Screening for symptoms of anxiety and depression in patients admitted to a university hospital with acute coronary syndrome.

OBJECTIVE:: To investigate the prevalence of anxiety and depression in patients admitted for acute coronary syndrome to a university hospital and to examine associations with use of psychotropic drugs. METHODS:: Ninety-one patients who had had an acute coronary event were enrolled on this cross-sectional prevalence study. Characteristics of the study population and the prevalence rates of depression and anxiety in the sample were assessed using the Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) psychiatric consultation protocol, which includes clinical and sociodemographic data, and the Hospital Anxiety and Depression Scale (HADS). RESULTS:: The prevalence of symptoms of anxiety was 48.4% (44 patients) and the prevalence of depressive symptoms was 26.4% (24 patients). Of these, 19 patients (20.9% of the whole sample) had scores indicative of both types of symptoms concomitantly. Considering the whole sample, just 17 patients (18.7%) were receiving treatment for anxiety or depression with benzodiazepines and/or antidepressants. CONCLUSIONS:: Anxiety and depression are disorders that are more prevalent among patients with acute coronary syndrome than in the general population, but they are generally under-diagnosed and under-treated. Patients with anxiety and depression simultaneously had higher scores on the HADS for anxiety and depression and therefore require more intensive care.

Screening for symptoms of anxiety and depression in patients admitted to a university hospital with acute coronary syndrome / Rastreio de sintomas ansiosos e depressivos em pacientes com síndrome coronariana aguda internados em um hospital universitário

Abstract Objective: To investigate the prevalence of anxiety and depression in patients admitted for acute coronary syndrome to a university hospital and to examine associations with use of psychotropic drugs. Methods: Ninety-one patients who had had an acute coronary event were enrolled on this cross-sectional prevalence study. Characteristics of the study population and the prevalence rates of depression and anxiety in the sample were assessed using the Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) psychiatric consultation protocol, which includes clinical and sociodemographic data, and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of symptoms of anxiety was 48.4% (44 patients) and the prevalence of depressive symptoms was 26.4% (24 patients). Of these, 19 patients (20.9% of the whole sample) had scores indicative of both types of symptoms concomitantly. Considering the whole sample, just 17 patients (18.7%) were receiving treatment for anxiety or depression with benzodiazepines and/or antidepressants. Conclusions: Anxiety and depression are disorders that are more prevalent among patients with acute coronary syndrome than in the general population, but they are generally under-diagnosed and under-treated. Patients with anxiety and depression simultaneously had higher scores on the HADS for anxiety and depression and therefore require more intensive care.

Resumo Objetivo: Investigar a prevalência de ansiedade e depressão em pacientes com síndrome coronariana aguda internados em um hospital universitário e examinar sua associação com o uso de drogas psicotrópicas. Métodos: Noventa e um pacientes que sofreram evento coronariano agudo foram incluídos nesse estudo transversal de prevalência. O protocolo de interconsulta psiquiátrica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), com os dados clínicos e sociodemográficos, e a Escala Hospitalar de Ansiedade e Depressão (HADS) foram utilizados para avaliar as características da população estudada e a prevalência de depressão e ansiedade nessa amostra. Resultados: A prevalência de sintomas ansiosos foi de 48,4% (44 pacientes), e a de sintomas depressivos, de 26,4% (24 pacientes). Desses, 19 (20,9% do total da amostra) pontuaram para os dois sintomas concomitantemente. Considerando a amostra como um todo, apenas 17 pacientes (18,7%) estavam recebendo tratamento para ansiedade ou depressão com benzodiazepínicos e/ou antidepressivos. Conclusão: Ansiedade e depressão são transtornos mais prevalentes em pacientes com síndrome coronariana aguda do que na população geral, mas geralmente são subdiagnosticados e subtratados. Os pacientes com presença simultânea de ansiedade e depressão apresentam escores mais altos na escala HADS para ansiedade e depressão e necessitam, portanto, de um controle mais intensivo.

Lifestyle Intervention on Metabolic Syndrome and its Impact on Quality of Life: A Randomized Controlled Trial / Intervenção de Estilo de Vida na Síndrome Metabólica e seu Impacto na Qualidade de Vida: Um Estudo Controlado Randomizado

Abstract Background: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays. Objective: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS. Methods: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months. Results: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention. Conclusion: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship.

