RESUMO
INTRODUCTION: Binge eating disorder (BED) is a psychiatric illness related to a high frequency of episodes of binge eating, loss of control, body image dissatisfaction, and suffering caused by overeating. It is estimated that 30% of patients with BED are affected by obesity. "Mindful eating" (ME) is a promising new eating technique that can improve self-control and good food choices, helping to increase awareness about the triggers of binge eating episodes and intuitive eating training. OBJECTIVES: To analyze the impact of ME on episodes of binge eating, body image dissatisfaction, quality of life, eating habits, and anthropometric data [weight, Body Mass Index (BMI), and waist circumference] in patients with obesity and BED. METHOD: This quantitative, prospective, longitudinal, and experimental study recruited 82 patients diagnosed with obesity and BED. The intervention was divided into eight individual weekly meetings, guided by ME sessions, nutritional educational dynamics, cooking workshops, food sensory analyses, and applications of questionnaires [Body Shape Questionnaire (BSQ); Binge Eating Scale (BES); Quality of Life Scale (WHOQOL-BREF)]. There was no dietary prescription for calories, carbohydrates, proteins, fats, and fiber. Patients were only encouraged to consume fewer ultra-processed foods and more natural and minimally processed foods. The meetings occurred from October to November 2023. STATISTICAL ANALYSIS: To carry out inferential statistics, the Shapiro-Wilk test was used to verify the normality of variable distribution. All variables were identified as non-normal distribution and were compared between the first and the eighth week using a two-tailed Wilcoxon test. Non-Gaussian data were represented by median ± interquartile range (IQR). Additionally, α < 0.05 and p < 0.05 were adopted. RESULTS: Significant reductions were found from the first to the eighth week for weight, BMI, waist circumference, episodes of binge eating, BSQ scale score, BES score, and total energy value (all p < 0.0001). In contrast, there was a significant increase in the WHOQOL-BREF score and daily water intake (p < 0.0001). CONCLUSIONS: ME improved anthropometric data, episodes of binge eating, body image dissatisfaction, eating habits, and quality of life in participants with obesity and BED in the short-term. However, an extension of the project will be necessary to analyze the impact of the intervention in the long-term.
Assuntos
Ácidos Alcanossulfônicos , Transtorno da Compulsão Alimentar , Bulimia , Humanos , Transtorno da Compulsão Alimentar/terapia , Transtorno da Compulsão Alimentar/psicologia , Estudos Prospectivos , Qualidade de Vida , Obesidade/psicologia , Índice de Massa Corporal , Bulimia/psicologiaRESUMO
CONTEXT: Joint hypermobility (JH) represents the extreme of the normal range of motion or a condition for a group of genetically determined connective tissue disorders. Generalized joint hypermobility (GJH) is suspected when present in all four limbs and the axial skeleton, scored in prepubescent children and adolescents by a Beighton Score (BS) ≥ 6. Parameters are also used to identify GJH in hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSDs). The purpose of this study is to characterize children with JH based on the location of variables in the BS ≥ 6 and identify children with JH in the axial skeleton, upper limbs (ULs), and lower limbs (LLs) simultaneously. METHODS: We analyzed 124 medical records of one- to nine-year-old children with JH by BS. RESULTS: The characterization of GJH by combinations of the axial skeleton, ULs, and LLs simultaneously totaled 25.7%. BS = 6 and BS = 8 consisted of variables located in ULs and LLs. BS = 7 included the axial skeleton, ULs, and LLs. BS ≥ 6 represents the majority of the sample and predominantly girls. CONCLUSIONS: BS ≥ 6 represents the majority of the sample and predominantly girls. Most characterized children with GJH present BS = 6 and BS = 8 with variables located only in ULs and LLs, a condition that does not imply the feature is generalized. In children, BS = 7 and BS = 9 characterize GJH by including the axial skeleton, ULs, and LLs. These results draw attention to the implications for defining the diagnosis of hEDS and HSDs.
RESUMO
Introduction: Mental health disorders (MHDs) are responsible for much impairment of quality of life in Brazil and worldwide. Early diagnosis and effective treatment strategies are required due to the heterogeneous symptoms and multifactorial etiology. Methods: A descriptive retrospective observational study was performed aiming to characterize the clinical and psychiatric profiles of patients with MHD attending a Brazilian public tertiary psychiatric outpatient clinic, which is a reference health service for more than 2 million inhabitants. Predominant clinical and sociodemographic aspects of patients were evaluated between March 2019 and March 2021. Results: A total of 8,384 appointments were analyzed. The majority of patients were female, and the mean age was 45 years old. Generalized anxiety disorder (GAD) was the most common MHD. The prevailing symptoms were sadness, anxiety, and irritability, with the most prescribed medications being selective serotonin reuptake inhibitors. Conclusion: The epidemiological characterization of mental disorders in specialized mental health outpatient clinics provides evidence for the establishment of more specific protocols and advocates a dimensional transdiagnostic approach as an aid to public mental health services.
