Prevalence and factors associated with burnout among health professionals of a public hospital network during the COVID-19 pandemic.

Burnout is most commonly defined as a syndrome characterized by emotional exhaustion, cynicism, and ineffectiveness, which occurs in response to chronic stressors at work. It can adversely affect health workers' physical and mental health, and the quality of care provided. The COVID-19 pandemic increased stressors and could impact burnout prevalence in this group. There is a lack of information regarding the prevalence of burnout among hospital health workers in Brazil. A newer definition of burnout has been proposed that considers three different clinical profiles: the frenetic, underchallenged and worn-out subtypes. This differentiation could lead to interventions tailored for each subtype. The present study aimed to estimate the prevalence of burnout, its subtypes, and associated factors in workers of a public hospital network in Brazil, during the pandemic. A total of 143 randomly selected participants answered an online form that included sociodemographic and occupational items, and the Burnout Clinical Subtypes Questionnaire, a summarized version. This questionnaire evaluates three burnout dimensions (overload, lack of development, neglect) that can be used to discriminate the three burnout subtypes (frenetic, underchallenged, worn-out, respectively); higher scores indicate higher burnout levels. The prevalence of burnout was high (53.85%), similar to other studies during the pandemic. The most common subtypes were 'frenetic' (34.97%), characterized by increased efforts to meet work demands, to the point of neglecting personal needs, and 'lack of development' (23.78%), characterized by a sense that work is uninteresting and does not contribute to personal development, and a perfunctory behavior towards tasks. Age was associated with burnout: workers with less than 51 years presented higher levels of burnout. These findings indicate the need for effective interventions to prevent and/or treat burnout. The assessment of burnout subtypes can allow managers to better understand the processes affecting employees, and inform actions to improve workforce health.

Livro de resumos: XVII Jornada Acadêmica de Saúde Mental da Faculdade de Medicina da Universidade Federal de Minas Gerais / Livro de resumos: XVII Jornada Acadêmica de Saúde Mental da Faculdade de Medicina da Universidade Federal de Minas Gerais

A XVII Jornada Acadêmica de Saúde mental é um evento que busca aproximar os estudantes de cursos variados do campo de estudo da Saúde Mental. Além de aulas ministradas na forma de palestras, os acadêmicos são convidados a produzirem trabalhos para serem apresentados aos demais participantes, ampliando o leque de assuntos abordados. Além de proporcionar aos estudantes interessados maior contato com temas específicos da área, a produção de resumos para apresentação é uma ferramenta para aprimoramento das técnicas de escrita e produção de conteúdo. Elaborar os trabalhos amplia os conhecimentos dos alunos sobre escrita científica e os aproxima do meio acadêmico científico. Ademais, o contato com professores e pesquisadores da área, que orientam os participantes durante o processo, cria canais de comunicação e abre novas oportunidades para os estudantes. Para esta edição do evento, os trabalhos foram selecionados pela Comissão Científica da Jornada, que verificou um alto nível nas submissões. Aqueles mais originais, relevantes e bem produzidos foram aprovados e compõem esse livro, mostrando à comunidade a qualidade dos estudantes e do conteúdo apresentado na XVII JASME. Os assuntos discutidos nos próximos capítulos, desenvolvidos por estudantes de cursos da área da saúde, abrangem a saúde mental por variados ângulos e sob diversas abordagens. Escolher alguns trabalhos significa, necessariamente, prescindir de outros. Cientes do desafio de estabelecer uma coletânea que tivesse o padrão de qualidade e a feição da UFMG sem nos obnubilar pela subjetividade, estabelecemos critérios objetivos e submetemos cada resumo à apreciação independente de pelo menos três integrantes da junta científica para apreciação. Por fim, aferimos que não houve divergência de rigor entre os subgrupos e selecionamos os trinta melhores, ou seja, os mais inovadores, bem escritos, objetivos e bem fundamentados. Procuramos, diante dos diversos recortes da pandemia da COVID-19, incluir aqueles que, em vez de vagos de tão abrangentes, descreviam impactos tangíveis, mensuráveis e inusitados, isto é, Relacionados a grupos que não têm sido abordados pela grande mídia e tampouco pelo profissional de saúde médio. Assim, cremos que os resumos a seguir são os que mais bem abordam tanto questões atemporais em saúde mental quanto aquelas que emergiram nos últimos meses e ainda não sabemos por quanto tempo perdurarão. Os trabalhos tratam desde questões relacionadas aos fatores de risco para o desenvolvimento de transtornos psiquiátricos aos aspectos do tratamento farmacológico. Com uma perspectiva atual e relevante para as condições de saúde vigente, as temáticas se relacionam com diversas áreas da saúde mental, como as consequências da pandemia da SARS-COV2, aspectos da saúde mental em jovens e idosos, condutas da saúde mental na saúde primária, psicofarmacologia, transtornos psiquiátricos.

