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1.
Psychiatr Danub ; 31(Suppl 3): 252-257, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488736

RESUMO

Major depression is one of the most frequent psychiatric conditions. Despite many available treatment methods, more than 30% of patients do not achieve remission, even after trying several antidepressants and augmentation strategies. S-enantiomer of ketamine, well-known anesthetic and analgesic, has been recently approved by Food and Drug Administration in the intranasal form as a new generation antidepressant. However, the mechanism in which ketamine reduces depressive symptoms in treatment-resistant depression patients is still not completely understood. There are several theories explaining how ketamine might reduce depressive symptoms, which have been described in detail; one of them is immunomodulatory effect of ketamine, according to the inflammatory theory of depression. In the review authors present and summarize studies showing ketamine effect on human immune system ex vivo and in vitro, including changes in cytokine levels, number, ratio and activity of various immune cell population and the correlation with clinical improvement in depressive symptoms. Most of the results confirm the anti-inflammatory effect of ketamine. There are only a few studies in the population of patients suffering from depression receiving ketamine, focused on correlation between immunological changes and clinical outcome of the therapy; further studies of that area are neccesary for understanding the immunomodulatory effect of ketamine in depression.


Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/imunologia , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/imunologia , Ketamina/imunologia , Ketamina/uso terapêutico , Antidepressivos/imunologia , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Depressão/imunologia , Humanos , Imunomodulação/imunologia
2.
Psychiatr Danub ; 31(Suppl 3): 258-260, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488737

RESUMO

Suicidal ideations or attempts in patients with major depressive disorder (MDD) are emergent conditions that require immediate treatment. Numerous therapeutic interventions to reduce suicide risk in psychiatric disorders are effective in long-term suicide prevention, but there is necessity of sufficient, rapid pharmacological treatment of suicidal risk in MDD. Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has been reported to have rapid antidepressant effect. Depressive symptoms, anxiety, hopelessness, suicidal ideation had decreased within hours after ketamine infusion. Ketamine's rapid symptoms relief and reduction of suicide thoughts has aroused growing interests in psychiatric association.


Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/uso terapêutico , Suicídio/prevenção & controle , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Humanos , Ideação Suicida , Suicídio/psicologia
3.
Psychiatr Danub ; 31(Suppl 3): 520-523, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488784

RESUMO

Major depressive disorder is one of the most important psychiatric issues worldwide, with important prevalence of treatment-resistant depression (TRD). Non-monoaminergic agents are currently in the spotlight. Objective was to explore for information about mechanisms of action of ketamine, its connections with copper and possible importance for TRD treatment. There are at least few possible pathways for ketamine action in depression in which copper and other divalent ions may show a vital role. There is urgent need for more studies to gather information about correlation between ketamine, copper and antidepressive features of these agents.


Assuntos
Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Cobre/metabolismo , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/metabolismo , Ketamina/farmacologia , Ketamina/uso terapêutico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/metabolismo , Humanos
4.
Psychiatr Danub ; 31(Suppl 3): 549-553, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488789

RESUMO

Depression affects over 121 million people annually worldwide. Relatively low remission rates among depressive patients enforce the search for new therapeutic solutions and an urgent need to develop faster-acting antidepressants with a different mechanism of action occurs. The pathomechanism of depression postulated by the monoamine hypothesis is limited. The results of abnormalities in glutamate and γ-aminobutyric acid (GABA) systems in the brains of people with mood disorders allowed to develop new theories regarding pathophysiology of these disorders. Glutamatergic transmission is influenced by magnesium and ketamine through glutamatergic N-methyl-D-aspartate receptor (NMDAR) antagonistic effects. Magnesium and ketamine have a common mechanism of action in the treatment of depression: an increase in GluN2B (NMDAR subunit) expression is related to the administration of both of the agents, as well as inhibition of phosphorylation of eEF2 (eukaryotic elongation factor 2) in cell culture and increase of the expression of BDNF in the hippocampus. Combination of ketamine and magnesium in a normal magnesium level presents a superadditive effect in depression treatment. Analysed substances affect the GABAergic system and have anti-inflammatory effects, which is correlated with their antidepressant effect. The synergistic interaction between the pharmacodynamic activity of magnesium and ketamine may be of particular importance for patients with mood disorders. Further research is needed to determine the relationship between magnesium levels and ketamine treatment response mainly in the attempt to establish if the magnesium supplementation can change ketamine treatment response time or present superadditive effect.


Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Ketamina/uso terapêutico , Magnésio/uso terapêutico , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Humanos , Fator 2 de Elongação de Peptídeos/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo
5.
Psychiatr Danub ; 31(Suppl 3): 554-560, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488790

RESUMO

Bipolar depression (BD) is among the most severe psychiatric disorders. A significant number of patients do not achieve an entirely symptom-free state and experience residual sub-syndromal depression. Most of the treatment options approved for bipolar depression give no rapid symptom improvement. Ketamine is an anaesthetic medication that acts as an antagonist of the NMDA receptor and has antidepressant potential. Due to its unique way of action, ketamine seems to be crucial for the treatment of anhedonia. This review paper aims to provide an overview of the efficacy of ketamine infusions in bipolar depression with a focus on anhedonia Literature suggests that intravenous ketamine 0.5 mg/kg over 40 min weekly could be useful in the treatment of bipolar depression with prominent anhedonia, but there is still a small number of studies that examine the efficacy of ketamine infusions in BD. In conclusion, ketamine should be considered as a valuable treatment option for patients with BD and anhedonia.


Assuntos
Anedonia/efeitos dos fármacos , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Depressão/complicações , Depressão/tratamento farmacológico , Ketamina/farmacologia , Ketamina/uso terapêutico , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Transtorno Bipolar/complicações , Humanos
6.
Magnes Res ; 31(2): 33-38, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30398153

RESUMO

Depression is one of the major causes of disability worldwide. A proportion of adults with major depression fail to achieve remission with first-line treatment. Magnesium influences the neurotransmission involved in emotional processes, such as the serotonergic, noradrenergic, dopaminergic, GABAergic and glutamatergic systems. It has been reported that the mechanism of antidepressants' action is involved in the glutamatergic system. Theories about the role of magnesium ions in pathophysiology of major depressive disorder include blocking the glutamatergic N-methyl-D-aspartate receptor (NMDAR). Ketamine, NMDAR antagonist, was found to promote fast-acting antidepressant and antisuicidal effects. Magnesium and ketamine seem to be involved in key mechanisms of the major depression pathophysiology. The evidence in the paper discussed may indicate the synergistic interaction between magnesium and ketamine pharmacodynamic activity being of particular importance in mood disorders.


Assuntos
Analgésicos/uso terapêutico , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Ketamina/uso terapêutico , Magnésio/uso terapêutico , Analgésicos/química , Animais , Antidepressivos/química , Humanos , Ketamina/química , Magnésio/química
7.
Med Hypotheses ; 119: 14-17, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30122482

RESUMO

Depression is one of the most common psychiatric issues with a proportion of adults with major depressive disorder who fail to achieve remission with index pharmacological treatment. There are unmet needs in ADT focus on non-monoaminergic agents. Accumulating evidence suggests that the N-Methyl-d-aspartate receptor (NMDAR) plays an important role in the neurobiology and treatment of major depressive disorder. The role of copper ions in pathogenesis and treatment of depression is not fully clarified, however interaction between copper and NMDAR is of prime importance. Release of copper ions inhibits NMDAR and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor function thus protects neurons from glutamatergic excitotoxity. Abnormalities in glutamatergic transmission are the key of glutamate hypothesis of depression. Some authors revealed that NMDARs are also regulated by cellular prion protein (PrPC) and indicated that interactions of copper, glycine and NMDARs subunits are vital for the regulation of the receptor. As NMDAR antagonist ketamine is known to produce rapid antidepressive effect, observation of copper serum levels in patients treated with ketamine may provide important information about connections between NMDAR antagonistic agents and trace elements antagonistic to that receptor. It is necessary to carry out further studies related to copper and ketamine in depression treatment.


