Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): discrete and regression-based norms for the Brazilian context / Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): normas discretas e regressivas para o contexto brasileiro

ABSTRACT Background: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been recently developed as a brief, practical, and feasible tool for cognitive impairment in multiple sclerosis (MS). Objective: This study aimed to provide continuous and discrete normative values for the BICAMS in the Brazilian context. Methods: Normatization was achieved using six hundred and one healthy controls from the community assessed at five Brazilian geopolitical regions. Results: Mean raw scores, T scores, percentiles, and Z scores for each BICAMS measure are provided, stratified by age and educational level. Regression-based norms were provided by converting raw scores to scaled scores, which were regressed on age, gender, and education, yielding equations that can be used to calculate the predicted scores. Regression analyses revealed that age, gender, and education significantly influenced test results, as in previous studies. Conclusions: The normative data of the BICAMS to the Brazilian context presented good representativeness, improving its use in daily clinical practice.

RESUMO Antecedentes: O BICAMS foi desenvolvido como uma ferramenta breve, prática e confiável para avaliar o comprometimento cognitivo na esclerose múltipla (EM). Objetivo: Neste estudo, objetivamos fornecer dados normativos para o BICAMS. Métodos: Normatização foi realizada com seiscentos e um controles saudáveis​​ da comunidade avaliados das cinco regiões geopolíticas brasileiras. Resultados: Escores brutos médios, escore T, percentil e escore Z para cada medida do BICAMS são fornecidos e estratificados por idade e nível educacional. Normas baseadas em regressão foram obtidas através da conversão dos pontos brutos em pontos ponderados, produzindo parâmetros de regressão que podem ser usados para calcular os escores preditos. As análises de regressão revelaram que idade, gênero e educação influenciaram significativamente nos resultados do teste, assim como em estudos prévios. Conclusão: Normas do BICAMS para o contexto brasileiro apresentaram boa representatividade, contribuindo para a utilização na prática clínica diária.

Evaluation of the relationship between anxiety and nutritional habits in Turkish patients with multiple sclerosis during the Covid-19 outbreak / Avaliação da relação entre ansiedade e hábitos nutricionais em pacientes turcos com esclerose múltipla durante o surto da Covid-19

ABSTRACT Objective The Coronavirus disease 2019 is a global public health problem that has led to psychological disorders (depression, anxiety, etc.), especially in fragile individuals such as those affected by multiple sclerosis. This study investigated the relationship between anxiety and nutritional habits during the Coronavirus disease 2019 outbreak in multiple sclerosis patients. Methods This cross-sectional study was an online survey of multiple sclerosis patients living in Turkey. The total sample consisted of 294 multiple sclerosis patients. A questionnaire containing general demographic data, the Beck Anxiety Inventory, and nutritional attitudes and habits was applied to multiple sclerosis patients. Results Moderate or severe anxiety scores were found in 42.2% of multiple sclerosis patients. Weight gain was reported in 40.5% of them during the outbreak. A statistically significant difference was found in the distribution of individuals' Beck Anxiety Inventory scores for consumption of nuts/seeds, rice/pasta, cake/cookies, and water. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.04 times increased consumption of bread and rice/pasta and a 1.05 times increased consumption of cake/cookies either before or after controlling for potential confounders. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.06 times decreased consumption of water and a 1.04 times decreased consumption of meat and poultry, fruit (fresh), and rice/pasta, either before or after controlling for potential confounders. Conclusion During the Coronavirus disease 2019 outbreak, anxiety led to changes in multiple sclerosis patients' nutritional habits and food preferences. The continuous surveillance of psychological consequences and nutritional counseling during outbreaks should become routine as part of preparedness efforts worldwide.

RESUMO Objetivo A doença do Coronavírus - 2019, causada pelo Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), é um problema de saúde pública global e tem levado os indivíduos desenvolverem distúrbios psicológicos (depressão, ansiedade, etc.), especialmente indivíduos frágeis, como aqueles afetados por esclerose múltipla. O objetivo deste trabalho foi investigar a relação entre ansiedade e hábitos nutricionais em pacientes com esclerose múltipla durante o surto de coronavírus. Métodos Este estudo transversal é resultado de uma pesquisa online com pacientes com esclerose múltipla que vivem na Turquia (n=294). Um formulário de questionário contendo dados demográficos gerais, o Inventário de Ansiedade de Beck e atitudes e hábitos nutricionais foi aplicado a pacientes com esclerose múltipla. Resultados Escores de ansiedade moderados ou graves foram encontrados em 42,2% dos pacientes com esclerose múltipla. O ganho de peso foi relatado em 40,5% durante o surto. Foi encontrada diferença estatisticamente significativa na distribuição dos escores do Inventário de Ansiedade de Beck dos indivíduos para o consumo de nozes/sementes, arroz/massa, bolo/biscoitos e água. Um aumento de uma unidade nas pontuações do Inventário de Ansiedade de Beck levou a um aumento de 1,04 vezes no consumo de pão e arroz/massa e 1,05 vezes no consumo de bolo/biscoitos antes ou depois de controlar possíveis fatores de confusão. Um aumento de uma unidade nas pontuações do Inventário de Ansiedade de Beck levou a uma redução de 1,06 vezes no consumo de água e 1,04 vezes no consumo de carnes e aves, frutas (frescas) e arroz/massa antes ou depois de controlar possíveis fatores de confusão. Conclusão Durante o surto de coronavírus, a ansiedade levou a mudanças nos hábitos nutricionais e nas preferências alimentares dos pacientes com esclerose múltipla. A vigilância contínua das consequências psicológicas e o aconselhamento nutricional para surtos devem se tornar rotina como parte dos esforços de preparação em todo o mundo.

