Definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in amyotrophic lateral sclerosis (ALS): Consensus from ALS and Motor Neuron Disease Scientific Department of the Brazilian Academy of Neurology / Definições, fenomenologia, diagnóstico e manejo das desordens do riso e do choro em esclerose lateral amiotrófica (ELA): Consenso do Departamento Científico de ELA e Doença do Neurônio Motor da Academia Brasileira de Neurologia

Abstract The spectrum of neuropsychiatric phenomena observed in amyotrophic lateral sclerosis (ALS) is wide and not fully understood. Disorders of laughter and crying stand among the most common manifestations. The aim of this study is to report the results of an educational consensus organized by the Brazilian Academy of Neurology to evaluate the definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in ALS patients. Twelve members of the Brazilian Academy of Neurology - considered to be experts in the field - were recruited to answer 12 questions about the subject. After exchanging revisions, a first draft was prepared. A face-to-face meeting was held in Fortaleza, Brazil on 9.23.22 to discuss it. The revised version was subsequently emailed to all members of the ALS Scientific Department from the Brazilian Academy of Neurology and the final revised version submitted for publication. The prevalence of pseudobulbar affect/pathological laughter and crying (PBA/PLC) in ALS patients from 15 combined studies and 3906 patients was 27.4% (N = 1070), ranging from 11.4% to 71%. Bulbar onset is a risk factor but there are limited studies evaluating the differences in prevalence among the different motor neuron diseases subtypes, including patients with and without frontotemporal dementia. Antidepressants and a combination of dextromethorphan and quinidine (not available in Brazil) are possible therapeutic options. This group of panelists acknowledge the multiple gaps in the current literature and reinforces the need for further studies.

Resumo O espectro de fenômenos neuropsiquiátricos observados na ELA é amplo e não completamente entendido. Desordens do riso e do choro estão entre as manifestações mais comuns. O objetivo deste estudo é relatar os resultados de um Consenso organizado pela Academia Brasileira de Neurologia para avaliar definições, fenomenologia, diagnóstico, e manejo dos distúrbios do riso e do choro em pacientes com ELA. Doze membros da Academia Brasileira de Neurologia - considerados experts na área - foram recrutados para responder 12 questões na temática. Depois da verificação das revisões, um primeiro manuscrito foi preparado. Após, foi realizado um encontro presencial em Fortaleza, Brasil, em 23/09/2022, para discussão do conteúdo. A versão revisada foi posteriormente enviada por e-mail para todos os membros do Departamento Científico de DNM/ELA da Academia Brasileira de Neurologia e a versão final revisada foi submetida para publicação. A prevalência da síndrome pseudobulbar em pacientes com ELA em 15 estudos combinados com 3906 pacientes foi de 27,4% (n = 1070), variando entre 11,4% e 71%. Início bulbar é um fator de risco, mas há limitados estudos avaliando as diferenças em prevalência entre os diferentes subtipos de Doença do Neurônio Motor, incluindo pacientes com e sem Demência Frontotemporal. Antidepressivos e uma combinação de dextrometorfana e quinidina (indisponíveis no Brasil) são opções terapêuticas possíveis. Esse grupo de panelistas reconhece as múltiplas demandas não atendidas na literatura atual e reforça a necessidade de futuros estudos.

Las prácticas de integración cuerpo-mente como promotoras de estados emocionales saludables / Mind­Body Integration Practices as Promoters of Healthy Emotional States / Práticas de integração corpo-mente como promotoras de estados emocionais saudáveis

Recientes investigaciones provenientes de diversos campos emergentes como la psiconeu-roinmunología, la medicina integrativa o la pigenética han dado cuenta de la estrecha vinculación entre los estados emocionales y la salud. El objetivo fue evaluar la eficacia de una intervención basada en la realización de prácticas de integración cuerpo-mente sobre la regulación emocional. Materiales y métodos: en 102 participantes, de entre 34 y 65 años de edad, se analizaron cambios en la Escala de Afectividad Positiva y Negativa (panas), antes y después de participar en la intervención propuesta, que se realizó durante ocho encuentros de seis horas de duración cada uno, a lo largo de cuatro meses. Resultados: se encontró un aumento en la afectividad positiva y una disminución en la afectividad negativa luego de la intervención. El índice de afectividad (i. e. afectividad positiva/afectividad negativa) se incrementó de una relación 2:1 a una relación 3:1. Esta última proporción ha sido asociada con estados saludables. Conclusiones: el estudio contribuye a demostrar el beneficio que brindan las prácticas de integración cuerpo-mente en la regulación emocional y la afectividad positiva. Esto podría propiciar un mayor bienestar psicofísico individual y colectivo.

