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Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 72-76, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1055367


Objective: Depression has been associated with hepatitis C, as well as with its treatment with proinflammatory cytokines (i.e., interferon). The new direct-acting antiviral agents (DAAs) have minimal adverse effects and high potency, with a direct inhibitory effect on non-structural viral proteins. We studied the incidence and associated factors of depression in a real-life prospective cohort of chronic hepatitis C patients treated with the new DAAs. Methods: The sample was recruited from a cohort of 91 patients with hepatitis C, of both sexes, with advanced level of fibrosis and no HIV coinfection, consecutively enrolled during a 6-month period for DAA treatment; those euthymic at baseline (n=54) were selected. All were evaluated through the depression module of the Patient Health Questionnaire (PHQ-9-DSM-IV), at three time points: baseline, 4 weeks, and end-of-treatment. Results: The cumulative incidence (95%CI) of major depression and any depressive disorder during DAA treatment was 13% (6.4-24.4) and 46.3% (33.7-59.4), respectively. No differences were observed between those patients with and without cirrhosis or ribavirin treatment (p > 0.05). Risk factors for incident major depression during DAA treatment included family depression (relative risk 9.1 [1.62-51.1]), substance use disorder (11.0 [1.7-73.5]), and baseline PHQ-9 score (2.1 [1.1-3.1]). Conclusions: The findings of this study highlight the importance of screening for new depression among patients receiving new DAAs, and identify potential associated risk factors.

Humanos , Masculino , Feminino , Adulto , Idoso , Antivirais/uso terapêutico , Hepatite C/psicologia , Hepatite C/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Escalas de Graduação Psiquiátrica , Ribavirina/uso terapêutico , Espanha/epidemiologia , Fatores de Tempo , Modelos Logísticos , Incidência , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Hepatite C/epidemiologia , Pessoa de Meia-Idade
An. bras. dermatol ; 94(6): 704-709, Nov.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1054884


Abstract Background: Rosacea may result in emotional distress and anxiety. However, data on the presence of generalized anxiety disorder in rosacea patients are scarce. Objective: The aim of the study was to detect the frequency and level of anxiety and depression in patients with rosacea. Methods: A total of 194 consecutive rosacea patients and 194 age- and sex-matched controls were enrolled. Severity of rosacea was assessed in patients according to the criteria of the National Rosacea Society Ethics Committee. Both patients and controls were evaluated by the Generalized Anxiety Disorder 7-item scale, and severity was measured by the Generalized Anxiety Disorder-Adult. Results: Individuals who were diagnosed with an anxiety and/or depressive disorder were more common in patient group (24.7% vs. 7.2%, p < 0,01). Female patients were particularly at risk for having generalized anxiety disorder (OR = 2.8; 95% CI 1.15-7.37; p = 0.02). Study limitations: Single center study and limited sample size. Conclusions: Rosacea patients show greater risk of having anxiety disorders, including generalized anxiety disorder. Female patients, those with lower educational levels, those with phymatous subtype, untreated patients, and patients with prior psychiatric morbidity may be at particular risk for anxiety. It is essential to consider the psychological characteristics of patients to improve their well-being.

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/epidemiologia , Rosácea/complicações , Rosácea/epidemiologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/epidemiologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Estudos de Casos e Controles , Modelos Logísticos , Prevalência , Estudos Transversais , Análise de Variância , Escolaridade
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(5): 428-432, Sept.-Oct. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1039099


Objective: Fibromyalgia (FM) patients have higher rates of depression and anxiety disorders than healthy controls. Affective temperament features are subclinical manifestations of mood disorders. Our aim was to evaluate the affective temperaments of FM patients and investigate their association with depression and anxiety levels and clinical findings. Methods: This cross-sectional study included FM patients and healthy controls. The Hospital Anxiety and Depression Scale (HADS) was used to determine patient anxiety and depression levels, and the Temperament Scale of Memphis, Pisa and San Diego, self-administered version was applied to assess affective temperaments in all subjects. Disease severity was assessed in FM patients with the Fibromyalgia Criteria and Severity Scales and the Fibromyalgia Impact Questionnaire (FIQ). Differences between groups were evaluated using Student's t-tests. Correlations among parameters were performed. Results: This study involved 38 patients with FM (30 female) and 30 healthy controls (25 female). Depressive, anxious and cyclothymic temperaments were significantly higher in FM patients than healthy controls. Statistically significant positive correlations were found between HADS depression score and all temperaments except hyperthymic, as well as between HADS anxiety score and cyclothymic and anxious temperaments. HADS depression and anxiety scores were correlated with symptom severity. We found a higher risk of depression and anxiety among FM patients with higher FIQ scores. Conclusion: This study is the first to evaluate affective temperament features of FM patients. Evaluating temperamental traits in FM patients may help clinicians determine which patients are at risk for depression and anxiety disorders.

