Challenges in the treatment of dysthymia: a narrative review.

INTRODUCTION: Despite its milder severity, the chronic nature of dysthymia leads to significant impairments and functional limitations. The treatment of dysthymia has received considerably less research attention compared to major depressive disorder (MDD). AREAS COVERED: The authors have conducted a comprehensive review on the treatment of dysthymia. Their primary objective was to identify therapeutic options that have demonstrated genuine efficacy. To do this, they searched the PubMed database, without any time restrictions, to retrieve original studies. The samples were exclusively comprised individuals diagnosed with dysthymia according to the diagnostic criteria outlined in DSM-III, DSM-III-R, DSM-IV, or DSM-IV-TR. EXPERT OPINION: Within the realm of dysthymia treatment, several antidepressants, including imipramine, sertraline, paroxetine, minaprine, moclobemide, and amineptine, in addition to the antipsychotic agent amisulpride, have demonstrated superiority over placebo. In certain studies, psychotherapeutic interventions did not distinguish themselves significantly from pharmacological treatments and failed to exhibit greater efficacy than a placebo. However, these findings remain inconclusive due to the limited number of studies and substantial methodological limitations prevalent in a significant proportion of them. Limitations include factors like small sample sizes, the absence of placebo comparisons, and a lack of study blinding.

An update on the pharmacotherapeutic strategies for the treatment of dysthymic disorder: a systematic review.

INTRODUCTION: Longer treatment times, more comorbidity, more severe impairments in social, psychological, and emotional functioning, increased healthcare use, and more hospitalizations are all factors that are related to dysthymia. Given the significant prevalence of dysthymia (including persistent depressive disorder) worldwide, its comorbidity with several mental disorders, and the detrimental effects of these comorbidities, it is important to conduct a systematic review to compare the effects of pharmacological acute and maintenance treatments for dysthymia with placebo and standard care in the last 10 years, based on the publication of DSM5. AREAS COVERED: This systematic review was performed according to PRISMA guidelines. Databases, including PubMed and Cochrane Central Register of Controlled Trials, were searched to assess the effects of pharmacological acute and maintenance treatments for dysthymia in comparison with placebo and treatment as usual. EXPERT OPINION: Our review shows that SSRIs and SNRIs present efficacy for dysthymia treatment, and L-Acetylcarnitine should be investigated further for this condition in elderly patients. The comparison of antidepressant medication versus placebo showed coherent results based on three studies favoring pharmacotherapy as an effective treatment for participants with dysthymia. However, the scarcity of research on continuation and maintenance therapy in people with dysthymia highlights the need for more primary research.

Avaliação da relação entre eventos traumáticos infantis e comportamentos autolesivos em adolescentes / Evaluation of the relationship between childhood traumatic events and self-injurious behavior in adolescents / Evaluación de la relación entre eventos traumáticos infantiles y comportamiento autolesivo en adolescentes

Esta pesquisa teve como objetivo verificar a relação entre eventos traumáticos (ET) na infância e a ocorrência de comportamentos autolesivos em adolescentes. Os instrumentos utilizados foram o Questionário sobre Traumas na Infância (QUESI) e o Inventário de Autolesão Deliberada - reduzido (IAD-r). Participaram 494 estudantes do ensino médio de ambos os sexos e idade entre 15 e 18 anos (M = 16,4). Destes, 58,5% afirmaram ter sofrido abuso emocional de forma recorrente e 19,0% e 59,5% assumiram já ter sofrido abuso sexual e físico, respectivamente. Quanto à prática de autolesão, 65,0% revelaram já ter se engajado em comportamentos autolesivos. De acordo com a análise de Regressão Logística Binomial, todos os tipos de ET exibiram associação significativa com a prática de comportamentos autolesivos. A análise de moderação a respeito da interação entre a ocorrência de ET infantis e a prática de autolesão revelou ausência de moderação pelo sexo e pela idade. Porém, quanto ao abuso físico, o efeito de moderação da idade apresentou significância estatística limítrofe e indicou que os adolescentes mais novos, de 15 e 16 anos, que sofreram este tipo de abuso na infância, foram mais susceptíveis à prática autolesiva. Portanto, as altas taxas de ET e de autolesão encontradas nesta pesquisa revelam a gravidade do problema. Espera-se que esta investigação possa contribuir para a elaboração de intervenções para prevenção e controle dos fatores de risco que acometem a população infanto-juvenil.(AU)

This research aimed to verify the relationship between traumatic events (TE) in childhood and the occurrence of self-injurious behavior in adolescents. The instruments used were the Childhood Trauma Questionnaire (QUESI) and the Deliberate Self-Injury Inventory - reduced (IAD-r). The sample was composed of 494 high school students of both genders and aged between 15 and 18 years old (M = 16.4). Of those, 58.5% declared to have suffered recurring emotional abuse and 19.0% declared to have suffered sexual abuse and 59.5% physical abuse. Regarding the practice of self-harm, 65.0% reported having already engaged in self-injurious behaviors. According to the Binomial Logistic Regression analysis, all types of TE were associated with the practice of self-injurious behaviors. The moderation analysis between the occurrence of childhood TE and self-injury showed no moderation by sex or age. However, regarding physical abuse, the moderating effect of age showed borderline statistical significance and indicated that younger adolescents, 15 and 16 years old, who suffered this type of abuse in childhood, were more susceptible to self-injurious behavior. Therefore, the high rates of TE and self-injury found in this research reveal the seriousness of the problem. It is hoped for this investigation to contribute to the development of interventions to prevent and control risk factors that affect children and adolescents.(AU)