Recent research from various emerging fields, such as psychoneuroimmunology, integra-tive medicine, and epigenetics, showed a close link between emotional states and health. This study was designed to evaluate the effectiveness of an intervention based on mind­body integration practices in emotional regulation. Materials and Methods: We evaluated changes in the positive and negative affectivity scale in 102 participants before and after the intervention, which was performed during eight meetings lasting 6 h each, for 4 months. Results: An increase in positive affectivity and a decrease in negative affectivity were found after the intervention. The affectivity index (i.e., positive affectivity/negative affectivity) increased from a 2:1 ratio to a 3:1 ratio. This latter ratio has been associated with healthy states. Conclusions: This study demonstrated that mind­body integration practices can confer to emotional regulation and positive affectivity. These beneficial effects could improve psychophysical well-being at both the individual and collective levels.

pesquisas recentes provenientes de vários campos emergentes, como a psiconeuroimuno-logia, medicina integrativa e epigenética, mostram a estreita ligação entre os estados emocionais e a saúde. O objetivo do presente trabalho é avaliar a eficácia de uma intervenção baseada na realização de práticas de integração corpo-mente, na regulação emocional. Materiais e métodos: em 102 participantes, entre 34 e 65 anos, foram analisadas as mudanças na escala de afetividade positiva e negativa (panas) antes e após a participação na intervenção proposta, que foi realizada durante 8 encontros de 6 horas de duração cada, durante 4 meses. Resultados: houve um aumento da afetividade positiva e diminuição da afetividade negativa após a intervenção. O índice de afetividade (ou seja, afetividade positiva/afetivi-dade negativa) aumentou, passando de uma relação de 2:1 para uma relação de 3:1, esta última propor-ção tem sido associada a estados saudáveis. Conclusões: o presente estudo contribui para demonstrar o benefício proporcionado pelas práticas de integração corpo-mente na regulação emocional e na afetivi-dade positiva. Isso poderia propiciar um maior bem-estar psicofísico a nível individual e coletivo.

Mindfulness-based interventions for non-affective psychosis: a comprehensive systematic review and meta-analysis.

AIM: Although mindfulness-based interventions (MBIs) are routinely used in clinical practice, a comprehensive synthesis of the effectiveness of MBIs for non-affective psychosis has yet to be conducted. The aim of the present review and meta-analysis was to investigate the effectiveness of MBIs including those with mindfulness as an active treatment component for alleviating symptoms of psychosis to inform future clinical practice. METHODS: A systematic review of studies published in journals or in dissertations in CINAHL, PubMed, EMBASE, PsycINFO, CENTRAL, ISRCTN, or CNKI from January 1990 until December 2020. A total of 31 eligible studies (n = 2146) were included. RESULTS: Effect-size estimates suggested that 22 independent samples (n = 1632) produced a statistically significant small effect for psychotic symptoms (g = -0.48), and with a clinically significant reduction of 50% from baseline (pooled OR: 1.84). Separate meta-analyses demonstrated small effects for affective symptoms (g = -0.44) and small-to-large positive effects for quality of life (g = 0.38), mindfulness skills (g = 0.45), and insight into illness/treatment (g = 1.35). The heterogeneity was high across the studies. CONCLUSION: Results suggest that short-term MBIs can be beneficial for non-affective psychosis. Future research is needed to test the efficacy and safety of dedicated MBIs for this population group over a longer term. KEY MESSAGESSchizophrenia spectrum and other psychotic disorders, also known as non-affective psychosis, is the most chronic and debilitating type of psychosis, seriously affecting every aspect of a person's life, including social, occupational, or general functioning.The aim of the current systematic review and meta-analysis was to investigate formerly unexamined questions regarding the clinical significance of MBIs including yoga as an increasingly utilized, conceptualized psychological intervention on overall psychotic symptoms for people with non-affective psychosis.No serious adverse events were reported in the studies, suggesting that MBIs may be safe interventions, while there is robust evidence to support the view that MBIs are beneficial to young people in particular.

