The different impacts of COVID-19 on the mental health of distinct health care worker categories.

The present study sought to explore the factors associated with the odds of having probable depression and posttraumatic stress disorder (PTSD) related to traumatic COVID-19 experiences and their impact on health care workers in distinct categories. In this cross-sectional study, 1843 health care workers (nurses, nurse technicians, physicians, physical therapists, and other healthcare workers) were recruited via convenience sampling. A survey was administered to obtain information regarding sociodemographic, occupational, and mental health status. Descriptive statistics and multivariable logistic regression were used for the analyses. Being a nurse technician was associated with an odds ratio of 1.76 for probable PTSD. No relation was observed between health care worker categories and the odds of probable depression. Additionally, being female and not receiving adequate PPE were related to greater odds of having probable PTSD and depression.

Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma.

The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.

To BDZ or not to BDZ? That is the question! Is there reliable scientific evidence for or against using benzodiazepines in the aftermath of potentially traumatic events for the prevention of PTSD? A systematic review and meta-analysis.

BACKGROUND: Most international guidelines suggest that benzodiazepines (BDZs) may be inefficient or iatrogenic in the aftermath of a potentially traumatic event (PTE). The goal of this study was to assess the strength of the evidence on whether the use of BDZs in the aftermath of a PTE negatively affects the incidence and severity of post-traumatic stress disorder (PTSD). METHODS: We systematically scrutinized the ISI Web of Knowledge, MEDLINE, SCOPUS, and PTSDpubs electronic databases in addition to citation searching. We included original studies providing data about the development of PTSD in adults after BDZ administration in the aftermath of a PTE. We screened 387 abstracts and selected eight studies for the qualitative synthesis and seven for the meta-analysis. We performed two separate meta-analyses, one for randomized clinical trials (RCTs) and the other for cohort studies. Heterogeneity between studies was evaluated with Higgins I² statistic and tested using the χ². This study was registered at PROSPERO (number 127170). RESULTS: The meta-analysis of the cohort studies showed an increased risk of PTSD in patients who received BDZs compared to those who did not (risk ratio (RR) = 1.53; 95% confidence interval (CI): 1.05-2.23) with a modest heterogeneity among studies (I2 = 41.8, p = 0.143). Regarding the RCTs, the combined measure revealed a tendency toward an increased severity of the PTSD symptoms (standardized mean difference (SMD): 0.24; 95% CI: 0.32-0.79). CONCLUSION: The studies reviewed showed a possible harmful effect of BDZs when used immediately after a PTE. However, these conclusions were based on a small number of studies of poor to moderate methodological quality.

Bipolar disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder comorbidity: a systematic review / Comorbidade entre o Transtorno Bipolar e Síndrome Pré-menstrual ou Transtorno Disfórico Pré-menstrual: uma revisão sistemática

OBJECTIVE: This article aims to review the comorbidity of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and bipolar disorder (BD), identify variables requiring further investigation and to remind physicians that special care is required for diagnosis and therapy. METHOD: A systematic review of articles published from 1987 to February 2012 was conducted in the Medline database with the following terms: (premenstrual syndrome OR premenstrual dysphoric disorder OR premenstrual) AND (bipolar OR mania OR manic). Seventeen articles were analyzed. RESULTS: PMS and PMDD were most often comorbid among BD-II patients and vice versa. Moreover, patients with PMS or PMDD also have an increased risk of having BD-I. In addition, bipolar women susceptible to hormonal changes exhibit more severe symptoms, more frequent relapses and a worse therapeutic response. CONCLUSION: Future investigations should attempt to stabilize hormonal levels through the continuous use of contraceptives to target a reduction in symptom severity. In addition, psychiatrists should note menstrual period dates and compare symptom intensity between the luteal and follicular phases. Finally, PMS and PMDD patients should be studied separately.