Assuntos
Cobre/química , Transtorno Depressivo/tratamento farmacológico , Ketamina/uso terapêutico , Anestésicos/uso terapêutico , Animais , Antidepressivos/uso terapêutico , Ácido Glutâmico/metabolismo , Hipocampo/metabolismo , Humanos , Íons , Camundongos , Proteínas do Tecido Nervoso/metabolismo , Neurônios/metabolismo , Proteínas Priônicas/metabolismo , Ratos , Receptores de N-Metil-D-Aspartato/metabolismo
8.
Neurol Neurochir Pol ; 52(6): 657-661, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30131174

RESUMO

People with epilepsy (PWE) frequently suffer from comorbid mood and anxiety disorders. Depression is one of the major psychiatric comorbidities having a negative impact on the quality of life in people with epilepsy. A review of the literature indicates that the majority of antidepressant-related seizures have been associated with either ultra-high doses or overdosing and, generally, the risk of antidepressant-associated seizures is low. Correspondingly, there is some evidence indicating that antidepressants of most widely used groups may additionally lower the risk of triggering seizures. Four antidepressants are not recommended for patients with epilepsy, i.e.: amoxapine, bupropion, clomipramine and maprotiline. Clinicians applying first line of depression treatment in patients with epilepsy should consider use of SSRIs or SNRIs, particularly sertraline, citalopram, mirtazapine, reboxetine, paroxetine, fluoxetine, escitalopram, fluvoxamine, venlafaxine, duloxetine. Implementation of anticonvulsive drugs in depressed patients should include valproate, carbamazepine, lamotrigine, gabapentin, pregabalin. The paper reviews the evidence for the clinical use of antidepressants in PWE.


Assuntos
Antidepressivos/efeitos adversos , Epilepsia , Qualidade de Vida , Citalopram , Epilepsia/induzido quimicamente , Humanos , Inibidores de Captação de Serotonina
9.
Psychiatr Danub ; 29(Suppl 3): 341-344, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953787

RESUMO

BACKGROUND: Neurosyphilis is an infection of the brain or spinal cord caused by Treponema pallidum. In the third phase of syphilis involving the central nervous system it may manifest in a widespread dysfunctions including psychiatric manifestations being often underestimated in the differential diagnosis. CASE REPORTS: Two patients demonstrating rapid cognitive decline as the primary symptom for neurosyphillis are described with particular focus on the diagnostic process complexity and adequate treatment delivery. CONCLUSIONS: Clinical manifestations as well as psychiatric symptoms of syphilis are diverse and often non-specific. The symptomatology of mood disorders in neurosyphilis is frequently atypical, intermittent, and pleomorphic and fails to meet DSM-5 diagnostic categories. Neurocognitive decline although could be one of the key symptoms domains in neurosyphilis. Those two cases emphasise the importance of specific differential diagnosis with rapid onset cognitive decline with spotlight to sexually transmitted diseases as syphilis.


Assuntos
Disfunção Cognitiva , Neurossífilis , Disfunção Cognitiva/etiologia , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico , Treponema pallidum
10.
Psychiatr Danub ; 29(Suppl 3): 353-356, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953790

RESUMO

BACKGROUND: The impaired decision-making with high risk-aversive behavior and elevated impulsivity are reported as a trait feature in anxiety disorders including panic disorder (PD). It is hypothesised that PD patients exhibit difficulties in executive functions which can influence patients behavioural strategies e.g. problem solving, decision making, planning, impulse control. The aim of this study was to asses decision making process, risk-taking and impulsivity in PD patients as compared to healthy controls. MATERIAL AND METHODS: Twenty-one psychotropic drug-naive PD outpatients and 20 healthy subjects matched by age and sex were examined. Cognitive decision-making and risk-taking behaviour was measured with CGT (Cambridge Gambling Task) from CANTAB battery. The PD severity was assessed with Panic and Agoraphobia Scale (PAS). The level of anxiety and depression was assessed with HADS (Hospital Anxiety and Depression Scale). Impulsivity was evaluated with the Barratt Impulsiveness Scale, 11th version (BIS-11). RESULTS: There were no statistically significant differences on CGT in PD patients as compared to healthy control. However, having observed more closely, there are some differences between patients and healthy control. PD patients with higher anxiety level in HADS exhibited lower percentages of risky decisions comparing to PD with lower anxiety in HADS. PD patients with higher depression level in HADS demonstrated slowed decision-making when compared to PD patients with low level of depression in HADS. Total impulsivity and its attentional and motor dimensions were significantly higher in panic disorder patients versus healthy controls. CONCLUSION: There were no statistically significant differences with regard to CGT assessed decision-making between drug-naive PD patients and healthy controls. The PD patients with higher HADS-D depression level demonstrated slowed decision-making as compared to PD patients with low level of depression.


