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1.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(4): 297-302, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1011514

RESUMO

Objective: The Montgomery-Åsberg Depression Rating Scale (MADRS) is widely used to assess depression severity. The Structured Interview Guide for the MADRS (SIGMA) was created to standardize MADRS assessment. The objective of this study was to translate and validate the original SIGMA into a Brazilian Portuguese version (SIGMA-VB). Methods: We translated and cross-culturally validated the original SIGMA into the SIGMA-VB, and assessed its psychometric properties using data from 93 adult outpatients enrolled in the Integral Assessment in Unipolar Depression (AIUNI) trial. Participants were assessed by two raters on five visits over 8 weeks. We calculated multiple interrater reliability indexes for the SIGMA-VB and used the Hamilton Depression Hating Scale (HAM-D) for validation purposes. Results: According to the SIGMA-VB, participants had moderate depression at baseline followed by mild depression at 8 weeks. We found over 90% of correlation between scores attributed by different raters using the SIGMA-VB. Correlations between the SIGMA-VB and the HAM-D were above 66%. Conclusion: Our findings confirm that the SIGMA-VB is a valid and reliable instrument to assess depression severity in clinical research and practice. Its interrater reliability was similar to that of a previously published Japanese version of the SIGMA.

2.
Braz J Psychiatry ; 41(4): 297-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785536

RESUMO

OBJECTIVE: The Montgomery-Åsberg Depression Rating Scale (MADRS) is widely used to assess depression severity. The Structured Interview Guide for the MADRS (SIGMA) was created to standardize MADRS assessment. The objective of this study was to translate and validate the original SIGMA into a Brazilian Portuguese version (SIGMA-VB). METHODS: We translated and cross-culturally validated the original SIGMA into the SIGMA-VB, and assessed its psychometric properties using data from 93 adult outpatients enrolled in the Integral Assessment in Unipolar Depression (AIUNI) trial. Participants were assessed by two raters on five visits over 8 weeks. We calculated multiple interrater reliability indexes for the SIGMA-VB and used the Hamilton Depression Hating Scale (HAM-D) for validation purposes. RESULTS: According to the SIGMA-VB, participants had moderate depression at baseline followed by mild depression at 8 weeks. We found over 90% of correlation between scores attributed by different raters using the SIGMA-VB. Correlations between the SIGMA-VB and the HAM-D were above 66%. CONCLUSION: Our findings confirm that the SIGMA-VB is a valid and reliable instrument to assess depression severity in clinical research and practice. Its interrater reliability was similar to that of a previously published Japanese version of the SIGMA.


Assuntos
Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Inquéritos e Questionários , Tradução , Adolescente , Adulto , Idoso , Brasil , Comparação Transcultural , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
3.
Neurosurgery ; 2018 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-30272245

RESUMO

BACKGROUND: More than 30% of major depressive disorder patients fail to respond to adequate trials of medications and psychotherapy. While modern neuromodulation approaches (ie, vagal nerve stimulation, deep brain stimulation) are yet to prove their efficacy for such cases in large randomized controlled trials, trigeminal nerve stimulation (TNS) has emerged as an alternative with promising effects on mood disorders. OBJECTIVE: To assess efficacy, safety, tolerability, and placebo effect duration of continuous subcutaneous TNS (sTNS) in treatment-resistant depression (TRD). METHODS: The TREND study is a single-center, double-blind, randomized, controlled, phase II clinical trial. Twenty unipolar TRD patients will receive V1 sTNS as adjuvant to medical therapy and randomized to active vs sham stimulation throughout a 24-wk period. An additional 24-wk open-label phase will follow. Data concerning efficacy, placebo response, relapse, and side effects related to surgery or electrical stimulation will be recorded. We will use the HDRS-17, BDI-SR, IDS_SR30, and UKU scales. EXPECTED OUTCOMES: The main outcome measure is improvement in depression scores using HAM-17 under continuous sTNS as adjuvant to antidepressants. Active stimulation is expected to significantly impact response and remission rates. Minor side effects are expected due to the surgical procedure and electrical stimulation. The open-label phase should further confirm efficacy and tolerability. DISCUSSION: This study protocol is designed to define efficacy of a novel adjuvant therapy for TRD. We must strive to develop safe, reproducible, predictable, and well-tolerated neuromodulation approaches for TRD patients impaired to manage their lives and contribute with society.

