RESUMO
BACKGROUND: Fear of falling may be significantly associated with falls in Parkinson's disease (PD) and may have a negative impact on quality of life. Nevertheless, there are no valid and reliable tools to examine this condition in PD. The objective of this study was to design and determine the psychometric attributes of an instrument to assess fear of falling in PD. METHODS: A prospective 1-year, 2-phase study was conducted to validate the Fear of Falling Scale, a self-assessed instrument for assessing fear of falling in PD. During phase 1, we designed a scale to measure the severity of fear of falling and determine its baseline psychometric characteristics, whereas phase 2 was a 1-year follow-up study to assess the frequency of falls and other clinical factors linked to fear of falling. Convergent and discriminant validity were assessed against the Fear of Falling Measure and the Starkstein Apathy Scale, respectively. RESULTS: The Fear of Falling Scale showed high internal consistency, test-retest reliability, and strong convergent and discriminant validity. There was a significant association between fear of falling score and the presence of both generalized anxiety disorder and major depression, poor balance-related motor ability, increased nonmotor symptoms of PD, more severe impairments in activities of daily living, and increased motor fluctuations. Finally, generalized anxiety disorder was a significant predictor of number of falls during a 12-month follow-up period. CONCLUSIONS: The Fear of Falling Scale is a valid and reliable instrument to assess fear of falling in PD. Fear of falling in PD is associated with specific psychiatric and motor disorders and is significantly related to the performance of balance-related motor functions. © 2019 International Parkinson and Movement Disorder Society.
Assuntos
Acidentes por Quedas/prevenção & controle , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida/psicologia , Inquéritos e QuestionáriosRESUMO
Although major depression is one of the most frequent psychiatric disorders among patients with Parkinson's disease, diagnostic criteria have yet to be validated. The main aim of our study was to validate depressive symptoms using latent class analysis for use as diagnostic criteria for major depression in Parkinson's disease. We examined a consecutive series of 259 patients with Parkinson's disease admitted to 2 movement disorders clinics for regular follow-ups. All patients were assessed with a comprehensive psychiatric interview that included structured assessments for depression, anxiety, and apathy. The main finding was that all 9 Diagnostic and Statistical Manual (4th edition) diagnostic criteria for major depression (ie, depressed mood, diminished interest or pleasure, weight or appetite changes, sleep changes, psychomotor changes, loss of energy, feelings of worthlessness or inappropriate guilt, poor concentration, and suicidal ideation) identified a patient class (severe depression group) with high statistical significance. Latent class analysis also demonstrated a patient class with minimal depressive symptoms (no-depression group), and a third patient class with intermediate depressive symptoms (moderate depression). Anxiety and apathy were both significant comorbid conditions of moderate and severe depression. Taken together, our findings support the use of the full Diagnostic and Statistical Manual (4th edition) criteria for major depression for use in clinical practice and research in Parkinson's disease and suggest that anxiety may be included as an additional diagnostic criterion.
Assuntos
Depressão/diagnóstico , Depressão/etiologia , Análise Multivariada , Doença de Parkinson/complicações , Idoso , Argentina , Austrália , Comparação Transcultural , Depressão/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Escalas de Graduação Psiquiátrica , Estatísticas não ParamétricasRESUMO
Apathy is one of the most prominent non-motor symptoms in Parkinson Disease (PD). Its range of prevalence in PD has been estimated in 20 to 45%. The objective of this work is to assess the prevalence of apathy in PD patients, and its relation with depression and executive function impairment. Fifty seven PD patients (54% women), mean age of 68.7 years, and a disease duration of 7.5 years from diagnosis were included. We used the following scales: UPDRS, Hoehn & Yahr, Mini Mental State Examination, the 14-item Apathy Scale (AS), the Beck Depression Inventory, and Trail Making Test versions A and B (TMT), and Parkinson's Disease Quality of Life Questionnaire (PDQL). Apathy was identified in 31.6%; apathy without depression was present in 33.3% of patients. The TMT A and B were abnormal in 66.7% and 83.3% respectively of the apathetic patients vs. 46.2% and 61.5% in non-apathetic patients. Quality of life was impaired in apathetic patients. In our PD sample apathy is highly prevalent, has a great impact on quality of life and it may occur in the absence of depression. The alterations of TMT in apathetic patients contributes to suggest a positive relationship between apathy and the impairment of executive function secondary to the involvement of frontal-subcortical circuits.
