Association between childhood trauma and loss of functionality in adult women with fibromyalgia.

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia / Associação entre trauma na infância e perda de funcionalidade em mulheres adultas com fibromialgia

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression

OBJETIVO: Investigar se a presença de história de trauma na infância está associada com perda de funcionalidade em mulheres adultas com fibromialgia (FM). Um segundo objetivo foi avaliar a presença de diferenças entre mulheres adultas deprimidas e não deprimidas com FM utilizando um modelo de regressão para funcionalidade. MÉTODOS: Um total de 114 mulheres adultas com FM de acordo com os critérios diagnósticos do American College of Rheumatology responderam o Childhood Trauma Questionnaire e o Questionário de Impacto da Fibromialgia. Todos os indivíduos foram entrevistados por psiquiatras treinados e avaliados para depressão utilizando o Mini International Neuropsychiatric Interview (MINI) - versão brasileira 5.0.0. Modelos de correlação e regressão foram utilizados para investigar associações entre trauma na infância e perda de funcionalidade em pacientes com FM. A amostra foi estratificada pela presença e ausência de depressão clínica. RESULTADOS: Em geral, o trauma na infância esteve associado com perda de funcionalidade em mulheres adultas com FM. Quando estratificadas por depressão, o modelo de regressão aumentou significativamente a associação em pacientes não deprimidos, mesmo após ajuste para idade e uso de medicação psicotrópica. CONCLUSÕES: Trauma na infância esteve associado de forma clinicamente importante à perda de funcionalidade em mulheres adultas com FM. As associações foram mais pronunciadas nos indivíduos sem depressão comórbida

Trauma precoce e manifestações psicossomáticas / Precocious trauma and psychosomatic manifestations

O presente artigo apresenta uma revisão da literatura sobre a relação entre trauma precoce e manifestações psicossomáticas. Iniciará com uma breve revisão da teoria das pulsões, seguido do estudo do trauma precoce na economia psicossomática e das manifestações de insuficiência mental descritas pela Escola Psicossomática de Paris. Ao final, serão apresentadas ilustrações clínicas e contribuições técnicas ao tratamento destes pacientes

This article presents a literature review of the relationship betwenn precocious trauma and psychosomatic manifestations. It begins with a short review of the drive theory, followed by the study of precocious trauma in the psychosomatic economy and the mental insufficiencies manisfestations described by the Paris Psychosomatic School. At the end it is presented some clinical illustrations and technical contributions to these patients’ treatment

Trauma precoce e manifestações psicossomáticas / Precocious trauma and psychosomatic manifestations

O presente artigo apresenta uma revisão da literatura sobre a relação entre trauma precoce e manifestações psicossomáticas. Iniciará com uma breve revisão da teoria das pulsões, seguido do estudo do trauma precoce na economia psicossomática e das manifestações de insuficiência mental descritas pela Escola Psicossomática de Paris. Ao final, serão apresentadas ilustrações clínicas e contribuições técnicas ao tratamento destes pacientes.

This article presents a literature review of the relationship betwenn precocious trauma and psychosomatic manifestations. It begins with a short review of the drive theory, followed by the study of precocious trauma in the psychosomatic economy and the mental insufficiencies manisfestations described by the Paris Psychosomatic School. At the end it is presented some clinical illustrations and technical contributions to these patients’ treatment.

The general practitioner and mental health problems: challenges and strategies for medical education.

CONTEXT AND OBJECTIVE: Within the context of primary health care and mental disorders, our aim was to study the opinions of general practitioners regarding attendance of people with mental health problems. DESIGN AND SETTING: Qualitative focal group study among primary care services in the cities of Porto Alegre and Parobé, State of Rio Grande do Sul. METHODS: A deliberately selected sample of 41 general practitioners who were working in basic health services met in focal groups. Two videos were presented, which simulated consultations for patients with depression and psychoses. The discussions about the identification and handling of mental health problems were recorded and assessed via content analysis. RESULTS: The opinions related to the difficulties of diagnosing and treating mental problems, the involvement of relatives in caring for patients, the difficulty of compliance with the treatment, the uncertainty experienced by physicians and the difficulty of referring patients to specialized services. CONCLUSIONS: The general practitioners indicated that they perceived the mental health problems among their clientele, but the diagnosis and treatment of these problems are still seen as a task for specialists. The challenge of continuing education on mental health requires methods of interactive and critical teaching, such as the problem-based approach.

The general practitioner and mental health problems: challenges and strategies for medical education

CONTEXTO E OBJETIVO: No contexto de cuidados primários de saúde e transtornos mentais, o objetivo foi conhecer as opiniões de médicos generalistas sobre o atendimento de pessoas com problemas mentais. TIPO DE ESTUDO E LOCAL: Estudo qualitativo, por grupos focais, nos Serviços Básicos de Saúde em Porto Alegre e Parobé, Rio Grande do Sul. MÉTODOS: Um grupo de 41 médicos que trabalham em cuidados primários de saúde foi escolhido de modo intencional e reunido em grupos focais. Foram apresentados a eles dois vídeos, que simulavam o atendimento de pacientes com depressão e psicose. Discussões sobre a identificação e o manejo dos problemas mentais foram gravadas e descritas pelo método de análise de conteúdo. RESULTADOS: As principais opiniões dos médicos referiram-se às dificuldades para diagnosticar e tratar os problemas mentais, o envolvimento dos familiares no cuidado dos pacientes, a dificuldade de adesão ao tratamento, as incertezas experimentadas pelos médicos e as dificuldades para referenciar os pacientes aos serviços especializados. CONCLUSÕES: Os médicos generalistas percebem os problemas mentais na sua clientela, mas consideram que o diagnóstico e tratamento destes problemas é tarefa do especialista. O desafio da educação continuada em saúde mental requer métodos de ensino interativos e críticos, como a abordagem de solução de problemas.