Humanos , Masculino , Feminino , Adulto , Transtornos de Ansiedade/psicologia , Temperamento , Fibromialgia/psicologia , Transtornos do Humor/psicologia , Transtorno Depressivo/psicologia , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Estudos de Casos e Controles , Projetos Piloto , Estudos Transversais , Inquéritos e Questionários , Estatísticas não Paramétricas , Sintomas Afetivos/psicologia , Pessoa de Meia-Idade
Trends psychiatry psychother. (Impr.) ; 41(3): 227-236, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1043524


Abstract Objective: An important subject in evaluation of the efficacy of treatments is to examine how the intervention is effective and to identify the consequences of that treatment. In this regard, the current study investigates the role of emotion regulation as the mediator of the treatment outcomes of therapy using the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders. Method: This article describes a double-blind randomized clinical trial. A sample of 26 individuals was selected based on cut-off scores for the Beck Depression Inventory and Beck Anxiety Inventory and their final diagnoses were confirmed with the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). The sample was randomly divided into two groups: control and treatment (13 patients each). The treatment group received 20 one-hour UP sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Difficulties in Emotion Regulation Scale were administered at two stages, pre-treatment and post-treatment. Results: The UP reduced anxiety and depression in patients through improvement in emotion regulation. Furthermore, the results showed that the difficulty engaging in goal-directed behavior and non-acceptance of emotional response subscales were capable of predicting 62% of variance in anxiety scores. In turn, two subscales, difficulty engaging in goal-directed behavior and lack of emotional clarity, predicted 72% of variance in depression scores. Conclusion: Emotion regulation can be considered as a potential mediating factor and as predictive of outcomes of transdiagnostic treatment based on the UP. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Resumo Objetivo: É importante, na avaliação da eficácia de tratamentos, examinar como a intervenção tem efeito e identificar suas consequências. O presente estudo investiga o papel da regulação emocional enquanto mediadora de desfechos do tratamento que emprega o Protocolo Unificado (PU) para o tratamento transdiagnóstico de transtornos psicológicos. Método: Este artigo descreve um ensaio clínico randomizado duplo-cego. Uma amostra de 26 indivíduos foi selecionada com base em escores pré-estabelecidos para o Inventário de Depressão de Beck e o Inventário de Ansiedade de Beck, e seus diagnósticos finais foram confirmados utilizando o instrumento Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). A amostra foi dividida aleatoriamente em dois grupos: controle e tratamento (13 pacientes em cada). O grupo tratamento recebeu 20 sessões de PU de 1 hora cada. O Inventário de Depressão de Beck, Inventário de Ansiedade de Beck Beck e Escala de Dificuldades de Regulação Emocional foram administrados em duas etapas, antes e depois do tratamento. Resultados: O PU reduziu a ansiedade e a depressão em pacientes, ao melhorar a regulação emocional. Além disso, os resultados mostraram que as subescalas dificuldade de se engajar em comportamentos orientados por objetivos e não aceitação de resposta emocional responderam por 62% da variância nos escores de ansiedade. Nos escores de depressão, duas subescalas, dificuldade de se engajar em comportamentos orientados por objetivos e falta de claridade emocional, explicaram 72% da variância. Conclusão: A regulação emocional pode ser considerada o principal fator mediador e também preditora de desfechos do tratamento transdiagnóstico baseado no PU. Registro do ensaio clínico: Iranian Registry of Clinical Trials, IRCT2017072335245N1.

Humanos , Masculino , Feminino , Adulto , Transtornos de Ansiedade/prevenção & controle , Sintomas Afetivos/terapia , Transtorno Depressivo/prevenção & controle , Transtornos de Ansiedade/etiologia , Escalas de Graduação Psiquiátrica , Protocolos Clínicos , Método Duplo-Cego , Resultado do Tratamento , Sintomas Afetivos/psicologia , Transtorno Depressivo/etiologia
Trends psychiatry psychother. (Impr.) ; 41(3): 262-267, July-Sept. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1043535


