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1.
J Clin Psychopharmacol ; 38(5): 502-504, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30106881

RESUMO

BACKGROUND: Few therapeutic options are available for patients with electroconvulsive therapy-resistant major depressive disorder (ECT-r MDD), leaving a substantial proportion of this population beyond treatment possibilities. The combination of monoamine oxidase inhibitors and tricyclic antidepressants could be a potential strategy for managing ECT-r MDD, and the specific association of amitriptyline and tranylcypromine may offer additional tolerability advantages. Although promising, in our knowledge, no studies have examined until now the effectiveness of this combination in ECT-r MDD. METHODS: We report a retrospective cohort of 31 patients with ECT-r MDD treated in an open-label fashion with the combination of amitriptyline and tranylcypromine. RESULTS: Overall, 80.6% of the sample met response criteria at the end of the first 12 weeks of treatment. Seventy-six percent (19 of 25) of the responders were followed for a mean of 9.37 ± 3.86 years. During this follow-up period, none of the patients had a recurring depressive episode. The combination was well tolerated, whereas minor adverse effects were common, and no severe or life-threatening events were reported throughout the study. CONCLUSIONS: These findings indicate that the combination tranylcypromine and amitriptyline is a potentially safe and effective candidate for future investigation in the treatment and long-term maintenance of ECT-r MDD.

3.
J Clin Psychopharmacol ; 32(1): 120-6, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22198456

RESUMO

This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)-Improvement rating than treatment with paroxetine (mean difference: CGI-Severity scale -3.48 vs -3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P < 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clonazepam over paroxetine with respect to the frequency and nature of adverse events.


Assuntos
Anticonvulsivantes/administração & dosagem , Clonazepam/administração & dosagem , Transtorno de Pânico/tratamento farmacológico , Paroxetina/administração & dosagem , Inibidores de Captação de Serotonina/administração & dosagem , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Brasil , Clonazepam/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Entrevista Psicológica , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/psicologia , Paroxetina/efeitos adversos , Inventário de Personalidade , Estudos Prospectivos , Retratamento , Inibidores de Captação de Serotonina/efeitos adversos , Adulto Jovem
4.
Braz J Psychiatr ; 33(3): 292-302, 2011 Sep.
Artigo em Português | MEDLINE | ID: mdl-21971784

RESUMO

INTRODUCTION: Social anxiety disorder (SAD) is the most common anxiety disorder, usually with no remission, and is commonly associated with significant functional and psychosocial impairment. The Brazilian Medical Association (BMA), with the project named Diretrizes (Guidelines, in English), seeks to develop consensus for the diagnosis and treatment of common diseases. The aim of this article is to present the most important findings of the guidelines on the treatment of SAD, serving as a reference for the general practitioner and specialist. METHOD: The method used was proposed by the BMA. The search was conducted in the databases of MEDLINE (PubMed), Scopus, Web of Science and LILACS, between 1980 and 2010. The strategy used was based on structured questions as PICO (acronym formed by the initials of "patient or population", "intervention, display or exhibition", "control or comparison" and "outcome"). RESULTS: Studies show that the first-line pharmacological treatment for adults and children are serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, whereas cognitive-behavioral therapy is considered the best psychotherapeutic treatment. Moreover, some psychiatric comorbidities were associated with a worse outcome of SAD. CONCLUSIONS: Despite its high prevalence, SAD does not receive adequate attention and treatment. The best choice for the treatment of adults is a combination of cognitive-behavioral psychotherapy with serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors. Other options as benzodiazepines or monoamine oxidase inhibitors must be used as second and third choices, respectively.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Transtornos Fóbicos/terapia , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/tratamento farmacológico , Brasil , Criança , Terapia Combinada/métodos , Humanos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico
5.
Rev. bras. psiquiatr ; 33(3): 292-302, Sept. 2011. ilus, tab
Artigo em Português | LILACS | ID: lil-609087