Resumo Fundamento: Programas de intervenção em estilo de vida podem reduzir a prevalência de síndrome metabólica (SM) e, portanto, diminuir o risco de doença cardíaca, um dos principais problemas de saúde pública da atualidade. Objetivo: Comparar os efeitos de três tipos de abordagem para programas de mudança no estilo de vida visando à redução dos parâmetros metabólicos, assim como identificar seu impacto na qualidade de vida (QV) de indivíduos com SM. Métodos: Estudo randomizado controlado incluindo 72 indivíduos com SM com idade de 30 a 59 anos, que foram randomizados em três grupos de intervenção multidisciplinar [Intervenção Padrão (IP) - grupo controle; Intervenção em Grupo (IG); e Intervenção Individual (II)] por 12 semanas. O desfecho primário foi a mudança nos parâmetros metabólicos, e o secundário, a melhora nas medidas de QV em três momentos: condição basal, aos 3 e aos 9 meses. Resultados: As intervenções IG e II resultaram em uma significativa redução em índice de massa corporal, circunferência abdominal e pressão arterial sistólica, e em melhoras da QV aos 3 meses, embora significativamente associadas com o domínio 'capacidade funcional'. Tais mudanças, entretanto, não permaneceram 6 meses após o final da intervenção. Depressão e ansiedade associaram-se significativamente com pior QV, embora sem efeito na resposta à intervenção. Conclusão: A intervenção multidisciplinar, em especial em grupo, pode ser uma estratégia efetiva e economicamente possível para controlar os parâmetros metabólicos de SM e melhorar a QV quando comparada à IP, mesmo em uma relação de dose-efeito.

Lifestyle Intervention on Metabolic Syndrome and its Impact on Quality of Life: A Randomized Controlled Trial.

BACKGROUND: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays. OBJECTIVE: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS. METHODS: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months. RESULTS: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention. CONCLUSION: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship.

Metabolic syndrome and quality of life: a systematic review.

Objectives: to present currently available evidence to verify the association between metabolic syndrome and quality of life. Method: Cochrane Library, EMBASE, Medline and LILACS databases were studied for all studies investigating the association with metabolic syndrome and quality of life. Two blinded reviewers extracted data and one more was chosen in case of doubt. Results: a total of 30 studies were included, considering inclusion and exclusion criteria, which involved 62.063 patients. Almost all studies suggested that metabolic syndrome is significantly associated with impaired quality of life. Some, however, found association only in women, or only if associated with depression or Body Mass Index. Merely one study did not find association after adjusted for confounding factors. Conclusion: although there are a few studies available about the relationship between metabolic syndrome and quality of life, a growing body of evidence has shown significant association between metabolic syndrome and the worsening of quality of life. However, it is necessary to carry out further longitudinal studies to confirm this association and verify whether this relationship is linear, or only an association factor.

Association between metabolic syndrome and quality of life / Associação entre síndrome metabólica e qualidade de vida

AIMS: Despite all progress made in understanding and treating metabolic syndrome, the study of its impact on quality of life is still controversial and not well understood. The aim of this study was to test the hypothesis that metabolic syndrome can be associated with a worse quality of life. MESTHODS: A controlled cross-sectional study included individuals with metabolic syndrome, from the sub-analysis of a randomized clinical trial about lifestyle modification and cardiovascular risk factors, as well as individuals with no metabolic syndrome, attended as outpatients in several clinics at a general university hospital in Southern Brazil. Measurements were made in individual interviews and included data collection, laboratory tests, and application of general scales such as Mini-Mental State Examination and Medical Outcomes Study Short Form, General Health Survey (SF-36). Comparisons of quantitative data used the Student's t test, followed by analysis of covariance or multiple linear regression for adjustment, and correlation coefficient. For categorical data, the Chi-square or Fisher's exact test were used. RESULTS: The study included 229 individuals, 118 metabolic syndrome and 111 no metabolic syndrome. In univariate analysis, metabolic syndrome was significantly associated with lower scores in the social functioning (p<0.001) and role emotional (p=0.019) quality of life domains, and with the Mental Component Summary score of the SF-36 (p=0.013). However, after adjustments for confounding factors, especially body mass index, the significance of these associations was lost. The only significant association between metabolic syndrome and quality of life that has remained after the adjustments was with worse QOL in the role emotional domain, but only in men (p=0.049). CONCLUSIONS: After adjusting for multiple variables, metabolic syndrome was significantly associated with decreased quality of life scores in men in the role emotional domain.