Neuropsychiatric changes during the COVID-19 pandemic in multiple sclerosis patients / Alterações neuropsiquiátricas durante a pandemia de COVID-19 em pacientes com esclerose múltipla

ABSTRACT Background: This study reported on a variety of psychological reactions related to anxiety, sleep quality, depression, fatigue, and quality of life in individuals with multiple sclerosis (MS), related to the Covid-19 quarantine experience. Objective: The aim of this study was to investigate the neuropsychiatric effects of the COVID-19 pandemic in MS patients and to analyze the risk factors contributing to psychological stress. Methods: The study was designed as a prospective, cross-sectional survey study. Multiple assessment tools that are used in neurological practice, including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fatigue Impact Scale (FIS), Pittsburgh Sleep Quality Index (PSQI), and Multiple Sclerosis Quality of Life-54 (MSQOL-54) were administered prospectively both during the early and the peak stages of COVID-19 outbreak (ESO and PSO, respectively). The survey forms were designed using SurveyMonkey and the participants were participating in the survey via a web link and QR code. Results: Fifty patients were included in the study. BDI scores, PSQI and FSI measurements, cognitive and social subscale scores and total FIS score, MSQOL-54 measurements, physical and mental subscale scores, and total MSQOL-54 score at PSO were significantly different than those at ESO. The body mass index values of the patients increased significantly at PSO compared to those measured at ESO. Conclusions: The results provide a basis for the development of psychological interventions that could minimize the prevalence of sleep disorders and depression and could improve patients' quality of life during the outbreak.

RESUMO Introdução: Este estudo relatou uma variedade de reações psicológicas relacionadas a ansiedade, qualidade do sono, depressão, fadiga e qualidade de vida em indivíduos com esclerose múltipla (EM), relacionadas à experiência de quarentena de COVID-19. Objetivo: O objetivo deste estudo foi investigar os efeitos neuropsiquiátricos da pandemia de Covid-19 em pacientes com EM e analisar os fatores de risco que contribuem para o estresse psicológico. Métodos: O estudo foi desenhado como um estudo prospectivo e transversal. Várias ferramentas de avaliação usadas na prática neurológica, incluindo Inventário de Depressão de Beck (Beck Depression Inventory - BDI), Inventário de Ansiedade de Beck (Beck Anxiety Inventory - BAI), Escala de Impacto de Fadiga (Fatigue Impact Scale - FIS), Índice de Qualidade de Sono de Pittsburgh (Pittsburgh Sleep Quality Index - PSQI) e Qualidade de Vida da Esclerose Múltipla-54 (Multiple Sclerosis Quality of Life-54 - MSQOL-54) foram administrados prospectivamente durante o estágio inicial do surto de COVID-19 (EIS) e o estágio de pico do surto de COVID-19 (EPS). Os formulários da pesquisa foram projetados usando o SurveyMonkey e os participantes participaram da pesquisa por meio de um link da web e código QR. Resultados: Foram incluídos 50 pacientes no estudo. Os escores BDI, PSQI, FSI, subescala cognitiva e social e escore total do FIS, MSQOL-54, subescala física e mental e MSQOL-54 total no PSO foram significativamente diferentes dos do EIS. Os valores do índice de massa corporal dos pacientes aumentaram significativamente na EPS em comparação com os medidos na EIS. Conclusões: Nossos resultados são uma base para o desenvolvimento de intervenções psicológicas que podem minimizar a prevalência de distúrbios do sono e depressão e melhorar a qualidade de vida dos pacientes durante o surto.

Effectiveness of mindfulness-integrated cognitive behavior therapy on anxiety, depression and hope in multiple sclerosis patients: a randomized clinical trial

Abstract Introduction Multiple sclerosis (MS) is a chronic medical condition that attracts particular attention because of the high risks associated with it. MS patients suffer from medical problems, depression, anxiety, and reduced hopefulness. These issues can increase the severity of the disease and treatment resistance and reduce patients' individual and social efficacy. Mindfulness-integrated cognitive behavior therapy (MICBT) is a new approach that is being applied in chronic diseases and can be used in combination with existing treatments. Therefore, the present study investigated the efficacy of MICBT in terms of anxiety, depression, and hope in MS patients. Methods A sample of 20 patients with MS was randomly selected at Shafa Hospital in Kerman City, Iran. Patients were then assigned to one of two groups of 10 people using a random number table. The experimental group received MICBT. The control group also received the same therapy after study completion. The assessment tools used in this study included the Beck Depression Inventory-Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and Miller Hope Scale (MHS). Measurements were conducted at three stages: pre-test, post-test, and follow-up. For data analysis, means and standard deviations were calculated and one-way analysis of covariance was conducted using SPSS 24. Results Compared with controls, MICBT was effective for reducing depression (P < 0.001, F = 72.55), anxiety (P < 0.001, F = 100.75). Additionally, MICBT was effective in improving hope (P < 0.001, F = 45.36). Changes were maintained in the follow-up phase. Conclusion The MICBT affects depression, anxiety and hope of MS patients. Therefore, mental health professionals can benefit from the results obtained in the present study to reduce depression and anxiety and increase hope in this group of patients. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT201601030258N4.

