DNA methylation in regulatory elements of the FKBP5 and NR3C1 gene in mother-child binomials with depression.

BACKGROUND: The FKBP5 and NR3C1 genes play an important role in stress response, thus impacting mental health. Stress factor exposure in early life, such as maternal depression, may contribute to epigenetic modifications in stress response genes, increasing the susceptibility to different psychopathologies. The present study aimed to evaluate the DNA methylation profile in maternal-infant depression in regulatory regions of the FKBP5 gene and the alternative promoter of the NR3C1 gene. METHODS: We evaluated 60 mother-infant pairs. The levels of DNA methylation were analyzed by the MSRED-qPCR technique. RESULTS: We observed an increased DNA methylation profile in the NR3C1 gene promoter in children with depression and children exposed to maternal depression (p < 0.05). In addition, we observed a correlation of DNA methylation between mothers and offspring exposed to maternal depression. This correlation shows a possible intergenerational effect of maternal MDD exposure on the offspring. For FKBP5, we found a decrease in DNA methylation at intron 7 in children exposed to maternal MDD during pregnancy and a correlation of DNA methylation between mothers and children exposed to maternal MDD (p < 0.05). LIMITATIONS: Although the individuals of this study are a rare group, the sample size of the study was small, and we evaluated the DNA methylation of only one CpG site for each region. CONCLUSION: These results indicate changes in DNA methylation levels in regulatory regions of FKBP5 and NR3C1 in the mother-child MDD context and represent a potential target of studies to understand the depression etiology and how it occurs between generations.

Monitoring the Mental Health and Professional Overload of Health Workers in Brazil: A Longitudinal Study Considering the First Wave of the COVID-19 Pandemic.

Few longitudinal studies assessed the less immediate consequences of the COVID-19 pandemic on health workers' mental health, especially in less developed countries. The objective was to assess the evolution of mental health indicators of Brazilian health workers providing care to COVID-19 patients, considering the beginning and first wave of the pandemic, identifying risk and protective factors. A non-probabilistic sample of health professionals was assessed for 6 months at seven different points in time using standardized instruments to measure anxiety, depression, insomnia, posttraumatic stress, and burnout symptoms. Risk and protective factors were assessed using a questionnaire addressing socio-demographic, clinical, occupational variables, and COVID-19 risk perception. The results indicate high rates for all the indicators (>30%) throughout the follow-up; only anxiety symptoms decreased in the different phases compared to the baseline. Depression and insomnia symptoms showed a significant drop in isolated points of the assessment, which were not maintained at the final follow-up. Burnout indicators concerning emotional exhaustion and depersonalization remained stable (40 and 20%), while professional achievement decreased by approximately 19%. Occupational and personal characteristics (profession and work setting), perceptions regarding protective measures imposed by the institutions, and future professional prospects stood out as risk/protective factors in mental health. Unlike European and Asian countries, where mental distress symptoms tended to decrease over the pandemic, this study's results suggest alarming indicators of mental health problems remaining stable with burnout symptoms on the rise. Hence, the different contexts across countries, with different management resources and investments in health actions, seem to influence workers' mental health differently, demanding constant attention and monitoring and measures to minimize the impacts on individuals and collectives, especially in less developed countries like Brazil.

Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis.

