Increased health burden associated with comorbid depression in older Brazilians with diabetes.

BACKGROUND: The health burden associated with comorbid depression and diabetes in older community residents in middle income countries is unclear. METHODS: Data came from a statewide representative sample (N = 6963, age ≥ 60) in Brazil. Controlled polytomous logistic regression was used to determine whether four mutually exclusive groups (all possible combinations of the presence or absence of depression and diabetes) differed in sociodemographic characteristics, social resources, health behaviors, and selected health conditions. RESULTS: While 2.37% were expected to have comorbid depression/diabetes given sample base rates (depression: 20.92% [1457/6963]; diabetes: 11.35% [790/6959]), comorbidity was present in 3.62% (52.5% beyond expectation; P<0.0001; OR = 1.58, 95% Confidence Interval 1.29-1.95). Depression without diabetes was reported by 17.3%, and diabetes without depression by 7.7%. In controlled analyses, the depression group had poorer socioeconomic status and health behaviors, and a greater likelihood of vascular, respiratory, and musculoskeletal problems than the diabetes group. Vascular, respiratory, and urinary problems were exacerbated in comorbid depression/diabetes; the comorbid group was also more likely to be female and younger. LIMITATIONS: Cross-sectional design. CONCLUSIONS: To our knowledge, this is the first study that explicitly reports on all four possible depression/diabetes combinations in an older representative community-resident sample, using controlled analyses to identify unique associations with sociodemographic characteristics and other health conditions. The burden of comorbid depression/diabetes in Brazil, a middle income country, appears to be comparable to that found in higher income countries. So, similarly, depression without diabetes had a greater odds of adverse sociodemographic and health conditions than diabetes without depression; comorbid depression/diabetes was more likely in women and young elderly, and the odds of vascular, respiratory, and urinary conditions was increased significantly. Attention to comorbid depression/diabetes as a unique entity is needed.

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1).

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses.

OBJECTIVE: The aim of the study was to identify the variables that predict the revolving door phenomenon in psychiatric hospital at the moment of a second admission. METHODS: The sample consisted of 3,093 patients who have been followed during 5 to 24 years after their first hospital admission due to schizophrenia, and affective or psychotic disorders. Those who had had four or more admissions during the study period were considered as revolving door patients. Logistic regression analyses were used to assess the impact of gender, age, marital status, urban conditions, diagnosis, mean period of stay on the first admission, interval between the first and second admissions on the patterns of hospitalization. RESULTS: The variables with the highest predictive power for readmission were the interval between first and second admissions, and the length of stay in the first admission. CONCLUSIONS: These data may help public health planners in providing optimal care to a small group of patients with more effective utilization of the available services.

[Atypical neurosyphilis: report of a case]. / Neurossífilis atípica: relato de caso.

The present study is based on the observation of a case at the inpatient service of Clinica Olivé Leite in August 1992. A 31 years old female patient, showing cognitive deterioration and dementia syndrome associated with paranoid elements (hallucination and delirium), was admitted as a case of organic psychosis. Diagnostic investigation evidenced positive tests for syphilis in serum and cerebrospinal fluid. The following peculiar aspects are emphasized in this case: severe clinical presentation, severe presentation symptoms (amaurosis and a severe cognitive deficit), sex, age, and for being the first case diagnosed in the service since 1968 (occasion in which the last neurosyphilis case was registered in its data bank). In the following nine months, after penicillin therapy, the patient showed some improvement characterized by a reduction of productive symptoms of hallucination and delusion type, reduction of the cognitive deficit, and a higher production of the social behavior activities.