4.
Epilepsy Behav ; 83: 181-185, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29709878

RESUMO

BACKGROUND: Temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) is the most frequent form of drug-resistant epilepsy in adults. Mood disorders are the most frequent psychiatric comorbidities observed in these patients. Common pathophysiological mechanisms of epilepsy and psychiatric comorbidities include abnormalities in the serotonin pathway. The primary goal of this study was to determine the possible association between polymorphisms of genes encoding the serotonin receptors 5HT1A (rs6295), 5HT1B (rs6296), and 5HT2C (rs6318) and the presence of mood disorders in patients with TLE-HS. Our secondary goal was to evaluate the possible association between these variants and susceptibility to develop seizures in TLE-HS. METHODS: We assessed 119 patients with TLE-HS, with and without psychiatric comorbidities; 146 patients with major depressive disorder; and 113 healthy volunteers. Individuals were genotyped for the rs6295, rs6296, and rs6318 polymorphisms. RESULTS: No difference was observed between the group with TLE-HS, healthy controls, and the group with major depressive disorder without epilepsy regarding the polymorphisms that were evaluated. There was no correlation between rs6318, rs6295, rs6296, and epilepsy-related factors and history of psychiatric comorbidities. CONCLUSIONS: Our work suggests that the studied polymorphisms were not related to the presence of TLE, psychiatric comorbidities in TLE, and epilepsy-related factors.

5.
J Affect Disord ; 235: 20-26, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29631203

RESUMO

BACKGROUND: Bipolar depression (BD) is a highly prevalent condition associated with marked cognitive deficits that persist even in the euthymic phase of the illness. Pharmacological treatments for BD might further aggravate cognitive impairment, highlighting the need of developing interventions that present cognitive safety. In this study, we evaluated the cognitive effects of H1-coil (deep) transcranial magnetic stimulation (TMS) in patients with treatment-resistant bipolar depression. METHODS: Fourty-three patients were randomized to receive 20 sessions of active (55 trains, 18 Hz, 120% resting motor threshold intensity) or sham rTMS within a double-blind, sham-controlled trial. A battery of 20 neuropsychological assessments, grouped in 6 domains (attention and processing speed, working memory and executive function, inhibitory control, language, immediate verbal memory, and long-term verbal memory) was performed at baseline and after 4 and 8 weeks of trial onset. Depressive symptoms were assessed with the 17-item Hamilton Rating Scale for Depression. RESULTS: Cognitive improvement was shown for all cognitive domains. It occurred regardless of intervention group and depression improvement. For the language domain, greater improvement was observed in the sham group over time. No correlations between depression (at baseline or during treatment) and cognitive improvement were found. LIMITATIONS: Absence of healthy control group. CONCLUSION: The results of this exploratory study provide evidence on the cognitive safety of H1-coil TMS for BD patients. Putative pro-cognitive effects of rTMS in BD were not observed and thus should be further investigated.

6.
Diversitas perspectiv. psicol ; 13(2): 255-266, jul.-dic. 2017. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-953075

RESUMO

Resumen Se realizó una revisión de literatura en la que se pretendió establecer el estado de la investigación y conceptualización del fenómeno de la resiliencia familiar y sus aportes entre los años 2010 y 2016. Se encontró que el estado de la investigación y conceptualización, si bien es aún incipiente, se observa una tendencia al aumento de trabajos de tipo empírico y teórico reflexivo, lo que implica una mayor relevancia frente a la investigación e intervención. Con respecto a las áreas de trabajo se observó la predominancia de: salud, neurociencias aplicadas y rehabilitación, social, comunitaria y de las organizaciones, seguidas por psicología clínica y prevención, psicología militar y en último lugar la educación, en su orden. Se concluyó que resulta imperante la continuidad en el desarrollo de estudios al respecto del tema y ampliar áreas de estudio como la psicología ambiental, política, de tránsito, de las organizaciones y el trabajo.