Esta investigación tuvo como objetivo verificar la relación entre eventos traumáticos (ET) en la infancia y la ocurrencia de conductas autolesivas en adolescentes. Los instrumentos utilizados fueron el Cuestionario de Trauma Infantil (QUESI) y el Inventario de Autolesiones Deliberadas -reducido (IAD-r). Participaron 494 estudiantes de la secundaria, de ambos sexos y con edades entre 15 y 18 años (M = 16,4). De estos, el 58,5% afirmaron haber sufrido maltrato emocional de forma recurrente, el 19,0% dijeron haber sufrido maltrato sexual y el 59,5%, maltrato físico. En cuanto a la práctica de la autolesión, el 65,0% informaron haber realizado conductas autolesivas. El análisis de Regresión Logística Binomial mostró que todos los tipos de ET tuvieron una asociación significativa con la práctica de conductas autolesivas. El análisis de la moderación respecto a la interacción entre la ocurrencia de ET infantil y la práctica de la autolesión reveló una ausencia de moderación por sexo o edad. En cuanto al maltrato físico, el efecto moderador de la edad mostró una significación estadística marginal e indicó que los adolescentes más jóvenes, de 15 y 16 años, que sufrieron este tipo de maltrato en la infancia, son más susceptibles a la práctica de autolesiones. Por lo tanto, las altas tasas de ET y autolesiones encontradas en esta investigación revelan la gravedad del problema. Se espera que esta investigación contribuya con el desarrollo de intervenciones para la prevención y control de los factores de riesgo que afectan a niños y adolescentes.(AU)

Estrategias de afrontamiento en pacientes con cáncer. Un estudio de centro único / Coping strategies in cancer patients. A single-center study

ntroducción: El diagnóstico de cáncer genera una inestabilidad emocionaly en muchos casos esto im-posibilita unafrontamiento adecuado.El afrontamiento es el esfuerzocognitivoy conductualconstan-temente cambiantes que se desarrollan para manejar las demandas específicas como el diangóstico oncológico. El objetivo de la presente investigación fue identificar las estrategias de afrontamiento en un grupo de pacientes con cáncer, en un Hospital de referencia nacional. Metodología: Este estudio transversal, se realizó en el Hospital Eugenio Espejo de Quito, Ecuador, período enero a junio del 2018, con una muestra no probabilística, de pacientes con neoplasias, se registraron variables demográficas, clínicas, y el test de afrontamiento de 40 preguntas CSI "El inventario de estrategias de afrontamiento (CSI). Se utiliza estadística descriptiva invariada y bivariado. Resultados: Se analizan 47 casos, 74% mujeres, de edad promedio 55 años. De instrucción secundaria completa en el 38%de los casos. Las Estrategias de Afrontamiento que se presentaron en el 70% de los pacientes fueron: Reestructuración Cognitiva (REC) y Evitación de problemas (EVP), en el 15% se presentó "Resolución de problemas" (REP). Las Estrategias de Afrontamiento en hombres fueron REP con el 57%, mientras que la Expresión Emocional (EEM) se presentó en mujeres en el 86%.En los prime-ros 6 meses el 77% usa la EEM; de 7 a 12 meses el 19% a la estrategia de Autocrítica (AUC); de 1 a 2 años con un 17% estrategia de Pensamiento Desiderativo (PSD); de 3 o más años con un 14% corresponde a Resolución de Problemas (REP).Conclusión: Las estrategias de afrontamientos utilizan en gran proporción en los primeros 6 meses del diagnóstico del cáncer, luego de lo cual las estrategias disminuyen por debajo del 20%

Introduction:The cancer diagnosis generates emotional instability, which precludes adequate coping in many cases. Coping is the constantly changing cognitive and behavioral effort that develops to handle specific demands such as cancer diagnosis. This research aimed to identify coping strategies in a group of cancer patients in a national reference hospital.Methodology: This cross-sectional study was carried out at the Eugenio Espejo Hospital in Quito, Ecua-dor, from January to June 2018, with a non-probabilistic sample of patients with neoplasms,demo-graphic and clinical variables were recorded, and the coping test of 40 CSI questions "The Coping Strat-egies Inventory (CSI). Univariate and bivariate descriptive statistics are used.Results: 47 cases were analyzed, 74% women, with an average age of 55. Complete secondary education in 38% of cases. The Coping Strategies that appeared in 70% of the patients were: Cognitive Restructur-ing (REC) and Problem Avoidance (EVP); in 15%, "Problem Resolution" (REP) was presented. Coping Strategies in men were REP with 57%, while Emotional Expression (EEM) was presented in women with 86%. In the first six months, 77% use the EEM; from 7 to 12 months, 19% to the Self-criticism strategy (AUC); from 1 to 2 years with 17% Wishful Thinking Strategy (PSD); of 3 or more years with 14% corre-sponds to Resolution of Problems (REP).Conclusion: Coping strategies are significantly used in the first six months after the cancer diagnosis, after which the strategies decrease below 20%