[Investigation on mindfulness level of patients with oral and maxillofacial malignant tumor after operation and analysis of its influencing factors].

OBJECTIVE: To investigate the status quo of postoperative mindfulness level in patients with oral and maxillofacial malignant tumors, to analyze its influencing factors, and to provide targeted support for the patients, in order to provide evidence for clinical support. METHODS: A total of 452 patients with oral and maxillofacial malignant tumor who were admitted to the Peking University School of Stomatology from January 2021 to June 2021 were followed up by convenience sampling method, the general information questionnaire, the Five Facet Mindfulness Questionnaire, the 10-item perceived stress scale, and the self-esteem scale were used. The t test and analysis of variance were used to compare the scores of mindfulness of the patients with different demographic characteristics after oral and maxillofacial malignant tumors, and the differences of mindfulness levels between the patients with oral and maxillofacial malignant tumors and the normal population were compared by the Z test, Spearman correlation analysis was used to analyze the correlation between the scores of mindfulness and perceived stress and self-esteem. Multiple linear regression was used to analyze the influencing factors of mindfulness levels. RESULTS: A total of 439 valid questionnaires were collected. The average score of postoperative mindfulness of the patients with oral and maxillofacial malignant tumor was 120.28±13.86. The scores of each dimension from high to low were as follows: act with awareness, non-judging, describing, observing, and non-reacting. Compared with the normal population, the patients with oral and maxillofacial malignant tumor showed significant differences in the total scores and scores of various dimensions after surgery. The t test and ANOVA showed that different duration of disease, age, residence, education, marital status, per capita monthly income, occupation, and medical payment methods had influences on postoperative mindfulness level of the patients with oral and maxillofacial malignant tumor (P < 0.10). Spearman correlation analysis showed that the level of mindfulness was negatively correlated with the level of perceived stress, and positively correlated with the level of self-esteem. The duration of illness, marital status, stress perception and self-esteem were included in the regression equation, suggesting that postoperative mindfulness levels of the patients with oral and maxillofacial malignant tumor had an important effect. CONCLUSION: Patients with oral and maxillofacial malignant tumors have low postoperative mindfulness, which is related to duration of disease, marital status, and the level of perceived stress. Medical staff should identify this group as soon as possible, provide effective psychological intervention, help to improve the level of mindfulness, and strive to improve the patients'mental health.

Effect of Aerobic Exercise on the Levels of Pain, Quality of Life, and Alexithymia in Alexithymic Individuals With Chronic Pain: A Single-Blinded Randomized Controlled Trial.

OBJECTIVE: This study aimed to investigate the effects of aerobic exercise on pain, degree of alexithymia, and quality of life in individuals with alexithymia and chronic pain. METHODS: A total of 40 participants who scored 61 or higher on the Toronto Alexithymia Scale-20 (TAS-20) were included in the study. The sample was subdivided into 2 groups using a computerized randomization program: an aerobic exercise group (n = 20) and a control group (n = 20). Participants in the aerobic exercise group underwent a 30-minute jogging protocol at 60% to 90% of maximum heart rate 3 days per week for 8 weeks under the supervision of a physiotherapist. Participants in the control group continued their daily physical activities. Outcome measures were the TAS-20, visual analog scale, Graded Chronic Pain Scale, and 36-Item Short Form Health Survey. RESULTS: There was no statistically significant difference between the demographics of the 2 groups (P > .05). There was a statistically significant improvement in TAS-20, Graded Chronic Pain Scale, visual analog scale, and 36-Item Short Form Health Survey scores of the participants in the aerobic exercise group compared to the control group (P ˂ .05). CONCLUSION: Aerobic exercise had a positive effect on pain, quality of life, and degree of alexithymia in individuals with alexithymia and chronic pain.

The effects of bright light treatment on affective symptoms in people with dementia: a 24-week cluster randomized controlled trial.

BACKGROUND: The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results. METHODS: Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates. RESULTS: Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24. CONCLUSION: Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.

Closed-loop neurostimulation for affective symptoms and disorders: An overview.

