A pandemia de Covid-19 e suas possíveis consequências para o desenvolvimento e atraso da linguagem e da fala em crianças: uma questão urgente / The Covid-19 pandemic and its possible consequences to language/speech development and delay in children: an urgent issue

RESUMO As crianças foram um dos grupos sociais mais impactados durante a pandemia de COVID-19. Suas rotinas diárias, incluindo ambientes sociais, escolares e familiares foram profundamente modificadas e podem ter consequências inadvertidas no desenvolvimento e bem-estar das crianças. Embora as escolas estejam atualmente retornando às atividades semipresenciais/híbridas em nosso país, há várias preocupações sobre como a pandemia de covid-19 pode impactar o desenvolvimento infantil a curto e longo prazo. O desenvolvimento da linguagem e da fala geralmente ocorre durante a primeira infância em uma aquisição gradual de habilidades receptivas e expressivas. Assim, embora o fechamento de escolas, o distanciamento social e o uso generalizado de máscaras possam impactar negativamente o desenvolvimento da linguagem, seu efeito específico ainda não foi amplamente acessado. Há poucos dias, um estudo longitudinal de crianças nascidas durante o período pandêmico mostrou evidências preliminares de desempenho verbal reduzido em comparação com crianças nascidas antes da pandemia. Logo, há uma necessidade urgente de mais estudos abordando esse assunto para melhor compreender o impacto potencial da pandemia COVID-19 no desenvolvimento da linguagem e da fala na infância. Nesse contexto, o fonoaudiólogo certamente terá um papel central na prevenção e abordagem terapêutica do atraso de linguagem. Junto com pais e professores, eles devem estar atentos a essa possibilidade, principalmente em crianças pequenas.

ABSTRACT Children have been one of the most disrupted social groups during the COVID-19 pandemic. Their daily routines, including social, scholar, and family environments have been profoundly disturbed and may have unintencional consequences on children development and well-being. While schools are currently returning to semi/hybrid "in person" activities in our country, there are several concerns regarding how the covid-19 pandemic may impact children development in the short and long term. Language and speech development usually occurs during early childhood in a gradual acquisition of receptive and expressive skills. Therefore, even though school closures, social distancing, and the widespread use of masks may adversely impact language development, their specific effect has not yet been widely accessed. Just a few days ago, a preprint of a longitudinal study of children born during the pandemic period have showed preliminary evidence of reduced verbal performance compared to pre pandemic born children. Thus, there is an urgent need for more studies addressing this issue to better understand the potential impact of the COVID-19 pandemic in childhood language and speech development. In this context, speech therapists will most certainly play a central role in the prevention and therapeutic approach of language delay. Along with parents and teachers, they must be attentive for this possibility specially in toddlers.

Childhood trauma and factors associated with depression among inpatients with cardiovascular disease.

AIM: To identify factors associated with depressive symptoms among inpatients with cardiovascular disease (CVD). METHODS: This is a cross-sectional study performed in a subsample of a large cross-sectional research that investigated affective disorders and suicide behaviour among inpatients hospitalized in non-surgical wards of the University Hospital of the Federal University of Minas Gerais from November 2013 to October 2015. Sociodemographic and clinical data were obtained through a structured interview and medical record review. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Scale, with scores ≥ 8 considered as positive screening for depression. We used the Fageström Test for Nicotine Dependence to characterize nicotine dependence. For assessing resilience and early-life trauma, we used the raw scores of the Wagnild and Young Resilience Scale and Childhood Trauma Questionnaire, respectively. RESULTS: At endpoint, we included 137 subjects. Thirty-eight (27.7%) subjects presented depressive symptoms and nine (23.7%) of those were receiving antidepressant treatment during hospitalization. The female sex; a lower mean educational level; a greater prevalence of previous suicide attempts; a higher level of pain; a higher prevalence of family antecedents of mental disorders; a lower resilience score; and higher childhood trauma score were the factors significantly associated with screening positive for major depression (P < 0.05). Multivariate analysis demonstrated that the factors independently associated with the depressive symptoms were a higher childhood trauma severity (OR = 1.06; P = 0.004); moderate to severe nicotine dependence (OR = 8.58; P = 0.008); and the number of previous hospital admissions (OR = 1.11; P = 0.034). The obtained logistic model was considered valid, indicating that the three factors together distinguished between having or not depressive symptoms, and correctly classified 74.6% of individuals in the sample. CONCLUSION: Our results demonstrate that inpatients presenting both CVD and a positive screening for depression are more prone to have antecedents of childhood trauma, nicotine dependence and a higher number of previous hospitalizations.

