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1.
Neurol Sci ; 41(10): 2681-2684, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32808174

RESUMO

BACKGROUND AND AIMS: Cerebral infarction in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes. METHODS: Clinical presentation and diagnostic work-up of the patients. RESULTS: Two patients in their sixties were hospitalized with a bilateral pneumonia COVID-19. They developed respiratory failure and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (case 1: affecting the left frontal and temporal lobes and both occipital lobes; case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes. CONCLUSION: Acutely altered mental status might be the main manifestation of multiple brain infarctions in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.


Assuntos
Betacoronavirus , Confusão/psicologia , Infecções por Coronavirus/psicologia , Estado Terminal/psicologia , Pneumonia Viral/psicologia , Doença Aguda , Idoso , Confusão/diagnóstico por imagem , Confusão/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem
2.
Epilepsia ; 61(6): 1045-1061, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32396219

RESUMO

This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.


Assuntos
Encéfalo/fisiopatologia , Confusão/fisiopatologia , Eletroencefalografia/tendências , Transtornos Mentais/fisiopatologia , Convulsões/fisiopatologia , Confusão/etiologia , Confusão/psicologia , Humanos , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Convulsões/complicações , Convulsões/psicologia
3.
Anesthesiology ; 133(1): 119-132, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32349070

RESUMO

BACKGROUND: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve cognitive function. The authors therefore tested the primary hypothesis that preoperative use of angiotensin inhibitors is associated with less delirium in critical care patients. Post hoc, the association between postoperative use of angiotensin system inhibitors and delirium was assessed. METHODS: The authors conducted a single-site cohort study of adults admitted to Cleveland Clinic critical care units after noncardiac procedures between 2013 and 2018 who had at least one Confusion Assessment Method delirium assessment. Patients with preexisting dementia, Alzheimer's disease or other cognitive decline, and patients who had neurosurgical procedures were excluded. For the primary analysis, the confounder-adjusted association between preoperative angiotensin inhibitor use and the incidence of postoperative delirium was assessed. Post hoc, the confounder-adjusted association between postoperative angiotensin system inhibitor use and the incidence of delirium was assessed. RESULTS: The incidence of delirium was 39% (551 of 1,396) among patients who were treated preoperatively with angiotensin system inhibitors and 39% (1,344 of 3,468) in patients who were not. The adjusted odds ratio of experiencing delirium during critical care was 0.98 (95% CI, 0.86 to 1.10; P = 0.700) for preoperative use of angiotensin system inhibitors versus control. Delirium was observed in 23% (100 of 440) of patients who used angiotensin system inhibitors postoperatively before intensive care discharge, and in 41% (1,795 of 4,424) of patients who did not (unadjusted P < 0.001). The confounder-adjusted odds ratio for experiencing delirium in patients who used angiotensin system inhibitors postoperatively was 0.55 (95% CI, 0.43 to 0.72; P < 0.001). CONCLUSIONS: Preoperative use of angiotensin system inhibitors is not associated with reduced postoperative delirium. In contrast, treatment during intensive care was associated with lower odds of delirium. Randomized trials of postoperative angiotensin-converting enzymes inhibitors and angiotensin receptor blockers seem justified.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Delírio do Despertar/induzido quimicamente , Delírio do Despertar/epidemiologia , Idoso , Benzodiazepinas/efeitos adversos , Estudos de Coortes , Confusão/etiologia , Confusão/psicologia , Cuidados Críticos , Delírio do Despertar/prevenção & controle , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Resultados Negativos , Pontuação de Propensão
4.
Emotion ; 20(4): 625-641, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30883147

