RESUMO
INTRODUCTION: Since 1980, there have been known cases of childhood neuropsychiatric syndromes in the world and its concept has evolved with changes in the definitions in 1995 (PITANDs - paediatric infection-triggered autoimmune neuropsychiatric disorders), 1998 (PANDAS - paediatric autoimmune neuropsychiatric syndrome associated with streptococci infection), 2010 (PANS - paediatric acute-onset neuropsychiatric syndrome) and 2012 (CANS - childhood acute neuropsychiatric syndrome). Despite being known for more than 20 years, it is still an illness that often goes unnoticed by many health professionals. OBJECTIVE: To sensitise the medical community about the identification of the disease and reduce the morbidity associated with a late diagnosis. CLINICAL CASE: A 6-year-old schoolgirl brought to the emergency department due to her refusal to eat. In the hospital treatment, a clinical history was identified with PANS-PANDAS diagnostic criteria. She exhibited a relapsing-remitting clinical course, as described in the literature, with poor response to first-line treatments. CONCLUSIONS: In all school-age child presenting with obsessive compulsive disorder or eating disorders, with other symptoms or not, a possible link to PANS-CANS should be evaluated and ruled out.
Assuntos
Doenças Autoimunes , Transtorno Obsessivo-Compulsivo , Infecções Estreptocócicas , Feminino , Criança , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/psicologia , SíndromeRESUMO
OBJECTIVE: To evaluate the relationship between resilience and clinical outcomes in patients with autoimmune rheumatic diseases. METHODS: Focus groups, individual interviews, and chart reviews were done to collect data on 188 women with autoimmune rheumatic diseases, namely rheumatoid arthritis (n=51), systemic lupus erythematosus (n=70), systemic sclerosis (n=35), and Sjögren's syndrome (n=32). Demographic, clinical, and laboratory variables were assessed including disease activity by patient reported outcomes. Resilience was evaluated by using the Brief Resilience Scale. Bivariate, multiple linear regression, and classification and regression trees were used to analyse data. RESULTS: Resilience was influenced by age, duration of disease, and socioeconomic status. Lower resilience scores were observed in younger patients (<48years) with systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis who had low socioeconomic status, whereas older patients (>50years) had higher resilience scores regardless of socioeconomic status. There was no influence of disease activity on resilience. A particular behaviour was observed in systemic sclerosis in which patients with high socioeconomic status and regular physical activity had higher resilience scores. CONCLUSION: Resilience in patients with autoimmune rheumatic diseases is a continuum process influenced by age and socioeconomic status. The ways in which these variables along with exercise influence resilience deserve further investigation.
Assuntos
Doenças Autoimunes/psicologia , Medidas de Resultados Relatados pelo Paciente , Doenças Reumáticas/psicologia , Estresse Psicológico , Adulto , Idoso , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/imunologia , Índice de Gravidade de Doença , Fatores SociológicosRESUMO
BACKGROUND: Autoimmune bullous dermatoses are complex diseases triggered by autoantibodies action against epidermal antigens or the dermoepidermal junction. Blisters and vesicles that evolve with erosion areas characterize them. Although rare, they present high morbidity, affecting the quality of life of patients. OBJECTIVES: To assess the magnitude of autoimmune bullous dermatoses on life quality of patients treated in a public university service in countryside of Brazil. METHODS: This cross-sectional study was based on an inquiry with autoimmune bullous dermatoses patients assisted at outpatient university referral service. Elements related to quality of life were evaluated by the Dermatology Life Quality Index, as well as clinical and demographic data. RESULTS: The study evaluated 43 patients with pemphigus foliaceus, 32 with pemphigus vulgaris, 6 with bullous pemphigoid and 3 with dermatitis herpetiformis. The average age was 48 ± 16 years and 34 (40%) were female. The median score (p25-p75) of the Dermatology Life Quality Index was 16 (9-19), classified as "severe impairment" of life quality, in which the greater impact was related to symptoms and feelings, daily and leisure activities. CONCLUSIONS: Autoimmune bullous dermatoses inflict severe impairment of quality of life for patients followed by a public outpatient clinic in the countryside of Brazil.