Abstract We conducted a literature review to establish the state of the art and conceptualization of family resilience between 2010 and 2016. Even if still incipient, there is an increase in both empirical and theoretical-reflective research, which involves a higher relevance in terms of research and intervention. Predominant research areas were: health, applied neuroscience and rehabilitation, social, community and organizational; followed by clinical psychology and prevention, military psychology, and education. Further research is definitely needed to continue expanding the literature and including areas such as environmental psychology, politics, mobility, organizations and work is also important.

7.
Neuropsychopharmacology ; 42(13): 2593-2601, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28145409

RESUMO

Bipolar depression (BD) is a highly prevalent condition with limited therapeutic options. Deep (H1-coil) transcranial magnetic stimulation (dTMS) is a novel TMS modality with established efficacy for unipolar depression. We conducted a randomized sham-controlled trial to evaluate the efficacy and safety of dTMS in treatment-resistant BD patients. Patients received 20 sessions of active or sham dTMS over the left dorsolateral prefrontal cortex (H1-coil, 55 18 Hz 2 s 120% MT trains). The primary outcome was changes in the 17-item Hamilton Depression Rating Scale (HDRS-17) from baseline to endpoint (week 4). Secondary outcomes were changes from baseline to the end of the follow-up phase (week 8), and response and remission rates. Safety was assessed using a dTMS adverse effects questionnaire and the Young Mania Rating Scale to assess treatment-emergent mania switch (TEMS). Out of 50 patients, 43 finished the trial. There were 2 and 5 dropouts in the sham and active groups, respectively. Active dTMS was superior to sham at end point (difference favoring dTMS=4.88; 95% CI 0.43 to 9.32, p=0.03) but not at follow-up. There was also a trend for greater response rates in the active (48%) vs sham (24%) groups (OR=2.92; 95% CI=0.87 to 9.78, p=0.08). Remission rates were not statistically different. No TEMS episodes were observed. Deep TMS is a potentially effective and well-tolerated add-on therapy in resistant bipolar depressed patients receiving adequate pharmacotherapy.


Assuntos
Transtorno Bipolar/terapia , Estimulação Magnética Transcraniana , Adulto , Antidepressivos/uso terapêutico , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pacientes Desistentes do Tratamento , Córtex Pré-Frontal , Escalas de Graduação Psiquiátrica , Indução de Remissão , Fatores de Tempo , Estimulação Magnética Transcraniana/efeitos adversos , Estimulação Magnética Transcraniana/métodos , Resultado do Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-27207914

RESUMO

OBJECTIVE: Oxidative stress and mitochondrial dysfunction are 2 closely integrated processes implicated in the physiopathology of bipolar disorder. Advanced proton magnetic resonance spectroscopy techniques enable the measurement of levels of lactate, the main marker of mitochondrial dysfunction, and glutathione, the predominant brain antioxidant. The objective of this study was to measure brain lactate and glutathione levels in bipolar disorder and healthy controls. METHODS: Eighty-eight individuals (50 bipolar disorder and 38 healthy controls) underwent 3T proton magnetic resonance spectroscopy in the dorsal anterior cingulate cortex (2x2x4.5cm(3)) using a 2-D JPRESS sequence. Lactate and glutathione were quantified using the ProFit software program. RESULTS: Bipolar disorder patients had higher dorsal anterior cingulate cortex lactate levels compared with controls. Glutathione levels did not differ between euthymic bipolar disorder and controls. There was a positive correlation between lactate and glutathione levels specific to bipolar disorder. No influence of medications on metabolites was observed. CONCLUSION: This is the most extensive magnetic resonance spectroscopy study of lactate and glutathione in bipolar disorder to date, and results indicated that euthymic bipolar disorder patients had higher levels of lactate, which might be an indication of altered mitochondrial function. Moreover, lactate levels correlated with glutathione levels, indicating a compensatory mechanism regardless of bipolar disorder diagnosis.


