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Introduction: Self-report scales have been considered to be useful for evaluating and monitoring symptoms of manic-depressive illnesses. The EMUN-AR scale is one of such scales but it has not been validated. Objective: To validate the EMUN-AR scale using Rasch models. Materials and methods: The EMUN-AR scale measures 26 items to assess comprehensively symptoms of manic-depressive illnesses in three domains: Frequency, severity, and level of disturbance caused by the symptoms. To test the psychometric properties of this scale, we used the exploratory factorial and Rasch analyses. The Rasch analysis included unidimensionality, reliability, item fit, threshold ordering, and person-item maps. Results: The study included 267 hospitalized patients, most of them with a manic episode diagnosis (n=204, 76.4%), and receiving pharmacological treatment. The factor structure was summarized in four domains: Activation, inhibition, depressive ideation, and maladaptive behavior. The Rasch analysis supported unidimensionality of the EMUN-AR factors, satisfactory levels of reliability, and appropriate item fit, except for one of the items measuring death or suicidal thoughts. However, the scale did not measure adequately the mild forms of the illness given its redundant and unordered thresholds. Conclusion: The EMUN-AR was modified in two aspects: An item whose marginal indicators were poorly adjusted and the reduction in the number of categories. In its current form, the EMUN-AR is appropriate for measuring severe forms of the illnesses, but it does not adequately measure the mild forms of manic-depressive illnesses.
Introducción. Las escalas de autorreporte se han considerado útiles para evaluar y vigilar los síntomas de la enfermedad maníaco-depresiva. Uno de estos instrumentos, la escala de medición de la enfermedad maníaco-depresiva mediante autorreporte (EMUN-AR), no se ha validado aún. Objetivo. Validar la escala EMUN-AR usando el modelo de Rasch. Materiales y métodos. La escala EMUN-AR mide 26 ítems que evalúan por dimensiones los síntomas de la enfermedad maníaco-depresiva en tres categorías: frecuencia, intensidad y grado de molestia causada. Para evaluar las propiedades psicométricas de la escala, se efectuaron análisis factoriales exploratorios con el fin de tener una aproximación de su estructura latente, y se usaron modelos de Rasch que incluyeron la 'unidimensionalidad', la confiabilidad, el ajuste de ítems, el ordenamiento de umbrales, y los mapas de personas e ítems. Resultados. Se seleccionó una muestra de 267 pacientes hospitalizados, 204 de los cuales había sufrido un episodio maníaco (76,4 %) y estaba recibiendo tratamiento farmacológico. Se encontró una estructura factorial que puede resumirse en cuatro dominios: activación, inhibición, ideas depresivas e inadaptación. El análisis de Rasch evidenció la unidimensionalidad en los factores, adecuados valores de confiabilidad, buen ajuste de los 26 ítems en general (excepto en el ítem que mide las ideas de muerte o suicidio), un funcionamiento deficiente del sistema de calificación de los ítems y un cubrimiento limitado de los síntomas de la enfermedad correspondientes a las formas atenuadas. Conclusión. Se modificó la escala original en dos aspectos: se ajustó un ítem cuyos indicadores marginales tenían mal ajuste y se redujo el número de categorías. En su forma actual, el instrumento es apropiado para medir las formas graves de la enfermedad maníaco-depresiva, mas no así las atenuadas.