Calidad de vida relacionada a la salud de las personas con esclerosis múltiple en la Región de Magallanes, Chile / Health-related quality of life of individuals with multiple sclerosis from the Magallanes Region of Chile

INTRODUCCIÓN: La esclerosis múltiple (EM) es una enfermedad autoinmune, crónica, inflamatoria y desmielinizante que afecta al sistema nervioso central (SNC) y la calidad de vida de las personas afectadas. Este último aspecto tiene especial relevancia por su impacto, ya que afecta a individuos jóvenes en etapa productiva. OBJETIVO: Describir las características demográficas y calidad de vida relacionada a la salud de personas con diagnóstico de EM de la región de Magallanes y Antártica Chilena. Materiales y métodos: Mediante un estudio descriptivo de pacientes con diagnóstico de EM, se registraron los antecedentes demográficos y se evaluó la Calidad de Vida Relacionada a la Salud (CVRS) con el cuestionario de salud SF-36 v.2. RESULTADOS: Se evaluaron 40 pacientes entre 21 y 65 años de edad (57,5% mujeres) con una evolución de EM de 7,59 ± 7,38 años. En la SF-36 v.2, los menores puntajes promedios fueron en las dimensiones Vitalidad (53,75 puntos) y Salud General (61,00 puntos), y los mayores fueron en las dimensiones Función Social (72,50 puntos) y Función Física (71,63 puntos). No hubo diferencias en la calidad de vida de las personas según el sexo. CONCLUSIÓN: La EM deteriora de manera gradual y diversa diferentes funciones neurológicas; esto determina una disminución de la calidad de vida, principalmente en las dimensiones de Vitalidad y Concepción General del estado de salud.

INTRODUCTION: Multiple sclerosis (MS) is an autoimmune, chronic, inflammatory and demyelinating disease that affects the central neuro system (CNS) and patients' quality of life. This is particularly relevant as MS impacts young individuals, during their productive years. AIM: To describe the demographic characteristics and health-related quality of life of individuals with MS in the Magallanes and Chilean Antarctic Region. Materials and methods: A descriptive study of individuals with MS was conducted; demographic information was collected, and health-related quality of life was assessed with the SF-36 v.2 instrument. RESULTS: A total of 40 patients, between 21 to 65 years of age (57.5% women) were evaluated. They had MS for an average of 7.59 ± 7.38 years. In the SF-36 v.2, the lowest average scores were in the dimensions of Vitality (53.75 points) and General Health (61.00 points), while the highest scores were in Social Functioning (72.50 points) and Physical Functioning (71.63 points). There was no sex-based difference in quality of life. CONCLUSIONS: MS produces a gradual and varied decline of neurological functions, leading to a reduction of quality of life, mainly in the dimensions of Vitality and General Health perception

Basal cortisol levels and the relationship with clinical symptoms in multiple sclerosis: a systematic review / Níveis de cortisol basal e a relação com sintomas clínicos na esclerose múltipla: uma revisão sistemática

ABSTRACT Multiple sclerosis (MS) is a demyelinating, progressive and neurodegenerative disease. A disturbance on the hypothalamic-pituitary-adrenal axis can be observed in patients with MS, showing altered cortisol levels. We aimed to identify basal cortisol levels and verify the relationship with clinical symptoms in patients with MS. A systematic search was conducted in the databases: Pubmed, Web of Science and SCOPUS. Both higher and lower cortisol levels were associated with MS. Higher cortisol levels were associated with depression and anxiety, while lower levels were associated with depression, fatigue and urinary dysfunction. Higher cortisol levels may be associated with the progression and severity of MS.

RESUMO A esclerose múltipla (EM) é uma doença desmielinizante, progressiva e neurodegenerativa. Um distúrbio no eixo hipotálamo-hipófise-adrenal pode ser observado em pacientes com EM, mostrando níveis alterados de cortisol. Nosso objetivo foi identificar os níveis basais de cortisol e verificar a relação com os sintomas clínicos em pacientes com EM. Uma busca sistemática foi realizada nas bases de dados: Pubmed, Web of Science e SCOPUS. Ambos os níveis de cortisol elevado e baixo foram associados com a EM. Níveis mais elevados de cortisol foram associados à depressão e ansiedade, enquanto níveis mais baixos foram associados à depressão, fadiga e disfunção urinária. Níveis altos de cortisol podem estar associados à progressão e gravidade da EM.

Relajación muscular y depresión en pacientes con esclerosis múltiple: estudio de caso múltiple / Muscular relaxation and depression among patients diagnosed with multiple sclerosis: a multiple-case study

El objetivo de esta investigación fue medir el efecto del Entrenamiento en Relajamiento Muscular Progresivo de Edmund Jacobson en los niveles de Depresión de tres pacientes con Esclerosis Múltiple (EM). Participaron inicialmente y de forma voluntaria 8 sujetos, todos del género femenino, de clase media, quienes no contaban con ningún tipo prestaciones en salud. De dichos casos valorados, se eligieron a tres pacientes con diferentes niveles de depresión: primer caso (sin depresión), segundo caso (depresión leve) y tercer caso (depresión moderada). Ya que sólo se encontraron estos niveles de depresión en el grupo valorado, es decir no se encontró depresión grave, lo anterior de acuerdo con los resultados arrojados por el Inventario de Depresión de Beck. El trabajo se basa en un diseño de estudio de caso múltiple, donde cada caso debe ser tratado en forma individual para luego sacar conclusiones del cruce de dichos casos. Con resultados alentadores, ya que en las tres situaciones hubo mejoras, demostrando que dicho entrenamiento de relajación muscular tiene efectos positivos sobre los niveles de ansiedad de este tipo de pacientes. Además, en cuanto al análisis introspectivo de cada paciente reportaron mejoras no sólo en depresión, sino, en autoestima, comunicación, socialización, aprendizaje y aceptación de la enfermedad.