Abstract Objectives To investigate resilience levels in adolescents with attention-deficit hyperactivity disorder (ADHD) using quantitative measures when compared to their non-affected siblings and controls. We also aimed to investigate the correlation between resilience and depression, anxiety, intelligence quotient (IQ) and socioeconomic status, which may affect resilience levels and be potential confounders. Methods Adolescents (n=45) diagnosed with ADHD referred to an outpatient ADHD clinic, and their siblings without ADHD (n=27), with ages ranging from 12 to 17 years, were interviewed along with their parents using a semi-structured interview (Children's Interview for Psychiatric Syndromes - Parent Version). Intelligence was measured with the Block Design and Vocabulary subtests from the Wechsler Battery. Anxiety and depression were investigated using the Children State-Trait Anxiety Inventory (CSTAI) and the Child Depression Inventory (CDI), respectively. Resilience was investigated using the Resilience Scale. A control group (typically developing adolescents [TDA] and their siblings; n=39) was recruited in another outpatient facility and at two schools using the same methodology. Results Socioeconomic status and intelligence levels, which may affect resilience, were similar in all groups. Adolescents with ADHD showed lower resilience levels compared to siblings and TDA even when controlled for anxiety and depression levels, which were higher in ADHD. Resilience levels were higher in siblings than in adolescents with ADHD, and lower than in TDA - this last result without statistical significance. Conclusion In our sample, ADHD in adolescents was associated with lower resilience, even when controlled for confounders often seen in association with the disorder.

Resumo Objetivos Investigar níveis de resiliência em adolescentes com transtorno do déficit de atenção/hiperatividade (TDAH) empregando medidas quantitativas de modo comparativo a irmãos não afetados e controles. Também se investigou a correlação entre resiliência e depressão, ansiedade, quociente de inteligência (QI) e status socioeconômico, que podem afetar os níveis de resiliência e atuar como confundidores potenciais. Métodos Adolescentes (n=45) diagnosticados com TDAH e encaminhados para um serviço ambulatorial de TDAH e seus irmãos sem o transtorno (n=27), com idades entre 12 e 17 anos, foram entrevistados junto com seus pais utilizando-se uma entrevista semiestruturada (Children's Interview for Psychiatric Syndromes - Parent Version), em português). A inteligência foi mensurada com os subtestes Blocos e Vocabulário da Bateria Wechsler. Ansiedade e depressão foram investigados com o Inventário de Estado-Traço Infantil [Children State-Trait Anxiety Inventory (CSTAI)] e o Inventário de Depressão Infantil [Child Depression Inventory (CDI)], respectivamente. A resiliência foi mensurada utilizando-se a Escala de Resiliência. Um grupo controle [adolescentes com desenvolvimento típico (ADT) e seus irmãos; n=39] foi recrutado em outro serviço ambulatorial e em duas escolas, empregando a mesma metodologia. Resultados O status socioeconômico e os níveis de inteligência, que podem afetar a resiliência, foram similares em todos os grupos. Adolescentes com TDAH apresentaram menores níveis de resiliência comparados aos seus irmãos e a ADT, mesmo após ajuste para níveis de ansiedade e depressão, que eram mais altos no TDAH. Os níveis de resiliência foram mais altos em irmãos do que nos portadores de TDAH, porém menores que em ADT - este último resultado sem significância estatística. Conclusão Em nossa amostra, adolescentes com TDAH apresentaram menor resiliência, mesmo após controle para confundidores habitualmente associados ao transtorno.

Humanos , Masculino , Feminino , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Resiliência Psicológica , Transtornos de Ansiedade/psicologia , Escalas de Graduação Psiquiátrica , Saúde da Família , Análise de Variância , Transtorno Depressivo/psicologia
Arch. Clin. Psychiatry (Impr.) ; 46(4): 107-112, July-Aug. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1019343


Abstract Background Mental health disorders are common in China. There is a lack of knowledge and resources of mental health in China. Objectives To assess the levels of psychiatric resources and services in general hospitals in China. Methods Data regarding psychiatric departments, wards and staff were collected from 57 general hospitals in four provinces of China (Hubei, Zhejiang, Heilongjiang and Yunnan) between April 2014 and June 2014. Questionnaires were distributed to 1,200 non-psychiatric clinicians. Results Among the 57 hospitals, 50 provided mental health services, 36 had mental health wards, and seven had neither mental health clinics nor wards. The median number of mental health clinicians was six per hospital. The median number of specialized nurses was 42 per hospital. A total of 1,152 non-psychiatric clinicians with a career duration of 9.4 ± 8.9 years returned completed questionnaires. Only 6.9% reported a good understanding of the manifestation of anxiety and depressive disorders, 4.5% reported a good understanding of the diagnostic criteria, and 3.8% reported a good understanding of the treatment protocols. Discussion There is inadequate awareness of anxiety and depressive disorders among non-psychiatric clinicians in general hospitals in China. This awareness/understanding increased with increasing hospital level.