Affective and anxiety disorders are the most prevalent and incident psychiatric disorders worldwide. Therapeutic approaches to these disorders using non-invasive brain stimulation (NIBS) and analogous techniques have been extensively investigated. In this paper, we discuss the combination of NIBS and neurofeedback in closed-loop setups and its application for affective symptoms and disorders. For this, we first provide a rationale for this combination by presenting some of the main original findings of NIBS, with a primary focus on transcranial magnetic stimulation (TMS), and neurofeedback, including protocols based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Then, we provide a scope review of studies combining real-time neurofeedback with NIBS protocols in the so-called closed-loop brain state-dependent neuromodulation (BSDS). Finally, we discuss the concomitant use of TMS and real-time functional near-infrared spectroscopy (fNIRS) as a possible solution to the current limitations of BSDS-based protocols for affective and anxiety disorders.

Análise das qualidades psicométricas da versão portuguesa do Inventário de Avaliação da Espontaneidade (SAI-R) / Analysis of the psychometric qualities of the portuguese version of the Spontaneity Assessment Inventory (SAI-R) / Análisis de las cualidades psicométricas de la versión portuguesa del Inventario de Evaluación de la Espontaneidad (SAI-R)

A espontaneidade e as suas ligações à saúde mental e ao bem-estar são uma componente central quer na teoria quer na prática do psicodrama, e a literatura especializada associa a presença de patologia à falta de espontaneidade. Neste artigo, elencam-se alguns dos resultados obtidos em estudos em língua inglesa do SAI-R e apresentam-se os estudos da sua validação para a população portuguesa. Na validação do SAI-R para o contexto português, foi confirmada a estrutura fatorial com 719 sujeitos, distribuídos em duas amostras independentes. Os participantes tinham idades entre os 18 e os 69 anos. Por fim, foram testadas a fiabilidade compósita e a validade convergente, bem como a validade do tipo critério em duas amostras independentes (n 1ªamostra =348 e n 2ªamostra =371). Apesar de serem necessários mais estudos com populações clínicas, o SAI-R apresenta-se como um instrumento curto e válido para aplicar em contextos clínicos e não clínicos quando se pretende avaliar a espontaneidade (AU).

Spontaneity and its connections to mental health and wellbeing are a central theme in both the theory and practice of psychodrama, and the specialized literature sometimes even associates the presence of pathology with a lack of spontaneity. In this article, we list some of the results obtained in studies with the English-language version of the spontaneity scale and present its validation studies for the Portuguese population. We verified a factorial structure with 719 subjects, divided into two independent samples in the validation of the SAI-R for the Portuguese context. Participants had an age range of 18 to 69 years old. Furthermore, composite reliability, convergent validity, and cross validity were tested in two other independent samples (n sample1 =348 and n sample2 =371). Although further studies with clinical samples are needed, the SAI-R presents itself as a short and valid instrument to apply in clinical and non-clinical settings when assessing spontaneity (AU).

La espontaneidad y sus vínculos con la salud mental y el bienestar son una componente central tanto en la teoría como en la práctica del psicodrama, y la literatura especializada asocia la presencia de patología con la falta de espontaneidad. En este artículo se enumeran resultados obtenidos con la versión inglesa del SAI-R y se presentan estudios para su aplicación en la población portuguesa. En la validación del SAI-R para el contexto portugués, se confirmó la estructura factorial con 719 sujetos, distribuidos en dos muestras independientes. Los participantes tenían entre 18 y 69 años. Finalmente, se probaron la confiabilidad compuesta y la validez convergente, así como la validez cruzada en las dos muestras independientes (n muestra 1 = 348 y n muestra2 = 371). Aunque son necesarios más estudios con poblaciones clínicas, el SAI-R se presenta como un instrumento breve y válido para ser aplicado en contextos clínicos y no clínicos en la evaluación de la espontaneidad (AU).

Are pharmacological interventions clinically useful to treat emotionalism after stroke? A Cochrane Review update summary with commentary.

BACKGROUND: Emotionalism, i.e. uncontrolled episodes of crying (or less commonly laughing) post stroke that are not triggered by situations that would have previously provoked such behavior occur in stroke survivors, may persist in some, and can be socially embarrassing. OBJECTIVE: To evaluate whether pharmacological interventions are beneficial, acceptable, and safe in the treatment of emotionalism post stroke. METHODS: A Cochrane review by Allida et al. was summarized with comments. RESULTS: From a total of 7 eligible trials with a total of 239 participants included in the review, five with 213 participants could be used for data extraction. Very low to moderate quality evidence pointed to some beneficial effects of antidepressants in the treatment of emotionalism after stroke. CONCLUSIONS: The available data suggest that antidepressants may reduce the frequency and severity of crying or laughing episodes in stroke survivors with emotionalism.