Assuntos
Transtornos Cognitivos/psicologia , Depressão/psicologia , Função Executiva/fisiologia , Doença de Parkinson/psicologia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Depressão/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Estatísticas não Paramétricas , Teste de Sequência AlfanuméricaRESUMO
La apatía es uno de los síntomas "no motores" más importantes de la Enfermedad de Parkinson (EP). Su prevalencia en EP oscila entre 20 y 45%. El objetivo de nuestro trabajo fue establecer la prevalencia de apatía en pacientes con EP y su relación con depresión y trastornos en las funciones ejecutivas. Se evaluaron 57 pacientes con EP (54% mujeres), con una edad promedio de 68.7 años y una duración promedio de enfermedad de 7.5 años. Se utilizaron las siguientes escalas: UPDRS, Hoehn & Yahr, Mini Mental State Examination, Escala de Apatía de 14 ítem (EA), Inventario de Depresión de Beck, Trail Making Test (TMT) A y B y Parkinson's Disease Quality of Life Questionnaire (PDQL). El 31.6% de los pacientes presentaban apatía; en el 33.3% de los apáticos este síntoma se presentó en ausencia de depresión. Alteraciones en el TMT A y B se observaron en 66.7% y 83.3% respectivamente de los pacientes apáticos contra el 46.2% y 61.5% de los no apáticos. La calidad de vida fue afectada en los pacientes apáticos. La apatía en EP es frecuente en esta población, ejerce un impacto negativo sobre la calidad de vida de los pacientes y puede ocurrir en ausencia de depresión. Las alteraciones del TMT en los pacientes apáticos sugerirían una posible relación entre apatía y las alteraciones de las funciones ejecutivas, probablemente por compromiso de circuitos fronto-subcorticales.
Apathy is one of the most prominent non-motor symptoms in Parkinson Disease (PD). Its range of prevalence in PD has been estimated in 20 to 45%. The objective of this work is to assess the prevalence of apathy in PD patients, and its relation with depression and executive function impairment. Fifty seven PD patients (54% women), mean age of 68.7 years, and a disease duration of 7.5 years from diagnosis were included. We used the following scales: UPDRS, Hoehn & Yahr, Mini Mental State Examination, the 14-item Apathy Scale (AS), the Beck Depression Inventory, and Trail Making Test versions A and B (TMT), and Parkinson's Disease Quality of Life Questionnaire (PDQL). Apathy was identified in 31.6%; apathy without depression was present in 33.3% of patients. The TMT A and B were abnormal in 66.7% and 83.3% respectively of the apathetic patients vs. 46.2% and 61.5% in nonapathetic patients. Quality of life was impaired in apathetic patients. In our PD sample apathy is highly prevalent, has a great impact on quality of life and it may occur in the absence of depression. The alterations of TMT in apathetic patients contributes to suggest a positive relationship between apathy and the impairment of executive function secondary to the involvement of frontal-subcortical circuits.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Cognitivos/psicologia , Depressão/psicologia , Função Executiva/fisiologia , Doença de Parkinson/psicologia , Qualidade de Vida , Argentina/epidemiologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Depressão/fisiopatologia , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Doença de Parkinson/fisiopatologia , Estatísticas não Paramétricas , Teste de Sequência AlfanuméricaRESUMO
OBJECTIVES: The objectives of this study were to examine the criterion validity in Alzheimer disease (AD) of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the International Classification of Diseases, 10th Revision (ICD-10) criteria for generalized anxiety disorder (GAD), to clarify the symptoms associated with excessive anxiety and worry in AD, to examine the co-occurrence of GAD and depression in these patients, and to determine the neuropsychologic and functional impact of GAD in AD. RESULTS: One hundred forty-four of a consecutive series of 552 patients with probable AD (26%) reported excessive anxiety and worry difficult to control for most of the 6 months before the psychiatric evaluation. Excessive anxiety and worry were significantly associated with restlessness, irritability, muscle tension, fears, and respiratory symptoms of anxiety. Using these symptoms as diagnostic criteria, 56 of the 552 patients (10%) met revised diagnostic criteria for GAD as compared with 15% when using DSM-IV criteria and 9% when using the ICD-10 criteria. GAD was present in 38 of the 144 patients (26%) with major depression and in 12 of the 261 patients (5%) without depression. Patients with both GAD and depression showed more severe cognitive deficits than patients with either GAD or depression only. CONCLUSION: The authors validated a set of diagnostic criteria for anxiety in dementia. These criteria include restlessness, irritability, muscle tension, fears, and respiratory symptoms in the context of excessive anxiety and worry. Anxiety in AD is a frequent comorbid condition of major depression.