Importance: Depression is highly prevalent among physicians and has been associated with increased risk of medical errors. However, questions regarding the magnitude and temporal direction of these associations remain open in recent literature. Objective: To provide summary relative risk (RR) estimates for the associations between physician depressive symptoms and medical errors. Data Sources: A systematic search of Embase, ERIC, PubMed, PsycINFO, Scopus, and Web of Science was performed from database inception to December 31, 2018. Study Selection: Peer-reviewed empirical studies that reported on a valid measure of physician depressive symptoms associated with perceived or observed medical errors were included. No language restrictions were applied. Data Extraction and Synthesis: Study characteristics and RR estimates were extracted from each article. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using subgroup meta-analysis and metaregression. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Main Outcomes and Measures: Relative risk estimates for the associations between physician depressive symptoms and medical errors. Results: In total, 11 studies involving 21 517 physicians were included. Data were extracted from 7 longitudinal studies (64%; with 5595 individuals) and 4 cross-sectional studies (36%; with 15 922 individuals). The overall RR for medical errors among physicians with a positive screening for depression was 1.95 (95% CI, 1.63-2.33), with high heterogeneity across the studies (χ2 = 49.91; P < .001; I2 = 82%; τ2 = 0.06). Among the variables assessed, study design explained the most heterogeneity across studies, with lower RR estimates associated with medical errors in longitudinal studies (RR, 1.62; 95% CI, 1.43-1.84; χ2 = 5.77; P = .33; I2 = 13%; τ2 < 0.01) and higher RR estimates in cross-sectional studies (RR, 2.51; 95% CI, 2.20-2.83; χ2 = 5.44; P = .14; I2 = 45%; τ2 < 0.01). Similar to the results for the meta-analysis of physician depressive symptoms associated with subsequent medical errors, the meta-analysis of 4 longitudinal studies (involving 4462 individuals) found that medical errors associated with subsequent depressive symptoms had a pooled RR of 1.67 (95% CI, 1.48-1.87; χ2 = 1.85; P = .60; I2 = 0%; τ2 = 0), suggesting that the association between physician depressive symptoms and medical errors is bidirectional. Conclusions and Relevance: Results of this study suggest that physicians with a positive screening for depressive symptoms are at higher risk for medical errors. Further research is needed to evaluate whether interventions to reduce physician depressive symptoms could play a role in mitigating medical errors and thus improving physician well-being and patient care.

Selective Cutoff Reporting in Studies of Diagnostic Test Accuracy: A Comparison of Conventional and Individual-Patient-Data Meta-Analyses of the Patient Health Questionnaire-9 Depression Screening Tool.

In studies of diagnostic test accuracy, authors sometimes report results only for a range of cutoff points around data-driven "optimal" cutoffs. We assessed selective cutoff reporting in studies of the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool. We compared conventional meta-analysis of published results only with individual-patient-data meta-analysis of results derived from all cutoff points, using data from 13 of 16 studies published during 2004-2009 that were included in a published conventional meta-analysis. For the "standard" PHQ-9 cutoff of 10, accuracy results had been published by 11 of the studies. For all other relevant cutoffs, 3-6 studies published accuracy results. For all cutoffs examined, specificity estimates in conventional and individual-patient-data meta-analyses were within 1% of each other. Sensitivity estimates were similar for the cutoff of 10 but differed by 5%-15% for other cutoffs. In samples where the PHQ-9 was poorly sensitive at the standard cutoff, authors tended to report results for lower cutoffs that yielded optimal results. When the PHQ-9 was highly sensitive, authors more often reported results for higher cutoffs. Consequently, in the conventional meta-analysis, sensitivity increased as cutoff severity increased across part of the cutoff range-an impossibility if all data are analyzed. In sum, selective reporting by primary study authors of only results from cutoffs that perform well in their study can bias accuracy estimates in meta-analyses of published results.

Mental health in medical residents: relationship with personal, work-related, and sociodemographic variables

Objective: To examine association of sociodemographic characteristics, personality traits, social skills, and work variables with anxiety, depression, and alcohol dependence in medical residents. Methods: A total of 270 medical residents completed the following self-report instruments: sociodemographic and work questionnaire, Patient Health Questionnaire-4 (PHQ-4), Alcohol Use Disorders Identification Test-3 (AUDIT-3), Revised NEO-Five Factor Inventory (NEO-FFI-R), and Social Skills Inventory (SSI-Del-Prette). Data were analyzed using descriptive statistics and univariate and multivariate logistic regression analyses. Results: Multivariate analysis showed an association of neuroticism (odds ratio [OR] 2.60, p < 0.001), social skills (OR 0.41, p < 0.01), and number of shifts (OR 1.91, p = 0.03) with anxiety or depression, and of male sex (OR 3.14, p = 0.01), surgical residency (OR 4.40, p = 0.001), extraversion (OR 1.80, p < 0.01), and number of shifts (OR 2.32, p = 0.04) with alcohol dependence. Conclusion: The findings support a multidetermined nature of mental health problems in medical residents, in addition to providing data that may assist in the design of preventive measures to protect the mental health of this group.