Assuntos
Doenças Autoimunes/psicologia , Qualidade de Vida , Dermatopatias Vesiculobolhosas/psicologia , Adulto , Brasil , Homólogo 5 da Proteína Cromobox , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Autoimmune bullous dermatoses are complex diseases triggered by autoantibodies action against epidermal antigens or the dermoepidermal junction. Blisters and vesicles that evolve with erosion areas characterize them. Although rare, they present high morbidity, affecting the quality of life of patients. OBJECTIVES: To assess the magnitude of autoimmune bullous dermatoses on life quality of patients treated in a public university service in countryside of Brazil. METHODS: This cross-sectional study was based on an inquiry with autoimmune bullous dermatoses patients assisted at outpatient university referral service. Elements related to quality of life were evaluated by the Dermatology Life Quality Index, as well as clinical and demographic data. RESULTS: The study evaluated 43 patients with pemphigus foliaceus, 32 with pemphigus vulgaris, 6 with bullous pemphigoid and 3 with dermatitis herpetiformis. The average age was 48 ± 16 years and 34 (40%) were female. The median score (p25-p75) of the Dermatology Life Quality Index was 16 (9-19), classified as "severe impairment" of life quality, in which the greater impact was related to symptoms and feelings, daily and leisure activities. CONCLUSIONS: Autoimmune bullous dermatoses inflict severe impairment of quality of life for patients followed by a public outpatient clinic in the countryside of Brazil. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Autoimunes/psicologia , Qualidade de Vida , Dermatopatias Vesiculobolhosas/psicologia , Brasil , Estudos Transversais , Análise Multivariada , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To explore associated clinical factors in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). STUDY DESIGN: Children with tics, obsessive-compulsive disorder, or both (n=109) were examined with personal and family history, diagnostic interview, physical examination, medical record review, and measurement of baseline levels of streptococcal antibodies. RESULTS: Significant group differences were found on several variables, such that children in whom PANDAS (versus without PANDAS) were more likely to have had dramatic onset, definite remissions, remission of neuropsychiatric symptoms during antibiotic therapy, a history of tonsillectomies/adenoidectomies, evidence of group A streptococcal infection, and clumsiness. CONCLUSION: The identification of clinical features associated with PANDAS should assist in delineating risks for this subtype of obsessive-compulsive disorder/tics.
Assuntos
Doenças Autoimunes/imunologia , Doenças Autoimunes/psicologia , Transtorno Obsessivo-Compulsivo/imunologia , Infecções Estreptocócicas/psicologia , Streptococcus pyogenes/imunologia , Transtornos de Tique/imunologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva , Fatores de RiscoRESUMO
INTRODUCTION: The incidence of depression accompanying medical pathologies is elevated and have prognostic importance. OBJECTIVE: To determine the frequency of depression in patients with systemic autoimmune diseases (SAD), as well as to determine the frequency of pain, fatigue and sleep disorders in these patients and their relation with depression. MATERIAL AND METHODS: We performed a descriptive, prospective study on 88 patients with AID. The CES-D depression questionnaire, FSS fatigue questionnaire and the Pittsburgh sleep quality index were administered. RESULTS: 69% (n=61) of patients were depressed. Pain was found in 97% (59/61) of depressed patients and in 62% (17/27) of non-depressed patients (P=.0006). Sleep disorders were found in 95% of depressed patients, whereas 60% of non-depressed patients presented them (P=.00008). Depression was associated with fatigue: 80% (49/61) for depressed and 44% for non-depressed (p=0,001) persons. DISCUSSION: A very elevated prevalence of depression was found in SAD: 69%; constituting the most frequent comorbidity. Depression was significantly associated with pain, fatigue and sleep disorders.