The purpose of this research was to measure what the effect of a Progressive Muscular Relaxation Training of Edmund Jacobson (Year) would have on the different depression levels of 3 multiple sclerosis (MS) patients. Participants included 8 middle-class females, who did not have any type of health care. From those 8 participants, only 3 were selected that showed a different level of depression: first participant (No depression), second participant (low depression), and third participant (moderate depression). Since only these types of different levels of depression were found among the participants, severe depression was not found, though according to Beck's Depression Questionnaire (Year). This is a multiple-case study type of research, where each participant was treated individually, to better understand in an in depth manner the connection of these cases. We can say that our results are promising, since all three participants showed improvements, indicating a positive effect with the Progressive Muscular Relaxation Training over anxiety levels of participants. As well, according to an introspective analysis of each participant were shown improvements not only in depression levels but in self-esteem, socialization, communication skills, learning and adaptability to their disease.

Psychiatric event in multiple sclerosis: could it be the tip of the iceberg?

Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system. Psychiatric comorbidities are highly prevalent in patients with MS, and can have drastic impact on quality of life and interpersonal relationships. Despite this high prevalence, whether psychiatric manifestations may represent the first signs of MS is still debatable. This constitutes an important issue, since early diagnosis of "psychiatric-onset MS" would result in prompt management, which usually ameliorates long-term prognosis. Here, we discuss clinical and radiological hints that suggest a diagnosis of psychiatric-onset MS. Briefly, this entity should be considered in healthy patients presenting with late-onset psychiatric symptoms, with or without cognitive decline, and with negative family history of psychiatric diseases. A thorough neurological exam is crucial to detect any subtle neurological signs. Brain magnetic resonance imaging is recommended to rule out frontotemporal lesions that might explain the clinical picture. Poor response to standard psychiatric treatments provides additional evidence for the diagnosis of an organic disease (e.g., MS). Combining psychopharmaceuticals with intravenous corticosteroids would result in good outcomes, but patients should be monitored carefully for possible psychiatric exacerbation, a common side effect of steroids.

Luto e enfrentamento em portadoras de esclerose múltipla: diálogo com a teoria de Kübler-Ross / Grief and coping in patients with multiple sclerosis: dialogue with Kübler-Ross

A Esclerose Múltipla (EM) é uma doença crônica e progressiva, que causa perdas motoras, sensoriais e psicológicas. Objetivo: Compreender o processo de luto e enfrentamento de pessoas com esclerose múltipla, em diferentes períodos do diagnóstico, sob enfoque das proposições teóricas de Kübler-Ross sobre o processo de luto. Método: Foram realizadas entrevistas semiestruturadas e foi feita a aplicação das pranchas um e 11 do Teste de Apercepção Temática a três mulheres, uma delas estava em investigação diagnóstica para EM, uma tinha diagnóstico de EM há um ano e a terceira havia sido diagnosticada com EM há cinco anos. Utilizou-se análise de conteúdo temática para organização dos dados e a teoria do luto de Kübler-Ross para analisá-los. Resultados: Diferenças na forma como cada participante lidava com a EM puderam ser observadas. As participantes com diferentes períodos de diagnóstico/investigação vivenciavam fases distintas do processo de luto e utilizavam diferentes tipos de estratégias de enfrentamento. Conclusões: O adoecimento conduz ao luto, que pode ser uma forma para realizar o enfrentamento e ressignificar a vida na nova condição

Multiple Sclerosis (MS) is a chronic and progressive disease that causes motor, sensory and psychological losses. Objective: To understand the process of grief and coping in people with multiple sclerosis, at different stages of diagnosis, based on Kübler-Ross' theoretical propositions of grief. Method: Semi-structured interview and application of pictures 1 and 11 of the Thematic Apperception Test to three women, one in diagnostic investigation for MS, one diagnosed with MS a year ago and the third has been diagnosed with MS for five years. We used thematic content analysis for data organization and the Kübler-Ross grief theory to analyze them. Results: Differences in the way each participant felt MS could be observed. The partici- pants at different stages of diagnosis/investigation experienced a different phase of the grief process and used different types of coping strategies. Conclusions: Illness leads to mourning, which can be a coping strategy to re-signify life in the new condition

Social support network and quality of life in multiple sclerosis patients / Rede de apoio social e qualidade de vida de pacientes com esclerose múltipla

ABSTRACT Objective To analyse the relationship between the social support network (SSN) and health related quality of life (HRQOL) in multiple sclerosis (MS) patients. Methods The sample comprised 150 consecutive MS patients attending our MS clinic. To assess the socio-demographic data, a specifically designed questionnaire was applied. The HRQOL dimensions were measured with the Short-Form Health Survey Questionnaire-SF36 and the SSN with the Medical Outcomes Study Social Support Survey. Spearman’s correlation was used to compare the magnitude of the relationship between the SSN and HRQOL. Results The mean patient age was 41.7 years (± 10.4; range: 18–70 yr); the mean Expanded Disability Status Score was 2.5 (±2.4; range: 0–9). There was a statistically significant correlation between the structure of the SSN and the HRQOL. Conclusion The composition of the SSN, social group membership and participation in voluntary work have an important role in the HRQOL of patients with MS.