Transtorno distímico: uma ilustração clínica pela perspectiva da Terapia Cognitivo-Comportamental e Terapia Cognitiva Processual / Dysthimic disorder: clinical illustration from the perspective of Cognitive- Behavioral Therapy and Processual Cognitive Therapy

O presente trabalho tem como objetivo ilustrar como a articulação entre a Terapia Cognitivo Comportamental e a Terapia Cognitiva Processual possibilita resultado satisfatório em casos de Trantorno distímico. Os estudos acerca do transtorno distímico ainda são limitados. No entanto, o caso clínico corrobora com a literatura, que aponta a importância dos psicofarmacos no tratamento dos transtornos de humor, bem como a importância da psicoterapia, inclusive em casos mais brandos, como os de distimia. A Terapia Congitivo Comportamental clássica não foi suficente para a melhora significativa da paciente, sendo necessário o acréscimo de técnicas da Tereapia Cognitiva Processual. Essa articulação das abordagens nas intervenções psicoterápicas proporcionou mudanças significativas no padrão de pensamento, sentimento e comportamento da paciente.(AU)

This paper aims to illustrate how the articulation between Cognitive-Behavioral Therapy and Cognitive Processual Therapy enables satisfactory results in cases of dysthymic disorder. Studies on dysthymic disorder are still limited. However, the clinical case corroborates the literature, which points out the importance of psychopharmaceuticals in the treatment of mood disorders, as well as the importance of psychotherapy even in milder cases such as dysthymia. The classic Cognitive-Behavioral Therapy was not enough for the patients significant improvement, and the addition of Cognitive Processual Therapy techniques was necessary. This articulation of approaches in psychotherapeutic interventions provided significant changes in the patients pattern of thinking, feeling, and behaving.(AU)

El presente trabajo pretende ilustrar cómo la articulación entre la Terapia Cognitivo Conducutal y la Terapia Cognitiva Procesal permite obtener resultados satisfactorios en casos de trastorno distímico. Los estudios sobre el trastorno distímico son todavía limitados. Sin embargo, el caso clínico corrobora la literatura, que señala la importancia de los psicofármacos en el tratamiento de los trastornos del estado de ánimo, así como la importancia de la psicoterapia, incluso en los casos más leves, como la distimia. La clásica Terapia CognitivoConductual no fue suficiente para la mejora significativa del paciente, siendo necesaria la adición de técnicas de la Terapia Cognitiva Procesal. Esta articulación de enfoques en las intervenciones psicoterapéuticas condujo a cambios significativos en el patrón de pensamiento, sentimiento y comportamiento del paciente.(AU)

Oxidative Stress Risk Is Increased with a Sedentary Lifestyle during Aging in Mexican Women.

Oxidative stress (OS) increases during the human aging process, and the sedentary lifestyle could be a prooxidant factor. In this study, we determine the effect of sedentary lifestyle on OS during the aging process in Mexican women. A longitudinal study of two-year follow-up was carried out with 177 community-dwelling women (40-69 y) from Mexico City. We measured as OS markers plasma malondialdehyde, erythrocyte glutathione peroxidase (GPx) and superoxide dismutase (SOD), total plasma antioxidant status, uric acid level, antioxidant gap, and SOD/GPx ratio. To define OS using all the markers, we defined cut-off values of each parameter based on the 90th percentile of young healthy subjects and, we calculated a stress score (SS) ranging from 0 to 7, which represented the intensity of the marker modifications. All the women answered a structured questionnaire about prooxidant factors, including physical activity specially the type of activity, frequency, and duration, and they answered Spanish versions of self-assessment tests for establishing dysthymia and insomnia as potential confounders. Principal component and Poisson regression analysis were used as statistical tools, being two-year OS the primary outcome. The OS was considerate as SS ≥ 4 and sedentary lifestyle as <30 min/day of physical activity, beside several prooxidant factors and age that were covariables. SS is higher in sedentary lifestyle women after the two-year follow-up; although, the difference was statistically significant only in older women. Four principal components were associated with the OS, and 7 out of 8 prooxidant factors were important for the analysis, which were included in the Poisson model. The predictive factors for OS were the sedentary lifestyle (adjusted PR = 2.37, CI95%: 1.30-4.30, p < 0.01), and age, in which the risk increases 1.06 (CI95%:1.02-2.11, p < 0.01) by each year of age. Our findings suggest that a sedentary lifestyle increases the OS during the aging in Mexican women.