Humanos , Hospitais Gerais , Transtornos Mentais , Serviços de Saúde Mental/provisão & distribução , Transtornos de Ansiedade , China , Conhecimentos, Atitudes e Prática em Saúde , Saúde Mental/educação , Estudos Transversais , Pessoal de Saúde/educação , Transtorno Depressivo , Recursos em Saúde/provisão & distribução
Arq. bras. psicol. (Rio J. 2003) ; 71(2): 130-149, mai.-ago 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1015012


As distorções cognitivas são erros lógicos de pensamentos que podem alterar a realidade do sujeito, causando possíveis sintomas depressivos. O objetivo do estudo foi construir um instrumento intitulado de Escala de Distorções Cognitivas Depressivas (EDICOD) e buscar evidências de validade baseada no conteúdo e estrutura interna, utilizando análise fatorial exploratória e o modelo da Teoria de Resposta ao Item (TRI). Na etapa de construção do estudo, participaram oito juízes e 27 estudantes de graduação para uma aplicação piloto para adequação dos itens. Posteriormente, 459 indivíduos, divididos entre sujeitos não clínicos e clínicos com diagnóstico de depressão, de ambos os sexos, com faixa etária entre 18 e 60 anos. Após as análises psicométricas, a escala ficou reduzida com 36 itens, divididos em três fatores interpretáveis, sendo esses, Abstração seletiva/personalização (F1), Inferência arbitrária/maximização e minimização (F2) e por último, Pensamento dicotômico/hipergeneralização (F3). Assim, a EDICOD apresentou ser um instrumento adequado de rastreio das principais distorções cognitivas, principalmente para possível uso em ambiente clínico

Cognitive distortions are logical errors of thoughts that can alter the subject's reality, causing possible depressive symptoms. The purpose of the study was to construct an instrument titled Depression Cognitive Distortion Scale (EDICOD) and to seek evidence of validity based on content and internal structure using exploratory factorial analysis and the Item Response Theory (TRI) model. In the construction phase of the study, eight judges and 27 undergraduate students participated in a pilot application to adjust the items. Subsequently, 459 individuals, divided between non-clinical and clinical subjects with a diagnosis of depression, of both sexes, aged between 18 and 60 years, participated. After the psychometric analysis, the scale was reduced to 36 items, divided into three interpretable factors: Selective abstraction/personalization (F1), arbitrary inference/maximization and minimization (F2), and finally, dichotomous thinking/hypergeneralization (F3). Thus, EDICOD presented an adequate tool for screening the main cognitive distortions, mainly for possible use in clinical settings

Las distorsiones cognitivas son errores lógicos de pensamientos que pueden alterar la realidad del sujeto, causando posibles síntomas depresivos. El objetivo del estudio fue construir un instrumento titulado de Escala de Distorsiones Cognitivas Depresivas (EDICOD) y buscar evidencias de validez basada en el contenido y la estructura interna, utilizando análisis factorial exploratorio y el modelo de la Teoría de Respuesta al Ítem (TRI). En la etapa de construcción del estudio, participaron ocho jueces y 27 estudiantes de graduación para una aplicación piloto para adecuación de los ítems. Posteriormente, 459 individuos, divididos entre sujetos no clínicos y clínicos con diagnóstico de depresión, de ambos sexos, con rango de edad entre 18 y 60 años. Después de los análisis psicométricos, la escala se redujo con 36 ítems, divididos en tres factores interpretables, siendo éstos, Abstracción selectiva/personalización (F1), Inferencia arbitraria/maximización y minimización (F2) y por último, Pensamiento dicotómico/hipergeneralización (F3). Así, la EDICOD presentó ser un instrumento adecuado de rastreo de las principales distorsiones cognitivas, principalmente para posible uso en ambiente clínico

Humanos , Testes Psicológicos , Psicometria , Transtornos Cognitivos , Transtorno Depressivo
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(3): 245-253, May-June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1011490


Objective: Bipolar depression is characterized by neurobiological features including perturbed oxidative biology, reduction in antioxidant levels, and a concomitant rise in oxidative stress markers. Bipolar depression manifests systemic inflammation, mitochondrial dysfunction, and changes in brain growth factors. The depressive phase of the disorder is the most common and responds the least to conventional treatments. Garcinia mangostana Linn, commonly known as mangosteen, is a tropical fruit. The pericarp's properties may reduce oxidative stress and inflammation and improve neurogenesis, making mangosteen pericarp a promising add-on therapy for bipolar depression. Methods: Participants will receive 24 weeks of either 1,000 mg mangosteen pericarp or placebo per day, in addition to their usual treatment. The primary outcome is change in severity of mood symptoms, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), over the treatment phase. Secondary outcomes include global psychopathology, quality of life, functioning, substance use, cognition, safety, biological data, and cost-effectiveness. A follow-up interview will be conducted 4 weeks post-treatment. Conclusion: The findings of this study may have implications for improving treatment outcomes for those with bipolar disorder and may contribute to our understanding of the pathophysiology of bipolar depression. Clinical trial registration: Australian and New Zealand Clinical Trial Registry, ACTRN12616000028404.

