Pica and Eating Attitudes: A Study of High-Risk Pregnancies.

OBJECTIVE: To describe and determine the association between the occurrence of pica and eating attitudes in women with high-risk pregnancies and to determine the prevalence of pica during pregnancy. METHODS: A cross-sectional and prospective 24-month study was conducted with 913 women with high-risk pregnancies. Structured interviews were carried out and the Eating Attitudes Test was applied. RESULTS: Pica was diagnosed in 5.7 % of the pregnant women, and its most commonly practiced type was geophagia (57.7 %). The association between pica and signs related to the eating attitudes: "to be considered too thin by others" (p < 0.02), and "to spend too much time thinking about food" (p = 0.05); and the association between pica and the risk of both anorexia nervosa and bulimia nervosa (p < 0.01) were statistically significant. CONCLUSIONS: The absence of validated instruments in the literature for assessing pica reinforces the difficulty of investigating this practice and the need for further studies. Moreover, additional efforts need to focus in the improvement of screening for other eating disorders with obstetric consequences associated with pica and be incorporated into the routine of healthcare professionals.

Perceptual organization deficits in traumatic brain injury patients.

Traumatic brain injury (TBI) is a prevalent condition and there is limited visual perception research with this population. Here, we investigated perceptual organization changes in a rather homogeneous sample of closed head TBI outpatients with diffuse axonal injury only and no other known comorbidities. Patients had normal or corrected visual acuity. Perceptual organization was measured with the Leuven Perceptual Organization Screening Test (L-POST), a coherent motion task (CM) and the Leuven Embedded Figures Test (L-EFT). These tests were chosen to screen for deficits in different aspects of perceptual organization (L-POST), to evaluate local and global processing (L-EFT) and grouping in a dynamic set of stimuli (CM). TBI patients were significantly impaired compared to controls in all measures for both response time and accuracy, except for CM thresholds and object recognition subtests. The TBI group was similarly affected in all aspects of the L-EFT. TBI was also similarly affected in all perceptual factors of the L-POST. No significant correlations were found between scores and time post-injury, except for CM thresholds (rs=-0.74), which might explain the lack of group-level differences. The only score significantly correlated to IQ was L-EFT response time (rs=-0.67). These findings demonstrate that perceptual organization is diffusely affected in TBI and this effect has no substantial correlations with IQ. As many of the neuropsychological tests used to measure different cognitive functions involve some level of visual discrimination and perceptual organization demands, these results must be taken into account in the general neuropsychological evaluation of TBI patients.

Executive function and depressive symptoms of retardation in nonelderly stroke patients.

The depression-executive dysfunction syndrome, a late-onset depression of vascular origin with executive dysfunction and psychomotor retardation, has also been described after stroke. We verified whether this syndrome also occurs in nonelderly stroke patients by investigating the association between domains of depressive symptoms with executive functions in 87 first-ever ischemic stroke patients. The retardation domain of the 31-item Hamilton Rating Scale for Depression was associated with decreased performance on verbal fluency (assessed with FAS). The association was maintained for younger patients (aged <60 years) after adjusting for confounders. This result supports the clinical presentation of depression-executive dysfunction syndrome in younger stroke patients. Confirmation of this finding, its neural correlates, and clinical implication deserve further investigation.

The self-rated Inventory of Depressive Symptomatology for screening prenatal depression.

OBJECTIVE: To examine whether the self-reported version of the Inventory of Depressive Symptomatology (IDS-SR), which is used for major depression, is a reliable tool for screening and assessment of prenatal depression. METHODS: Between June 2006 and July 2008, pregnant women attending a teaching hospital in São Paulo, Brazil, completed the Portuguese version of the IDS-SR. Trained psychologists diagnosed depression via the Primary Care Evaluation of Mental Disorders questionnaire, which is based on the Diagnostic and Statistical Manual of Mental Disorders IV. RESULTS: Of 543 participants, 60 (11%) were diagnosed with depression. The Cronbach α of the IDS-SR was 0.89, and the area under the ROC curve was 0.8. The IDS-SR cutoff score at 30 gave a sensitivity and specificity of 78% and 76%, respectively, for diagnosis of prenatal depression. Exploratory and confirmatory analyses revealed a 2-factor structure for the IDS-SR, characterized by symptoms of "mood/cognition" and "irritability/anxiety/pain". CONCLUSION: The IDS-SR gave satisfactory internal consistency and accuracy for diagnosing prenatal depression, showing that it can improve early diagnosis and treatment of this condition, thereby minimizing the burden. In addition, a 2-factor model was found to account for depressive symptomatology during pregnancy, which will be useful for developing further depression subscales specific to prenatal depression.

Twin pregnancies: evaluation of major depression, stress, and social support.

