RESUMO
Major depression is one of the most common medical disorders seen in primary care practice. Management frequently fails to meet recommended standards of treatment. For example, only a minority of patients are treated with antidepressants. The goals of this study were to establish the safety and effectiveness in the real world of a protocol-based pharmacological intervention administered by primary care physicians trained by psychiatrists. This was a naturalistic, open, 8-week, noncomparative, multicenter study of sertraline, 50-100 mg, in the treatment of 469 patients with mild-to-moderate major depression seen in primary care office settings. Effectiveness was assessed using the Hamilton Depression Rating Scale. The mean value of the HDRS declined steadily from 25.4 at baseline to 8.5 at day 56 (p < 0.0001). Fifty-two percent of patients achieved a full remission (HDRS <10 on day 56) and 70% had a positive response (50% reduction in HDRS scores). Only 26% had side effects, most of them mild. Major depression can be successfully diagnosed and treated by primary care physicians when adequately trained and supported by psychiatrists.
Assuntos
Transtorno Depressivo/tratamento farmacológico , Atenção Primária à Saúde , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Adolescente , Adulto , Idoso , Protocolos Clínicos , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Sertralina/efeitos adversos , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Humanos , Masculino , Adulto , Infecções por HIV/complicações , Púrpura Trombocitopênica Trombótica/etiologia , Síndrome da Imunodeficiência Adquirida/complicações , Infecções por HIV/tratamento farmacológico , Plasmaferese/normas , Púrpura Trombocitopênica Trombótica/tratamento farmacológico , Púrpura Trombocitopênica Trombótica/sangueAssuntos
Humanos , Masculino , Adulto , Infecções por HIV/complicações , Síndrome da Imunodeficiência Adquirida/complicações , Púrpura Trombocitopênica Trombótica/etiologia , Púrpura Trombocitopênica Trombótica/tratamento farmacológico , Púrpura Trombocitopênica Trombótica/sangue , Plasmaferese/normas , Infecções por HIV/tratamento farmacológicoAssuntos
Humanos , Masculino , Paraplegia/etiologia , Siringomielia/etiologia , Tuberculose Pulmonar/complicações , Doença Aguda , Adulto , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Resumo em Inglês , Paraplegia/diagnóstico , Paraplegia/tratamento farmacológico , Siringomielia/diagnóstico , Siringomielia/tratamento farmacológico , Recusa do Paciente ao Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológicoAssuntos
Humanos , Masculino , Paraplegia/etiologia , Siringomielia/etiologia , Tuberculose Pulmonar/complicações , Doença Aguda , Adulto , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Resumo em Inglês , Paraplegia/diagnóstico , Paraplegia/tratamento farmacológico , Siringomielia/diagnóstico , Siringomielia/tratamento farmacológico , Recusa do Paciente ao Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
This 42-year-old male patient voluntarily discontinued treatment for lung TBC and twenty days later developed acute paraplegia. Magnetic resonance imaging (MRI) demonstrated a large intramedullary cavity extending from T2 to the conus medullaris. Having resumed anti-TBC treatment, the patient progressed favourably, despite any change in cavity size. Tuberculous meningitis may be complicated by the appearance of intramedullary cavities by two distinct mechanisms: 1) adhesive arachnoiditis at the skull base with obstruction of Luschka and Magendie foramina, followed by hydrocephalus and hydromyelia; and 2) spinal cord arachnoiditis with the development of arachnoidal and intramedullary cysts. In either case, symptoms are of late presentation. To the best of our knowledge, this is the first report in the literature of lung tuberculosis associated with syringomyelia but without basal arachnoiditis. Acute clinical presentation with paraplegia is exceptional.
Assuntos
Paraplegia/etiologia , Siringomielia/etiologia , Tuberculose Pulmonar/complicações , Doença Aguda , Adulto , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Paraplegia/diagnóstico , Paraplegia/tratamento farmacológico , Siringomielia/diagnóstico , Siringomielia/tratamento farmacológico , Recusa do Paciente ao Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
This 42-year-old male patient voluntarily discontinued treatment for lung TBC and twenty days later developed acute paraplegia. Magnetic resonance imaging (MRI) demonstrated a large intramedullary cavity extending from T2 to the conus medullaris. Having resumed anti-TBC treatment, the patient progressed favourably, despite any change in cavity size. Tuberculous meningitis may be complicated by the appearance of intramedullary cavities by two distinct mechanisms: 1) adhesive arachnoiditis at the skull base with obstruction of Luschka and Magendie foramina, followed by hydrocephalus and hydromyelia; and 2) spinal cord arachnoiditis with the development of arachnoidal and intramedullary cysts. In either case, symptoms are of late presentation. To the best of our knowledge, this is the first report in the literature of lung tuberculosis associated with syringomyelia but without basal arachnoiditis. Acute clinical presentation with paraplegia is exceptional.
RESUMO
This 42-year-old male patient voluntarily discontinued treatment for lung TBC and twenty days later developed acute paraplegia. Magnetic resonance imaging (MRI) demonstrated a large intramedullary cavity extending from T2 to the conus medullaris. Having resumed anti-TBC treatment, the patient progressed favourably, despite any change in cavity size. Tuberculous meningitis may be complicated by the appearance of intramedullary cavities by two distinct mechanisms: 1) adhesive arachnoiditis at the skull base with obstruction of Luschka and Magendie foramina, followed by hydrocephalus and hydromyelia; and 2) spinal cord arachnoiditis with the development of arachnoidal and intramedullary cysts. In either case, symptoms are of late presentation. To the best of our knowledge, this is the first report in the literature of lung tuberculosis associated with syringomyelia but without basal arachnoiditis. Acute clinical presentation with paraplegia is exceptional.