Mental health in medical residents: relationship with personal, work-related, and sociodemographic variables.

OBJECTIVE:: To examine association of sociodemographic characteristics, personality traits, social skills, and work variables with anxiety, depression, and alcohol dependence in medical residents. METHODS:: A total of 270 medical residents completed the following self-report instruments: sociodemographic and work questionnaire, Patient Health Questionnaire-4 (PHQ-4), Alcohol Use Disorders Identification Test-3 (AUDIT-3), Revised NEO-Five Factor Inventory (NEO-FFI-R), and Social Skills Inventory (SSI-Del-Prette). Data were analyzed using descriptive statistics and univariate and multivariate logistic regression analyses. RESULTS:: Multivariate analysis showed an association of neuroticism (odds ratio [OR] 2.60, p < 0.001), social skills (OR 0.41, p < 0.01), and number of shifts (OR 1.91, p = 0.03) with anxiety or depression, and of male sex (OR 3.14, p = 0.01), surgical residency (OR 4.40, p = 0.001), extraversion (OR 1.80, p < 0.01), and number of shifts (OR 2.32, p = 0.04) with alcohol dependence. CONCLUSION:: The findings support a multidetermined nature of mental health problems in medical residents, in addition to providing data that may assist in the design of preventive measures to protect the mental health of this group.

SDQ: discriminative validity and diagnostic potential.

The Strengths and Difficulties Questionnaire (SDQ) was designed to screen for behavioral problems in youths based on cutoff points that favor the instrument's diagnostic sensitivity. The present study aimed to analyze the discriminative validity of the SDQ to identify behavioral difficulties and prosocial resources in school-age children compared with the diagnostic data collected by the corresponding sections of the Development and Well-being Assessment (DAWBA). In addition, new cutoff points that value specificity were defined for the SDQ scales, exploring its diagnostic potential. This study was conducted in Brazil and assessed a community convenience sample that consisted of 120 children aged 6-12 years who were not under psychological/psychiatric treatment. The mothers of the participants also completed a sociodemographic questionnaire. Descriptive statistics were used to clinically characterize the sample. A ROC curve was used to assess the discriminant validity of the SDQ, and new cutoff points were established to maximize the instrument's specificity. The new cutoff points enabled a significant increase in specificity without a significant loss of sensitivity, which favors approaches based on measures of screening and diagnosis yet does not damage the instrument's screening capacity. The following increases were observed: 100% for the depressive disorder scale (cutoff point = 7), 95.1% for the generalized anxiety disorder scale (cutoff point = 7), 46.6% for the conduct disorder scale (cutoff point = 6), 19.2% for the hyperactive disorder scale (cutoff point = 8), and 27.6% for the antisocial personality disorder scale (cutoff point = 6). A cutoff point of 8 was applied to the prosocial behavior scale, which exhibited a 62.1% increase in specificity. The use of more specific cutoff points generated more accurate results and favored SDQ's use, particularly in contexts of care that require more precise and faster procedures for identification of problems.

Can the Liebowitz Social Anxiety Scale - self-report version be used to differentiate clinical and non-clinical SAD groups among Brazilians?

BACKGROUND: The Liebowitz Social Anxiety Scale (LSAS) was the first evaluation instrument developed for screening for the signs and symptoms of Social Anxiety Disorder (SAD) and is currently still the most used worldwide. The aim of this study is to evaluate the ability of the LSAS - self-report version (LSAS-SR) to discriminate different Social Anxiety Disorder (SAD) clinical groups. METHOD: The sample was composed of Brazilians university students, allocated into three different groups, i.e., cases (C=118), non-cases (NC=95) and subclinical cases (SC=39). To achieve the aim, calculations of the ROC Curve and ANOVA were performed. RESULTS: The results found were excellent regardless of the technique used, highlighting the discriminatory capacity of the LSAS-SR. The score equal to or greater than 32 is suggested as a cutoff score for the Brazilian population, since this presented balance between the standards evaluated and the ability to differentiate both clinical and subclinical SAD cases from non-cases. CONCLUSION: Despite the specific sample used in this study being composed only of university students, the use of the LSAS-SR can be indicated, in the Brazilian setting, for SAD screening in both clinical and research contexts.