OBJETIVOS: Apesar dos avanços no entendimento e tratamento da síndrome metabólica, o estudo do seu impacto sobre a qualidade de vida é ainda controverso e inconclusivo. O objetivo deste estudo foi testar a hipótese de que a síndrome metabólica estaria associada à piora da qualidade de vida. MÉTODOS: Um estudo transversal controlado incluiu indivíduos com síndrome metabólica, advindos da subanálise de um estudo controlado randomizado sobre modificação de estilo de vida e fatores de risco cardiovascular; e indivíduos sem síndrome metabólica, provenientes de diversos ambulatórios de um hospital geral no sul do Brasil. As medidas foram realizadas em entrevistas individuais, que incluíram coleta de dados demográficos, testes laboratoriais e aplicação do Exame do Estado Mental e o Medical Outcome Study Short Form, General Health Survey (SF-36). Para comparações entre dados quantitativos, foram utilizados teste t de Student, análise de covariância ou regressão linear múltipla para os ajustes dos fatores confundidores, e coeficiente de correlação. Para dados categóricos foi utilizado o qui quadrado ou o Exato de Fisher quando necessário. RESULTADOS: O estudo incluiu 229 indivíduos, sendo 118 com síndrome metabólica e 111 sem síndrome metabólica. A síndrome metabólica foi significativamente associada com baixos escores de qualidade de vida nos domínios funcionamento social (p<0,001) e aspectos emocionais (p=0,019); e com baixos escores no Componente Sumário da Saúde Mental do SF-36 (p=0,013). Entretanto, após ajustes para os fatores confundidores, especialmente índice de massa corporal, a significância dessas associações foi perdida. A única associação significativa que foi mantida entre síndrome metabólica e qualidade de vida após a análise ajustada foi com o domínio aspectos emocionais, embora somente em homens (p=0,049). CONCLUSÕES: Após o ajuste para múltiplas variáveis, a síndrome metabólica foi significativamente associada com diminuição da pontuação para qualidade de vida em homens, no domínio aspectos emocionais.

Metabolic syndrome and quality of life: a systematic review / Síndrome metabólica e qualidade de vida: uma revisão sistemática / Síndrome metabólico y calidad de vida: una revisión sistemática

ABSTRACT Objectives: to present currently available evidence to verify the association between metabolic syndrome and quality of life. Method: Cochrane Library, EMBASE, Medline and LILACS databases were studied for all studies investigating the association with metabolic syndrome and quality of life. Two blinded reviewers extracted data and one more was chosen in case of doubt. Results: a total of 30 studies were included, considering inclusion and exclusion criteria, which involved 62.063 patients. Almost all studies suggested that metabolic syndrome is significantly associated with impaired quality of life. Some, however, found association only in women, or only if associated with depression or Body Mass Index. Merely one study did not find association after adjusted for confounding factors. Conclusion: although there are a few studies available about the relationship between metabolic syndrome and quality of life, a growing body of evidence has shown significant association between metabolic syndrome and the worsening of quality of life. However, it is necessary to carry out further longitudinal studies to confirm this association and verify whether this relationship is linear, or only an association factor.

