ABSTRACT
BACKGROUND: The onset of the COVID-19 pandemic has brought to light a significant surge in depression across diverse populations. While a considerable body of research has linked this upswing to lockdowns and restrictive measures, it is crucial to recognize that lockdowns alone cannot fully elucidate the observed increase in mental health disorders, given the vast array of individual psychological responses. OBJECTIVE: This study aims to test e whether personality dimensions (Extroversion, Neuroticism, and Psychoticism) and resilience play a role in shielding individuals from developing depression during the COVID-19 pandemic, as observed in a sample of Brazilian adults. METHODS: This research employed a one-year longitudinal naturalistic study involving the general population. It utilized a web-based questionnaire administered in three waves during the COVID-19 pandemic: April 2020, September 2020, and May 2021. The research protocol contains the Patient Health Questionnaire-9 - PHQ-9, the Connor-Davidson Resilience Scale - CD-RISC, and the Eysenck Personality Questionnaire Revised-Abbreviated - EPQR-A. RESULTS: Our study encompassed 455 participants, of which 35.6 % met the criteria for depression in the first wave, and this figure decreased to 18.5 % in the second and third waves (p = 0.001). Resilience levels in the non-depressed group (consistently exhibited higher means across all three waves when compared to the depressed group (first wave: x¯= 27.98; second wave: x¯= 37.26; third wave: x¯= 36.67; p = 0.001). Furthermore, resilience exhibited an overall protective effect against depression in all waves (PR = 0.93, p = 0.000). Neuroticism and Psychoticism emerged as predictors of depression across all waves (PR = 1.346; p = 0.0001 and PR = 1.157; p = 0.030), while the Extroversion dimension showed no significant effect. CONCLUSION: The decline in depression rates during the first year of the COVID-19 pandemic was influenced by levels of resilience, which acted as a protective factor against the development of depressive symptoms. Notably, Neuroticism and Psychoticism predicted the risk of developing depressive symptoms. Implications for practical intervention in future crisis scenarios suggest the need for public health policy programs featuring personalized interventions that prioritize enhancing resilience.
Subject(s)
COVID-19 , Psychological Tests , Resilience, Psychological , Adult , Humans , COVID-19/epidemiology , Depression/epidemiology , Pandemics , Longitudinal Studies , Communicable Disease Control , NeuroticismABSTRACT
O impacto da pandemia de SARS-CoV2 e as recomendações de reduzir a circulação de pessoas produziu uma série de mudanças no nosso cotidiano. Tratamentos tradicionalmente realizados face-a-face de forma presencial as psicoterapias sofreram forte impacto com riscos de abandono e interrupção. O objetivo deste artigo é apresentar um relato de experiência sobre o processo de implementação de psicoterapia on-line no ambulatório de psicoterapias do Serviço de Psiquiatria de um hospital escola durante a pandemia de SARS-CoV2, exibindo as principais adaptações realizadas nos procedimentos de comunicação, protocolos de atendimento e registros das sessões de psicoterapia. Tendo como foco a garantia da manutenção dos atendimentos durante períodos de distanciamento social foram criadas diretrizes para a realização de psicoterapia on-line com a elaboração de um manual norteador (Material suplementar) de procedimentos para continuidade dos atendimentos dentro dos parâmetros éticos e técnicos estabelecidos pelo serviço. O manual foi elaborado a partir da discussão entre supervisores e residentes, de forma que refletisse a realidade e as demandas comumente atendidas. As adaptações realizadas no ambulatório foram norteadas por quatro grandes objetivos: 1) manutenção e continuidade dos atendimentos; 2) diminuição de barreiras de comunicação entre psicoterapeuta-paciente; 3) manutenção de reuniões on-line e web conferência entre todos os membros da equipe e manutenção dos estudos e; 4) normatização de procedimentos durante as sessões de psicoterapia.(AU)
The impact of the SARS-CoV2 pandemic and the recommendations to reduce the movement of people and agglomerations produced a series of changes in our daily lives, changing the way various health services were provided. Treatments traditionally performed face-to-face such as psychotherapies suffered a strong impact with risks of abandonment and interruption. This paper is an experience report about the process online psychotherapy implementation in a Psychiatry School Hospital Service during the SARS-CoV2 pandemic, showing the adaptations in communication procedures, care protocols and records of psychotherapy sessions. With a focus on ensuring the maintenance of care during periods of social distancing, guidelines were created for online psychotherapy based on the preparation of a guiding manual (Supplementary material) of procedures so that care was performed within the parameters ethical and technical established by the service. The manual was created from the discussion between supervisors and residents, so that it reflected the reality and demands commonly met. The adaptations were guided by four major objectives: 1) maintenance and continuity of care, 2) reduction of communication barriers between psychotherapist-patient, 3) maintenance of online meetings and web conferences between all team members and maintenance of studies and 4) standardization of procedures during psychotherapy sessions.(AU)