RESUMO

Some epistemic emotions, such as surprise and curiosity, have attracted increasing scientific attention, whereas others, such as confusion, have yet to receive the attention they deserve. In addition, little is known about the relations between these emotions, their joint antecedents and outcomes, and how they differ from other emotions prompted during learning and knowledge generation (e.g., achievement emotions). In 3 studies (Ns = 102, 373, 125) using a trivia task with immediate feedback, we examined within-person interrelations, antecedents, and effects of 3 epistemic emotions (surprise, curiosity, and confusion). Studies 2 and 3 additionally included 2 achievement emotions (pride and shame). Using multilevel modeling to disentangle within- and between-person variance, we found that achievement emotions were associated with accuracy (i.e., correctness of the answer), whereas epistemic emotions were related to high-confidence errors (i.e., incorrect answers a person was confident in) generating cognitive incongruity. Furthermore, as compared with achievement emotions, epistemic emotions were more strongly and positively related to subsequent knowledge exploration. Specifically, surprise and curiosity were positive predictors of exploration. Confusion had positive predictive effects on exploration which were significant in Studies 1 and 3 but not in Study 2, suggesting that the effects of confusion are less stable and need to be investigated further. Apart from the findings for confusion, the results were fully robust across all 3 studies. They shed light on the distinct origins and outcomes of epistemic emotions. Directions for future research and practical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Confusão/psicologia , Emoções/fisiologia , Comportamento Exploratório/fisiologia , Conhecimento , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
5.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471356

RESUMO

A 47-year-old woman presented an episode of confusion and disorientation. According to remarkable psychiatric records, she had been treated for major depression and obsessive-compulsive disorder; however, no other relevant background was known. After preliminary examinations, blood analysis and neurological tests were unspecific and inconclusive. Therefore, the case was treated as a possible psychiatric episode related to her previous psychiatric disorders. However, due to the atypical presentation of the case, a cerebral MRI was performed, which demonstrated multiple central lesions of the corpus callosum ('snowball lesions'), as well as several supratentorial white matter lesions. As a result of the follow-up of the case, sensorineural hearing loss and branch retinal artery were detected, which concluded in the classic triad and the confirmation of the diagnosis of a Susac syndrome.


Assuntos
Confusão/diagnóstico , Transtornos Dissociativos/diagnóstico , Síndrome de Susac/diagnóstico , Confusão/psicologia , Diagnóstico Diferencial , Transtornos Dissociativos/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome de Susac/psicologia
6.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
7.
Pediatr Rheumatol Online J ; 17(1): 30, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215480

RESUMO

BACKGROUND: Juvenile Dermatomyositis is a rare, potentially life-threatening condition with no known cure. There is no published literature capturing how children and young people feel about their condition, from their perspective. This study was therefore unique in that it asked children and young people what is it like to live with Juvenile Dermatomyositis. METHODS: Data were obtained from fifteen young people with Juvenile Dermatomyositis, between eight and nineteen years of age from one Paediatric Rheumatology department using audio-recorded interpretive phenomenology interviews. Data were analyzed phenomenologically, using a process that derives narratives from transcripts resulting in a collective composite of participants shared experiences, called a 'phenomenon'. RESULTS: The overarching metaphor of a rollercoaster captures the phenomenon of living with Juvenile Dermatomyositis as a young person, with the ups and downs at different time points clearly described by those interviewed. The five themes plotted on the rollercoaster, began with confusion; followed by feeling different, being sick, steroidal and scared from the medications; uncertainty; and then ended with acceptance of the disease over time. CONCLUSION: Young people were able to talk about their experiences about having Juvenile Dermatomyositis. Our findings will aid clinicians in their practice by gaining a deeper understanding of what daily life is like and highlighting ways to enhance psychosocial functioning. Hopefully, this study and any further resulting studies, will raise understanding of Juvenile Dermatomyositis worldwide and will encourage health care professionals to better assess psychosocial needs in the future.


Assuntos
Dermatomiosite/psicologia , Atividades Cotidianas , Adaptação Psicológica , Adolescente , Atitude Frente a Saúde , Criança , Pré-Escolar , Doença Crônica , Confusão/psicologia , Fármacos Dermatológicos/uso terapêutico , Dermatomiosite/tratamento farmacológico , Feminino , Humanos , Relações Interpessoais , Masculino , Metotrexato/uso terapêutico , Qualidade de Vida , Doenças Raras , Autoimagem , Esteroides/uso terapêutico
8.
Brain Inj ; 33(9): 1200-1207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216900

