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1.
Nurs Clin North Am ; 54(4): 561-567, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703781

RESUMO

Postpartum depression (PPD) affects10% to 20% of women within the first year after birth and 25% beyond the first year. PPD, despite advances in diagnosis and treatment, remains underdiagnosed and misunderstood. Women do not always display signs of PPD while in care for delivery of the infant and may not discuss mood changes to their primary care provider at discharge and first post-delivery appointment. Identifying screening and treatment options for non-mental health providers was the purpose of this article.


Assuntos
Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/terapia , Programas de Rastreamento , Papel do Profissional de Enfermagem/psicologia , Depressão Pós-Parto/epidemiologia , Tratamento Farmacológico , Feminino , Humanos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores de Risco
2.
East Asian Arch Psychiatry ; 29(3): 81-86, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31566183

RESUMO

OBJECTIVE: This study aimed to examine the association between five personality traits and late-onset depression in Hong Kong older people. METHODS: This cross-sectional study included a convenience sample of 40 older people with late-onset depression (LOD) and 54 non-depressed elderly controls. The patients were assessed using the NEO Five Factor Inventory (for personality), the Hamilton Depression Rating Scale (for depression severity), the Mini-Mental State Examination (for cognitive function), the Lawton Instrumental Activities of Daily Living (for functioning), and the Cumulative Illness Rating Scale (for number of physical illnesses). RESULT: The LOD group had a higher Hamilton Depression Rating Scale score (18.9 vs 3.7, p < 0.001), lower Mini Mental State Examination score (24.9 vs 26.4, p = 0.004), and lower Instrumental Activities of Daily Living scale score (21.9 vs 23.7, p = 0.013). On the NEO Five Factor Inventory, the LOD group had a higher neuroticism score (30.7 vs 17.5, p < 0.001) and lower scores on extraversion (19.0 vs 26.4, p < 0.001), openness (18.9 vs 21.5, p = 0.026), and conscientiousness (29.1 vs 33.8, p < 0.001). Neuroticism was the only significant predictor of LOD (odds ratio = 2.325, p = 0.001) and the only significant factor associated with depression severity (ß = 0.581, p = 0.003). CONCLUSIONS: The personality trait of neuroticism is associated with LOD and its severity. Assessment of personality traits should be included in the assessment of people with depression.


Assuntos
Depressão/psicologia , Transtornos de Início Tardio/psicologia , Personalidade , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Hong Kong , Humanos , Masculino , Inventário de Personalidade/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos
3.
Med Care ; 57(11): 890-897, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31415337

RESUMO

BACKGROUND: Anxiety is one of the most prevalent mental disorders and accounts for substantial disability as well as increased health care costs. This study examines the minimally important difference (MID) and responsiveness of 6 commonly used anxiety scales. METHODS: The sample comprised 294 patients from 6 primary care clinics in a single VA medical center who were enrolled in a telecare trial for treatment of chronic musculoskeletal pain and comorbid depression and/or anxiety. The measures assessed were the Patient Reported Outcomes Measurement Information System (PROMIS) 4-item, 6-item, and 8-item anxiety scales; the Generalized Anxiety Disorder 7-item scale (GAD-7); the Symptom Checklist anxiety subscale (SCL); the Posttraumatic Stress Disorder Checklist (PCL); the Short Form (SF)-36 Mental Health subscale; and the SF-12 Mental Component Summary (MCS). Validity was assessed with correlations of these measures with one another and with measures of quality of life and disability. MID was estimated by triangulating several methods. Responsiveness was evaluated by comparing: (a) the standardized response means for patients who reported their mood as being better, the same, or worse at 3 months; (b) the area under the curve for patients who had improved (better) versus those who had not (same/worse). RESULTS: Convergent and construct validity was supported by strong correlations of the anxiety measures with one another and moderate correlations with quality of life and disability measures, respectively. All measures differentiated patients who reported global improvement at 3 months from those who were unchanged, but were less able to distinguish worsening from no change. The area under the curves showed comparable responsiveness of the scales. The estimated MID was 4 for the PROMIS scales; 3 for the GAD-7; 6 for the PCL; 9 for the SF-36 mental health subscale; 5 for the MCS score, and 0.3 for the SCL anxiety scale. CONCLUSIONS: Six commonly used anxiety scales demonstrate similar responsiveness, and estimated MIDs can be used to gauge anxiety change in clinical research and practice.