Managing severe behavioral symptoms of a patient with anti-NMDAR encephalitis: case report and findings in current literature.

OBJECTIVE: Psychiatric symptoms emerge in the early stages of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, and patients often seek treatment in psychiatric departments before visiting any other general medical services. Numerous articles about anti-NMDAR encephalitis have been published in the scientific community worldwide, but few emphasize the role of psychiatry in symptom management. CASE DESCRIPTION: We describe the case of a patient with anti- -NMDAR encephalitis seen in our service and discuss the management of behavioral symptoms based on current scientific literature. High doses of atypical antipsychotics and benzodiazepines were used to control agitation, and trazodone was administered to treat insomnia. COMMENTS: Consultation-liaison psychiatry may help the healthcare team adjust the management of neuropsychiatric complications that might affect inpatients with anti-NMDAR encephalitis.

Managing severe behavioral symptoms of a patient with anti-NMDAR encephalitis: case report and findings in current literature / Manejo de sintomas comportamentais severos em um paciente com encefalite-anti-NMDAR: relato de caso e literatura atual

Objective: Psychiatric symptoms emerge in the early stages of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, and patients often seek treatment in psychiatric departments before visiting any other general medical services. Numerous articles about anti-NMDAR encephalitis have been published in the scientific community worldwide, but few emphasize the role of psychiatry in symptom management. Case description: We describe the case of a patient with anti- -NMDAR encephalitis seen in our service and discuss the management of behavioral symptoms based on current scientific literature. High doses of atypical antipsychotics and benzodiazepines were used to control agitation, and trazodone was administered to treat insomnia. Comments: Consultation-liaison psychiatry may help the healthcare team adjust the management of neuropsychiatric complications that might affect inpatients with anti-NMDAR encephalitis. .

Objetivo: Sintomas psiquiátricos surgem em estágios precoces da encefalite antirreceptor N-metil-D-aspartato (NMDAR), o que faz muitos pacientes procurarem tratamento em serviços de psiquiatria antes de se dirigirem a unidades de clínica geral. Embora muitos artigos sobre encefalite anti-NMDAR venham sendo publicados na comunidade científica internacional, poucos enfatizam o papel do psiquiatra no seu manejo sintomatológico. Descrição do caso: O presente artigo relata o caso de um paciente que desenvolveu encefalite anti-NMDAR em nosso serviço e discute manejo de alterações comportamentais com base na literatura científica atual. Altas doses de antipsicóticos atípicos e benzodiazepínicos foram usados para controle de agitação, e trazodona foi utilizada para tratar insônia. Comentários: A interconsulta psiquiátrica pode ajudar no ajuste de condutas de toda a equipe assistente para as complicações neuropsiquiátricas que possam surgir na evolução de pacientes internados por encefalite anti-NMDAR. .

Significant sleep disturbances in euthymic bipolar patients.

OBJECTIVE: A growing amount of data suggests that sleep dysfunction is frequently observed in bipolar disorder (BD) patients even when they do not fulfill the criteria for major mood episodes. Thus, we performed a case-control study assessing sleep status in a group of euthymic BD patients and a group of health controls. METHODS: A total of 209 subjects (104 health controls and 105 BD patients) were enrolled in the study. The Pittsburgh Sleep Quality Index (PSQI) was used for sleep assessment. Inclusion criteria for the BD group were a diagnosis of BD, following DSM-IV-TR criteria, according to the MINI-plus structured clinical interview. Euthymia was established as a score lower than 7 both in the Hamilton Depression Rating Scale (HDRS) and in the Young Mania Rating Scale (YMRS). Health controls were also interviewed using the MINI-plus and included in this study if they were free of any current or past DSM-IV-TR axis I psychiatric disorder as well the actual use of psychopharmacological medications. RESULTS: While 21.2 % of the control group displayed poor sleep quality according to the global PSQI-BR score, 82.9 % of the euthymic BD patients had poor sleep quality (p=0.000). PSQI sleep duration subcomponent showed comparable results in the two groups (p=0.535), even though BD patients had significant disruptions in sleep latency (p=0.000) and sleep efficiency (p=0.000) subcomponents. CONCLUSION: We were able to show that BD patients, even in euthymic phase, exhibit a significantly worse sleep quality as compared with health controls as assessed by PSQI total score and five of its seven subcomponents.