BACKGROUND: Twin pregnancies are at increased physiological and psychosocial risks. OBJECTIVE: To investigate the prevalence of major depression in twin pregnancies and correlate with stress and social support. METHOD: The study included 51 pregnant women under specialized prenatal care who were evaluated by a Portuguese version of the semi-structured questionnaire Primary Care Evaluation of Mental Disorders (PRIME-MD) for Major Depression, and the Prenatal Psychosocial Profile (PPP) for evaluation of stress and social support. RESULTS: Major depression was found in 33.3% of pregnant women, and prevailing symptoms were fatigue or loss of energy (100%), insomnia or hypersomnia (82.4%), changes in appetite (82.4%), decreased interest in daily activities (82.4%), and psychomotor agitation or retardation (82.4%). Among pregnant women who were diagnosed depressive, 76.5% also had a high level of stress and 47.1% complained about lack of social support. Statistical significance was found when correlating depression with perception of negative aspects of having twins and belief in significant body changes during pregnancy (p = .005 and .03, respectively). Marital status, occupation, and pregnancy planning were not significantly associated with the diagnosis of depression. CONCLUSION: Major depression occurs in one-third of pregnant women expecting twins and is associated with higher levels of stress and lack of social support. A multidisciplinary approach in these cases is fundamental to minimize further risks and complications.

Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation.

OBJECTIVE: this study investigated the feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation. The aim of this study was to present the decision making process of women that chose for pregnancy termination and to present selected speeches of women about their feelings. DESIGN: open psychological interviews conducted by a psychologist immediately after the diagnosis of fetal malformation by ultrasound. Analysis of the results was performed through a content analysis technique. SETTING: the study was carried out at a public university hospital in Brazil. PARTICIPANTS: 249 pregnant women who had received the diagnosis of a severe lethal fetal malformation. FINDINGS: fetal anencephaly was the most frequent anomaly detected in 135 cases (54.3%). Termination of pregnancy was decided by 172 (69.1%) patients and legally authorised by the judiciary (66%). The reason for asking for termination was to reduce suffering in all of them. In the 77 women who chose not to terminate pregnancy (30.9%), the reasons were related to feelings of guilt (74%). KEY CONCLUSIONS: the results support the importance of psychological counselling for couples when lethal fetal malformation is diagnosed. The act of reviewing moral and cultural values and elements of the unconscious provides assurance in the decision-making process and mitigates the risk of emotional trauma and guilt that can continue long after the pregnancy is terminated.

Women's opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital.

OBJECTIVE: to describe women's feelings about mode of birth. DESIGN: exploratory descriptive design. Semi-structured interviews were conducted using a questionnaire that had been developed previously (categorical data and open- and closed-ended questions). Qualitative analysis of the results was performed through a context analysis technique. SETTING: the largest public university hospital in Brazil. PARTICIPANTS: 48 women in their third trimester of pregnancy. FINDINGS: most women expressed a preference for vaginal birth, as they perceived that they would have a faster recovery. Women who expressed a preference for caesarean section did so because of lack of pain during the birth and the need for tubal sterilisation. The majority of women considered it important to have experience with a mode of birth in order to choose a preference. Complications associated with maternal illness were very influential in the decision-making process. KEY CONCLUSIONS: these results provide a useful first step towards the identification of aspects of women's feelings about modes of birth. Most women expressed a preference for vaginal birth. Further exploration of women's feelings regarding parturition and the decision-making process is required.

Depressão e eventos de vida relacionados à asma grave / Depression and life events related to severe asthma

Objetivo: Investigar a relação entre o diagnóstico e tratamento da asma grave e o fenômeno da depressão nos pacientes em tratamento ambulatorial e avaliar se existe associação entre depressão e eventos de vida e que situações mais freqüentes se correlacionam aos aspectos depressivos. Métodos: O estudo foi caracterizado por uma entrevista clínica transversal ex post facto. Foram entrevistados 30 pacientes com o diagnóstico confirmado de asma grave, com idade de 18 a 70 anos, em tratamento no Serviço de Alergia e Imunologia do HCFMUSP e aplicados os seguintes instrumentos: entrevista psicológica semidirigida, Escala Diagnóstica Adaptativa Operacionalizada (EDAO), Escala Classificatória de Readaptação Social e PRIMEMD. Resultados: Segundo a EDAO, 63,4 (per cent) dos pacientes apresentaram depressão, 20 (per cent) apresentaram depressão crônica e 36,6 depressão reativa). De acordo com o PRIME, 66,7 (per cent) apresentaram algum tipo de depressão. Dos pacientes que apresentaram depressão, 41 (per cent) referiram pelo menos um evento de vida estressante (os eventos mais referidos foram doença pessoal importante e alteração importante na saúde de familiar), e obtiveram maior pontuação de adaptação ineficaz moderada e ineficaz severa. Conclusão: A depressão está correlacionada à asma grave, principalmente como conseqüência do prejuízo na qualidade de vida ocasionado pela doença. Os pacientes que conseguiram adaptarse à condição crônica da asma grave, apresentando respostas mais eficazes no decorrer da vida, obtiveram menor índice de depressão. Podemos concluir que a asma afeta a qualidade de vida, causa grande prejuízo na produtividade e interfere no cotidiano do paciente. Estes dados enfatizam a importância do psicólogo na equipe que assiste aos pacientes com esta doença.