Ansiedad, depresión, bienestar subjetivo y salud mental general en reclusos / Anxiety, depression, subjective well-being and general mental health in inmates

Introducción: El estudio de variables psicológicas asociadas al encarcelamiento, reviste esencial importancia en la actualidad. Se ha reportado la vivencia de estados psicológicos patológicos en individuos dentro de las prisiones. Objetivo: Describir los estados de ansiedad, depresión, bienestar psicológico y el estado de salud mental general de los reclusos en regímenes de prisión provisional y prisión severa. Métodos: Se empleó un enfoque cuantitativo con un tipo de estudio transversal y descriptivo, mediante el uso de cuestionarios. La población fueron los internos de los regímenes de prisión provisional y severos (grupo de prisión provisional y grupo de severos). Los instrumentos empleados fueron: Escala de Bienestar Subjetivo; Cuestionario de Salud Mental General de Goldberg; Escala de Zung y Conde; e Inventario de Situaciones y Respuestas de Ansiedad. Los datos se analizaron mediante el paquete estadístico SPSS para Windows: versión 22.0. Se utilizó la estadística descriptiva y la Prueba T para muestras independientes. El estudio se llevó a cabo entre enero y mayo de 2019. Resultados: Se observó alta percepción del deterioro de la salud mental general. El bienestar subjetivo mostró valores similares en ambos grupos, con mínimas diferencias entre los altos y bajos niveles de bienestar. La mayoría de los participantes mostró niveles de ansiedad moderada. La vivencia de depresión también fue elevada; se observó distimia moderada y grave. Todos los participantes del régimen de prisión provisional, presentaron alguna variante de depresión. Conclusiones: Se encontraron altos niveles de ansiedad, depresión y un alto deterioro de la salud mental general. Se reportaron bajos índices de percepción de bienestar subjetivo(AU)

Introduction: The study of psychological variables associated with incarceration is of essential importance today. The experience of pathological psychological states has been reported in individuals within prisons. Objective: To describe the states of anxiety, depression, psychological well-being and the general state of mental health of inmates in provisional prison and severe prison regimes. Methods: A quantitative approach was used with a type of cross-sectional and descriptive study through surveys. The population was the inmates of the provisional and severe prison regimes. The instruments used were: Subjective Well-being Scale; Goldberg General Mental Health Questionnaire; Zung and Conde scale; and Inventory of Anxiety Situations and Responses. The data were analyzed using the statistical package SPSS for Windows: version 22.0. Descriptive statistics and the T-test were used for independent samples. The study was carried out from January to May 2019. Results: A high perception of the deterioration of general mental health was observed. Subjective well-being showed similar values in both sample groups, with minimal differences between high and low levels of well-being. Most of the participants showed moderate anxiety levels. The experience of depression was also high; moderate and severe dysthymia were observed. All the participants of the provisional prison regime presented some variant of depression. Conclusions: High levels of anxiety, depression and a high deterioration of general mental health were found. Low rates of subjective well-being perception were reported(AU)

The use of biofeedback intervention in the improvement of depression levels: a randomised trial.

OBJECTIVE: To evaluate the use of biofeedback intervention in the levels of depression. The main hypothesis tested if the use of biofeedback improves depression levels compared to the control group. METHODS: A randomised clinical trial. The final sample was composed of 36 participants (18 in the experimental group, receiving 6 training, once a week, with biofeedback; and 18 in the control group, who received conventional treatment in the service).Outcome measures were assessed in two stages: pre-test and post-test. The research used the following instruments: demographic survey data, Mini International Neuropsychiatric Interview 5.0.0 and Beck Depression Inventory (BDI). The factors and variables were presented in terms of descriptive and inferential statistics. Fisher's exact test (p < 0.05) was used to verify the existence of an association between the counting variables. The multinomial logistic regression model was adopted, and the Logit link function was used, as the software RStudio version 3.6.2. RESULTS: The factors that remained in the final model were group, sex, partner, atypical antidepressant, benzodiazepines, mood stabiliser, antiepileptic and antihistamine, according to the levels of depression based on the BDI. The group that did not receive biofeedback intervention had 16 times more chances of increasing the depression levels compared to participants in the experimental group. CONCLUSION: The use of biofeedback reduces depression, thus, representing a complementary alternative for the treatment of moderate and severe depression, and dysthymia.

Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017.

BACKGROUND: Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017. METHODS: We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY), and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. RESULTS: In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (- 9.01%, - 11.66 to - 6.31). The highest proportion of YLD was observed in the age range of 15-64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil's, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. CONCLUSIONS: Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable.

Quality of life among post-menopausal women due to oxidative stress boosted by dysthymia and anxiety.