RESUMO Objetivos: apresentar as evidências disponíveis atuais para verificar a associação entre síndrome metabólica e qualidade de vida. Métodos: Cochrane Library, EMBASE, Medline e LILACS foram as bases de dados consultadas na identificação de todos os estudos que investigavam a associação entre síndrome metabólica e qualidade de vida. Dois revisores de forma independente e cegados extraíram os dados e, em caso de dúvidas, um outro revisor foi escolhido. Resultados: um total de 30 estudos foram incluídos, considerando os critérios de inclusão e exclusão, os quais envolveram 62.063 pacientes. A maioria dos estudos sugerem que a síndrome metabólica é significativamente associada à piora da qualidade de vida. Alguns, no entanto, demonstram associação apenas em mulheres, ou somente se associadas à depressão ou índice de massa corporal. Entretanto, um estudo não demonstrou tal associação, após ajuste para os fatores confundidores. Conclusão: apesar de dispormos de poucos estudos a respeito da relação entre síndrome metabólica e qualidade de vida, um número crescente de evidências tem demonstrado uma significativa associação entre a síndrome metabólica e o prejuízo na qualidade de vida. Entretanto, é necessário que sejam conduzidos estudos longitudinais com objetivo de confirmar esta associação e, determinar se esta relação é linear ou somente um fator de associação.

RESUMEN Objetivo: presentar las evidencias actualmente disponibles para verificar la asociación entre el síndrome metabólico y la calidad de vida. Métodos: se consultaron las bases de datos Cochrane Library, EMBASE, Medline y LILACS para la identificación de todos los estudios que investigaban la asociación entre síndrome metabólico y calidad de vida. Dos revisores de tipo ciego extrajeron los datos y en caso de dudas se eligió un revisor adicional. Resultados: un total de 30 estudios fueron incluidos, llevando en consideración los criterios de inclusión y exclusión, totalizando 62.063 pacientes. La mayoría de los estudios sugieren que el síndrome metabólico esta significativamente asociado al empeoramiento de la calidad de vida. Algunos, sin embargo muestran asociación solamente en mujeres, o sólo asociados a depresión o índice de masa corporal. También un estudio no mostró esta asociación después de ajustar por los factores confundentes. Conclusión: a pesar de tener a disposición pocos estudios en referencia a la relación entre síndrome metabólico y calidad de vida, un número creciente de evidencias ha demostrado una asociación significativa entre síndrome metabólico y perjuicio de la calidad de vida. Sin embargo es necesario que se realicen estudios longitudinales con el objetivo de confirmar esta asociación y determinar si esta relación es linear o solamente un factor de asociación.

Drug interactions between antineoplastic and antidepressant agents: analysis of patients seen at an oncology clinic at a general hospital.

OBJECTIVES: To determine the prevalence of depressive symptoms among oncology patients and identify simultaneous use of antineoplastic and antidepressant agents. METHODS: This was a cross-sectional study that interviewed 56 oncology patients using two data collection instruments: a questionnaire covering clinical and sociodemographic data and the Beck Depression Inventory-II (BDI-II), for assessment of depressive symptoms. For data analysis, descriptive statistics were used to determine the prevalence of depressive symptoms and the chi-square test was used to evaluate associations between sociodemographic and clinical variables and depressive symptoms. RESULTS: A 26.7% (15 patients) prevalence of depression was detected. Just eight of these 15 patients (53.3%) were receiving treatment for depression. In the sample as a whole, 13 of the patients interviewed (23.2%) were taking antidepressants and 11 of these 13 patients (19.6%) were taking antidepressive and antineoplastic agents simultaneously. A total of five (8.9% of the sample) contraindicated drug interactions were detected. CONCLUSIONS: Depressive symptoms are more prevalent among cancer patients than in the general population, but they are generally under-diagnosed and under-treated. Simultaneous use of antidepressant and antineoplastic agents is common and so, in order to reduce the number of harmful adverse effects, possible drug interactions must be identified before antidepressants are prescribed to cancer patients.

Drug interactions between antineoplastic and antidepressant agents: analysis of patients seen at an oncology clinic at a general hospital / Interação medicamentosa entre antineoplásicos e antidepressivos: análise de pacientes do ambulatório de oncologia de um hospital geral