Evidências sobre a combinação de antidepressivos na depressão maior / Evidence on the combination of antidepressants in major depression

O objetivo desta revisão narrativa é avaliar as evidências científicas do emprego de combinação de antidepressivos no tratamento da depressão maior. Foram avaliadas duas modalidades de combinação: a introdução da combinação desde o início do tratamento e a associação de um segundo antidepressivo em pacientes que não apresentaram resposta satisfatória com o primeiro antidepressivo. Foram pesquisadas as principais bases de dados até outubro de 2012, sem restrição de língua (PubMed, Cochrane Library, Embase, PsycINFO, Lilacs, registros de ensaios clínicos e bancos de teses) e referências secundárias. Foram utilizadas revisões sistemáticas recentes, ensaios clínicos não contemplados pelas revisões e artigos de revisão sobre o tema. Ambas as formas de combinação de antidepressivos foram muito pouco estudadas. De maneira geral, os ensaios incluíram número muito pequeno de sujeitos e apresentaram problemas metodológicos significativos. Os resultados são controversos. As evidências existentes não permitem conclusões sólidas acerca da eficácia e tolerabilidade do emprego de associações de antidepressivos.

Antidepressants for depression in Parkinson's disease: systematic review and meta-analysis.

Depression is common in Parkinson's disease (PD) and is associated with several poor outcomes. However the literature regarding treatment with antidepressants in this population is controversial. The aim of this paper was to systematically review all randomized controlled trials that studied the efficacy of antidepressants for depression in PD (dPD). Studies were retrieved from PubMed (1966-July 2012), Cochrane Library (-July 2012, issue 7), Embase (1980-July 2012), PsycINFO (1980-July 2012), Lilacs (1982-July 2012), secondary references, clinical trials registries and a thesis database. Only double-blind, randomized controlled trials in which an antidepressant was given as the main treatment and compared with placebo and/or another antidepressant were included. Out of the 1438 studies retrieved, only six could be included. Taking into account the five placebo-controlled trials, the overall risk ratio (RR) for response was 1.36 (0.98, 1.87), indicating no statistically significant superiority of antidepressants over placebo. However, in the sensitivity analysis, the RR for response was 1.41 (1.01, 1.96) and 1.48 (1.05, 2.10) after exclusion of one study with questionable results, and when only studies with low risk of bias were considered, respectively. No specific antidepressant class was superior to placebo. In general antidepressant medications were well tolerated. The results suggest antidepressants may be efficacious in the treatment of dPD. However, the results were unstable. In fact, the small number of trials and methodological drawbacks preclude definitive conclusions about their efficacy and tolerability in dPD.

Antidepressant combination for major depression in incomplete responders--a systematic review.

BACKGROUND: Antidepressant combination has been suggested as a strategy to increase treatment efficacy. The objective of this study was to perform a systematic review and meta-analysis of studies that assessed the effect of antidepressant combination for major depression in patients with incomplete response to an initial antidepressant. METHODS: Studies were retrieved from PubMed (1966-February, 2012), Cochrane Library (-February, 2012), Embase (1980-February, 2012), PsycINFO (1980-February, 2012), Lilacs (1982-February, 2012), clinical trials registry, thesis database (www.capes.gov.br), and secondary references. Included studies had an open label phase in which an initial antidepressant was used for the treatment of major depression and a double blind phase for the incomplete responders that compared monotherapy with the first antidepressant versus the association of a second antidepressant to the first one. RESULTS: Out of the 4,884 studies retrieved, only five satisfied the inclusion criteria. The total number of patients included was 483. Only two small trials reported benefits of adding a second antidepressant to the initial antidepressant. Dropouts due to side effects were not reported in three studies. Meta-analysis was not performed due to the small number of studies, the inconsistency in the direction of effect and the possible instability of effect size. Only limited kinds of combination, involving mianserin, mirtazapine and desipramine were studied. Some properties of the first two drugs such as the anxiolytic, sedative, and orexigenic effects, can mimic depression improvement. LIMITATIONS: Publication bias cannot be ruled out. Only one study included a monotherapy arm with the antidepressant used for augmentation of the first antidepressant. CONCLUSIONS: The practice of using a combination of antidepressants for major depression in incomplete responders is not warranted by the literature.