RESUMO

Objective: To longitudinally explore the transition home for a spousal dyad following mild stroke, in the context of a mild stroke-specific health service. Research Design: A case study approach, using an Interpretative Phenomenological Analysis (IPA), was identified as suitable for this study, as it enabled the essence of the phenomenon to be examined. Method: Participants were purposively chosen from a Randomised Control Trial (RCT), to reflect the average age, gender and marital status of the mild stroke population. The participants were a male (age 64) and his wife (age 62). Participants received the RCT intervention. Semi-structured interviews were completed separately with participants at 1-, 3-, 6- and 9- months post stroke. Results: Two themes were identified: (1) The Unexpected, Undesirable and Short-Lived, and (2) The New 'Normal'. The first theme reflects the confusion, adjustment and adaptation that occurred for the couple, especially during the first month at home. The second represents the couple's journey back to their everyday lives following hospital discharge, but also the questions and changes that remained present at 9-months post-discharge. Conclusions: Themes demonstrate an ongoing process of adjustment and the contextual nature of the transitional experience. Results also indicate the need to ensure that individuals have access to mild-stroke specific information across the transition continuum.


Assuntos
Cônjuges/psicologia , Acidente Vascular Cerebral/psicologia , Adaptação Psicológica , Confusão/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Reabilitação do Acidente Vascular Cerebral
9.
J Alzheimers Dis ; 69(3): 709-716, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127777

RESUMO

Previous studies showed that the Confusion Assessment Method based delirium severity evaluation tool (CAM-S) had good reliability and validity. However, there is no Chinese version of the CAM-S. Therefore, we set out to perform a prospective investigation in older Chinese patients who had total joint replacement surgery under general anesthesia in Tenth People's Hospital in Shanghai, P.R. China. A total of 576 participants, aged 60 years or older, were screened, 179 participants were enrolled, and 125 of them were included for the final analysis. Pre-operative evaluations were conducted one day before the surgery. Postoperative evaluations were conducted twice daily from postoperative day 1 to day 3. The incidence of postoperative delirium was 24.8%. The Chinese version of CAM-S [including a Short Form (CAM-S Short Form) and a Long Form (CAM-S Long Form)] had an optimal reliability reflected by internal consistency (Cronbach's α= 0.748 and 0.839 for CAM-S Short Form and CAM-S Long Form respectively), split-halves reliability (Pearson correlation coefficient = 0.372 and 0.384 for CAM-S Short Form and CAM-S Long Form respectively), and inter-rater reliability (intra-class correlation coefficients = 0.629 and 0.945 for CAM-S Short Form and CAM-S Long Form respectively). Additionally, the Chinese version of CAM-S also showed a good discriminate validity. The domain scores of CAM-S were inversely correlated with corresponding domain scores of the MMSE. Finally, a receiver operating characteristic (ROC) analysis obtained an optimal cutoff point of 2.5 for CAM-S Short Form and 3.5 for CAM-S Long Form in recognizing delirium diagnosed by CAM. The areas under the ROC were 0.989 (95% CI 0.972 - 1.000, p < 0.001) and 0.964 (95% CI 0.946 - 0.982, p < 0.001), respectively. These data suggest that the Chinese version of CAM-S has good reliability and validity in evaluating postoperative delirium in geriatric Chinese patients and may be a useful tool to assess the severity of delirium.


Assuntos
Confusão/diagnóstico , Confusão/psicologia , Delírio/diagnóstico , Delírio/psicologia , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Artroplastia de Substituição/efeitos adversos , Artroplastia de Substituição/psicologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Traduções
10.
BMC Geriatr ; 19(1): 107, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30991945

RESUMO

BACKGROUND: Delirium occurs commonly in older adults and is associated with adverse outcomes. Multicentre clinical trials evaluating interventions to prevent delirium are needed. The Confusion Assessment Method (CAM) is a validated instrument for delirium detection. We hypothesised it would be possible for a large feasibility study to train a large number of research assistants, with varying experience levels, to conduct CAM assessments reliably in multiple hospital sites. METHODS: A standardised training programme was followed, incorporating structured training at a central location and at study sites. CAM practice sessions on both delirious and non-delirious patients by research assistants were conducted and, thereafter, there was ongoing inter-rater reliability assessment on the CAM between research assistant pairs at study sites. The setting was eight acute care hospitals in England and Wales. Participants were research assistants working on a multicentre feasibility study of delirium prevention. The measurement used was the Confusion Assessment Method. RESULTS: Thirty-seven research assistants were trained in CAM assessment and 33 returned training logs. The logs showed there was 100% overall agreement between research assistant pairs on 295 CAM assessments, of which 263 (89.2%) were negative for delirium and 32 (10.8%) were positive. In the course of the feasibility study, research assistants successfully completed 5065 (89.7%) of the 5645 expected CAM assessments, with minimal missing data. CONCLUSION: Using the training methods described in this study, it is possible to achieve high quality delirium assessments for large numbers of patients with little missing data across geographically dispersed sites in multicentre studies. The standardisation of multisite delirium assessments is an important contribution to research methodology, and provides a much-needed advance for the field. TRIAL REGISTRATION: ISRCT ISRCTN01187372 . Registered 13 March 2014.