Assuntos
Transtorno Bipolar/diagnóstico , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Escalas de Graduação Psiquiátrica , Autorrelato , Adulto , Feminino , Humanos , Masculino , PsicometriaRESUMO
Resumen Introducción. Las escalas de autorreporte se han considerado útiles para evaluar y vigilar los síntomas de la enfermedad maníaco-depresiva. Uno de estos instrumentos, la escala de medición de la enfermedad maníaco-depresiva mediante autorreporte (EMUN-AR), no se ha validado aún. Objetivo. Validar la escala EMUN-AR usando el modelo de Rasch. Materiales y métodos. La escala EMUN-AR mide 26 ítems que evalúan por dimensiones los síntomas de la enfermedad maníaco-depresiva en tres categorías: frecuencia, intensidad y grado de molestia causada. Para evaluar las propiedades psicométricas de la escala, se efectuaron análisis factoriales exploratorios con el fin de tener una aproximación de su estructura latente, y se usaron modelos de Rasch que incluyeron la 'unidimensionalidad', la confiabilidad, el ajuste de ítems, el ordenamiento de umbrales, y los mapas de personas e ítems. Resultados. Se seleccionó una muestra de 267 pacientes hospitalizados, 204 de los cuales había sufrido un episodio maníaco (76,4 %) y estaba recibiendo tratamiento farmacológico. Se encontró una estructura factorial que puede resumirse en cuatro dominios: activación, inhibición, ideas depresivas e inadaptación. El análisis de Rasch evidenció la unidimensionalidad en los factores, adecuados valores de confiabilidad, buen ajuste de los 26 ítems en general (excepto en el ítem que mide las ideas de muerte o suicidio), un funcionamiento deficiente del sistema de calificación de los ítems y un cubrimiento limitado de los síntomas de la enfermedad correspondientes a las formas atenuadas. Conclusión. Se modificó la escala original en dos aspectos: se ajustó un ítem cuyos indicadores marginales tenían mal ajuste y se redujo el número de categorías. En su forma actual, el instrumento es apropiado para medir las formas graves de la enfermedad maníaco-depresiva, mas no así las atenuadas.
Abstract Introduction: Self-report scales have been considered to be useful for evaluating and monitoring symptoms of manic-depressive illnesses. The EMUN-AR scale is one of such scales but it has not been validated. Objective: To validate the EMUN-AR scale using Rasch models. Materials and methods: The EMUN-AR scale measures 26 items to assess comprehensively symptoms of manic-depressive illnesses in three domains: Frequency, severity, and level of disturbance caused by the symptoms. To test the psychometric properties of this scale, we used the exploratory factorial and Rasch analyses. The Rasch analysis included unidimensionality, reliability, item fit, threshold ordering, and person-item maps. Results: The study included 267 hospitalized patients, most of them with a manic episode diagnosis (n=204, 76.4%), and receiving pharmacological treatment. The factor structure was summarized in four domains: Activation, inhibition, depressive ideation, and maladaptive behavior. The Rasch analysis supported unidimensionality of the EMUN-AR factors, satisfactory levels of reliability, and appropriate item fit, except for one of the items measuring death or suicidal thoughts. However, the scale did not measure adequately the mild forms of the illness given its redundant and unordered thresholds. Conclusion: The EMUN-AR was modified in two aspects: An item whose marginal indicators were poorly adjusted and the reduction in the number of categories. In its current form, the EMUN-AR is appropriate for measuring severe forms of the illnesses, but it does not adequately measure the mild forms of manic-depressive illnesses.
Assuntos
Adulto , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtorno Bipolar/diagnóstico , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Autorrelato , PsicometriaRESUMO
Los endofenotipos son rasgos presentes antes de la aparición de un trastorno y podrían ser útiles para identificar genes de susceptibilidad. Se determinó si personas con esquizofrenia y sus familiares de primer grado no afectados tenían un desempeño menor que los controles en la Tarea de Multitransformación de Expresión Emocional, que mide reconocimiento de emociones faciales. Las personas con esquizofrenia y sus familiares mostraron menor sensibilidad o requirieron más intensidad para identificar emociones que los controles. La exactitud para identificar emociones fue similar entre familiares y controles, pero menor en aquellos con esquizofrenia. Esto sugiere que la sensibilidad para el reconocimiento de emociones faciales es un endofenotipo de la esquizofrenia.
Endophentoypes are the traits present before the appearance of a disorder and could be useful to identify susceptibility genes. The purpose of this study was to determine whether persons suffering from schizophrenia and their immediate relatives performed less well than controls in the Emotional Expression Multi-transformation Task, which measures recognition of facial expressions. Persons with schizophrenia and their relatives showed less sensitivity than controls or required greater intensity to identify emotions than controls did. Accuracy in the identification of emotions was similar in relatives and controls, but lower in individuals with schizophrenia. This suggests that sensitivity in the recognition of facial emotions is an endophenotype for schizophrenia.