Objectives: To determine the prevalence of depressive symptoms among oncology patients and identify simultaneous use of antineoplastic and antidepressant agents. Methods: This was a cross-sectional study that interviewed 56 oncology patients using two data collection instruments: a questionnaire covering clinical and sociodemographic data and the Beck Depression Inventory-II (BDI-II), for assessment of depressive symptoms. For data analysis, descriptive statistics were used to determine the prevalence of depressive symptoms and the chi-square test was used to evaluate associations between sociodemographic and clinical variables and depressive symptoms. Results: A 26.7% (15 patients) prevalence of depression was detected. Just eight of these 15 patients (53.3%) were receiving treatment for depression. In the sample as a whole, 13 of the patients interviewed (23.2%) were taking antidepressants and 11 of these 13 patients (19.6%) were taking antidepressive and antineoplastic agents simultaneously. A total of five (8.9% of the sample) contraindicated drug interactions were detected. Conclusions: Depressive symptoms are more prevalent among cancer patients than in the general population, but they are generally under-diagnosed and under-treated. Simultaneous use of antidepressant and antineoplastic agents is common and so, in order to reduce the number of harmful adverse effects, possible drug interactions must be identified before antidepressants are prescribed to cancer patients. .

Objetivos: Verificar a prevalência de sintomas depressivos em pacientes oncológicos e identificar o uso simultâneo de antineoplásicos e antidepressivos. Métodos: Foi realizado um estudo transversal, no qual 56 pacientes oncológicos foram entrevistados. Foram empregados dois instrumentos: um questionário para a coleta de dados clínicos e sociodemográficos e o Inventário de Depressão de Beck - Segunda Edição (BDI-II) para a avaliação de sintomas depressivos. Para a análise dos dados, foram utilizadas medidas descritivas para determinar a prevalência de sintomas depressivos, o teste de qui-quadrado para avaliar associações entre variáveis sociodemográficas e clínicas e sintomas depressivos. Resultados: Foi encontrada uma prevalência de depressão de 26,7% (15 pacientes). Apenas oito desses pacientes (53,3%) estavam recebendo tratamento para depressão. Considerando a amostra como um todo, estavam fazendo uso de antidepressivos 13 pacientes (23,2%); destes, 11 faziam uso simultâneo de antidepressivo e antineoplásico (19,6%). Foram encontradas cinco situações de interações medicamentosas contraindicadas (8,9%). Conclusão: Sintomas depressivos são mais prevalentes em pacientes oncológicos do que na população em geral, mas geralmente são subdiagnosticados e subtratados. O uso simultâneo de antidepressivos e antineoplásicos é frequente. Sendo assim, para reduzir os efeitos adversos prejudiciais, as possíveis interações medicamentosas devem ser identificadas antes que os antidepressivos sejam prescritos para pacientes oncológicos. .

Psychiatric symptoms in patients with systemic lupus erythematosus: frequency and association with disease activity using the Adult Psychiatric Morbidity Questionnaire.

INTRODUCTION: While the neurolupus criteria are well-established, global psychiatric manifestations are of variable frequency in patients with systemic lupus erythematosus (SLE); their relation with disease activity is unknown. OBJECTIVE: To evaluate the frequency of psychiatric symptoms in SLE using the Adult Psychiatric Morbidity Questionnaire (APMQ); to correlate APMQ changes with disease activity and socio-economic variables. MATERIALS AND METHODS: This cross-sectional study evaluated patients with active or inactive SLE as to the prevalence of psychiatric symptoms utilizing, for the first time, the APMQ. Eight or more affirmative replies out of 45 questions defined the APMQ as abnormal. Patients were classified according to the American College of Rheumatology 1997 criteria, and disease activity was measured by the SLEDAI. RESULTS: Seventy-two SLE patients entered the study, being 68 females (94.4%). Mean age was 46.1 years (± 12 SD). The frequency of abnormal APMQ was of 89%. Out of the 64 SLE patients with altered APMQ, 60 (93.7%) had common mental disorders, mostly anxiety and somatization. There was no correlation of psychiatric symptoms with active disease (rs = 0.09; P = 0.46), or with history of psychosis and/or seizures attributable to SLE (P = 1.00). Psychiatric symptoms also did not correlate with age at disease onset (rs = -0.16) or disease duration (rs = -0.11). There was an association of abnormal APMQ with low education level (P = 0.02), but not with family income allotted to the patient (P = 0.24). CONCLUSION: The frequency of psychiatric symptoms measured by the APMQ was high in our SLE population. An abnormal APMQ was disconnected from SLE activity, but it did associate with low education level.