RESUMO

INTRODUÇÃO: O transtorno de ansiedade social (TAS) é o transtorno de ansiedade mais comum, freqüentemente sem remissões, sendo comumente associado com importante prejuízo funcional e psicossocial. A Associação Médica Brasileira (AMB), através do "Projeto Diretrizes", busca desenvolver consensos de diagnóstico e tratamento para as doenças mais comuns. O objetivo deste trabalho é apresentar os achados mais relevantes das diretrizes relativas ao tratamento do TAS, servindo de referência para o médico generalista e especialista. MÉTODO: O método utilizado foi o proposto pela AMB. A busca foi realizada nas bases de dados do MEDLINE (PubMed), Scopus, Web of Science e Lilacs, entre 1980 e 2010. A estratégia utilizada baseou-se em perguntas estruturadas na forma P.I.C.O (acrônimo das iniciais "paciente ou população"; "intervenção, indicador ou exposição"; "controle ou comparação" e; "outcome ou desfecho"). RESULTADOS: Estudos evidenciam que o tratamento farmacológico de primeira linha para adultos e crianças são os inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina, enquanto que a terapia cognitivo-comportamental é apontada como melhor tratamento psicoterápico. Além disso, algumas comorbidades psiquiátricas foram associadas a uma pior evolução do TAS. CONCLUSÕES: Apesar da alta prevalência, o TAS acaba por não receber a devida atenção e tratamento. A melhor escolha para o tratamento de adultos é a associação psicoterapia cognitivo-comportamental com inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina. Outras opções como benzodiazepínicos ou inibidores da monoamino-oxidase devem ser usados como segunda e terceira opção respectivamente.


INTRODUCTION: Social anxiety disorder (SAD) is the most common anxiety disorder, usually with no remission, and is commonly associated with significant functional and psychosocial impairment. The Brazilian Medical Association (BMA), with the project named Diretrizes (Guidelines, in English), seeks to develop consensus for the diagnosis and treatment of common diseases. The aim of this article is to present the most important findings of the guidelines on the treatment of SAD, serving as a reference for the general practitioner and specialist. METHOD: The method used was proposed by the BMA. The search was conducted in the databases of MEDLINE (PubMed), Scopus, Web of Science and LILACS, between 1980 and 2010. The strategy used was based on structured questions as PICO (acronym formed by the initials of "patient or population", "intervention, display or exhibition", "control or comparison" and "outcome"). RESULTS: Studies show that the first-line pharmacological treatment for adults and children are serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, whereas cognitive-behavioral therapy is considered the best psychotherapeutic treatment. Moreover, some psychiatric comorbidities were associated with a worse outcome of SAD. CONCLUSIONS: Despite its high prevalence, SAD does not receive adequate attention and treatment. The best choice for the treatment of adults is a combination of cognitive-behavioral psychotherapy with serotonin selective reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors. Other options as benzodiazepines or monoamine oxidase inhibitors must be used as second and third choices, respectively.


Assuntos
Adolescente , Adulto , Criança , Humanos , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Guias de Prática Clínica como Assunto , Transtornos Fóbicos/terapia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/tratamento farmacológico , Brasil , Terapia Combinada/métodos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico
7.
Rev. bras. psiquiatr ; 32(4): 444-452, dez. 2010. tab
Artigo em Português | LILACS | ID: lil-573854

RESUMO

OBJETIVO: O transtorno de ansiedade social é o transtorno de ansiedade mais comum, apresenta curso crônico, frequentemente sem remissões, sendo comumente associado com importante prejuízo funcional e comprometimento psicossocial. A Associação Médica Brasileira, por meio do projeto "Diretrizes", busca desenvolver consensos de diagnóstico e tratamento para as doenças mais comuns. O objetivo deste trabalho é apresentar os achados mais relevantes das diretrizes da Associação Médica Brasileira relativas ao diagnóstico e diagnóstico diferencial do transtorno de ansiedade social. MÉTODO: O método utilizado foi o proposto pela Associação Médica Brasileira para o projeto Diretrizes. A busca foi realizada nas bases de dados do Medline (PubMed), Scopus, Web of Science e Lilacs, sem limite de tempo. A estratégia utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (acrônimo das iniciais "paciente ou população"; "intervenção, indicador ou exposição"; "controle ou comparação" e; "outcome ou desfecho"). RESULTADOS: São apresentados dados relativos a manifestações clínicas, prejuízos e implicações, diferenças entre os subtipos generalizado e circunscrito, e impacto com depressão, abuso e dependência de drogas e outros transtornos de ansiedade. Além disso, foram realizadas discussões acerca dos principais diagnósticos diferenciais. CONCLUSÃO: As diretrizes propõem-se a servir de referência para o médico generalista e especialista, auxiliando e facilitando o diagnóstico do transtorno de ansiedade social.


OBJECTIVE: Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending"). RESULTS: We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION: The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.