Assuntos
Ansiedade/diagnóstico , Diferença Mínima Clinicamente Importante , Medidas de Resultados Relatados pelo Paciente , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Ansiedade/complicações , Depressão/complicações , Depressão/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Reprodutibilidade dos Testes
4.
Lancet Psychiatry ; 6(9): 745-752, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31303567

RESUMO

BACKGROUND: Reports claiming that antidepressants are effective only in patients with severe depression have affected treatment guidelines but these reports usually use a disputed measure of improvement, a decrease in the sum-score of the 17-item Hamilton Depression Rating Scale (HDRS-17), and are based on group-level rather than patient-level data. METHOD: In this item-based, patient-level, post-hoc analysis, we pooled data from all completed, acute-phase, placebo-controlled, industry-sponsored, HDRS-based trials of the SSRIs citalopram, paroxetine, or sertraline in adult major depression. Patient-level data were pooled and subjected to item-based post-hoc analyses to assess the effect of baseline severity of depression on the response to treatment as assessed with HDRS-17 sum score, the depressed mood item of the HDRS, a six-item HDRS subscale (HDRS-6), and the remaining 11 HDRS items not included in this subscale (non-HDRS-6). Patients were defined as having non-severe depression if they had a baseline HDRS-17 sum score of 18 points or less and as having severe depression if they had a score of 27 points or more. FINDINGS: Our study population consisted of 8262 patients from 28 placebo-controlled SSRI trials. Participants were treated with either citalopram (n=744), paroxetine (n=2981), sertraline (n=1202), fluoxetine (active-control group; n=754), or placebo (n=2581). 654 patients were defined as having non-severe depression and 1377 as having severe depression. Patients with non-severe and severe depression did not differ with respect to SSRI-induced decrease in depressed mood and other HDRS symptoms belonging to the HDRS-6 subscale. However, after exclusion of patients with rare extreme baseline values, a positive association was seen between severity and efficacy when using HDRS-17 sum score as the effect parameter. This result was largely due to a more pronounced response to treatment with respect to non-HDRS-6 items in patients with severe depression than in those with non-severe depression. This outcome could be explained by non-HDRS-6 items, more so than HDRS-6 items, being more severe and prevalent at baseline in severe than in non-severe cases; hence, less room was left for improvement in these areas in patients with non-severe depression. INTERPRETATION: The use of an outcome measure that includes symptoms that rate low at baseline in patients with non-severe depression might result in the interpretation that SSRIs are ineffective in these patients. With respect to alleviation of HDRS-6 items, SSRIs appear to be as effective in patients with non-severe depression as in those with severe depression. FUNDING: Swedish Medical Research Council, AFA Insurance, Swedish Brain Foundation, Sahlgrenska University Hospital (Avtal om Läkarutbildning och Forskning), Bertil Hållsten's Foundation, and Söderberg's Foundation.


Assuntos
Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Antidepressivos/administração & dosagem , Antidepressivos/uso terapêutico , Citalopram/administração & dosagem , Citalopram/uso terapêutico , Ensaios Clínicos como Assunto , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Fluoxetina/administração & dosagem , Fluoxetina/uso terapêutico , Humanos , Estudos Longitudinais , Paroxetina/administração & dosagem , Paroxetina/uso terapêutico , Placebos/administração & dosagem , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Reprodutibilidade dos Testes , Inibidores de Captação de Serotonina/administração & dosagem , Sertralina/administração & dosagem , Sertralina/uso terapêutico , Índice de Gravidade de Doença
5.
BMC Musculoskelet Disord ; 20(1): 268, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153373

RESUMO

BACKGROUND: About one fourth of patients with hip fracture have cognitive impairment. These patients are at higher risk of surgical and medical complications and are often excluded from participating in clinical research. The aim of the present study was to investigate orthopaedic surgeons' ability to determine the cognitive status of patients with acute hip fracture and to compare the treatment given to patients with and without cognitive impairment. METHODS: The cognitive function of 1474 hip fracture patients reported by the orthopaedic surgeons to the nationwide Norwegian Hip Fracture Register was compared with data registered in quality databases in two hospitals with orthogeriatric service on the same patients. Cognitive function registered in the quality databases was determined either by the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or by pre-fracture diagnosis of dementia. The information registered in the quality databases was defined as the reference standard. Cognitive function in the Norwegian Hip Fracture Register was reported as: Chronic cognitive impairment? "Yes", "Uncertain" or "No" by the orthopaedic surgeons. Sensitivity, specificity, negative and positive predictive values for chronic cognitive impairment reported to the Norwegian Hip Fracture Register by the orthopaedic surgeons was calculated. Baseline data and treatment of hip fractures in patients with and without cognitive impairment in the Norwegian Hip Fracture Register were compared. RESULTS: Orthopaedic surgeons reported chronic cognitive impairment in 31% of the patients. Using documented dementia or IQCODE > 4.0 as the reference, this assessment of cognitive impairment by the orthopaedic surgeons had a sensitivity of 69%, a specificity of 90%, a positive predictive value of 78%, and a negative predictive value of 84% compared to information registered in the two hospital quality databases. There were no differences in type of hip fracture or type of surgical treatment by cognitive function. CONCLUSION: The treatment of hip fractures was similar in patients with chronic cognitive impairment and cognitively well-functioning patients. The surgeons had an acceptable ability to identify and report chronic cognitive impairment in the peri-operative period, indicating that the Norwegian Hip Fracture Register is a valuable resource for future registry-based research also on hip fracture patients with chronic cognitive impairment.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Avaliação Geriátrica/métodos , Fraturas do Quadril/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/epidemiologia , Demência/complicações , Demência/epidemiologia , Feminino , Avaliação Geriátrica/estatística & dados numéricos , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Masculino , Noruega/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Cirurgiões Ortopédicos/estatística & dados numéricos , Período Perioperatório , Sistema de Registros/estatística & dados numéricos , Sensibilidade e Especificidade , Inquéritos e Questionários
6.
Psychol Assess ; 31(8): 1006-1018, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31070449