Assuntos
Transtorno Bipolar/metabolismo , Glutationa/metabolismo , Giro do Cíngulo/metabolismo , Ácido Láctico/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espectroscopia de Prótons por Ressonância Magnética , Adulto Jovem
9.
Eur Neuropsychopharmacol ; 25(12): 2221-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26476706

RESUMO

Bipolar disorder (BD) has been consistently associated with abnormalities in the Glutamate/GABA-Glutamine cycle. Magnetic resonance spectroscopy (MRS) studies have reported increased brain Glutamate (Glu) and Glx (Glu+Glutamine) in subjects with BD. However, data on separate measures of GABA and Glutamine (Gln) in BD are sparse due to overlapping resonant signals. The development of new sequence methods in the quantification of these metabolites has allowed a better understanding of the Glu/GABA-Gln cycle but data on this field of research remains sparse in BD. Eighty-eight subjects (50 euthymic BD and 38 HC) underwent 3T proton magnetic resonance spectroscopy (1H MRS) in the anterior cingulate cortex (ACC; 2×2×4.5cm(3)) using a two-dimensional JPRESS sequence. GABA, Glutamine (Gln) and Glutamate (Glu) were quantified with the ProFit program. Using image segmentation and known creatine (Cre) concentrations for white and grey matter, metabolite concentrations were calculated for the excited MRS voxel. GABA levels did not differ between groups. Gln level was higher in euthymic BD patients than in healthy controls. The Glu level and Glu/Gln ratio were lower in BD patients than in controls. The use of anticonvulsants was associated with Gln increase but did not affect Glu or Glu/Gln. Neither lithium nor antipsychotic use influenced metabolite levels. The ACC MRS findings indicate that the glutamatergic function in euthymic medicated BD patients is altered relative to controls. Whether this feature is a metabolic signature of euthymic BD subjects should be the focus of future studies.


Assuntos
Transtorno Bipolar/patologia , Ácido Glutâmico/metabolismo , Glutamina/metabolismo , Giro do Cíngulo/metabolismo , Adolescente , Adulto , Análise de Variância , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Feminino , Giro do Cíngulo/efeitos dos fármacos , Humanos , Imagem por Ressonância Magnética , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Adulto Jovem , Ácido gama-Aminobutírico/metabolismo
10.
Braz J Psychiatr ; 37(3): 235-41, 2015 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26376054

RESUMO

OBJECTIVE: To assess the relationship between cognitive function, a proposed schizophrenia endophenotype, and two genetic polymorphisms related to dopamine function, catechol-O-methyl transferase (COMT) Val158Met and dopamine receptor 3 (DRD3) Ser9Gly. METHODS: Fifty-eight outpatients with schizophrenia/schizoaffective disorder and 88 healthy controls underwent neurocognitive testing and genotyping. Analyses of covariance (ANCOVAs) using age, sex, and years of education as covariates compared cognitive performance for the proposed genotypes in patients and controls. ANCOVAs also tested for the epistatic effect of COMT and DRD3 genotype combinations on cognitive performance. RESULTS: For executive functioning, COMT Val/Val patients performed in a similar range as controls (30.70-33.26 vs. 35.53-35.67), but as COMT Met allele frequency increased, executive functioning worsened. COMT Met/Met patients carrying the DRD3 Ser/Ser genotype performed poorest (16.184 vs. 27.388-31.824). Scores of carriers of this COMT/DRD3 combination significantly differed from all DRD3 Gly/Gly combinations (p < 0.05), from COMT Val/Met DRD3 Ser/Gly (p = 0.02), and from COMT Val/Val DRD3 Ser/Ser (p = 0.01) in patients. It also differed significantly from all control scores (p < 0.001). CONCLUSION: Combined genetic polymorphisms related to dopamine neurotransmission might influence executive function in schizophrenia. Looking at the effects of multiple genes on a single disease trait (epistasis) provides a comprehensive and more reliable way to determine genetic effects on endophenotypes.