OBJETIVO: Esse artigo tem como objetivo revisar a comorbidade entre a Síndrome Pré-Menstrual (SPM) ou Transtorno Disfórico Pré-Menstrual (TDPM) e o Transtorno Bipolar (TB), identificar as variáveis que exigem uma investigação mais aprofundada e lembrar os médicos que as mulheres necessitam de cuidados especiais para diagnóstico e tratamento. MÉTODO: Foi realizada uma revisão sistemática de 1987 a fevereiro de 2012 através da base de dados Medline utilizando os seguintes descritores: (premenstrual syndrome OR premenstrual dysphoric disorder OR premenstrual) AND (bipolar OR mania OR manic). Dezessete artigos foram analisados. RESULTADOS: Pacientes com SPM ou TDPM possuem comorbidade com TB-II com maior frequência e vice-versa. Mulheres com SPM ou TDPM também possuem um risco aumentado apresentar TB-I. Além disso, as mulheres bipolares suscetíveis a mudanças hormonais cursam com sintomas mais graves, recaídas mais freqüentes e pior resposta terapêutica. CONCLUSÃO: Futuras investigações devem estabilizar os níveis hormonais com o uso contínuo de contraceptivos na tentativa de diminuir a gravidade dos sintomas. Além disso, psiquiatras devem observar os períodos menstruais e comparar a intensidade dos sintomas entre as fases folicular e lútea. Pacientes com SPM ou TDPM devem ser estudadas separadamente.

Exploratory factor analysis of the Brazilian version of the Post-Traumatic Stress Disorder Checklist: civilian version (PCL-C).

OBJECTIVE: To evaluate the factor structure of the Brazilian Portuguese version of the Post-Traumatic Stress Disorder Checklist-civilian version (PCL-C), in order to complement its validation process in Brazil. METHOD: An exploratory factor analysis with promax rotation was conducted in 175 ambulance workers of the Emergence Rescue Group (GSE from Portuguese) of the Rio de Janeiro fire brigade and 343 military police officers (MP) (150 from an elite unit of the state of Goiás). RESULTS The results revealed a two-factor solution: re-experience/avoidance, numbing/hyperarousal. All variables loaded highly in at least one factor, except for one; variable 16. This item may have had a bad performance because the analysis was based on a sample of police officers, whose professional activity demands hypervigilance as one of its basic characteristics. Internal consistency values were acceptable. CONCLUSIONS: Avoidance and numbing seem to be independent dimensions, differently from what is expected according to the DSM-IV. Therefore, new trials should be carried out in other populations, with victims of different kinds of trauma, and including females, to verify these findings.

Exploratory factor analysis of the brazilian version of the Post-Traumatic Stress Disorder Checklist: civilian version (PCL-C) / Análise fatorial exploratória da versão brasileira da Post-Traumatic Stress Disorder Checklist: versão civil (PCL-C)

OBJECTIVE: To evaluate the factor structure of the Brazilian Portuguese version of the Post-Traumatic Stress Disorder Checklist - civilian version (PCL-C), in order to complement its validation process in Brazil. METHOD: An exploratory factor analysis with promax rotation was conducted in 175 ambulance workers of the Emergence Rescue Group (GSE from Portuguese) of the Rio de Janeiro fire brigade and 343 military police officers (MP) (150 from an elite unit of the state of Goiás). RESULTS The results revealed a two-factor solution: re-experience/avoidance, numbing/hyperarousal. All variables loaded highly in at least one factor, except for one; variable 16. This item may have had a bad performance because the analysis was based on a sample of police officers, whose professional activity demands hypervigilance as one of its basic characteristics. Internal consistency values were acceptable. CONCLUSIONS: Avoidance and numbing seem to be independent dimensions, differently from what is expected according to the DSM-IV. Therefore, new trials should be carried out in other populations, with victims of different kinds of trauma, and including females, to verify these findings.