RESUMO

Questionnaire measures offer a time and cost-effective alternative to full diagnostic assessments for identifying and differentiating between potential anxiety disorders and are commonly used in clinical practice. Little is known, however, about the capacity of questionnaire measures to detect specific anxiety disorders in clinically anxious preadolescent children. This study aimed to establish the ability of the Spence Children's Anxiety Scale (SCAS) subscales to identify children with specific anxiety disorders in a large clinic-referred sample (N = 1,438) of children aged 7 to 12 years. We examined the capacity of the Separation Anxiety, Social Phobia, Generalized Anxiety, and Physical Injury Fears (phobias) subscales to discriminate between children with and without the target disorder. We also identified optimal cutoff scores on subscales for accurate identification of children with the corresponding disorder, and examined the contribution of child, mother, and father reports. The Separation Anxiety subscale was able to accurately identify children with separation anxiety disorder, and this was replicated across all 3 reporters. Mother- and father-reported Social Phobia subscales also accurately identified children with social anxiety disorder, although child report was only able to accurately detect social anxiety disorder in girls. Using 2 or more reporters improved the sensitivity of the Separation Anxiety and Social Phobia subscales but reduced specificity. The Generalized Anxiety and Physical Injury Fears subscales failed to accurately identify children with the corresponding disorders. These findings have implications for the potential use of mother-, father-, and child-report SCAS subscales to detect specific disorders in preadolescent children in clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/diagnóstico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Mães , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
7.
Infant Ment Health J ; 40(4): 459-478, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31083770

RESUMO

The aim of the study was to analyze which maternal factors (depressive symptoms, effect of life events, maternal sensitivity and structuring) and infant characteristics (temperament, social withdrawal symptoms, interactive behavior, genotype, gender) contribute to shared pleasure (SP) in parent-infant interaction. Participants were 113 mother-infant dyads. The mothers filled in the Edinburgh Postnatal Depression Scale, the Infant Behavior Questionnaire, and the Life Events Questionnaire. The dyads were videotaped in a free-play situation, and the videos were analyzed using the Alarm Distress Baby Scale and the Emotional Availability Scales. The infants were genotyped for four genes involved in emotion regulation. The occurrence and duration of SP (SP-MD) in mother-infant interactions were analyzed from the videotapes. Higher maternal sensitivity and depressive symptoms, better infant responsiveness, and the infant having the GG variant of the gene tryptophan hydroxylase isoform 2 (TPH2) -307 were associated with the occurrence of SP. Lower level depressive symptoms, better maternal structuring, and greater infant involvement were associated with the longer duration of SP. Those dyads where the mother and infant were best able to read each other's positive cues and to respond to them were more likely to experience mutual positive affect, as seen in SP.


Assuntos
Comportamento do Lactente/psicologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Prazer , Adulto , Sinais (Psicologia) , Depressão/psicologia , Feminino , Humanos , Lactente , Acontecimentos que Mudam a Vida , Masculino , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Temperamento
8.
Eat Disord ; 27(2): 110-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31084428

RESUMO

Eating disorders and social anxiety are highly comorbid. Understanding this comorbidity may improve treatment outcomes, as social anxiety can impair the ability to benefit from eating disorder treatment. The primary model of social anxiety and eating disorder comorbidity includes social appearance anxiety, high standards, and maladaptive perfectionism. In the current study, we tested for ethnic invariance between Asians (n = 82) and European Americans (n = 182) in a cross-sectional and prospective comorbidity model of social anxiety and eating disorder symptoms. Differences were found across ethnicity in eating disorder and social anxiety symptom comorbidity. Maladaptive perfectionism predicted social anxiety and eating disorder symptoms in European Americans, whereas social appearance anxiety predicted social anxiety and eating disorder symptoms in Asians. Our findings suggest that interventions for social anxiety and eating disorders in Asian populations may be improved by assessing and targeting social appearance anxiety, while maladaptive perfectionism should be targeted among European Americans.