RESUMO
INTRODUCTION: Suicide has been described in patients with Alzheimer's disease. Some promising medications for treating Alzheimer's disease have had their studies suspended because they increase the risk of suicide. Understanding the correlations between suicide and Alzheimer's disease is essential in an aging world. METHODS: A search was carried out on electronic websites (PubMed and Scielo) using the MeSH Terms "suicide" and "Alzheimer" (1986-2023). Of a total of 115 articles, 26 were included in this review. RESULTS: Depression and the allele ε4 of Apolipoprotein (APOE4) were demonstrated to be the main risk factors for suicide in patients with Alzheimer's disease. CONCLUSION: Adequately delineating which elderly people are vulnerable to suicide is important so that new treatments for Alzheimer's disease can be successful. This review showed a need for new studies to investigate the interface between Alzheimer's disease and suicide.
Assuntos
Doença de Alzheimer , Suicídio , Humanos , Doença de Alzheimer/genética , Suicídio/psicologia , Fatores de RiscoRESUMO
Introduction: The COVID-19 outbreak exposes healthcare workers to an increased risk of distress and psychiatric symptoms. Objectives: To evaluate psychological suffering and mental disorders among healthcare workers at a tertiary hospital, a referral center for COVID-19 treatment. Methods: An observational, cross-sectional, quantitative study with descriptive methodology. Fifty-eight healthcare workers who attended consultations at the hospital's Mental Health Outpatient Clinic were included. The study was carried out after approval by the research ethics committee at the Faculdade de Medicina de São José do Rio Preto (32665020.3.0000.5415). Results: 81% were women, mean age was 38.98±10.6 years, 20 (34.5%) were administrative staff, 24 (41.4%) were attending a first consultation, and 28 had had previous psychiatric attention at other services. Sixteen (28%) reported new symptoms during the pandemic, with anxious (10), irritable (3), and depressive (2) symptoms being the most frequent. Anxiety (26) and depressive disorders (19) were the most prevalent. As for exposure to news, the most common feelings were fear (19) and anguish or concern (9). The most common feelings associated with the pandemic were fear and recurrent thoughts of social and economic impact (27). The main reflections were about the meaning of life (17), human vulnerability (11), and the importance of the family (7). Regarding prospects for the future, 70.7% (41) reported hope for improvement. Conclusions: Initial data suggest a high prevalence of anxiety and depressive symptoms, as well as sleep disturbances, regardless of work team. Fear of death and uncertainty about the future are also prevalent. These data reinforce the importance of developing strategies to reduce the risks to this population's mental health.
RESUMO
Psychiatric disorders and behavioral manifestations in patients with epilepsy have complex and multifactorial etiologies. The psychotropic properties of anti-seizure medications (ASMs) and psychiatric effects of epilepsy surgery can result in iatrogenic psychiatric symptoms or episodes or can yield a therapeutic effect of underlying psychiatric disorders and have a significant impact on the patients' quality of life. The aims of this chapter are to review the available evidence of psychotropic properties of ASMs, which may be responsible for iatrogenic psychiatric symptoms and/or disorders. Moreover, the several aspects associated with the impact of epilepsy surgery on the possible improvement/development of psychiatric disorders were addressed.
Assuntos
Epilepsia , Transtornos Mentais , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Epilepsia/cirurgia , Humanos , Doença Iatrogênica/prevenção & controle , Transtornos Mentais/tratamento farmacológico , Psicotrópicos , Qualidade de VidaRESUMO
Depression is the most frequent psychiatric comorbidity seen in mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS). Moreover, the HS is the most frequent pathological hallmark in MTLE-HS. Although there is a well-documented hippocampal volumetric reduction in imaging studies of patients with major depressive disorder, in epilepsy with comorbid depression, the true role of the hippocampus is not entirely understood. This study aimed to verify if patients with unilateral MTLE-HS and the co-occurrence of depression have differences in neuronal density of the hippocampal sectors CA1-CA4. For this purpose, we used a histopathological approach. This was a pioneering study with patients having both clinical disorders. However, we found no difference in hippocampal neuronal density when depression co-occurs in patients with epilepsy. In this series, CA1 had the lowest counting in both groups, and HS ILAE Type 1 was the most prevalent. More studies using histological assessments are needed to clarify the physiopathology of depression in MTLE-HS.