OBJETIVO: Avaliar a estrutura de fatores da versão brasileira em português da Post-Traumatic Stress Disorder Checklist - versão civil (PCL-C) - para complementar seu processo de validação no Brasil. MÉTODO: Uma análise fatorial exploratória com rotação promax foi realizada em 175 funcionários de ambulâncias do Grupo de Socorro de Emergência (GSE) dos bombeiros da cidade do Rio de Janeiro e em 343 soldados da polícia militar (PM) (150 dos quais de uma unidade de elite do estado de Goiás). RESULTADOS: Os resultados revelaram uma solução com dois fatores: revivência/evitação e embotamento/hiperativação. Todas as variáveis apresentaram uma carga elevada em pelo menos um fator, exceto pela variável 16. Esse item pode ter tido um desempenho fraco pela análise ter sido baseada em uma amostra de policiais, cuja atividade profissional exige a hipervigilância como uma de suas características básicas. Os valores de consistência interna foram aceitáveis. CONCLUSÕES: A evitação e o embotamento parecem ser dimensões independentes, diferentemente do que era esperado de acordo com a DSM-IV. Portanto, novos ensaios clínicos devem ser realizados em outras populações, com vítimas de diferentes tipos de trauma e incluindo mulheres, para se comprovar esses achados.

Bipolar disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder comorbidity: a systematic review.

OBJECTIVE: This article aims to review the comorbidity of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and bipolar disorder (BD), identify variables requiring further investigation and to remind physicians that special care is required for diagnosis and therapy. METHOD: A systematic review of articles published from 1987 to February 2012 was conducted in the Medline database with the following terms: (premenstrual syndrome OR premenstrual dysphoric disorder OR premenstrual) AND (bipolar OR mania OR manic). Seventeen articles were analyzed. RESULTS: PMS and PMDD were most often comorbid among BD-II patients and vice versa. Moreover, patients with PMS or PMDD also have an increased risk of having BD-I. In addition, bipolar women susceptible to hormonal changes exhibit more severe symptoms, more frequent relapses and a worse therapeutic response. CONCLUSION: Future investigations should attempt to stabilize hormonal levels through the continuous use of contraceptives to target a reduction in symptom severity. In addition, psychiatrists should note menstrual period dates and compare symptom intensity between the luteal and follicular phases. Finally, PMS and PMDD patients should be studied separately.

Análise de custo-efetividade da trombólise com alteplase no acidente vascular cerebral / Analysis of the cost-effectiveness of thrombolysis with alteplase in stroke

FUNDAMENTO: Acidente Vascular Cerebral (AVC) é a principal causa de óbito no Brasil e pouca informação está disponível sobre custo do tratamento. OBJETIVO: Elaborar análise de custo-efetividade da trombólise no AVC, até três horas após o início dos sintomas, comparando o tratamento com alteplase versus conservador, sob a perspectiva do Sistema Único de Saúde (SUS). MÉTODOS: Modelo de análise de decisão foi desenvolvido para comparar os dois tratamentos. Ciclos foram considerados, durante os quais pacientes poderiam transitar entre cinco estágios de incapacidade pós-AVC, baseados na escala modificada de Rankin. A probabilidade de apresentar hemorragia intracerebral no primeiro ano foi obtida do ensaio NINDS. Para os anos subsequentes, ciclos de um ano foram considerados, para contabilizar a mortalidade dos pacientes. O desfecho foi expresso em Anos de Vida Ajustados pela Qualidade (QALY). Tanto os custos diretos quanto os indiretos foram considerados na análise. Custos e desfecho foram descontados em 5 por cento ao ano. RESULTADOS: No primeiro ano, o QALY ganho foi de 0,06 para ambos os gêneros, com custo incremental de R$ 2.558 para homens e R$ 2.312 para mulheres. A razão de custo-efetividade incremental em um ano foi de R$ 40.539 / QALY (USD 28.956) para homens e R$ 36.640 / QALY (USD 26.171) para mulheres. Após o segundo ano, o tratamento com alteplase reduziu o custo do tratamento (índice de Paridade do Poder de Compra US$ 1 = R$ 1,4). CONCLUSÃO: Terapia trombolítica com alteplase nas primeiras três horas após o AVC é custo-efetiva no cenário do Sistema Único de Saúde.