Assuntos
Doenças Autoimunes/complicações , Depressão/etiologia , Transtorno Depressivo/etiologia , Adolescente , Adulto , Idoso , Doenças Autoimunes/psicologia , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Adulto JovemRESUMO
El autor propone una reflexión sobre las patologías auto-inmunes, tomando como punto de partida su idea de que el estrés durante el embarazo de los padres de pacientes con trastornos inmunológicos pueda ser responsable, en parte, de la configuración de las patologías. Conceptos contemporáneos de las neurociencias, sobre el tema estrés y embarazo, dan soporte a sus ideas. Propone poner mayor atención a los embarazos, usando el concepto winnicottiano de medio ambiente facilitador, antes del nacimiento. Incluye, además de las teorías de Winnicott sobre el desarrollo primitivo, conceptos de los psicoanalistas de la Escuela Americana de la Intersubjetividad y aquellos de los neurocientíficos
The author proposes a reflection on the auto-inmunes pathologies, taking as a starting point the idea that stress during mothers pregnancy in patients with immune disorders, may be responsible, in part, on the configuration of pathologies. Contemporary concepts of neuroscience, on the theme of stress and pregnancy, support his ideas. He proposed to pay more attention to pregnancies, using the winnicottian concept of faciliting environment, before birth. Includes Winnicott theories of primitive development, psychoanalysts of the American School of intersubjectivity and those of the neurociences concepts
Assuntos
Humanos , Masculino , Feminino , Gravidez , Doenças Autoimunes/psicologia , Doenças do Sistema Imunitário , Imunidade , Feto , Hormônios , Gravidez , Medicina Psicossomática , Estresse PsicológicoRESUMO
O lúpus eritematoso sistêmico (LES) é uma doença crônica e auto-imune que gera diversos quadros clínicos que se tornam uma ameaça à vida da pessoa. Sua etiologia aponta para a combinação de fatores genéticos, hormonais e ambientais, e sua incidência recai principalmente em mulheres. Acredita-se que os sentidos atribuídos ao processo de adoecer influenciam no tratamento do LES e na forma de lidar com as dificuldades desse processo. Objetivando aprofundar os processos de significação e geração de sentidos relacionados à experiência de LES, foram entrevistadas oito mulheres portadoras da doença. A análise das narrativas evidencia que não é só o LES que tem inúmeras maneiras de se apresentar, mas a experiência da doença é subjetiva e dinâmica, tendo diversas formas de significação conforme as condições advindas do processo de adoecer e suas implicações. Ratifica-se, assim, a necessidade de uma abordagem interdisciplinar que abarque essa complexidade, considerando a dimensão biopsicossocial envolvida no processo.(AU)
Systemic Lupus Erythematosus (SLE) is a chronic and auto-immune disease which causes different clinical syndromes that can put in risk the person's life. Its etiology indicates the combination of genetic, hormonal and environmental factors, presenting a higher incidence among women. It is believed that meanings attributed to the illness process influence its treatment, as well as the person's capacity to cope with the difficulties implicit in the illness process. Aiming a study in depth of meanings and sense making process related to the experience of SLE, eight women affected by the disease were interviewed. The analysis of their narratives shows not only the different symptoms and complex clinic evidences related to SLE, but also the diverse subjective and dynamic ways the illness is experienced. This ratifies the necessity of an interdisciplinary approach to embrace the SLE complexity.(AU)
Assuntos
Humanos , Feminino , Adulto , Lúpus Eritematoso Sistêmico/complicações , Doenças Autoimunes/psicologia , Processo Saúde-Doença , Efeitos Psicossociais da Doença , Psicologia Social , Sinais e Sintomas , DiagnósticoRESUMO
O presente artigo visa apresentar os desdobramentos de um dos eixos temáticos fundamentais do projeto de pesquisa intitulado , Patologias narcísicas e doenças auto-imunes: estudo comparativo sob a ótica da psicanálise, comparação clínica e metapsicológica entre pacientes melancólicos e portadores de Lúpus Eritematoso Sistêmico (LES), que se realiza a partir de um acordo entre o Instituto de Psicologia, o Instituto de Psiquiatria e o Hospital Universitário Clementino Fraga Filho da UFRJ. Trata-se aqui de pensar a relação que as pacientes atendidas pela pesquisa estabelecem com o próprio corpo. O desenvolvimento teórico-clínico da pesquisa apontou-nos para a especificidade com que o corpo se apresenta em ambas as configurações subjetivas. Consideramos esta uma questão fundamental, uma vez que, nesses casos, o estatuto do corpo diverge daquele que costumamos delinear pelo viés da neurose.(AU)
Assuntos
Lúpus Eritematoso Sistêmico/psicologia , Transtorno Depressivo/psicologia , Psicanálise , Doenças Autoimunes/psicologiaRESUMO
The association between obsessive-compulsive symptoms (OCS) and Sydenham chorea (SC) supports the hypothesis of a common neuroimmunological dysfunction in basal ganglia associated with group A beta-hemolytic streptococcal infection underlying both conditions. Four children with 2 distinct SC episodes were evaluated to assess the course of OCS. All patients developed OCS during their second episodes (3 met criteria for obsessive-compulsive disorder [OCD]), but not in their first episodes (2 developed OCS and met criteria for OCD). These data suggest that the recurrence of SC episodes may result in a cumulative effect, thus increasing the risk of appearance and intensification of OCS.