The association of fatigue with dispositional mindfulness: relationships by levels of depressive symptoms, sleep quality, childhood adversity, and chronic medical conditions.

Although mindfulness-based interventions may be effective in addressing the common symptom of fatigue, no population-based studies have examined the relationship between mindfulness and fatigue. We determined whether higher levels of dispositional mindfulness were associated with lower levels of fatigue. Cross-sectional data were obtained through the Pennsylvania Head Start Staff Wellness Survey, a 2012 web-based survey in which 2199 of 3375 (65%) eligible staff participated. The analytic sample was restricted to the 2083 female respondents with complete data on dispositional mindfulness (Cognitive and Affective Mindfulness Scale-Revised) and fatigue (Fatigue Severity Scale). We determined the mean covariate-adjusted fatigue scores in each quartile of dispositional mindfulness. This relationship was examined in the overall sample and within subgroups defined by levels of four variables: depressive symptoms, poor sleep quality, childhood adversity, and chronic medical conditions. The sample was 86% non-Hispanic White, and 61% had a bachelor's or more advanced degree. The mean (SD) Fatigue Severity Scale score was 3.3 (1.3). The adjusted mean fatigue score decreased significantly and in a graded manner across higher quartiles of mindfulness, with the adjusted fatigue score 1.4 points lower (95% confidence interval: -1.5, -1.2) among those in the highest quartile of dispositional mindfulness compared to the lowest. This significant graded relationship was present within each subgroup examined, and there was not a statistically significant interaction between dispositional mindfulness and any subgroup variable. Future trials of mindfulness-based interventions should consider assessing the outcome of fatigue in both clinical and non-clinical populations.

Youth-focused group mindfulness-based intervention in individuals with early psychosis: A randomized pilot feasibility study.

AIM: To assess the feasibility of a randomized pilot trial that evaluated the acceptability and potential clinical utility of the Mindfulness Ambassador Program (MAP), a unique, standardized 12-session facilitated group mindfulness-based intervention (MBI) for youth experiencing early psychosis. METHODS: Twenty-one patients of an early psychosis intervention program were randomized to receive MAP (n = 11) or treatment as usual (n = 10). Acceptability was measured by group attendance rate and client satisfaction; feasibility of the study design was measured by the recruitment and retention rate. The means, standard deviations, and 95% confidence intervals were described for outcomes of interest. RESULTS: MAP is associated with a high degree of acceptability and has beneficial effects for depression and fatigue. The randomized trial design is feasible. CONCLUSIONS: This study provides important pilot data supporting a larger randomized trial of effectiveness for MAP as a group MBI for early psychosis. Details of MAP and study limitations are discussed.

La psicología y la oncología: en una unidad imprescindible

El cáncer está considerado como un grave problema de salud en el mundo, no solo por constituir una de las principales causas de muerte en quienes lo padecen, sino también por las limitaciones físicas y psicológicas que provoca. La creciente incidencia de este padecimiento en la población mundial, la peculiar problemática emocional que acarrea el diagnóstico y los tratamientos que se deben seguir con los pacientes han permitido que la psicooncología surja y se desarrolle como una especialidad relativamente nueva, para resguardar las necesidades psicológicas asociadas a este proceso mórbido. Estos objetivos generan nuevas expectativas en el trabajo psicológico que requiere una mirada más abarcadora e integral, y a su vez específica, interdisciplinar y multifactorial. El objetivo de este artículo es exponer entre los aspectos fundamentales de la psicooncología, sus antecedentes, la relación entre el cáncer, el estrés y la personalidad y las intervenciones psicológicas básicas en esta especialidad.

Cancer is considered a serious health problem worldwide, not only because it constitutes one of the main causes of death of who suffer from it but also due to the physical and psychological limitations it provokes. The increasing incidence of this disease in the world population, the peculiar emotional problems involved in the diagnosis and treatment to be followed with patients have allowed onco-psychology to emerge an develop as a new specialty to safeguard the psychological needs associated to this morbid process. These objectives generate new expectations in the psychological work which demands of a more holistic and comprehensive look and at the same time specific, interdisciplinary and multi-factorial. The objective of this article is to resent among other main aspects of onco-psychology, its antecedents, its relation with cancer, stress and personality and basic psychological interventions in this specialty.