RESUMO Objetivo Analisar a relação entre a rede de apoio social (RAS) e a qualidade de vida relacionada com a saúde (QVRS) em pacientes com esclerose múltipla (EM). Métodos Foram avaliados consecutivamente 150 pacientes na consulta de esclerose múltipla. As dimensões da QVRS foram medidas com Short-Form Health Survey Questionnaire-SF36 e a RAS com o Medical Outcomes Study Social Support Survey. A correlação de Spearman foi utilizada para comparar a magnitude da relação entre a RAS e a QVRS. Resultados A idade média dos pacientes foi 41,7 anos (± 10,4; intervalo: 18–70 anos); a média da EDSS foi 2,5 (± 2,4; intervalo: 0–9). Foi encontrada uma correlação estatisticamente significativa entre a estrutura da RAS e a QVRS. Conclusão A composição da RAS, a pertença a um grupo social e a participação em trabalho voluntário têm um papel importante na QVRS dos pacientes com MS.

Patients with multiple sclerosis present low levels of empathy / Pacientes com esclerose múltipla apresentam baixos níveis de empatia

ABSTRACT Multiple sclerosis (MS) is a chronic neuroimmunological disease that mainly affects young adults, leading to neurological disabilities over the course of their lives. Many psychiatric conditions have been reported in patients with MS, but there are remarkably few studies assessing empathy among these patients. Methods This is a single center, cross-sectional study, of 34 patients with MS and 34 matched control subjects. A specific questionnaire (empathy quotient) was used. Results Patients with MS showed significantly lower levels of empathy. This finding was not correlated with disease duration, degree of disability, drugs for treating MS or lesion load on resonance magnetic imaging. Conclusion Decreased empathy is a frequent condition in patients with MS and should be addressed in order to diminish the psychosocial burden of this neurological disease.

RESUMO Esclerose múltipla (EM) é uma doença crônica neuroimune que afeta principalmente adultos jovens, levando a incapacidades neurológicas ao longo do curso de suas vidas. Diversas condições psiquiátricas foram relatadas em pacientes com EM, porém existem muito poucos trabalhos que avaliam empatia nestes pacientes. Métodos Este foi um estudo transversal e unicêntrico com 34 pacientes com EM e 34 controles saudáveis pareados. Um questionário específico foi utilizado (Quociente de Empatia). Resultados Os pacientes com EM mostraram níveis significativamente mais baixos de empatia. Este achado não estava correlacionado com a duração da doença, grau de incapacidade, droga utilizada no tratamento da EM ou carga lesional na ressonância magnética. Conclusão Redução da empatia parece ser uma condição frequente em pacientes com EM e deve ser abordada para diminuir a carga psicossocial nos pacientes que apresentam esta doença neurológica.

Evaluation of the effects of group psychotherapy on cognitive function in patients with multiple sclerosis with cognitive dysfunction and depression / Avaliação do efeito da psicoterapia de grupo sobre as funções cognitivas de pacientes com esclerose múltipla que apresentam simultaneamente alterações cognitivas e depressão

Objective This study will evaluate how decreasing depression severity via group psychotherapy affects the cognitive function of patients with multiple sclerosis (MS) who are also diagnosed with depression and cognitive dysfunction. Method MS patients completed the Brief Repeatable Battery of Neuropsychological Tests and Beck Depression Inventory (BDI). The group members diagnosed with depression and cognitive dysfunction underwent group psychotherapy for 3 months. Upon completion of psychotherapy, both tests were readministered. Results Depression and cognitive dysfunction were comorbid in 15 (13.9%) of patients. Although improvement was detected at the end of the 3-month group psychotherapy intervention, it was limited to the BDI and the Paced Auditory Test. Conclusion Group psychotherapy might decrease cognitive impairment in MS patients. .

Objetivo Avaliar como a melhora da depressão grave através da psicoterapia afeta a função cognitiva de pacientes com esclerose múltipla (EM) diagnosticados com depressão e disfunção cognitiva. Método Foram aplicados a pacientes com EM o “Brief Repeatable Battery of Neuropsychological Test” e o ınventário de depressão de beck (BDI). Os pacientes com depressão e disfunção cognitiva foram submetidos a psicoterapia de grupo por 3 meses. Depois desse período, foram reaplicados os mesmos testes. Resultados Depressão e disfunção cognitiva foram detectadas conjuntamente em 15 (13,9%) dos pacientes. Embora os pacientes se tivessem recuperado ao fim dos 3 meses de psicoterapia de grupo, somente através do BDI e do “Paced Auditory Test” foi possível detectar uma recuperação significativa. Conclusão Psicoterapia de grupo pode diminuir o comprometimento cognitivo em pacientes com EM. .