El impacto de la pandemia de SARS-CoV2 y las recomendaciones para reducir el movimiento de personas ha producido una serie de cambios en nuestra vida cotidiana. Los tratamientos tradicionalmente realizados en psicoterapias presenciales sufrieron un fuerte impacto con riesgos de abandono e interrupción. El propósito de este artículo es presentar un informe de experiencia sobre el proceso de implementación de la psicoterapia online en el ambulatorio de psicoterapia del Servicio de Psiquiatría de un hospital escuela durante la pandemia de SARSCoV2, mostrando las principales adaptaciones realizadas en los procedimientos de comunicación, protocolos asistenciales y registros de sesiones de psicoterapia. Con el foco en asegurar el mantenimiento de la atención durante los períodos de distanciamiento social, se crearon pautas para la realización de la psicoterapia en línea a partir de la elaboración de un manual guía (Material Complementario) de procedimientos para que las exploraciones asistenciales se realizaran dentro de los parámetros éticos y técnicos establecidos por el servicio. Las adaptaciones realizadas en el ambulatorio se basaron en cuatro objetivos principales: 1) mantenimiento y continuidad de la atención; 2) reducción de las barreras de comunicación entre psicoterapeuta-paciente; 3) mantenimiento de reuniones en línea y conferencias web entre todos los miembros del equipo y mantenimiento de estudios y; 4) estandarización de los procedimientos durante las sesiones de psicoterapia.(AU)
Subject(s)
Psychotherapy , Telemedicine , Physical Distancing , COVID-19ABSTRACT
Background: Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods: Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results: We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions: This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.
Subject(s)
Attention Deficit Disorder with Hyperactivity/therapy , Central Nervous System Stimulants/therapeutic use , Cognitive Remediation , Therapy, Computer-Assisted , Attention Deficit Disorder with Hyperactivity/diagnostic imaging , Attention Deficit Disorder with Hyperactivity/physiopathology , Attention Deficit Disorder with Hyperactivity/psychology , Brain/diagnostic imaging , Brain/physiopathology , Child , Clinical Protocols , Cognitive Remediation/methods , Combined Modality Therapy , Comorbidity , Feasibility Studies , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Patient Selection , Pilot Projects , Psychotropic Drugs/therapeutic use , Single-Blind Method , Treatment OutcomeABSTRACT
Abstract Background Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups - mainly on trained tasks. Conclusions This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.
Resumo Introdução O treinamento cognitivo tem recebido atenção especial como abordagem não medicamentosa para o tratamento do transtorno de déficit de atenção/hiperatividade (TDAH) em crianças e adolescentes. Poucos estudos avaliaram o treinamento cognitivo como abordagem complementar à medicação em ensaios clínicos randomizados controlados por placebo. O objetivo deste estudo foi explorar a viabilidade para a implementação de um programa de treinamento cognitivo computadorizado, descrever suas características principais e potencial eficácia em um pequeno estudo piloto. Métodos Seis pacientes com TDAH entre 10-12 anos de idade, em uso de psicoestimulantes e apresentando sintomas residuais, foram recrutados e randomizados para um dos dois grupos (treinamento cognitivo ou placebo) por 12 semanas. O desfecho principal foram os sintomas nucleares do TDAH avaliados através do Questionário de Swanson, Nolan e Pelham (SNAP-IV). Resultados Encontramos maior resistência do que a esperada no recrutamento dos pacientes em função de problemas logísticos para atender às sessões presenciais no hospital assim como para preencherem os critérios de status medicamentoso e ausência de algumas comorbidades. Ambos os grupos apresentaram diminuição nos escores dos sintomas de TDAH reportados pelos pais, mas sem diferença estatística entre eles. Além disso, foi observada melhora nos testes neuropsicológicos em ambos os grupos - principalmente nas tarefas treinadas pelo programa. Conclusão Este protocolo revelou a necessidade de novas estratégias para melhor avaliar a eficácia do treinamento cognitivo tal como a necessidade de implementar a intervenção no ambiente escolar a fim de obter uma avaliação com maior validade externa. Devido ao pequeno tamanho amostral deste estudo, conclusões definitivas sobre os efeitos do treinamento cognitivo como abordagem complementar aos psicoestimulantes seriam prematuras.