Health and mood among HIV-positive outpatients attending an ART Clinic of a University Hospital.

AIMS AND OBJECTIVES: To evaluate how individuals at different stages of infection with HIV perceive their health status and its association with mood states. BACKGROUND: With the introduction of Highly Active Antiretroviral Therapy in 1996, the quality of life of people living with HIV has improved. However, the literature emphasises the negative effects of the disease on the mental health of individuals suffering from this condition and the high incidence of depression among infected individuals. Although people diagnosed and living with HIV are overwhelmed by emotions, we found that various emotional manifestations are understudied within this group of patients. DESIGN: A cross-sectional study was conducted in an outpatient unit of a University Hospital (antiretroviral therapy clinic), with a consecutive sample composed of 152 patients. METHODS: Data were collected through a questionnaire used to assess the sociodemographic and clinical characteristics, the Short Form (36) Health Survey, and the Profile of Mood States scale. RESULTS AND CONCLUSIONS: The health status negatively affects the role at the emotional and mental health dimensions. The participants showing a worse health condition than in the previous year had higher levels of tension/anxiety, depression/dejection, fatigue/inertia and confusion/bewilderment. The stage of disease and the profile of mood state emerged as independent phenomena. RELEVANCE TO CLINICAL PRACTICE: The results of this study indicate that nurses worldwide should be aware of the emotional aspects (negative emotions strongly impact health) related to the subjective perception of a worsening health status, regardless of the stage of the disease.

Screening for depression and anxiety in patients with storage or voiding dysfunction: A retrospective cohort study predicting outcome of sacral neuromodulation.

AIMS: It has been reported that somatic treatment in patients with affective symptoms has a higher risk of failure. The aim was to investigate whether affective symptoms could predict the outcome of sacral neuromodulation (SNM) for lower urinary tract symptoms (LUTS). METHODS: All patients that underwent a SNM evaluation between 2006 and 2013 and filled out a Hospital Anxiety and Depression Score (HADS) before treatment, were included. Chi-square analysis and bivariate logistic regression were used to assess associations and predictive value. RESULTS: Eighty-six patients were included, 65 females and 21 males. Most patients, 66, had overactive bladder syndrome (OAB). The remaining 20 patients suffered from non-obstructive urinary retention (NOR). Thirty-nine OAB patients and 17 NOR patients, had a normal total HADS score before treatment. Significantly more patients showed abnormal HADS-D (P = 0.047) and HADS-A (P = 0.015) scores in the OAB group compared to the NOR group. Success of SNM could not be predicted by the HADS score P = 0.464 (after 1 year P = 0.446). Subsequent analysis revealed that an abnormal HADS score was not related to the occurrence of SNM adverse events. CONCLUSIONS: The present study did not reveal a significant relationship between an abnormal HADS score and failure of the SNM test period in a mixed group of OAB and NOR patients. However, differences between OAB and NOR patients concerning affective symptoms were present. It is known that psychological factors play a role in the severity of LUTS, but they may not predict SNM outcome. Neurourol. Urodynam. 35:1011-1016, 2016. © 2015 Wiley Periodicals, Inc.

Efeitos da acupuntura sobre os pacientes com asma leve e moderada persistentes: um estudo randomizado, controlado e cruzado / Effects of acupuncture on patients with mild to moderate persistent asthma: a randomized, controlled, crossover