Assuntos
Catecol O-Metiltransferase/genética , Cognição/fisiologia , Epistasia Genética , Polimorfismo de Nucleotídeo Único , Receptores de Dopamina D3/genética , Esquizofrenia/genética , Adulto , Análise de Variância , Estudos de Casos e Controles , Escolaridade , Função Executiva/fisiologia , Feminino , Frequência do Gene , Estudos de Associação Genética , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Reação em Cadeia da Polimerase em Tempo Real , Esquizofrenia/fisiopatologia , Adulto Jovem
11.
Rev. bras. psiquiatr ; 37(3): 235-241, July-Sept. 2015. tab, ilus
Artigo em Inglês | LILACS | ID: lil-759435

RESUMO

Objective:To assess the relationship between cognitive function, a proposed schizophrenia endophenotype, and two genetic polymorphisms related to dopamine function, catechol-O-methyl transferase (COMT) Val158Met and dopamine receptor 3 (DRD3) Ser9Gly.Methods:Fifty-eight outpatients with schizophrenia/schizoaffective disorder and 88 healthy controls underwent neurocognitive testing and genotyping. Analyses of covariance (ANCOVAs) using age, sex, and years of education as covariates compared cognitive performance for the proposed genotypes in patients and controls. ANCOVAs also tested for the epistatic effect of COMT and DRD3 genotype combinations on cognitive performance.Results:For executive functioning, COMT Val/Val patients performed in a similar range as controls (30.70-33.26 vs. 35.53-35.67), but as COMT Met allele frequency increased, executive functioning worsened. COMT Met/Met patients carrying the DRD3 Ser/Ser genotype performed poorest (16.184 vs. 27.388-31.824). Scores of carriers of this COMT/DRD3 combination significantly differed from all DRD3 Gly/Gly combinations (p < 0.05), from COMT Val/Met DRD3 Ser/Gly (p = 0.02), and from COMT Val/Val DRD3 Ser/Ser (p = 0.01) in patients. It also differed significantly from all control scores (p < 0.001).Conclusion:Combined genetic polymorphisms related to dopamine neurotransmission might influence executive function in schizophrenia. Looking at the effects of multiple genes on a single disease trait (epistasis) provides a comprehensive and more reliable way to determine genetic effects on endophenotypes.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Catecol O-Metiltransferase/genética , Cognição/fisiologia , Epistasia Genética , Polimorfismo de Nucleotídeo Único , /genética , Esquizofrenia/genética , Análise de Variância , Estudos de Casos e Controles , Escolaridade , Função Executiva/fisiologia , Frequência do Gene , Estudos de Associação Genética , Testes Neuropsicológicos , Reação em Cadeia da Polimerase em Tempo Real , Esquizofrenia/fisiopatologia
12.
Exp Ther Med ; 8(4): 1205-1208, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25187825

RESUMO

Lithium has a narrow therapeutic index with a subtle balance between effectiveness and adverse effects. Current guidelines recommend the use of lithium as a treatment for acute bipolar depression; however, the therapeutic range for the treatment has not been fully defined. Recently, the adjunctive lower lithium dose in bipolar depression has revealed potential efficacy; however, no study has investigated it predominantly in monotherapy. In this open-label, proof-of-concept study, 31 individuals with bipolar disorder during a depressive episode were randomized and 29 were followed up for six weeks with flexible lithium dosing. All subjects had a 21-item Hamilton Rating Scale for Depression (HAM-D) score of ≥18 at baseline. Subjects were divided into two groups, with higher (Li ≥0.5 mEq/l) or lower (Li <0.5 mEq/l) blood lithium levels. Response and remission rates were evaluated using the HAM-D scores. Following 6 weeks of lithium treatment, the remission rate for all patients was 62.0%. The plasma lithium levels did not impact the clinical response. However, subjects with higher blood lithium levels had an increased prevalence of nausea, restlessness, headaches and cognitive complaints. The results indicate that the lithium dose for the treatment of bipolar depression in an individual should be based on the clinical efficacy and side-effects. In the context of personalized psychiatric treatments, it is necessary to evaluate the therapeutic action of lithium with individual regimens in order to develop more tolerable and effective treatment approaches.