Sintomas psiquiátricos em pacientes com lúpus eritematoso sistêmico: frequência e associação com atividade da doença com o uso do Questionário de Morbidade Psiquiátrica em Adultos / Psychiatric symptoms in patients with systemic lupus erythematosus: frequency and association with disease activity using the Adult Psychiatric Morbidity Questionnaire

INTRODUÇÃO: Enquanto os critérios de neurolúpus estão bem-estabelecidos, manifestações psiquiátricas globais são de frequência variável em pacientes com lúpus eritematoso sistêmico (LES); suas relações com atividade da doença e prognóstico são desconhecidas. OBJETIVO: Avaliar a frequência de sintomas psiquiátricos no LES utilizando o Questionário de Morbidade Psiquiátrica em Adultos (QMPA); correlacionar alterações no QMPA com atividade da doença e variáveis socioeconômicas. MATERIAIS E MÉTODOS: Este estudo transversal avaliou pacientes com LES ativo ou inativo quanto à prevalência de sintomas psiquiátricos utilizando, pela primeira vez, o QMPA. Oito ou mais respostas afirmativas entre 45 perguntas definiram um QMPA como anormal. Os pacientes foram classificados de acordo com os critérios do American College of Rheumatology de 1997, e o grau de atividade da doença foi mensurado pelo SLEDAI. RESULTADOS: Participaram do estudo 72 pacientes com LES, dos quais 68 eram do sexo feminino (94,4%). A média de idade foi de 46,1 anos (± 12 DP). A frequência de QMPA anormal foi de 89%. Entre os 64 pacientes lúpicos com QMPA alterado, 60 (93,7%) apresentavam distúrbios mentais comuns, a maioria ansiedade e somatização. Não houve correlação de sintomas psiquiátricos com atividade da doença (P = 0,46; rs = 0,09) ou com história de psicose e/ou convulsões atribuíveis ao LES (P = 1,00). Sintomas psiquiátricos também não se correlacionaram com idade de início da doença (rs = -0,16) ou duração da doença (rs = -0,11). Houve associação de QMPA anormal com baixo nível educacional (P=0,02), mas não com renda familiar destinada ao paciente (P = 0,24). CONCLUSÃO: A frequência de sintomas psiquiátricos medidos pelo QMPA foi alta em nossa população com LES. Um QMPA anormal esteve dissociado da atividade do LES, mas se associou com baixo nível educacional.

INTRODUCTION: While the neurolupus criteria are well-established, global psychiatric manifestations are of variable frequency in patients with systemic lupus erythematosus (SLE); their relation with disease activity is unknown. OBJECTIVE: To evaluate the frequency of psychiatric symptoms in SLE using the Adult Psychiatric Morbidity Questionnaire (APMQ); to correlate APMQ changes with disease activity and socio-economic variables. MATERIALS AND METHODS: This cross-sectional study evaluated patients with active or inactive SLE as to the prevalence of psychiatric symptoms utilizing, for the first time, the APMQ. Eight or more affirmative replies out of 45 questions defined the APMQ as abnormal. Patients were classified according to the American Collge of Rheumatology 1997 criteria, and disease activity was measured by the SLEDAI. RESULTS: Seventy-two SLE patients entered the study, being 68 females (94.4%). Mean age was 46.1 years (± 12 SD). The frequency of abnormal APMQ was of 89%. Out of the 64 SLE patients with altered APMQ, 60 (93.7%) had common mental disorders, mostly anxiety and somatization. There was no correlation of psychiatric symptoms with active disease (rs = 0.09; P = 0.46), or with history of psychosis and/or seizures attributable to SLE (P = 1.00). Psychiatric symptoms also did not correlate with age at disease onset (rs = -0.16) or disease duration (rs = -0.11). There was an association of abnormal APMQ with low education level (P = 0.02), but not with family income allotted to the patient (P = 0.24). CONCLUSION: The frequency of psychiatric symptoms measured by the APMQ was high in our SLE population. An abnormal APMQ was disconnected from SLE activity, but it did associate with low education level.

Estado confusional agudo / Acute confusional status

Estado confusional agudo é um termo utilizado na prática médica para a designação de delirium, uma síndrome neuropsiquiátrica aguda decorrente de uma patologia orgânica subjacente. Apesar de ser altamente prevalente e um potencial alerta para um distúrbio em evolução, o delirium pode passar despercebido. Os autores fazem uma revisão sobre o assunto, com ênfase no diagnóstico etiológico de suas principais patologias de base.