Assuntos
Tomada de Decisões , Comportamento Impulsivo , Transtorno de Pânico , Agorafobia , Ansiedade , Humanos , Transtorno de Pânico/psicologia
11.
Psychiatr Danub ; 29(Suppl 3): 361-364, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953792

RESUMO

BACKGROUND: Lithium carbonate is valuable and effective agent in the treatment and prophylaxis of mood disorders, particularly bipolar disorder (BD). Due to its narrow therapeutic range, frequent serum lithium estimation is necessary. To avoid the discomfort of frequent venipuncture, a non-invasive method for serum lithium concentration is needed. An alternative method of determining lithium level could be saliva or urine. Literature data regarding the reliability of saliva lithium levels is not conclusive. MATERIAL AND METHODS: The aim of this study is to provide an overview of possibility to replace blood serum with saliva look through research in that field. RESULTS: Some authors conclude that there is constant ratio between serum and saliva lithium level and they suggest that saliva can replace serum for estimation lithium level. Other revealed that saliva/serum lithium ratio is constant individually, so saliva/serum lithium ratio should be estimated individually. Finally there are studies excluding the possibility of replacement serum with saliva. CONCLUSIONS: There is little number of studies on saliva clinical use in lithium level monitoring. Further studies should base on current data including methods of obtaining saliva and its biochemical analysis, collecting samples in a specific time frame from the last dosage of lithium, as well as inter-subject or intra-subject measurements.


Assuntos
Antimaníacos , Transtorno Bipolar , Carbonato de Lítio , Antimaníacos/farmacocinética , Antimaníacos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Humanos , Carbonato de Lítio/farmacocinética , Carbonato de Lítio/uso terapêutico , Reprodutibilidade dos Testes , Saliva/química
12.
Psychiatr Danub ; 29(Suppl 3): 656-659, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953847

RESUMO

BACKGROUND: Treatment and rehabilitation of people with intellectual and developmental disabilities is a multidisciplinary challenge, which require implementing new attitudes. The use of modern technology solutions like telepsychiatry or virtual reality may be a valuable addition to the traditional methods. OBJECTIVE: The objective of this review was to explore the usability of new technological solutions in this special population of patients. METHODS: The search in the PubMed was conducted using the following terms: (intellectual disability (Title/Abstract) OR developmental disability OR learning disorder (Title/Abstract)) AND virtual reality (Title/Abstract) OR telepsychiatry OR telemedicine OR e-mental health AND English (lang) AND (1995/01/01(PDAT): 2017/07/31(PDAT)). RESULTS: Telepsychiatry may be a useful tool in situations, when the direct access to professional assistance is limited, in solving particular problems like e.g. managing challenging behavior, also to support patients' parents and for diagnostic and educational purposes. Virtual reality can be a safe and effective method of improving different skills, developing physical fitness, and enriching the ways of spending the leisure time. CONCLUSIONS: Using modern technology is a relatively new and promising field in which new ideas may develop to support the already existing services for patients with intellectual and developmental disabilities.