RESUMO
INTRODUCTION: Schizophrenia is a complex psychiatric disorder that affects approximately twenty million people worldwide. Various factors have been associated with the physiopathology of this disease such as oxidative stress, which is an imbalance between pro-oxidant and antioxidant molecules. OBJECTIVE: This study evaluated the association between biomarkers of oxidative stress and response to pharmacological treatment among patients with schizophrenia in the context of their clinical information, demographic data, and lifestyle. METHODS: A total of 89 subjects were included, 26 of whom were treatment-responsive schizophrenia patients (Group 1), 27 treatment-resistant schizophrenia patients (Group 2), and 36 healthy controls (Group 3). All of the subjects completed a questionnaire to provide clinical and demographic data, and all provided peripheral blood samples. The oxidative stress markers analyzed using spectrophotometry were catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), total glutathione (GSH-t), malondialdehyde (MDA), and Trolox-equivalent antioxidant capacity (TEAC; p < 0.05). RESULTS: When all schizophrenia patients (G1 + G2) were compared to the control group, SOD levels were found to be lower among schizophrenia patients (p < 0.0001), while MDA and CAT levels were higher (p < 0.0001 and p = 0.0191, respectively). GPx, GSH-t, and TEAC levels were similar in all three groups (p > 0.05). CONCLUSION: Lower SOD levels and higher MDA and CAT levels indicate oxidative damage in schizophrenia patients, regardless of their response to pharmacological treatment. Smoking is associated with oxidative stress, in addition, a family history of the disease was also found to be correlated with cases of schizophrenia, which reflects the relevance of genetics in disease development.
Assuntos
Esquizofrenia , Biomarcadores , Glutationa Peroxidase/metabolismo , Humanos , Estresse Oxidativo , Esquizofrenia/tratamento farmacológico , Esquizofrenia Resistente ao TratamentoRESUMO
BACKGROUND: Substance abuse is a public health concern given its high prevalence worldwide. The early onset of such abuse predicts greater severity of addiction, morbidity, and use of multiple drugs. The use of psychoactive substances among Brazilian university students is frequent and cannabis stands out as the most consumed illicit drug. This study aimed to assess the prevalence of cannabis use among medical students from public universities in the state of São Paulo, correlating it with socioeconomic data, perceptions, and conceptions about use, triggering factors and possible implications in academic performance. METHODS: The data were collected using an anonymous online survey, which was sent to students attending public medical universities in the state of São Paulo in the year 2020. FINDINGS: The survey was answered by 225 participants. Among all participants, 147 (65.3%) reported at least one episode of cannabis use during their study in university. 91 (61.9%) reported the first use before entering university, while 56 (38.1%) used it for the first time during the university years. The frequent group included 41 (27.9%) people and the sporadic group included 106 (72.1%) people. CONCLUSION: The present study indicated that the medical students in public universities in the state of São Paulo have higher cannabis use rates compared to the general Brazilian population and to other medical students worldwide. The users are aware of the possible damages caused by cannabis use, but this does not stop them from smoking.
RESUMO
Abstract Considering suicide is a public health problem, this study identified misconceptions about patients at risk of suicide as well as strategies to manage patients and their families, also verifying changes in conceptions and attitudes throughout graduation. We applied a questionnaire with five categories: "medical confidentiality," "deontology," "medical negligence," "graduation," and "myths and conceptions". One hundred and twenty-six subjects participated in the research: 45 (35.7%) first-year medical students, 48 (38.1%) interns, and 33 (26.2%) doctors. The variables were analyzed, and the difference between groups was significant for 15 questions (62.5%). In one question (myths and conceptions) the answers were distant from the expected, and in two questions (myths and conceptions, deontology) the result did not give adequate information. We observed improvements at medical graduation for most of the studied aspects; among the deficiencies, we highlight those related to compulsory notification, electroconvulsive therapy, and the responsibility of doctors.
Resumen Considerando el suicidio como un problema de salud pública, este estudio identificó las concepciones erróneas sobre el tema, las estrategias para atender a los pacientes y sus familias y verificó los cambios en los conceptos y actitudes de estudiantes de medicina durante la graduación. Se elaboró un cuestionario con cinco categorías: "confidencialidad médica", "deontología", "mala praxis médica", "graduación", y "mitos y conceptos". De los 126 participantes 45 (35,7%) eran estudiantes del primer año de medicina, 48 (38,1%) becarios, y 33 (26,2%) médicos. Las variables se analizaron estadísticamente, y la diferencia entre grupos fue significativa para 15 preguntas (62,5%). Una pregunta (mitos y conceptos) tuvo una respuesta inesperada, y dos preguntas (mitos y conceptos, deontología) no presentaron un resultado adecuado. Se observaron mejoras durante la graduación en la mayoría de los aspectos estudiados; entre las deficiencias, se destacaron la notificación obligatoria, la terapia electroconvulsiva y la responsabilidad del profesional médico.
Resumo Partindo do princípio de que o suicídio é problema de saúde pública, este estudo identificou concepções equivocadas sobre o assunto, estratégias de manejo dos pacientes e familiares, e verificou se há mudanças nessas concepções e atitudes ao longo da graduação. Foi elaborado questionário com cinco categorias: "confidencialidade médica", "deontologia", "negligência médica", "graduação", e "mitos e conceitos". Cento e vinte e seis sujeitos participaram da pesquisa: 45 (35,7%) alunos do primeiro ano de medicina, 48 (38,1%) estagiários e 33 (26,2%) doutores. As variáveis foram analisadas, e a diferença entre os grupos foi significativa para 15 questões (62,5%). Em uma questão (mitos e conceitos) houve distanciamento da resposta esperada e em duas questões (mitos e conceitos, deontologia), o resultado não deu a informação adequada. Verificamos melhoras durante a graduação para a maioria dos aspectos considerados; dentre as deficiências, destacaram-se as relacionadas à notificação compulsória, eletroconvulsoterapia e responsabilização do profissional médico.