Os endofenótipos são traços presentes antes do surgimento de um transtorno e poderiam ser úteis para identificar genes de suscetibilidade. Determinou-se se pessoas com esquizofrenia e seus familiares de primeiro grau não afetados tinham um desempenho menor que os controles na Tarefa de Multitransformação de Expressão Emocional, que mede reconhecimento de emoções faciais. As pessoas com esquizofrenia e seus familiares mostraram menor sensibilidade ou requereram mais intensidade para identificar emoções que os controles. A exatidão para identificar emoções foi similar entre familiares e controles, mas menor naqueles com esquizofrenia. Isso sugere que a sensibilidade para o reconhecimento de emoções faciais é um endofenótipo da esquizofrenia.
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Resumen Antecedentes. No existen instrumentos de auto-reporte en español para medir síntomas de trastorno bipolar. La perspectiva del paciente puede dar información complementaria de utilidad para el diagnóstico y manejo de la enfermedad. Objetivo. Desarrollar una escala de auto-reporte para medir síntomas maníacos, a partir de la escala EMUN. Materiales y métodos. Los ítems de la escala EMUN se transformaron a un lenguaje en primera persona por parte de dos psiquiatras. Esta versión preliminar en primera persona fue analizada en un estudio piloto y ajustada de acuerdo con los resultados de la evaluación. Se realizó un segundo estudio piloto con 20 pacientes con enfermedad bipolar, aplicando la versión ajustada. Resultados. Se generó una escala con 26 ítems que incorporan síntomas del episodio mixto. La escala mide tres dimensiones de importancia clínica en salud mental: frecuencia, intensidad y grado de desadaptación producido por los síntomas. Conclusión. El instrumento desarrollado puede ser de utilidad en áreas de investigación y en escenarios clínicos para intervenciones psicoeducativas y seguimiento del paciente.
Summary Background. In Spanish language, no self-report instruments have been specifically developed to measure symptoms of bipolar disorder. The patient's perspective provides valuable information useful to diagnose and treat the disorder. Objective. Develop a self-report scale for measuring manic symptoms making use of the EMUN scale. Materials and methods. The items of the EMUN scale were transformed into a first person language by two psychiatrists. This preliminary version was evaluated in a pilot testing and adjusted according to this evaluation. A second pilot study applying the adjusted version to 20 patients having bipolar disorder was performed. Results. A 26 items scale including symptoms of mixed episode was developed. This scale measures three clinical relevant dimensions in mental health: frequency, severity and maladaptive effect of symptoms. Conclusions. The instrument developed can be a useful tool for researchers and in clinical settings to support educational interventions and patient's follow-up.
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OBJECTIVE: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. METHODS: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for "negative symptoms" and "disorganization" was performed afterwards. RESULTS: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. CONCLUSION: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia.