Assuntos
Deficiência Intelectual , Telemedicina , Realidade Virtual , Deficiências do Desenvolvimento/terapia , Humanos
13.
Psychiatr Danub ; 29(Suppl 3): 664-666, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953849

RESUMO

BACKGROUND: In the literature we can find evidence that immunological processes are involved the alterations of cognition in schizophrenic patients. Another factor, which may have an impact on cognitive domains in this clinical group are hormones. OBJECTIVE: The objective of this review was to explore studies, in which the role of both immunological and endocrine factors on cognitive functions in schizophrenia are analyzed. METHODS: The search of papers covering this topic in PubMed and Google Scholar was performed. RESULTS: The studies focusing on this co-relation are not numerous. The role such hormones like cortisol, insulin and sex hormones may be important in the immunomodulatory processes influencing cognition in schizophrenia. CONCLUSIONS: More studies are necessary to confirm these possible co-relations.


Assuntos
Transtornos Cognitivos , Hormônios Esteroides Gonadais , Inflamação , Psicologia do Esquizofrênico , Cognição , Transtornos Cognitivos/complicações , Humanos , Hidrocortisona , Testes Neuropsicológicos
14.
Postepy Dermatol Alergol ; 31(2): 92-7, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-25097474

RESUMO

Clinical manifestations of drug-induced skin reactions include a wide range of symptoms, from mild drug-induced exanthemas to dangerous and life-threatening generalized systematic reactions. Adverse drug reactions of low risk include phenomena such as drug-induced rashes, phototoxic reactions, eczemas and urticarias, which appear most often when the medication is being introduced. Drug-induced skin reactions to psychotropic medication are usually associated with antiepileptic drugs. However, a significant role can be assigned to selective serotonin reuptake inhibitors. The aim of this paper is to review a spectrum of severe skin complications in patients treated with antidepressants with the indication of their clinical monitoring and management.

15.
Psychiatr Danub ; 25 Suppl 2: S146-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23995164

RESUMO

BACKGROUND: In Panic Disorder (PD) both somatic and cognitive symptoms occur. Cognitive functions which may be involved with anxiety and maladaptive cognition such as e.g. attention, memory and perception might be decreased. MATERIAL AND METHODS: Within the preliminary studies eleven patients diagnosed with panic disorder (DSM-IV-TR), and nine healthy controls were studied. The severity of disorder was measured by the Panic and Agoraphobia Scale. To assess working memory Delayed Match to Sample (DMS) with CANTAB (Cambridge Neuropsychological Test Automated Battery) was used. RESULTS: Percent of correct answers was significantly different in both groups in delayed visual memory and recognition test. In the control group results were higher (M=92.22) than in the experimental group (86.06). CONCLUSIONS: PD is associated with impaired performance on a DMS task that requires the stable maintenance of representations in working memory.


Assuntos
Transtornos da Memória/etiologia , Transtorno de Pânico/complicações , Adulto , Humanos , Transtornos da Memória/diagnóstico , Memória de Curto Prazo/fisiologia , Percepção Visual/fisiologia , Adulto Jovem
16.
Psychiatr Danub ; 25 Suppl 2: S149-52, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23995165

RESUMO

BACKGROUND: Impulsivity plays a prominent role in numerous psychopathological states and poses an important clinical dilemma. However, different aspects of impulsivity are related to mood disorders, addictions, personality disorders, eating disorders, the relationship between anxiety and impulsivity is controversial and not well explored. The impact of anxiety on cognitive functioning is less explored than in other disorders (e.g. depression). The findings on cognitive functioning and impulsivity in anxiety disorders are inconsistent and are most likely due to methodological differences between the studies. MATERIAL AND METHODS: Eleven patients diagnosed with panic disorder (DSM-IV-TR) and nine healthy volunteers were enrolled to the study. Both groups did not differ significantly in terms of age, gender and educational level. The experimental group comprised of psychotropic drug naïve patients. The severity of PD was measured with Panic and Agoraphobia Scale. Impulsiveness was evaluated with the Barratt Impulsiveness Scale - 11th version (BIS-11). To asses cognitive functions CANTAB (Cambridge Neuropsychological Test Automated Battery) was used and Paired Associate Learning (PAL) test was chosen for episodic memory evaluation. RESULTS: Mean BIS-11 scores observed in the group of psychotropic drug naïve patients with panic disorder were 71.36 (SD 7.31). Mean BIS-scores recorded in the control group were 60.77 (SD 9.57). The correlation between impulsivity and PAL results in the experimental group was found at the level r=0.708723; p<0.05. The respective value for the controls was r=0.200839; p<0.05. CONCLUSIONS: Impulsivity in the experimental group was higher than adjusted average for the control group. Our findings indicate also the correlation between impulsivity and cognitive deficits in panic disorder in psychotropic drug naïve patients.