BACKGROUND: Menopause is the onset of aging in women. During this process, some women experience physical changes that may impact upon their psychological and social status, also affecting their quality of life. Furthermore, several psychological changes following menopause have been shown to act as pro-oxidant, but the association between the psychological status that modify the quality of life and oxidative stress in postmenopausal women is still unclear. The aim of this study was to determinate the relationship between oxidative stress with psychological disturbances, low self-esteem, depressive mood and anxiety, and quality of life in the postmenopausal women. METHODS: We carried out a cross-sectional study with101 premenopausal and 101 postmenopausal women from Mexico City. As markers of oxidative stress we measured plasma lipoperoxide levels, erythrocyte superoxide dismutase and glutathione peroxidase activities, and total antioxidant status. We calculate a stress score as global oxidative stress status, with cut-off values for each parameter; this score range from 0 to 6, representing the severity of markers modifications. All the women were rated using the Coopersmith Self-Esteem Inventory, the Zung Self-Rating Anxiety and the Zung Self-Rating Depression Scales, and the WHO Quality of Life-brief. RESULTS: The postmenopausal women with low quality of life in the WHO Quality of Life-brief and their subscales had higher stress score compared with premenopausal women with high quality of life (p < 0.05). We found a positive correlation among lipoperoxide levels and Zung Self-Rating Anxiety and Zung Self-Rating Depression score (r = 0.226 and r = 0.173, respectively, p < 0.05), and a negative correlation with WHO Quality of Life-brief scores (r = -0.266, p < 0.01) in postmenopausal women. Multiple linear regression analysis revealed that average lipoperoxide levels increase by 0.0007 µmol/L for every 1-point increase in the Coopersmith Self-Esteem Inventory and by 0.001 µmol/L for every 1-point decrease in the WHO Quality of Life-brief, after adjusted for pro-oxidant factors. Zung Self-Rating Anxiety and Zung Self-Rating Depression Scales scores also contribute to increase lipoperoxides levels, but not significant. CONCLUSION: Our findings suggest that oxidative stress is increased in postmenopausal women with psychological disturbances and low quality of life.

Longitudinal course of disaster-related PTSD among a prospective sample of adult Chilean natural disaster survivors.

Background: With an increasing number of individuals surviving natural disasters, it is crucial to understand who is most at risk for developing post-traumatic stress disorder (PTSD). The objective of this study was to prospectively examine the role that pre-existing psychopathology plays in developing PTSD after a disaster. Methods: This study uses data from a prospective 5-wave longitudinal cohort (years 2003-11) of Chilean adults from 10 health centres ( N = 1708). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument. In 2010, the sixth most powerful earthquake on record struck Chile. One year later, a modified version of the PTSD module of the CIDI was administered. Marginal structural logistic regressions with inverse probability censoring weights were constructed to identify pre-disaster psychiatric predictors of post-disaster PTSD. Results: The majority of participants were female (75.9%) and had a high-school/college education (66.9%). After controlling for pre-disaster PTSD, pre-existing dysthymia [odds ratio (OR) = 2.21; 95% confidence interval (CI) = 1.39-3.52], brief psychotic disorder (OR = 2.67; 95% CI = 1.21-5.90), anxiety disorders (not including PTSD; OR = 1.49; 95% CI = 1.27-1.76), panic disorder (OR = 2.46; 95% CI = 1.37-4.42), agoraphobia (OR = 2.23; 95% CI = 1.22-4.10), social phobia (OR = 1.86; 95% CI = 1.06-3.29), specific phobia (OR = 2.07; 95% CI = 1.50-2.86) and hypochondriasis (OR = 2.10; 95% CI = 1.05-4.18) were predictors of post-disaster PTSD. After controlling for pre-disaster anxiety disorders, dysthymia, and non-affective psychotic disorders, individuals with pre-disaster PTSD (vs those without pre-disaster PTSD) had higher odds of developing post-disaster PTSD (OR = 2.53; 95% CI = 1.37-4.65). Conclusions: This is the first Chilean study to demonstrate prospectively that pre-disaster psychiatric disorders, independent of a prior history of other psychiatric disorders, increase the vulnerability to develop PTSD following a major natural disaster.

Evaluación neuropsicológica de los procesos cognitivos básicos en pacientes distímicos con intento de suicidio / Neuropsychological assessment of basic cognitive processes in dysthymic patients attempted suicide

La distimia incluye síntomas crónicos que interfieren en el funcionamiento y bienestar de la persona, pudiendo traer consecuencias fatales como el intento de suicidio, así como alteraciones neuropsicológicas en los procesos afectivos y cognitivos que afectan el comportamiento. En el municipio de Guisa, Provincia Granma, existe un alto número de pacientes distímicos que son infradiagnosticados, por lo que las conductas suicidas se tornan más frecuentes. Por este motivo se realizó la investigación que se muestra bajo el título “Evaluación neuropsicológica de los procesos cognitivos básicos en pacientes distímicos con intento de suicidio”, con el objetivo de caracterizar el estado neuropsicológico de dichos procesos. Se aplicaron métodos del nivel teórico: análisis-síntesis y el inductivo-deductivo, así como las siguientes técnicas: entrevista inicial, anamnesis, observación, Inventario de Beck, test Gestáltico Bisomotor, Tarea de denominación de objetos, Tarea go/no go, Series gráficas y motoras alternantes, Test de memoria acortado y el Test de la figura compleja de Rey. A través de los cuales se obtuvo que el estado neuropsicológico de los procesos cognitivos básicos en estos pacientes está alterado, manifestando déficits en la percepción, atención y memoria, sustentados en posibles hallazgos biológicos en determinadas áreas cerebrales. Este trabajo investigativo es de vital importancia, permitirá diseñar intervenciones terapéuticas acertadas para el tratamiento, convirtiéndose de esta manera la exploración neuropsicológica en un elemento clave para el diagnóstico e intervención en los pacientes.