Humanos , Transtorno Bipolar/tratamento farmacológico , Garcinia mangostana/química , Transtorno Depressivo/tratamento farmacológico , Frutas/química , Antioxidantes/uso terapêutico , Placebos/uso terapêutico , Qualidade de Vida , Austrália
Ágora (Rio J. Online) ; 22(1): 87-98, jan.-abr. 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-986221


RESUMO: Procuramos traçar um panorama amplo sobre as diversidades conceitual e de referentes sobre o que preferimos denominar de "estados maníacos". Partimos da proposta freudiana de que a mania seria a expressão de triunfo sobre o mesmo complexo da melancolia, para problematizá-la. Sugerimos que a mania não pode ser inteiramente recoberta pela lógica melancólica e que muitos aspectos deste quadro vêm sendo negligenciados pela psicanálise. Examinamos autores tão heterogêneos quanto aqueles provenientes da escola lacaniana e Melanie Klein, para formular a hipótese de que há pelo menos duas visadas sobre a mania que precisam ser melhor articuladas.

Abstract: We seek to draw a broad picture of conceptual and referential diversities about what we prefer to call "manic states". We start with the Freudian proposal that mania would be the expression of triumph over the same complex of melancholia as to problematize it. We suggest that mania cannot be entirely covered by melancholic logic and that many aspects of this picture have been neglected by psychoanalysis. We examine authors as diverse as those from the Lacanian school and Melanie Klein, to formulate the hypothesis that there are at least two views on mania that need to be better articulated.

Psicanálise , Psicologia Clínica , Transtorno Bipolar , Transtorno Depressivo
Rev. bras. psiquiatr ; 41(1): 44-50, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-985358


Objective: This study aimed to determine the prevalence of benzodiazepine (BZD) use in Brazil and to investigate the direct and indirect effects of alcohol consumption, sedentary lifestyle (SL), depressive symptoms (DS), and sleep dissatisfaction (SD) on BZD use. Methods: The Second Brazilian Alcohol and Drugs Survey (II BNADS) used stratified cluster probabilistic sampling to select 4,607 individuals aged 14 years and older from the Brazilian household population. Results: The lifetime and 12-month prevalence of BZD use was 9.8 and 6.1%, respectively. Older participants (age 40 and older) and women had higher rates. Alcohol use disorder, DS, and SD were significantly more prevalent in BZD users. The parallel multiple mediator model showed a positive direct effect of alcohol consumption on BZD use, with significant positive indirect effects of SL, SD, and DS as simultaneous mediators leading to higher BZD intake. Other statistically significant indirect pathways were DS alone, SD alone, and all of the above except SL. Conclusion: The prevalence of BZD use in Brazil is high compared to that of other countries. Knowledge of the main risk factors and pathways to consumption can guide prevention initiatives and underlie the development of better tailored and effective treatment strategies.

Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Transtornos do Sono-Vigília/tratamento farmacológico , Benzodiazepinas/administração & dosagem , Consumo de Bebidas Alcoólicas/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Comportamento Sedentário , Fatores Socioeconômicos , Brasil/epidemiologia , Prevalência , Fatores de Risco , Pessoa de Meia-Idade
Rev. bras. psiquiatr ; 41(1): 15-21, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-985361


Objective: Disorders characterized by "distressing unexplained somatic symptoms" are challenging. In the ICD-11 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (ICD-11 PHC), a new category, bodily stress syndrome (BSS), was included to diagnose patients presenting unexplained somatic symptoms. The present study investigated the association of BSS with anxiety, depression, and four subgroups of physical symptoms in a Brazilian primary health care (PHC) sample. Methodology: As part of the international ICD-11 PHC study, 338 patients were evaluated by their primary care physicians, followed by testing with Clinical Interview Schedule (CIS-R) and World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0). BSS was diagnosed in the presence of at least three somatic symptoms associated with incapacity. The association between anxiety, depression, and four subgroups of physical symptoms with being a BSS case was analyzed. Results: The number of somatic symptoms was high in the overall sample of 338 patients (mean = 8.4), but even higher in the 131 BSS patients (10.2; p < 0.001). Most BSS patients (57.3%) had at least three symptoms from two, three, or four subgroups, and these were associated with anxiety and depression in 80.9% of these patients. The symptom subgroup most strongly associated with "being a BSS" case was the non-specific group (OR = 6.51; 95%CI 1.65-24.34), followed by musculoskeletal (OR = 2,31; 95%CI 1.19-4.72). Conclusion: Somatic symptoms were frequent in a sample of PHC patients in Brazil. In the present sample, one third were BSS cases and met the criteria for at least two symptom subgroups, supporting the hypothesis that different functional symptoms are related to each other.