Coping strategies and mood profiles in patients with multiple sclerosis / Estratégias de enfrentamento e perfis de humor em pacientes com esclerose múltipla

Objective: The aim of the present study was to investigate the coping strategies, mood characteristics and the association between these aspects in patients diagnosed with multiple sclerosis and healthy subjects. Method: Fifty consecutive patients who were diagnosed with multiple sclerosis according to McDonald criteria and thirty-one healthy subjects were included in the study. In addition to the sociodemographic form, Expanded Disability Status Scale (EDSS), Coping Orientation for Problem Experiences Scale (COPE), and Profile of Mood States (POMS) tests were applied to the participants. Results: Non-functional coping strategies were significantly higher in the secondary-progressive type (p≤0.05). Depression-dejection, fatigue-inertia and total POMS scores were significantly higher in the secondary-progressive type (p≤0.05). Conclusion: The results of our study demonstrate the importance of rehabilitation programs that encourage exercise among patients with multiple sclerosis to increase vigor-activity levels. .

Objetivo: Investigar as estratégias de enfrentamento, as características de humor e a associação entre estes aspectos em pacientes com diagnóstico de esclerose múltipla em comparação a indivíduos saudáveis. Método: Foram incluídos no estudo 50 pacientes com diagnóstico de esclerose múltipla de acordo com os critérios de McDonald e 31 pessoas saudáveis. Além da caracterização sócio-econômica, foram aplicados a todos os pacientes testes para avaliar o Expanded Disability Status Scale (EDSS), o Coping Orientation for Problem Experiences Scale (COPE) e o Profile of Mood States (POMS). Resultados: Escores referentes a estratégias de enfrentamento não funcionais foram significativamente maiores na forma secundariamente progressiva (p≤0.05). Escores relativos a depressão-abatimento, fadiga-inércia e escores totais POMS foram significativamente maiores na forma secundariamente progressiva (p≤0.05). Conclusão: Os resultados deste estudo mostram a importância de programas de reabilitação que encorajem os pacientes com esclerose múltipla a praticar exercícios com maiores níveis de vigor e atividade. .

Calidad de vida en la esclerosis múltiple:: su relación con la depresión, fatiga y calidad del sueño / Life quality in multiple sclerosis:: its relationship with depression, fatigue and sleep quality

Fundamento: el efecto incapacitante de la esclerosis múltiple impacta negativamente en la calidad de vida, superior incluso a los producidos por otras enfermedades crónicas. Objetivos: determinar la asociación de la fatiga, depresión y calidad del sueño con la calidad de vida en los pacientes con esclerosis múltiple. Metodología: se realizó un estudio correlacional transversal en 30 pacientes que ingresaron en el Hospital de Rehabilitación de Sancti Spíritus. Las pruebas aplicadas fueron el cuestionario de calidad de vida (MSQOL-54), inventario de depresión de beck, escala de severidad de fatiga, e índice de calidad de sueño de Pittsburg. Para correlacionar variables cuantitativas entre sí se utilizó el coeficiente de correlación de Pearson. Resultados: la depresión y el sueño se relacionaron estadísticamente con varios componentes de la calidad de vida como: las limitaciones del rol por problemas físicos y emocionales, dolor, energía, función social, función cognitiva, función sexual y cambio en la salud. La fatiga influyó en la totalidad de los componentes de la calidad de vida. Conclusiones: Los hallazgos indicaron que la depresión, las alteraciones del sueño y la fatiga influyeron significativamente en la calidad de vida de los pacientes con esclerosis múltiple.

Background : the incapacitating effect of multiple sclerosis impacts negatively on life quality, even higher to the ones produced by other chronic diseases. Objectives: to determine the association of fatigue, depression and sleep quality with the life quality in multiple sclerosis patients. Material and method: a correlational-transversal study was made in 30 patients who were admitted in the Rehabilitation Hospital of Sancti Spíritus. The applied tests were the life quality (MSQOL-54) questionnaire, Beck depression inventory, fatigue severity scale and sleep quality index of Pittsburg . For quantitative variables to correlate each other the Pearson coefficient correlation was used. Results: depression and sleep were statistically related to some components of life quality such as: role limitations because of physical and emotional problems, pain, energy, social function, cognitive function, sexual function and health change. Fatigue influenced on most of the components of life quality. Conclusions: the findings indicated that depression, sleep alterations and fatigue significantly influenced on the life quality of patients with multiple sclerosis.

Caracterização e queixas relacionadas ao desempenho ocupacional: considerações de indivíduos com esclerose múltipla / Characterization and complains related to occupational performance: considerations of people with multiple sclerosis

Indivíduos com esclerose múltipla (EM) exibem sequelas características, como fadiga, paresia e déficit de marchae equilíbrio que são prejudicais ao desempenho de atividades. Os objetivos do estudo foram identificar atividades relativas ao desempenho ocupacional consideradas importantes para indivíduos com EM, analisar suas limitações ao realizá-las e averiguar suasatisfação como as executam. Trata-se de estudo exploratório e descritivo com 21 indivíduos com EM que frequentavam um hospital universitário. O grau de desempenho nas atividades e satisfação foi mensurado através da Medida Canadense de Desempenho Ocupacional (COPM) sendo os resultados analisadosatravés de estatística descritiva. A maioria das 104 atividades identificadas foi categorizada em “autocuidado” (ex., andar na rua, subir/descer escada), “lazer” (ex., praticar esportes, visitar amigos e familiares) e “produtividade” (ex., limpar/arrumar casa, trabalhar fora de casa). O estudo possibilitou identificar as limitações que indivíduos com EM apresentam ao realizar atividades variadas e o grau de satisfação como as executam.