Acute confusional state is a termination used in the clinical practice to designate delirium, an acute neuropsychiatric syndrome due to an underlying organic pathology. Despite being highly prevalent and a potential alert for an ongoing disorder, delirium may go unnoticed. The authors make a review about the subject, emphasizing the etiologic diagnosis of its main base pathologies.

Semiologia psiquiátrica: as funções simples do ego / Psychiatric semiology: the simple functions of the ego

Este trabalho tem como objetivo revisar e discutir a semiologia psiquiátrica das funções simples do ego, fornecendo uma visão geral sobre a entrevista e avaliação do estado mental como maneiras essenciais da avaliação do paciente psiquiátrico.

A cohort study to assess the impact of depression on patients with kidney disease.

AIMS: This study assessed the impact of depression on mortality and quality of life of patients with kidney disease. MATERIAL: This study was conducted at Hospital São Lucas of Pontificia Universidade Católica of Rio Grande do Sul, Porto Alegre, Brazil, with a cohort of 125 patients seen from 1996 to 2004. (mean follow-up = 77.6 months). Patients undergoing renal replacement therapy were asked to fill in the Beck Depression Inventory (BDI). At the completion of follow-up, 72 patients were alive, and 56 answered the BDI and the Medical Outcome Study Short Form General Health Survey (SF-36) to assess quality of life. Main outcome measures were mortality and quality of life. RESULTS: Initial analysis showed that mortality was associated with age, treatment modality--continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (hd)--and depression. When controlling for age, gender, depression, and treatment modality in a multiple regression analysis, transplantation (tx), gender and age was associated with lower mortality. However, levels of depression at the end of follow-up were strongly associated with quality of life. CONCLUSIONS: Depression was not associated with mortality of patients with kidney disease when controlling for gender, age, and treatment modality. Transplantation was the main factor associated with lower mortality. Depression was, however, a strong predictor of quality of life. Number of depressive symptoms was directly associated with lower quality of life in most of the items of the SF-36.

Demência: manejo do paciente e impacto na família / Dementia: management of the patient and impact in the family

O processo de envelhecimento é uma fase marcada por mudanças profundas que culminam, às vezes, em doenças e incapacidades de naturezas diversas. a demência torna-se um desafio nessa faixa etária englobando paciente, família, equipe de saúde e cuidadores.a demência é uma síndrome clínica e não uma doença específica, na qual o decréscimo da função cognitiva que se manifesta principalmente com alterações de memória e comportamento traz prejuízos de amplo espectro para o paciente. portanto o tratamento deve ter um enfoque multidisciplinar visando conforto, apoio e dignidade da pessoa/ do indivíduo.

O paciente terminal e a morte / Terminally ill and the death

O objetivo desse trabalho é abordar a morte e o morrer, temas esses tão pouco discutidos, apesar da extrema relevância que têm para todos. Para os médicos e estudantes de medicina tal assunto é ainda mais importante, uma vez que lidam diretamente com pacientes terminais. Para tanto, iremos fornecer alguns dados epidemiológicos e fundamentos teóricos, a fim de auxiliar no aprendizado sobre esse assunto. Pretendemos também compartilhar experiências vivenciadas na tentativa de facilitar o manejo com tais pacientes

Impacto da depressão e outros fatores psicossociais no prognóstico de pacientes renais crônicos / The impact of depression and others psychosocial factors in the prognosis of chronic renal patients

Os autores realizaram uma revisão bibliográfica sobre a depressão e outros fatores psicossociais que poderiam influenciar a evolução dos pacientes renais. Avaliaram trabalhos relativos a depressão, idade, gênero, raça, suporte social e status marital/suporte familiar. Ao final, ficou demonstrado que não existem resultados definitivos nas pesquisas realizadas sobre esses fatores. A idade parece ser um fator que influencia a evolução, mas os fatores de confusão não foram contemplados nos trabalhos examinados, e surgiram evidências fortes de que o gênero não estaria associado à evolução desses pacientes.