Assuntos
Confusão/diagnóstico , Confusão/psicologia , Pessoal de Saúde/educação , Pessoal de Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Confusão/epidemiologia , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/psicologia , Inglaterra/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , País de Gales/epidemiologia
12.
Therapie ; 74(6): 591-598, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31014975

RESUMO

INTRODUCTION: Faced with the increasing number of pharmaceutical products on the market, several pharmacovigilance notifications regarding confusion between look-alike and sound-alike drugs have been reported. This study of perception among patients, family physicians and pharmacists aims to evaluate drug identification factors and the risk of errors of confusion for patients. MATERIAL AND METHODS: Patients were systematically approached in randomly selected pharmacies within the Midi-Pyrénées region in France and invited to complete a questionnaire. Two other questionnaires were respectively sent to family physicians and pharmacists in the same region asking for their opinion on patients' perception of the identification of prescribed medicines. RESULTS: Of the 768 patients interviewed, most report identifying their medications by name (brand name: 50%; generic: 21%), while a smaller number cite physical appearance (box: 16%, tablet: 7% and blister packaging: 3%). In practice the factors considered most likely to cause confusion by patients relate to drug appearance (look-alike tablets: 28%, look-alike boxes: 20% and look-alike blister packaging: 13%). In contrast, look-alike and sound-alike names (generic and brand names combined) were cited in 31% of cases. Physicians (n=345) and pharmacists (n=198) understimate that patients identify their treatment by name (physicians: 46%; pharmacists: 26% vs. patients: 71%), reporting instead that problems arise mainly from the appearance of medicines (physicians: identification: 52% and risk factors for confusion: 74%; pharmacists: identification: 74% and risk factors for confusion: 83%; versus patients: identification: 26%; risk factors for confusion: 61%). DISCUSSION: Our study highlights the critical role of medication name in identifying drugs among patients. However, confusion of look-alike tablets or pills figures prominently among fears surrounding medication errors. Despite several notifications of pharmacovigilance, this issue appears to be underestimated within the body of medical literature. Proper identification of medicines by patients is essential to improving medication safety and therapeutic compliance. Concrete measures can be undertaken to reach this goal.


Assuntos
Rotulagem de Medicamentos , Erros de Medicação/psicologia , Pacientes/psicologia , Percepção , Farmacêuticos/psicologia , Médicos/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Confusão/epidemiologia , Confusão/psicologia , Formas de Dosagem , Rotulagem de Medicamentos/estatística & dados numéricos , Embalagem de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos , França/epidemiologia , Humanos , Erros de Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Farmacêuticos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Fatores de Risco , Autoeficácia , Inquéritos e Questionários , Adulto Jovem
13.
Respir Res ; 20(1): 22, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704469

RESUMO

BACKGROUND: Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality, but the major problem associated with IDSA/ATS minor criteria might be a lack of consideration of weight in prediction in clinical practice. Would awarding different points to the presences of the minor criteria improve the accuracy of the scoring system? It is warranted to explore this intriguing hypothesis. METHODS: A total of 1230 CAP patients were recruited to a retrospective cohort study. This was tested against a prospective two-center cohort of 1749 adults with CAP. 2 points were assigned for the presence of PaO2/FiO2 ≤ 250 mmHg, confusion, or uremia on admission and 1 point for each of the others. RESULTS: The mortality rates, and sequential organ failure assessment (SOFA) and pneumonia severity index (PSI) scores increased significantly with the numbers of IDSA/ATS minor criteria present and minor criteria scores. The correlations of the minor criteria scores with the mortality rates were higher than those of the numbers of IDSA/ATS minor criteria present. As were the correlations of the minor criteria scores with SOFA and PSI scores, compared with the numbers of IDSA/ATS minor criteria present. The pattern of sensitivity, specificity, positive predictive value, and Youden's index of scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria for prediction of mortality was the best in the retrospective cohort, and the former was better than the latter. The validation cohort confirmed a similar pattern. The area under the receiver operating characteristic curve of scored minor criteria was higher than that of IDSA/ATS minor criteria in the retrospective cohort, implying higher accuracy of scored version for predicting mortality. The validation cohort confirmed a similar paradigm. CONCLUSIONS: Scored minor criteria orchestrated improvements in predicting mortality and severity in patients with CAP, and scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria might be more valuable cut-off value for severe CAP, which might have implications for more accurate clinical triage decisions.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Pneumonia/diagnóstico , Pneumonia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Coortes , Confusão/etiologia , Confusão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Oxigênio/sangue , Valor Preditivo dos Testes , Padrões de Referência , Estudos Retrospectivos , Uremia/etiologia , Adulto Jovem
14.
J Anxiety Disord ; 63: 1-8, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30721799