Dysthymia includes chronic symptoms that interfere with the functioning and well-being of the person and can bring fatal consequences such as suicide attempt, and neuropsychological alterations in affective and cognitive processes that affect behavior. In the municipality of Guisa, Granma Province there is a high number of dysthymic patients are underdiagnosed, so suicidal behavior become more frequent. For this reason, research shown under the title "Neuropsychological assessment of basic cognitive processes in dysthymic patients attempted suicide" in order to characterize the neuropsychological status of basic cognitive processes in these patients was performed. Analysis-synthesis and inductive-deductive and the following techniques: initial interview, anamnesis, observation, Inventory Beck, test Gestalt Bisomotor,Task object naming, Task go / no go, graphics series theoretical methods were applied and alternating motor, shortened memory test and test the complex figure of Rey. Through which was obtained that the neuropsychological status of basic cognitive processes in these patients is altered, showing deficits in perception, attention and memory, sustained in possible biological findings in certain brain areas. This research work is vital, it will allow designing successful therapeutic interventions for treatment, thus becoming the neuropsychological a key for diagnosis and intervention in these patient’s element.

Factores asociados a ideación suicida en universitarios / Factors Associated with Suicidal Ideation in College Students

Estudio no experimental de tipo transeccional descriptivo cuyo objetivo fue identificar los factores asociados a ideación suicida en una muestra de 258 universitarios con edades comprendidas entre los 18 y los 24 años, pertenecientes a una universidad ubicada en el departamento de Boyacá; a partir del inventario de ideación suicida positiva y negativa (PANSI), la Escala de autoevaluación para la depresión de Zung (SDS), la Escala de impulsividad de Barratt (BIS), el Cuestionario de dependencia emocional (CDE), la Escala de eventos vitales estresantes (EEVA) y una ficha sociodemográfica. El análisis de resultados indican que el 31 % de la población participante presentó ideación suicida, hallándose a partir de las pruebas U de Mann-Whitney y Kruskal Wallis, que el estado civil unión libre, los eventos vitales estresantes, la dependencia emocional, la impulsividad y la depresión son factores asociados a ideación en universitarios.

Transactional descriptive non-experimental study aimed to identify factors associated with suicidal ideation in a sample of 258 college students aged between 18 and 24 years old, belonging to a university located in the Boyacá state; through the Positive and Negative Suicide Ideation Inventory (PANSI), the Zung Self-Rating Depression Scale (SDS), the Barratt Impulsiveness Scale (BIS), Emotional Dependency Questionnaire (CDE), Stressful Life Events Scale (EEVA) and a socio-demographic questionnaire. The analysis results indicate 31 % of the participant population had suicidal ideation, being from the U Mann-Whitney and Kruskal Wallis, the common law marital status, stressful life events, emotional dependency, impulsivity and depression are factors associated with suicidal ideation in college.

[Enviromental factors related to depressive disorders]. / Factores ambientales relacionados a trastornos depresivos.

BACKGROUND: As a result of their high prevalence, mayor depressive disorder single episode (MDDSE); major depressive disorder recurrent episodes (MDDREC); and dysthymia are considered an important public health problem. The objective of this paper was to identify and correlate environmental factors in patients with MDDSE, MDDREC and dysthymia. METHODS: 121 patients from the Instituto Mexicano del Seguro Social's Subzone General Hospital of San Andres Tuxtla, at Veracruz, were questioned by history with the risk variables. RESULTS: 16 of them were diagnosed with MDDREC, 72 with MDD and 33 with dysthymia; in all of those cases, females prevailed. Depressive disorders were observed more frequently in people over 40 years, married, with medium or low educational level, with dysfunctional family environment, victims of family violence and who were the middle siblings. The main comorbidities that arose were gastrointestinal disorders, obesity and hypertension. RESULTS: 16 of them were diagnosed with MDDREC, 72 with MDD and 33 with dysthymia; in all of those cases, females prevailed. Depressive disorders were observed more frequently in people over 40 years, married, with medium or low educational level, with dysfunctional family environment, victims of family violence and who were the middle siblings. The main comorbidities that arose were gastrointestinal disorders, obesity and hypertension. CONCLUSIONS: The main risk factors identified for developing depressive disorders were: being female, over 40 years old and being married. The differences obtained in this study, if it is compared with others, are probably due to sample size, selection criteria and ethnic origin.