Prevalence of non-communicable diseases in Brazilian children: follow-up at school age of two Brazilian birth cohorts of the 1990's.

BACKGROUND: Few cohort studies have been conducted in low and middle-income countries to investigate non-communicable diseases among school-aged children. This article aims to describe the methodology of two birth cohorts, started in 1994 in Ribeirão Preto (RP), a more developed city, and in 1997/98 in São Luís (SL), a less developed town. METHODS: Prevalences of some non-communicable diseases during the first follow-up of these cohorts were estimated and compared. Data on singleton live births were obtained at birth (2858 in RP and 2443 in SL). The follow-up at school age was conducted in RP in 2004/05, when the children were 9-11 years old and in SL in 2005/06, when the children were 7-9 years old. Follow-up rates were 68.7% in RP (790 included) and 72.7% in SL (673 participants). The groups of low (<2500 g) and high (≥ 4250 g) birthweight were oversampled and estimates were corrected by weighting. RESULTS: In the more developed city there was a higher percentage of non-nutritive sucking habits (69.1% vs 47.9%), lifetime bottle use (89.6% vs 68.3%), higher prevalence of primary headache in the last 15 days (27.9% vs 13.0%), higher positive skin tests for allergens (44.3% vs 25.3%) and higher prevalence of overweight (18.2% vs 3.6%), obesity (9.5% vs 1.8%) and hypertension (10.9% vs 4.6%). In the less developed city there was a larger percentage of children with below average cognitive function (28.9% vs 12.2%), mental health problems (47.4% vs 38.4%), depression (21.6% vs 6.0%) and underweight (5.8% vs 3.6%). There was no difference in the prevalence of bruxism, recurrent abdominal pain, asthma and bronchial hyperresponsiveness between cities. CONCLUSIONS: Some non-communicable diseases were highly prevalent, especially in the more developed city. Some high rates suggest that the burden of non-communicable diseases will be high in the future, especially mental health problems.

Validity of the PHQ-2 for the screening of major depression in Parkinson's disease: two questions and one important answer.

INTRODUCTION: Depression is the most common psychiatric comorbidity in Parkinson's disease (PD), but is often under-diagnosed and under-recognized. OBJECTIVES: To evaluate and compare the psychometric qualities of the Patient Health Questionnaire (PHQ-2) and the depression item of the Unified Parkinson's Disease Rating Scale (UPDRS). METHOD: Cross-sectional study conducted at a movement disorders outpatient clinic. One hundred ten patients with a diagnosis of PD without dementia were evaluated. A neurologist administered the PHQ-2 and the UPDRS, and the diagnosis of major depression was performed using the structured clinical interview for DSM disorders - clinical version. Two self-rating scales (Zung Self-rating Depression Scale and 15-item Geriatric Depression Scale) were also used. RESULTS: The prevalence of current depression in the sample was 25.5% (n = 28). The scores of the PHQ-2 discriminated between subjects with and without depression, with an area under the receiver operating characteristic curve of 0.90. The sensitivity and specificity for a cut-off score of three were 75% and 89%, respectively. The values for the depression item of the UPDRS were slightly lower. CONCLUSION: The PHQ-2 is a valid tool for screening depression in PD.

Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions.