Subject(s)
Humans , Male , Female , Child , Attention Deficit Disorder with Hyperactivity/therapy , Therapy, Computer-Assisted , Central Nervous System Stimulants/therapeutic use , Psychotropic Drugs/therapeutic use , Attention Deficit Disorder with Hyperactivity/physiopathology , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/diagnostic imaging , Brain/physiopathology , Brain/diagnostic imaging , Magnetic Resonance Imaging , Comorbidity , Single-Blind Method , Pilot Projects , Clinical Protocols , Feasibility Studies , Follow-Up Studies , Treatment Outcome , Combined Modality Therapy , Patient Selection , Cognitive Remediation/methods , Neuropsychological TestsABSTRACT
A técnica de neurofeedback, também conhecida como biofeedback neurofisiológico, é não invasiva e visa a autorregulação de processos neurofisiológicos básicos. Nos últimos anos o treinamento com neurofeedback vem apresentando resultados promissores nos campos da saúde, educação e esportes, sendo esse processo empregado desde o tratamento complementar dos transtornos de ansiedade e deficit de atenção até em treinamentos para alto desempenho. A presente revisão tem como objetivo apresentar a técnica de neurofeedback hemoencefalográfico (ou HEG neurofeedback, de Hemoncephalography neurofeedback), suas possibilidades de aplicação no treinamento da autorregulação do lobo pré-frontal e suas consequentes aplicações no campo da saúde.
Neurofeedback, also called as neurophysiological biofeedback, is a non-invasive technique for selfregulationof basic neurophysiological processes.On the last years, the neurofeedback training has shown promising results on health, education, and sports applications and it has been used as a complementary treatment for attention deficit disorders, as well as to high performance training. This review has the aim to discuss about the HEG neurofeedback as a technique for self-regulatory training of pre-frontal lobe and its possible applications, especially on the health field.
Subject(s)
Humans , Biofeedback, Psychology , Neurology , Frontal Lobe/physiopathologyABSTRACT
Esta pesquisa investigou quais os fatores que influenciam psiquiatras e psicólogos a indicarem o trabalho de Acompanhante Terapêutico (AT) e qual seu papel no tratamento de pacientes. Participaram do estudo três psicólogos e três psiquiatras, que trabalham em clínicas multiprofissionais de Porto Alegre. Foi utilizada uma entrevista semi-estruturada, constituída de sete questões abertas que abordaram os temas relativos ao problema de pesquisa. Os dados obtidos foram submetidos à análise de conteúdo qualitativa, que permitiu a delimitação das seguintes categorias: 1) Fatores para indicação de AT; 2) Papel no tratamento; 3) Habilidades e características necessárias para atuar como AT; 4) referencial teórico e área de conhecimento mais adequada para a prática. O trabalho do acompanhante terapêutico é percebido como coadjuvante no tratamento, exercendo um papel ativo e, muitas vezes, de crucial importância para o sucesso deste, por atuar diretamente no ambiente em que o paciente está inserido.(AU)
This study has investigated the issues influencing psychiatrists and psychologists to lead patients to be assisted by a psychotherapist and its role on the treatment of patients, according to the perceptions of those professionals. Three psychiatrists and three psychologists of multi-professional clinics from Porto Alegre (RGS) were interviewed. A semi-structured interview with seven open questions regarding this research subject was applied. The data obtained from the interviews were subjected to a qualitative analysis, resulting in the following categories subdivision: 1) Elements for psychotherapist indication; 2) The role of the psychotherapist during the treatment; 3) The necessary abilities and skills in relation to that profession; 4) Bibliographical reference and appropriate knowledge area for therapist practice. The Therapist work is recognized as co-adjuvant during treatment, exerting an active role and, sometimes, having a crucial role for the success of the treatment by acting within the patient's environment. Based on the participant's opinion, it was concluded that the most appropriate approach, regarding psychotherapy, was the cognitive-behavioral approach.(AU)