Introducción: debido a su alta prevalencia, la depresión mayor, episodio único (DMEU); la depresión mayor recurrente (DMR); y la distimia son consideradas un problema importante de salud pública. El objetivo de este estudio fue identificar y relacionar los factores ambientales en pacientes con DMEU, DMR y distimia. Métodos: 121 pacientes procedentes del Hospital General de Subzona del Instituto Mexicano del Seguro Social (IMSS) de San Andrés Tuxtla, Veracruz, fueron cuestionados mediante una historia clínica con las variables de riesgo. Resultados: 16 pacientes presentaron DMEU, 72 DMR y 33 distimia. En todos prevaleció el sexo femenino. Los trastornos depresivos se observaron con más frecuencia en personas de más de 40 años, casadas, con un nivel de estudios medio o bajo, provenientes de una familia disfuncional, víctimas de violencia familiar, además de ser hijos intermedios. Las comorbilidades que se presentaron fueron trastornos gastrointestinales, obesidad e hipertensión arterial. Conclusión: los principales factores de riesgo que se identificaron para desarrollar trastornos depresivos fueron: ser mujer, tener más de 40 años de edad y estar casada. Las diferencias obtenidas en este estudio respecto a otros probablemente se deban al tamaño de la muestra, los criterios de selección y el origen de la etnia.

Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study.

OBJECTIVE: This study aims to investigate the prevalence of psychiatric disorders, i.e., the presence of signs and symptoms of anxiety and depression in type 1 diabetic patients, as well as to investigate the prevalence of psychiatric disorders in insulin dependent patients. METHODS: A cross-sectional observational study of 110 diabetic outpatients (mean = 58.3, SD = 14.5; 50 male and 60 female) was conducted in a public health clinic with patients diagnosed with diabetes mellitus who were under the medical supervision of an endocrinologist. The patients were evaluated through the Mini International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale(HADS). RESULTS: With respect to anxiety symptoms, we found a prevalence of 60% (n = 66) among patients, while in depression symptoms we found a prevalence of 53.6% (n = 59) concerning the 110 patients evaluated. More specifically, we found 28.2% (n = 31) of patients without depression or anxiety, 13.6% (n = 15) of patients with depression, 16.4% (n = 18) of patients with anxiety and 41.8% (n = 46) of patients with depression combined with anxiety. The most remarkable data were generalized anxiety disorder (22.7%), dysthymia (18.2%), panic disorder (8.2%) and social phobia (5.5%). CONCLUSION: The need for accurate assessments about the presence of symptoms related to psychopathology in patients with type 1 diabetes is evident.

Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population.

OBJECTIVE: To assess the association between lifetime crack cocaine use and psychiatric (post-traumatic stress disorder, current depression, current dysthymia, generalized anxiety disorder, panic disorder with agoraphobia, social phobia, as well as SRQ scores and suicide risk) and substance-use disorders (tobacco, alcohol, cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens and opioids) in youth in the general population of the city of Pelotas, RS. METHOD: This was a cross-sectional population-based study, involving 1560 participants between 18 and 24 ears old. Lifetime substance use and abuse were investigated using the ASSIST inventory. Psychiatric comorbidities were assessed using the Mini-International Neuropsychiatric Interview and symptoms of common mental disorders were evaluated with the Self-Reported Questionnaire (SRQ). RESULTS: The prevalence of lifetime crack cocaine use in the sample was 2.5%. Its use was associated with total SRW scores and the presence of post-traumatic stress disorder, antisocial personality disorder and suicide risk in the final regression model. Tobacco, alcohol, cannabis, cocaine, amphetamine and cocaine dependence were also associated with lifetime use of crack cocaine. DISCUSSION: Youth with a history of crack cocaine use had a higher prevalence of psychiatric conditions such as post-traumatic stress disorder, as well as an increased risk of tobacco, alcohol, cannabis, cocaine, amphetamine and inhalant use and dependence.

Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study / Comorbidade psiquiátrica no diabetes tipo 1: um estudo transversal observacional

Objective This study aims to investigate the prevalence of psychiatric disorders, i.e., the presence of signs and symptoms of anxiety and depression in type 1 diabetic patients, as well as to investigate the prevalence of psychiatric disorders in insulin dependent patients. Methods A cross-sectional observational study of 110 diabetic outpatients (mean = 58.3, SD = 14.5; 50 male and 60 female) was conducted in a public health clinic with patients diagnosed with diabetes mellitus who were under the medical supervision of an endocrinologist. The patients were evaluated through the Mini International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale(HADS). Results With respect to anxiety symptoms, we found a prevalence of 60% (n = 66) among patients, while in depression symptoms we found a prevalence of 53.6% (n = 59) concerning the 110 patients evaluated. More specifically, we found 28.2% (n = 31) of patients without depression or anxiety, 13.6% (n = 15) of patients with depression, 16.4% (n = 18) of patients with anxiety and 41.8% (n = 46) of patients with depression combined with anxiety. The most remarkable data were generalized anxiety disorder (22.7%), dysthymia (18.2%), panic disorder (8.2%) and social phobia (5.5%). Conclusion The need for accurate assessments about the presence of symptoms related to psychopathology in patients with type 1 diabetes is evident. .

