo multidisciplinario.

The encephalitis associated with antibodies against N-methyl-D-aspartate Receptor (anti-R NMDA) was first described in 2005. Today it is the second leading cause of autoimmune encephalitis in the pediatric population. Unlike the presentation in adults, in children, it is less frequently associated with tumors but, movement disorders are more common. Here, we present two cases of children with anti-R NMDA encephalitis. The first one was three and a half years old at the time of diagnosis and the second was seven years old. Dyskinesias were the presenting symptom in the first case, and this patient showed no psychiatric symptoms. She subsequently developed a convulsive status and impaired consciousness with language disorders. The second case, after a prodromal period, developed behavioral changes, dyskinesias, dysautonomia, convulsive status and impaired consciousness. In both cases a good outcome was achieved with treatment and patients were found in good functional class status during the follow up. We conclude that reaching the appropriated diagnosis early on during the course of the disease allowed the establishment of the proper and timely treatment which leads to a good functional recovery over time. This usually requires the support of a multidisciplinary team.

A successful case of anti-NMDAR encephalitis without tumor treated with a prolonged regimen of plasmapheresis / Um caso bem-sucedido de encefalite por anti-receptor de NMDAR sem tumor tratado com um regime prolongado de plasmaférese

Anti-NMDA receptor encephalitis is a severe but treatable autoimmune disease of the CNS. However, the use of immunotherapy and long-term outcomes have yet to be defined for this disease. We describe a case of an 18-year-old male diagnosed with anti-NMDAR encephalitis not associated with tumor, which did not respond to initial treatment with immunoglobulin, followed by corticosteroids, cyclophosphamide and evolved with significant clinical improvement after a prolonged course of plasmapheresis. Although it is not possible to affirm the good outcome was due solely to the prolonged plasmapheresis regimen, recently published data shows that improvement may take weeks or months to occur. This case discloses another therapeutic possibility for patients with refractory disease who fail to respond to recommended first-line and second-line therapy.

A encefalite antirreceptor de NMDA é uma grave doença autoimune do sistema nervoso central, mas responsiva a tratamento. No entanto o uso da imunoterapia e o prognóstico a longo prazo ainda não foram estabelecidos para esta doença. Aqui nós descrevemos o caso de um homem de 18 anos de idade diagnosticado com encefalite antirreceptor de NMDA, não associada a tumor, o qual provavelmente não respondeu à terapia inicial com corticosteroides, ciclofosfamida e, o qual evoluiu com melhora clínica importante após um curso prolongado de plasmaférese. Embora não seja possível atribuir o desfecho favorável apenas ao regime de plasmaférese prolongado, uma vez que publicações recentes demonstram que a resposta à imunoterapia pode levar semanas à meses, nosso caso abre uma possibilidade terapêutica nova para casos com doença refratária, não responsivos ao tratamento de primeira e segunda-linha preconizados

Anti-NMDA-R encephalitis: follow-up of 24 months / Encefalite anti-NMDA-R: seguimento de 24 meses

Anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is the second-most-common cause of autoimmune encephalitis, based on epidemiological studies.It has been predominantly described in young females, with prominent psychiatric symptoms, memory loss, decrease in level of consciousness, epilepsy, and central hypoventilation. The condition is commonly associated with mature ovarian teratomas. We describe a video report with a classic presentation of anti-NMDA-R encephalitis in a young patient with no identifiable tumor. Anti-NMDA encephalitis is a recognizable and treatable illness. The prognosis of patients depends on early diagnosis, implementation of appropriate immunomodulatory therapy and, in paraneoplastic cases, complete tumor removal. Clinicians should be wary of this condition, especially when assessing patients with recent onset of psychiatric symptoms unresponsive to antipsychotic treatment.