Assuntos
Humanos , Transtornos de Ansiedade/diagnóstico , Transtornos Fóbicos/diagnóstico , Brasil , Diagnóstico Diferencial , Sociedades Médicas
8.
J Clin Psychopharmacol ; 30(3): 290-3, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20473065

RESUMO

High-potency benzodiazepines, such as clonazepam, are frequently used in the treatment of panic disorder (PD) because of their rapid onset of action and good tolerability. However, there is concern about their potential to cause withdrawal symptoms. We aimed to develop a protocol for safely tapering off clonazepam in patients with PD who had been receiving treatment for at least 3 years. A specific scale for judging withdrawal was also developed, the Composite Benzodiazepine Discontinuation Symptom Scale. We selected 73 patients with PD who had been asymptomatic for at least 1 year and who wished to discontinue the medication. The trial consisted of a 4-month period of tapering and an 8-month follow-up period. The dosage of clonazepam was decreased by 0.5 mg per 2-week period until 1 mg per day was reached, followed by a decrease of 0.25 mg per week. The mean dosage at the start of tapering was 2.7 +/- 1.2 mg/d. In total, 51 (68.9%) of the patients were free of the medication after the 4 months of tapering according to the protocol, and 19 (26.0%) of the patients needed another 3 months to be free of medication. Clonazepam discontinuation symptoms were mostly mild and included mainly: anxiety, shaking/trembling/tremor, nausea/vomiting, insomnia/nightmares, excessive sweating, tachycardia/palpitations, headache, weakness, and muscle aches. The improvement in PD and general well-being was maintained during both the taper and follow-up phases. Clonazepam can be successfully discontinued without any major withdrawal symptoms if the dose is reduced gradually. We recommend reducing the dosage of clonazepam after intermediate-term use by 0.25 mg/wk.


Assuntos
Clonazepam/administração & dosagem , Transtorno de Pânico/tratamento farmacológico , Transtorno de Pânico/psicologia , Síndrome de Abstinência a Substâncias/prevenção & controle , Síndrome de Abstinência a Substâncias/psicologia , Adolescente , Adulto , Idoso , Clonazepam/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica/normas , Síndrome de Abstinência a Substâncias/etiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Rev. psiquiatr. clín. (São Paulo) ; 37(1): 16-22, jan. 2010. tab
Artigo em Português | LILACS | ID: lil-545761

RESUMO

CONTEXTO: Atualmente há na literatura um crescente interesse na interface entre exercício físico e transtornos psiquiátricos. Apesar disso, ainda há uma deficiência de instrumentos de autorrelato para medir os níveis de atividade física dos pacientes. OBJETIVO: A tradução, a aferição da equivalência semântica e uma aplicação piloto (n = 30), sem pretensão psicométrica, do Questionário de Atividade Física Habitual, visando sua utilização na população brasileira de diferentes níveis de escolaridade. MÉTODOS: O processo envolveu duas traduções e retrotraduções realizadas por avaliadores independentes, avaliação das versões seguida da elaboração de uma versão síntese e pré-teste comentado. RESULTADOS: A maioria dos participantes (91 por cento) não apresentou dificuldades de compreensão com o questionário. Para cada item do instrumento, apresentam-se os resultados das quatro etapas. Mais estudos são necessários para determinar a adequação para populações de baixa escolaridade. Os autores recomendam que sujeitos menos instruídos sejam supervisionados ao preencher o questionário. CONCLUSÕES: A utilização de duas versões de tradução e retrotradução, a discussão sobre a versão síntese e a interlocução com a população-alvo proporcionam maior segurança ao processo de equivalência semântica.


BACKGROUND: There has been a growing scientific interest on the interface between exercise and psychiatric disorders. However, there is a lack of self-report instruments to assess levels of physical activity adapted to Brazilian Portuguese. OBJECTIVE: To translate, assess the semantic equivalence of the Habitual Physical Activity Questionnaire and perform a non-psychometric pre-test with subjects (n = 30) from the Brazilian population, with different educational backgrounds. METHODS: The cross-cultural adaptation process consisted of two translations and back translations performed by two independent evaluators; an evaluation of the versions and the development of a synthetic version; and a commented pretest of the questionnaire. RESULTS: For each item of the instrument, the results of the four stages are reported. Most of the participants (91 percent) did not present any difficulties comprehending the items of the instrument. Further studies should be addressed to determine the adequacy of using this instrument in the less-educated population. We recommend that less instructed subjects be supervised while responding the questionnaire. DISCUSSION: The use of two translations versions, their critical appraisal and the assessment of the target population conceives more safety to the process of semantic equivalence.