RESUMO

The inference-based approach (IBA) is one cognitive model that aims to explain the aetiology and maintenance of obsessive-compulsive disorder (OCD). IBA theory suggests that certain reasoning processes lead an individual with OCD to confuse imagined possibilities with actual probabilities, a process termed inferential confusion. One such reasoning process is inverse reasoning, where hypothetical causes form the basis of conclusions about reality. Recently, we developed a task-based measure of inverse reasoning. In an online sample, we reported significant and positive associations between endorsement of inverse reasoning on this task and OCD symptomatology. We concluded that there was some support for the role of inverse reasoning in OCD but these results required extension using a between-groups design in a clinical sample. Therefore, the present study compared endorsement in inverse reasoning on this task between individuals diagnosed with OCD, anxiety and/or mood disorder (clinical controls), and healthy individuals (healthy controls). Relative to both control groups, the OCD group demonstrated significantly greater endorsement in inverse reasoning on scenarios where OCD relevant concerns were prompted. When non-OCD relevant concerns were involved, the OCD group only evidenced greater endorsement in inverse reasoning relative to the healthy control group. Implications for IBA theory are discussed.


Assuntos
Transtorno Obsessivo-Compulsivo/psicologia , Adolescente , Adulto , Idoso , Ansiedade/psicologia , Confusão/psicologia , Feminino , Humanos , Imaginação , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Probabilidade , Resolução de Problemas , Adulto Jovem
15.
Dement Geriatr Cogn Disord ; 48(3-4): 207-214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32008004

RESUMO

BACKGROUND: Delirium is common in old patients who undergo cardiac surgery, and it is associated with adverse outcomes. The genesis of delirium is thought to be multi-factorial, but it is still not well understood. Symptoms of depression and elevated cortisol level have been described in some previous studies as factors associated with delirium, suggesting a shared pathophysiology. AIMS: The objective of the present study was to determine whether preoperative depression symptoms and increased cortisol level represent risk factors for delirium after cardiac surgery. METHODS: We performed a prospective cohort study in 183 patients aged >50 years undergoing elective cardiac surgery. The Geriatric Depression Scale (GDS) was used to assess patients for depressive symptoms before surgery. Preoperative plasma cortisol levels were available in 145 participants. Delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) during the first 7 days after surgery. Spearman correlation was used for correlations between GDS, Mini-Mental State Examination (MMSE), Charlson comorbidity index, and age. Binary logistic regression was used to determine whether GDS and cortisol levels predict postoperative delirium. RESULTS: Delirium occurred in 60 patients out of 183 (32.8%) included and lasted 2.3 days (SD 1.36). GDS was correlated with age (p = 0.001) and comorbidity index (p = 0.003) and inversely correlated with MMSE score (p < 0.001). Higher preoperative GDS scores were associated with incidence of delirium in the postoperative period (p = 0.002). The association was significant after controlling for age, MMSE score, history of stroke, and Charlson comorbidity index (p = 0.045). Preoperative cortisol level was not associated with the development of postoperative delirium. CONCLUSION: Our results suggest that a higher preoperative depression score is associated with an increased risk of postoperative delirium. On the other hand, preoperative plasma cortisol level does not seem to be a predictor of delirium after surgery. Further studies are needed to determine the potential of preoperative depression treatment to prevent postoperative delirium.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Depressão/complicações , Delírio do Despertar/psicologia , Hidrocortisona/sangue , Período Pré-Operatório , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Confusão/psicologia , Depressão/psicologia , Delírio do Despertar/epidemiologia , Feminino , Avaliação Geriátrica , Humanos , Incidência , Masculino , Testes de Estado Mental e Demência , Complicações Pós-Operatórias , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco
16.
Cogn Emot ; 33(4): 754-767, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29962270