13.
J. bras. med ; 102(3)jul. 2014.
Artigo em Português | LILACS | ID: lil-719967

RESUMO

A ansiedade patológica e suas repercussões fisiológicas não afligem apenas o bem-estar psíquico e a funcionalidade. A saúde geral também fica comprometida, com aumento da incidência de comorbidades clínicas. Entre estas, as mais significativamente associadas com ansiedade são as doenças da tireoide, doença do refluxo gastroesofágico, psoríase e, sobretudo, as doenças cardíacas. Estas são as mais importantes do ponto de vista de morbidade e mortalidade. Ansiedade e doença cardíaca não são meras comorbidades, mas exercem uma complexa interação, que discutiremos neste texto...


The pathological anxiety and the physiological rebounds don't attack well-being and the functionality only. General health is committed as well, whith medical comorbidity increase. Among these, the more associated significantly with anxiety are thyroid disease, gastroesophageal reflux disease, psoriasis, and mainly heart diseases. These are the mostly important point of view about morbidity and mortality. Anxiety and heart disease are not just comorbidity, but they act with a complex interaction which will be discussing in this paper...


Assuntos
Humanos , Masculino , Feminino , Ansiedade/complicações , Doenças Cardiovasculares/diagnóstico , Ansiedade/epidemiologia , Comorbidade , Doença da Artéria Coronariana , Depressão/complicações , Transtorno Depressivo Maior/diagnóstico , Transtorno de Pânico/diagnóstico , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico
14.
Eur Neuropsychopharmacol ; 24(7): 1139-43, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24731723

RESUMO

Telomeres are DNA-protein complexes that cap linear DNA strands, protecting DNA from damage. Recently, shorten telomeres length has been reported in bipolar disorder (BD) and depression. The enzyme telomerase regulates telomeres׳ length, which has been associated with cellular viability; however it is not clear how telomerase may be involved in the pathophysiology and therapeutics of BD. In the present study, leukocyte telomerase activity was assessed in 28 medication-free BD depressed individuals (DSM-IV-TR criteria) at baseline and after 6 weeks of lithium therapy (n=21) also matching with 23 healthy controls. There was no difference between telomerase activity in subjects with BD depression (before or after lithium) and controls. Improvement of depressive symptoms was negatively associated with telomerase activity after 6 weeks of lithium therapy. This is the first study describing telomerase activity in BD research. Overall, telomerase activity seems not directly involved in the pathophysiology of short-term BD. Lithium׳s antidepressant effects may involve regulation at telomerase activity. Further studies with larger samples and long-term illness are also warranted.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Bipolar/enzimologia , Leucócitos/enzimologia , Lítio/uso terapêutico , Telomerase/metabolismo , Adulto , Transtorno Bipolar/sangue , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
15.
J Psychiatr Res ; 46(12): 1564-8, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23000368

RESUMO

Although lithium has been the first line agent in the treatment of bipolar disorder (BD), few studies have evaluated lithium's efficacy in mania with psychosis and its association with later response. Furthermore, given the widespread concern about antipsychotic side effects, answering a question about whether lithium alone can manage to treat both psychotic and non-psychotic mania seems a very relevant one. The present study addresses the antipsychotic efficacy of lithium monotherapy in acute mania and early improvement of psychotic symptoms as a predictor of later response of manic symptoms. Forty-six patients presenting a manic episode (32 with psychotic features and 14 subjects without psychotic features) were treated for 4 weeks with lithium monotherapy and evaluated weekly using the Young Mania Rating Scale (YMRS). Subjects with rapid cycling, substance abuse/dependence, or mixed episodes were excluded. The overall antimanic efficacy of lithium in psychosis vs. non-psychosis groups was evaluated. In addition, early improvement of psychotic symptoms and its prediction of subsequent response (>50% decrease in total YMRS scores) or remission were evaluated. Lithium showed a similar efficacy in both psychosis and non-psychosis mania. Early improvement of psychotic symptoms was associated with clinical response and remission at endpoint.