Combination of antidepressants in the treatment of major depressive disorder: a systematic review and meta-analysis.

The objective was to perform a systematic review and meta-analysis of studies that assessed the effect of the combination of antidepressants from the beginning of the treatment of major depressive disorder. Studies were retrieved from PubMed (1966 to August 2010), Cochrane Library (August 2010), Embase (1980 to August 2010), PsycINFO (1980 to August 2010), Lilacs (1982 to August 2010), clinical trials registry, thesis database (www.capes.gov.br), and secondary references. All randomized controlled trials that compared a combination of antidepressants with a single antidepressant from the beginning of the treatment of major depressive disorder in adults were included. Data analysis was performed using the Review Manager 5.0. Of 3492 studies retrieved, five satisfied the inclusion criteria. In one study, only data about dropouts were included. Antidepressant combination was shown to be better than a single antidepressant considering remission (relative risk [RR], 2.71; 95% confidence interval [CI], 1.69-4.35) and response (RR, 1.55; 95% CI, 1.21-1.97). Mirtazapine plus selective serotonin reuptake inhibitor (SSRI) was superior to an isolated SSRI for remission (RR, 1.88; 95% CI, 1.06-3.33). Tricyclic antidepressant plus SSRI was superior to SSRI for remission and response (RR, 8.58; 95% CI, 1.70-43.32 and RR, 1.78; 95% CI, 1.07-2.93, respectively). There was no difference between combined and monotherapy groups in dropouts owing to adverse effects. The results suggest that antidepressant combination is more efficient than a single antidepressant without a significant decrease in tolerability. However, the small number of clinical trials and methodological problems precludes definitive conclusions.

Insomnia subtypes and their relationship to excessive daytime sleepiness in Brazilian community-dwelling older adults.

STUDY OBJECTIVES: To investigate the association between different types of insomnia as exposures and excessive daytime sleepiness (EDS) as a binary outcome in older Brazilian residents. DESIGN: The baseline examination of the Bambuí Health and Ageing Study (BHAS), which is an ongoing population-based prospective cohort study of older adults. SETTING: Bambuí (15,000 inhabitants), a city in the State of Minas Gerais, Southeast Brazil PARTICIPANTS: All residents aged ≥ 60 years were eligible to take part in the BHAS baseline. Of 1742 residents identified who were ≥ 60 years, 1606 (92.2%) were interviewed and received comprehensive examinations of health status. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: EDS was defined as the presence of sleepiness ≥ 3 times per week in the last month, causing any interference in usual activities. All insomnia subtypes were significantly associated with EDS in unadjusted analyses, and these associations were only modestly altered after adjusting incrementally for the other covariates. In a final model, the 3 insomnia subtypes were entered into a fully adjusted model simultaneously to investigate mutual independence, giving prevalence ratios of 1.63 (95% CI 1.14-2.31) for initial insomnia, 2.13 (95% CI 1.48-3.07) for middle insomnia, and 1.36 (95% CI 0.94-1.96) for terminal insomnia. The population attributable fractions for initial, middle, and terminal insomnia on prevalence of EDS were 17.6%, 32.9%, and 9.7%, respectively. CONCLUSIONS: Middle insomnia emerged as the insomnia subtype most strongly associated with EDS. Further research is required to clarify causal pathways underlying this cross-sectional association.

Dimensions underlying the mini-mental state examination in a sample with low-education levels: the Bambuí health and aging study.

OBJECTIVES: To investigate the validity of previously suggested dimensions underlying the Mini-Mental State Examination (MMSE) and differences in associations of these dimensions with sociodemographic and health characteristics in an older Latin-American community sample with low levels of education. DESIGN: Secondary analysis of baseline data from a population-based cohort study. SETTING: Bambuí, Brazil. PARTICIPANTS: Of 1,742 total residents aged 60 years or older, 1,558 (89.4%) participated at this study. MEASUREMENTS: A standard Brazilian version of the MMSE. RESULTS: A five-factor solution (Concentration, Language/Praxis, Orientation, Attention, and Memory) for the MMSE was generated from Principal Components Analysis, and the five-factor solutions proposed in previous studies of developed nation samples were tested in this sample by Confirmatory Factor Analysis. In the adjusted linear regression models, MMSE factors varied in their correlates: for example, female gender was associated with higher concentration, orientation, and attention but lower Language/Praxis; increased age was inversely associated only with language and attention; and activity of daily living impairment was principally associated with lower Language/Praxis. CONCLUSION: This study provides support for the cross-sectional equivalence of the MMSE, suggesting that most of the items and underlying constructs remain meaningful after alteration and translation in a low-education sample with lower overall distribution of scores.