Assuntos
Ansiedade/psicologia , Americanos Asiáticos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/etnologia , Adolescente , Feminino , Humanos , Estudos Longitudinais , Modelos Psicológicos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Estados Unidos
9.
JMIR Mhealth Uhealth ; 7(5): e12794, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31094354

RESUMO

BACKGROUND: Smartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers. OBJECTIVE: This study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life. METHODS: A single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as "intervention" or "control" by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses. RESULTS: The final sample was 660 expectant mothers (nintervention=330 and ncontrol=330). The mean difference in EPDS scores between the two groups was -0.65 (95% CI -1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels. CONCLUSIONS: The smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers. TRIAL REGISTRATION: HKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384.


Assuntos
Depressão Pós-Parto/diagnóstico , Educação em Saúde/normas , Aplicativos Móveis/normas , Mães/psicologia , Adulto , Análise de Variância , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Educação em Saúde/métodos , Educação em Saúde/estatística & dados numéricos , Hong Kong/epidemiologia , Humanos , Aplicativos Móveis/estatística & dados numéricos , Mães/estatística & dados numéricos , Gravidez , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Método Simples-Cego
10.
Psychol Assess ; 31(8): 1073-1079, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30958024

RESUMO

In this study, we addressed the ongoing debate about what burnout and depression scales measure by conducting an exploratory structural equation modeling (ESEM) bifactor analysis. A sample of 734 U.S. teachers completed a survey that included the Center for Epidemiologic Studies Depression scale (CES-D-10), the depression module of the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), and the Maslach Burnout Inventory (MBI), which contains emotional exhaustion (EE), depersonalization (DP), and (diminished) personal accomplishment (PA) subscales. Job adversity and workplace support were additionally measured for the purpose of a nomological network analysis. EE, burnout's core, was more highly correlated with the depression and anxiety scales than it was with DP and PA, even with controls for item content overlap. The CES-D-10, PHQ-9, GAD-7, and EE subscale of the MBI were similarly related to job adversity and workplace support. ESEM bifactor analysis revealed that the CES-D-10, PHQ-9, GAD-7, and EE items loaded highly on a general factor, which we labeled nonspecific psychological distress (NSPD). We conclude that depression, anxiety, and EE scales reflect NSPD. DP items largely reflect two factors, NSPD and depersonalization, about equally. PA items were found to be less related to NSPD. With respect to the debate surrounding burnout-depression overlap, our findings do not support the view that the burnout construct represents a syndrome that consists of EE, DP, and diminished PA and excludes (or does not primarily include) depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/diagnóstico , Esgotamento Profissional/diagnóstico , Transtorno Depressivo/diagnóstico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Adulto , Transtornos de Ansiedade/psicologia , Esgotamento Profissional/psicologia , Transtorno Depressivo/psicologia , Análise Fatorial , Feminino , Humanos , Masculino , Professores Escolares/psicologia , Professores Escolares/estatística & dados numéricos , Estados Unidos , Local de Trabalho/psicologia
11.
Eur J Clin Pharmacol ; 75(8): 1109-1116, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30968172