Humanos , Masculino , Feminino , Transtornos de Ansiedade/diagnóstico , Transtornos Somatoformes/diagnóstico , Classificação Internacional de Doenças , Transtorno Depressivo/diagnóstico , Transtornos de Ansiedade/classificação , Atenção Primária à Saúde , Transtornos Somatoformes/classificação , Síndrome , Estudos Transversais , Transtorno Depressivo/classificação , Pessoa de Meia-Idade
Trends psychiatry psychother. (Impr.) ; 41(1): 43-50, Jan.-Mar. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1004839


Abstract Introduction Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. Objective To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. Methods In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. Results The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Conclusion Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Resumo Introdução A psicoterapia psicodinâmica de longo prazo (PPLP) enfatiza a centralidade dos conflitos intrapsíquicos e inconscientes e sua relação com o desenvolvimento. Apesar da evidência em favor da eficácia da PPLP em transtornos mentais, há poucos dados sobre a eficácia da PPLP em transtornos de depressão/ansiedade. Objetivo Examinar se pacientes com transtornos de depressão/ansiedade demonstram melhora em seus estilos de apego, estilos defensivos, sintomas psiquiátricos, sintomas de ansiedade/depressão e alexitimia com PPLP. Métodos Neste estudo retrospectivo, descritivo, os desfechos psicológicos de pacientes tratados na clínica psicanalítica da Babol University of Medical Sciences foram avaliados. Quatorze pacientes com diagnóstico de transtorno de depressão ou ansiedade participaram do estudo sobre PPLP com abordagem de psicologia do self. O Inventário de Depressão de Beck II, o Inventário de Ansiedade de Beck, a Escala de Apego do Adulto, o Questionário de Estilo de Defesa-40 e a Escala de Alexitimia de Toronto-20 foram administrados antes e após o tratamento e no seguimento de 6 meses. Equações de estimação generalizadas foram usadas para analisar mudanças nos desfechos psicológicos após cada avaliação. Resultados Os escores médios de depressão/ansiedade e apego seguro melhoraram significativamente após PPLP com abordagem de psicologia do self do início do estudo ao pós-tratamento e seguimento. Além disso, os escores médios de defesas neuróticas e imaturas, dificuldade em identificar sentimentos, dificuldade em descrever sentimentos, pensamentos orientados externamente e escores totais de alexitimia diminuíram significativamente do início do estudo ao pós-tratamento e seguimento. Conclusão Sintomas de transtornos de ansiedade, transtornos depressivos, estilos de apego inseguro, alexitimia e estilos de defesa neuróticos/imaturos melhoraram após PPLP com abordagem de psicologia do self. Além disso, as melhoras persistiram no seguimento de 6 meses.

Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Transtornos de Ansiedade/terapia , Avaliação de Resultados em Cuidados de Saúde , Sintomas Afetivos/terapia , Mecanismos de Defesa , Transtorno Depressivo/terapia , Psicoterapia Psicodinâmica/métodos , Apego ao Objeto , Transtornos de Ansiedade/fisiopatologia , Fatores de Tempo , Estudos Retrospectivos , Sintomas Afetivos/fisiopatologia , Transtorno Depressivo/fisiopatologia , Irã (Geográfico) , Pessoa de Meia-Idade
Cad. Saúde Pública (Online) ; 35(5): e00093718, 2019. tab
Artigo em Português | LILACS | ID: biblio-1001665


