[Sleep spindles-Function, detection and use as biomarker for diagnostics in psychiatry]. / Schlafspindeln ­ Funktion, Detektion und Nutzung als Biomarker für die psychiatrische Diagnostik.

BACKGROUND: The sleep spindle is a graphoelement of an electroencephalogram (EEG), which can be observed in light and deep sleep. Alterations in spindle activity have been described for a range of psychiatric disorders. Due to their relatively constant properties, sleep spindles may therefore be potential biomarkers in psychiatric diagnostics. METHOD: This article presents an overview of the state of the science on the characteristics and functions of the sleep spindle as well as known alterations of spindle activity in psychiatric disorders. Various methodological approaches and developments of spindle detection are explained with respect to their potential for application in psychiatric diagnostics. RESULTS AND CONCLUSION: Although alterations in spindle activity in psychiatric disorders are known and have been described in detail, their exact potential for psychiatric diagnostics has yet to be fully determined. In this respect, the acquisition of knowledge in research is currently constrained by manual and automated methods for spindle detection, which require high levels of resources and are error prone. Newer approaches to spindle detection based on deep-learning procedures could overcome the difficulties of previous detection methods, and thus open up new possibilities for the practical application of sleep spindles as biomarkers in the psychiatric practice.

Síndrome de Ekbom o delirio parasitario: a propósito de un caso / Ekbom syndrome or parasitic delirium: a case report

RESUMEN Fundamento: el síndrome de Ekbom o delirio de parasitosis, infrecuente trastorno psiquiátrico, está caracterizado por una única idea delirante hipocondríaca de tener la piel infestada por insectos o parásitos, sin deterioro del resto de las funciones. Objetivo: tratar un caso poco infrecuente y típico, de gran interés para dermatólogos, psiquiatras y médicos generales. Presentación del caso: paciente femenina, blanca, de 51 años de edad, enfermera, con antecedentes de salud mental, quien poco después de divorciarse presentó prurito en piel de muslos, tronco y brazos, considerándose infestada por insectos e intentó extraérselos con una aguja de insulina. Acudió a consulta de Dermatología con una muestra de lo obtenido (signo de la caja de fósforos) al inicio se mostró reticente a acudir al psiquiatra. Al examen dermatológico se constataron lesiones autoinflingidas en piel de muslos, tronco y brazos. Al examen psiquiátrico: parestesias, idea delirante hipocondríaca, labilidad afectiva, disforia, hipobulia, desdoblamiento alucino delirante. Juicio crítico ausente. Funciones de relación alteradas. Llevó tratamiento con tioridazina 50 mg diarios. El caso reúne todas las características clínicas descritas. Se comparó con otros casos publicados y similares manifestaciones, y con otros que difirieron en sexo y edad. Conclusiones: el síndrome de Ekbom es una rara afección psiquiátrica de difícil tratamiento que representa un reto para el paciente y su médico. Por su poca frecuencia e inusuales características, debe ser identificado por médicos de familia y otros especialistas.

ABSTRACT Background: Ekbom syndrome is a rare psychiatric disease characterized by the unwavering conviction of having the skin infested of insects or parasites, without deterioration of the rest of the functions. Objective: to present a typical case of an uncommon disorder, of interest for dermatologists and psychiatrists. Clinical case: 51 years old white, female patient, nurse, with a history of mental health, who shortly after divorcing presented itching of the skin of the thighs, trunk and arms, considering herself infested by insects and tried to extract them with a needle of insulin. She went to the Dermatology consultation with a sample of what was obtained (matchbox sign) at the beginning, she was reluctant to go to the psychiatrist. The dermatological examination revealed self-inflicted skin lesions on the thighs, trunk and arms. On psychiatric examination: paresthesias, hypochondriac delusional idea, affective lability, dysphoria, hypobulia, delusional hallucinatory splitting. Critical judgment absent. Altered relationship functions. She was treated with thioridazine 50 mg daily. The case meets all the clinical characteristics described. It was compared with other published cases and similar manifestations, and with others that differed in sex and age. Conclusions: Ekbom syndrome is a rare psychiatric condition that is difficult to treat and represents a challenge for the patient and his doctor. Due to its infrequency and unusual characteristics, it must be identified by family doctors and other specialists.