Assuntos
Estudantes de Medicina , Suicídio , Teoria Ética , ImperíciaRESUMO
Seizure recurrence (SR) after epilepsy surgery in patients with medically resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) can compromise medical treatment and quality of life (QOL). However, there is a scarcity of interventions specifically addressing this issue in the literature. We aimed to evaluate the impact of a four-week psychotherapeutic intervention on the levels of resilience, behavioral symptoms, and QOL of patients with drug-resistant TLE-MTS who underwent corticoamygdalohippocampectomy (CAH) and who presented with late SR. Fifty patients who had been diagnosed with TLE-TMS, undergone CAH, and presented with late SR were included. The study instruments included a clinical and sociodemographic questionnaire and the Brazilian versions of the Connor-Davidson Resilience Scale (CD-RISC-10), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Interictal Dysphoric Disorder Inventory (IDDI), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Significant reductions in the IDDI (pâ¯<â¯0.001) and NDDI-E (pâ¯<â¯0.001) scores, improvements in the CD-RISC-10 (pâ¯<â¯0.001) and QOLIE-31 (pâ¯<â¯0.001) scores, and positive correlations between resilience levels and QOL (pâ¯<â¯0.01), as well as a negative correlation between depressive symptoms and resilience (pâ¯<â¯0.01) and QOL (pâ¯<â¯0.01), were observed after the psychotherapeutic intervention. Improvements in the resilience levels and QOL, with concomitant reductions in depressive symptoms, were observed in patients with TLE-MTS and late SR after a brief psychotherapeutic intervention. Since there is a lack of studies that measured the impact of interventions in this patient subpopulation, these results may support the development of treatment strategies for this specific group.
Assuntos
Epilepsia Resistente a Medicamentos/terapia , Epilepsia do Lobo Temporal/terapia , Psicoterapia/métodos , Resiliência Psicológica , Adulto , Análise de Variância , Brasil , Depressão/psicologia , Transtorno Depressivo/complicações , Epilepsia Resistente a Medicamentos/psicologia , Epilepsia do Lobo Temporal/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Convulsões/terapia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: The objective of this study was to verify if the presence of psychogenic nonepileptic seizures (PNES) could be a risk factor precluding corticoamygdalohippocampectomy (CAH) in patients with refractory temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS) (TLE-MTS). METHODS: This retrospective cohort study analyzed medical data of patients with refractory TLE-MTS accompanied in a Brazilian epilepsy surgery center. Presurgical psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Engel's I classification two years after surgery was considered as a favorable outcome. RESULTS: Of the 81 patients initially included (65 females; 56.5%), 49 (60.5%) had TLE-MTS without PNES, 24 (29.7%) with TLE-MTS and PNES, and eight (9.8%) with PNES only, who were excluded from further statistical comparisons. Nine patients with PNES (37.5%) underwent CAH versus 35 (71.4%) without PNES (pâ¯=â¯0.005). Five patients (55.5%) with PNES versus 26 (74.3%) without PNES presented Engel I (pâ¯=â¯0.54). The relative risk (RR) was of 1.90 for patients without PNES to undergo CAH and of 1.33 to be at Engel I. CONCLUSIONS: In this study, PNES were associated with less CAH. There were no differences, however, regarding favorable postsurgical outcomes. These results highlight that the sole presence of PNES should not preclude CAH in patients with TLE-MTS, despite the necessity of careful presurgical psychiatric evaluation.
Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Transtornos Mentais/complicações , Procedimentos Neurocirúrgicos , Convulsões/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Epilepsia Resistente a Medicamentos/psicologia , Epilepsia do Lobo Temporal/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Convulsões/diagnóstico , Convulsões/etiologia , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Eye closure sensitivity (ECS) has been described as a reflex trait in juvenile myoclonic epilepsy (JME). However, there is no consensus regarding its significance on prognosis. The aim of this study is to clarify the long-term impact of ECS documented by a clinical interview and a video-EEG neuropsychological protocol (VNPP) in a series of 133 JME patients. METHODS: Data from 22 JME patients with ECS confirmed by a VNPP (Group 1) were compared with those of 20 JME patients without any reflex traits (Group 2). They were followed for a mean of 8.21 years (SD=±5.044). The frequency of seizures was assessed using a diary. Except for photosensitivity (PS), any other reflex traits occurrence, drugs/alcohol abuse intake, noncompliance, and Jeavons syndrome, were considered exclusion criteria. RESULTS: Group 1 had a lower age at epilepsy onset (p = 0.028), higher incidence of febrile seizures (13.6%), and familial history of epilepsy (p = 0.023). Only 18.2% had self-perception of eyelid myoclonia (EM) (kappa coefficient = 0.193), which persisted in 77.3% of patients. Limb myoclonia, tonic-clonic seizures (TCS) and/or myoclonic-tonic-clonic seizures (MTCS), as well as absences were more frequent (p = 0.015; p = 0.013; p = 0.011, respectively) in Group 1. PS did not influenced frequency of EM (p = 1.0), absences (p = 0.648), or TCS/MTCS (p = 0.934). Psychiatric comorbidities were not different between groups. CONCLUSIONS: ECS is related to a worse outcome regarding control of all seizure types, persistence of EM, and higher frequency of limb myoclonia, as well as the total number of TCS and/or MTCS.