Resumo: O objetivo foi avaliar o efeito da exposição e do tempo de exposição ao aleitamento materno na ocorrência de transtornos mentais comuns (TMC) entre adolescentes escolares brasileiros. Este trabalho analisou dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), avaliando aqueles que tiveram o questionário referente ao aleitamento materno respondido pelos pais ou responsáveis. A presença de TMC foi identificada pelo General Health Questionnaire, versão 12 itens (GHQ-12), considerando-se dois pontos de corte (escores ≥ 3 e ≥ 5). As associações foram testadas em análises bivariadas e por meio de modelos de regressão logística múltipla, com ajustes por variáveis potenciais de confusão. Dentre os 41.723 adolescentes avaliados, a maioria foi composta por estudantes do sexo feminino (54,6%), que tinham idades entre 12 e 15 anos (71%), estudavam em escolas públicas (83,1%), residiam na Região Sudeste (51,9%) e eram das classes econômicas B (53,8%) e C (34,1%). Cerca de metade das mães dos adolescentes não tinha o ensino médio completo (51,7%). O grupo de adolescentes com mais de seis meses de aleitamento materno (51,8%) apresentou uma menor prevalência de TMC para os dois pontos de corte do GHQ-12 avaliados, quando comparado com o grupo que não recebeu aleitamento materno ou que o recebeu por período ≤ 1 mês (RI = 0,82; IC95%:0,69-0,97 e RI = 0,74; IC95%: 0,59-0,91 para 3 e 5 pontos, respectivamente). O aleitamento materno prolongado parece desempenhar um papel protetor para a ocorrência de TMC na adolescência.

Abstract: This article sought to evaluate the effect of exposure, and exposure time, to breastfeeding on the occurrence of common mental disorders (CMD) among Brazilian adolescents enrolled in school. This study analyzed data from the Study of Cardiovascular Risk in Adolescents (ERICA), evaluating those whose questionnaire regarding breastfeeding had been filled out by parents or guardians. The presence of CMD was identified using the General Health Questionnaire, version 12 items (GHQ-12), and we considered two cutoff points (scores ≥ 3 and ≥ 5). We tested the associations in bivariate analyses and through multiple logistical regression models, adjusting for potential confounding variables. Of the 41,723 adolescents we evaluated, most were students of the female sex (54.6%), aged between 12 and 15 years (71%), attended public schools (83.1%), resided in the Southeastern region (51.9%) and belonged to the economic classes B (53.8%) and C (34.1%). Around half of the adolescents' mothers had not completed their secondary education (51.7%). The group of adolescents who were breastfed for more than six months (51.8%) had a lower CMD prevalence for both GHQ-12 cutoff points, when compared with the group who were not breastfed or who were breastfed for ≤ 1 month (IR = 0.82; 95%CI: 0.69-0.97 and IR = 0.74; 95%CI: 0.59-0.91 for 3 and 5 points, respectively). Prolonged breastfeeding seems to play a protective role on the occurrence of CMD in adolescence.

Resumen: El objetivo fue evaluar el efecto de la exposición y del tiempo de exposición a la lactancia materna en la ocurrencia de trastornos mentales comunes (TMC) entre adolescentes escolares brasileñas. Este trabajo analizó datos del Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA), evaluando aquellos, cuyo cuestionario -referente a la lactancia materna- había sido respondido por los padres o responsables legales. La presencia de TMC fue identificada por el General Health Questionnaire, versión 12 ítems (GHQ-12), considerándose dos puntos de corte (puntuaciones ≥ 3 y ≥ 5). Las asociaciones fueron probadas en análisis bivariados, y a través de modelos de regresión logística múltiple, con ajustes por variables potenciales de confusión. Entre los 41.723 adolescentes evaluados, la mayoría estuvo compuesta por estudiantes que eran del sexo femenino (54,6%), que tenían una edad entre 12 y 15 años (71%), estudiaban en escuelas públicas (83,1%), residían en la región Sudeste (51,9%) y eran de las clases económicas B (53,8%) y C (34,1%). Cerca de la mitad de las madres de los adolescentes no contaba con la enseñanza media completa (51,7%). El grupo de adolescentes con más de seis meses de lactancia materna (51,8%) presentó una menor prevalencia de TMC para los dos puntos de corte del GHQ-12 evaluados, cuando se comparan con el grupo que no recibió lactancia materna o que la recibió durante un período ≤ 1 mes (RI = 0,82; IC95%: 0,69-0,97 y RI = 0,74 y IC95%: 0,59-0,91 para 3 y 5 puntos, respectivamente). La lactancia materna prolongada parece desempeñar un papel protector para la ocurrencia de TMC en la adolescencia.