BACKGROUND: The cerebrovascular accident (CVA) or stroke is the main cause of death in Brazil and little information is available on the cost of treatment. OBJECTIVE: To carry out a cost-effectiveness analysis of thrombolysis in stroke, up to three hours after symptom onset, comparing the treatment with alteplase versus the conservative treatment, under the perspective of the Brazilian Public Health System (SUS). METHODS: A decision analysis model was developed to compare the two types of treatment. Cycles were considered, during which the patients would go through five stages of disability post-stroke, based on the modified Rankin scale. The probability to present intracranial hemorrhage in the first year was obtained from the NINDS trial. For the subsequent years, one-year cycles were considered to calculate patients' mortality. The outcome was expressed as quality-adjusted life years (QALY). Both direct and indirect costs were considered in the analysis. Costs and outcomes were discounted at 5 percent a year. RESULTS: In the first year, the QALY gained was 0.06 for both sexes, with an incremental cost of R$ 2,558 for men and R$ 2,312 for women. The incremental cost-effectiveness ratio (ICER) in one year was R$ 40,539 / QALY (USD 28,956) for men and R$ 36,640 / QALY (USD 26,171) for women. After the second year, the treatment with alteplase reduced the cost of treatment (Purchasing Power Parity index: US$ 1 = R$ 1.4). CONCLUSION: The thrombolytic therapy with alteplase within the first three hours following a stroke is cost-effective in the Brazilian Public Health System scenario.

Analysis of the cost-effectiveness of thrombolysis with alteplase in stroke.

BACKGROUND: The cerebrovascular accident (CVA) or stroke is the main cause of death in Brazil and little information is available on the cost of treatment. OBJECTIVE: To carry out a cost-effectiveness analysis of thrombolysis in stroke, up to three hours after symptom onset, comparing the treatment with alteplase versus the conservative treatment, under the perspective of the Brazilian Public Health System (SUS). METHODS: A decision analysis model was developed to compare the two types of treatment. Cycles were considered, during which the patients would go through five stages of disability post-stroke, based on the modified Rankin scale. The probability to present intracranial hemorrhage in the first year was obtained from the NINDS trial. For the subsequent years, one-year cycles were considered to calculate patients' mortality. The outcome was expressed as quality-adjusted life years (QALY). Both direct and indirect costs were considered in the analysis. Costs and outcomes were discounted at 5% a year. RESULTS: In the first year, the QALY gained was 0.06 for both sexes, with an incremental cost of R$ 2,558 for men and R$ 2,312 for women. The incremental cost-effectiveness ratio (ICER) in one year was R$ 40,539 / QALY (USD 28,956) for men and R$ 36,640 / QALY (USD 26,171) for women. After the second year, the treatment with alteplase reduced the cost of treatment (Purchasing Power Parity index: US$ 1 = R$ 1.4). CONCLUSION: The thrombolytic therapy with alteplase within the first three hours following a stroke is cost-effective in the Brazilian Public Health System scenario.

Síndrome de Gilles de la Tourette associada ao transtorno de déficit de atenção com hiperatividade: resposta clínica satisfatória a inibidor seletivo da recaptura de serotonina e metilfenidato / Tourette syndrome associated with attention-deficit hyperactivity disorder: satisfactory clinical response to selective serotonin reuptake inhibitor and methylphenidate

A Síndrome de Gilles de la Tourette (SGT), caracterizada pela presença de tiques motores e vocais, apresenta elevada associação com transtorno obsessivo-compulsivo (TOC) e transtorno de déficit de atenção com hiperatividade (TDAH). Essas condições frequentemente causam mais prejuízo aos pacientes do que os tiques, propriamente. Relata-se o caso clínico de um paciente com SGT e comorbidade com TDAH e TOC. O tratamento com inibidor seletivo de recaptura de serotonina (ISRS) e metilfenidato promoveu melhora significativa dos sintomas de TDAH, sintomas compulsivos e tiques.

Tourette Syndrome (TS), characterized by motor and vocal tics, is often associated with obsessive compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). These associated conditions frequently cause more impairment in patients than tics themselves. We report the case of TS with comorbid ADHD and OCD. Treatment with selective serotonin reuptake inhibitor and methylphenidate, led to significantly improvement of ADHD symptoms, compulsive symptoms and tics.