A encefalite anti-NMDA é a segunda causa mais comum de encefalite autoimune, com base em estudos epidemiológicos. Foi descrito predominantemente em mulheres jovens, com sintomas psiquiátricos proeminentes, perda de memória , diminuíção do nível de consciência, epilepsia e hipoventilação central. É comumente associada a teratomas ovarianos maduros. Descrevemos uma paciente jovem, com a apresentação clássica da encefalite anti-NMDA, sem tumor identificável. A encefalite anti-NMDA é uma doença tratável e reconhecível. O prognóstico dos pacientes depende do diagnóstico precoce, da implementação da terapia imunomoduladora apropriada e, no caso de paraneoplasia, a remoção completa do tumor. Esta condição deve ser lembrada, especialmente quando Tratam-se de pacientes com início recente de sintomas psiquiátricos que não respondem ao tratamento antipsicótico.

Sintomas psiquiátricos em pacientes com lúpus eritematoso sistêmico: frequência e associação com atividade da doença com o uso do Questionário de Morbidade Psiquiátrica em Adultos / Psychiatric symptoms in patients with systemic lupus erythematosus: frequency and association with disease activity using the Adult Psychiatric Morbidity Questionnaire

INTRODUÇÃO: Enquanto os critérios de neurolúpus estão bem-estabelecidos, manifestações psiquiátricas globais são de frequência variável em pacientes com lúpus eritematoso sistêmico (LES); suas relações com atividade da doença e prognóstico são desconhecidas. OBJETIVO: Avaliar a frequência de sintomas psiquiátricos no LES utilizando o Questionário de Morbidade Psiquiátrica em Adultos (QMPA); correlacionar alterações no QMPA com atividade da doença e variáveis socioeconômicas. MATERIAIS E MÉTODOS: Este estudo transversal avaliou pacientes com LES ativo ou inativo quanto à prevalência de sintomas psiquiátricos utilizando, pela primeira vez, o QMPA. Oito ou mais respostas afirmativas entre 45 perguntas definiram um QMPA como anormal. Os pacientes foram classificados de acordo com os critérios do American College of Rheumatology de 1997, e o grau de atividade da doença foi mensurado pelo SLEDAI. RESULTADOS: Participaram do estudo 72 pacientes com LES, dos quais 68 eram do sexo feminino (94,4%). A média de idade foi de 46,1 anos (± 12 DP). A frequência de QMPA anormal foi de 89%. Entre os 64 pacientes lúpicos com QMPA alterado, 60 (93,7%) apresentavam distúrbios mentais comuns, a maioria ansiedade e somatização. Não houve correlação de sintomas psiquiátricos com atividade da doença (P = 0,46; rs = 0,09) ou com história de psicose e/ou convulsões atribuíveis ao LES (P = 1,00). Sintomas psiquiátricos também não se correlacionaram com idade de início da doença (rs = -0,16) ou duração da doença (rs = -0,11). Houve associação de QMPA anormal com baixo nível educacional (P=0,02), mas não com renda familiar destinada ao paciente (P = 0,24). CONCLUSÃO: A frequência de sintomas psiquiátricos medidos pelo QMPA foi alta em nossa população com LES. Um QMPA anormal esteve dissociado da atividade do LES, mas se associou com baixo nível educacional.

INTRODUCTION: While the neurolupus criteria are well-established, global psychiatric manifestations are of variable frequency in patients with systemic lupus erythematosus (SLE); their relation with disease activity is unknown. OBJECTIVE: To evaluate the frequency of psychiatric symptoms in SLE using the Adult Psychiatric Morbidity Questionnaire (APMQ); to correlate APMQ changes with disease activity and socio-economic variables. MATERIALS AND METHODS: This cross-sectional study evaluated patients with active or inactive SLE as to the prevalence of psychiatric symptoms utilizing, for the first time, the APMQ. Eight or more affirmative replies out of 45 questions defined the APMQ as abnormal. Patients were classified according to the American Collge of Rheumatology 1997 criteria, and disease activity was measured by the SLEDAI. RESULTS: Seventy-two SLE patients entered the study, being 68 females (94.4%). Mean age was 46.1 years (± 12 SD). The frequency of abnormal APMQ was of 89%. Out of the 64 SLE patients with altered APMQ, 60 (93.7%) had common mental disorders, mostly anxiety and somatization. There was no correlation of psychiatric symptoms with active disease (rs = 0.09; P = 0.46), or with history of psychosis and/or seizures attributable to SLE (P = 1.00). Psychiatric symptoms also did not correlate with age at disease onset (rs = -0.16) or disease duration (rs = -0.11). There was an association of abnormal APMQ with low education level (P = 0.02), but not with family income allotted to the patient (P = 0.24). CONCLUSION: The frequency of psychiatric symptoms measured by the APMQ was high in our SLE population. An abnormal APMQ was disconnected from SLE activity, but it did associate with low education level.