Objetivo Elementos relacionados à saúde mental do paciente diabético tipo 1 são encontrados em várias pesquisas. O objetivo desse estudo é avaliar sinais e sintomas depressivos nesse grupo de pacientes, como também investigar as principais prevalências psiquiátricas que os acometem. Métodos Pesquisa realizada em 110 pacientes diabéticos atendidos em ambulatórios (média = 58.3, D = 14.5; 50 masculinos e 60 femininos) conduzida em Postos de Saúde Pública nos momentos de consulta médica com endocrinologista. A avaliação transcorreu com as escalas Mini International Neuropsychiatric Interview and Hospital Anxiety and Depression Scale (HADS). Resultados Os sintomas de ansiedade tiveram prevalência de 60% (n = 66), enquanto para depressão encontramos resultados de 53.6% (n = 59), considerando que 110 pacientes foram avaliados. Mais especificamente, nós encontramos 28,2 (n. 31) pacientes sem depressão ou ansiedade, 13,6 (n. 15) pacientes com depressão, 16,4 pacientes (n. 18) com ansiedade e 41,8 (n. 46) pacientes com depressão combinada com ansiedade. Outros transtornos comórbidos tiveram prevalência de ansiedade generalizada (22,7%), distimia (18,2%), pânico (8,2%) e fobia social (5,5%). Conclusão Sintomas ansiosos e depressivos são comuns em pacientes diabéticos do tipo 1, porém há prevalência de psicopatologias diversas nesse grupo de pacientes, levando em conta novas necessidades de pesquisas futuras para validar protocolos de tratamentos mais adequados para diabéticos do tipo 1. .

Distimia e homeopatia: um relato de caso

A distimia é uma forma de depressão crônica, não-episódica, de sintomatologia menos intensa do que as chamadas depressões maiores. O presente trabalho refere-se ao uso de um medicamento homeopático, Pulsatilla nigrans, como abordagem terapêutica em um caso clínico de distimia...(AU)

Sintomatología depresiva y función reflexiva en la psicoterapia psicodinámica con pacientes distímicas: comparación de tres casos / Depressive symptoms and reflective function of dysthymic patients in a psychodynamic psychotherapy: a comparison of three single cases

El estudio examina empíricamente la relación entre el estado de ánimo depresivo y la mentalización en el curso de la terapia. Las preguntas de investigación fueron: ¿Pueden observarse cambios en el estado de ánimo depresivo y / o en la mentalización en el curso de la terapia? ¿Puede observarse una relación entre el síntoma depresivo cardinal y la mentalización? Método: La muestra se compuso de tres casos únicos homogéneos en cuanto a sexo, edad, diagnóstico y resultado del tratamiento. La terapia incluyó como mínimo 50 sesiones. Los instrumentos utilizados fueron Profile of Mood States (POMS) para medir la Depresión y Reflective Functioning Scale para medir la Función Reflexiva (Reflective Function, RF). Para el análisis estadístico se utilizó la correlación de rangos de Spearman. Resultados: En los tres casos se observó una tendencia descendente para la variable Depresión. La RF disminuyó en un caso, y en dos casos no se modificó. Sólo en un caso se halló una correlación (negativa) entre Depresión y RF. Conclusiones: En estudios futuros deberá investigarse una muestra más amplia y homogénea. Se recomienda la utilización de un diseño de investigación y de métodos estadísticos más complejos, así como la inclusión de diversas variables de proceso.(AU)

Sintomatología depresiva y función reflexiva en la psicoterapia psicodinámica con pacientes distímicas: comparación de tres casos / Depressive symptoms and reflective function of dysthymic patients in a psychodynamic psychotherapy: a comparison of three single cases

El estudio examina empíricamente la relación entre el estado de ánimo depresivo y la mentalización en el curso de la terapia. Las preguntas de investigación fueron: ¿Pueden observarse cambios en el estado de ánimo depresivo y / o en la mentalización en el curso de la terapia? ¿Puede observarse una relación entre el síntoma depresivo cardinal y la mentalización? Método: La muestra se compuso de tres casos únicos homogéneos en cuanto a sexo, edad, diagnóstico y resultado del tratamiento. La terapia incluyó como mínimo 50 sesiones. Los instrumentos utilizados fueron Profile of Mood States (POMS) para medir la Depresión y Reflective Functioning Scale para medir la Función Reflexiva (Reflective Function, RF). Para el análisis estadístico se utilizó la correlación de rangos de Spearman. Resultados: En los tres casos se observó una tendencia descendente para la variable Depresión. La RF disminuyó en un caso, y en dos casos no se modificó. Sólo en un caso se halló una correlación (negativa) entre Depresión y RF. Conclusiones: En estudios futuros deberá investigarse una muestra más amplia y homogénea. Se recomienda la utilización de un diseño de investigación y de métodos estadísticos más complejos, así como la inclusión de diversas variables de proceso.