RESUMO

PURPOSE: To assess in a large naturalistic sample, whether clinical response to a treatment with venlafaxine is associated with different patterns of plasma concentrations of active moiety, AM (sum of venlafaxine (VEN) and its active metabolite O-desmethylvenlafaxine (ODVEN)). METHODS: Applying a regression model, plasma concentrations and plasma concentrations corrected-by-dosage (C/D) for AM were included as independent variable with Clinical Global Impressions-Improvement (CGI-I) scale ratings as dependent variable. Moreover, AM, VEN, and ODVEN were compared between treatment responders and non-responders, defining response as much or very much improved on the CGI-I scale based on the non-parametric Mann-Whitney U (M-W-U) test with a significance level of 0.05. RESULTS: No correlations were found between AM and C/D AM plasma concentrations and CGI-I ratings (regression coefficient 0.0, CI 0.000, 0.001, p = 0.492 for AM and 0.047, CI - 0.065, 0.159, p = 0.408 for C/D AM). Venlafaxine daily dosage did not differ between responders and non-responders (217.7 ± 76.9 vs. 222.0 ± 72.7 mg/day, p = 0.45 for M-W-U). Responders displayed lower ODVEN (p = 0.033) and AM (p = 0.031) plasma concentrations than non-responders (p = 0.033 and 0.031, respectively for M-W-U). No other differences were detected. Using a cut-off level of 400 ng/mL for AM concentrations, a higher percentage of responders was reported in the group of patients with AM < 400 ng/mL (13.04%) compared to patients with AM > 400 ng/mL (8%) (p = 0.038). CONCLUSIONS: Higher ODVEN and AM concentrations in non-responders than in responders indicate that treatment escalation above upper thresholds of therapeutic reference ranges of venlafaxine is not promising. Hence, the therapeutic reference range for venlafaxine can help in improving outcomes in a measurement-based care model that takes advantage of therapeutic drug monitoring.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Inibidores da Recaptação de Serotonina e Norepinefrina/farmacocinética , Cloridrato de Venlafaxina/farmacocinética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno Bipolar/sangue , Transtorno Bipolar/diagnóstico , Bases de Dados Factuais/estatística & dados numéricos , Succinato de Desvenlafaxina/farmacocinética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Estudos Retrospectivos , Esquizofrenia/sangue , Esquizofrenia/diagnóstico , Inibidores da Recaptação de Serotonina e Norepinefrina/administração & dosagem , Resultado do Tratamento , Cloridrato de Venlafaxina/administração & dosagem , Adulto Jovem
12.
Drug Alcohol Depend ; 198: 176-179, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30947051

RESUMO

AIMS: Opioid related deaths have more than tripled in recent years. Identifying and referring individuals with opioid use disorder (OUD) to treatment is one of the promising approaches to reduce opioid related deaths. However, using urine toxicology to identify opioid misuse is not reliable. This study validates the Screen of Drug Use (SoDU) to screen for OUD in the primary care setting, and establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status. METHODS: We used data from 1283 primary care patients recruited in the VA in CA. This sample matched patient characteristics general VA population with mean age = 62, and 95% men. A total of 10.4% met DSM-5 criteria for any drug use disorder and 2.7% met criteria for OUD (with or without other drug use disorders). An opioid use abuse or dependence diagnosis based on the Mini International Diagnostic Interview was used as the criterion for having a DSM-5 opioid use disorder. RESULTS: The SoDU was 100% sensitive (95% confidence interval [CI], 89.9%-100%), and 86.3% specific (95% CI, 84.3%-88.1%). When tested in subgroups of patients, the SoDU maintained 100% sensitivity in all subgroups. Specificity ranged from 74.5% to 94.2% for diverse subgroups of patients. CONCLUSIONS: The SoDU is an appropriate instrument to screen for opioid use disorder in primary care. It is brief, easy to use, and has good concurrent diagnostic validity for diverse groups of patients.


Assuntos
Avaliação Pré-Clínica de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Atenção Primária à Saúde/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Idoso , Analgésicos Opioides/análise , Manual Diagnóstico e Estatístico de Transtornos Mentais , Avaliação Pré-Clínica de Medicamentos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Estados Unidos , United States Department of Veterans Affairs
13.
PLoS One ; 14(2): e0212667, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817752

RESUMO

BACKGROUND: The present study conducted secondary analyses of a randomized controlled trial to examine the transgenerational relationship between cognitive-behavioral therapy for child Separation Anxiety Disorder (SepAD) and the mental health of parents. Symptoms of anxiety and depression were compared before and after child treatment between parents of children treated for SepAD and parents of healthy children, who did not receive any treatment. METHODS: One hundred and seven children aged 4-14 years with SepAD received one of two cognitive behavioral treatment programs for SepAD (TAFF; TrennungsAngstprogramm Für Familien; English: Separation Anxiety Family Therapy or CC; Coping Cat). Their parents (N = 189; 101 mothers and 88 fathers) were assessed at baseline and post-treatment for symptoms of separation anxiety, general anxiety, and depression. A comparison group of parents (N = 74; 42 mothers and 32 fathers) of 45 children without SepAD, who did not receive any treatment, were also assessed. RESULTS: Results indicated a significant interaction effect between group and time on mothers' depression and separation anxiety, indicating that maternal symptoms of depression and separation anxiety improved in the child treatment condition in comparison to mothers of healthy children. There was no significant improvement in parental pathology levels among fathers of children treated for SepAD. CONCLUSIONS: Treatment for child SepAD may have subsequent positive effects on mothers' own levels of separation anxiety and depression, though the mechanisms are yet unknown. Future studies are needed that test the transgenerational effect of child SepAD treatment on parental mental health as the primary research question.