Assesment of psychiatric symptoms and co-morbidities in patients with irritable bowel syndrome / Evaluación de los síntomas psiquiátricos y las comorbilidades en pacientes con el síndrome del intestino isrritable

AIM: To determine the psychiatric symptom assesment of patients seeking treatment for irritable bowel syndrome (IBS) and to demonstrate the presence of more complicated psychiatric disorders. SUBJECTS AND METHOD: The participants were recruited from patients who were attending internal medicine and gastroenterology clinics and who fullfilled the Rome III criteria for IBS. Fifty patients with IBS (IBS group) and 50 patients with complaints other than gastrointestinal symptoms (control group) were randomly selected. All participants were screened by the Structured Clinical Interview for DSM-IV (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list - 90 (Revised) [SCL-90-R]. RESULTS: Seventeen patients (34%) and three control subjects (6%) had at least one psychiatric diagnosis (p = 0.001). Global severity index (GSI) total scores and SCL-90-R items were significantly higher in the IBS group than the control group (0.92 ± 0.46 vs 0.358 ± 0.19, p < 0.001). Beck anxiety inventory and BDI scores were higher in the IBS group than the control group (p < 0.001). Axis-I psychiatric disorders diagnosed with SCID-I were significantly higher in the IBS group (34% vs 6%) [p = 0.001]. Among the Axis-I disorders, somatoform and anxiety disorders were higher in the patient group than in the control subjects (p = 0.002 and p = 0.0057) whereas there was no difference for mood disorders (p = 0.204). Seven (14%) of the patients and two (4%) of the control subjects had at least one Axis-II psychiatric disorder diagnosed with SCID-II without any significance (p = 0.159). CONCLUSION: These findings suggest that except for mood and personality disorders, almost all psychiatric symptoms and disease co-morbities with IBS are higher than in the sample without IBS. We can easily use SCL-90-R, BAI and BDI in internal medicine and gastroenterology clinics to detect psychiatric symptom levels and then to refer patients to a psychiatrist for further evaluation and treatment.

OBJETIVO: Determinar la evaluación del síntoma psiquiátrico de pacientes que buscan tratamiento para el síndrome del intestino irritable (IBS), y demostrar la presencia de trastornos psiquiátricos más complicados. SUJETOS Y MÉTODO: Los participantes reclutados fueron pacientes que asistían a clínicas de medicina interna y gastroenterología, y satisfacían los criterios de Roma III para el IBS Cincuenta pacientes con IBS (grupo IBS) y 50 pacientes aquejados de otras dolencias no gastrointestinales (grupo control) fueron seleccionados al azar. Todos los participantes pasaron por el tamiz de la Entrevista Clínica Estructurada para DSM-IV (SCID-I), el Inventario de Depresión de Beck (BDI), el Inventario de Ansiedad de Beck (BAI), y el Listado de Síntomas-90 (Revisado) [SCL-90-R]. RESULTADOS: Diecisiete pacientes (34%) y tres sujetos de control (6%) tenían al menos un diagnóstico psiquiátrico (p = 0.001). Las puntuaciones totales del índice de severidad global (GSI) y los ítems del SCL-90-R fueron significativamente más altos en el grupo de IBS que en el grupo control (0.92 ± 0.46 frente a 0.358 ± 0.19, p < 0.001). Las puntuaciones del Inventario de Ansiedad de Beck y BDI fueron más altas en el grupo IBS que el grupo control (p < 0.001). Los trastornos psiquiátricos del eje I diagnosticados con SCID-I fueron significativamente más altos en el grupo IBS (34% vs. 6%) [p = 0.001]. Entre los desórdenes del Eje I, los trastornos somatoformos y los trastornos de ansiedad fueron más altos en el grupo de pacientes que en los sujetos del control (p = 0.002) y (p = 0.0057), en tanto que no hubo ninguna diferencia en cuanto a los trastornos de estados de ánimo (p = 0.204). Siete (14%) de los pacientes y dos (4%) de los sujetos del control tuvieron por lo menos un trastorno psiquiátrico del eje II diagnosticados con el SCID-II sin ninguna significación (p = 0.159). CONCLUSIÓN: Estos hallazgos sugieren que salvo el caso de los trastornos de estados de ánimo y personalidad, casi todos los síntomas psiquiátricos y comorbilidades con el IBS son más altos que en la muestra sin IBS. Se puede usar con facilidad el SCL-90-R, el BAI y el BDI en las clínicas de medicina interna y gastroenterología para detectar los niveles de síntomas psiquiátricos, y remitir entonces a los pacientes a un psiquiatra para ulterior evaluación y tratamiento.

