Prenatal alcohol use as a risk for attention-deficit/hyperactivity disorder.

The objective of the study was to investigate the association between alcohol use during pregnancy and mental disorders in childhood, controlling for confounding risk factors by a longitudinal study of pregnant women and their offspring. The initial cohort comprised pregnant women attending an obstetric service. From the initial sample of 449 pregnant women, 81 mother-child pairs agreed to participate. After 12 years, mother-child pairs were assessed through self-administered questionnaires and semi-structured interviews. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was used to assess the presence of any mental disorders in the children. The mothers were assessed by the Self-Reporting Questionnaire (SRQ) and the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, data on the mother's alcohol use collected during pregnancy were analysed. A logistic regression tested the influence of alcohol consumption in all trimesters and binge drinking on the occurrence of attention-deficit/hyperactivity disorder (ADHD), controlling for covariates. Binge drinking at any time during pregnancy or low-moderate alcohol consumption in all trimesters of pregnancy was associated with a fivefold increased odds of child ADHD. The combination of both patterns of alcohol use added an increase of 19% in the variance of ADHD's occurrence. The episodic use of at least four drinks or the regular use of low-moderate alcohol doses during pregnancy was associated with significantly increased odds of subsequent child ADHD. Reducing binge drinking and regular alcohol use of pregnant women may lead to a significant decrease in their children developing ADHD.

Comparison of quality of life between medical students and young general populations.

BACKGROUND: During the course of their education, medical students learn to attend to the quality of life of their patients. However, their own quality of life can begin to decrease early in medical school. The purpose of this study was to compare the quality of life of medical students to that of others their age, taking into account the medical school phase and gender. METHODS: We used the short version of the World Health Organization Quality of Life Instrument to assess psychological well-being, physical health, social relationships and environmental conditions. The quality of life among 206 medical students was compared to that of 199 young people from a normative population using independent sample t- tests. In addition, the effects of medical school phase and gender on quality of life domains were also assessed by two-way between-groups analysis of variance. RESULTS: Medical students showed worse psychological well-being and social relationships than young people in the normative sample. About one-half of the students revealed a low quality of life in the psychological and social domains and one-quarter showed a low quality of life in the physical health and environment domains. Medical school phase did not influence quality of life, however, gender had a large effect, where female students showed worse physical and psychological well-being than male students. DISCUSSION: Poor psychological well-being and social relationships can have implications that exceed the doctor's personal well-being. Future doctors with a low quality of life may translate into their poorer performance, impairing patient care.

The relation between burnout and sleep disorders in medical students.

OBJECTIVE: The aim of this study is to assess the mutual relationships between burnout and sleep disorders in students in the preclinical phase of medical school. METHODS: This study collected data on 127 medical students who filled in the Maslach Burnout Inventory-Student Survey, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Inventory, and Beck Anxiety Inventory. Hierarchical logistic regressions tested the reciprocal influence between sleep disorders and burnout, controlling for depression and anxiety. RESULTS: Regular occurrence of emotional exhaustion, poor sleep quality, and excessive daytime sleepiness affected 60, 65, and 63% of medical students, respectively. Emotional exhaustion and daytime sleepiness influenced each other. Daytime sleep dysfunctions affected unidirectionally the occurrence of cynicism and academic efficacy. The odds of emotional exhaustion (odds ratio (OR)=1.21, 95% confidence interval (CI)=1.08 to 1.35) and cynicism (OR=2.47, 95% CI=1.25 to 4.90) increased when daytime sleepiness increased. Reciprocally, the odds of excessive daytime sleepiness (OR=2.13, 95% CI=1.22 to 3.73) increased when emotional exhaustion worsened. Finally, the odds of academic efficacy decreased (OR=0.86, 95% CI=0.75 to 0.98) when daytime sleepiness increased. CONCLUSIONS: Burnout and sleep disorders have relevant bidirectional effects in medical students in the early phase of medical school. Emotional exhaustion and daytime sleepiness showed an important mutual influence. Daytime sleepiness linked unidirectionally with cynicism and academic efficacy.

Burnout and career choice motivation in medical students.

BACKGROUND: Burnout is a stress-induced syndrome, which affects medical students. Some environmental and personal factors can favor burnout onset and its serious consequences as dropping out, sleep disorders, depression, and suicide. The motivation for choosing medicine is a personal aspect that can modulate the distress with academic demands. METHODS: We applied self-administered questionnaires in 277 medical students to investigate the predictive role of career choice motivations on burnout dimensions. Specifically, we studied the influence of the main reasons for choosing medicine on emotional exhaustion, cynicism, and academic efficacy. RESULTS: Intellectual curiosity, professional autonomy, altruism, and interest in human relationships were the most common reasons for choosing medicine. However, the medical students motivated by personal illness or family member's illness or death revealed a significant greater emotional exhaustion when compared with the students with other motivations. CONCLUSION: The students who apply for medical school motivated by illness/death experiences are at a great risk for burnout. We suggest that students who are at risk for emotional exhaustion can be identified at the admission of medical school. Primary prevention strategies for burnout should consider this risk group.

