Association between history of suicide attempts and family functioning in bipolar disorder.

OBJECTIVES: To investigate the association between history of suicide attempts (SA) and family functioning in bipolar disorder (BD) patients. METHODS: Thirty-one BD type I patients with lifetime history of SA, 31 BD type I with no lifetime history of SA, participating in the Outpatient Clinic of the Bipolar Disorder Program at the Institute of Psychiatry of the University of São Paulo Medical School were recruited for this study. We used the Family Assessment Device (FAD) to evaluate family functioning. We compared these two groups on demographic and clinical variables to identify which variables were associated with family functioning impairment. Fifty-one relatives of the same patients were also asked to complete a FAD. RESULTS: BD patients with SA presented more psychiatric hospitalizations, higher frequency of psychotic symptoms, and higher scores on depressive, manic, and suicidal ideation than BD patients without SA. BD patients with SA presented significantly higher scores in several subscales of the FAD, including Problem Solving (p=0.042), Communication (p=0.009), Roles (p=0.006), and General Functioning (p=0.025), when compared with BD patients without SA. Relatives of BD patients with SA presented significantly higher scores in Communication, Roles, Affective Responsiveness, and General Functioning than relatives of BD patients without SA. LIMITATIONS: Cross-sectional study and long time elapsed since last SA. CONCLUSION: History of SA in BD is associated with worse family functioning in several domains of FAD, including Problem Solving, Communication, Roles, and General Functioning. As suicide attempts are routinely assessed in clinical practice, these findings may help to identify patients with poorer family functioning and may suggest a role for environmental risk factors in suicidal behavior among BD patients.

Social dysfunction in bipolar disorder: pilot study.

OBJECTIVE: The purpose of the present study was to assess the social skills of euthymic patients with bipolar disorder. METHODS: A group of 25 outpatients with bipolar disorder type I were evaluated in comparison with a group of 31 healthy volunteers who were matched in terms of level of education, age, sex and intelligence. Both groups were assessed using a self-report questionnaire, the Brazilian Inventario de Habilidades Sociais (IHS, Social Skills Inventory). Two Wechsler Adult Intelligence Scale subtests (Picture Arrangement and Comprehension) were also used in order to assess subject ability to analyse social situations and to make judgements, respectively. RESULTS: Patients with bipolar disorder had lower IHS scores for the domains that assessed conversational skills/social self-confidence and social openness to new people/situations. Patients with anxiety disorders had high scores for the domain that assessed self-confidence in the expression of positive emotions. No differences were found between patients and controls in performance on the Wechsler Adult Intelligence Scale Picture Arrangement and Comprehension subtests. CONCLUSIONS: Euthymic patients with bipolar disorder present inhibited and overattentive behaviour in relation to other people and their environment. This behaviour might have a negative impact on their level of social functioning and quality of life.

Verbal fluency dysfunction in euthymic bipolar patients: a controlled study.

OBJECTIVE: To study the executive functioning in euthymic bipolar patients in comparison to healthy controls and to examine the relationship between neuropsychological deficits and clinical variables. METHODS: Twenty-five euthymic bipolar patients and 31 controls underwent a battery of executive tasks including mental flexibility, inhibitory control and verbal fluency tests. RESULTS: There were no significant differences between bipolar patients and controls in relation to mental flexibility and inhibitory control. However, patients performed worse than controls on verbal fluency tests. Poor performances on the Stroop Test and the Hayling and Brixton Tests--part A were associated to lifetime occurrence of psychotic symptoms, prior number of episodes, and previous hospitalizations. CONCLUSIONS: In our study, only verbal fluency tests differentiated bipolar euthymic patients from healthy controls. Patients who showed deficits in information processing speed and inhibitory control had more episodes and hospitalizations and lifetime occurrence of psychotic symptoms.

Fratura do tubérculo maior do úmero: comparaçäo dos resultados obtidos, a longo prazo, no tratamento cirúrgico de casos agudos e crônicos / Fracture of the greater tuberosity of the humerus: comparison of longterm results of the surgical treatment of acute and chronic cases

A fratura-arrancamento do tubérculo maios do úmero é uma lesäo encontrada com certa freqüência, associada ou näo a uma luxaçäo anterior traumática do ombro, geralmente em pacientes acima de 40 anos. No período de julho de 1987 a agosto de 1994, foram operados 37 ombros de 37 pacientes com fratura-arrancamento do tubérculo maior do úmero, sendo 24 operados na fase aguda e 13 na fase crônica. Na média, as fraturas agudas foram operadas após 12,3 dias do trauma e as fraturas crônicas após 11,5 meses. Dos 37 pacientes, 26 foram analisados, pois tinham seguimento mínino de 12 meses, sendo 18 fraturas agudas (média de seguimento pós-operatório de 31,7 meses). Na avaliaçäo dos resultados, utilizando os critérios de pontuaçäo da UCLA, obtivemos índices de 88,9 porcento de resultados excelentes e bons nas fraturas agudas, enquanto que nas crônicas este resultado foi de 25 porcento, apesar de termos obtido índice subjetivo da dor pré-operatória. Com base em nossos resultados, concluímos que estas fraturas devem ser tratadas cirurgicamente logo após o trauma e que mesmo desvios inferiores a 10mm devem ser operados. Concluímos também que o resultado obtido no tratamentocirúrgico dos casos crônicos é diretamente dependente do estado de degeneraçäo dos tendöes do manguito rotador.