Prevalencia de la sintomatología del Síndrome de Asperger y variables asociadas en preescolares españoles / Prevalence of Asperger Syndrome symptomatology and associated variables in Spanish preschoolers

El Síndrome de Asperger (AS) forma parte del espectro de trastornos autistas, su estudio es reciente para el caso de edades tempranas. El objetivo de esta investigación es determinar la prevalencia de los síntomas del AS en población preescolar general, rural y urbana en preescolares de España. Además, analizamos las áreas de desarrollo y síntomas de ansiedad asociados a la presencia de sintomatología del AS. La muestra de este estudio se conforma de 1104 preescolares de 3 a 6 años de edad. La presencia de síntomas del AS se evaluó con base en el reporte de padres y maestros, mediante un instrumento de detección de desórdenes psiquiátricos. La prevalencia informada por padres fue de 11,7%, mientras que para los maestros fue de 8,1%. La presencia de sintomatología del AS se asoció a retrasos en el desarrollo de la comprensión del lenguaje, la coordinación motora, las habilidades de autoayuda y la práctica de juegos. Además, nuestros resultados indican que el AS tiene una fuerte relación con síntomas de fobia específica y tics. Concluimos que es posible hacer una detección temprana de la sintomatología del AS, ya que encontramos prevalencias similares a otras descritas en investigaciones recientes. Dada la afectación asociada al AS, su detección es altamente recomendable.

Asperger's Syndrome (AS) forms part of the whole spectrum of autistic disorders. Until recently it has not been studied in early ages. The aim of this study is to determine the AS's prevalence of symptoms in general preschool, rural and urban population. In addition, the association of the development areas and symptoms of anxiety and the presence of symptoms of AS was analized. The sample of this study consisted in 1104 preschool children between 3-6 years old. The presence of AS's symptoms was evaluated by a screening tool for psychiatric disorders. This tool was applied to both, preschooler's parents and their teachers. The prevalence of symptoms of AS for parents and teachers was 11.7% and 8.1%, respectively. The presence of AS's symptoms was associated with language compression delays, general and fine motor coordination, self-help skills and impairment in game activities. In addition, our results showed that the AS has a strong association with specific phobia symptoms and tics. We conclude that an early detection of AS's symptoms is possible since we found similar prevalence described in other recent researches. Given the impairment associated with AS, its detection is highly recommended.

Avaliação de saúde mental em gestantes / Mental health assessment of pregnant women