Assuntos
Pálpebras/fisiopatologia , Epilepsia Mioclônica Juvenil/diagnóstico , Epilepsia Mioclônica Juvenil/fisiopatologia , Reflexo/fisiologia , Adulto , Fatores Etários , Anticonvulsivantes/uso terapêutico , Eletroencefalografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Epilepsia Mioclônica Juvenil/tratamento farmacológico , Prognóstico , Estatísticas não Paramétricas , Adulto JovemRESUMO
PURPOSE: Psychogenic nonepileptic seizures (PNES) are paroxysmal episodes superficially resembling epileptic seizures but are not associated with any electrical abnormalities. Despite the existence of recent evidence addressing psychological interventions on PNES, there is a scarcity of studies investigating such interventions on patients with dual diagnoses, such as in temporal lobe epilepsy/mesial temporal sclerosis (TLE-MTS) with comorbid PNES; TLE-MTS is a very frequent epilepsy syndrome found in tertiary centers. We aimed to investigate the effects of a group psychotherapeutic intervention program based on cognitive-behavioral therapy (CBT) on patients dually diagnosed with TLE-MTS and PNES treated in a tertiary center. METHOD: Patients with TLE-MTS and PNES who were followed-up in a tertiary center were invited. The intervention consisted of eight weekly, semi-structured group meetings. The Brazilian versions of the Quality of Life Scale (SF-36), the Toronto Alexithymia Scale (TAS), the Hamilton Depression Scale (HAM-D), the Hamilton Anxiety Scale (HAM-A), and the Ways of Coping Checklist (WCC) were applied before and after the intervention. RESULTS: Forty-seven patients were enrolled (25 females; 53.2%). Psychiatric disorders (PD) were observed in all 47 patients (100%); Major Depressive Disorder (MDD) was the most frequent PD (24; 51.0%). There were improvements on quality of life (Pâ¯=â¯0.003), decreased depression (P<0.0001) and anxiety symptoms (Pâ¯=â¯0.02), decreased levels of alexithymia (Pâ¯=â¯0.02) and a reduction in seizure frequency (Pâ¯=â¯0.02) after the intervention. CONCLUSIONS: Present data suggest a positive impact of a group psychological intervention based on CBT in patients with TLE-MTS and PNES, highlighting this therapeutic possibility for this specific subgroup.
Assuntos
Epilepsia Resistente a Medicamentos/terapia , Epilepsia do Lobo Temporal/terapia , Transtornos Psicofisiológicos/terapia , Psicoterapia de Grupo , Convulsões/terapia , Adulto , Ansiedade/complicações , Ansiedade/epidemiologia , Ansiedade/terapia , Terapia Cognitivo-Comportamental , Comorbidade , Depressão/complicações , Depressão/epidemiologia , Depressão/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Epilepsia Resistente a Medicamentos/complicações , Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtornos Psicofisiológicos/complicações , Transtornos Psicofisiológicos/epidemiologia , Psicoterapia de Grupo/métodos , Psicotrópicos/uso terapêutico , Convulsões/complicações , Convulsões/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of this study was to investigate the psychological aspects and psychiatric disorders (PDs) in patients dually diagnosed with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) with psychogenic nonepileptic seizures (PNES) treated in a tertiary center in order to find any gender differences in psychiatric, clinical, and sociodemographic characteristics. METHOD: Psychiatric assessment was performed through the Diagnostic and Statistical Manual for Psychiatric Disorders - 5th edition (DSM-5). The Brazilian versions of the Medical Outcomes Study 36 (SF-36), Toronto Alexithymia Scale (TAS-20), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), and Ways of Coping Checklist (WCC) were applied. RESULTS: Of the 47 patients enrolled (25 females; 53.2%), females were significantly more likely to have a history of previous psychiatric treatment (P=0.02), family history of epilepsy (P=0.01), and family history of PD (P=0.03). They also presented earlier onset of PNES (P=0.01) and higher PNES duration (P=0.02) compared with males. Major depressive disorder (MDD) was the most frequent PD (24; 51.0%). Females presented more psychiatric diagnoses (P<0.001), more diagnoses of MDD (P<0.001), and posttraumatic stress disorder (PTSD) (P<0.001). Several differences regarding quality of life, levels of alexithymia, anxiety/depressive symptoms, and coping strategies were observed between groups. CONCLUSIONS: There are significant gender differences in psychiatric, clinical, and sociodemographic aspects in a group of patients with TLE-MTS and PNES, as well as in quality of life, levels of alexithymia, anxiety/depressive symptoms, and coping strategies. These gender differences suggest that specific approaches might be adopted depending on the patient's gender and, consequently, their distinct psychological/psychiatric profile.