Assuntos
Doença de Alzheimer/psicologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Classificação Internacional de Doenças , Idoso , Doença de Alzheimer/epidemiologia , Transtornos de Ansiedade/epidemiologia , Argentina/epidemiologia , Comorbidade , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Testes Neuropsicológicos , Reprodutibilidade dos TestesRESUMO
We report on the development in Argentina of a screening questionnaire for autism administered over the telephone. The Autism Diagnostic Inventory-Telephone Screening in Spanish (ADI-TSS) is based on the Autism Diagnostic Interview-Revised (ADI-R), keeping its structure but including fewer questions, which were rephrased to assess them over the telephone. The ADI-TSS went through different versions, with each modification gaining in reliability. The final version of the ADI-TSS could be assessed in 20 to 40 minutes and demonstrated a high validity (using the ADI-R as the diagnostic gold-standard), high intrarater and interrater reliability (as measured with intraclass correlations), and high internal consistency (as measured with Cronbach's alpha). The validity of the ADI-TSS remained high when used by a health-related professional without formal training in the assessment of autistic patients. We believe the ADI-TSS is useful in field research studies as a screening instrument for patients with a potential diagnosis of autism, although future validation studies should include larger samples.
Assuntos
Transtorno Autístico/diagnóstico , Transtorno Autístico/epidemiologia , Idioma , Programas de Rastreamento , Inquéritos e Questionários , Criança , Diagnóstico Diferencial , Feminino , Humanos , Entrevistas como Assunto , Masculino , Sensibilidade e EspecificidadeRESUMO
The authors examined the efficacy of methylphenidate (MPH) and lithium to treat attention-deficit/ hyperactivity disorder (ADHD) in adults, using a randomized, double-blind, crossover design. Patients received 8 weeks of MPH treatment (up to 40 mg/day) and 8 weeks of lithium treatment (up to 1,200 mg/day), by random assignment. Independent evaluators blind to group assignment assessed response every 2 weeks and at the end of each phase. The primary outcome measure was the Conners' Adult ADHD Rating Scale sum score for the clusters of hyperactivity, impulsivity, and learning problems. Secondary outcome measures were scores of irritability, overt aggression, antisocial behavior, anxiety, and depression, and scores on tests of verbal learning and sustained attention. In this preliminary study, lithium and MPH produced similar improvements on the primary outcome measure and on measures of irritability, aggressive outbursts, antisocial behavior, anxiety, and depression.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Cloreto de Lítio/uso terapêutico , Metilfenidato/uso terapêutico , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Intervalos de Confiança , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Cloreto de Lítio/efeitos adversos , Masculino , Metilfenidato/efeitos adversos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Resultado do TratamentoRESUMO
One important challenge in neuropsychiatry is how to diagnose depression in patients with acute brain lesions, since there may be an overlap between symptoms of depression and signs associated with the neurologic disease. The best approach is to assess the presence of depressive symptoms using semi-structured or structured psychiatric interviews such as the Present State Exam, the Structured Clinical Interview for DSM-IV, or the Schedules for Clinical Assessment in Neuropsychiatry. The diagnosis of a depressive syndrome should be made using standardized diagnostic criteria for mood disorders due to neurological disease such as in the DSM-IV or the ICD-10. Depression rating scales, such as the Hamilton Depression Scale and the Center for Epidemiologic Scales for Depression may be used to rate the severity of depression and monitor the progression of antidepressant treatment. Most studies in acute and chronic neurologic disorders demonstrated the specificity of both autonomic and psychological symptoms for the syndrome of depression. The present review article examines important considerations before a diagnosis of depression in neurologic disease, discusses a variety of psychiatric instruments that are used to examine the presence and severity of depression in neurologic disease, examines relevant phenomenological issues, and proposes different diagnostic strategies.