Assuntos
Comportamento Impulsivo/epidemiologia , Transtorno de Pânico/epidemiologia , Adolescente , Adulto , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Psychiatr Danub ; 24 Suppl 1: S41-3, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22945185

RESUMO

BACKGROUND: Impulsivity is the neurophysiologically based inability to confirm behaviour to its context or consequences. Overimpulsiveness characterizes many mental disorders and poses an important clinical dilemma. Although the relationship between mood disorders and impulsivity has been well studied the relationship between anxiety and impulsivity is controversial and not well explored. Some studies hypothesise that patients with the diagnosis of panic disorders are characterised by higher levels of impulsivity as a trait as compared to healthy individuals. The aim of this study was to assess cognitive correlates in panic disorder as related to impulsivity measures. MATERIAL AND METHODS: Within the preliminary studies four patients diagnosed with panic disorder (DSM-IV-TR) were studied. The severity measure was the Panic and Agoraphobia Scale. The experimental group comprised of psychotropic drug naive patients. Impulsiveness was evaluated with the Barrat Impulsiveness Scale - 11th version (BIS-11). To asses cognitive functions we used CANTAB (Cambridge Neuropsychological Test Automated Battery). RESULTS: BIS-11 scores observed in the group of psychotropic drug naive patients with panic disorder were higher than the adjusted average for the population and correlated with the number of mistakes in CANTAB (Spatial Working Memory Test); rs=0.949; p=0.0513. CONCLUSIONS: The preliminary findings indicate a correlation between impulsivity and cognitive deficits in panic disorder in psychotropic drug naive patients.


Assuntos
Agorafobia/psicologia , Conscientização , Transtornos Cognitivos/psicologia , Comportamento Impulsivo/psicologia , Transtorno de Pânico/psicologia , Adolescente , Adulto , Agorafobia/diagnóstico , Transtornos Cognitivos/diagnóstico , Humanos , Comportamento Impulsivo/diagnóstico , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Transtorno de Pânico/diagnóstico , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Estatística como Assunto , Adulto Jovem
18.
Psychiatr Danub ; 24 Suppl 1: S44-50, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22945186

RESUMO

BACKGROUND: Mood disorders are common in people with epilepsy (PWE) with prevalence rates ranging from 11% to 62%. The variation in epidemiological data results probably from the diversity of methodologies employed and selection of the populations across the studies. Moreover, the symptomathology of mood disorders in epilepsy is often atypical, intermittent and pleomorphic and fails to meet DSM-IV-TR categories. Several studies suggested the existence of distinct interictal dysphoric disorder (IDD) in patients with epilepsy. The majority of research studies in mood disorders in epilepsy were based on screening instruments in the diagnosis of mood disorders in PWE. However, the results in validity and reliability in detecting major depression in epilepsy using self-report inventories of mood symptoms is vague. The aim of this study was to review studies on mood disorders in epilepsy with particular focus on diagnostic methods. SUBJECTS AND METHODS: The focus of this Review was on patient studies on mood disorders in epilepsy (2000-2012). We searched PubMed using the following search terms (effective date: 20th May 2012): (epilepsy (Title/Abstract) OR seizure (Title/Abstract)) AND depression (Title/Abstract) OR Dysthymia OR mania OR bipolar disorder OR affective disorder OR Interictal Dysphoric Disorder OR AND (humans (MeSH Terms) AND English (lang) AND (2000/01/01(PDAT): 2012/04/31(PDAT)). RESULTS: Depression is the most frequent comorbid psychiatric disorder in epilepsy. Recent studies pointed out that bipolar disorders are not rare in epilepsy. Most of the research in PWE did not rely on standardized psychiatric measures and only about 18% of studies were based on diagnostic psychiatric interviews (mainly MINI and SCID-I). Mood disorders in epilepsy excluding the ictal or periictal symptoms can be categorized using standardized measures. CONCLUSIONS: Common self-report depression measures may be used to screen for depression in clinical settings. The use of screening instruments in epilepsy must be followed by structured psychiatric interviews designed to establish a DSM-IV-TR diagnoses. Standardized psychiatric interview procedures based on DSM criteria like SCID-I or MINI provide a comprehensive way to diagnose mood disorders in patients with epilepsy.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/diagnóstico , Transtorno Distímico/epidemiologia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Transtorno Bipolar/classificação , Transtorno Bipolar/psicologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/classificação , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtorno Distímico/classificação , Transtorno Distímico/psicologia , Epilepsia/classificação , Epilepsia/psicologia , Humanos , Classificação Internacional de Doenças
19.
Psychiatr Danub ; 24 Suppl 1: S51-5, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22945187