Humanos , Masculino , Feminino , Criança , Adolescente , Aleitamento Materno/estatística & dados numéricos , Transtornos Mentais/prevenção & controle , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/prevenção & controle , Fatores Socioeconômicos , Fatores de Tempo , Brasil/epidemiologia , Prevalência , Inquéritos e Questionários , Saúde do Adolescente , Transtorno Depressivo/etiologia , Transtorno Depressivo/prevenção & controle , Transtornos Mentais/etiologia , Transtornos Mentais/epidemiologia
Clin. biomed. res ; 39(3): 193-199, 2019.
Artigo em Inglês | LILACS | ID: biblio-1052933


Introduction: Among the most ordinary clinical manifestations of Multiple Sclerosis (MS) are depression and the presence of Lower Urinary Tract Symptoms (LUTS). Both can compromise a person's quality of life. The objective of this research was to identify the major urinary symptoms and correlate them with quality of life and with depressive symptoms in women with MS. Methods: This was an observatory, descriptive and correlational study, with nonprobabilistic sampling by convenience. This research included women over 18 years old who displayed LUT symptoms and who had been diagnosed with Relapsing-Remitting MS. Assessment consisted of an anamnesis card, the Kurtzke Expanded Disability Status Scale (EDSS), the Incontinence Impact Questionnaire-7 (IIQ-7-BR), the Urogenital Distress Inventory-6 (UDI-6-BR), the Beck Depression Inventory-2 (BDI-II) and the Multiple Sclerosis Quality of Life Questionnaire - Portuguese version (MSQOL-54). Results: 41 women participated in the study, with average age of 50.1 (± 9.45) and average of 4.11 in the EDSS. The most common urinary symptom was urinary urgency (78%). There was no correlation between the severity of the urinary symptom and quality of life. Moderate and significant negative correlation (r = -0.561 p < 0.001) was found between depression and the physical component of quality of life and strong negative correlation (r = -0.729 p < 0.001) was found between depression and the mental component. Conclusions: The most prevalent urinary symptom was urinary urgency. A strong correlation was found between symptoms of depression and quality of life and there was no correlation between urinary symptoms and quality of life.

Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade de Vida , Esclerose Múltipla/epidemiologia , Transtorno Depressivo/epidemiologia , Sintomas do Trato Urinário Inferior/epidemiologia
Poiésis (En línea) ; 36(Ene.-Jul.): 46-59, 2019.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-994708


Depresión y melancolía son dos conceptos diferentes, existen pocos esclarecimientos sobre dónde empieza o termina su definición en el psicoanálisis, además en su concepción psicógena y/o somática, y las similitudes que comparten. Este artículo propone abordar estos dos conceptos desde la teoría, plantear una diferencia entre ambos, desde el cambio conceptual hasta las diferencias en los movimientos psíquicos, para posteriormente abordar la trilogía de la depresión de Lars von Trier: Melancolía, Anticristo y Ninfomaníaca, en la que los aspectos mencionados se ilustran desde la vivencia de la mujer, lo cual posibilita vislumbrar estos estados, sus exigencias y consecuencias para el devenir del ser humano.

Depression and melancholy are two different concepts, there are few clarifications about where their definition begins or ends in psychoanalysis, also in their psychogenic and / or somatic conception, and the similarities they share. This article aims to approach these two concepts from the theory, difference between them will be considered from the merely conceptual change to the differences in the psychic movements, to later approach the trilogy of the depression of Lars von Trier: Melancholy, Antichrist and Nymphomaniac, in which the mentioned aspects are illustrated from the experience of the woman, which makes it possible to look these states, their demands and consequences for the future of the human being.

Humanos , Depressão , Psicologia , Transtorno Depressivo/psicologia , Teoria da Mente
Ágora (Rio J. Online) ; 21(3): 354-364, set.-dez. 2018.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-963596


Resumo: Observa-se comumente, na clínica com pacientes neurológicos, quando o adoecimento apresenta sequelas cognitivas, um quadro psicopatológico cujas características permitem articulações com o modelo melancólico freudiano. Com base na análise de casos de pacientes neurológicos incluídos em uma pesquisa teórico-clínica em psicanálise, buscaremos desenvolver uma análise comparativa entre o processo de luto nestes sujeitos, decorrente da percepção de suas limitações cognitivas, e o quadro melancólico. A figura da nostalgia e a especificidade da experiência de perda relacionada às instâncias ideais serão alguns dos aspectos analisados.

Abstract: It is often observed in clinical care of neurological patients with cognitive sequelae the occurrence of a psychopathological condition whose traits are similar to Freud's melancholic model. Based on the analysis of neurological cases included in a research in psychoanalysis, we intend to develop a comparative analysis of the mourning process in neurological patients, due to perception of their cognitive sequelae, and melancholic organizations. The nostalgic sentiment and the loss experience related to the ideal instances are some of the aspects analyzed.

Humanos , Psicanálise , Transtorno Depressivo , Solidão