Assuntos
Lesões Encefálicas/complicações , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , Lesões Encefálicas/diagnóstico , Demência/diagnóstico , Demência/epidemiologia , Demência/etiologia , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Testes Neuropsicológicos , Prevalência , Prognóstico , Escalas de Graduação Psiquiátrica , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologiaRESUMO
Diagnosing depression in stroke patients is a challenge in neuropsychiatry since depression symptoms may overlap neurological deficit signs. The best approach is to assess the presence of depressive symptoms using semi-structured or structured psychiatric interviews, such as the Present State Exam, the Structured Clinical Interview for DSM-IV or the Schedules for Clinical Assessment in Neuropsychiatry. The diagnosis of a depressive syndrome should be made according to standardized diagnostic criteria for mood disorders due to neurological disease such as in the DSM-IV or ICD-10. Depression rating scales such as the Hamilton Depression Scale and the Center for Epidemiologic Scales for Depression may be used to rate the depression severity and monitor the progression of antidepressant treatment. Most studies have reported the effectiveness of pharmacological treatment in patients with post-stroke depression, and there is preliminary evidence that the degree of impairment in activities of daily living (ADL) may improve as well
RESUMO
La finalidad del trabajo fue examinar la prevalencia, fenomenología, tratamiento y mecanismo de los trastornos neuropsiquiátricos en las demencias degenerativas primarias. Se evaluaron 97 pacientes que cumplieron los criterios del DSM-III-R de demencia degenerativa primaria. Objetivos: 1) Determinar la prevalencia de trastornos psiquiátricos mayores en la demencia degenerativa primaria. 2) Examinar los correlatos demográficos, genéticos, de funcionamiento social, personalidad previa, severidad de la demencia y déficits en las actividades de la vida diaria en pacientes con depresión y demencia degenerativa primaria. 3) Examinar los correlatos neuropsicológicos de la depresión en la demencia. 4) Examinar la eficacia del antidepresivo tricíclico clorimipramina en el tratamiento de la depresión en la demencia degenerativa primaria. 5) Examinar el mecanismo de la depresión en la demencia degenerativa primaria. 6) Examinar la prevalencia, fenomenología y mecanismo del síndrome de desinhibición en la demencia degenerativa primaria.
Assuntos
Humanos , Idoso , Clomipramina , Demência/epidemiologia , Demência/terapia , Depressão , Doença de Alzheimer , Envelhecimento , Transtornos Psicóticos , Transtornos da PersonalidadeRESUMO
La finalidad del trabajo fue examinar la prevalencia, fenomenología, tratamiento y mecanismo de los trastornos neuropsiquiátricos en las demencias degenerativas primarias. Se evaluaron 97 pacientes que cumplieron los criterios del DSM-III-R de demencia degenerativa primaria. Objetivos: 1) Determinar la prevalencia de trastornos psiquiátricos mayores en la demencia degenerativa primaria. 2) Examinar los correlatos demográficos, genéticos, de funcionamiento social, personalidad previa, severidad de la demencia y déficits en las actividades de la vida diaria en pacientes con depresión y demencia degenerativa primaria. 3) Examinar los correlatos neuropsicológicos de la depresión en la demencia. 4) Examinar la eficacia del antidepresivo tricíclico clorimipramina en el tratamiento de la depresión en la demencia degenerativa primaria. 5) Examinar el mecanismo de la depresión en la demencia degenerativa primaria. 6) Examinar la prevalencia, fenomenología y mecanismo del síndrome de desinhibición en la demencia degenerativa primaria. (AU)