Internal consistency of the self-reporting questionnaire-20 in occupational groups / Consistência interna do self-reporting questionnaire-20 em grupos ocupacionais

ABSTRACT OBJECTIVE To assess the internal consistency of the measurements of the Self-Reporting Questionnaire (SRQ-20) in different occupational groups. METHODS A validation study was conducted with data from four surveys with groups of workers, using similar methods. A total of 9,959 workers were studied. In all surveys, the common mental disorders were assessed via SRQ-20. The internal consistency considered the items belonging to dimensions extracted by tetrachoric factor analysis for each study. Item homogeneity assessment compared estimates of Cronbach's alpha (KD-20), the alpha applied to a tetrachoric correlation matrix and stratified Cronbach's alpha. RESULTS The SRQ-20 dimensions showed adequate values, considering the reference parameters. The internal consistency of the instrument items, assessed by stratified Cronbach's alpha, was high (> 0.80) in the four studies. CONCLUSIONS The SRQ-20 showed good internal consistency in the professional categories evaluated. However, there is still a need for studies using alternative methods and additional information able to refine the accuracy of latent variable measurement instruments, as in the case of common mental disorders.

RESUMO OBJETIVO Avaliar a consistência interna das medidas do Self-Reporting Questionnaire (SRQ-20) em diferentes grupos ocupacionais. MÉTODOS Realizou-se estudo de validação com dados de quatro inquéritos de grupos de trabalhadores, utilizando procedimentos metodológicos semelhantes. Foram estudados 9.959 trabalhadores. Em todos os inquéritos, os transtornos mentais comuns foram avaliados por meio do SRQ-20. A consistência interna considerou os itens pertencentes às dimensões extraídas por análise fatorial tetracórica, para cada estudo. A avaliação da homogeneidade dos itens comparou estimativas alpha de Cronbach (KD-20), o alpha aplicado a uma matriz de correlações tetracóricas e do alpha de Cronbach estratificado. RESULTADOS As dimensões do SRQ-20 apresentaram valores adequados, considerando os parâmetros de referência. A consistência interna dos itens do instrumento, avaliada pelo escore do alpha de Cronbach estratificado, foi elevada (> 0,80) nos quatro estudos. CONCLUSÕES O SRQ-20 apresentou boa consistência interna nas categorias profissionais avaliadas. Entretanto, ainda são necessários estudos que utilizem métodos alternativos e informações adicionais que possam refinar a precisão dos instrumentos de mensuração de construtos latentes, como no caso dos transtornos mentais comuns.

Interface between Intellectual Disability and Mental Health: hermeneutic review / Interface entre Deficiência Intelectual e Saúde Mental: revisão hermenêutica

A literature review was conducted aiming to understand the interface between the Intellectual Disability and Mental Health fields and to contribute to mitigating the path of institutionalizing individuals with intellectual deficiencies. The so-called dual diagnosis phenomenon remains underestimated in Brazil but is the object of research and specific public policy internationally. This phenomenon alerts us to the prevalence of mental health problems in those with intellectual disabilities, limiting their social inclusion. The findings reinforce the importance of this theme and indicate possible diagnostic invisibility of the development of mental illness in those with intellectual disabilities in Brazil, which may contribute to sustaining psychiatric institutionalization of this population. .

Realizou-se revisão da literatura com o objetivo de compreender a interface entre os campos da Deficiência Intelectual e da Saúde Mental e contribuir para a mitigação da trajetória de institucionalização das pessoas com deficiência intelectual. Ainda subestimado no Brasil, mas constituindo-se internacionalmente como objeto de investigações e de políticas públicas específicas, o chamado diagnóstico dual alerta à prevalente ocorrência de problemas de saúde mental em pessoas com deficiência intelectual e sua consequente limitação aos processos de inclusão social. Os achados corroboram a relevância da temática e apontam possível invisibilidade dos processos de adoecimento psíquico das pessoas com deficiência intelectual no País, o que pode contribuir para manutenção de percursos de institucionalização psiquiátrica dessa população.