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Memória de Curto Prazo , Esquizofrenia/diagnóstico , Esquizofrenia/genética , Psicologia do Esquizofrênico , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia Hebefrênica/diagnóstico , Esquizofrenia Hebefrênica/genética , Esquizofrenia Hebefrênica/psicologia , Adulto JovemRESUMO
Introducción: En los trastornos bipolares, la edad de inicio se ha sugerido como una variable que puede asociarse con diferentes subtipos clínicos. Objetivo: Identificar patrones en la distribución de la edad de inicio de la enfermedad bipolar y determinar si la edad de inicio se asocia con características clínicas específicas. Métodos: Se usó análisis de distribuciones normales mezcladas para identificar subtipos de trastorno bipolar de acuerdo con la edad de inicio. Se aplicó la escala EMUN para evaluar las características clínicas y se estimaron componentes principales para evaluar la relación entre subtipos, según edad de inicio y síntomas en la fase aguda de la enfermedad, utilizando análisis multivariables. Resultados: De acuerdo con la edad de inicio, se encontraron tres distribuciones: inicio temprano: 17,7 años (S. D. 2,4); inicio intermedio: 23,9 años (S. D. 5,6); inicio tardío: 42,8 años (S. D. 12,1). El grupo de inicio tardío es asocial, con síntomas depresivos, trastornos del pensamiento y el lenguaje, y comportamientos socialmente peligrosos. Conclusión: En pacientes con enfermedad bipolar, la edad de inicio es asocial, con tres grupos que tienen características clínicas específicas
Introduction: Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. Objective: To identify patterns in the distribu-tions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. Methods: Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. Results: According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors. Conclusions: In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics
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Transtorno Bipolar , Predisposição Genética para Doença , Fatores SexuaisRESUMO
INTRODUCTION: Age at onset of bipolar disorder has been reported as a variable that may be associated with different clinical subtypes. OBJECTIVE: To identify patterns in the distributions of age at onset of bipolar disease and to determine whether age at onset is associated with specific clinical characteristics. METHODS: Admixture analysis was applied to identify bipolar disorder subtypes according to age at onset. The EMUN scale was used to evaluate clinical characteristics and principal components were estimated to evaluate the relationship between subtypes according to age at onset and symptoms in the acute in the acute phase, using multivariable analyses. RESULTS: According to age at onset, three distributions have been found: early onset: 17.7 years (S.D. 2.4); intermediate-onset: 23.9 years (S.D. 5.6); late onset: 42.8 years (S.D. 12.1). The late-onset group is antisocial, with depressive symptoms, thinking and language disorders, and socially disruptive behaviors. CONCLUSIONS: In patients having bipolar disorder, age at onset is antisocial with three groups having specific clinical characteristics.
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The delay time of the Hb S polymerization process was investigated in 63 patients with sickle cell disease during steady state and 10 during painful crisis starting from spin-spin proton magnetic resonance (PMR) time behavior measured at 36 degrees C and during spontaneous deoxygenation. We found a significant decrease of delay time as a result of the crisis (36 +/- 10%) and two well-differentiated ranges of values for each state: 273-354 min for steady state and 166-229 min for crisis with an uncertainty region of 15%. It is possible to use PMR as an objective and quantitative method in order to differentiate both clinical conditions of the sickle cell patient, but a more clear differentiation can be established comparing the delay time (td) value of one patient during crisis with his own td value during steady state.
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Anemia Falciforme/patologia , Hemoglobina Falciforme/metabolismo , Espectroscopia de Ressonância Magnética/métodos , Adulto , Anemia Falciforme/sangue , Criança , Hemoglobina Falciforme/química , Humanos , Oxigênio/química , Oxigênio/metabolismo , Fatores de TempoRESUMO
The antisickling action on polymerization of 4-hydroxy-3-metoxybenzaldehyde (Vanillin) was demonstrated in vivo in a double blind, placebo-controlled clinical therapeutic trial performed in 30 patients (11 belonging to the control group), through the increment of the delay time (td). The td was observed in the kinetic curve of the polymerization of the Hb S solution at 26 degrees C and pH 7.4. The kinetics of the Hb S aliquots was monitored by measuring the proton spin-spin magnetic relaxation time (T2) at 4 MHz. The kinetic curve families of the control group showed similarities and the td values remained constant during the 8 weeks of the study. This was not so for the patients treated with Vanillin, for which the td increased on average 1.6 times. On the other hand, the relative variation of drepanocytes observed by the Simple Test decreased 24.50% Both results indicate a decrease in the effectiveness of the polymerization process.
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Anemia Falciforme/tratamento farmacológico , Antioxidantes/administração & dosagem , Benzaldeídos/administração & dosagem , Hemoglobina Falciforme/análise , Espectroscopia de Ressonância Magnética , Administração Oral , Adolescente , Adulto , Anemia Falciforme/sangue , Método Duplo-Cego , Feminino , Humanos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Complexos Multiproteicos/análiseRESUMO
Utilizando la entrevista clínica y varias escalas de evaluación se realizó la caracterización de un grupo de 28 niños con TOC en la ciudad de Bogotá. Estos hallazgos fueron contrastados con lo reportado en la literatura mundial