Este trabajo investigó qué factores influencian psiquiatras y psicólogos a indicar el trabajo de Acompañante Terapéutico (AT), y cual es su papel en el tratamiento de pacientes, según la percepción de estos profesionales. Participaron en el estudio tres psicólogos y tres psiquiatras que trabajan en clínicas multiprofesionales de Porto Alegre (RS). Fue utilizada una entrevista semiestructurada, constituida de siete cuestiones de respuesta libre que abordaron los temas relativos al problema de investigación. Los datos obtenidos por medio de la entrevista fueron sometidos al análisis de contenido cualitativo, que permitió la delimitación de las siguientes categorías: 1) factores para indicación de acompañante terapéutico; 2) papel del acompañante terapéutico en el tratamiento; 3) habilidades y características necesarias para el acompañante terapéutico; 4) referencial teórico y área de conocimiento más adecuada para la práctica de acompañante terapéutico. El trabajo del acompañante terapéutico es visto como coadjuvante en el tratamiento, ejerciendo un papel activo y, muchas veces, de crucial importancia para el éxito de éste, por actuar directamente en el ambiente en el que el paciente está inserto. Se constató aún que el enfoque considerado más adecuado para el trabajo de AT sería, según los participantes, el cognitivo-comportamental.(AU)
Subject(s)
Humans , Mental Health , Homeopathic Therapeutic ApproachesABSTRACT
Esta pesquisa investigou quais os fatores que influenciam psiquiatras e psicólogos a indicarem o trabalho de Acompanhante Terapêutico (AT) e qual seu papel no tratamento de pacientes. Participaram do estudo três psicólogos e três psiquiatras, que trabalham em clínicas multiprofissionais de Porto Alegre. Foi utilizada uma entrevista semi-estruturada, constituída de sete questões abertas que abordaram os temas relativos ao problema de pesquisa. Os dados obtidos foram submetidos à análise de conteúdo qualitativa, que permitiu a delimitação das seguintes categorias: 1) Fatores para indicação de AT; 2) Papel no tratamento; 3) Habilidades e características necessárias para atuar como AT; 4) referencial teórico e área de conhecimento mais adequada para a prática. O trabalho do acompanhante terapêutico é percebido como coadjuvante no tratamento, exercendo um papel ativo e, muitas vezes, de crucial importância para o sucesso deste, por atuar diretamente no ambiente em que o paciente está inserido.
This study has investigated the issues influencing psychiatrists and psychologists to lead patients to be assisted by a psychotherapist and its role on the treatment of patients, according to the perceptions of those professionals. Three psychiatrists and three psychologists of multi-professional clinics from Porto Alegre (RGS) were interviewed. A semi-structured interview with seven open questions regarding this research subject was applied. The data obtained from the interviews were subjected to a qualitative analysis, resulting in the following categories subdivision: 1) Elements for psychotherapist indication; 2) The role of the psychotherapist during the treatment; 3) The necessary abilities and skills in relation to that profession; 4) Bibliographical reference and appropriate knowledge area for therapist practice. The Therapist work is recognized as co-adjuvant during treatment, exerting an active role and, sometimes, having a crucial role for the success of the treatment by acting within the patient's environment. Based on the participant's opinion, it was concluded that the most appropriate approach, regarding psychotherapy, was the cognitive-behavioral approach.
Este trabajo investigó qué factores influencian psiquiatras y psicólogos a indicar el trabajo de Acompañante Terapéutico (AT), y cual es su papel en el tratamiento de pacientes, según la percepción de estos profesionales. Participaron en el estudio tres psicólogos y tres psiquiatras que trabajan en clínicas multiprofesionales de Porto Alegre (RS). Fue utilizada una entrevista semiestructurada, constituida de siete cuestiones de respuesta libre que abordaron los temas relativos al problema de investigación. Los datos obtenidos por medio de la entrevista fueron sometidos al análisis de contenido cualitativo, que permitió la delimitación de las siguientes categorías: 1) factores para indicación de acompañante terapéutico; 2) papel del acompañante terapéutico en el tratamiento; 3) habilidades y características necesarias para el acompañante terapéutico; 4) referencial teórico y área de conocimiento más adecuada para la práctica de acompañante terapéutico. El trabajo del acompañante terapéutico es visto como coadjuvante en el tratamiento, ejerciendo un papel activo y, muchas veces, de crucial importancia para el éxito de éste, por actuar directamente en el ambiente en el que el paciente está inserto. Se constató aún que el enfoque considerado más adecuado para el trabajo de AT sería, según los participantes, el cognitivo-comportamental.