Assuntos
Antimaníacos/administração & dosagem , Transtorno Bipolar/tratamento farmacológico , Lítio/administração & dosagem , Transtornos Psicóticos/tratamento farmacológico , Adulto , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/epidemiologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
16.
J Affect Disord ; 139(2): 181-6, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22484201

RESUMO

INTRODUCTION: Creativity is a complex human ability influenced by affective and cognitive components but little is known about its underlying neurobiology. Bipolar Disorder (BD) is highly prevalent among creative individuals. Brain-derived neurotrophic factor (BDNF) is the most widely distributed neurotrophic factor, and has been implicated in the pathophysiology of BD. In contrast to the better functioning of the BDNF polymorphism (Val(66)Met) Val allele, the Met allele decreases BDNF transport and has been associated with worsened performance on several cognitive domains in euthymic BD subjects and controls. We hypothesized that the Val allele is associated with increased creativity in bipolar disorder. MATERIALS AND METHODS: Sixty-six subjects with BD (41 in manic and 25 in depressive episodes) and 78 healthy volunteers were genotyped for BDNF Val(66)Met and tested for creativity using the Barrow Welsh Art Scale (BWAS) and neuropsychological tests. RESULTS: Manic patients with the Val allele (Met-) had higher BWAS scores than Met+ carriers. This relationship was not observed among patients in depressive episodes or among control subjects. BDNF Met allele status showed no association with cognitive function in any of the groups. CONCLUSION: As postulated, these findings suggest that the better functioning allele of BDNF may selectively facilitate creative thinking in subjects with manic episodes, but not in controls or depressives. Further studies exploring the role of BDNF in the neurobiology of creativity in BD and in euthymic phases are warranted.


Assuntos
Transtorno Bipolar/genética , Fator Neurotrófico Derivado do Encéfalo/genética , Criatividade , Adolescente , Adulto , Alelos , Transtorno Bipolar/fisiopatologia , Transtorno Bipolar/psicologia , Feminino , Genótipo , Humanos , Masculino , Adulto Jovem
17.
Med. oral patol. oral cir. bucal (Internet) ; 16(6): 750-756, sept. 2011. tab
Artigo em Inglês | IBECS | ID: ibc-93084

RESUMO

Objectives: To investigate whether daily systemic and/or topical medication contributes to the development of orallichen planus (OLP) lesions.Study Design: The study involved 110 OLP patients and 76 control subjects, matched by age, race and sex. Theanalyzed data included medical records, drug intake and topical medication. Criteria for analysis of drug intakeincluded: (1) ATC-code drug classification; (2) number of different drugs used daily in the categories of monopharmacy(1 drug), minor polypharmacy (2–4 drugs), and major polypharmacy (> 5 drugs); and (3) drugs implicatedin lichenoid reactions (DILRs).Results: Sixty (54.5%) of the 110 OLP patients reported daily medication (prior to the appearance of the OLPlesion) compared to 52 (68.4%) of the 76 control subjects. No statistical difference was found between the twogroups in terms of systemic diseases, number of medicated individuals in the categories of mono- and polypharmacy,nor use of DILRs (P > 0.05). Regarding the clinical forms and site of involvement, a statistically significantdifference was only found for the clinical erosive form of OLP, seen more frequently in non-DILR (P = 0.04) andnonmedicated OLP patients (P = 0.02) than in DILR OLP patients. Daily use of topical oral medication was reportedby 2 (1.8%) OLP patients and 1 (1.3%) control subject.Conclusions: It seems that the use of systemic medication does not lead to a significant increase in the incidence ofOLP lesions. For their part, lichenoid drug reactions are likely to occur only in a very low percentage of patients (AU)


No disponible


Assuntos
Humanos , Líquen Plano Bucal/induzido quimicamente , Uso de Medicamentos , Doença Crônica/tratamento farmacológico , Fatores de Risco
18.
J Affect Disord ; 135(1-3): 292-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21767880

RESUMO

INTRODUCTION: Creativity is a complex construct involving affective and cognitive components. Bipolar Disorder (BD) has been associated with creativity and is characterized by a wide range of affective and cognitive symptoms. Although studies of creativity in BD have tended to focus on creativity as a trait variable in medicated euthymic patients, it probably fluctuates during symptomatic states of BD. Since creativity is known to involve key affective and cognitive components, it is plausible to speculate that cognitive deficits and symptoms present in symptomatic BD could interfere with creativity. MATERIAL AND METHODS: Sixty-seven BD type I patients medication free, age 18-35 years and experiencing a maniac, mixed, or depressive episodes, were assessed for creativity, executive functioning, and intelligence. RESULTS: Manic and mixed state patients had higher creativity scores than depressive individuals. Creativity was influenced by executive function measures only in manic patients. Intelligence did not influence creativity for any of the mood episode types. CONCLUSION: We propose that creativity in BD might be linked to the putative hyperdopaminergic state of mania and be dependent on intact executive function. Future studies should further explore the role of dopaminergic mechanisms in creativity in BD.