BACKGROUND: This study was aimed at assessing the psychometric qualities of the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT-3, AUDIT-4, AUDIT-C, AUDIT-PC, AUDIT-QF, FAST, and Five-Shot) and at comparing them to the 10-item AUDIT and the CAGE in 2 samples of Brazilian adults. METHODS: The validity and internal consistency of the scales were assessed in a sample of 530 subjects attended at an emergency department and at a Psychosocial Care Center for Alcohol and Drugs. The Structured Clinical Interview for DSM-IV was used as the diagnostic comparative measure for the predictive validity assessment. The concurrent validity between the scales was analyzed by means of Pearson's correlation coefficient. RESULTS: The assessment of the predictive validity of the abbreviated versions showed high sensitivity (of 0.78 to 0.96) and specificity (of 0.74 to 0.94) indices, with areas under the curve as elevated as those of the AUDIT (0.89 and 0.92 to screen for abuse and 0.93 and 0.95 in the screening of dependence). The CAGE presented lower indices: 0.81 for abuse and 0.87 for dependence. The analysis of the internal consistency of the AUDIT and its versions exhibited Cronbach's alpha coefficients between 0.83 and 0.94, while the coefficient for the CAGE was 0.78. Significant correlations were found between the 10-item AUDIT and its versions, ranging from 0.91 to 0.99. Again, the results for the CAGE were satisfactory (0.77), although inferior to the other instruments. CONCLUSIONS: The results obtained in this study confirm the validity of the abbreviated versions of the AUDIT for the screening of alcohol use disorders and show that their psychometric properties are as satisfactory as those of the 10-item AUDIT and the CAGE.

Social anxiety disorder women easily recognize fearfull, sad and happy faces: the influence of gender.

BACKGROUND: It has been suggested that individuals with social anxiety disorder (SAD) are exaggeratedly concerned about approval and disapproval by others. Therefore, we assessed the recognition of facial expressions by individuals with SAD, in an attempt to overcome the limitations of previous studies. METHODS: The sample was formed by 231 individuals (78 SAD patients and 153 healthy controls). All individuals were treatment naïve, aged 18-30 years and with similar socioeconomic level. Participants judged which emotion (happiness, sadness, disgust, anger, fear, and surprise) was presented in the facial expression of stimuli displayed on a computer screen. The stimuli were manipulated in order to depict different emotional intensities, with the initial image being a neutral face (0%) and, as the individual moved on across images, the expressions increased their emotional intensity until reaching the total emotion (100%). The time, accuracy, and intensity necessary to perform judgments were evaluated. RESULTS: The groups did not show statistically significant differences in respect to the number of correct judgments or to the time necessary to respond. However, women with SAD required less emotional intensity to recognize faces displaying fear (p=0.002), sadness (p=0.033) and happiness (p=0.002), with no significant differences for the other emotions or men with SAD. CONCLUSIONS: The findings suggest that women with SAD are hypersensitive to threat-related and approval-related social cues. Future studies investigating the neural basis of the impaired processing of facial emotion in SAD using functional neuroimaging would be desirable and opportune.

Psychometric qualities of the Brazilian versions of the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index.

INTRODUCTION: This study examined the psychometric properties of the Brazilian versions of the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI). METHODS: The test-retest reliability of the FTND was assessed in a sample of 61 smoking university students, with a 15-day interval between assessments. The interrater reliability was examined in 30 smoking patients of a psychosocial care center for alcohol and drug users (PCC-AD). The reliability coefficient was estimated by the kappa and intraclass correlation coefficients. The predictive validity, internal consistency, and factor structure of the FTND and the HSI were evaluated by factor analysis in 271 smokers treated at an emergency unit and at the PCC-AD. The gold standard was the nicotine dependence criteria of DSM-IV, as assessed by the Structured Clinical Interview for DSM-IV. RESULTS: The FTND showed high reliability, with correlation coefficients of .92 for test-retest reliability and .99 for interrater reliability. Both the FTND and the HSI presented high levels of sensitivity and specificity. The internal consistency evaluation yielded a Cronbach's alpha coefficient of .83 for the FTND and of .56 for the HSI. An exploratory factor analysis found 2 factors in the FTND, which were validated by a confirmatory factor analysis. DISCUSSION: The results obtained in this study confirm the validity and reliability of the Brazilian versions of the FTND and the HSI.