Assuntos
Ansiedade de Separação/terapia , Transtornos do Comportamento Infantil/terapia , Terapia Cognitivo-Comportamental , Depressão/diagnóstico , Pai/psicologia , Mães/psicologia , Adolescente , Adulto , Ansiedade de Separação/diagnóstico , Ansiedade de Separação/psicologia , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Depressão/psicologia , Pai/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Autorrelato/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento
14.
Int J Methods Psychiatr Res ; 28(1): e1771, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30734401

RESUMO

OBJECTIVES: Multiple-item measuring instruments are frequently used in a wide range of disciplines for the purpose of research in substantive areas. The quality of items in these instruments determine to a large extent whether the results are trustworthy. In this paper, we suggested to use property fitting analysis to evaluate the appropriateness of items content validity based on explicit item property criteria. METHODS: Using Center for Epidemiologic Studies Depression scale as an example, item property fitting analyses via multidimensional scaling model was used to quantitatively evaluate the properties of items based on rating data from 12 counselors. RESULTS: The results of the analyses indicated that using explicit item property criteria to select items for subsequent psychometric analyses improved the item quality in terms of reliability and factor structure. CONCLUSIONS: Item property fitting analysis seemed to provide the researcher a viable quantitative method when evaluating item content validity.


Assuntos
Escalas de Graduação Psiquiátrica , Adulto , Depressão/diagnóstico , Depressão/psicologia , Análise Fatorial , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica/normas , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
15.
Psychol Assess ; 31(7): 851-860, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30802120

RESUMO

The current project outlines the development of the Attention-Deficit/Hyperactivity Disorder (ADHD) Symptom Infrequency Scale (ASIS), a stand-alone measure designed to identify individuals feigning or exaggerating symptoms to receive a diagnosis of ADHD. Over the course of 3 studies, valid data was collected from 402 participants assigned to control, simulator, ADHD diagnosed, or possible undiagnosed ADHD groups. Group assignment was based on self-reported history of ADHD diagnosis including information about the credentials of diagnosing professional and methods used. The ASIS includes an Infrequency Scale (INF) designed to detect rarely reported symptoms of ADHD and several clinical scales designed to measure genuine symptoms. The final version of the ASIS demonstrated high internal consistency for the INF (α = .96) and the ADHD Total scales (α= .96). Convergent validity for the ADHD Total was established through a strong correlation with Barkley Adult ADHD Rating Scale-IV (r = .92). Initial validation of the INF yielded high discriminability between groups (d = 2.76; 95% confidence interval [2.17, 3.36]). The final INF scale demonstrated strong sensitivity (.79-.86) and excellent specificity (.89). Using our study's malingering base rate of 29%, positive and negative predictive values were strong (.71-.79 and .92-.93, respectively). Additional information is provided for a range of base rates. Current results suggest that the ASIS has potential as a reliable and valid measure of ADHD that is sensitive to malingering when compared to a sample of individuals self-reporting a history of ADHD diagnosis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Simulação de Doença/diagnóstico , Simulação de Doença/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/normas , Reprodutibilidade dos Testes , Autorrelato , Sensibilidade e Especificidade , Adulto Jovem
16.
J Nerv Ment Dis ; 207(2): 59-68, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30672875

RESUMO

Identifying predictors of planned suicide attempts (PSA) is critical because these are associated with grave consequences. Using data of suicide attempters visiting emergency departments, we investigated whether the Columbia-Suicide Severity Rating Scale (C-SSRS) subscales, by retrospectively evaluating ideation before an attempt, could predict the occurrence of PSA versus unplanned suicide attempts using logistic regression analyses. The severity subscale was used as a continuous (model A) and a categorical (model B) variable. In model A, higher scores on each subscale were associated with increased risk of PSA. In model B, the highest score on the severity subscale and a higher intensity subscale score predicted PSA. The severity and intensity subscales had areas under receiver operating curves of 0.712 and 0.688 with optimum cutoff points of 4/5 and 15/16, respectively. In addition, being aged 30 to 49 and 50 to 69 years, being male, interpersonal stress, and depressive and adjustment disorders increased PSA risk. The C-SSRS subscales, along with sociodemographic and clinical risk factors, can predict PSA.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Índice de Gravidade de Doença , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica/normas , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-30684527