Prevalência de dismenorréia primária e seu impacto sobre a produtividade em mulheres brasileiras: estudo DISAB / Prevalence and productivity impact of primary dysmenorrhea in brazilian women: DISAB study

Objetivo: Determinar a prevalência da dismenorréia primária em mulheres brasileiras com vínculo empregatício e estimar o seu impacto sobre a produtividade das mesmas. Métodos: Foi realizado um inquérito epidemiológico envolvendo 156 funcionárias de call center de uma empresa situada na cidade do Rio de Janeiro, com idade superior a 18 anos e em período de menacme. As mulheres foram entrevistadas por médicas para o rastreamento clínico de dismenorréia primária, conforme diretrizes da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia. As funcionárias que preencheram os critérios diagnósticos foram solicitadas a responderem o WPAI-GH, para avaliação de produtividade, e a Escala Numérica da Dor. A redução global da produtividade leva em conta tanto o absenteísmo quanto o presenteísmo. Multiplicando-se o percentual de limitação global ao trabalho pela remuneração por hora da trabalhadora, foi obtido o valor monetário da perda de produtividade. Resultados: A prevalência obtida foi igual a 65%. A intensidade média da dor foi 7,5 (em escala de 0 a 10). Relataram absenteísmo devido à dismenorréia 30% das mulheres, sendo o tempo médio igual 41 minutos. Os sintomas de dismenorréia causaram prejuízo de 66,8% na produtividade das horas trabalhadas. A intensidade da cólica menstrual se correlacionou significativamente com a perda de produtividade. O custo da redução global de produtividade em um ano foi igual a 99,3% do salário mensal (aproximadamente um mês de trabalho/ano/funcionária). Conclusão: A dismenorréia primária e a intensidade da cólica menstrual constituem importantes fatores associados à perda de produtividade laboral e em outras atividades diárias entre mulheres brasileiras durante o seu período de vida reprodutiva.

Estrutura fatorial da versão brasileira do "Post-traumatic Stress Disorder Checklist - Civilian Version (PCL-C)" / Factor structure of Brazilian Portuguese version of “Post-traumatic Stress Disorder Checklist – Civilian Version (PCL-C)

Com o advento do DSM-III, o transtorno de estresse pós-traumático (TEPT) emergiu como uma nova entidade diagnóstica, na classe dos transtornos de ansiedade. Ao contrário dos demais transtornos psiquiátricos, oTEPT apresenta uma etiologia definida: a exposição a um evento traumático. Em consequência deste evento desenvolveram-se três dimensões de sintomas: revivescência, esquiva/ entopercimento emocional e hiperexcitabilidade. Inicialmente, acredita-se que o TEPT era restrito a situações de guerra. Estudos recentes sobre a prevalência do TEPT revelam, contudo, que este transtorno é mais prevalente do que se acreditava em princípio. As evidências sugerem que eventos relativamente comuns na vida das pessoas podem desencadear TEPT, como, por exemplo, condições médicas graves e acidentes de trânsito. No Brasil, a taxa de prevalência não é conhecida. Contudo, em conseqüência da alta taxa de eventos traumáticos em nosso país, supomos que a prevalência de TEPT seja elevada. O Postraumatic Stress Disorder Checklist - civilian version (PCL-C) é uma escala auto-administrada amplamente utilizada para avaliar sintomas relacionados a traumas não militares. É o único instrumento de rastreamento de TEPT adaptado para a língua portuguesa. Embora tenha sido demonstrada a equivalência semântica desta versão, as outras etapas do processo de adaptação transcultural ainda não foram realizadas. A revisão da literatura não revela um padrão consistente de soluções fatoriais, variando entre 3 e 4 fatores. O presente estudo tem como objetivo complementar a validação da versão em português do Post Traumatic Stress Disorder Checklist - civilian version (PCL- C), através da apreciação da validade de construto (avaliação da estrutura fatorial do instrumento) e da confiabilidade (consistência interna de suas dimensões)...