Assuntos
Adaptação Psicológica , Sintomas Afetivos/epidemiologia , Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia do Lobo Temporal/epidemiologia , Convulsões/epidemiologia , Caracteres Sexuais , Adaptação Psicológica/fisiologia , Adulto , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/psicologia , Brasil/epidemiologia , Comorbidade , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/psicologia , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Estudos Retrospectivos , Convulsões/diagnóstico , Convulsões/psicologia , Adulto JovemRESUMO
RESUMO Objetivos Analisar o perfil sociodemográfico, antecedentes pessoais/familiares e a prevalência de comorbidades psiquiátricas em uma amostra de dependentes de álcool e/ou substâncias psicoativas (SPAs) acompanhados em duas comunidades terapêuticas. Métodos Trata-se de um estudo de prevalência, com coleta de dados realizada em uma amostra de 90 entrevistados por meio da aplicação de uma ficha de dados sociodemográficos/antecedentes pessoais e familiares e do Mini International Neuropsychiatric Interview versão Plus (MINI Plus). Os entrevistados foram divididos em três grupos: etilistas (grupo A), dependentes de SPAs ilícitas (Grupo B) e dependentes de álcool e SPAs ilícitas (grupo C). Resultados Observou-se prevalência elevada de comorbidades psiquiátricas (88,8%) e, em específico, do transtorno depressivo maior (TDM) no grupo A (36,7%) e do transtorno de personalidade antissocial nos grupos B e C (46,7% e 30%, respectivamente). Foi possível traçar perfis próprios para cada grupo, havendo convergência quanto aos dados sociodemográficos para os grupos A e C e entre os grupos B e C para as comorbidades psiquiátricas. Conclusão A vulnerabilidade sociodemográfica e a alta prevalência de comorbidades psiquiátricas denotam a fragilidade da população de dependentes químicos. Os perfis próprios de cada grupo evidenciam a importância de tratamento individualizado.
ABSTRACT Objectives Analyze the sociodemographic profile, personal/family antecedents and the prevalence of psychiatric comorbidities in a sample of alcohol and/or psychoactive substances (PAS) accompanied in two therapeutic communities. Methods This is a prevalence study, having gathered data from a sample with 90 interviewee through a form with sociodemographic/personal/family antecedents data and the Mini International Neuropsychiatric Interview (MINI Plus). The interviewee were divided in three groups: alcohol dependent (group A), illicit PAS dependents (group B) and alcohol and illicit PAS (group C). Results A high prevalence of psychiatric comorbidities (88.8%) and, specifically, the major depressive disorder (MDD) in group A (36.7%) and antisocial personality disorder in groups B and C (46.7% and 30%, respectively) was found. It was possible to track characteristic profile for each group, having found a convergence of sociodemographic data for groups A and C, and between groups B and C, for psychiatric comorbidities. Conclusion The sociodemographic vulnerability and the high prevalence of psychiatric comorbidities denote the fragility of the population of chemical dependents. The characteristic profiles for each group demonstrate the importance of an individualized treatment.
RESUMO
ABSTRACT BACKGROUND AND OBJECTIVES: Failed back surgery syndrome is one of the most frequent nosological entities in a Pain Clinic and is characterized by the persistent maintenance of lumbar and/or lower limbs pain complaints in individuals already submitted to lumbar vertebral surgery. This study aimed at evaluating quality of life and at investigating the presence of alexithymia in a sample of individuals with failed back surgery syndrome, in addition to analyzing correlations between pain intensity and symptoms of anxiety and depression. METHODS: This is a descriptive, exploratory, comparative, cross-sectional study with quantitative approach in a sample of individuals with failed back surgery syndrome (G1) (n=38) and a group with low back pain without surgical intervention (G2) (n=42) of a Teaching Hospital Pain Clinic. Participants were evaluated by the Brief Pain Inventory and the Toronto Alexithymia scale. Emotional factors, such as anxiety and depression, were evaluated by Beck scales and quality of life by the generic WHOQOL-BREF questionnaire. RESULTS: There were mean alexithymia, anxiety and depression scores significantly higher for G1 and poorer quality of life in all domains as compared to G2. There were significant correlations between alexithymia and depression (p<0.01) and quality of life (except for the environment domain) and anxiety/depression (p<0.001). CONCLUSION: Results have highlighted the negative impact of frequently under-diagnosed psychological variables on quality of life. A better understanding of these emotional reactions may promote a more effective participation of health professionals.
RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome da falha cirúrgica é uma das mais frequentes entidades nosológicas em uma Clinica de Dor e caracteriza-se pela manutenção persistente de queixas álgicas lombares e/ou nos membros inferiores em indivíduos já submetidos a cirurgia vertebral lombar. O objetivo deste estudo foi avaliar a qualidade de vida e investigar a presença de alexitimia em uma amostra de indivíduos com síndrome da falha cirúrgica, e analisar as correlações entre intensidade de dor e presença de sintomas de ansiedade e depressão. MÉTODOS: Trata-se de um estudo descritivo, exploratório, comparativo, de corte transversal com abordagem quantitativa em uma amostra composta de indivíduos com diagnóstico de síndrome da falha cirúrgica (G1) (n=38) e um grupo com dor lombar e sem intervenção cirúrgica (G2) (n=42) pertencentes a uma Clinica da Dor de um hospital escola. Os participantes foram avaliados pelo Inventario Breve de Dor e a escala de Alexitimia de Toronto. Fatores emocionais como ansiedade e depressão foram avaliados pelas escalas Beck e, a qualidade de vida pelo questionário genérico WHOQOL-BREF. RESULTADOS: Apontaram escores médios significativamente mais elevados de alexitimia, ansiedade e depressão no G1 e pior qualidade de vida em todos os domínios, se comparado ao G2. Correlações significativas entre alexitimia e depressão (p<0,01) e qualidade de vida (exceto no domínio ambiente) e ansiedade/ depressão (p<0,001). CONCLUSÃO: Os resultados destacam o impacto negativo que as variáveis psicológicas, frequentemente subdiagnosticadas, têm na qualidade vida. A melhor compreensão dessas reações emocionais pode promover uma atuação mais eficaz do profissional de saúde.
RESUMO
Psychiatric disorders (PD) have an elevated prevalence and an important negative impact on patients with epilepsy (PWE) since they are associated with lower quality of life and clinical refractoriness. However, it is also necessary to identify behavioral conditions possibly associated with epilepsy that are not part of the standard psychiatric classifications, such as Interictal Dysphoric Disorder (IDD) and Interictal Personality (IP). The frequency of IDD and IP in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) was assessed. The Brazilian versions of the Neurobehavioral Inventory (NBI) and Interictal Dysphoric Disorder Inventory (IDDI) were applied to patients and to a control group. Psychiatric standard assessment was conducted through the Diagnostic and Statistical Manual for Psychiatric Disorders - 5th edition (DSM-5). The value of p considered significant was <0.05. Ninety-five patients (51 women; 53.6%) and 50 controls (29 women; 58.0%) were assessed. Axis I PD were observed in 41 patients (43.1%). Interictal Dysphoric Disorder was observed in 18 patients (18.4%) and IP in 36 (37.9%). Interictal Dysphoric Disorder was associated with left-sided MTS (OR=3.22; p=0.008), previous psychiatric treatment (OR=4.29; p=0.007), and more than one AED used (OR=2.73; p=0.02) while presence of bilateral MTS (OR=3.27; p=0.008), longer disease duration (OR=3.39; p=0.006), and presence of Major Depressive Disorder (OR=4.73; p=0.004) were associated with IP. In the present study, there was a high prevalence of IDD and IP in patients with drug-resistant TLE-MTS; studies should be conducted to identify the presence of behavioral conditions that are not present in the conventional psychiatric classifications.
Assuntos
Transtorno Depressivo Maior/diagnóstico , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia do Lobo Temporal/diagnóstico , Transtornos da Personalidade/diagnóstico , Adulto , Brasil/epidemiologia , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia Resistente a Medicamentos/psicologia , Epilepsia do Lobo Temporal/epidemiologia , Epilepsia do Lobo Temporal/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/psicologia , Qualidade de Vida/psicologiaRESUMO
Previous studies, using surveys, provided an understanding about how health-care providers address patients with PNES. To date, there is limited information on the management of patients with PNES by tertiary referral centers for epilepsy. In this study, we surveyed 11 Brazilian epilepsy center directors about diagnosis, treatment, education and research on PNES. Respondents reported that patients with PNES represented 10-20% of all adult patients recorded by video-EEG (VEEG). All respondents recognized VEEG as the method to confirm the diagnosis, and 81.8% used this approach for confirmation. Most centers had a standard protocol for diagnosis. None of the centers had a particular protocol to treat PNES, but 90.9% had a uniform treatment approach including therapy and educational measures. Psychotherapy was not easily obtained in nine centers (81.8%). Seven (63.3%) centers reported ongoing research projects with PNES. Five centers referred to an educational PNES program discussing diagnosis, but only one reported an educational program for treatment. This study showed a commitment to PNES diagnosis; however, some gaps remain regarding treatment and training, namely implementing a psychotherapy approach for patients and providing educational curricula for clinicians.