Introdução: Este estudo foi realizado com o intuito de avaliar efeitos da acupuntura sobre os pacientes com asma leve e moderada persistentes com o uso de beta-2 agonista ou corticoide inalatório. Métodos e casuística: Trata-se de um estudo prospectivo, duplo-cego, randomizado e cruzado com dois braços. Os 74 pacientes com diagnóstico de asma leve/moderada, de acordo com a classificação de GINA 2002/2003, foram divididos em dois grupos, sendo 31 do Grupo I, e 43 do Grupo II inicialmente. Foram realizadas consultas médicas e exames que incluíram espirometria, citologia de escarro induzido, NO expirado, preenchimento de escala de sintoma, questionários de qualidade de vida de asma e de SF 36, e realização de peak-flow, dependendo da Fase do protocolo. A Fase I constituiu-se dos exames pré-intervenção. Na Fase II, foram realizadas 10 sessões de Acupuntura Real no Grupo I e 10 sessões de Acupuntura Sham no Grupo II, na Fase III, houve 4 semana de washout, na Fase IV, houve a troca de técnicas de acupuntura, sendo uma sessão por semana e, na Fase V, realização dos exames. Resultados: Não há diferença nos critérios de avaliação no pré-tratamento entre dois grupos, com exceção de maior celularidade inflamatória no Grupo II. No entanto, houve uma redução significativa de eosinófilos (p = 0,035) e neutrófilos (p = 0,047), e aumento de macrófagos (p = 0,001), melhora da medida de volume do peak-flow (p = 0,01) na fase IV do Grupo II. No Grupo I, na avaliação de escala de sintomas diária, havia menor uso de medicação de resgate (p = 0,043) na Fase II, e, depois de receber a Acupuntura Sham na Fase IV, havia menos tosse (p = 0,007), menos chiado (p = 0,037), menos dispneia (p < 0,001) e menor uso de medicação de resgate (p < 0,001). No Grupo II, após receber o tratamento com a Acupuntura Sham na Fase II, houve diminuição de tosse (p = 0,037), de chiado (p = 0,013) e de dispneia (p = 0,014), e, na...

Introduction: This survey has been conducted in order to evaluate the effects of acupuncture in patients with persistent mild and moderate asthma (according to GINA criteria 2003), using beta agonist and/or inhaled glucocorticoid. Methods and patients: This is a prospective, double blinded, randomized and cross-over study with two branches: 74 patients diagnosed with mild and moderate asthma were divided into two groups: Group I with 31, initiating with real acupuncture and Group II, starting with sham acupuncture. Medical interview and laboratory tests including spirometry, induced sputum citology, exhaled NO measurement, quality of life questionnaire (SF-36 and QQL), besides, daily symptom scores and measurement of peak-flow were performed, in the beginning of the study, and in the end of each phase of treatment. Phase I: laboratory tests and other qualitative measurements. There were 10 real acupuncture weekly sessions to Group I and 10 sham acupuncture sessions to Group II in Phase II. On the other hand, in the Phase IV, there was an exchange between Group I and Group II, which was receiving real acupuncture started to receive sham, and vice-versa, the number of sessions remained the same (10 weekly sessions). Phase III, during the interval between Phase II and Phase IV, there was an interval of 4 weeks of washout. Phase V: laboratory tests and other qualitative measurements. Results: There was no difference beween both the groups in all criteria of evaluation pré treatment, with only na exception: in the Group II there was large inflammatory cell counts. However, there was a significant reduction in eosinophils (p = 0.035) and neutrophils (p = 0.047), and increase of macrophages (p = 0.001), improved peak-flow measurement in the morning (p = 0.01) in Group II (started with sham) in Phase IV. In Daily Symptons Score, there was a significant reduction in use of rescue medication (p = 0.043) in Group I (real acupuncture) in Phase II and after received...

Modelos conceptuales en medicina psicosomática / Sychosomatic Medicine: Models for Understanding it

En este trabajo se presentan algunos modelos conceptuales que permiten un acercamiento al campo de la medicina psicosomática. El modelo psicoanalítico ha tenido una influencia histórica, y ha evolucionado a través de conceptos derivados como la alexitimia. La idea básica sigue siendo la dificultad de mentalizar o procesar las emociones, con una descarga somática posterior. Los modelos cognitivos han hecho interesantes aportes recientes, y permiten una exploración conjunta con imágenes funcionales de cerebro. También se discuten los términos de alostasis, el modelo del estrés, la psiconeuroinmunología y la importancia de eventos tempranos en la respuesta posterior del organismo ante situaciones adversas. Finalmente, se destaca el impacto de los aspectos sociales en el estado de salud del individuo.

This paper shows some of the conceptual models underlying an understanding of psychosomatic medicine. Psychoanalysis had an important historic influence and has evolved in concepts such as alexithymia. The basic idea consists in the difficulty mentally processing emotional contents, leading to a somatic discharge. Cognitive models have offer interesting ideas recently, allowing a joint exploration with brain functional images. Other concepts including allostasis, stress, psychoneuroinmunology and the importance of early events en the later response of the organism facing adverse situations are also discussed. Finally, the importance of social aspects in the individual’s health status is also underlined.