RESUMO

BACKGROUND: Transient receptor potential canonical (TRPC) 6 inhibits Aß in Alzheimer's disease (AD) mouse brain and improves the behavioral performance. AIMS: To evaluate the association of TRPC6 expression in peripheral leucocytes from AD and mild cognitive impairment (MCI) patients and to explore its potential value in early diagnosis of AD. METHODS: TRPC6 mRNA levels in peripheral leucocytes were detected by quantitative real-time PCR. The Spearman correlation test was used to ascertain the associations between TRPC6 and the scores of MMSE, ADL, CSDD, CDR. The Receiver Operating Characteristic (ROC) curve was drawn to evaluate the diagnostic potential of TRPC6 for AD and MCI. RESULTS: There were 108 CE, 136 MCI, 164 Con and 60 PD in the study. The expression of TRPC6 mRNA level in peripheral leucocytes was significantly lower: 1) in patients with AD and MCI compared to Con; 2) in AD compared to MCI; 3) in hospitalized AD compared to AD from communities. There was a significantly positive correlation between TRPC6 mRNA and MMSE score (p = .001, R = 0.327). Significantly inverse correlations were found between TRPC6 and CDR score (p < 0.001, R = -0.303) as well as between TRPC6 and ADL score (p = .001, R = -0.342) for all AD. The area under curve of ROC was 0.881 for the classification of AD, and 0.706 for the classification of MCI, respectively. CONCLUSION: TRPC6 expression is inversely correlated with cognitive performance of AD. TRPC6 in peripheral leucocytes may be a potential biomarker for the diagnosis of AD.


Assuntos
Doença de Alzheimer/metabolismo , Disfunção Cognitiva/metabolismo , Canal de Cátion TRPC6/biossíntese , Idoso , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Hospitalização , Humanos , Leucócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/metabolismo , Escalas de Graduação Psiquiátrica/estatística & dados numéricos
18.
Enferm. glob ; 18(53): 499-510, ene. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183425

RESUMO

Introducción: La gestación es un período en la vida de la mujer que la expone a diversos cambios físicos y psíquicos. Es en este momento de su vida cuando la mujer es más susceptible a desarrollar trastornos mentales, los cuales pueden estar relacionados con bajo nivel de escolaridad y / o socioeconómico, ser del sexo femenino, estar soltero o separado, no tener empleo, ser fumadora, alcoholica y tener antecedentes familiares de enfermedad mental.Objetivo: Analizar la ocurrencia de trastornos mentales en gestantes y los factores asociados al mismo.Método: Estudio transversal, con abordaje cuantitativo. La población del estudio fue constituida por gestantes registradas en Unidades de Salud de la Familia. Para la recolección de los datos se utilizó el cuestionario con datos de identificación de las participantes y el cuestionario Self-Reporting Questionnaire (SRQ-20). Para el análisis de los datos, se utilizó una frecuencia absoluta y relativa, como también la prueba de chi-cuadrado sin corrección, prueba de chi-cuadrado de tendencia con extensión de Mantel-Haenzel y la prueba de chi-cuadrado con corrección de yates para analizar la asociación entre la enfermedad mental y las variables socio demográficas, gestacionales y de salud. Estudio aprobado por el Comité de Ética en Investigación de la Universidad Federal de Pernambuco (CAAE 64945317.1.0000.5208).Resultados: La proporción de sugerencia de enfermedad mental en gestantes fue de 31,9% y estuvo asociada con estar soltera, haber estudiado hasta la enseñanza básica, no haber planeado el embarazo y tener enfermedad crónica.Conclusiones: Por lo tanto, la enfermedad mental identificada en las gestantes participantes del estudio puede estar asociada a variables estado civil, escolaridad, planificación del embarazo y tener enfermedad crónica


Introdução: a gestação é um período na vida da mulher que a expõe a diversas alterações físicas e psíquicas. É neste momento de sua vida que a mulher esta mais susceptível a desenvolver transtornos mentais, os quais podem estar relacionados a baixo nível de escolaridade e/ou socioeconômico, ser do sexo feminino, estar solteiro ou separado, não ter emprego, ser tabagista, etilista e ter história familiar de doença mental.Objetivo: analisar a ocorrência de adoecimento mental em gestantes e os fatores associados ao mesmo.Método: estudo transversal, com abordagem quantitativa. A população do estudo foi constituída por gestantes cadastradas em Unidades de Saúde da Família. Para a coleta dos dados foi utilizado questionário com dados de identificação das participantes e o questionário Self-Reporting Questionnaire (SRQ-20). Para análise dos dados, utilizou-se frequência absoluta e relativa, como também o teste de qui-quadrado sem correção, teste de qui-quadrado de tendência com extensão de Mantel-Haenzel e o teste de qui-quadrado com correção de yates para analisar a associação entre o adoecimento mental e as variáveis sócio-demográficas, gestacionais e de saúde. Estudo aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Pernambuco (CAAE 64945317.1.0000.5208).Resultados: a proporção de sugestão de adoecimento mental em gestantes foi de 31,9% e esteve associada com estar solteira, ter estudado até o ensino fundamental, não ter planejado a gravidez e possuir doença crônica.Conclusões: portanto, o adoecimento mental identificado nas gestantes participantes do estudo pode estar associado a variáveis estado civil, escolaridade, planejamento da gravidez e possuir doença crônica