RESUMO

BACKGROUND: Primary insomnia (PI) is a common sleep disorder affecting diurnal functioning. It may contribute to the development of several comorbidities such as major depression or arterial hypertension. It affects about 7% of the adult population. Pharmacotherapy remains the most common treatment for insomnia. However, many studies suggest CBT may be a supreme therapeutic approach resulting in a better long-term outcome. The aim of the study was to determine the efficacy of a CBT-protocol in the treatment of PI by means of sleep onset latency and the number of awakenings during night parameters along with sleep quality and the level of psychophysiological hyperarousal. The secondary outcomes were focused on CBT efficacy as determined by the predisposition to insomnia as related to higher vulnerability to stress (measured with FIRST) MATERIAL AND METHODS: Twenty-six individuals from a tertiary reference sleep disorders outpatients' clinic (22 women; mean age 41.4; 4 men; mean age 42.5) with primary insomnia (DSM-IV-TR) were included in the study. The exclusion covered other primary sleep disorders, secondary insomnia (psychiatric illness, unstable somatic illness, shift work), substance abuse/dependence, high results in HADS-M scale (score above 11). The participants were scored with HADS-M, Ford Insomnia Response to Stress Test (FIRST) at the beginning of the study. The Athens Insomnia Scale (AIS), Hyperarousal Scale, Leeds Sleep Questionnaire (LSEQ) were applied at the beginning, at the end and three months after the end of the study. The participants were also examined by 7 days actigraphic records before and after treatment. During the course of the treatment patients completed a Sleep Diary (SD). The CBT program employed was based on the Perlis protocol. Standard individual sessions of 50 minutes were provided on a weekly basis for 8-10 weeks by a board certified CBT therapist. After 3 months a follow-up session was scheduled. RESULTS: The significant improvement as related to the CBT treatment was present in the measures of sleep onset latency (67.2 vs. 23.4 min.; p<0.000), numbers of awakenings during night (2 vs. 0.4; p<0.000) and sleep efficiency (77.3 vs. 91%; p<0.000) - data from SD, quality of falling asleep (3.2 vs. 6; p<0.000), quality of sleep (3.3 vs. 5.8; p<0.000) and quality of morning awakening (3.2 vs. 6; p<0.000) - data from LSEQ. The improvement reached the significance level in the measure of psychophysiological arousal (52.3 vs. 42.4; p<0.000) and AIS (15.7vs. 6.8; p<0.000). No significant differences were identified between actigraphic records (light/dark ratio) before and after CBT. FIRST scores allocating patients to high and low stress vulnerability groups were non-contributory to the observed treatment efficacy. CONCLUSION: CBT is an effective treatment in primary insomnia. No relationship between CBT efficacy and predisposition to insomnia as determined by higher vulnerability to stress was identified.


Assuntos
Nível de Alerta , Terapia Cognitivo-Comportamental/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/psicologia , Estresse Psicológico/complicações , Inquéritos e Questionários , Resultado do Tratamento , Vigília
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