Subjects with multiple sclerosis (MS) exhibit characteristic sequelae, such as fatigue, weakness, and impairedbalance which might be harmful to the performance of activities. The study aimed to identify activities considered important to people with MS related to their occupational performance, analyzetheir limitations to accomplish them, and check their satisfaction on how to execute them. This is an exploratory and descriptive study conducted with 21 people with MS that attended a university hospital. The degree of performance and satisfaction with it was measured by the Canadian Occupational Performance Measure(COPM) and the results were analyzed by descriptive statistics. The majority of the 104 identified activities was classified as “selfcare” (e.g., walking on street, going up/go stairs), “leisure” (e.g., playing sports, visiting friends and relatives) and “productivity” (e.g., cleaning and working outside house). The study identified the constraints individuals with MS have to perform activities and the degree of satisfaction to do them.

Cognitive impairment is correlated with reduced quality of life in patients with clinically isolated syndrome / Comprometimento cognitivo correlaciona-se com redução da qualidade de vida em pacientes com síndrome clinicamente isolada

OBJECTIVE: To evaluate the quality of life (QoL) and potential QoL determinants in patients with clinically isolated syndrome (CIS). METHODS: Eighteen CIS patients and eighteen controls were submitted to QoL evaluation with Functional Assessment of Multiple Sclerosis QoL instrument (FAMS). Cognition was evaluated with specific battery tests; Anxiety and depression with Beck Anxiety (BAI) and Depression (BDI) Inventories and Neurological disability with Guy's Neurological Disability Scale (GNDS). RESULTS: There was a significant difference in QoL between CIS patients and controls. CIS patients had worse performance in Paced Auditory Serial Addition 2 seconds (p=0.009) and fluency tests (p=0.0038). There was a significant difference in BAI (p=0.003), but no significant difference in BDI between patients and controls. There were significant correlations between QoL measure and verbal fluency and Stroop's test. CONCLUSIONS: Cognition, but not anxiety, depression and disability, was associated with reduced quality of life.

OBJETIVO: Avaliar a qualidade de vida (QoL) e seus potenciais determinantes em pacientes com síndrome clinicamente isolada (SCI). MÉTODOS: Dezoito pacientes com SCI e 18 controles realizaram avaliação da QoL com Escala de Determinação da QoL na Esclerose Múltipla; cognição foi avaliada com bateria de testes específica; ansiedade e depressão com os Inventários de Beck de ansiedade (BAI) e de depressão (BDI) e a incapacidade neurológica com a Guy's Neurological Disability Scale. RESULTADOS: Houve diferença significativa na QoL avaliada entre pacientes com SCI e controles. Pacientes com SCI apresentaram pior desempenho no Pased Auditory Serial Addition 2 segundos (p=0,009) e na fluência verbal (p=0,0038). Houve diferença no BAI (p=0,003), entretanto sem diferença do BDI entre pacientes e controles. Houve correlações significativas entre QoL, fluência verbal e Stroop. CONCLUSÕES: Alterações cognitivas tiveram correlação com diminuição da QoL, o que não ocorreu com a depressão, ansiedade e incapacidade neurológica.

[Impacts of emotional catharsis by writing on depression in multiple sclerosis patients]

Multiple sclerosis [MS] is an acquired chronic neurological disease whose prevalence is more in some areas of Iran. Of its significant features are that most patients are young adults and also it's disabling nature. Psychiatric disorders such as depression are seen in MS patients considerably. Expression of emotions or emotional Catharsis by writing is one of the cost-effective self-helping methods whose efficacy has been studied on mental and physical health and survival in chronic patients. This method has not been studied on MS patients yet. This research has been conducted to evaluate the effects of Journaling on depression in MS patients. This study has been done in ''Interventional and Quazi experiment'' before and after method, on patients with [MS] coming to MS ASSOSIATION, in TEHRAN, IRAN within [2010]. After getting patients' written consents, candidates were asked to complete first DASS-21 questionnaire and then write negative feelings and emotions about a traumatic event, 30 minutes a day for four continuous weeks. After 1 month they were asked to complete another DASS-21 questionnaire. Finally Data of questionnaire were analyzed by SPSS version 16. Depression score are higher than normal in MS patients. Mean of depression score of intervention group was significantly better than before Journaling [P=0.008]. Journaling efficacy was not dependent on sex and patients age. Journaling and writing emotional expression is effective on depression score in patients with MS

Qualidade de vida relacionada à saúde de pacientes com esclerose múltipla antes do transplante de células-tronco hematopoéticas / Health related quality of life of patients with multiple sclerosis before hematopoietic stem cells transplantation

Este estudo teve por objetivo avaliar qualidade de vida (QV) e vulnerabilidade psicológica (ansiedade, depressão e estresse) de pacientes com Esclerose Múltipla (EM) que seriam submetidos ao Transplante de Células-Tronco Hematopoéticas (TCTH). Participaram do estudo 13 pacientes. Os instrumentos utilizados foram: Questionário Genérico de Avaliação de Qualidade de Vida - SF-36, Escala Hospitalar de Ansiedade e Depressão (HAD) e Inventário de Sintomas de Stress para Adultos de Lipp (ISSL). A análise dos dados foi realizada segundo as recomendações específicas de cada instrumento. Os resultados evidenciaram a existência de relação significativa entre prejuízos físicos e mentais impostos pela enfermidade (e/ou pelo transplante) e a instalação de quadros de depressão, ansiedade e estresse nos participantes.