Norms for the mini-mental state examination: adjustment of the cut-off point in population-based studies (evidences from the Bambuí health aging study).

OBJECTIVE: To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. METHOD: A total of 1558 subjects aged>60 years (89.4% of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. RESULTS: The estimated prevalences of cognitive impairment varied from 13.2% to 27.0% depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cut-off point 13/14 corresponded to the 5th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. CONCLUSION: In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.

Norms for the mini-mental state examination: adjustment of the cut-off point in population-based studies (evidences from the Bambuí health aging study) / Normas para o uso do mini-exame do estado mental: adequação do ponto de corte em estudos populacionais (evidências do Projeto Bambuí)

OBJECTIVE: To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. METHOD: A total of 1558 subjects aged >60 years (89.4 percent of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. RESULTS: The estimated prevalences of cognitive impairment varied from 13.2 percent to 27.0 percent depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cut-off point 13/14 corresponded to the 5th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. CONCLUSION: In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.

OBJETIVO: Estimar a prevalência de déficit cognitivo em uma base populacional de idosos, utilizando-se os diferentes pontos de corte do Mini-Exame do Estado Mental (MEEM) recomendados por autores brasileiros e verificar a distribuição em percentis da pontuação do MEEM na população estudada. MÉTODO: Participaram do estudo 1558 (89,4 por cento do total) indivíduos com idade >60 anos residentes na cidade de Bambuí, MG, que foram submetidos ao MEEM. RESULTADOS: A prevalência estimada de déficit cognitivo variou de 13,2 por cento a 27,0 por cento, dependendo do ponto de corte utilizado, observando-se grande variação na sua concordância (índices de kappa entre 0,38 e 0,88). O ponto de corte de 13/14 correspondeu ao 5º percentil e o de 21/22, ao quartil inferior da distribuição dos escores do MEEM. CONCLUSÃO: Na ausência de pontos de corte comparáveis, a distribuição em percentis é mais adequada para estudos de base populacional de idosos com baixa escolaridade.

Prevalence of excessive daytime sleepiness in Brazilian community-dwelling older adults with very low levels of schooling, and its association with sociodemographic characteristics and lifestyle: the Bambuí Health and Ageing Study (BHAS) / Prevalência de sonolência diurna excessiva em uma comunidade brasileira de idosos com baixa escolaridade e sua associação com características sociodemográficos e estilos de vida: Projeto Saúde e Envelhecimento Bambuí

OBJECTIVE: Population-based studies on excessive daytime sleepiness (EDS) in older adults living in less developed countries are scarce. The purpose of this paper was to estimate the prevalence of EDS and its association with sociodemographic characteristics and lifestyle factors in Brazilian community-dwelling older adults. METHODS: The study was carried out in Bambuí, a city in the state of Minas Gerais, Brazil. EDS was defined as the presence of sleepiness in the last month occurring three or more times per week, with any interference in usual activities. The exploratory variables were: gender, age, skin color, marital status, schooling level, current employment status, religion, recent migration, smoking, binge drinking and physical activities during leisure time. RESULTS: Of 1,742 residents aged > 60 years, 1,514 (86.9 percent) participated. The prevalence of EDS was 13 percent. After adjustment for confounders, female gender and low schooling level remained positively and independently associated with EDS. CONCLUSIONS: The prevalence of EDS in the study population was within the range observed in studies carried out in developed countries. The most impressive finding was the association of EDS with schooling, indicating that even in a population with low levels of schooling, this was an important factor to explain the distribution of EDS.

