[Electroconvulsive therapy in major depression: current aspects]. / Eletroconvulsoterapia na depressão maior: aspectos atuais.

OBJECTIVE: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerable studies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of electroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice. METHOD: We reviewed in the literature studies on efficacy, symptom remission, predictive response factors as well as current aspects regarding quality of life, the patients' perception, mechanism of action, technique and cognitive impairment. RESULTS: The main results found in the this revision were: 1) electroconvulsive therapy is more effective than any antidepressant medication; 2) the remission of depression with electroconvulsive therapy varies, in general, from 50 to 80%; 3) The effect of electroconvulsive therapy in brain-derived neurotrophic factor levels is still controversial; 4) electroconvulsive therapy has a positive effect in the improvement of quality of life; 5) patients submitted to electroconvulsive therapy have, in general, a positive perception about the treatment. CONCLUSION: Electroconvulsive therapy remains a highly efficacious treatment in treatment-resistant depression. With the improvement of its technique, electroconvulsive therapy has become an even safer and more useful procedure both for the acute phase and for the prevention of new depressive episodes.

Clinical outcomes and quality of life in patients submitted to electroconvulsive therapy.

OBJECTIVES: The aims of this study were to evaluate the effect of electroconvulsive therapy (ECT) on clinical and quality of life improvement in patients hospitalized at the Hospital de Clínicas de Porto Alegre and to compare psychopathology measures between the patient's and the physician's perspectives. METHODS: In a longitudinal and observational study, 58 patients who submitted to ECT were assessed for clinical symptoms and quality of life before and 24 hours after treatment. Symptoms were assessed using the Behavior and Symptom Identification Scale 32 (BASIS-32), Brief Psychiatry Rating Scale--Anchored (BPRS-A), and Clinical Global Impression (CGI). Quality of life was assessed using the World Health Organization Quality of Life--Bref (WHOQOL-BREF) assessment. RESULTS: Of 58 patients assessed, 25 (43.1%) had major depression and 23 (39.7%) had bipolar disorder. Electroconvulsive therapy was indicated because of resistant depression in 47 patients (81.1%). There was a significant difference (P < 0.001) between the periods before and after ECT in BASIS-32, BPRS-A, and CGI scores and in all WHOQOL domains, with greater difference in physical and psychological domains than in social relationships and environment. Size effects of BASIS-32 and BPRS scales were similar. CONCLUSION: Electroconvulsive therapy is associated with improvement in symptoms and in quality of life of patients with psychiatric disorders, which could be seen in measurements assessed by physicians (BPRS and CGI) and by patients (WHOQOL and BASIS-32). There was similarity between the patient's and the physician's perspectives.

Eletroconvulsoterapia na depressão maior: aspectos atuais / Electroconvulsive therapy in major depression: current aspects

Objetivo: A eficácia da eletroconvulsoterapia em tratar sintomas depressivos está estabelecida por meio de inúmeros estudos desenvolvidos durante as últimas décadas. A eletroconvulsoterapia é o tratamento biológico mais efetivo para depressão atualmente disponível. O objetivo deste estudo foi demonstrar o papel da eletroconvulsoterapia no tratamento da depressão e destacar aspectos atuais relativos à sua prática. Método: Foram revisados na literatura estudos de eficácia, remissão de sintomas, fatores preditores de resposta, assim como aspectos atuais acerca da qualidade de vida, percepção dos pacientes, mecanismo de ação, técnica e prejuízo cognitivos. Resultados: Os principais achados desta revisão foram: 1) a eletroconvulsoterapia é mais efetiva do que qualquer medicação antidepressiva; 2) a remissão da depressão com a eletroconvulsoterapia varia, em geral, de 50 a 80%; 3) Ainda é controverso o efeito da eletroconvulsoterapia nos níveis de fator neurotrófico derivado do cérebro (acho que aqui pode colocar entre parenteses o “BNDF”); 4) a eletroconvulsoterapia tem efeito positivo na melhora da qualidade de vida; 5) os pacientes submetidos à eletroconvulsoterapia, em geral, têm uma percepção positiva do tratamento. Conclusão: A eletroconvulsoterapia permanece sendo um tratamento altamente eficaz em pacientes com depressão resistente. Com o avanço da sua técnica, a eletroconvulsoterapia tornou-se um procedimento aindamais seguro e útil tanto para a fase aguda, quanto para a prevenção de novos episódios depressivos.

Objective: The efficacy of electroconvulsive therapy in treating depressive symptoms has been established by means of innumerablestudies developed along the last decades. Electroconvulsive therapy is the most effective biological treatment for depression currently available. The objective of this study was to demonstrate the role of lectroconvulsive therapy in the treatment of depression and highlight present aspects related to its practice. Method: We reviewed in the literature studies on efficacy, symptom remission, predictive response factors as well as current aspects regarding quality of life, the patients’ perception, mechanism of action, technique and cognitive impairment. Results: The main results found in the this revision were: 1) electroconvulsive therapy is more effective than any antidepressant medication; 2) the remission of depression with electroconvulsive therapy varies, in general, from 50 to 80%; 3) The effect of electroconvulsive therapy in brain-derived neurotrophic factor levels is still controversial; 4) electroconvulsive therapy has a positive effect in the improvement of quality of life; 5) patients submitted to electroconvulsive therapy have, in general, a positive perception about the treatment. Conclusion: Electroconvulsive therapy remains a highly efficacious treatment in treatment-resistant depression. With the improvement of its technique, electroconvulsive therapy has become an even safer and more useful procedure both for the acute phase and for the prevention of new depressive episodes.

Violência sexual: Papel da Delegacia da Mulher e manejo médico / Sexual violence: The role of the Women's Police Station and the medical management

Os autores tecem comentários sobre a violência sexual contra a mulher, bem como as definiçöes pertinentes. É exaltada a importância da criaçäo da Delegacia para a Mulher e nela säo pesquisados os registros de estupro ocorridos em Porto Alegre-RS nos anos de 1999 e 2000. Säo abordados aspectos do exame ginecológico e do resguardo de provas médico-legais, bem como as medidas profiláticas referentes à gestaçäo, às doenças sexualmente transmissíveis e às seqüelas psico-sexuais. Ressalta-se a importância do seguimento dessas pacientes como importante elemento terapêutico. Os autores destacam que este atendimento holístico permitirá que a mulher violentada, recupere sua integridade física, social, psicológica e sexual mais rapidamente e com um mínimo cicatriz.