O período gravídico-puerperal é a fase de maior incidência de transtornos psíquicos na mulher, necessitando de atenção especial para manutenção de bem-estar e prevenção de dificuldades futuras para o desenvolvimento cognitivo e emocional do filho. A presente pesquisa objetivou verificar, através de um estudo piloto, a prevalência de sintomas psiquiátricos e uso de álcool entre gestantes do sistema público de saúde de Juiz de Fora, MG. Foram entrevistadas 33 gestantes de três unidades de saúde, e utilizados os instrumentos QMPA e MINI/DSM-IV. Verificou-se que 54,5% das entrevistadas apresentou sete ou mais sintomas psiquiátricos descritos no QMPA, com destaque para a subescala de ansiedade. Dentre os resultados do MINI/DSM-IV, destacaram-se os índices elevados de Agorafobia atual (37,7%), Agorafobia sem Transtorno de Pânico (33,3%), Síndrome Psicótica (25,0%), Episódio Depressivo Maior Atual (24,2%) e Transtorno de Ansiedade Generalizada (15,2%). Os altos índices encontrados de transtornos psiquiátricos indicaram a necessidade de investigações clínicas mais detalhadas para a avaliação da saúde mental dessas gestantes e possível indicação para tratamento. O estudo piloto se configura numa importante etapa da pesquisa, pois os resultados preliminares, bem como as dificuldades metodológicas iniciais, servem para o aprofundamento e a qualificação do estudo definitivo.

The pregnancy and puerperium period is a phase of increased incidence of mental disorders in women, requiring special attention to ensure the maintenance of their well-being and prevention of future cognitive and emotional difficulties for their child. The present research aimed at verifying, through a pilot study, the incidence of psychiatric symptoms and alcohol use among pregnant women attending the public health system of Juiz de Fora, MG. 33 pregnant women of 3 health units had been interviewed using the instruments QMPA and MINI/DSM-IV. It was verified that 54.5% of the women interviewed presented seven or more psychiatric symptoms described in the QMPA, with a prominence of the anxiety subscale. Amongst the results of the MINI/DSM-IV, the high incidence of current Agoraphobia can be highlighted (37.7%), Agoraphobia without Panic Disorder (33.3%), Psychotic Syndrome (25.0%), Bigger Depressive Episode Current (24.2%) and Generalized Anxiety Disorder (15.2%). The high incidence of psychiatric disorders found indicated the necessity of detailed clinical inquiries for the evaluation of the mental health of pregnant women and possible referal for treatment. The pilot study constitutes an important stage of the research, since the preliminary results, as well as the initial methodological difficulties, will ensure the improvement of the final study.

Prevalência de transtornos mentais em trabalhadores de uma universidade pública do estado de São Paulo / Prevalence of mental disorders in university workers from a state university in São Paulo

Em uma amostra com 552 trabalhadores de uma universidade pública do interior do estado de São Paulo, realizou-se um estudo epidemiológico de corte transversal, objetivando estimar a prevalência anual de Suspeição para Transtornos Mentais (STM). Foi utilizado o Questionário de Morbidade Psiquiátrica de Adultos-QMPA (SANTANA, 1982) em versão validada para uso em população trabalhadora (GUIMARÃES, 1992). Encontrou-se uma prevalência anual de 35% de STM. Associações estatisticamente significativas foram obtidas entre STM e: gênero (p = 0,01); estado civil (p = 0,05); religião (p = 0,05); renda familiar (p = 0,01); maior número de faltas/mês (p = 0,00). Não foram encontradas associações estatisticamente significativas entre STM e: idade, escolaridade, local de trabalho. Obteve-se somente uma tendência à associação entre STM e mudança de local de trabalho no último ano (p = 0,08). A alta prevalência de STM encontrada alerta para a magnitude do problema na organização, evidenciando a urgência da implantação de medidas preventivas relativas aos fatores psicossociais de risco e a necessidade de intervenções adequadas para o enfrentamento dos mesmos.

In a cross-sectional study designed to assess the annual prevalence of Suspected Cases of Mental Disorders (SCMD), the Adult Psychiatric Morbidity Questionnaire (QMPA; (Santana, 1982) adapted to the Brazilian working population (Guimarães, 1992) was administered to a stratified sample of 552 university workers from a State University in the city of Campinas, São Paulo. The annual prevalence of SCMD was 35%. Moreover, SCMD were significantly associated with gender (p=0.01), marital status (p=0.05), religion (p=0.05), income (p-0.01), absenteeism from work (p=0.00) on one hand; and not associated with age, education, on the other. The results showed only a tendency of association between SCMD and the changing of workplace during the previous year.(p=0.08). The high prevalence of SCMD highlights the magnitude of the problem and emphasizes the urgent need of correct preventive measures, actions and interventions to cope with the psychosocial risk factors.