OBJETIVO: Estudos populacionais sobre sonolência diurna excessiva (SDE) em idosos conduzidos em países em desenvolvimento são escassos. A proposta do presente trabalho é estimar a prevalência de SDE e sua associação com características sociodemográficas e estilo de vida em idosos residentes em uma cidade brasileira. MÉTODOS: Este estudo foi conduzido na cidade de Bambuí, localizada no Estado de Minas Gerais. SDE foi definida como presença de sonolência no último mês ocorrendo pelo menos três vezes por semana, com prejuízo das atividades. As variáveis exploratórias foram sexo, idade, cor da pele, estado civil, escolaridade, ocupação, religião, migração recente, tabagismo, uso excessivo de álcool e prática de atividade física. RESULTADOS: Entre os 1.742 residentes com 60 anos ou mais, 1.514 (86,9 por cento) participaram. A prevalência de SDE foi 13 por cento. Após ajustamento por fatores de confusão, sexo feminino e menor escolaridade permaneceram positivamente associadas à SDE. CONCLUSÕES: A prevalência de SDE na população do estudo encontra-se dentro da faixa observada em estudos conduzidos em países desenvolvidos. Um achado relevante foi a associação de SDE com escolaridade, indicando que mesmo em uma população de menor nível de escolaridade, este é um fator importante na distribuição de SDE.

Correlation and agreement between the Mini-mental State Examination and the Clock Drawing Test in older adults with low levels of schooling: the Bambuí Health Aging Study (BHAS).

BACKGROUND: The aim of the study was to determine the correlation and agreement between the Mini-mental State Examination (MMSE) and Clock Drawing Test (CDT), administered and scored using Shulman's method (2000), in elderly Brazilian adults with very low levels of formal education. METHODS: CDT and MMSE tests, performed by a sample of 1118 elderly subjects from a population-based cohort, were evaluated. Spearman's correlation coefficient was calculated for the total sample and according to gender, age and schooling level. Agreement was assessed using receiver operating characteristic (ROC) analysis. RESULTS: CDTs with high scores had high corresponding MMSE scores whereas CDTs with low scores had a wide range of corresponding MMSE scores. Correlation was moderate (rho=0.64) and no difference was found according to gender, age or schooling level. For CDT cut-off 3/4, the best MMSE cut-off was 27/28 and agreement between tests was 75.1%. CONCLUSIONS: Correlation between tests was moderate. Subjects who performed well on the CDT could be expected to obtain high MMSE scores. Although one test does not substitute for the other, the CDT may be more practical in developing countries where resources are limited and low education is common in the elderly, as well as in situations where time for assessment or screening is limited. Moreover, the CDT may be sensitive to cognitive domains not assessed by the MMSE.

Is insomnia a marker for psychiatric disorders in general hospitals?

BACKGROUND AND PURPOSE: The aim was to evaluate the relationship between insomnia and psychiatric disorders in general hospital inpatients. PATIENTS AND METHODS: Information about insomnia was collected using a structured and codified questionnaire adapted from a previously validated one in Brazil. For Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) psychiatric diagnosis, the Portuguese version of the International Neuropsychiatric Interview (MINI) was used. RESULTS: Out of the 200 patients interviewed, 56.5% complained of insomnia, and 50.0% suffered from at least one psychiatric disorder. Major depressive episode (MDE) (P<0.001), generalized anxiety disorder (P=0.025) and suicide risk (P=0.034) were associated with insomnia (univariate analysis). The results of the multivariate analysis showed that only MDE had a statistically significant association with insomnia (OR=3.6; 95% CI=1.9-6.9). CONCLUSIONS: This study found a high prevalence of psychiatric disorders and insomnia in a general hospital population and found that insomnia can be a marker for MDE.

Teste do relógio: uma revisão da literatura sobre este teste para rastreamento de déficit cognitivo / Clock drawing test: a review on this cognitive screening test

O presente trabalho refere-se a uma revisão sobre o teste do relógio (TR), abordando suas indicações, as funções cognitivas por ele avaliadas, suas características principais, validade e confiabilidade. Além disso, apontam-se possíveis vantagens do TR em relação ao Mini-Mental State Examination (MMSE) e descreve-se com maior detalhe a aplicação do TR, segundo a forma proposta por Shulman (2000). O levantamento bibliográfico principal foi realizado através do Medline, compreendendo o período de janeiro de 1980 a setembro de 2001. Utilizando-se a livre expressão clock drawing foram obtidos 108 artigos. As medianas da sensibilidade e da especificidade do TR são iguais a 0,79 e 0,8, respectivamente. O TR possui boa confiabilidade entre observadores e teste-reteste, assim como boa correlação com o Mini-Mental State Examination. Na maioria dos estudos, verificou-se pior desempenho no TR com o aumento da idade, com a redução da escolaridade e no sexo feminino. A literatura existente mostra que o TR pode ser facilmente incorporado à prática clínica, melhorando a detecção de quadros de déficit cognitivo como delirium e demência.