Assuntos
Transtorno Bipolar/psicologia , Criatividade , Função Executiva , Adolescente , Adulto , Afeto , Depressão , Transtorno Depressivo/complicações , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Inteligência , Masculino , Adulto Jovem
19.
BMC Psychiatry ; 11: 59, 2011 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-21489298

RESUMO

BACKGROUND: Bipolar Disorder (BD) is a chronic, recurrent and highly prevalent illness. Despite the need for correct diagnosis to allow proper treatment, studies have shown that reaching a diagnosis can take up to ten years due to the lack of recognition of the broader presentations of BD. Frequent comorbidities with other psychiatric disorders are a major cause of misdiagnosis and warrant thorough evaluation. METHODS/DESIGN: ESPECTRA (Occurrence of Bipolar Spectrum Disorders in Eating Disorder Patients) is a single-site cross-sectional study involving a comparison group, designed to evaluate the prevalence of bipolar spectrum in an eating disorder sample. Women aged 18-45 years will be evaluated using the SCID-P and Zurich criteria for diagnosis and the HAM-D, YOUNG, SCI-MOODS, HCL-32, BIS-11, BSQ, WHOQoL and EAS instruments for rating symptoms and measuring clinical correlates. DISCUSSION: The classificatory systems in psychiatry are based on categorical models that have been criticized for simplifying the diagnosis and leading to an increase in comorbidities. Some dimensional approaches have been proposed aimed at improving the validity and reliability of psychiatric disorder assessments, especially in conditions with high rates of comorbidity such as BD and Eating Disorder (ED). The Bipolar Spectrum (BS) remains under-recognized in clinical practice and its definition is not well established in current diagnostic guidelines. Broader evaluation of psychiatric disorders combining categorical and dimensional views could contribute to a more realistic understanding of comorbidities and help toward establishing a prognosis.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Adolescente , Adulto , Transtorno Bipolar/classificação , Brasil/epidemiologia , Protocolos Clínicos , Comorbidade , Estudos Transversais , Erros de Diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/classificação , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Prognóstico , Psicometria/estatística & dados numéricos
20.
Med Oral Patol Oral Cir Bucal ; 16(6): e750-6, 2011 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-21196843

RESUMO

OBJECTIVES: To investigate whether daily systemic and/or topical medication contributes to the development of oral lichen planus (OLP) lesions. STUDY DESIGN: The study involved 110 OLP patients and 76 control subjects, matched by age, race and sex. The analyzed data included medical records, drug intake and topical medication. Criteria for analysis of drug intake included: (1) ATC-code drug classification; (2) number of different drugs used daily in the categories of monopharmacy (1 drug), minor polypharmacy (2-4 drugs), and major polypharmacy ( > 5 drugs); and (3) drugs implicated in lichenoid reactions (DILRs). RESULTS: Sixty (54.5%) of the 110 OLP patients reported daily medication (prior to the appearance of the OLP lesion) compared to 52 (68.4%) of the 76 control subjects. No statistical difference was found between the two groups in terms of systemic diseases, number of medicated individuals in the categories of mono- and polypharmacy, nor use of DILRs (P > 0.05). Regarding the clinical forms and site of involvement, a statistically significant difference was only found for the clinical erosive form of OLP, seen more frequently in non-DILR (P = 0.04) and nonmedicated OLP patients (P = 0.02) than in DILR OLP patients. Daily use of topical oral medication was reported by 2 (1.8%) OLP patients and 1 (1.3%) control subject. CONCLUSIONS: It seems that the use of systemic medication does not lead to a significant increase in the incidence of OLP lesions. For their part, lichenoid drug reactions are likely to occur only in a very low percentage of patients.


Assuntos
Líquen Plano Bucal/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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