Prevalence and burden of bipolar disorders in European countries.

A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5-1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5-2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization.

Predictors of attrition from day treatment of adolescents with substance-related disorders.

The study assessed the predictor variables of attrition from a day treatment for adolescents with substance-related disorders. The adolescents who were living in housing services and had more delinquent behaviors presented more difficulties to adhere, to attend regularly, and to maintain a link with the day program. The presence of cocaine among the substance-related disorders predicted an irregular attendance. Conversely, the adolescents with more self-reported symptoms of anxious and depression revealed a better initial adherence, a more regular attendance, and a longer length of the treatment.

Influence of burnout and sleep difficulties on the quality of life among medical students.

This study assessed the influence of burnout dimensions and sleep difficulties on the quality of life among preclinical-phase medical school students. Data were collected from 193 students through their completion of the World Health Organization Quality of Life Instrument, the Maslach Burnout Inventory-Student Survey, the Mini-Sleep Questionnaire, the Social Readjustment Rating Scale, and the Beck Depression Inventory. This survey performed hierarchical multiple regressions to quantify the effects of emotional exhaustion, cynicism, academic efficacy, and sleep difficulties on the physical, psychological, social, and environmental components of an individual's quality of life. The influence of confounding variables, such as gender, stress load, and depressive symptoms, were controlled in the statistical analyses. Physical health decreased when emotional exhaustion and sleep difficulties increased. Psychological well-being also decreased when cynicism and sleep difficulties increased. Burnout and sleep difficulties together explained 22 and 21 % of the variance in the physical and psychological well-being, respectively. On the other hand, physical health, psychological well-being, and social relationships increased when the sense of academic efficacy increased. Physical and psychological well-being are negatively associated with emotional exhaustion, cynicism, and sleep difficulties in students in the early phase of medical school. To improve the quality of life of these students, a significant effort should be directed towards burnout and sleep difficulties.

Effects of electroacupuncture on stress-related symptoms in medical students: a randomised controlled pilot study.

OBJECTIVE: To assess the effects of electroacupuncture on stress-related symptoms-sleep disorders, anxiety, depression and burnout-in medical students, and provide data to inform a power analysis to determinate numbers for future trials. METHODS: Twenty-five students were randomly assigned to an electroacupuncture (n=12) group or control group (n=13) that did not receive treatment. Electroacupuncture was applied at a continuous frequency 2 Hz for 20 min once a week for 8 weeks at sites on the extremities, face, ear and scalp. The outcomes of the students treated with electroacupuncture were compared with those of the control group at the endpoint, controlling the influence of baseline scores. The instruments used were self-administered questionnaires that comprised the validated Portuguese version of the mini-sleep questionnaire (MSQ), the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the Beck depression inventory (BDI), the Beck anxiety inventory, the Maslach burnout inventory-student survey (MBI-SS), and World Health Organization quality of life assessment - abbreviated version (WHOQOL-bref). RESULTS: The medical students treated with electroacupuncture showed a significant decrease compared with the control group for MSQ scores (p=0.04) and PSQI (p=0.006). After treatment, 75% students in the electroacupuncture group presented a good sleep quality, compared with 23.1% of the students in the control group. No significant difference on daytime sleepiness was shown by the ESS. The electroacupuncture group showed significant improvement on depressive symptoms (BDI), the emotional exhaustion and cynicism dimensions of burnout (MBI-SS) and physical health (WHOQOL-bref). CONCLUSIONS: Electroacupuncture was associated with a significant reduction of stress-related symptoms, but because of the study design the authors cannot say what proportion of the reduction was due to needle stimulation.

Efficacy of ECT in depression: a meta-analytic review.

This study analyzed the efficacy of electroconvulsive therapy (ECT) in depression by means a meta-analytic review of randomized controlled trials that compared ECT with simulated ECT or placebo or antidepressant drugs and by a complementary meta-analytic review of nonrandomized controlled trials that compared ECT with antidepressants drugs. The review revealed a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs. The nonrandomized controlled trials also revealed a significant statistical difference in favor of ECT when confronted with antidepressants drugs. Data analyzed suggest that ECT is a valid therapeutic tool for treatment of depression, including severe and resistant forms.

As alucinaçöes na infância e adolescência: uma revisä dos últimos 15 anos / Hallucinations in childhood and adolescence: a review of the past fifteen years

As alucinaçöes em crianças e adolescentes ocorrem em uma grande variedade de transtornos mentais, mas um importante problema é como fazer a distinçäo entre alucinaçöes verdadeiras e fenômenos associados com a imaturidade. Esta revisäo resume a literatura representativa, publicada nos últimos 15 anos sobre o tema