A population based study on the intra and inter-rater reliability of the clock drawing test in Brazil: the Bambuí Health and Ageing Study.

BACKGROUND: Reliability should be considered when selecting a scoring system since it influences validity. CDT reliability has rarely been assessed in population based studies and in developing countries. The aim of the present study was to determine intra and inter-rater reliabilities of the CDT scored by the Shulman (2000) method, in elderly with very low formal educational level from Brazil. METHODS: CDTs performed by a random sample of 202 subjects of a population-based cohort of elderly were scored on two occasions by the same rater and by two independent raters. Reliability was measured using the kappa statistic, weighted kappa and the intraclass correlation coefficient. Data were stratified according to gender, age and schooling level. RESULTS: Intra and inter-rater reliabilities were excellent when CDTs were classified as 'normal' (scores 4 or 5) or 'abnormal' (scores 0 to 3) (kappa = 0.99 and 0.94, respectively) and were in the good to excellent range when scored from 0 to 5 (kappa = 0.88 and 0.74, respectively). Difficulties in distinguishing between scores 4 and 5, and a low proportion of score 1 tests were found. CONCLUSIONS: The CDT scored by the Shulman (2000) method appears to have good to excellent reliability in an elderly population with very low formal educational level. However, difficulties in distinguishing between scores 4 and 5, and a low proportion of score 1 tests suggest these scores may not be totally adequate for this population. Further studies are necessary to determine the consistency of our results in similar populations.

IMAO e Dieta: Atualizaçäo - orientaçöes práticas para o uso clínico / Monoamine oxidase inhibitors and diet Update and practical recommendations for clinical use

Os inibidores da monoaminoxidade (IMAOs) säo eficazes no tratamento da depressäo, fobia social e do transtorno do pânico. Mas o risco da ocorrência de reaçöes hipertensivas por sua interaçäo com medicamentos ou aminas, especialmente a tiramina, presentes em alimentos, e as dietas pouco práticas propostas para diminuir este risco têm limitado seu uso. Neste artigo, faz-se uma revisäo da literatura sobre dieta e IMAO e säo introduzidos dados novos acerca do teor de tiramina em produtos nacionais. O paciente em uso de IMAO deve consumir apenas alimentos frescos. Säo proibidos: queijos, exceto tipos minas padräo fresco, ricota, mussarela (até 200g), prato (até 200g), "cotage" e "cream" e cheese "cheese bread"; chope, cervejas preta e "bock"; mais que 1.200ml de cerveja "pilsen" ou sem álcool; mais que 250 ml de vinho; carne ou peixe näo fresco; vagem da fava, chucrute, derivados fermentados da soja; framboesa, casca de banana, abacate (acima de 200g) e extrato de levedura. Säo permitidos: até 100g de päo de queijo e até 1/6 de pizza média (25 cm de diâmentro) que näo contenha outro item proibido. Säo discutidas outras orientaçöes quanto à dieta e à conduta nas reaçöes hipertensivas

IMAO e dieta - atualizacao - orientacoes praticas para o uso clinico

Os inibidores da monoaminoxidase (IMAOs) sao eficazes no tratamento da depressaao, fobia e do transtorno do panico. Mas o risco da ocorrencia de reacoes hipertensivas por sua interacao com medicamentos ou aminas, especialmente a tiramina, presentes em alimentos, e as dietas pouco praticas propostas para diminuir este risco tem limitado seu uso. Neste artigo, faz-se uma revisao da literatura sobre dieta e IMAO e sao introduzidos dados novos acerca do teor de tiramina em produtos nacionais. O paciente em uso de IMAO deve consumir apenas alimentos frescos. Sao proibidos: queijos, exceto os tipos minas padrao fresco, ricota, mussarela (ate 200g), prato (ate 200g), 'cottage' e 'cream' e cheese 'cheese bread'; chope, cervejas preta e 'bock'; mais que 1.200ml de cerveja 'pilsen'ou sem alcool; mais que 250ml de vinho; carne ou peixe nao fresco; vagem da fava, chucrute, derivados fermentados da soja; framboesa, casca de banana, abacate (acima de 200g) e extrato de levedura. Sao permitidos: ate 100g de pao de queijo e ate 1/6 de pizza media (25cm de diametro) que nao contenha outro item proibido. Sao discutidas outras orientacoes quanto a dieta e a conduta nas reacoes hipertensivas.