RESUMO

The six basic emotions (disgust, anger, fear, happiness, sadness, and surprise) have long been considered discrete categories that serve as the primary units of the emotion system. Yet recent evidence indicated underlying connections among them. Here we tested the underlying relationships among the six basic emotions using a perceptual learning procedure. This technique has the potential of causally changing participants' emotion detection ability. We found that training on detecting a facial expression improved the performance not only on the trained expression but also on other expressions. Such a transfer effect was consistently demonstrated between disgust and anger detection as well as between fear and surprise detection in two experiments (Experiment 1A, n = 70; Experiment 1B, n = 42). Notably, training on any of the six emotions could improve happiness detection, while sadness detection could only be improved by training on sadness itself, suggesting the uniqueness of happiness and sadness. In an emotion recognition test using a large sample of Chinese participants (n = 1748), the confusion between disgust and anger as well as between fear and surprise was further confirmed. Taken together, our study demonstrates that the "basic" emotions share some common psychological components, which might be the more basic units of the emotion system.


Assuntos
Emoções/fisiologia , Expressão Facial , Aprendizagem/fisiologia , Percepção/fisiologia , Reconhecimento Psicológico/fisiologia , Adolescente , Adulto , Ira/fisiologia , China , Confusão/psicologia , Asco , Medo/psicologia , Feminino , Felicidade , Humanos , Masculino , Tristeza/psicologia , Adulto Jovem
17.
Phys Sportsmed ; 47(3): 312-317, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30477376

RESUMO

Objectives: This study aimed to analyze the association between sleep quality and mood in elite athletes of different competitive levels. Methods: Participants were 1041 elite athletes (aged 20.82 ± 6.62 years), with 671 men (64.5%/21.52 ± 6.90 years) and 370 women (35.5%/19.55 ± 5.89 years) from 10 individual sports and 6 team sports. Participants self-reported sleep quality on a Likert-type scale and mood was measured with the Brunel Mood Scale (BRUMS). The data were analyzed using the Kruskal-Wallis test, and binary logistic regression. Results: Results revealed that athletes who compete internationally are 84% more likely to have poor sleep quality than athletes who compete at a regional level. International athletes with good sleep quality showed greater vigor. National athletes with poor sleep quality showed more confusion, depression, and fatigue. Thus, mood and competitive level are factors associated with sleep quality. Confusion, fatigue, and tension impair sleep, and vigor reduces the likelihood of poor sleep. Conclusions: Sleep should be monitored, especially in international level athletes, in order to prevent sleep disorders during competitions. Coaches and athletes should use techniques and strategies for appropriate management of sleep and mood, to maintain the athletes in optimal condition before important competitions.


Assuntos
Afeto , Atletas/psicologia , Sono , Adolescente , Adulto , Confusão/psicologia , Depressão/psicologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Autorrelato , Adulto Jovem
18.
Acta Anaesthesiol Scand ; 63(3): 352-359, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30324653

RESUMO

BACKGROUND: Delirium is underinvestigated in the neuro-critically ill, although the harmful effect of delirium is well established in patients in medical and surgical intensive care units (ICU).To detect delirium, a valid tool is needed. We hypothesized that delirium screening would be feasible in patients with acute brain injury and we aimed to validate and compare the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist against clinical International Classification of Diseases-10 criteria as reference. METHODS: Nurses assessed delirium using the Confusion Assessment Method for the ICU and Intensive Care Delirium Screening Checklist in adult patients with acute brain injury admitted to the Neurointensive care unit (Neuro-ICU), Copenhagen University Hospital, if their Richmond agitation-sedation scale score was -2 or above. As the reference, a team of psychiatrist assessed patients using the International Classification of Diseases-10 criteria. RESULTS: We enrolled 74 patients, of whom 25 (34%) were deemed unable to assess by the psychiatrists, leaving 49 (66%) for final analysis. Sensitivity and specificity for the Confusion Assessment Method for the ICU was 59% (95% CI: 41-75) and 56% (95% CI: 32-78), respectively, and 85% (95% CI: 70-94) and 75% (95% CI: 51-92), respectively, for the Intensive Care Delirium Screening Checklist. CONCLUSIONS: Our findings suggest that the Intensive Care Delirium Screening Checklist may be a valid tool and the Confusion Assessment Method for the ICU is less suitable for delirium detection for patients in the Neuro-ICU. In the neuro-critically ill, delirium screening is challenged by limited feasibility.