Acidentes de trânsito e variáveis psicossociais: uma revisão da literatura / Traffic accidents and psychosocial variables: a literature review

Objetiva-se identificar e analisar estudos empíricos sobre acidentes de trânsito que abordam variáveis psicossociais como conseqüências ou preditoras do envolvimento com acidentes de trânsito. Procedeu-se ao levantamento bibliográfico eletrônico da literatura indexada, no período de 2000 a 2006, através do PsycINFO, MedLINE e LILACS, utilizando-se as palavras chave:Acidentes de Trânsito, Ansiedade, Depressão, Adaptação Psicossocial e Qualidade de Vida. Foram identificados e analisados 36 artigos agrupados em duas categorias, uma relativa à ansiedade e qualidade de vida pós-acidente e outra relativa às variáveis pessoais dos condutores que se envolveram em acidentes. Os estudos analisados constataram a associação de acidentes de trânsito à ansiedade, depressão, prejuízos psicossociais, identificando como indicadores do envolvimento com os acidentes de trânsito: jovens, sexo masculino, com tendência a agressividade e transgressão social.

The objective of this study was to identify and analyze empirical studies on traffica ccidents in terms of psychosocial variables as consequences or predictors of involvement intraffic accidents. An electronic bibliographic search of literature indexed with PsycINFO, MedLINE and LILACS, between 2000 to 2006, was undertaken using the key words: Traffic Accidents,Anxiety, Depression, Psychosocial Adaptation and Quality of Life. A total of 36 articles were identified and grouped into two categories, one relative to anxiety and quality of life after accident and theother relative to the personal variables of the drivers. The studies evaluated associated traffica ccidents with anxiety and depression, psychosocial loss, identifying the following characteristicsas indicators of involvement in traffic accidents: young, male, with tendency to aggressiveness and social transgression.

Animal defense strategies and anxiety disorders.

Anxiety disorders are classified according to symptoms, time course and therapeutic response. Concurrently, the experimental analysis of defensive behavior has identified three strategies of defense that are shared by different animal species, triggered by situations of potential, distal and proximal predatory threat, respectively. The first one consists of cautious exploration of the environment for risk assessment. The associated emotion is supposed to be anxiety and its pathology, Generalized Anxiety Disorder. The second is manifested by oriented escape or by behavioral inhibition, being related to normal fear and to Specific Phobias, as disorders. The third consists of disorganized flight or complete immobility, associated to dread and Panic Disorder. Among conspecific interactions lies a forth defense strategy, submission, that has been related to normal social anxiety (shyness) and to Social Anxiety Disorder. In turn, Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder do not seem to be directly related to innate defense reactions. Such evolutionary approach offers a reliable theoretical framework for the study of the biological determinants of anxiety disorders, and a sound basis for psychiatric classification.

Animal defense strategies and anxiety disorders

Anxiety disorders are classified according to symptoms, time course and therapeutic response. Concurrently, the experimental analysis of defensive behavior has identified three strategies of defense that are shared by different animal species, triggered by situations of potential, distal and proximal predatory threat, respectively. The first one consists of cautious exploration of the environment for risk assessment. The associated emotion is supposed to be anxiety and its pathology, Generalized Anxiety Disorder. The second is manifested by oriented escape or by behavioral inhibition, being related to normal fear and to Specific Phobias, as disorders. The third consists of disorganized flight or complete immobility, associated to dread and Panic Disorder. Among conspecific interactions lies a forth defense strategy, submission, that has been related to normal social anxiety (shyness) and to Social Anxiety Disorder. In turn, Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder do not seem to be directly related to innate defense reactions. Such evolutionary approach offers a reliable theoretical framework for the study of the biological determinants of anxiety disorders, and a sound basis for psychiatric classification.