This study aimed to evaluate quality of life (QoL) and psychological vulnerability (anxiety, stress and depression) of patients with multiple sclerosis (MS) who would undergo Hematopoietic Stem Cell Transplantation (HSCT). The sample consisted of 13 patients. The following instruments were used: MOS 36-Item Short-Form Health Survey (SF-36), Hospital Anxiety and Depression Scale (HAD) and Lipp's Stress Symptoms Inventory for Adults (ISSL). Data analysis was performed according to specific recommendations for each instrument. The obtained results showed that the physical and mental damage the illness (and/or transplantation) imposed is significantly related with the emergence of depression, anxiety and stress in participants.

The effect of social support on the quality of life of patients with multiple sclerosis / Efeito do apoio social na qualidade de vida de pacientes com esclerose múltipla

OBJECTIVE: To determine the predictive value of social support on health related quality of life (HRQoL) in multiple sclerosis (MS) patients. METHODS: The sample is composed by 150 MS consecutive patients. We used the Medical Outcomes Study Social Support Survey to assess social support and the Health Status Questionnaire to assess HRQoL. For inferential analysis, we used the Multiple Linear Regression with stepwise selection of variables. RESULTS: The age, basic education, psychological support and disability explains 41.6 percent of the variance in physical function, 29.4 percent in physical performance and 30.6 percent in emotional performance. Age and psychological support explains 23.1 percent of the variance in physical function and 29.4 percent in vitality. CONCLUSION: This study demonstrated that social support is a predictor with a significant effect on HRQoL in MS.

OBJETIVO: Determinar o valor preditivo do apoio social na qualidade de vida relacionada com a saúde dos doentes com esclerose múltipla (HRQoL). MÉTODO: Cento e cinquenta doentes foram consecutivamente avaliados na consulta de esclerose múltipla. Usamos o Medical Outcomes Study Social Support Survey para avaliar o apoio social e o Health Status Questionnaire para avaliar a qualidade de vida. Na análise inferencial, utilizamos a regressão múltipla linear com a seleção de variáveis passo a passo. RESULTADOS: A idade, a educação básica, o apoio psicológico e a incapacidade explicam 41,6 por cento da variância na função física, 29,4 por cento da variância no desempenho físico e 30,6 por cento da variância no desempenho emocional. Idade e apoio psicológico explicam 23,1 por cento da variância na função física e 29,4 por cento na vitalidade. CONCLUSÃO: Este estudo demonstrou que o apoio social é o preditor com um efeito significativo sobre HRQoL.

Imagem corporal em pessoas com esclerose múltipla ativas e sedentárias / Body Image in active and sedentary people with multiple sclerosis

Objetivo: Desta pesquisa foi verificar aspectos perceptivos e atitudinais da imagem corporal pessoas com Esclerose Múltipla e as diferenças destas variáveis entre praticantes e não praticantes de atividade física. Método: Esta foi uma pesquisa descritiva e exploratória, de corte transversal.A amostra foi composta por 26 voluntários, com Expanded Disability Status Scale (EDSS) até 6.Os instrumentos utilizados foram: o Software de Avaliação Perceptiva (SAP), o Adaptive Probit Estimation, Escala de Apreciação do Próprio Corpo, Escala de Sintomas e um questionário demográfico. Os dados nominais foram submetidos a uma análise descritiva e os intervalares à análises inferenciais. Resultados: Principais indicam acurácia na percepção do corpo, com alta sensibilidade a mudanças corporais, sendo os praticantes de atividade física os mais sensíveis. Ainda, que73% estão insatisfeitos com sua aparência e que o tipo de dor em formigamento é a queixa mais frequente. Não houve uma associação entre insatisfação com partes do corpo e áreas dolorosas,e os motivos para a insatisfação aglutinam-se em razões estéticas. Conclusão: A prática regular de atividade física parece contribuir para aumentar a percepção corporal, mas não a satisfação como corpo. A dor estabeleceu-se como um fato real, porém independente da aparência física, indicando aos profissionais de saúde que trabalham com estas pessoas que a aparência e a função do corpo são elementos distintos da identidade corporal, e tanto um quanto o outro provoca impacto na relação do sujeito com seu corpo.

Objective: The aim of this research was to evaluate perceptive and attitudinal aspects of body image among people with multiple sclerosis, and the differences between these variables among active and sedentary people. Method: This study was descriptive, exploratory, and cross-sectional.The sample was composed of 26 volunteers, with Expanded Disability Status Scale (EDSS) up to 6.Software for Perceptual Assessment, Adaptive Probit Estimation, Appreciation Scale of Own Body,Symptom scale, and a demographic questionnaire were the scales used to collect data. Nominal data were submitted to a descriptive analysis and interval data were submitted to inferential analysis. Results: The main results indicate accuracy in body perception, with high sensitivity to body change - the active people being the more sensitive. Also, 73% were dissatisfied with their appearance and tingling pain was the most frequent complaint. There was no association betweendis satisfaction with body parts and painful body parts, and the reasons for their being dissatisfied were mostly esthetic. Conclusion: We concluded that regular physical activity seems to contributeto enhancing body perception, but not body satisfaction. In its turn, pain was established as a realfact - however, apart from physical appearance, indicating for health professionals who work withthis clinical group that appearance and body function are distinct elements of body identity, and both have an impact on the subject relationship with its body.