Assuntos
Exercício , Atividade Motora , Inquéritos e Questionários , Semântica , Tradução
10.
Braz J Psychiatr ; 32(4): 444-52, 2010 Dec.
Artigo em Português | MEDLINE | ID: mdl-21308267

RESUMO

OBJECTIVE: Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English), endeavors to develop diagnostic and treatment protocols for the most common disorders. This work presents the most relevant findings regarding the guidelines of the Brazilian Medical Association concerning the diagnosis and differential diagnosis of social anxiety disorder. METHOD: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes project. The search was performed on the online databases Medline (PubMed), Scopus, Web of Science, and Lilacs, with no time restraints. Searchable questions were structured using PICO format (acronym for "patient or population"; "intervention, indicator or exposition"; "control or comparison" and; "outcome or ending"). RESULTS: We present data regarding the clinical manifestations of social anxiety disorder, impairments and implications related to the condition, differences between the generalized and specific subtypes, and the relationship with depression, drug dependence and abuse, and other anxiety disorders. Additionally, the main differential diagnoses are discussed. CONCLUSION: The guidelines are intended to serve as references to the general practitioner and the specialist as well, facilitating the diagnosis of social anxiety disorder.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos Fóbicos/diagnóstico , Brasil , Diagnóstico Diferencial , Humanos , Sociedades Médicas
11.
Expert Rev Neurother ; 9(2): 245-54, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19210198

RESUMO

The clinical and therapeutic aspects of nocturnal panic attacks (NPAs) remain poorly understood. Some authors present NPAs as a more severe and less cognitive form of panic disorder (PD), whereas others treat it as a different manifestation of conventional panic attack. Overall, few articles address NPA relative to the large amount of literature regarding PD. Important aspects regarding the management of NPAs, such as the appropriate pharmacological and psychological treatment, rely on relatively few studies. This review provides an update and review of the most relevant articles regarding conceptualization of NPA, differential diagnosis, comorbidities, treatments, etiological theories and new investigations developed by various research centers. We also discuss the etiological hypotheses of NPAs, focusing on the suffocation false alarm theory and conditioned fear. NPA patients may represent a subtype of PD with specific agoraphobic features, respiratory connections and unique therapeutic aspects.


Assuntos
Terrores Noturnos , Transtorno de Pânico , Animais , Humanos
12.
World J Biol Psychiatry ; 10(4 Pt 3): 702-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18663667

RESUMO

Research into the aetiology of social phobia can contribute to the prevention and treatment of socially anxious people. Based on the theory of social skills deficits, we reviewed several studies that examined the adequacy of social behaviour through behavioural experiments with the purpose of evaluating the existence of lack of social skills in socially anxious people compared with the general population. In addition to electronic searches for papers published since 1970, using Medline, Scielo and Lilacs, references from articles were identified. In general, the results indicate that socially anxious people perform poorly in spontaneous social interactions than control participants, are classified by observers as less assertive, friendly and shy but present only discrete differences in structured situations. Social skills deficit seems to be more easily identified when children and adolescents are observed, since they probably still have not developed coping strategies. Differences between social phobics appear to be found on the more global measures of performance rather than specific skills measures.


Assuntos
Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/psicologia , Comportamento Social , Adaptação Psicológica , Avaliação da Deficiência , Humanos , Relações Interpessoais
13.
J Affect Disord ; 106(1-2): 185-9, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17604118

RESUMO

BACKGROUND: Mood disorders are considered related to anxiety disorders and their association may determine clinical course and prognosis. We aimed to describe with retrospective methodology the demographic, clinical, and treatment features in a group of panic disorder comorbid with bipolar I disorder (PD-BI) patients who were been treated for at least 3 year-period and compare them with bipolar I (BI) patients who were treated during the same period. METHOD: We compared the demographic and clinical data of 26 PD-BI, 28 BI, and 25 panic disorder (PD) outpatients without history of comorbidity with mood disorder were diagnosed and treated for at least 3 years in the Federal University of Rio de Janeiro. RESULTS: PD group have a higher educational level, are more married, and are more economically active. In the PD-BI and BI patients the disorders started earlier. They also turn out to have an equivalent pattern in the presence of drug abuse episodes, moderate or severe depressive episodes, psychotic episodes, suicide attempts, maniac episodes, mixed episodes, use of fewer days of antidepressants and benzodiazepines, and use of more days of antipsychotics and mood stabilizers. The PD-BI and the BI groups had a higher frequency of depressive episodes and psychotic episodes. LIMITATIONS: It is a retrospective data description based on a naturalistic treatment. The sample has a small size and the some data could be different in a large sample. CONCLUSION: PD-BI patients have demographic, clinical and therapeutic features similar to BI and the data support its validation as a special severe bipolar I disorder subgroup.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno de Pânico/epidemiologia , Adolescente , Adulto , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Brasil , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/tratamento farmacológico , Estudos Retrospectivos , Fatores Socioeconômicos
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