Assuntos
Lista de Checagem , Estado Terminal/psicologia , Delírio/diagnóstico , Testes Neuropsicológicos , Adulto , Confusão/diagnóstico , Confusão/etiologia , Confusão/psicologia , Cuidados Críticos , Delírio/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Prevalência , Estudos Prospectivos , Agitação Psicomotora/diagnóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
Anaesthesia ; 74(1): 33-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30338515

RESUMO

This aim of this prospective observational cohort study was to evaluate any association between postoperatively impaired cerebrovascular autoregulation and the onset of delirium following cardiac surgery. Previous studies have shown that impaired intra-operative cerebrovascular autoregulation during cardiopulmonary bypass is associated with delirium. However, postoperative changes in cerebrovascular autoregulation and its association with delirium have not been investigated. One-hundred and eight consecutive adult cardiac surgical patients without baseline cognitive dysfunction or aphasia were included in the study. Cerebrovascular autoregulation was assessed by the Pearson correlation between near-infrared spectroscopy-derived cerebral tissue oxygen saturation and mean arterial pressure to derive the tissue oximetry index. Cerebrovascular autoregulation was monitored for a minimum of 90 min on postoperative day 0 and postoperative day 1. Delirium was assessed throughout intensive care unit admission using the confusion assessment method for the intensive care unit. We observed delirium in 24 of the 108 patients studied. The mean (SD) tissue oximetry index was higher in delirious patients on postoperative day 0 compared with non-delirious patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All patients showed improvement in tissue oximetry index on postoperative day 1 compared with postoperative day 0. Logistic regression analysis demonstrated tissue oximetry index on postoperative day 0 to be independently associated with delirium; odds ratio 1.05 (95%CI 1.01-1.10), p = 0.043. In conclusion, we found an association between impaired cerebrovascular autoregulation, measured by near-infrared spectroscopy, and delirium in the early postoperative period.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Circulação Cerebrovascular , Delírio do Despertar/fisiopatologia , Homeostase , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Afasia/etiologia , Afasia/psicologia , Pressão Arterial , Procedimentos Cirúrgicos Cardíacos/psicologia , Ponte Cardiopulmonar/efeitos adversos , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Estudos de Coortes , Confusão/psicologia , Delírio do Despertar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Oxigênio/sangue , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Adulto Jovem
20.
Int J Ment Health Nurs ; 28(2): 582-591, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30549214

RESUMO

Delirium is a common neuropsychiatric disorder that causes fluctuations in consciousness and attention, impairments in cognitive functioning and information processing, and changes in how individuals perceive what is going on around them. Delirium is associated with increased mortality, ongoing impairment in cognitive functioning, and a high possibility of discharge to residential care. The experience of delirium may be distressing for the patient and their family. Despite the frequency of delirium in hospitalized elderly patients, there is a dearth of literature that examines their experience of this phenomenon, and how it affects individuals as they continue their lives. This study uses descriptive qualitative methodology to explore the question: 'What is the experience of delirium for older adults during hospitalisation?' Data were collected from older adults who had received hospital care in a tertiary general hospital setting. Seven participants were recruited between January and June 2017. Semi-structured individual interviews were used to gather data which was analysed using content analysis. Four themes were identified. These were sense of confusion, disrupted sense of autonomy, perceptual disturbances, and emotional response. Participants exercised agency in the way they responded to these experiences. The study highlighted the need for delirium prevention, and education to improve nurses' recognition, understanding, and management of delirium. In particular, there is a need for nurses to attend to the psychological and emotional experience of delirium.


Assuntos
Delírio/psicologia , Idoso , Idoso de 80 Anos ou mais , Confusão/psicologia , Emoções , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Transtornos das Sensações/psicologia
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