Os transtornos de ansiedade são classificados conforme a sintomatologia, decurso temporal e resposta terapêutica. Paralelamente, a análise experimental dos comportamentos de defesa identificou três estratégias comuns a diferentes espécies de animais, desencadeadas por situações de perigo predatório potencial, distal ou proximal, respectivamente. A primeira consiste na investigação cautelosa do ambiente, avaliando o risco. Supõe-se que a emoção que a acompanha seja a ansiedade e sua patologia, o Transtorno de Ansiedade Generalizada. A segunda é expressa pela fuga orientada ou pela inibição comportamental, sendo a emoção correlata o medo, e a patologia representada pelas Fobias Específicas. Finalmente, a terceira estratégia consiste na fuga desordenada ou na total imobilidade, relacionando-se com o pavor e o Transtorno de Pânico. Nas interações entre indivíduos da mesma espécie, aparece uma quarta estratégia de defesa, a submissão, que tem sido relacionada com o Transtorno de Ansiedade Social. Já o Transtorno de Estresse Pós-Traumático e o Transtorno Obsessivo-Compulsivo não estão diretamente relacionadoscom reações de defesa inatas. Esta abordagem evolucionária oferece um paradigma teórico confiável para o estudo dos determinantes biológicos dos transtornos de ansiedade, que pode melhor fundamentar a classificação psiquiátrica.

Pacientes com psoríase: adaptaçäo psicossocial e caracteristicas de personalidade / Patients with psoriasis: psychosocial adaptation and personality features

A psoríase tem suscitado interesse na investigaçäo por causa dos aspectos psicológicos e sociais de seus portadores. Objetivou-se avaliar as condições psicológicas e adaptativas de pacientes com psoríase e suas relações com variáveis demográficas e condições clínicas. Foram avaliados, no Ambulatório de Dermatologia do Hospital das Clínicas da FMRP -USP, 25 mulheres e 25 homens com idade entre 20-50 anos com diagnóstico de psoríase vulgar. Procedeu-se, em sessões individuais, à aplicaçäo individual do Inventário Simplificado de Personalidade (ISP) e do Inventário de Qualidade de Vida (PDI), conforme as recomendações técnicas, e como complemento houve uma entrevista semi-estruturada. Os protocolos foram cotados e, comparados aos dados normativos, procedeu-se à quantificaçäo e tratamento estatístico. Observou-se que 80 por cento dos pacientes apresentaram tendência a desvio de traço de personalidade, predominando as escalas de Extroversäo, Insanidade e Neuroticidade. A maioria relatou dificuldades de adaptaçäo psicossocial, principalmente nas áreas de atividades rotineiras (p<0.001); Extensäo psoriática, faixa etária entre 20 a 30 anos, insatisfaçäo quanto à aparência física e desvios de Insanidade e Neuroticidade mostraram-se associados a prejuízos nas atividades rotineiras, relações pessoais e lazer. Os dados apontam a inter-relaçäo de aspectos psíquicos, adaptaçäo psicossocial e peculiaridades clínicas da doença

Aspectos psicológicos e psiquiátricos do transplante de medula óssea / Psychological and psychiatric aspects of bone marrow transplantation

A intensidade e a complexidade envolvidas no transplante de medula óssea (TMO) em seus vários níveis, produz profundos efeitos psicológicos no paciente, na família e na equipe profissional. Ignorar esta realidade e reduzir os problemas do TMO a seus aspectos puramente técnicos pode trazer consequências catastróficas para o paciente e seus familiares e ameaçar a sobrevivência da equipe. Neste trabalho, säo discutidos três aspectos muito importantes de saúde mental no TMO, enfatizando a prática desenvolvida na Unidade de TMO do HCFMRP: 1) os múltiplos papéis desempenhados pela assistência psiquiátrica na Unidade de TMO, desde a prescriçäo de psicofármacos até o apoio à equipe multiprofissional em grupos de reflexäo; 2) uma análise dos sentimentos vivenciados pelo paciente submetido ao TMO nas diferentes fases do transplante (pré, intra e pós-TMO) sob a perspectiva da esperança de cura; 3) uma avaliaçäo da qualidade de vida dos pacientes submetidos ao TMO, a curto e médio prazos, integrando vários instrumentos de análise, incluindo técnicas projetivas.