Assuntos
Coreia/diagnóstico , Coreia/psicologia , Transtorno Obsessivo-Compulsivo/etiologia , Doença Aguda , Doenças Autoimunes/complicações , Doenças Autoimunes/psicologia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Índice de Gravidade de Doença , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/psicologiaRESUMO
A controversial theory postulates that there is an association between left handedness and immune and speech disorders. There are reports of increased frequency of left handedness in type I diabetic patients. The aim of this study was to compare 65 type I diabetics, 65 type II diabetics and 130 normal controls using a 7 item questionnaire for handedness. No differences were found for strong left handedness. However the frequency of strong right handedness decreased significantly from controls to type II diabetics and type I diabetics. Since less intense right handedness is not the same as left handedness, it is concluded that the theory is not supported by the present findings.
Assuntos
Doenças Autoimunes/imunologia , Diabetes Mellitus/imunologia , Lateralidade Funcional/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/psicologia , Diabetes Mellitus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Some patients with autoimmune disease have an elevation of the B lymphocyte population bearing the CD5 marker. In an attempt to replicate an earlier report of elevated CD5+ B cells in schizophrenic patients, lymphocytes were phenotyped in 116 patients with schizophrenia and 166 control subjects. The CD5+ B lymphocyte population was not elevated in medicated or never-medicated patients as compared with control subjects of similar age, race, gender, or social class. CD5+ B cells were also not elevated in patients who had circulating autoantibodies. The CD5+ B lymphocyte population was significantly elevated in African-American control subjects and patients in comparison with that in Caucasian control subjects and patients. Thus, although other immune alterations characterized a subset of patients with schizophrenia, an elevation of the CD5+ B lymphocyte population was not found in this study.
Assuntos
Antígenos CD/análise , Linfócitos B/imunologia , Esquizofrenia/imunologia , Psicologia do Esquizofrênico , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Doenças Autoimunes/psicologia , Biomarcadores , Antígenos CD5 , Feminino , Humanos , Contagem de Leucócitos , Masculino , Esquizofrenia/diagnósticoRESUMO
The central nervous system (CNS) manifestations of the chronic autoimmune disease systemic lupus erythematous (SLE) are reviewed. SLE-CNS dysfunction is broadly divided into neurologic and psychiatric clinical categories. The distinct clinical entities within these broad categories are fully described. Diagnostic criteria employed to verify the presence of SLE-CNS dysfunction, including laboratory serum and cerebral spinal fluid analyses as well as radiologic and other multimodality diagnostic tools, are compared and contrasted with respect to sensitivity and specificity.