Assuntos
Educação de Pacientes como Assunto , Transtornos Psicofisiológicos/diagnóstico , Psicoterapia , Convulsões/diagnóstico , Brasil , Eletroencefalografia/métodos , Pesquisas sobre Atenção à Saúde , Humanos , Transtornos Psicofisiológicos/psicologia , Transtornos Psicofisiológicos/terapia , Convulsões/psicologia , Convulsões/terapiaRESUMO
ABSTRACT Objective: To evaluate the results of an interdisciplinary program administered to patients with failed back surgery syndrome, aiming at functional improvement, modulation of pain, reduction of anxiety symptoms and depression, and improvement of quality of life. Method: This is a non-randomized prospective study with a sample of patients with failed back surgery pain syndrome diagnosed with persistent or recurrent pain after surgery to the lumbar spine (laminectomy and arthrodesis) referred to liaison in the Pain Clinic (n= 26). The instruments used were Brief Pain Inventory, Roland-Morris Questionnaire and Beck Anxiety and Depression Inventories. The generic WHOQOL-bref13 questionnaire was used to evaluate the quality of life and the fear of moving was assessed by the Tampa Scale for Kinesiophobia. Results: There was a predominance of females, the mean age was 42.3 ± 5.8 years, 43% were married and average schooling was 7 ± 4.5 years. The mean time of pain reported was 8 ± 6.8 months in addition to high levels of anxiety, depression and kinesiophobia. After the intervention, there was a significant improvement in the perception of quality of life and of all parameters evaluated (p<0.05), with functional gains as well as decreased pain threshold. Conclusion: The interdisciplinary intervention in patients with failed back surgery syndrome provides better functional performance, decreases the intensity of pain, anxiety and depression symptoms, and improves quality of life. The inclusion of this intervention associated with drug therapy may the patient develop an active and independent lifestyle.
RESUMO Objetivo: Avaliar os resultados de um programa interdisciplinar aplicado a pacientes com síndrome pós-laminectomia, visando melhora funcional, modulação da dor, redução de sintomas de ansiedade e depressão e aumento da qualidade de vida. Método: Trata-se de um estudo prospectivo não randomizado, com amostra constituída por um grupo de pacientes com síndrome dolorosa pós-laminectomia diagnosticados com dor persistente ou recorrente após cirurgias da coluna lombar (laminectomia e artrodese) encaminhados para interconsultas na Clínica da Dor (n= 26). Os instrumentos utilizados foram: Inventário Breve de Dor, Questionário Roland-Morris e Inventários Beck de ansiedade e depressão. Para avaliar a qualidade de vida, foi utilizado Questionário Genérico Whoqol-bref13 e o medo de se movimentar foi avaliado pela Escala Tampa para Cinesiofobia. Resultados: Houve predomínio de mulheres, a média de idade foi 42,3 ± 5,8 anos, 43% eram casados e a média de escolaridade foi de 7 ± 4,5 anos. O tempo médio de dor relatado foi de 8 ± 6,8 meses, além de níveis altos de ansiedade, depressão e cinesiofobia. Após a intervenção houve melhora significativa na percepção da qualidade de vida e de todos os parâmetros avaliados (p < 0,05) observando-se ganhos funcionais, assim como a diminuição do limiar de dor. Conclusão: A intervenção interdisciplinar nos pacientes com síndrome pós-laminectomia proporciona melhor desempenho funcional, diminui a intensidade da dor, os sintomas de ansiedade e depressão, melhorando a qualidade de vida. A inclusão desta intervenção associada ao tratamento farmacológico pode desenvolver um estilo de vida ativo e independente.
RESUMEN Objetivo: Evaluar los resultados de un programa interdisciplinario subministrado a pacientes con síndrome postlaminectomía que busca la mejora funcional, la modulación del dolor, la reducción de los síntomas de ansiedad y depresión y calidad de vida. Método: Se trata de un estudio prospectivo no aleatorio de una muestra compuesta por un grupo de pacientes con síndrome doloroso postlaminectomía diagnosticados con dolor persistente o recurrente después de la cirugía de la columna lumbar (laminectomía y fusión) referidos a interconsultas en la Clínica del Dolor (n= 26). Los instrumentos utilizados fueron: Cuestionario breve del dolor, Cuestionario Roland-Morris e inventarios de ansiedad y depresión de Beck. Para evaluar la calidad de vida se utilizó el cuestionario genérico WHOQOL-BREF13 y el miedo de moverse fue evaluado por la Escala de Tampa de Kinesiofobia. Resultados: Hubo un predominio de mujeres, la edad promedio fue de 42,3 ± 5,8 años, 43% eran casados y la educación promedio fue de 7 ± 4,5 años. Se reportó una duración promedio del dolor de 8 ± 6,8 meses, además de altos niveles de ansiedad, depresión y kinesiofobia. Después de la intervención se observó una mejoría significativa en la percepción de la calidad de vida y de todos los parámetros (p < 0,05), siguiendo las ganancias funcionales, así como la disminución del umbral del dolor. Conclusión: La intervención interdisciplinaria en pacientes con síndrome postlaminectomía mejora la funcionalidad, disminuye la intensidad del dolor, los síntomas de ansiedad y depresión y mejora la calidad de vida. La inclusión de esta intervención asociada con el tratamiento farmacológico puede proporcionar una vida activa e independiente.