Introduction: Gestation is a period in the life of the woman that exposes her to various physical and psychic changes. It is at this point in her life that a woman is more likely to develop mental disorders, which may be related to low level of schooling and/or socioeconomic status, being female, being single or separated, having no job, being a smoker, and have a family history of mental illness.Objective: to analyze the occurrence of mental illness in pregnant women and the associated factors.Method: cross-sectional study with quantitative approach. The study population consisted of pregnant women enrolled in Family Health Units. To collect the data, a questionnaire was used with identification data of the participants and the Self-Reporting Questionnaire (SRQ-20). Absolute and relative frequency were used to analyze the data, as well as the chi-square test without correction, chi-square test with Mantel-Haenzel extension and the chi-square test with yacht correction to analyze the association between mental illness and socio-demographic, gestational and health variables. Study approved by the Research Ethics Committee of the Federal University of Pernambuco (CAAE 64945317.1.0000.5208).Results: the proportion of suggestion of mental illness in pregnant women was 31.9% and was associated with being single, having studied until elementary school, not having planned pregnancy and having a chronic illness.Conclusions: therefore, the mental illness identified in pregnant women participating in the study may be associated with variables marital status, schooling, pregnancy planning, and chronic illness


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Transtornos Mentais/epidemiologia , Complicações na Gravidez/epidemiologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Estudos Transversais , Fatores de Risco , Gestantes/psicologia , Ansiedade/epidemiologia , Depressão/epidemiologia
19.
Early Interv Psychiatry ; 13(2): 308-313, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29708308

RESUMO

AIM: The primary aim was to quantify, relative to older men, young men's externalizing of depression symptoms and past-month suicidal ideation. METHODS: A non-probability national sample of 1000 Canadian men self-reported internalizing and externalizing symptoms of depression and past-month suicidal ideation. Stratification quotas reflected Canadian census data to age and region. RESULTS: Young men (18-25 years) were at markedly higher risk of past-month suicidal ideation than were older men. When controlling for internalizing depression, a multivariate age × recent suicidal ideation interaction indicated higher externalizing of depression symptoms in young men relative to older men, especially for those reporting recent suicidal ideation (P < .001). Interactions were observed for drug use, anger and aggression, and risk-taking domains. A sizable proportion of younger men were uniquely identified by the MDRS-22. CONCLUSIONS: Screening tools that include assessment of externalizing symptoms may assist in improving detection of distress and suicide risk in young men.


Assuntos
Transtorno Depressivo/psicologia , Controle Interno-Externo , Ideação Suicida , Adolescente , Adulto , Fatores Etários , Idoso , Canadá , Transtorno Depressivo/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria , Fatores de Risco , Autorrelato , Comportamento Autodestrutivo , Transtornos Relacionados ao Uso de Substâncias , Violência , Adulto Jovem
20.
J Int Med Res ; 47(1): 411-419, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30304968

RESUMO

OBJECTIVES: This study aimed to investigate whether early-onset schizophrenia (EOS) cases differ from controls regarding volumes of the total cerebellum and the right and left cerebellar hemispheres, and volumetric asymmetry. Correlations of cerebellar volumes and asymmetry indices with severity of symptoms and general functioning in cases of EOS were also assessed. METHODS: Adolescents with EOS (n = 23) were compared with controls (n = 23). Sociodemographic and clinical data, and magnetic resonance imaging scans that were acquired for routine clinical purposes were collected retrospectively. Cerebellar volumes were evaluated using the stereological method. Asymmetry indices were subsequently calculated. Scores of the Positive and Negative Syndrome Scale and the Children's Global Assessment Scale were used to assess the severity of symptoms and general functionality. RESULTS: There were no significant differences in any of the cerebellar volumes and asymmetry indices between the two groups. Neither cerebellar volumes nor asymmetry indices were correlated with the severity of symptoms and general functionality in EOS. CONCLUSIONS: Our findings suggest that the early-onset form of schizophrenia does not show apparent volumetric changes of the cerebellum. Additionally, the neural circuits involved in formation of symptomatology may not reflect any correlation with cerebellar volumes at mid-adolescence.


Assuntos
Cérebro/patologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Esquizofrenia/patologia , Adolescente , Idade de Início , Cérebro/diagnóstico por imagem , Cérebro/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Tamanho do Órgão , Estudos Retrospectivos , Esquizofrenia/diagnóstico por imagem , Esquizofrenia/fisiopatologia , Índice de Gravidade de Doença
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