Assuntos
Doenças Autoimunes/complicações , Doenças do Sistema Nervoso Central/etiologia , Lúpus Eritematoso Sistêmico/complicações , Transtornos Mentais/etiologia , Anticorpos Antinucleares/sangue , Especificidade de Anticorpos , Atrofia , Autoanticorpos/imunologia , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/psicologia , Encéfalo/imunologia , Encéfalo/patologia , Doenças do Sistema Nervoso Central/imunologia , Infarto Cerebral/etiologia , Infarto Cerebral/patologia , Humanos , Imunoglobulinas/líquido cefalorraquidiano , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/patologia , Lúpus Eritematoso Sistêmico/psicologia , Transtornos Mentais/imunologia , Neurônios/imunologia , Sensibilidade e Especificidade , Vasculite/etiologia , Vasculite/patologiaRESUMO
This study evaluated the self-reported patterns of handedness among a large subsample (n = 1612) of the gay/bisexual men comprising the Multicenter AIDS Cohort Study (MACS). There was a small but significant elevation in left-handedness among gay/bisexual men compared to available normative data. However, there were no differences within the cohort in measures of immune function, self-reported autoimmune disorders, asthma, or hay fever, although there was an association between handedness and allergy. Performance on neuropsychological tests also did not differ as a function of handedness.
Assuntos
Síndrome da Imunodeficiência Adquirida/fisiopatologia , Doenças Autoimunes/fisiopatologia , Bissexualidade , Lateralidade Funcional/fisiologia , Homossexualidade , Hipersensibilidade/fisiopatologia , Testes Neuropsicológicos , Síndrome da Imunodeficiência Adquirida/psicologia , Adulto , Doenças Autoimunes/psicologia , Bissexualidade/psicologia , Estudos de Coortes , Suscetibilidade a Doenças/fisiopatologia , Suscetibilidade a Doenças/psicologia , Soropositividade para HIV/fisiopatologia , Soropositividade para HIV/psicologia , Homossexualidade/psicologia , Humanos , Hipersensibilidade/psicologia , Masculino , Fatores de RiscoRESUMO
O conhecimento das manifestaçöes psiquiátricas do Lúpus Eritematoso Sistêmico (LES) e de outras doenças auto-imunes é importante, tanto para o clínico como para o psiquiatra, uma vez que elas podem preceder de muitos anos as manifestaçöes sistémicas. Neste estudo é apresentada uma paciente com síndrome catatónica näo associada a distúrbios metabólicos e cuja evoluçäo näo foi de uma doença esquizofrênica. A paciente apresentava imunocomplexos liquóricos durante a crise e as provas imunológicas mostravam a presença de imunocomplexos circulantes, FAN positivo (1/800) com padräo nucleolar a imunofluorescência. O quadro clínico regrediu concomitantemente com a negativaçäo dos imunocomplexos liquóricos e com a acentuaçäo dos imunocomplexos circulantes, sem o uso de imunossupressores. A síndrome cataônica é uma manifestaçäo rara em pacientes com doença auto-imune e poucos säo os casos relatados sem manifestaçöes sistêmicas concomitantes. Este estudo clínico mostra que devemos estar atentos para as manifestaçöes psiquiátricas das doenças auto-imunes e que alguns marcadores como imunocomplexos liquóricos säo de grande valia para o seu diagnóstico e poderäo revelar que este tipo de manifestaçäo é mais freqüente do que revela a literatura
Assuntos
Adulto , Humanos , Feminino , Doenças Autoimunes/psicologia , Catatonia/psicologia , Transtornos Psicofisiológicos/psicologia , Complexo Antígeno-Anticorpo/análise , Catatonia/etiologia , Sistema Nervoso Central/fisiopatologiaRESUMO
The psychiatric manifestations of systemic lupus erythematosus and other autoimmune diseases, which may precede by many years systemic involvement, should be held in mind by both the internist and psychiatrist. This case report focuses on a female catatonic patient without metabolic disturbances, whose evolution did not suggest a schizophrenic disorder. Immune complexes were demonstrated to be present in cerebrospinal fluid (CSF) obtained during psychotic crisis and immunologic tests showed circulating immune complexes with a positive antinuclear factor. (1/800) and a nucleolar pattern with immunofluorescence. The psychiatric picture receded concomitantly with a fall in CSF immune complexes and with an increase in circulating immune complexes, without the administration of immunosuppressive drugs. The catatonic syndrome is a rare manifestation in patients with autoimmune disease and few cases have been reported without systemic manifestation. This report emphasizes the need for increased awareness of the psychiatric effects brought about by autoimmune diseases and shows that CSF immune complexes are valuable markers for their diagnosis.